Accuracy of the WHO Haemoglobin Colour Scale for the diagnosis of anaemia in primary health care settings in low-income countries: a systematic review and meta-analysis.

BACKGROUND: Anaemia is a major cause of morbidity and mortality in low-income countries. Primary health-care workers in resource-poor settings usually diagnose anaemia clinically, but this is inaccurate. The WHO Haemoglobin Colour Scale (HCS) is a simple, cheap quantitative method to assess haemoglobin concentration outside of the laboratory. We systematically reviewed the literature to assess the accuracy of the HCS in primary care to diagnose anaemia, and compared this with clinical assessment. METHODS: We searched the electronic databases including MEDLINE, EMBASE, SCOPUS, Web of Science, Cochrane library, CINAHL plus, Popline, Reproductive Health Library, and Google Scholar and regional databases up to Nov 14, 2014, "haemoglobin colour scale" in alternative spellings published in any language. Two reviewers independently screened studies, extracted data, and assessed quality using the QUADAS-2 instrument. Statistical analyses were carried out in STATA using the bivariate model. FINDINGS: Of 141 records and abstracts screened, 14 studies were included. The pooled sensitivity of the HCS to diagnose anaemia was 80% (95% CI 68-88) compared with 52% for clinical assessment ([95% CI 36-67]; p=0·008). Specificity was similar between the HCS (80% [95% CI 59-91]) and clinical assessment (75% [56-88]; p=0·8250). For severe anaemia, diagnostic accuracy was again higher overall for the HCS (p<0·0001); sensitivity was 57% (36-76) for the HCS and 45% (95% CI 12-83) for clinical assessment, but specificity was 99·6% (95% CI 95-99·9) versus 92% (62-99). Combining clinical assessment and the HCS could result in higher sensitivity (anaemia: 91% [95% CI 81-96]); severe anaemia 83% (33-98), but at the expense of specificity (anaemia: 59% [35-79]; severe anaemia 90% [40-99]). Individual studies were highly heterogeneous but pooled results did not differ substantially in a series of sensitivity analyses for indicators of study robustness. INTERPRETATION: In so-called real-life primary health-care conditions, HCS can significantly reduce misdiagnosis of anaemia compared with clinical assessment alone. Future research is required to optimise training, and assess clinical outcomes and cost-effectiveness. FUNDING: None

Characteristics and outcomes of patients with severe COVID-19 in Indonesia: Lessons from the first wave.

BackgroundIndonesia's national response to COVID-19 evolved rapidly throughout 2020. Understanding pandemic response and outcomes is crucial for better mitigation strategies ahead. This study describes the characteristics and outcomes of patients admitted to ICU during the early stages of the pandemic.MethodsThis is a multi-centre prospective observational study including patients from twelve collaborating hospitals in Indonesia. All patients were clinically suspected or laboratory-confirmed COVID-19 cases admitted to ICU between January 2020 and March 2021. The primary outcome was monthly ICU mortality. Descriptive statistics of patient characteristics and treatment were generated as secondary outcomes.ResultsFrom 559 subjects, the overall mortality was 68% and decreased over the study period, while the mortality of patients that received mechanical ventilation was 92%, consistently high over the study period. Fatal cases showed 2- and 4-day delays from symptoms onset to hospital admissions and ICU admissions, respectively. Evidence-backed approaches which could influence patient outcome, such as extracorporeal membrane oxygenation, prone positioning, renal replacement therapy, and neuromuscular blockade were scarcely administered.ConclusionsThe mortality rate of COVID-19 patients in Indonesia was extremely high during the first major outbreak of disease, particularly in those mechanically ventilated. Delayed admission and unavailability of evidence-based approaches due to high burden on health facility during COVID-19 crisis could be addressed by efficient public health measures and enhancing health infrastructure to improve the future pandemic response

Mortality rates in pediatric septic shock

Background Septic shock remains a major cause of morbidity and mortality in children admitted to the intensive care unit. Recent investigations from developed countries have reported mortality rates of 20-30%. Few studies have reported mortality rates from pediatric septic shock in intensive care settings in developing countries with limited resources.  Objective  To determine the current mortality rates for pediatric patients with septic shock in a developing country. Methods A retrospective study was conducted in the Pediatric Intensive Care Unit (PICU) at DR. Sardjito General Hospital. Medical records and charts were reviewed and recorded for diagnoses of septic shock, from November 1st, 2011 to June 30th, 2014. Results  A database of all PICU admissions was assembled, and cases with diagnoses of septic shock were reviewed. The final data consisted of 136 patients diagnosed with septic shock. Septic shock was defined as a clinical suspicion of sepsis, manifested by hyperthermia or hypothermia, and accompanied by hypoperfusion  The overall mortality rate for the study cohort was 88.2%.  The median age of patients was 16 months, with 52.2% males. Median initial PRISM III and PELOD scores were 10 and 22, respectively. The median length of PICU stay was 4 days. A total of 48.5% of the subjects were in need of crystalloid and colloid fluid at a median amount of 40 mL/kg. The median time required to complete the initial resuscitation was 60 minutes. Mechanical ventilator support in the first 24 hours was required in 79.4% of the cases. Fluid overload of > 10% (FO>10%) was found in 58.8% of the subjects. Conclusion The mortality rate in pediatric septic shock in our hospital is very high. There is a higher incidence of fluid overload in the non-survival group

