Training health workers to assess anaemia with the WHO haemoglobin colour scale

WHO recommends that all pregnant women be screened for anaemia. In rural Af rica this is often done by clinical examination which is known to have vari able reliability. The recently developed WHO Haemoglobin Colour Scale may b e the answer to this problem as it is simple and reliable. This study exami nes the training procedure recommended by WHO for the Haemoglobin Colour Sc ale when resources are very limited. We trained 7 laboratory technicians fr om the Medical Research Council Laboratories Hospital, Fajara, The Gambia a nd 13 Community Health Nurses (CHNs) from North Bank Division East, a rural area in The Gambia, to use the Colour Scale. The CHNs used the Scale to es timate haemoglobins on all new bookings to the antenatal clinics for a peri od of one month and recorded how they were managed. At the end of the study period they completed a qualitative questionnaire about the scale. Both gr oups of trainees were successfully trained although the WHO protocol for tr aining was impossible to follow due to resource limitations. Eight of the 1 3 trained CHNs used the scale in practice and recorded 307 estimations with a mean haemoglobin of 9.1 g/dl. The results were normally distributed. Six of the 9 patients with Hb readings of < 4 g/dl were managed correctly. In response to the questionnaire the CHNs thought the scale was cheap, easy an d quick to use and as good as the haemoglobinometer they had used previousl y. The main criticism was that it was not robust enough. The development of a low-technology, cheap, simple and reliable method for measuring haemoglo bin is a welcome development. However, a simpler training procedure and a s tandard way of measuring observer performance are necessary.