Mogensen Christian B, Soerensen Jeff, Bjorkman Anders, Montgomery Scott M
Department of Infectious Diseases C, Odense University Hospital, Denmark.
Acta Trop. 2006 Oct;99(2-3):119-25. doi: 10.1016/j.actatropica.2005.12.011. Epub 2006 Oct 4.
Anaemia among small children in tropical Africa is common and often caused by infection with Plasmodium falciparum. The diagnosis of anaemia is difficult without a laboratory estimation of haemoglobin. The aim of this study was to examine if clinical findings related to malaria and anaemia would help to detect moderate and/or severe anaemia in children in rural Tanzania.
Children between 6 and 36 months were examined by health workers in an Out Patient Department (OPD) to detect severe anaemia (packed cell volume, PCV< or =20%) and in a cross sectional survey at village level to identify moderate anaemia (PCV 21-25%). History of recent fever and treatments was recorded and a clinical examination was performed.
In the survey, comparison of 65 moderately anaemic children with 373 mild/non anaemic children revealed no differences in history of fever or in the clinical examination. In the OPD comparison of 100 severely anaemic children with 116 non-severely anaemic control children revealed that pallor, respiratory rate, number of fever days last week, deteriorated general condition, heart rate, age, splenomegaly, low body weight and elevated body temperature were all indicators of severe 'anaemia, only pallor, respiratory rate, fever days and palpable spleen however, remained associated with severe anaemia in multiple regression analysis. The combination of any pallor and either respiratory rate >55/min or fever >3 days, could predict severe anaemia with a sensitivity of 96% and a specificity of 71%. This was better than the currently recommended signs of severe pallor or an approximation of the Integrated Management of Childhood Illness (IMCI) criteria's for referral of children.
At primary health care level detection of severe anaemia can be improved by information about fever duration and determination of respiratory rate in children with pallor.
热带非洲幼儿贫血情况普遍，常由恶性疟原虫感染所致。若不通过实验室检测血红蛋白，贫血诊断会很困难。本研究旨在探讨与疟疾和贫血相关的临床症状是否有助于检测坦桑尼亚农村儿童的中度和/或重度贫血。
在门诊部，医护人员对6至36个月的儿童进行检查以检测重度贫血（红细胞压积，PCV≤20%），并在村级进行横断面调查以确定中度贫血（PCV 21 - 25%）。记录近期发热史和治疗情况，并进行临床检查。
在调查中，65名中度贫血儿童与373名轻度/无贫血儿童相比，发热史或临床检查方面无差异。在门诊部，100名重度贫血儿童与116名非重度贫血对照儿童相比，面色苍白、呼吸频率、上周发热天数、一般状况恶化、心率、年龄、脾肿大、低体重和体温升高均为重度贫血的指标，但在多元回归分析中，只有面色苍白、呼吸频率、发热天数和可触及脾脏与重度贫血相关。面色苍白且呼吸频率>55次/分钟或发热>3天的组合可预测重度贫血，敏感性为96%，特异性为71%。这比目前推荐的重度面色苍白体征或儿童疾病综合管理（IMCI）转诊标准的近似值要好。
在初级卫生保健层面，通过了解发热持续时间以及测定面色苍白儿童的呼吸频率，可改善重度贫血的检测。
