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Namaste SM, Baingana R, Brindle E. Hemoglobin measurement in venous blood compared with pooled and single-drop capillary blood: a method-comparison study in a controlled and survey setting in Uganda among children and women. Am J Clin Nutr 2024; 119:949-959. [PMID: 38176682 DOI: 10.1016/j.ajcnut.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 12/03/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Standard practice for estimating anemia in population-based surveys is to use a point-of-care device to measure hemoglobin (Hb) in a single drop of capillary blood. Emerging evidence points to larger than expected differences in Hb concentration depending on the blood source. OBJECTIVE We evaluated use of different blood sources to measure Hb with a HemoCue 201+ analyzer compared with the reference method of venous blood tested with a Sysmex XN-450 hematology analyzer. METHODS Hb concentration in venous, pooled capillary, and single-drop capillary blood were collected in controlled (laboratory) and survey (Demographic Health Survey-8 pilot) settings in Uganda among children 6-59 mo and nonpregnant women 15-49 y. Venous and capillary blood collected from the same individual was tested using a HemoCue 201+ analyzer and the venous blood was also measured with a Sysmex XN-450 hematology analyzer. Agreement between measures was estimated using Lin's concordance correlation coefficient, Bland-Altman plots, and Deming regression. Means and prevalences were compared using paired t-tests and McNemar's tests, respectively. RESULTS The limits of agreement between Hb measured using a HemoCue 201+ analyzer and the reference method were lowest for venous (1.1-1.96 g/dL), followed by pooled capillary (1.45-2.27 g/dL), and single-drop capillary blood (2.23-3.41 g/dL). Mean differences were <0.5 g/dL across comparators. There were statistically significant differences in Hb concentration from both types of capillary blood. Anemia prevalence was lower in pooled capillary blood compared with the reference method. CONCLUSIONS The variability of Hb measured by capillary blood using the HemoCue 201+ analyzer is higher than venous blood but the extent to which this impacts the validity of Hb and anemia estimates requires further exploration. Future research is also needed to evaluate the implications of using venous compared with capillary blood in population-based surveys. This trial was registered at clinicaltrials.gov (NCT05059457).
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Affiliation(s)
| | - Rhona Baingana
- Makerere University College of Natural Sciences, Kampala, Uganda, Africa
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Brehm R, South A, George EC. Use of point-of-care haemoglobin tests to diagnose childhood anaemia in low- and middle-income countries: A systematic review. Trop Med Int Health 2024; 29:73-87. [PMID: 38044262 PMCID: PMC7615606 DOI: 10.1111/tmi.13957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
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.
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Affiliation(s)
- Rebecca Brehm
- Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Annabelle South
- Medical Research Council Clinical Trials Unit (MRC CTU), University College London, London, UK
| | - Elizabeth C George
- Medical Research Council Clinical Trials Unit (MRC CTU), University College London, London, UK
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Jolly SP, Roy Chowdhury T, Sarker TT, Afsana K. Water, sanitation and hygiene (WASH) practices and deworming improve nutritional status and anemia of unmarried adolescent girls in rural Bangladesh. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:127. [PMID: 37957706 PMCID: PMC10644610 DOI: 10.1186/s41043-023-00453-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/06/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND In Bangladesh, undernutrition and anemia are more occurrent among adolescent girls. BRAC, the largest non-governmental organization (NGO), has been implementing a community-based nutrition education service package targeting adolescent girls for reducing their undernutrition and anemia. OBJECTIVE We aimed to explore the underlying factors associated with nutritional status and anemia among adolescent girls under the BRAC nutrition program areas to improve their existing intervention package. METHODOLOGY We conducted a cross-sectional and comparative study in 2016, in 24 upazilas of Bogra, Barguna, Comilla, Dinajpur, Feni, Jessore, and Meherpur districts where the BRAC nutrition program was implemented while the remaining 27 upazilas of those districts were selected as comparison area. We followed a multistage cluster random sampling for selecting 1620 unmarried adolescent girls aged 10-19 years for interviewing in the intervention and comparison areas. Data were collected on socio-demographic information, dietary intake, morbidity, water, sanitation, and hygiene (WASH) practice, anthropometry, and serum hemoglobin (Hb) level by using a pre-structured questionnaire. The nutritional status of the adolescent girls was expressed as height-for-age Z (HAZ) and body mass index-for-age Z (BMIZ) score, while anemia referred to the serum Hb at the level of below 12 g/dl for adolescent girls. All statistical analyses were done in STATA version 17 (Chicago Inc.). FINDINGS The prevalence of stunting (22.9% vs. 22.5%), thinness (12% vs. 14%), and anemia (34.5% vs. 37.3%) exhibited similarities between the intervention and comparison regions. Stunting and thinness were predictors for each other for this population group. Our findings indicated that adolescent girls who were not washing hands with soap after defecation were likely to be stunted [AOR 1.51 (95% CI 1.12-2.04)], and who did not utilize sanitary latrines had an increased likelihood of being thin [AOR 2.38 (95% CI 1.11-5.08)]. Conversely, those who did not watch television [AOR 1.69 (95% CI 1.12-2.56)] and did not have deworming tablets [AOR 1.33 (95% CI 1.07-1.64)] in the 6 months leading up to the interview had a 69% and 33% higher probability of being anemic, respectively. CONCLUSION For sustainable improvement in the undernutrition and anemia of adolescent girls, integration of WASH, consistent administration of deworming tablets and broadcasting awareness programs through television are urgent to scale up the nutrition intervention programs in similar settings like Bangladesh.
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Affiliation(s)
- Saira Parveen Jolly
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor, Medona Tower, 28 Mohakhali Commercial Area, Bir Uttom A K Khandakar Road, Dhaka, 1213, Bangladesh.
