Poor Validity of Noninvasive Hemoglobin Measurements by Pulse Oximetry Compared with Conventional Absorptiometry in Children in Côte d'Ivoire

Isaac I. Bogoch Department of Medicine, University of Toronto, Toronto, Canada.
Divisions of General Internal Medicine and Infectious Diseases, Toronto General Hospital, Toronto, Canada.

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Jean T. Coulibaly Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.
Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire.
Swiss Tropical and Public Health Institute, Basel, Switzerland.
University of Basel, Basel, Switzerland.

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Jason Rajchgot Department of Medicine, University of Toronto, Toronto, Canada.

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Jason R. Andrews Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California.

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Jana Kovac Swiss Tropical and Public Health Institute, Basel, Switzerland.
University of Basel, Basel, Switzerland.

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Jürg Utzinger Swiss Tropical and Public Health Institute, Basel, Switzerland.
University of Basel, Basel, Switzerland.

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Gordana Panic Swiss Tropical and Public Health Institute, Basel, Switzerland.
University of Basel, Basel, Switzerland.

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Jennifer Keiser Swiss Tropical and Public Health Institute, Basel, Switzerland.
University of Basel, Basel, Switzerland.

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Anemia remains a major public health issue in many African communities. We compared a novel, commercially available noninvasive hemoglobin (Hb)–measuring device to direct Hb measurements by finger-prick samples in a pediatric cohort in rural Côte d'Ivoire. Noninvasive Hb measurements were attempted in 191 children 2–15 years of age and obtained in 102 (53.5%) children. The median Hb for the 102 children was 12.0 g/dL (interquartile range [IQR] = 11.3–12.7 g/dL) for conventional absorptiometry and 13.3 g/dL (IQR = 12.1–14.2 g/dL) for noninvasive measurements. A Bland–Altman analysis demonstrated a median bias of +1.1 g/dL (IQR = 0.4–2.0 g/dL), with greater overestimation of Hb by noninvasive testing occurring at low Hb values. This overestimation of the noninvasive Hb–measuring device to direct Hb measurements persisted across preschool- and school-aged children, and both sexes. The Pearson correlation coefficient was 0.50 for children 4–9 years of age, and 0.33 for children 10–15 years of age. Further study and development of noninvasive Hb devices is necessary prior to implementation in African pediatric populations.

Author Notes

* Address correspondence to Jennifer Keiser, Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland. E-mail: jennifer.keiser@unibas.ch

Financial support: Jennifer Keiser is grateful to the European Research Council for financial support (ERC-2013-CoG 614739-A_HERO).

Authors' addresses: Isaac I. Bogoch, Divisions of General Internal Medicine and Infectious Diseases, Toronto General Hospital, Toronto, Canada, E-mail: isaac.bogoch@uhn.ca. Jean T. Coulibaly, Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire, E-mail: couljeanvae@yahoo.fr. Jason Rajchgot, Department of Medicine, University of Toronto, Toronto, Canada, E-mail: jason.rajchgot@mail.utoronto.ca. Jason R. Andrews, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, E-mail: jandr@stanford.edu. Jana Kovac, Gordana Panic, and Jennifer Keiser, Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland, E-mails: jana.kovac@unibas.ch, gordana.panic@unibas.ch, and jennifer.keiser@unibas.ch. Jürg Utzinger, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland, E-mail: juerg.utzinger@unibas.ch.

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