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USAID Advancing Nutrition
Publication Date:

USAID Advancing Nutrition, the Agency’s flagship multi-sectoral nutrition project, seeks public comments on our research protocol titled, Laboratory Protocol for Comparative Evaluation of Blood Sampling Methods and Analytical Devices in the Measurement of Hemoglobin in Population Surveys. The public comment period is from June 2, 2020 to September 2, 2020. After the comments are received, we will work with USAID to revise the protocol, then open a request for applications to award grants to organizations and firms willing and qualified to conduct studies according to the final protocol.

The rationale for sharing the protocol publicly at this time is two-fold:

  1. We wish to offer an instrument to organizations or individuals who would like to conduct or fund primary studies to assess the variability in measurement of hemoglobin concentration.
  2. Due to the COVID-19 pandemic, our plans for release of grant awards have been delayed. This public comment period allows interested groups or firms to prepare to apply for the grants that will be awarded by USAID Advancing Nutrition.

Anemia is diagnosed by measuring hemoglobin (Hb) concentration in blood. Anemia prevalence is determined by the percent of cases below a predetermined reference value of the Hb concentration. In a laboratory, automated hematology analyzers are used to measure Hb concentration in venous blood. In the field, portable devices like the HemoCue® machine are commonly used, and generally use capillary blood collected by finger pricking. The advantage of the HemoCue device is its portability and flexibility in field conditions, where it can run on battery power when electric supply is a constraint.

Many studies have reported variability in measurement of Hb concentration due to the mode of blood collection (venous or capillary), setting (laboratory or field), models of portable devices, environmental factors (humidity), and operational factors (sample loading time), among others. There is an urgent need to make a systematic comparison of the determination of Hb concentration using different types of blood samples from the same individuals and analyzed using different instruments (either in the laboratory or the field). This is needed to establish the proper conditions to attain reasonably accurate results for Hb in population surveys, which use standardized instruments to collect demographic and health information that is representative of the population being studied.

USAID Advancing Nutrition has convened the HEmoglobin MEasurement (HEME) working group, a multi-institutional research collaborative initiative that brings together researchers and experienced practitioners working on Hb measurement in different countries and institutions. The research collaborative initiative aims to improve the reliability and validity of Hb measurements in population surveys. With the guidance of the HEME working group, we have developed a protocol to identify the best procedures and methods for determining Hb concentration in population surveys. The protocol identifies the design of studies that will systematically compare the determination of Hb concentration using different types of blood samples from the same individuals, which are then analyzed using different instruments.

We have developed two protocols for two different settings—the laboratory and the field. This public release shares the laboratory component. We welcome your opinions and thoughts on the various aspects of the protocol. We will release the field protocol after satisfactory completion of the laboratory phase.

HEME Protocol (PDF, 985.89 KB)
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