- BRAC Research and Evaluation Division, BRAC, 75 Mohakhali, Dhaka, 1212, Bangladesh.
| | - Tridib Roy Chowdhury
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor, Medona Tower, 28 Mohakhali Commercial Area, Bir Uttom A K Khandakar Road, Dhaka, 1213, Bangladesh
- BRAC Research and Evaluation Division, BRAC, 75 Mohakhali, Dhaka, 1212, Bangladesh
| | - Tanbi Tanaya Sarker
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor, Medona Tower, 28 Mohakhali Commercial Area, Bir Uttom A K Khandakar Road, Dhaka, 1213, Bangladesh
| | - Kaosar Afsana
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor, Medona Tower, 28 Mohakhali Commercial Area, Bir Uttom A K Khandakar Road, Dhaka, 1213, Bangladesh
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Arai Y, Shoji H, Awata K, Inage E, Ikuse T, Shimizu T. Evaluation of the use of non-invasive hemoglobin measurement in early childhood. Pediatr Res 2023; 93:1036-1040. [PMID: 35906313 DOI: 10.1038/s41390-022-02204-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Iron deficiency anemia in children affects psychomotor development. We compared the accuracy and trend of a non-invasive transcutaneous spectrophotometric estimation of arterial hemoglobin (Hb) concentration (SpHb) by rainbow pulse CO-oximetry technology to the invasive blood Hb concentration measured by an automated clinical analyzer (Hb-Lab). METHODS We measured the SpHb and Hb-Lab in 109 patients aged 1-5 years. Regression analysis was used to evaluate differences between the two methods. The bias, accuracy, precision, and limits of agreement of SpHb compared with Hb-Lab were calculated using the Bland-Altman method. RESULTS Of the 109 enrolled subjects, 102 pairs of the SpHb and Hb-Lab datasets were collected. The average value of measured Hb was 12.9 ± 1.03 (standard deviation [SD]) g/dL for Hb-Lab. A significant correlation was observed between SpHb and Hb-Lab measurements (SpHb = 7.002 + 0.4722 Hb-Lab, correlation coefficient r = 0.548, 95% confidence interval = 0.329-0.615). Bland-Altman analysis showed good visual agreement, with a mean bias between SpHb and Hb-Lab of 0.188 ± 0.919 g/dL (mean ± SD). CONCLUSIONS We concluded that non-invasive Hb measurement is useful for Hb estimation in children and provides new insights as a screening tool for anemia. IMPACT Our results indicated a good correlation between non-invasive transcutaneous spectrophotometric estimation of arterial hemoglobin (Hb) concentration using a finger probe sensor by rainbow pulse CO-oximetry technology and invasive blood Hb concentration. Although previous studies have indicated that in patients with a worse condition, the bias between the two methods was large, this study, which was conducted on children with stable disease, showed a relatively small bias. Further studies using this non-invasive device might help to understand the current status of anemia in Japan and promote iron intake and nutritional management in children.
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Affiliation(s)
- Yoshiteru Arai
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiromichi Shoji
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Kentaro Awata
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Eisuke Inage
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Tamaki Ikuse
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Fothergill A, Crider KS, Johnson CB, Raj MP, Guetterman HM, Bose B, Rose CE, Qi YP, Williams JL, Kuriyan R, Bonam W, Finkelstein JL. Comparison of Anemia Screening Methods Using Paired Venous Samples in Women of Reproductive Age in Southern India. J Nutr 2023; 152:2978-2992. [PMID: 36130238 PMCID: PMC9840000 DOI: 10.1093/jn/nxac218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/28/2022] [Accepted: 09/16/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Anemia is an important public health problem, and accurate estimates may inform policy and programs. Although hemoglobin (Hb) assessment of venous blood via automated hematology analyzers (AHAs) is recommended, most population-based surveys estimate anemia prevalence based on analysis of capillary blood via portable hemoglobinometers. OBJECTIVES We aimed to evaluate screening methods for hemoglobin and anemia assessment using paired venous samples. METHODS Participants were women 15-40 y who were not pregnant or lactating. Paired venous whole blood samples (n = 896) were analyzed for hemoglobin (Hb) via portable hemoglobinometer (HemoCue 301) and Coulter Counter AHA. Anemia and severe anemia were defined as Hb <12.0g/dL and <8.0 g/dL, respectively. Bland-Altman methods were used to assess the level of agreement for Hb results (mean difference, SD of differences, limits of agreement). Diagnostic accuracy parameters (sensitivity, specificity, positive predictive value, negative predictive value, accuracy) were calculated to evaluate HemoCue performance compared to the AHA reference, overall and by sociodemographic, nutritional, and metabolic characteristics. RESULTS The estimated anemia prevalence was significantly lower via HemoCue vs. AHA (36.3% compared with 41.6%; P value < 0.0001). The HemoCue had 84.4% accuracy for anemia screening and 98.8% for severe anemia, compared to the AHA reference. The HemoCue had 74.8% sensitivity and 91.2% specificity, compared to AHA. HemoCue sensitivity was higher in women with iron deficiency [serum ferritin (SF) <15.0 μg/L: 81.6% compared with SF ≥15.0 μg/L: 41.3%], and lower in women with metabolic risk factors, including overweight [BMI ≥25.0 kg/m2: 63.9% vs. BMI <25.0 kg/m2: 78.8%], or elevated CRP (>1.0 mg/L: 67.2% vs. ≤1.0 mg/L: 82.9%), trunk fat (>35%: 62.7% vs. ≤35%: 80.1%), or whole-body fat (>35%: 63.9% vs. ≤35%: 80.3%). CONCLUSIONS Findings suggest that women with anemia may be incorrectly identified as not anemic via portable hemoglobinometer, and anemia prevalence may be underestimated at the population level.This study was registered at clinicaltrials.gov as NCT04048330.
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Affiliation(s)
- Amy Fothergill
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Krista S Crider
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | | | - Mical P Raj
- Arogyavaram Medical Centre, Andhra Pradesh, India
| | | | - Beena Bose
- Division of Nutrition, St. John's Research Institute, Bangalore, India
| | - Charles E Rose
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Yan P Qi
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Jennifer L Williams
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Rebecca Kuriyan
- Division of Nutrition, St. John's Research Institute, Bangalore, India
| | - Wesley Bonam
- Arogyavaram Medical Centre, Andhra Pradesh, India
| | - Julia L Finkelstein
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
- Division of Nutrition, St. John's Research Institute, Bangalore, India
- Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
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Sandean D, Samaras M, Chatterji U, Power R, Qureshi H. Reduzindo as transfusões de sangue em pacientes com artroplastia total primária do quadril: A eficácia dos testes rápidos de Hb e uma clínica especializada em anemia pré-operatória. Rev Bras Ortop 2022; 57:569-576. [PMID: 35966429 PMCID: PMC9365490 DOI: 10.1055/s-0041-1731359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/01/2020] [Indexed: 10/25/2022] Open
Abstract
Resumo
Objetivo A anemia pré-operatória em pacientes ortopédicos, está associada a maiores taxas de transfusão de sangue alogênico, resultando em desfechos mais desfavoráveis. Até 25% dos pacientes encaminhados para cirurgia ortopédica de grande porte, apresentam algum grau de anemia. O controle adequado do sangue do paciente no perioperatório é essencial, a fim de reduzir as sequelas da anemia e a necessidade de transfusões. Avaliamos a eficácia do teste rápido, em conjunto com uma clínica especializada no tratamento da anemia pré-operatória, com o objetivo de detectar e tratar a anemia dos pacientes a serem submetidos a artroplastia total primária do quadril.
