背景:产科瘘(OF)是低资源环境中产妇发病率的重要原因,在这种环境中,妇女在无法及时获得熟练产科护理的情况下经历难产。OF的真正流行是未知的;然而,据估计,这将影响全球200万至350万妇女。人口和健康调查(DHS)瘘模块包括最常用于患病率估计的OF症状问题,但是这些问题还没有得到验证。这项研究的目的是验证基于症状的筛查问卷,包括国土安全部瘘模块中的一个问题。
方法:与一个国际瘘管外科专家小组合作,我们开发并面部验证了筛查问卷,评估下尿路瘘(LUTF)和下胃肠道瘘(LGTF)的症状,以及尿失禁和大便失禁(UI,FI).我们使用1:2:2比例的病例对照研究设计评估了问卷的辨别能力:病例为检查证实为瘘管的产妇,对照组包括检查时没有瘘管的产妇,有和没有UI症状。所有妇女都接受了瘘管症状筛查和体格检查,审查员对筛查结果视而不见。
结果:在完成问卷并接受临床检查的367名卢旺达妇女中,59名妇女患有LUTF,34名妇女患有LGTF,274名女性被归类为有和没有UI症状的对照。所有LUTF筛选问题都表现良好,包括国土安全部的瘘管问题.两个LUTF筛查问题的组合具有最高的敏感性(100%;95%CI94%,100%),特异性(96%;95%CI93%,98%),和曲线下面积(AUC)(0.98)。LGTF筛查问题和FI问题的组合显示出最高的敏感性(97%;95%CI85%,100%),特异性(98%;95%CI95%,99%)和AUC(0.98)。
结论:我们的筛选问卷,包括国土安全部的瘘管问题,表现出高度的敏感性,特殊性,AUC。
产科瘘(OF)是一种产伤,可能发生在资源较低的妇女中,她们在没有熟练产科护理的情况下经历了难产(不正常进展)。这种伤害导致妇女不断地从她的产道中泄漏尿液和/或粪便。由于OF影响远离医疗保健的贫困妇女,很难完全理解全球有多少妇女患有OF。此外,尽管一些人口和健康调查(DHS)包括症状问题,这些问题在确定女性患有OF时的准确性尚未得到研究。为了更准确地确定哪些女性可能患有OF,我们在咨询了世界各地的专家后制定了一份OF筛查问卷,其中包括一个国土安全部的问题。我们向卢旺达的妇女询问了这份问卷,然后检查了这些妇女,看看她们是否有OF。通过这个过程,我们确定了59名患有LUTF的女性,34带有LGTF,274没有OF。表现最好的问题能够识别出100%的LUTF女性和97%的LGTF女性。我们还表明,一个DHS问题100%和85%的时间检测到LUTF和LGTF的女性,分别。公共卫生官员现在可以使用我们研究的问题来更准确地估计全球有多少女性患有OF,和最好的直接资源和熟练的卫生保健工作者到最需要的地区。
BACKGROUND: Obstetric fistula (OF) is a significant cause of maternal morbidity in lower resource settings where women experience obstructed labor without timely access to skilled obstetric care. The true prevalence of OF is unknown; however, it is estimated to affect 2 to 3.5 million women globally. The Demographic and Health Surveys\' (DHS) Fistula Module includes the OF symptom questions most frequently used for prevalence estimates, but these questions have not been validated. The aim of this study is to validate a symptom-based screening questionnaire for OF, including a question in the DHS\' Fistula Module.
METHODS: With an international panel of fistula surgeons, we developed and face-validated a screening questionnaire that assessed for symptoms of lower urinary tract fistula (LUTF) and lower gastrointestinal tract fistula (LGTF), as well as urinary and fecal incontinence (UI, FI). We evaluated the discriminative ability of the questionnaire using a
case-control study design in a 1:2:2 ratio: cases were parous women with fistula confirmed on examination, controls included parous women without fistula on examination, with and without UI symptoms. All women underwent screening for fistula symptoms and a physical examination, with examiners blinded to screening results.
RESULTS: Of the 367 Rwandan women who completed the questionnaires and underwent clinical examination, 59 women had LUTFs and 34 had LGTFs, 274 women were classified as controls with and without symptoms of UI. All LUTF screening questions performed well, including the DHS fistula question. The combination of two LUTF screening questions had the highest sensitivity (100%; 95% CI 94%, 100%), specificity (96%; 95% CI 93%, 98%), and area under the curve (AUC) (0.98). The combination of a LGTF screening question and FI question demonstrated the highest sensitivity (97%; 95% CI 85%, 100%), specificity (98%; 95% CI 95%, 99%) and AUC (0.98).
CONCLUSIONS: Our OF screening questionnaire, including the DHS fistula question, demonstrated high sensitivities, specificities, and AUC.
Obstetric fistula (OF) is a birth injury which may occur in women living in lower resource settings who experience obstructed labor (not progressing normally) without access to skilled obstetric care. This injury causes a woman to constantly leak urine and/or feces from her birth canal. As OF affects poor women who live far from healthcare it is difficult to fully understand how many women worldwide have an OF. Furthermore, although some Demographic and Health Surveys (DHS) include OF symptom questions, the accuracy of these questions in identifying women with OF has not been studied.To more accurately determine which women may have an OF, we developed an OF screening questionnaire after consulting OF experts worldwide, which included a DHS OF question. We asked women from Rwanda this questionnaire and then examined these women to see if they have OF. Through this process we identified 59 women with a LUTF, 34 with a LGTF, and 274 without an OF. The best performing questions were able to identify women with LUTF 100% of the time and women with LGTF 97% of the time. We also showed that one DHS question detects women with LUTF and LGTF 100% and 85% of the time, respectively. Public health officials can now use the questions we studied to more accurately estimate how many women worldwide have OF, and best direct resources and skilled health care workers to the areas with the greatest need.