Anaemia in children: Part I. Can simple observations by primary care provider help in diagnosis?

The commonest and reliable method of diagnosing anaemia is by determining haemoglobin levels, which is an invasive technique. This cross-sectional study aims to detect the validity of diagnosing anaemia by simple non-invasive clinical techniques. This study screened 951 children (6-60 months) residing in a squatter settlement of Karachi. Every child was first labelled anaemic or normal by a clinical scoring system and then his/her haemoglobin was tested by finger prick method on a Hemocue. Mean age was 31.1 +/- 15.3 months (n = 945) and median was 32 months. The prevalence of anaemia by Hemocue was 78% (Anaemia = Hb < 11 gms%) and by clinical examinations 68%. Conjunctivae alone had the highest sensitivity (74%) and nails alone highest specificity (96%). Nails alone had the highest positive predictive value and conjunctivae alone highest negative predictive value (43.2%). Combinations of conjunctivae with either nails, palm or tongue yielded the highest validity. The results indicate that in PHC settings with no laboratory facilities, anaemia can be detected by pallor of conjunctivae associated with pallor of either nails, palm or tongue.