Métodos A comparação das taxas totais de transfusão de sangue alogênico, foi realizada em pacientes submetidos a artroplastia total primária do quadril, antes e depois da implementação dos testes rápidos e da clínica especializada no tratamento da anemia pré-operatória ao longo de um ano. Também foi feita uma comparação entre os pacientes com anemia, que foram encaminhados para a clínica, com aqueles que não foram encaminhados. Foram revisados os níveis de hemoglobina pré-operatória, as taxas de transfusão de sangue alogênico e o tratamento clínico em 1.095 pacientes.
Resultados Houve uma redução significativa nas taxas de transfusão, em pacientes submetidos à ATQ primária, caindo de 10,0% para 6,2% (p <0,05, teste χ2), após a implementação do teste rápido e da clínica especializada em anemia pré-operatória. A taxa de transfusão de sangue alogênico para pacientes anêmicos tratados na clínica foi de 6,7%, em comparação com 26,9% para pacientes anêmicos no pré-operatório, que não foram tratados na clínica (p <0,05, teste exato de Fisher). Em média, o tratamento na clínica aumentou a taxa de hemoglobina dos pacientes em 20 g/L, passando de 104 g/L para 124 g/L p <0,001.
Conclusões O teste rápido, juntamente com a clínica especializada no tratamento da anemia pré-operatória, reduziu a necessidade de transfusão de sangue alogênico perioperatório, em pacientes submetidos a artroplastia total primária do quadril, proporcionando uma identificação rápida e um tratamento eficaz da anemia pré-operatória.
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Affiliation(s)
- Darren Sandean
- Hospital Universitário de Leicester, Leicester General Hospital, Gwendolen Rd, Leicester, Reino Unido
| | - Michail Samaras
- Hospital Universitário de Leicester, Leicester General Hospital, Gwendolen Rd, Leicester, Reino Unido
| | - Urjit Chatterji
- Hospital Universitário de Leicester, Leicester General Hospital, Gwendolen Rd, Leicester, Reino Unido
| | - Richard Power
- Hospital Universitário de Leicester, Leicester General Hospital, Gwendolen Rd, Leicester, Reino Unido
| | - Hafiz Qureshi
- Hospital Universitário de Leicester, Leicester General Hospital, Gwendolen Rd, Leicester, Reino Unido
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Darmawati D, Nizwan-Siregar T, Hajjul K, Teuku T. Exploring Indonesian mothers' perspectives on anemia during pregnancy: A qualitative approach. ENFERMERIA CLINICA (ENGLISH EDITION) 2022; 32 Suppl 1:S31-S37. [PMID: 35688565 DOI: 10.1016/j.enfcle.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 11/02/2020] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The study aims to investigate the perceptions of anemia among pregnant women to design culturally relevant interventions in Indonesia. METHOD Qualitative study with dates from 24 pregnant women in a province in Indonesia through focus group discussions. Data were analyzed using the inductive content analysis method. RESULTS Five themes emerged from the experiences of pregnant women with anemia: (1) anemia during pregnancy is perceived as a woman's destiny; (2) lack of knowledge related to clinical indicators of anemia; (3) the traditional taboo related to anemia; (4) the husband and family provide support related to anemia prevention; and (5) there is a need for cultural and religious-based health counseling. CONCLUSIONS Interventions to provide health information about anemia in pregnancy should be designed with consideration of local knowledge, beliefs and values, combined with medical elements. It is likely these interventions can change the perceptions of pregnant women's perceptions about anemia, ensuring that they are able to maintain their pregnancy. The implementation of programs to support these women should involves health workers who can understand their needs and who are adequately trained in cultural competence.
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Affiliation(s)
- Darmawati Darmawati
- Graduate School of Mathematics and Applied Science, Department of Maternity Nursing, Faculty of Nursing, Universitas Syiah Kuala, Aceh, Indonesia.
| | | | - Kamil Hajjul
- Department of Management Nursing, Faculty of Nursing, Universitas Syiah Kuala, Aceh, Indonesia
| | - Tahlil Teuku
- Department of Community Nursing, Faculty of Nursing, Universitas Syiah Kuala, Aceh, Indonesia
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Field Experiences with Handheld Diagnostic Devices to Triage Children under Five Presenting with Severe Febrile Illness in a District Hospital in DR Congo. Diagnostics (Basel) 2022; 12:diagnostics12030746. [PMID: 35328299 PMCID: PMC8947034 DOI: 10.3390/diagnostics12030746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 12/10/2022] Open
Abstract
As part of a field study (NCT04473768) in children presenting with severe febrile illness to Kisantu hospital (DR Congo), we retrospectively compiled user experiences (not performance) with handheld diagnostic devices assisting triage: tympanic thermometer, pulse oximeter (measuring heart rate, respiratory rate and oxygen saturation), hemoglobinometer and glucometer. Guidance documents for product selection were generic and scattered. Stock rupture, market withdrawal and unaffordable prices interfered with procurement. Challenges at implementation included environmental temperature, capillary blood sampling (antisepsis, order of multiple tests, filling microcuvettes and glucose strips), calibration (environmental temperature, cold chain) and liability-oriented communication with a manufacturer. Instructions for use were readable and contained symbol keys; two devices had printed French-language instructions. Shortcomings were poor integration of figures with text and distinct procedures for the oximeter and its sensor. Usability interview revealed appreciations for quick results, visibility of the display and memory function (three devices) but also problems of capillary blood sample transfer, cleaning, too long of a time-to-results (respiratory rate) and size, fitting and disposal of thermometer probes. Pictorial error messages were preferred over alphanumeric error codes but interpretation of symbols was poor. Alarm sounds of the oximeter caused unrest in children and caretakers perceived the device as associated with poor prognosis.
