BACKGROUND: Anemia is a substantial contributor to poor pregnancy outcomes in low- and middle-income countries. Access to laboratory facilities is limited; therefore, on-site testing warrants attention. OBJECTIVES: To determine the accuracy of on-site tests to detect anemia in pregnancy. SEARCH STRATEGY: MEDLINE, Embase, Scopus, CINAHL, and Web of Science were searched from inception until March 2016, with no language restrictions, using the terms "pregnancy," "an(a)emia," and "h(a)emoglobin." SELECTION CRITERIA: Studies that evaluated the diagnostic accuracy of on-site hemoglobin tests versus laboratory-based reference tests during pregnancy were included. DATA COLLECTION AND ANALYSIS: Study characteristics and true positive, true negative, false positive, and false negative rates were extracted. Sensitivity, specificity, likelihood ratios, and post-test probabilities were calculated. Anemia was defined as a hemoglobin level of less than 110 g/L. MAIN RESULTS: Ten studies (4239 participants) were assessed. Copper sulfate provided 97% sensitivity (95% confidence interval [CI] 88%-100%) and 71% specificity (95% CI 55%-85%); the Sahli method provided 86% sensitivity (95% CI 75%-94%) and 83% specificity (95% CI 68%-93%); and HemoCue provided 85% sensitivity (95% CI 79%-90%) and 80% specificity (95% CI 76%-83%). CONCLUSIONS: Some on-site tests are accurate and should be made widely available to improve detection of anemia in pregnancy
