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Use of point‐of‐care haemoglobin tests to diagnose childhood anaemia in low‐ and middle‐income countries: A systematic review

Brehm, Rebecca; South, Annabelle; George, Elizabeth C; (2023) Use of point‐of‐care haemoglobin tests to diagnose childhood anaemia in low‐ and middle‐income countries: A systematic review. Tropical Medicine & International Health 10.1111/tmi.13957. (In press). Green open access

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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 10 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, Ängelholm, 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 4.5 g/dL. Diagnostic accuracy varied, with sensitivity and specificity to detect anaemia ranging from 24.2% to 92.2% and 70% to 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.

Type: Article
Title: Use of point‐of‐care haemoglobin tests to diagnose childhood anaemia in low‐ and middle‐income countries: A systematic review
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/tmi.13957
Publisher version: https://doi.org/10.1111/tmi.13957
Language: English
Additional information: Copyright © 2023 The Authors This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10183150
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