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  • Title: Comparing women's reports with medical diagnoses of reproductive morbidity conditions in rural Egypt.
    Author: Zurayk H, Khattab H, Younis N, Kamal O, el-Helw M.
    Journal: Stud Fam Plann; 1995; 26(1):14-21. PubMed ID: 7785064.
    Abstract:
    This article is based on a survey of a random sample of 509 ever-married nonpregnant women residing in two villages in the Giza Governorate of Egypt, each of whom responded to a questionnaire on symptoms of gynecological conditions and then was accompanied to the village health center for a gynecological exam. A response rate of 91 percent was achieved. The article focuses on reproductive tract infections and genital prolapse, highly prevalent conditions in the community. The women's reports of symptoms are compared with the medical diagnoses, using indicators of sensitivity, specificity, positive and negative predictive values, and percentage of agreement. The findings show that women's reports of vaginal discharge agree moderately well with the physicians' observations but are not good predictors of the occurrence of reproductive tract infections. Women's reports of the symptoms of prolapse do not agree well with medical diagnoses of the condition. The findings are analyzed, taking into account the social context of the lives of the women surveyed to arrive at conclusions as to how to improve ways of learning from women themselves about gynecological problems in the community. During November 1989 to July 1990 in two villages in Giza Governate, Egypt, medical and social scientists compared self-reports of 509 ever married women with medical diagnoses to determine the feasibility of using a questionnaire for a community diagnosis. The assumption was that a questionnaire is an inexpensive data collection method to identify women's health problems in developing countries. Based on self-reports, 77% of the women had vaginal discharge. 68% of these women considered the discharge as unusual. When the researchers compared self-reports with medical diagnoses of the presence of reproductive tract infection (RTI), they found a relatively high sensitivity (79%) but a low specificity (26%) for presence of discharge. The positive predictive value and percentage of agreement were 53% and the Kapp statistic was only 5%, indicating little agreement between self-reported symptoms and clinical or laboratory diagnostic status. Comparison of self-reports of at least one of the two symptoms of genital prolapse with clinical diagnoses of genital prolapse revealed a rather low sensitivity (36-50%, depending on severity of the prolapse) and relatively high specificity (76%). The positive predictive value and percentage of agreement were 66% and 54%, respectively, and the Kapp statistic was 11%, indicating poor agreement between self-reported symptoms and clinical or laboratory diagnostic status. 90% of the 40 women with uterine prolapse had first degree prolapse, but all 40 also had some vaginal prolapse. Women with more severe anterior vaginal prolapse or posterior and anterior vaginal prolapse plus uterine prolapse were more likely to report symptoms than those having posterior vaginal prolapse and uterine prolapse (56% vs. 17%; p 0.05). These findings show that vaginal discharge, considered as a symptom or sign, is not a good predictor of RTIs.
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