Poor Validity of Noninvasive Hemoglobin Measurements by Pulse Oximetry Compared with Conventional Absorptiometry in Children in C？te d'Ivoire

Anemia remains a major public health issue in many African communities. We compared a novel, commercially available noninvasive hemoglobin (Hb)–measuring device to direct Hb measurements by finger-prick samples in a pediatric cohort in rural C？te d'Ivoire. Noninvasive Hb measurements were attempted in 191 children 2–15 years of age and obtained in 102 (53.5%) children. The median Hb for the 102 children was 12.0 g/dL (interquartile range [IQR] = 11.3–12.7 g/dL) for conventional absorptiometry and 13.3 g/dL (IQR = 12.1–14.2 g/dL) for noninvasive measurements. A Bland–Altman analysis demonstrated a median bias of +1.1 g/dL (IQR = 0.4–2.0 g/dL), with greater overestimation of Hb by noninvasive testing occurring at low Hb values. This overestimation of the noninvasive Hb–measuring device to direct Hb measurements persisted across preschool- and school-aged children, and both sexes. The Pearson correlation coefficient was 0.50 for children 4–9 years of age, and 0.33 for children 10–15 years of age. Further study and development of noninvasive Hb devices is necessary prior to implementation in African pediatric populations