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Neogi SB, John D, Sharma J, Kar R, Kar SS, Bhattacharya M, Tiwari K, Saxena R. Cost-effectiveness of point-of-care devices for detection of anemia in community settings in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Jin Y, Coad J, Zhou SJ, Skeaff S, Ramilan T, Brough L. Prevalence of thyroid dysfunction in postpartum women with suboptimal iodine and selenium and adequate iron status. Clin Endocrinol (Oxf) 2021; 95:873-881. [PMID: 34008190 DOI: 10.1111/cen.14502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Postpartum women experience thyroid dysfunction at twice the prevalence of the general population. Adequate biosynthesis of thyroid hormones depends on three trace elements: iodine, selenium and iron. This study aimed to investigate thyroid dysfunction within a cohort of women at six months postpartum in relation to iodine, selenium and iron status. DESIGN This cross-sectional study was part of an observational longitudinal cohort Mother and Infant Nutrition Investigation; data obtained at six months postpartum are reported. SUBJECTS Mother-infant pairs (n = 87) were recruited at three months postpartum and followed up at six months postpartum (n = 78). MEASUREMENTS Thyroid hormones (free triiodothyronine, free thyroxine, thyroid-stimulating hormone) and thyroid peroxidase antibodies were measured. Urinary iodine concentration, breast milk iodine concentration, serum thyroglobulin, plasma selenium, serum ferritin and serum soluble transferrin receptors were determined. Nonparametric data were expressed as median (25th, 75th percentile). RESULTS Thyroid dysfunction was found in 18% of women, and 4% of women had iron deficiency. Median urinary iodine concentration was 85 (43, 134) µg/L, median breast milk iodine concentration was 59 (39, 109) µg/L, and median serum thyroglobulin at 11.4 (8.6, 18.6) µg/L, indicating iodine deficiency. Median plasma selenium concentration was 105.8 (95.6, 115.3) µg/L. Women with marginally lower plasma selenium concentration were 1.12% times more likely to have abnormal TSH concentrations (p = .001). CONCLUSIONS There was a high prevalence of thyroid dysfunction. Plasma selenium concentration was the only significant predictor of the likelihood that women had thyroid dysfunction within this cohort, who were iodine deficient and mostly had adequate iron status. Strategies are required to improve both iodine and selenium status to better support maternal thyroid function.
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Affiliation(s)
- Ying Jin
- School of Health Sciences, College of Health, Massey University, Palmerston North, New Zealand
| | - Jane Coad
- Nutrition Science, School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North, New Zealand
| | - Shao J Zhou
- School of Agriculture, Food and Wine, Faculty of Sciences & Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Sheila Skeaff
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Thiagarajah Ramilan
- School of Agriculture and Environment, College of Sciences, Massey University, Palmerston North, New Zealand
- School of Agriculture and Food, The University of Melbourne, Victoria, Australia
| | - Louise Brough
- Nutrition Science, School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North, New Zealand
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Asymptomatic Malaria and Helminths Coinfection and Its Association with Anemia among Primary School Children in Gedeo Zone, Southern Ethiopia: A Cross-Sectional Study. J Trop Med 2021; 2021:7742960. [PMID: 34552634 PMCID: PMC8452447 DOI: 10.1155/2021/7742960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/07/2021] [Indexed: 12/03/2022] Open
Abstract
Background Asymptomatic malaria and helminths coinfection occurs mainly in the tropics and subtropics where poverty and sanitary practice favor its high prevalence. In the tropics, where malaria is endemic, helminths also thrive resulting in coinfection. This study aimed to access the prevalence of asymptomatic malaria and helminths coinfection and its contribution for anemia in primary school children of Gedeo Zone, Southern Ethiopia. Methodology. This was a cross-sectional study conducted among 413 primary school children from February to April 2020. Finger-prick blood samples were used to determine asymptomatic malaria and hemoglobin concentrations. Stool samples were collected and processed through formalin-ether concentration techniques to detect the presence of intestinal helminths. Data were double entered into Epi Data version 3.1 software and exported to SPSS version 20 for analysis. Pearson's chi-square and correlation analysis were performed as part of the statistical analyses. Result A total of 413 primary school children aged 6 to 16 years (mean age ± SD: 10.7 ± 2.64years) were enrolled in the study. 159 (38.5%) of school children were infected with at least one of the parasitic diseases. The overall prevalence of asymptomatic malaria and intestinal helminths was 46 (11.1%) and 113 (27.3%) respectively. Asymptomatic malaria and helminths coinfection was 29 (7%). Total of 39.1% of asymptomatic malaria-infected school children were anemic, which is statistically significant (P < 0.05). 15.9% of helminths-infected school children were anemic, not statistically significant (P > 0.05). The prevalence of anemia was 12 (41.3%) among coinfected students, which is statistically significant (P < 0.005). Conclusion Asymptomatic malaria and helminths coinfection affects the health status of considerable number of primary school children in the study area. Therefore, simultaneous combat against the two parasitic infections is crucial to improve health of the school children.
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Beal T, White JM, Arsenault JE, Okronipa H, Hinnouho GM, Morris SS. Comprehensive Nutrient Gap Assessment (CONGA): A method for identifying the public health significance of nutrient gaps. Nutr Rev 2021; 79:4-15. [PMID: 33693909 PMCID: PMC7947985 DOI: 10.1093/nutrit/nuaa140] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Identifying dietary nutrient gaps and interpreting their public health significance are essential for improving poor diets and reducing malnutrition. Evidence indicative of the burden of nutrient deficiencies and inadequate nutrient intake or availability exists in many countries yet is often misinterpreted or underused in decision-making. Clear guidance is lacking on how to synthesize and interpret the relevant evidence, which comes in many forms. To fill this methodological gap, an approach called Comprehensive Nutrient Gap Assessment was created to enable use of existing evidence to assess the public health significance of nutrient gaps and identify evidence gaps. Comprehensive Nutrient Gap Assessment requires ≥ 2 experts in nutritional assessment but does not require primary data collection or secondary quantitative data analysis. It can be implemented relatively quickly with low costs, for specific countries and subnational regions, and updated on the basis of new data with minimal effort. The findings from a Comprehensive Nutrient Gap Assessment are easily interpretable by nontechnical decision makers yet include clear justification for technical audiences.
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Affiliation(s)
- Ty Beal
- Global Alliance for Improved Nutrition, Washington, DC, USA
- Department of Environmental Science and Policy, University of California, Davis, California, USA
| | | | - Joanne E Arsenault
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
- Intake, Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Harriet Okronipa
- Institute for Global Nutrition, University of California , Davis, Davis, California, USA
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, New York, USA
| | - Guy-Marino Hinnouho
- Institute for Global Nutrition , University of California , Davis, Davis, California, USA
- Helen Keller International, New York, New York, USA
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Gragasin FS, Ospina MB, Serrano-Lomelin J, Kim SH, Kokotilo M, Woodman AG, Renaud SJ, Bourque SL. Maternal and Cord Blood Hemoglobin as Determinants of Placental Weight: A Cross-Sectional Study. J Clin Med 2021; 10:jcm10050997. [PMID: 33801215 PMCID: PMC7957881 DOI: 10.3390/jcm10050997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Both high and low placental weights are associated with adverse pregnancy outcomes. Maternal hemoglobin levels can influence placental weight, but the evidence is conflicting. Since maternal hemoglobin does not invariably correlate with fetal/neonatal blood hemoglobin levels, we sought to determine whether cord blood hemoglobin or maternal hemoglobin status more closely associates with placental weight in women undergoing elective cesarean section at term. Methods: This was a cross-sectional study conducted at the Royal Alexandra Hospital, Edmonton, Canada, involving 202 women with term singleton pregnancies undergoing elective cesarean section. Maternal blood and mixed cord blood hemoglobin levels were analyzed using a HemoCue Hb201+ system. Birth weight, placental weight, one- and five-minute APGAR scores, American Society of Anesthesiologists physical state classification, maternal age, and maternal height were also recorded. Relationships between maternal and cord blood hemoglobin levels with placental weight, birth weight, and birth weight to placental weight ratio were the main outcome measures. Results: A total of 182 subjects were included in the analysis. Regression analysis showed that cord blood hemoglobin, but not maternal hemoglobin, was inversely related with placental weight (β = −2.4, p = 0.001) and positively related with the birth weight to placental weight ratio (β = 0.015, p = 0.001 and p = 0.63, respectively). Conclusions: Our findings suggest that measuring cord blood hemoglobin levels, rather than maternal hemoglobin levels, may provide important diagnostic information about in utero fetal adaptation to suboptimal placental function and neonatal health.
