Clinical Anaemia Detection in Children of Varied Skin Complexion: A Community-based Study in Southeast, Nigeria

J Trop Pediatr. 2017 Feb;63(1):23-29. doi: 10.1093/tropej/fmw044. Epub 2016 Jul 22.


Background: Clinicians rely on clinical detection of pallor to diagnose anaemia. This makes it important to evaluate the effect of different skin complexions on the accuracy of the pallor in diagnosing anaemia in children.

Methods: Clinicians conducted blind-independent physical examination, and their reports were compared with HemoCue 301 haemoglobin estimated with. The sensitivity and specificity were calculated.

Results: A total of 573 children were reviewed by 27 healthcare workers. The prevalence of anaemia was high. The highest prevalence was among children between the age of 4 and 12 months (urban 63.4% and rural 69.2%). Anaemia was detected better among dark-skinned children. Conjunctivae and palm pallor had the highest sensitivity (78.6% and 69.2%, respectively).

Discussion: Clinical pallor is a good screening assessment for anaemia but not diagnostic. Its sensitivity and specificity vary among different sites and skin complexions. Thus combining findings at any of the sites can improve detection of anaemia in children.

Keywords: childhood anaemia; haemoglobin estimation; sensitivity; skin complexion; specificity..

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anemia / diagnosis*
  • Anemia / epidemiology
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Nigeria / epidemiology
  • Observer Variation
  • Pallor*
  • Physical Examination / methods*
  • Prevalence
  • Sensitivity and Specificity
  • Skin Pigmentation*