Cost effective on-site screening for anaemia in pregnancy in primary care clinics

Objective. To determine the feasibility, accuracy and cost of developing a system of on-site screening for anaemia in pregnancy in primary care clinics. Setting. Mobile clinic team in Hlabisa health district, KwaZulu-Natal. Methods. Four hundred and forty-nine consecutive women attending antenatal clinics were screened for anaemia (haemoglobin < 10 g/dl) using copper sulphate solution; the results were compared with true haemoglobin levels as determined by an automated analyser. Three hundred women had haemoglobin concentration estimated with a portable haemoglobinometer and results compared with those from the automated analyser. Results. Screening with copper sulphate solution was highly sensitive (95.7%) but had low positive predictive value for anaemia (37.2%). Haemoglobin concentration estimated by haemoglobinometer correlated highly with results from the analyser (r = 0.82; P < 0.0001), and the mean difference in concentrations between the two methods was 1.1 g/dl. The average cost of screening all women with copper sulphate solution (6 cents/sample) and determining the true concentration in those screened as possibly anaemic (R2.64/sample) was 72 cents per woman. The cost of using an automated analyser was R6.20 per sample. Conclusion. Combined use of copper sulphate solution and a haemoglobinometer is a feasible, accurate and cost-effective way of screening for and diagnosing anaemia in pregnant women, on-site, in primary care clinics.