Performance indices of clinical pallor and health workers adherence to the IMCI guidelines in the detection of anaemia among children in Mkuranga district, -coast region, Tanzania.

Abstract

Childhood anaemia is a major public health problem in African countries that are also holoendemic for malaria. In most of the peripheral health facilities in these countries, health workers rely on physical signs and not laboratory tests to detect anemic children who may need efficacious antimalarial drugs or referral for blood transfusion A cross- sectional study was conducted during the period of June to July 2004, to assess the performance indices of pallor of the conjunctiva, nail bed and palms for the detection of anaemic children who should receive an antimalarial drug and those who should be referred for blood transfusion. The study also assessed health workers adherence to the IMCI guidelines for the detection of anaemic children. A total of 274 sick children aged 2 to 59 months were evaluated for clinical pallor at the three anatomical sites. The presence of pallor was compared with the measured haemoglobin concentrations and the level of parasitaemia. A total of 26 health workers were interviewed and observed for their performance and adherence to the IMCI guidelines for the detection of anaemic children. Overall, the prevalence of anaemia (haemoglobin < 11.0 g/dl) was 84.7%; severe anaemia (haemoglobin < 5.0 g/dl) was found in 6.2% of the children. The presence of '"

some pallor was associated with mild and moderate anaemia (haemoglobin <11.Og/dl) and could be detected with sensitivities of 78%, 80% and 75% respectively. in the conjunctiva, nail bed and palms. Definite / severe pallor was detected in 5.8% of the children with a sensitivity 73% and specificity of 96% for the detection of severe anaemia (haemoglobin < 5.0g/d!). The prevalence of malaria parasitaemia of any level was 80%. The presence of some pallor had a sensitivity of 65% and specificity of 43% to detect malaria parasitaemia of any level. Definite / severe pallor had a very low sensitivity (I 1.0%) but a very high specificity for the detection of children with any level of parasitaemia. Most of the health workers had adequate knowledge (I 00%) and skill (95%), however they lacked the skill for assessing general danger signs compatible with anaemia; 75% had poor performance. The time health workers spent with children was very short (8 minutes) and with mean workload of29 patients per day. This study has further validated that pallor is a feasible and reliable clinical sign for the detection of anaemic children who should receive an antimalarial drug and those who should be referred for blood transfusion. Most health workers in Mkuranga district are knowledgeable of the IMCI guidelines and have adequate performance in the use of IMCI guidelines for the assessment of children with mild to moderate anaemia but however they need re-training in the evaluation of dangers signs compatible with severe anerma.