Screening for severe anaemia in pregnancy in Kenya, using pallor examination and self-reported morbidity

Severe anaemia in pregnancy is an important preventable cause of maternal a nd perinatal morbidity and mortality. Different methods of screening for se vere anaemia in pregnancy were evaluated in a 2-phased study conducted in K ilifi, Kenya. In phase 1 (in 1994/95), pallor testing was evaluated alone a nd in addition to raised respiratory;pulse rates: 1787 pregnant women were examined by one of 2 midwives. Sensitivities for detecting severe anaemia ( haemoglobin < 7 g/dL) were 62% and 69% and specificities 87% and 77%, respe ctively for each of the midwives. Addition of high pulse rate increased sen sitivity to 77% and 81%, but specificity reduced to 60% and 51%, respective ly. In phase 2, following qualitative in-depth work, a screening questionna ire was developed. An algorithm based on screening questions had 80% sensit ivity and 40% specificity. Midwife pallor-assessment was conducted followin g the screening questionnaire. In this phase (conducted in 1997), the midwi fe performed very highly in detecting severe anaemia, achieving sensitivity of 84% and specificity of 92%. Spending a few minutes asking women questio ns may have improved the ability to interpret pallor findings. This study d emonstrates the value of pallor testing and raises alternative approaches t o improving it.