Can a home-based pelvic examination be used in assessing reproductive morbidity in population-based studies? A Jordanian experience
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.