title: Transfer of clinical breast examination skills to female community health volunteers in Nepal.
abstract: OBJECTIVE
  To observe skill transfer for detection of clinical abnormalities in the breast by determining kappa agreement, sensitivity, specificity, positive predictive value and negative predictive value of clinical breast examination by female community health workers (FCHVs) considering surgeon findings as the gold standard.
  
  
  METHODS
  This cross-sectional study was conducted in Dharan Municipality, Eastern Nepal for period of one year from June 2008 to May 2009. A total of 1,238 women were examined by both a FCHV and the surgeon.
  
  
  RESULTS
  The interobserver kappa agreement for the detection of clinical abnormalities in breast was 67% indicating a good agreement. Sensitivity, specificity, positive predictive value and negative predictive values of "FCHVs' clinical breast examination" to detect clinical abnormalities in breast in comparison to the surgeon's were 70%, 95%, 74% and 94% respectively.
  
  
  CONCLUSIONS
  In view of good clinical breast examination skill transfer to FCHVs for detection of clinical abnormalities in breast, we conclude effective training of FCHVs may be a feasble approach for diagnosis of breast abnormalities in rural Nepal.
authors.affiliation: The Seventh Day Adventists, Kathmandu, Nepal. surichhya_b@hotmail.com
authors.forename: S K
authors.initials: SK
authors.lastname: Hyoju
authors.forename: C S
authors.initials: CS
authors.lastname: Agrawal
authors.forename: P K
authors.initials: PK
authors.lastname: Pokhrel
authors.forename: S
authors.initials: S
authors.lastname: Agrawal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000523:psychology; D002983:Clinical Competence; D003150:Community Health Workers / Q000193:education* / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009390:Nepal; D010808:Physical Examination; D011237:Predictive Value of Tests; D014838:Volunteers / Q000193:education* / Q000523:psychology