CLINICAL SIGNS FOR THE RECOGNITION OF CHILDREN WITH MODERATE OR SEVERE ANEMIA IN WESTERN KENYA

Optimal treatment of Plasmodium falciparum-related paediatric anaemia can result in improved haematological recovery and survival. Clinical predictors are needed to identify children with anaemia in settings wh ere laboratory measurements are not available. The use of conjunctival (eyelid), palmar, nailbed, and tongue pallor to detect children with moderate anaemia (haemoglobin, 5.0-7.9 g/dl) or severe anaemia (haemog lobin, <5.0 g/dl) was evaluated among children seen at an outpatient a nd inpatient setting in a hospital in western Kenya. Severe nailbed or severe palmar pallor had the highest sensitivity (62% and 60%, resp.) , compared with severe conjunctival pallor (sensitivity = 31%), to det ect children with severe anaemia in the outpatient setting. Children w ith moderate anaemia were best identified by the presence of nailbed o r palmar pallor (sensitivity = 90% for both signs), compared with conj unctival pallor (sensitivity = 81%). Clinical signs of respiratory dis tress, in addition to the presence of severe pallor, did not increase the recognition of children requiring hospitalization for severe anaem ia. Among inpatients, the sensitivity of severe nailbed pallor (59%) w as highest for detecting children with severe anaemia, although the se nsitivity of severe conjunctival parlor and severe palmar pallor was t he same (53% for both signs). Presence of conjunctival pallor (sensiti vity = 74%) was similar in sensitivity to both nailbed and palmar pall or (70% for both signs) among children with moderate anaemia. The sens itivity of tongue pallor was low among all children evaluated. Low hae moglobin levels were significantly associated with the likelihood of b eing smear-positive for P. falciparum. This study demonstrates that cl inical criteria can be used to identify children with moderate and sev ere anaemia, thus enabling implementation of treatment algorithms. Chi ldren aged <36 months who live in an area with P, falciparum malaria s hould receive treatment with an effective antimalarial drug if they ha ve pallor.