Anaemia is a serious and common problem among young children in sub-Saharan Africa. As a first step towards developing guidelines for its recognition and treatment, we conducted a study to evaluate the ability of health workers to use clinical findings to identify children with anaemia. Health care workers examined a total of 1104 children under 5 years of age at two hospital-based outpatient clinics in rural Malawi. Blood samples were taken to determine haemoglobin concentrations. Pallor of the conjunctiva, tongue, palm or nail beds was 66% sensitive and 68% specific in distinguishing children with moderate anaemia (haemoglobin concentration 5-8 g/dl) and 93% sensitive and 57% specific in distinguishing those with severe anaemia (haemoglobin concentration, <5 g/dl). Even without laboratory support, which is often unavailable in rural Africa, clinical findings can identify the majority of children with anaemia.; Anemia is a serious and common problem among young children in Sub-Saharan Africa. As a first step towards developing guidelines for its recognition and treatment, a study was conducted to evaluate the ability of health workers to use clinical findings to identify children with anemia. The study was conducted in the outpatient departments of Mangochi District Hospital and Nkhoma Hospital, serving predominately rural areas. A systematic sample was recruited by approaching the parent of every 4th sick child brought to the clinic for under-5-year-olds in Mangochi between April 17 and May 28, 1993, and every 2nd and 3rd sick child brought to the pediatric clinic in Nkhoma between April 28 and June 5, 1993. Of these, 1104 (97%) underwent a physical examination of the conjunctiva, tongue, palm, and nail bed, and a blood test was taken to determine haemoglobin concentration. The median age of the enrolled children was 13 months (range, 1 month to 60 months); 580 (53%) were boys, and 590 (53%) were seen at Mangochi District Hospital. The mean hemoglobin concentration of enrolled patients was 8.8 g/dl (range, 2.1-17.1 g/dl). 82% were anemic according to the World Health Organization definition; 35% had moderate anemia; and 5% had severe anemia. Pallor of the conjunctiva, tongue, palm, or nail beds was 66% sensitive and 68% specific in distinguishing children with moderate anemia (hemoglobin concentration, 5-8 g/dl) and 93% sensitive and 57% specific in distinguishing those with severe anemia (hemoglobin concentration, 5 g/dl). Probable pallor at any anatomical site was 70% sensitive, 68% specific, and had a 54% positive predictive value in diagnosing a hemoglobin concentration of 8 g/dl. Multiple linear regression models predicting haemoglobin levels showed that children with definite pallor had significantly lower hemoglobin concentrations than children with probable pallor, and those with probable pallor had significantly lower concentrations than those without pallor (p 0.05 for each comparison). Laboratory support is often unavailable in rural Africa, thus clinical findings can identify the majority of children with anemia.