Nutritional therapy and caloric achievement within the first week of PICU admission

Background Nutritional therapy is an important aspect in managing PICU patients. Careful decisions should be made regarding initiation, route of administration, and achievement based on caloric requirements. Many conditions could affect the application of nutritional therapy. Objective To investigate the implementation of nutritional therapy during the 1st week after PICU admission. Methods We conducted a retrospective study involving 156 children aged 1 month-18 years who were hospitalized for at least 4 days in the PICU during the period of  January 1st, 2015 to  December 31st, 2015. Subjects were divided into three groups according to initiation time of caloric administration, which were: category I (within the first 24 hours of PICU admission), category II (within the first 25-48 hours of PICU admission), and category III: (more than 48 hours after PICU admission). Caloric requirement was calculated using the Caldwell or Schofield formula, whilst caloric achievement was figured up from PICU daily monitoring sheets containing nutritional therapy given to the subjects. Results Of 131 subjects, 72 (55%) had good nutritional status and 59 (45%) children had malnutrition. Caloric administration was initiated within 24 hours of admission in 101 (77.1%) patients, of whom 90 (89.1%) patients received enteral feeding. Nineteen (14.5%) patients received their initial calories within 25-48 hours of admission, with 16 (84.2%) using the enteral route. At the 4th and 7th days of hospitalization, 93 (71%) and 107 (81.7%) patients achieved >70% of their caloric requirements. Delays in feeding initiation were due to shock, gastrointestinal bleeding, inotropic support, and feeding intolerance, which reduced caloric achievement. Conclusion Most patients receive nutritional therapy in the first 48 hours after PICU admission and achieve >70% of their caloric requirements at the 4th day of hospitalization. The enteral route is preferred. Delayed initiation of nutritional therapy reduce caloric achievement

Lag time to diagnosis as a predictor of mortality in children with extraocular retinoblastoma: Experience from a developing country

Aim To define the prevalence of mortality and identify factors associated with mortality in pediatric patients with extraocular retinoblastoma attending the tertiary hospital in Indonesia. Methods We retrospectively collected medical records from 2013 to 2019 of patients who were diagnosed with extraocular retinoblastoma. Cox proportional hazard regression analysis with 95% confidence interval (CI) was used to evaluate the association of mortality predictors with patient outcomes (Hazard Ratio [HR], 95% CI) with significance set as p < .05. Results Overall, 60 patients were included in this study for a retrospective chart review, with 55% males and 45% females. The median age at diagnosis was 13 (5–24) months. About 60% of the patients did not survive, while 2-year survival probability was 45%. The overall median survival time was 21.5 (7.25–40.75) months. Predictors of mortality were laterality (unilateral/bilateral): HR 2.15 (95% CI: 1.07–4.28; p = .03), nutritional status: HR 2.65 (95% CI: 1.34–5.25; p = .05), and lag time to diagnosis: HR 3.12 (95% CI: 1.56–6.2; p = .001). Conclusion Laterality, nutritional status and lag time to diagnosis were identified to be mortality predictors in extraocular retinoblastoma. The 2-year survival for children with extraocular retinoblastoma was 45% with 21 months for median survival

Neutrophil lymphocyte ratio as predictor of mortality in pediatric patients with bacterial meningitis: A retrospective cohort study

Background: Bacterial meningitis causes high mortality rates among children. Even with early diagnosis and prompt treatment, around 15 of patients die especially in the first and second days after diagnosis. The neutrophil lymphocyte ratio has been reported to be a predicting factor of severity and outcome for patients with pneumonia and sepsis. However, only a few studies are available to rate the neutrophil lymphocyte ratio as a predictor of mortality in bacterial meningitis. This study aimed to know the role of the neutrophil lymphocyte ratio as a predictor of mortality in patients with bacterial meningitis. Methods: This retrospective study was conducted at Dr. Sardjito General Hospital, Yogyakarta, Indonesia between January 2016 to December 2020. Multivariate analysis was used to assess the correlation between predicting factors and outcomes using logistic regression analysis. Results: A total of 94 samples were included and analyzed in this study with bacterial meningitis. Neutrophil lymphocyte ratio >5.225 was a significant predictor of mortality in patients with bacterial meningitis with p = 0.004 and risk ratio 10.78. Other factors that were significant predictors of mortality included the pediatric coma scale ≤8 and positive cerebrospinal fluid culture. Conclusion: Neutrophil lymphocyte ratio is a statistically significant predictor of mortality in patients with bacterial meningitis, and can be used as a parameter to predict outcomes in patients with bacterial meningitis. © 202

