title: Visual inspection for cervical cancer screening: evaluation by doctor versus paramedical worker.
abstract: BACKGROUND
  In the absence of an effective cervical cancer screening programme, efforts are being made to explore the feasibility of using the existing infrastructure to develop effective low-cost screening methods.
  
  
  OBJECTIVE
  To evaluate and compare test performance of visual inspection of the cervix by a doctor and a paramedical worker.
  
  
  METHODS
  Gynaecology outpatient department (OPD), All India Institute of Medical Sciences, New Delhi; cross-sectional study.
  
  
  METHODS
  One hundred women with complaints of vaginal discharge, irregular bleeding, post coital bleeding or unhealthy cervix underwent visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) by a doctor and nurse, followed by colposcopy and biopsy.
  
  
  METHODS
  Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each test and compared. Concordance was determined by kappa statistics.
  
  
  RESULTS
  VIA by nurse had a higher sensitivity (100% versus 87.5%), but lower specificity (53% versus 63%) when compared with the doctor, but it was not statistically significant. There was moderate agreement between their VIA findings (kappa=0.56). VILI findings were comparable to that of the VIA, both by the doctor and nurse. There was almost perfect agreement (kappa=0.89) between VILI by the doctor and nurse.
  
  
  CONCLUSIONS
  Visual inspection can be performed reliably by trained paramedical workers and doctors and is an effective screening option in low resource settings.
authors.affiliation: Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi-110 029, India. nbhatla@aiims.ac.in
authors.forename: N
authors.initials: N
authors.lastname: Bhatla
authors.forename: A
authors.initials: A
authors.lastname: Mukhopadhyay
authors.forename: S
authors.initials: S
authors.lastname: Joshi
authors.forename: A
authors.initials: A
authors.lastname: Kumar
authors.forename: A
authors.initials: A
authors.lastname: Kriplani
authors.forename: R M
authors.initials: RM
authors.lastname: Pandey
authors.forename: K
authors.initials: K
authors.lastname: Verma
mesh_terms: D019342:Acetic Acid; D000328:Adult; D000368:Aged; D001706:Biopsy; D004396:Coloring Agents; D003127:Colposcopy; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D006176:Gynecology; D006801:Humans; D007202:Indicators and Reagents; D007454:Iodides; D008403:Mass Screening; D008875:Middle Aged; D009726:Nurses; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D002577:Uterine Cervical Diseases / Q000175:diagnosis; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014592:Uterine Hemorrhage / Q000175:diagnosis; D019522:Vaginal Discharge / Q000175:diagnosis
chemical_list: D004396:Coloring Agents; D007202:Indicators and Reagents; D007454:Iodides; D019342:Acetic Acid; C010389:Lugol's solution