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 deri ved from health service-based studies. However, these numbers do not reflec t the actual magnitude of the problem because of barriers to health care an d differences in health-seeking behaviour. As a result, this study uses an alternative method to measure reproductive morbidities amongst women in a J ordanian community. Objective, To assess the validity of a home-based pelvic examination in det ecting signs of reproductive morbidity when compared with a clinic-based ex amination. Methodological design. Descriptive study in which women were randomly selec ted 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 selecte d and consented to a second pelvic examination in a clinical setting. Instr uments, Two trained female obstetricians conducted the pelvic examination w hich included examination of the vulva, examination of the vagina and a bim anual examination. Outcome measures, Strength of association between the pr esence or absence of physical signs of reproductive morbidity detected by t he home-based pelvic examination and the same signs identified by the clini c-based examination, deemed in this study as the 'truth'. Results. The overall sensitivity, specificity, positive and negative predic tive values of the home-based pelvic examination were 66, 86, 69 and 84%, r espectively. Study limitations. The sample size was small, so further studies are recomm ended to replicate the findings here. Conclusions. Results suggest home-based pelvic examinations can be used in population-based studies fur a comprehensive assessment of women's reproduc tive morbidities.