Lag time to diagnosis as a predictor of mortality in children with extraocular retinoblastoma: Experience from a developing country

Aim: To define the prevalence of mortality and identify factors associated with mortality in pediatric patients with extraocular retinoblastoma attending the tertiary hospital in Indonesia. Methods: We retrospectively collected medical records from 2013 to 2019 of patients who were diagnosed with extraocular retinoblastoma. Cox proportional hazard regression analysis with 95% confidence interval (CI) was used to evaluate the association of mortality predictors with patient outcomes (Hazard Ratio [HR], 95% CI) with significance set as p < .05. Results: Overall, 60 patients were included in this study for a retrospective chart review, with 55% males and 45% females. The median age at diagnosis was 13 (5-24) months. About 60% of the patients did not survive, while 2-year survival probability was 45%. The overall median survival time was 21.5 (7.25-40.75) months. Predictors of mortality were laterality (unilateral/bilateral): HR 2.15 (95% CI: 1.07-4.28; p = .03), nutritional status: HR 2.65 (95% CI: 1.34-5.25; p = .05), and lag time to diagnosis: HR 3.12 (95% CI: 1.56-6.2; p = .001). Conclusion: Laterality, nutritional status and lag time to diagnosis were identified to be mortality predictors in extraocular retinoblastoma. The 2-year survival for children with extraocular retinoblastoma was 45% with 21 months for median survival. Keywords: death; developing country; extraocular retinoblastoma; lag time to diagnosis; mortality predictors

Early detection of anemia among school children using the World Health Organization Hemoglobin Color Scale 2006

Background The high prevalence of anemic children in Indonesia is caused by the high incidence of diseases caused by parasitic infection such as malaria as well as iron deficiency. Early detection is needed for early intervention in order to allow optimal growth and development. A simple, economic, and practical tool for early detection of anaemic children is needed. The WHO recommended a Hemoglobin Color Scale as a suitable tool for the detection of anemia. Objective To assess the sensitivity, specificity, and predictive values of the WHO Hemoglobin Color Scale for early detection of anemic children. Methods A cross sectional diagnostic test was conducted in elementary school age children. Samples consisting of two drops of venous blood on paper were assessed by two observers (pediatrician & paramedic) using the Hemoglobin Color Scale to visually determine the level of hemoglobin. In addition, the hemoglobin level was also measured using a Hematology Analyzer to allow the visual test results to be compared to the results obtained using the gold standard of analysis. Agreement between these two methods of analysis was examined using the Cohen's kappa. Results Hemoglobin levels < 11.5 g/dL were detected in 15 of 124 (12%) elementary school children. The sensitivity, specificity, positive and negative predictive values when using the Hemoglobin Color Scale were 93%, 100%, 100% and 99% respectively for the first observer and 100%,99%,93%, and 100% respectively for the second observer. The Cohen's Kappa value was 0. 76. Conclusion The WHO Hemoglobin Color Scale 2006 could be used as an early detection method for anemia in children

Sepsis and disseminated intravascular coagulation are rare complications of typhoid fever: A case report

Introduction: and importance: Typhoid fever is an infection caused by Salmonella typhi. The common complications are intestinal perforation and typhoid encephalopathy. Cases of typhoid fever with sepsis and/or disseminated intravascular coagulation (DIC) are rarely reported, even though typhoid fever is endemic in Indonesia. Case presentation: A 4-year-old male referral case from a district hospital was experiencing fever, decrease of consciousness and massive bleeding from his gastrointestinal tract and nose. Investigation revealed results from the IgM typhoid test using Tubex®TF, with the score of +8. PELOD 2 score was 10, and PSOFA was 5. DIC score was 7. Based on these findings, the patient was diagnosed with typhoid fever, with DIC and sepsis being the complication of the typhoid fever. Clinical discussion: DIC is mostly a subclinical event, and severe bleeding complications found in typhoid fever are uncommon, although DIC scores which indicate an imbalance of coagulation and fibrinolysis are markedly elevated in patients with typhoid. DIC can be a part of multi-organ dysfunction due to sepsis syndrome. Acute infection can also result in systemic activation of coagulation. Conclusion: Sepsis and DIC are rare complications of typhoid fever. Typhoid fever can be presented with profound bleeding manifestation other than gastrointestinal bleeding, since it is a common symptom of typhoid fever. Further research should be conducted to postulate association between typhoid fever and DIC. © 202