Training health workers to assess anaemia with the WHO haemoglobin colour scale.

The WHO recommends that all pregnant women be screened for anemia. In rural Africa this is often done by clinical examination which is known to have variable reliability. The recently developed WHO Haemoglobin Colour Scale may be the answer to this problem as it is simple and reliable. This study examines the training procedure recommended by WHO for the Haemoglobin Colour Scale when resources are very limited. The authors trained 7 laboratory technicians from the Medical Research Council Laboratories Hospitals Fajara The Gambia and 13 Community Health Nurses (CHNs) from North Bank Division East a rural area in The Gambia to use the Haemoglobin Colour Scale. The CHNs used the Scale to estimate hemoglobins on all new bookings to antenatal clinics for a period of 1 month and recorded how they were managed. At the end of the study period they completed a qualitative questionnaire about the Scale. Both groups of trainees were successfully trained although the WHO protocol for training was impossible to follow due to resource limitations. 8 of the 13 trained CHNs used the Scale in practice and recorded 307 estimations with a mean hemoglobin of 9.1 g/dl. The results were normally distributed. 6 of the 9 patients with Hb readings of <4 g/dl were managed correctly. In response to the questionnaire the CHNs thought the Scale was cheap easy and quick to use and as good as the hemoglobinometer they had used previously. The main criticism was that it was not robust enough. The development of a low-technology cheap simple and reliable method for measuring hemoglobin is a welcome development. However a simpler training procedure and a standard way of measuring observer performance are necessary. (authors)