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The utility of pallor detecting anemia in under five years old children
T Getaneh1, T Girma, T Belachew
1Department of Pediatrics and Child Health, Jimma Institute of Health Sciences, Jimma.
Insights
Pallor assessment in children is unreliable for detecting anemia. Palmar or conjunctival pallor improved detection, but single sites lack sensitivity for moderate anemia.
Area of Science:
- Pediatrics
- Hematology
- Public Health
Background:
- Anemia is prevalent in young children in developing nations.
- Clinical assessment for pallor is a common diagnostic tool for anemia.
- The diagnostic utility of pallor in identifying anemia requires further evaluation.
Purpose of the Study:
- To evaluate the effectiveness of clinical pallor assessment in detecting anemia among young children.
- To compare the sensitivity of pallor in different anatomical sites for anemia diagnosis.
Main Methods:
- A cross-sectional study involving 574 children aged 2-60 months at Jimma Hospital.
- Trained nurses assessed pallor in conjunctivae, tongue, buccal mucosa, nailbeds, and palms.
- Hemoglobin levels were measured using the HemoCue method.
Main Results:
- Anemia prevalence was 46%, with higher rates in children under 2 years.
- Palmar pallor showed the highest sensitivity (58%) for moderate anemia.
- Combining palmar and conjunctival pallor increased sensitivity to 73%.
Conclusions:
- Pallor in a single anatomical site is insufficient for accurately diagnosing moderate anemia.
- Further research is needed on the efficacy of severe pallor in identifying severe anemia.
- Community-based studies are recommended to investigate anemia's prevalence and causes.
Abstract:
The diagnosis and management of anemia, which affects a significant proportion of young children in developing countries, largely depends on the clinical assessment for pallor. This study was conducted with the aim of evaluating the utility of pallor in detecting anemia. Children aged 2 to 60 months who visited the pediatric outpatient department of Jimma Hospital over 3 months period were assessed for the presence and degree of pallor in 4 anatomic sites (conjunctivae, tongue and buccal mucosa, nailbeds, palm) by trained nurses. Hemoglobin was then determined using the HemoCue method. Individuals involved in clinical examination did not have access to the laboratory results before documenting their findings. The mean hemoglobin in the 574 children examined was 11.03 gm/dl, and about 46% had anemia. Children younger than 2 years were found to have a higher prevalence of anemia as compared to older children (p < 0.001). Palmar pallor, with a sensitivity of 58%, had the highest sensitivity to detect moderate anemia as compared to other anatomic sites. The presence of either palmar or conjunctival pallor increased the sensitivity to 73%. The inter-observer agreement was highest for conjunctival pallor (kappa value = 0.81). The findings of the study suggest that pallor of a single anatomic site does not have adequate sensitivity to detect moderate anemia. We recommend further studies to look at the performance of severe pallor in correctly identifying severe anemia. Furthermore, the magnitude and causes of anemia need to be studied in a community setting.
