Design and Performance of a Low-Cost, Handheld Reader for Diagnosing Anemia in Blantyre, Malawi

Anemia, a condition characterized by insufficient hemoglobin, affects 56.2% of pregnant women and 66.1% of children under five in low-resource countries. Though hemoglobin concentration measurement is the most common laboratory test in the world, the high cost of disposables (>$1.00 per test in Malawi) limits its availability in these settings. We have demonstrated a spectrophotometric method that reduces the per-test cost of anemia diagnosis to under $0.01 by using chromatography paper as the only disposable. Improvements in the hand-held reader, including using laser modules and a reference photodiode, enabled repeatable results within and across devices. We evaluated this method by analyzing capillary blood samples from 70 patients in the pediatric ward of Queen Elizabeth Central Hospital, Blantyre, Malawi. ~90% of these samples were within 2 g/dL of the standard value, with higher accuracy on more anemic samples. Current work aims to improve this accuracy by converting the hemoglobin in the sample to the more stable form methemoglobin.