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Affiliation(s)
- Ferrante S. Gragasin
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada; (F.S.G.); (M.K.)
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada; (M.B.O.); (J.S.-L.); (A.G.W.)
| | - Maria B. Ospina
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada; (M.B.O.); (J.S.-L.); (A.G.W.)
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - Jesus Serrano-Lomelin
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada; (M.B.O.); (J.S.-L.); (A.G.W.)
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - Su Hwan Kim
- Department of Mathematical & Statistical Sciences, University of Alberta, Edmonton, AB T6G 2G1, Canada;
| | - Matthew Kokotilo
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada; (F.S.G.); (M.K.)
| | - Andrew G. Woodman
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada; (M.B.O.); (J.S.-L.); (A.G.W.)
- Department of Pharmacology, University of Alberta, Edmonton, AB T6G 2H7, Canada
| | - Stephen J. Renaud
- Department of Anatomy and Cell Biology, University of Western Ontario, London, ON N6A 5C1, Canada;
| | - Stephane L. Bourque
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada; (F.S.G.); (M.K.)
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada; (M.B.O.); (J.S.-L.); (A.G.W.)
- Department of Pharmacology, University of Alberta, Edmonton, AB T6G 2H7, Canada
- Correspondence: ; Tel.: +1-780-492-6000
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14
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Mahapatra S, Parker ME, Dave N, Zobrist SC, Shajie Arul D, King A, Betigeri A, Sachdeva R. Micronutrient-fortified rice improves haemoglobin, anaemia prevalence and cognitive performance among schoolchildren in Gujarat, India: a case-control study. Int J Food Sci Nutr 2021; 72:690-703. [PMID: 33427528 DOI: 10.1080/09637486.2020.1855126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Anaemia is a public health problem in India. A case-control, quasi-experimental study was conducted to evaluate the effect of a multiple micronutrient fortified rice intervention among school children (6-12 years) through the midday meal programme in Gujarat, India, over 8 months. The fortified rice provided approximately 10% Recommended Dietary Allowance of iron; 25-33% of vitamin A, thiamine, niacin and vitamin B6; and 100% of folic acid and vitamin B12. Outcomes of interest included haemoglobin concentration, anaemia prevalence, and cognitive performance. Cognitive performance was evaluated using J-PAL-validated Pratham reading and mathematics testing tools. 973 children completed the study (cases n = 484; controls n = 489). The intervention significantly increased mean haemoglobin by 0.4 g/dL (p = 0.001), reduced anaemia prevalence by 10% (p < 0.00001), and improved average cognitive scores by 11.3 points (p < 0.001). Rice fortification can help address anaemia in settings where rice is a staple food.
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Affiliation(s)
- Sudip Mahapatra
- Maternal, Newborn, Child Health and Nutrition Division, PATH, New Delhi, India
| | - Megan E Parker
- Maternal, Newborn, Child Health and Nutrition Division, PATH, Seattle, WA, USA
| | - Niraj Dave
- Nielsen India Pvt. Ltd., Gurugram, India
| | - Stephanie C Zobrist
- Maternal, Newborn, Child Health and Nutrition Division, PATH, Seattle, WA, USA
| | - Danie Shajie Arul
- Maternal, Newborn, Child Health and Nutrition Division, PATH, New Delhi, India
| | - Allie King
- Maternal, Newborn, Child Health and Nutrition Division, PATH, Seattle, WA, USA
| | - Arvind Betigeri
- Maternal, Newborn, Child Health and Nutrition Division, PATH, New Delhi, India
| | - Ruchika Sachdeva
- Maternal, Newborn, Child Health and Nutrition Division, PATH, New Delhi, India
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Darmawati D, Nizwan-Siregar T, Kamil H, Tahlil T. Exploring Indonesian mothers' perspectives on anemia during pregnancy: A qualitative approach. ENFERMERIA CLINICA 2020; 32:S1130-8621(20)30551-9. [PMID: 33384251 DOI: 10.1016/j.enfcli.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/23/2020] [Accepted: 11/02/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The study aims to investigate the perceptions of anemia among pregnant women to design culturally relevant interventions in Indonesia. METHOD Qualitative study with dates from 24 pregnant women in a province in Indonesia through focus group discussions. Data were analyzed using the inductive content analysis method. RESULTS Five themes emerged from the experiences of pregnant women with anemia: (1) anemia during pregnancy is perceived as a woman's destiny; (2) lack of knowledge related to clinical indicators of anemia; (3) the traditional taboo related to anemia; (4) the husband and family provide support related to anemia prevention; and (5) there is a need for cultural and religious-based health counseling. CONCLUSIONS Interventions to provide health information about anemia in pregnancy should be designed with consideration of local knowledge, beliefs and values, combined with medical elements. It is likely these interventions can change the perceptions of pregnant women's perceptions about anemia, ensuring that they are able to maintain their pregnancy. The implementation of programs to support these women should involves health workers who can understand their needs and who are adequately trained in cultural competence.
