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Comparative Study
. 2013 Sep;89(3):592-6.
doi: 10.4269/ajtmh.13-0122. Epub 2013 Jul 22.

Patients routinely report more symptoms to experienced field enumerators than physicians in rural Cote d'Ivoire

Thomas Fürst  1 , Kigbafori D Silué, Mamadou Ouattara, Lukas G Adiossan, Dje N N'Goran, Azragnou J Yao, Siaka Koné, Eliézer K N'Goran, Jürg Utzinger, Isaac I Bogoch
Affiliations
Comparative Study

Patients routinely report more symptoms to experienced field enumerators than physicians in rural Cote d'Ivoire

Thomas Fürst et al. Am J Trop Med Hyg. 2013 Sep.

Abstract

Medical history-taking is among the most powerful diagnostic tools for healthcare professionals. However, its accuracy and reliability are underexplored areas. The present post-hoc study compares medical histories from 463 people in a rural part of Côte d'Ivoire. The medical histories of the same individuals were taken by physicians and experienced field enumerators who were blinded to the results of the others. Kappa (κ) statistics for 14 symptoms revealed only poor-to-moderate agreement between physicians and field enumerators (κ = 0.01-0.54). Participants reported consistently more symptoms to field enumerators than physicians. Only 33 (7.1%) participants gave no discordant statement at all. The average number of discordant statements per participant was 3.7. Poisson regression revealed no significant association between the number of discordant statements and participants' age, sex, educational attainment, occupation, or socioeconomic status. Operational research should further explore best practices to obtain reliable medical histories in resource-constrained settings.

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Figures

Figure 1.
Figure 1.
Flow chart illustrating the sample for the present post-hoc analysis. The data for the present study were collected during the third annual cross-sectional epidemiological survey in the Taabo HDSS in southcentral Côte d'Ivoire in June of 2011 and complemented with information from the existing Taabo HDSS database.
Figure 2.
Figure 2.
Histogram displaying the discordance in medical history-taking between physicians and experienced field enumerators. Each study participant (N = 463) was asked to report the presence or absence of a host of different symptoms to a physician and a trained field enumerator (14 symptoms asked by both investigators). The number of discordant statements to physicians and field enumerators was summed up for each patient. The data for the present study were collected during the third annual cross-sectional epidemiological survey in the Taabo HDSS in southcentral Côte d'Ivoire in June of 2011 and complemented with information from the existing Taabo HDSS database.
See this image and copyright information in PMC

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