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Volume 2014, Article ID 543860, 4 pages
Research Article

Validity of Palmar Pallor for Diagnosis of Anemia among Children Aged 6–59 Months in North India

School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India

Received 16 August 2014; Revised 12 October 2014; Accepted 21 October 2014; Published 9 November 2014

Academic Editor: Eitan Fibach

Copyright © 2014 Arun Kumar Aggarwal et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. The Integrated Management of Childhood and Neonatal Illness (IMNCI) recommends the use palmar pallor to diagnose anaemia. Earlier studies to validate palmar pallor as clinical sign for anaemia were largely done in African context. There was a need to test validity of palmar pallor to detect anemia in different settings. Objective. To study the validity and interobserver agreement of palmar pallor examination to diagnose anemia in children under 5 years of age in India. Methods. In a village in Northern India, hemoglobin estimation was done for 80 children using cyanomethemoglobin method. Two examiners, a physician and a health worker, trained in IMNCI evaluated children for palmar pallor. Sensitivity and specificity and Kappa statistics were calculated. Results. Health worker diagnosed palmar pallor with sensitivity of 30.8–42.8% and specificity of 70–89%. Similar figures for doctor were 40–47% and 60–66%, respectively. Kappa agreement between a health worker and a physician was 0.48 (95% CI = 0.298–0.666) and then increased to 0.51 when categories of severe pallor and mild pallor were merged. Conclusion. While using palmar pallor as clinical sign for anaemia, children with no pallor should also be followed up closely for possible detection of missed cases during follow-up.