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Affiliation(s)
- Darmawati Darmawati
- Graduate School of Mathematics and Applied Science, Department of Maternity Nursing, Faculty of Nursing, Universitas Syiah Kuala, Aceh, Indonesia.
| | | | - Hajjul Kamil
- Department of Management Nursing, Faculty of Nursing, Universitas Syiah Kuala, Aceh, Indonesia
| | - Teuku Tahlil
- Department of Community Nursing, Faculty of Nursing, Universitas Syiah Kuala, Aceh, Indonesia
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16
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Rappaport AI, Karakochuk CD, Hess SY, Whitehead RD, Namaste SML, Dary O, Parker ME, Neufeld LM, Larson LM, Newton S, Wegmuller R, Moorthy D. Variability in haemoglobin concentration by measurement tool and blood source: an analysis from seven countries. J Clin Pathol 2020; 74:657-663. [PMID: 33023940 DOI: 10.1136/jclinpath-2020-206717] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/22/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We explore factors such as the blood sampling site (capillary vs venous), the equipment (HemoCue vs automated haematology analyser) and the model of the HemoCue device (201+ vs 301) that may impact haemoglobin measurements in capillary and venous blood. METHODS Eleven studies were identified, and bias, concordance and measures of diagnostic performance were assessed within each study. FINDINGS Our analysis included 11 studies from seven countries (Cambodia, India, The Gambia, Ghana, Laos, Rwanda and USA). Samples came from children, men, non-pregnant women and pregnant women. Mean bias ranged from -8.7 to 2.5 g/L in Cambodian women, 6.2 g/L in Laotian children, 2.4 g/L in Ghanaian women, 0.8 g/L in Gambian children 6-23 months and 1.4 g/L in Rwandan children 6-59 months when comparing capillary blood on a HemoCue to venous blood on a haematology analyser. Bias was 8.3 g/L in Indian non-pregnant women and 2.6 g/L in Laotian children and women and 1.5 g/L in the US population when comparing capillary to venous blood using a HemoCue. For venous blood measured on the HemoCue compared with the automated haematology analyser, bias was 5.3 g/L in Gambian pregnant women 18-45 years and 11.3 g/L in Laotian children 6-59 months. CONCLUSION Our analysis found large variability in haemoglobin concentration measured on capillary or venous blood and using HemoCue Hb 201+ or Hb 301 or automated haematology analyser. We cannot ascertain whether the variation is due to differences in the equipment, differences in capillary and venous blood, or factors affecting blood collection techniques.
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Affiliation(s)
- Aviva I Rappaport
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING), Arlington, Virginia, USA.,School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Crystal D Karakochuk
- Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonja Y Hess
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA
| | - Ralph D Whitehead
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, USA
| | - Sorrel M L Namaste
- The Demographic and Health Survey (DHS) Program, ICF, Rockville, Maryland, USA
| | - Omar Dary
- US Agency for International Development (USAID), Bureau of Global Health, Office of Maternal Child Health and Nutrition, Washington, DC, USA
| | - Megan E Parker
- Maternal, Newborn, Child Health and Nutrition, PATH, Seattle, Washington, USA
| | - Lynnette M Neufeld
- Knowledge Leadership, Global Alliance for Improved Nutrition, Geneva, Switzerland
| | - Leila M Larson
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Sam Newton
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rita Wegmuller
- GroundWork, Fläsch, Switzerland.,Medical Research Council Unit The Gambia, Keneba, The Gambia
| | - Denish Moorthy
- USAID Advancing Nutrition, John Snow Inc. Research and Training Institute, Arlington, Virginia, USA
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Nass SA, Hossain I, Sanyang C, Baldeh B, Pereira DIA. Hemoglobin point-of-care testing in rural Gambia: Comparing accuracy of HemoCue and Aptus with an automated hematology analyzer. PLoS One 2020; 15:e0239931. [PMID: 33002049 PMCID: PMC7529235 DOI: 10.1371/journal.pone.0239931] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 09/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background Anemia is one of the most impactful nutrient deficiencies in the world and disproportionately affects children in low-resource settings. Point-of-care devices (PoCDs) measuring blood hemoglobin (Hb) are widely used in such settings to screen for anemia due to their low cost, speed, and convenience. Here we present the first iteration of Aptus, a new PoCD which measures Hb and hematocrit (HCT). Aim To evaluate the accuracy of Aptus and HemoCue® Hb 301 against an automated hematology analyzer (Medonic®) in Gambian children aged 6–35 months and the Aptus’ usage in the field. Methods Aptus, HemoCue® and Medonic® were compared using venous blood (n = 180), and Aptus and HemoCue® additionally using capillary blood (n = 506). Agreement was estimated using Bland-Altman analysis and Lin’s concordance. Usage was assessed by error occurrence and user experience. Results Mean Hb values in venous blood did not significantly differ between Aptus and HemoCue® (10.44±1.05 vs 10.56±0.93g/dl, p>0.05), but both measured higher Hb concentrations than Medonic® (9.75±0.99g/dl, p<0.0001). Lin’s coefficient between Aptus and Medonic® was rc = 0.548, between HemoCue® and Medonic® rc = 0.636. Mean bias between the PoCDs venous measurements was -0.11g/dl with limits of agreement (LoA) -1.63 and 1.40g/dl. The bias was larger for the comparisons between the Medonic® and both Aptus (0.69g/dl, LoA 0.92 and 2.31g/dl) and HemoCue® (0.81g/dl, LoA 0.17 and 1.78g/dl). ROC curves showed an AUC of 0.933 in HemoCue® and 0.799 in Aptus. Capillary Hb was higher with Aptus than HemoCue® (10.33±1.11g/dl vs 10.01±1.07g/dl, p<0.0001). Mean bias was 0.32g/dl with LoA of -1.91 and 2.54g/dl. Aptus‘ usage proved intuitive, yet time-to-results and cuvettes could be improved. Conclusion Both PoCDs showed a relatively limited bias but large LoA. Aptus and HemoCue® showed similar accuracy, while both overestimated Hb levels. Aptus showed promise, with its operation unimpaired by field conditions as well as being able to show HCT values.
