VALIDITY OF USING PALMAR AND CONJUNCTIVAL PALLOR TO DETECT ANAEMIA AMONG PRE-SCHOOL CHILDREN AGED 4 – 6 YEARS OLD IN ETHIOPIA

Abstract

Background: The use of hemoglobin for the determination of anemia is an objective method of assessment, costly for screening purposes & require invasive technique. Validated techniques of palmar and conjunctival pallor provide an opportunity for large population screening with lower cost and non-invasive techniques. The aim of the study is, therefore, to validate the accuracy of clinical pallor to detect moderate and severe anemia among children in the community. Method: A cross-sectional study design nested under intervention was used. Children age from 4 -6 years who live in agrarian region of Ethiopia was included in the analysis. Multi-stage sampling technique was used for selecting the children during baseline data collection. Checklists for recording the sign of palmar and conjunctival pallor and finger prick blood samples for estimation of hemoglobin concentration of the child. Sensitivity and specificity of pallor for detecting anemia were estimated based on hemoglobin concentration as “true anemia.” We compared their areas under the receiver operating characteristic (ROC) curves to estimate the cutoff point of hemoglobin to identify pallor sign. Results: Around 82% (1,288) of the estimated child-mothers were included for this analysis. The prevalence of conjunctival & palmar pallor among children were 9.2% (95%CI: 7.7, 10.9) and 4.6% (95%CI: 3.6, 5.9), respectively. The mean (SD) hemoglobin concentration was 11.93 g/dL (1.29), and the prevalence of anemia was 30.7% (95%CI: 28.2, 33.3). The sensitivity of conjunctival pallor was significantly higher than palmar pallor (14.40% (95%CI: 12.46, 16.33) vs 7.99% (95%CI: 6.49, 9.49), respectively) for detecting anemia among children but the specificity was significantly lower (93.17% (95%CI: 91.78, 94.56) vs 96.91% (95%CI: 95.96, 97.87), respectively). Both pallor signs had similar diagnostic accuracy for determining anemia among children. The sensitivity improved for detecting children with moderate to severe anemia compared to anemia including mild. Both the pallor indicators used to determine anemia from hemoglobin concentration have AUC below 0.50. Conclusion: There was no highly accurate clinical sign of pallor for detecting anemia among children. The conjunctiva or palm pallor among children is not an accurate method for screening anemia. The combination of both conjunctiva and palm pallor increased the sensitivity and diagnostic accuracy while there was a reduction in the specificity. The presence of pallor sign may be used to rule out the presence of anemia among children