title: Screening for severe anaemia in pregnancy in Kenya, using pallor examination and self-reported morbidity.
abstract: Severe anaemia in pregnancy is an important preventable cause of maternal and perinatal morbidity and mortality. Different methods of screening for severe anaemia in pregnancy were evaluated in a 2-phased study conducted in Kilifi, Kenya. In phase 1 (in 1994/95), pallor testing was evaluated alone and in addition to raised respiratory/pulse rates: 1787 pregnant women were examined by one of 2 midwives. Sensitivities for detecting severe anaemia (haemoglobin < 7 g/dL) were 62% and 69% and specificities 87% and 77%, respectively for each of the midwives. Addition of high pulse rate increased sensitivity to 77% and 81%, but specificity reduced to 60% and 51%, respectively. In phase 2, following qualitative in-depth work, a screening questionnaire was developed. An algorithm based on screening questions had 80% sensitivity and 40% specificity. Midwife pallor-assessment was conducted following the screening questionnaire. In this phase (conducted in 1997), the midwife performed very highly in detecting severe anaemia, achieving sensitivity of 84% and specificity of 92%. Spending a few minutes asking women questions may have improved the ability to interpret pallor findings. This study demonstrates the value of pallor testing and raises alternative approaches to improving it.
authors.affiliation: Disease Control and Vector Biology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. caroline.shulman@lshtm.ac.uk
authors.forename: C E
authors.initials: CE
authors.lastname: Shulman
authors.forename: M
authors.initials: M
authors.lastname: Levene
authors.forename: L
authors.initials: L
authors.lastname: Morison
authors.forename: E
authors.initials: E
authors.lastname: Dorman
authors.forename: N
authors.initials: N
authors.lastname: Peshu
authors.forename: K
authors.initials: K
authors.lastname: Marsh
mesh_terms: D000740:Anemia / Q000175:diagnosis* / Q000517:prevention & control; D005260:Female; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008403:Mass Screening / Q000379:methods*; D010167:Pallor; D010808:Physical Examination; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis* / Q000517:prevention & control; D011296:Prenatal Diagnosis / Q000379:methods / Q000592:standards; D012650:Self Disclosure; D012680:Sensitivity and Specificity