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Affiliation(s)
- Stefan A. Nass
- Medical Humanities, Amsterdam-UMC—VUmc Location, Vrije Universiteit, Amsterdam, The Netherlands
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- * E-mail:
| | - Ilias Hossain
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Chilel Sanyang
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Bakary Baldeh
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Dora I. A. Pereira
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
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Jin Y, Coad J, Zhou SJ, Skeaff S, Benn C, Kim N, Pond RL, Brough L. Mother and Infant Nutrition Investigation in New Zealand (MINI Project): Protocol for an Observational Longitudinal Cohort Study. JMIR Res Protoc 2020; 9:e18560. [PMID: 32852279 PMCID: PMC7484772 DOI: 10.2196/18560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 12/31/2022] Open
Abstract
Background Thyroid dysfunction is associated with cognitive impairment, mood disturbance, and postnatal depression. Sufficient thyroid hormone synthesis requires adequate intake of iodine, selenium, and iron. Iodine deficiency was historically a problem for New Zealand, and initiatives were introduced to overcome the problem: (1) mandatory fortification of all bread (except organic) with iodized salt (2009) and (2) provision of subsidized iodine supplements for pregnant and breastfeeding women (2010). Subsequent to these initiatives, most adults and children have adequate iodine status; however, status among breastfeeding women and their infants remains unclear. This paper outlines the methodology of the Mother and Infant Nutrition Investigation (MINI) study: an observational longitudinal cohort study of breastfeeding women and their infants. Objective This study will determine (1) women’s iodine intake and status among supplement users and nonusers; (2) women’s intake and status of iodine, selenium, and iron relating to thyroid function; (3) associations between women’s selenium status, thyroid function, and postnatal depression; (4) infants’ iodine and selenium status relating to first year neurodevelopment. Methods Breastfeeding women aged over 16 years with a healthy term singleton infant were recruited from Manawatu, New Zealand. Participants attended study visits 3, 6, and 12 months postpartum. Maternal questionnaires investigated supplement use before and after birth, iodine knowledge, and demographic information. Dietary assessment and urine, blood, and breast milk samples were taken to measure iodine, selenium, and iron intake/status. The Edinburgh Postnatal Depression Scale was used repeatedly to screen for postnatal depression. Thyroid hormones (free triiodothyronine, free thyroxine, thyroid stimulating hormone, thyroglobulin, antithyroglobulin antibodies, and antithyroid peroxidase) were measured in blood samples, and thyroid gland volume was measured by ultrasound at 6 months postpartum. Infant iodine and selenium concentrations were determined in urine. The Ages and Stages Questionnaire was used to assess infant development at 4, 8, and 12 months. Results Data collection was completed. Biological samples analysis, excluding nail clippings, is complete. Data analysis and presentation of the results will be available after 2020. Conclusions This study will provide data on the current iodine status of breastfeeding women. It will also provide a greater understanding of the three essential minerals required for optimal thyroid function among breastfeeding women. The prospective longitudinal design allows opportunities to examine women’s mental health and infant neurodevelopment throughout the first year, a crucial time for both mothers and their infants. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12615001028594; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369324 International Registered Report Identifier (IRRID) DERR1-10.2196/18560
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Affiliation(s)
- Ying Jin
- School of Health Sciences, College of Health, Massey University, Palmerston North, New Zealand
| | - Jane Coad
- School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North, New Zealand
| | - Shao J Zhou
- School of Agriculture, Food and Wine and Robinson Research Institute, Faculty of Sciences, University of Adelaide, Adelaide, Australia
| | - Sheila Skeaff
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Cheryl Benn
- MidCentral District Health Board, Palmerston North, New Zealand
| | - Nicholas Kim
- School of Health Sciences, College of Health, Massey University, Wellington, New Zealand
| | - Rachael L Pond
- Institute of Education, College of Humanities and Social Sciences, Massey University, Palmerston North, New Zealand
| | - Louise Brough
- School of Food and Advanced Technology, College of Sciences, Massey University, Palmerston North, New Zealand
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Roberts SB, Franceschini MA, Silver RE, Taylor SF, de Sa AB, Có R, Sonco A, Krauss A, Taetzsch A, Webb P, Das SK, Chen CY, Rogers BL, Saltzman E, Lin PY, Schlossman N, Pruzensky W, Balé C, Chui KKH, Muentener P. Effects of food supplementation on cognitive function, cerebral blood flow, and nutritional status in young children at risk of undernutrition: randomized controlled trial. BMJ 2020; 370:m2397. [PMID: 32699176 PMCID: PMC7374799 DOI: 10.1136/bmj.m2397] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess the effects of food supplementation on improving working memory and additional measures including cerebral blood flow in children at risk of undernutrition. DESIGN Randomized controlled trial. SETTING 10 villages in Guinea-Bissau. PARTICIPANTS 1059 children aged 15 months to 7 years; children younger than 4 were the primary population. INTERVENTIONS Supervised isocaloric servings (≈1300 kJ, five mornings each week, 23 weeks) of a new food supplement (NEWSUP, high in plant polyphenols and omega 3 fatty acids, within a wide variety and high fortification of micronutrients, and a high protein content), or a fortified blended food (FBF) used in nutrition programs, or a control meal (traditional rice breakfast). MAIN OUTCOME MEASUREMENTS The primary outcome was working memory, a core executive function predicting long term academic achievement. Additional outcomes were hemoglobin concentration, growth, body composition, and index of cerebral blood flow (CBFi). In addition to an intention-to-treat analysis, a predefined per protocol analysis was conducted in children who consumed at least 75% of the supplement (820/925, 89%). The primary outcome was assessed by a multivariable Poisson model; other outcomes were assessed by multivariable linear mixed models. RESULTS Among children younger than 4, randomization to NEWSUP increased working memory compared with the control meal (rate ratio 1.20, 95% confidence interval 1.02 to 1.41, P=0.03), with a larger effect in the per protocol population (1.25, 1.06 to 1.47, P=0.009). NEWSUP also increased hemoglobin concentration among children with anemia (adjusted mean difference 0.65 g/dL, 95% confidence interval 0.23 to 1.07, P=0.003) compared with the control meal, decreased body mass index z score gain (-0.23, -0.43 to -0.02, P=0.03), and increased lean tissue accretion (2.98 cm2, 0.04 to 5.92, P=0.046) with less fat (-5.82 cm2, -11.28 to -0.36, P=0.04) compared with FBF. Additionally, NEWSUP increased CBFi compared with the control meal and FBF in both age groups combined (1.14 mm2/s×10-8, 0.10 to 2.23, P=0.04 for both comparisons). Among children aged 4 and older, NEWSUP had no significant effect on working memory or anemia, but increased lean tissue compared with FBF (4.31 cm2, 0.34 to 8.28, P=0.03). CONCLUSIONS Childhood undernutrition is associated with long term impairment in cognition. Contrary to current understanding, supplementary feeding for 23 weeks could improve executive function, brain health, and nutritional status in vulnerable young children living in low income countries. Further research is needed to optimize nutritional prescriptions for regenerative improvements in cognitive function, and to test effectiveness in other vulnerable groups. TRIAL REGISTRATION ClinicalTrials.gov NCT03017209.
