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Can a home-based pelvic examination be used in assessing reproductive morbidity in population-based studies? A
R Al-Qutob1, S Mawajdeh, D Massad
1Department of Community and Family Medicine, Faculty of Medicine, University of Jordan, Amman, Jordan. fhg@index.com.jo
Rationale:
Most estimates of reproductive morbidity in a community are derived from health service-based studies. However, these numbers do not reflect the actual magnitude of the problem because of barriers to health care and differences in health-seeking behaviour. As a result, this study uses an alternative method to measure reproductive morbidities amongst women in a Jordanian community.
Objective:
To assess the validity of a home-based pelvic examination in detecting signs of reproductive morbidity when compared with a clinic-based examination.
Methodological Design:
Descriptive study in which women were randomly selected from the study area to participate in the study.
Research Methods:
Three hundred and seventy nine women, 18 years and above were randomly selected, and general and pelvic examinations were conducted in each woman's home. Thirty-two of these women were again randomly selected and consented to a second pelvic examination in a clinical setting.
Instruments:
Two trained female obstetricians conducted the pelvic examination which included examination of the vulva, examination of the vagina and a bimanual examination. Outcome measures. Strength of association between the presence or absence of physical signs of reproductive morbidity detected by the home-based pelvic examination and the same signs identified by the clinic-based examination, deemed in this study as the 'truth'.
Results:
The overall sensitivity, specificity, positive and negative predictive values of the home-based pelvic examination were 66, 86, 69 and 84%, respectively.
Study Limitations:
The sample size was small, so further studies are recommended to replicate the findings here.
Conclusions:
Results suggest home-based pelvic examinations can be used in population-based studies for a comprehensive assessment of women's reproductive morbidities.