title: Validation of an obstetric fistula screening questionnaire in rural Nepal: a community-based cross-sectional and nested case-control study with clinical examination.
abstract: OBJECTIVE
  To validate a symptom-based fistula screening questionnaire and estimate obstetric fistula (OF) prevalence in rural Nepal.
  
  
  METHODS
  Cross-sectional and nested case-control study.
  
  
  METHODS
  Sarlahi District, Nepal.
  
  
  METHODS
  Parous, reproductive age women.
  
  
  METHODS
  The questionnaire assessed symptoms of vesicovaginal and rectovaginal fistula (VVF and RVF, respectively), stress and urge urinary incontinence (SUI and UUI, respectively), fecal incontinence (FI), and included interviewer observations on the smell and presence of urine and/or stool. All women who screened positive for OF and a randomly selected group of women who screened negative for OF were included in a nested case-control study (one case, four normal controls, and four incontinent controls) and underwent confirmatory clinical examinations.
  
  
  METHODS
  Clinically confirmed OF, and questionnaire sensitivity (Se) and specificity (Sp).
  
  
  RESULTS
  Of the 16 893 women who completed cross-sectional screening, 68 were screened-positive cases. Fifty-five (82%) screened-positive cases, 203 screened-negative normal controls, and 203 screened-incontinent controls participated in the case-control study, which confirmed one case of VVF and one case of both VVF and RVF without any false-negative cases. For VVF, the screening tool demonstrated Se 100% (95% CI 34.2-100.0%), Sp 86.9% (95% CI 83.3-89.9%), and estimated VVF prevalence as 12 per 100 000 (95% CI 3-43); for RVF, it demonstrated Se 100% (95% CI 20.7-100.0), Sp 99.8% (95% CI 98.6-100.0), and estimated RVF prevalence as 6 per 100 000 (95% CI 1-34).
  
  
  CONCLUSIONS
  The OF screening questionnaire demonstrated high sensitivity and specificity in this low-prevalence setting.
  
  
  CONCLUSIONS
  Community-based obstetric fistula screening tool validation study, Nepal, n = 16 893: High Se, Sp & feasibility.
authors.affiliation: Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Ccg
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.|Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: D
authors.initials: D
authors.lastname: Barry
authors.affiliation: Nepal Nutrition Intervention Project - Sarlahi, Kathmandu, Nepal.
authors.forename: S K
authors.initials: SK
authors.lastname: Khatry
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Klasen
authors.affiliation: Department of Obstetrics and Gynaecology, Institute of Medicine, Kathmandu, Nepal.
authors.forename: M
authors.initials: M
authors.lastname: Singh
authors.affiliation: Nepal Nutrition Intervention Project - Sarlahi, Kathmandu, Nepal.|Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: LeClerq
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: J
authors.initials: J
authors.lastname: Katz
authors.affiliation: Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Tielsch
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: L C
authors.initials: LC
authors.lastname: Mullany
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D009390:Nepal / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000453:epidemiology; D011296:Prenatal Diagnosis / Q000379:methods / Q000592:standards*; D015995:Prevalence; D012006:Rectovaginal Fistula / Q000175:diagnosis* / Q000453:epidemiology; D015203:Reproducibility of Results; D012424:Rural Population; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires / Q000592:standards*; D014719:Vesicovaginal Fistula / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult
keywords: Rectovaginal fistula; rural Nepal; sensitivity; specificity; symptom-based screening questionnaire; vesicovaginal fistula