Clinical pallor is useful to detect severe anemia in populations where anemia is prevalent and severe

Clinical pallor is recommended as a simple way to detect severe anemia, but more data are needed on its accuracy and usefulness when assessed by nonph ysicians in diverse settings. We measured hemoglobin and trained non-physic ian health workers to assess clinical pallor of the conjunctiva, palm and n ail beds in five population samples in Nepal and Zanzibar, where severe ane mia is common. In total, 5,760 individuals were examined,. 3,072 of whom we re anemic and 192 of whom had severe anemia (hemoglobin <70 g/L). The preva lence of pallor did not correspond to the prevalence of anemia or severe an emia in the groups studied. However, in all studies, pallor at each anatomi cal site was-associated with a significantly lower hemoglobin concentration . The relative performance of different anatomical sites was not consistent among studies, and we recommend that multiple sites be assessed. Palter at any of the three sites detected severe anemia with >84% specificity. Howev er, the sensitivity varied from 81% in Nepalese postpartum women to 29% in Zanzibari preschoolers in 1996. Overall estimates for sensitivity and speci ficity were 50 and 92%, respectively. Although imperfect, Use of parlor to screen and treat severe anemia by primary care providers is feasible and wo rthwhile where severe anemia is common. Usually, the majority of persons wi th severe anemia will be detected at practically no cost. Many people who a re not severely anemic will also receive treatment, but the costs of this e rror are low compared to the benefits.