Abstract
ObjectiveTo evaluate the accuracy and precision of HemoCue 201 (HemoCue) and Masimo Pronto 7 (Masimo) devices for measuring hemoglobin (Hb) in epidemiological studies, having venous blood samples as a gold standard.Material and methodsWe measured Hb concentrations in a field sample of 148 children from one to five years of age. Masimo and HemoCue were used for capillary blood samples and an automatic analyzer for venous blood samples. Regression models with no intercept were constructed to measure precision and predictability, concordance correlations to measure accuracy and precision, and Bland-Altman limits of agreement as well as hierarchical linear models to estimate variance.ResultsBoth HemoCue and Masimo underestimated Hb concentrations compared to the gold standard. They respectively yielded the following results: regression coefficients of 0.887 and 0.876 with 98.7% and 98.6% predictability; concordance correlation coefficients of 0.183 (p<0.001) and 0.166 (p<0.001); and Bland-Altman variances of -1.51 and -1.62. With regard to Masimo specifically, the three-level Hierarchical Linear Model showed that 57.9% of total variance stemmed from random errors in repeated measures from the same subject.ConclusionsHemoCue and Masimo measure lower Hb concentrations than the gold standard. Their accuracy and precision levels are comparable. It is essential to ensure proper use of devices through enhanced training of field workers.
Highlights
Anemia is the leading nutritional problem faced by public health worldwide
Both HemoCue and Masimo underestimated Hb concentrations compared to the gold standard
Anemia is defined as an Hb concentration of
Summary
Anemia is the leading nutritional problem faced by public health worldwide. Of the 1.62 billion affected individuals, children under five years bear the heaviest burden with a prevalence of 47%. [3] The government has responded by creating assistance programs to develop the capacities of beneficiary children through improved nutrition, money transfers for food items, access to low-cost milk fortified with micronutrients, school breakfasts for malnourished children in preschool facilities, health services and the promotion of healthy diets. As a means for evaluating the effectiveness of food assistance programs and characterizing anemia at baseline and follow-up measurements, there is growing interest in obtaining biochemical indicators for anemia at the population level. Accurate assessment of anemia levels in the population is indispensable for social programs to focus on the most vulnerable populations and evaluate the impact of interventions. The international diagnostic indicator for anemia is blood hemoglobin (Hb) concentration, controlling for age, sex, altitude and physiological status. The complexity of collecting and preserving venous blood samples during epidemiological studies has prompted the development of other methods for establishing adequate Hb concentration estimates
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