Point-of-care hemoglobin technologies to improve early detection of anemia in children 6–59 months in rural high-altitude areas: a narrative review of diagnostic performance, feasibility, acceptability and cost-effectiveness

Abstract

Early detection of childhood anemia in high-altitude rural areas faces diagnostic challenges because altitude affects hemoglobin interpretation and field conditions limit laboratory access. Objective: To assess diagnostic performance, operational feasibility and cost-effectiveness of point-of-care (POC) hemoglobin devices, invasive and non-invasive, for children aged 6–59 months in rural high-altitude settings. Methodology: Narrative review of Spanish and English literature from 2017 to 2025; databases were screened and a working library of 54 references was compiled, from which 15 key sources were selected for synthesis. Results: POC devices show wide variation in sensitivity (approx. 24–92%) and specificity (≈70–97%), influenced by device model, sample type (capillary vs venous) and altitude. Some portable photometric hemoglobinometers have good reproducibility for population estimates but limited sensitivity for individual diagnosis; non-invasive monitors show systematic bias and reduced accuracy in certain conditions (e.g., darker skin tones, undernutrition). Altitude adjustments and standardized sampling procedures significantly affect diagnostic thresholds and classification. Economic evaluations indicate potential cost-effectiveness for large-scale screening if volume and per-test costs are optimized, but costs for confirmatory testing, maintenance and training may offset benefits. Conclusions: POC hemoglobin testing can enhance early anemia detection in rural high-altitude communities when embedded in diagnostic algorithms that include altitude correction, selective venous confirmation/biomarkers, and quality assurance and training programs. Pilot implementation studies and context-specific cost analyses are recommended.