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Affiliation(s)
- Susan B Roberts
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Maria A Franceschini
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Rachel E Silver
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Salima F Taylor
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Augusto Braima de Sa
- International Partnership for Human Development, Leesburg, VA, USA and Bissau, Guinea Bissau
| | - Raimundo Có
- International Partnership for Human Development, Leesburg, VA, USA and Bissau, Guinea Bissau
| | - Aliu Sonco
- International Partnership for Human Development, Leesburg, VA, USA and Bissau, Guinea Bissau
| | | | - Amy Taetzsch
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Patrick Webb
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sai Krupa Das
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - C-Y Chen
- Biofortis, Mérieux NutriSciences, Addison, IL, USA
| | - Beatrice L Rogers
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Edward Saltzman
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Pei-Yi Lin
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Nina Schlossman
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Global Food and Nutrition, Washington, DC, USA
| | - William Pruzensky
- International Partnership for Human Development, Leesburg, VA, USA and Bissau, Guinea Bissau
| | - Carlito Balé
- International Partnership for Human Development, Leesburg, VA, USA and Bissau, Guinea Bissau
| | - Kenneth Kwan Ho Chui
- Department of Public Health and Community Medicine, Tufts School of Medicine, Boston, MA, USA
| | - Paul Muentener
- Department of Psychology, Tufts University, Medford, MA, USA
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20
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Neogi SB, Sharma J, Pandey S, Zaidi N, Bhattacharya M, Kar R, Kar SS, Purohit A, Bandyopadhyay S, Saxena R. Diagnostic accuracy of point-of-care devices for detection of anemia in community settings in India. BMC Health Serv Res 2020; 20:468. [PMID: 32456639 PMCID: PMC7249358 DOI: 10.1186/s12913-020-05329-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/17/2020] [Indexed: 11/25/2022] Open
Abstract
Background Accurate diagnosis of anemia by community workers using a point-of-care device is a challenge. The objective of the study was to establish the diagnostic accuracy of point-of-care devices for detecting anemia in community settings. Methods It was diagnostic accuracy study with cross-sectional design on adult patients attending the outpatient department of rural/ urban health centres of Medical colleges from India. The index tests were HemoCue, TrueHb, Massimo’s device and spectroscopic device, compared against autoanalyzer (gold standard). Accuracy was expressed by sensitivity, specificity, likelihood ratios, predictive values, area under the curve (AUC) and levels of agreement. For the diagnostic accuracy component, 1407 participants were recruited with a minimum of 600 for each device. An additional 200 participants were considered to elucidate the performance of devices in different weather conditions. Results HemoCue and TrueHb performed better than Massimo and spectroscopic devices. Detection of anemia by technicians was similar between TrueHb and HemoCue (AUC 0.92 v/s 0.90, p > 0.05). Community workers performed better with Hemocue for detecting anemia compared to TrueHb (AUC 0.92 v/s 0.90, p < 0.05). For detection of severe anemia, accuracy of TrueHb was significantly better with technicians (AUC 0.91 v/s 0.70; p < 0.05) and community workers (AUC 0.91 v/s 0.73; p < 0.05). HemoCue showed a bias or mean difference (95%CI) of 0.47 g/dl (0.42, 0.52) for all values, and 0.92 g/dl (0.82, 1.03) for severe anemia. For TrueHb, it was − 0.28 g/dl (− 0.37, − 0.20) for all readings, and 0.06 g/dl (− 0.52, 0.63) for severe anemia. TrueHb appeared to be more consistent across different weather conditions, although it overestimated Hb in extreme cold weather conditions. Conclusion For detection of anemia, True Hb and HemoCue were comparable. For severe anemia, True Hb seemed to be a better and feasible point-of-care device for detecting anemia in the community settings.
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Affiliation(s)
| | - Jyoti Sharma
- Indian Institute of Public Health- Delhi, Delhi NCR, India
| | - Shivam Pandey
- Indian Institute of Public Health- Delhi, Delhi NCR, India
| | - Nausheen Zaidi
- Indian Institute of Public Health- Delhi, Delhi NCR, India
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Tanner KE, Moore‐O'Leary KA, Parker IM, Pavlik BM, Hernandez RR. Simulated solar panels create altered microhabitats in desert landforms. Ecosphere 2020. [DOI: 10.1002/ecs2.3089] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Karen E. Tanner
- Ecology and Evolutionary Biology Department University of California 1156 High Street Santa Cruz California 95064 USA
| | - Kara A. Moore‐O'Leary
- U.S. Fish and Wildlife Service Pacific Southwest Region 3020 State University Drive East Sacramento California 95819 USA
| | - Ingrid M. Parker
- Ecology and Evolutionary Biology Department University of California 1156 High Street Santa Cruz California 95064 USA
| | - Bruce M. Pavlik
- Conservation Department Red Butte Garden and Arboretum University of Utah Salt Lake City Utah 84108 USA
| | - Rebecca R. Hernandez
- Department of Land, Air & Water Resources University of California One Shields Avenue Davis California 95616 USA
- Wild Energy Initiative John Muir Institute of the Environment University of California One Shields Avenue Davis California 95616 USA
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22
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Karakochuk CD, Hess SY, Moorthy D, Namaste S, Parker ME, Rappaport AI, Wegmüller R, Dary O. Measurement and interpretation of hemoglobin concentration in clinical and field settings: a narrative review. Ann N Y Acad Sci 2019; 1450:126-146. [PMID: 30652320 DOI: 10.1111/nyas.14003] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/16/2018] [Accepted: 12/26/2018] [Indexed: 12/26/2022]
Abstract
Anemia affects over 800 million women and children globally. Defined as a limited or insufficient functional red blood cell supply in peripheral blood, anemia causes a reduced oxygen supply to tissues and can have serious health consequences for women and children. Hemoglobin (Hb) concentration is most commonly measured for anemia diagnosis. Methods to measure Hb are usually invasive (requiring a blood sample); however, advances in diagnostic and clinical chemistry over the past decade have led to the development of new noninvasive methods. Accurate diagnosis at the individual level is important to identify individuals who require treatment. At the population level, anemia prevalence estimates are often the impetus for national nutrition policies or programs. Thus, it is essential that methods for Hb measurement are sensitive, specific, accurate, and reproducible. The objective of our narrative review is to describe the basic principles, advantages, limitations, and quality control issues related to methods of Hb measurement in clinical and field settings. We also discuss other biomarkers and tests that can help to determine the severity and underlying causes of anemia. In conclusion, there are many established and emerging methods to measure Hb concentration, each with their own advantages, limitations, and factors to consider before use.
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Affiliation(s)
- Crystal D Karakochuk
- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonja Y Hess
- Department of Nutrition, University of California Davis, Davis, California
| | - Denish Moorthy
- USAID-funded Strengthening Partnerships, Results, and Innovation in Nutrition Globally Project, John Snow Inc., Arlington, Virginia
| | | | - Megan E Parker
- Nutrition Innovation, Maternal Newborn and Child Health and Nutrition, PATH, Seattle, Washington
| | - Aviva I Rappaport
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rita Wegmüller
- GroundWork, Fläsch, Switzerland.,Medical Research Council Unit the Gambia, Keneba, the Gambia
| | - Omar Dary
- Nutrition Division, Office of Maternal and Child Health and Nutrition, Bureau for Global Health, United States Agency for International Development, Washington, DC
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- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada
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