Use of Point-of-care Haemoglobin Tests to Diagnose Childhood Anaemia in Low-and Middle-Income Countries: A Systematic Review

Abstract

Objectives: Anaemia is a major cause of mortality and transfusion in children in Low- and Middle-Income Countries (LMICs), however current diagnostics are slow, costly, and frequently unavailable. Point-of-care haemoglobin tests (POC(Hb)Ts) could improve patient outcomes and use of resources by providing rapid and affordable results. We systematically reviewed the literature to investigate what, where and how POC(Hb)Ts are being used by health facilities in LMICs to diagnose childhood anaemia, and to explore challenges to their use. Methods: We searched a total of nine databases and trial registries up to 10th June 2022 using the concepts: anaemia, POC(Hb)T, LMIC and clinical setting. Adults >21 years and literature published >15 years ago were excluded. A single reviewer conducted screening, data extraction and quality assessment (of diagnostic studies) using QUADAS-2. Outcomes including POC(Hb)T used, location, setting, challenges and diagnostic accuracy were synthesised. Results: Of 626 records screened, 41 studies were included. Evidence is available on the use of 15 POC(Hb)Ts in hospitals (n=28, 68%), health centres (n=9, 22%) and clinics/units (n=10, 24%) across 16 LMICs. HemoCue (HemoCue AB, Angelholm, Sweden) was the most used test (n=31, 76%). Key challenges reported were overestimation of haemoglobin concentration, clinically unacceptable limits of agreement, errors/difficulty in sampling, environmental factors, cost, inter-observer variability, and supply of consumables. Five POC(Hb)Ts (33%) could not detect haemoglobin levels below 4g/dl. Diagnostic accuracy varied, with sensitivity and specificity to detect anaemia ranging from 24.2-92.2% and 70-96.7%, respectively. Conclusions: POC(Hb)Ts have been successfully utilised in health facilities in LMICs to diagnose childhood anaemia. However, limited evidence is available, and challenges exist that must be addressed before wider implementation. Further research is required to confirm accuracy, clinical benefits, and cost-effectiveness.

Diagnostic Validation and Feasibility of a Non-invasive Haemoglobin Screening Device (EzeCheck) for 'Anaemia Mukt Bharat' in India

“…Furthermore, the device can do follow-up longitudinally. Non-invasive Hb screening methods have the potential to screen large populations quickly and efficiently, which is especially useful for mass screening programmes in low-and middle-income countries (LMICs) such as India or during disaster relief situations [18]. Moreover, it also doesn't require any consent/assent from parents for blood, which needs to be taken from <18-year-old children.…”