{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T13:13:20Z","timestamp":1779887600727,"version":"3.53.1"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.14801.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2019,3,18]],"date-time":"2019-03-18T00:00:00Z","timestamp":1552867200000}}],"reference-count":30,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2019,3,18]],"date-time":"2019-03-18T00:00:00Z","timestamp":1552867200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000761","name":"Imperial College London","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000761","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["203077"],"award-info":[{"award-number":["203077"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["100693"],"award-info":[{"award-number":["100693"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["091758"],"award-info":[{"award-number":["091758"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["202800"],"award-info":[{"award-number":["202800"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns4:p>\n                    <ns4:bold>Background:<\/ns4:bold>\n                    Severe anaemia in children requiring hospital admission is a major public health problem in malaria-endemic Africa. Affordable methods for the assessment of haemoglobin have not been validated against gold standard measures for identifying those with severe anaemia requiring a blood transfusion, despite this resource being in short supply.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Methods:<\/ns4:bold>\n                    We conducted a prospective descriptive study of hospitalized children aged 2 months \u2013 12 years at Mbale and Soroti Regional Referral Hospitals, assessed to have pallor at triage by a nurse and two clinicians. Haemoglobin levels were measured using the HemoCue\n                    <ns4:sup>\u00ae<\/ns4:sup>\n                    Hb 301 system (gold standard); the Haemoglobin Colour Scale; Colorimetric and Sahli\u2019s methods. We report clinical assessments of the degree of pallor, clinicians\u2019 intention to transfuse, inter-observer agreement, limits of agreement using the Bland-Altman method, and the sensitivity and specificity of each method in comparison to HemoCue\n                    <ns4:sup>\u00ae<\/ns4:sup>\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Results:<\/ns4:bold>\n                    We recruited 322 children, clinically-assessed by the admitting nurse (n=314) as having severe (166; 51.6%), moderate (97; 30.1%) or mild (51; 15.8%) pallor. Agreement between the clinicians and the nurse were good: Clinician A Kappa=0.68 (0.60\u20130.76) and Clinician B Kappa=0.62 (0.53\u20130.71) respectively (\n                    <ns4:italic>P<\/ns4:italic>\n                    &lt;0.0001 for both). The nurse, clinicians A and B indicated that of 94\/116 (81.0%), 83\/121 (68.6%) and 93\/120 (77.5%) respectively required transfusion. HemoCue\n                    <ns4:sup>\u00ae<\/ns4:sup>\n                    readings indicated anaemia as mild (Hb10.0\u201311.9g\/dl) in 8\/292 (2.7%), moderate (Hb5.0\u20139.9g\/dl) in 132\/292 (45.2%) and severe (Hb&lt;5.0g\/dl) in 152\/292 (52.1%). Comparing to HemoCue\u00ae the Sahli\u2019s method performed best in estimation of severe anaemia, with sensitivity 84.0% and specificity 87.9% and a Kappa score of \u200a0.70 (0.64\u20130.80).\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Conclusions<\/ns4:bold>\n                    : Clinical assessment of severe pallor results has a low specificity for the diagnosis of severe anaemia. To target blood transfusion Hb measurement by either Hemocue\u00ae or Sahli\u2019s method for the cost of USD 4 or and USD 0.25 per test, respectively would be more cost-effective.\n                  <\/ns4:p>","DOI":"10.12688\/wellcomeopenres.14801.2","type":"journal-article","created":{"date-parts":[[2019,3,18]],"date-time":"2019-03-18T10:55:17Z","timestamp":1552906517000},"page":"130","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Evaluation of the diagnostic accuracy and cost of different methods for the assessment of severe\u00a0 anaemia in hospitalised children in Eastern Uganda"],"prefix":"10.12688","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5757-609X","authenticated-orcid":false,"given":"Peter","family":"Olupot-Olupot","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Prevatt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Engoru","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius","family":"Nteziyaremye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Amorut","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Chebet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tonny","family":"Senyondo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Ongodia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyne M.","family":"Ndila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4456-2382","authenticated-orcid":false,"given":"Thomas N.","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0007-0645","authenticated-orcid":false,"given":"Kathryn","family":"Maitland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2019,3,18]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"494-495","DOI":"10.1016\/S0140-6736(02)07666-3","article-title":"Blood transfusion for severe anaemia in children in a Kenyan hospital.","volume":"359","author":"M English","year":"2002","journal-title":"Lancet."},{"key":"ref-2","article-title":"Guidelines for the treatment of 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Guidelines for the management of common childhood illnesses","year":"2013"},{"key":"ref-29","doi-asserted-by":"publisher","first-page":"e8545","DOI":"10.1371\/journal.pone.0008545","article-title":"Accuracy and reliability of pallor for detecting anaemia: a hospital-based diagnostic accuracy study.","volume":"5","author":"A Kalantri","year":"2010","journal-title":"PLoS One."