Cost-effective on-site screening for anaemia in pregnancy in primary care clinics.
OBJECTIVE
To determine the feasibility, accuracy and cost of developing a system of on-site screening for anaemia in pregnancy in primary care clinics.


METHODS
Mobile clinic team in Hlabisa health district, KwaZulu-Natal.


METHODS
Four hundred and forty-nine consecutive women attending antenatal clinics were screened for anaemia (haemoglobin < 10 g/dl) using copper sulphate solution; the results were compared with true haemoglobin levels as determined by an automated analyser. Three hundred women had haemoglobin concentration estimated with a portable haemoglobinometer and results compared with those from the automated analyser.


RESULTS
Screening with copper sulphate solution was highly sensitive (95.7%) but had low positive predictive value for anaemia (37.2%). Haemoglobin concentration estimated by haemoglobinometer correlated highly with results from the analyser (r = 0.82; P < 0.0001), and the mean difference in concentrations between the two methods was 1.1 g/dl. The average cost of screening all women with copper sulphate solution (6 cents/sample) and determining the true concentration in those screened as possibly anaemia (R2.64/sample) was 72 cents per woman. The cost of using an automated analyser was R6.20 per sample.


CONCLUSIONS
Combined use of copper sulphate solution and a haemoglobinometer is a feasible, accurate and cost-effective way of screening for and diagnosing anaemia in pregnant women, on-site, in primary care clinics.
Wilkinson
D
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Centre for Epidemiological Research in Southern Africa, Medical Research Council, Hlabisa, KwaZulu-Natal.
Sach
M E
ME
D000740:Anemia / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control*; D019327:Copper Sulfate; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000295:instrumentation / Q000379:methods; D011237:Predictive Value of Tests; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control*; D011320:Primary Health Care; D012680:Sensitivity and Specificity; D013019:South Africa
D006454:Hemoglobins; D019327:Copper Sulfate