},{"key":"ref-30","article-title":"Data for: Evaluation of the diagnostic accuracy and cost of different methods for the assessment of severe anaemia in hospitalised children in Eastern Uganda.","author":"C Ndila","year":"2018"}],"container-title":["Wellcome Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/3-130\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/3-130\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/3-130\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,3,26]],"date-time":"2019-03-26T02:25:24Z","timestamp":1553567124000},"score":1,"resource":{"primary":{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/3-130\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,18]]},"references-count":30,"URL":"https:\/\/doi.org\/10.12688\/wellcomeopenres.14801.2","relation":{"has-review":[{"id-type":"doi","id":"10.21956\/wellcomeopenres.16570.r35087","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/wellcomeopenres.16570.r35087","asserted-by":"object"}]},"ISSN":["2398-502X"],"issn-type":[{"value":"2398-502X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,3,18]]},"assertion":[{"value":"Indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/3-130\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/wellcomeopenres.16129.r34130, Dora Mbanya, Department of Hematology, University of Yaound\u00e9 I, Yaound\u00e9, Cameroon, 14 Nov 2018, version 1, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/3-130\/v1#referee-response-34130","order":0,"name":"referee-response-34130","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Kathryn Maitland<\/b>; \n<i>Posted: 11 Mar 2019<\/i>; 1. A few grammatical errors to correct (example: use of the wrong tense \u2013 \u201cused \u201d instead of \u201cuse \u201detc.)\n<i>We have spelled checked and corrected these&nbsp;<\/i>2. The Abstract presents inconsistent results, and the arithmetics must be corrected: The total of&nbsp;164 severely anaemic children, 99 moderate cases and 57 mild cases sums up to 320 children and&nbsp;not 322. Similarly, their corresponding percentages (51%, 30.7% and 17.7%) only add up to 99.4%&nbsp;and not 100%.&nbsp;\n<i>Thank you for noting this. We corrected these numbers.<\/i>&nbsp;3.The Introduction&nbsp; also talks of \u201cTable 3\u201d as the first table of the paper. Tables and Figures should be introduced in chronological order. Hence, this, being the first table introduced in the article, should&nbsp;be \u201cTable 1\u201d.&nbsp;\n<i>We agree that this is not relevant in the methods section so we have removed the reference to Table 3 results at this point. We therefore do not require the production team to reorder the tables.<\/i>&nbsp;4. The Results: children under 12 years do not give direct consent. If guardians are providing consent, then, \u201cassent \u201d should be used. Furthermore, that information should be under METHODS&nbsp;and not under RESULTS.&nbsp;\n<i>We have added the word \u2018parental\u2019 into the consent sentence. But believe that the following sentence in the original manuscript did qualify this was parental consent. We are sorry this was misleading.&nbsp;\u2018Children were included, following <u>parental<\/u> consent, if assessed to have a pallor. Children whose guardian or parent declined consent were excluded from the study.\u2019<\/i>&nbsp;5. As mentioned above, Table 1 should now read Table 2 and Table 2 should now read Table 3 etc.etc.&nbsp;\n<i>We request the production team to remove the reference to Table 3 in the methods therefore reordering the tables in not required.<\/i>6. The Conclusions respond to the research question.\n<i>We have reread the final conclusion and believe our summary reflects on the question we posed: which method would reliably assess haemoglobin.<\/i>","URL":"https:\/\/wellcomeopenresearch.org\/articles\/3-130\/v2#referee-comment-3815","order":1,"name":"referee-comment-3815","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.16570.r35087, Jean\u2010Pierre Allain, Department of Haematology, University of Cambridge, Cambridge, UK, 19 Mar 2019, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/3-130\/v2#referee-response-35087","order":2,"name":"referee-response-35087","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.16129.r34909, Walter H Dzik, Department of Pathology (Transfusion), Harvard University\/Massachusetts General Hospital, Boston, Massachusetts, USA, 05 Mar 2019, version 1, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/3-130\/v1#referee-response-34909","order":3,"name":"referee-response-34909","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Kathryn Maitland<\/b>; \n<i>Posted: 11 Mar 2019<\/i>; The Hemocue device (Hb 301) is the 'gold standard' claimed by the authors and all comparisons are pegged to its performance. For that reason, can the authors please cite literature that reports the degree of accuracy and the precision (variability) of this device at hemoglobin concentrations in the 3-5 g\/dL range?\n<i>Whilst the HemoCue has a measuring range: 0 - 25.6 g\/dl we agree that it has not been comprehensively evaluated for children with haemoglobins &lt; 4g\/dl. The closest study included in the references is Evaluation and costs of different haemoglobin methods for use in district hospitals in Malawi Medina et al. &nbsp;We have added a couple of sentences to make this point and suggest this should be an area for future investigation.<\/i>","URL":"https:\/\/wellcomeopenresearch.org\/articles\/3-130\/v2#referee-comment-3817","order":4,"name":"referee-comment-3817","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This study was supported by the Wellcome Trust through Core Support for the East African Major Overseas programme [203077] and Imperial College Centre for Global Research [100693], and a Wellcome Trust Senior Fellowships to TNW [202800 and 091758]. \n\nThis study was also funded by Imperial College London through support to KM. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":5,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}