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Patients Routinely Report More Symptoms to Experienced Field Enumerators than Physicians in Rural Côte d'Ivoire

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  • Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire; Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire; Hôpital Général de Taabo Cité, Taabo Cité, Côte d'Ivoire; Programme National de Lutte contre la Schistosomiase, les Géohelminthiases et la Filariose Lymphatique, Abidjan, Côte d'Ivoire; Unité de Formation et de Recherche Sciences Médicales, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire; Divisions of Internal Medicine and Infectious Diseases, Toronto General Hospital, Toronto, Canada

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.

Author Notes

* Address correspondence to Jürg Utzinger, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, PO Box, CH–4002 Basel, Switzerland. E-mail: juerg.utzinger@unibas.ch

Financial support: We are grateful to FAIRMED for sustained funding of the Taabo HDSS. This work is part of the NIDIAG network (Collaborative Project; www.NIDIAG.org) supported by the European Commission under the Health Cooperation Work Program of 7th Framework Program Grant 260260. T.F. is associated with the National Center of Competence in Research (NCCR) North–South. T.F. received financial support through a Pro*Doc Research Module from the Swiss National Science Foundation (SNSF) project PDFMP3-123185 and a contribution of the Freiwillige Akademische Gesellschaft Basel. The research of E.K.N. and J.U. is financially supported by SNSF project IZ70Z0-123900.

Authors' addresses: Thomas Fürst and Jürg Utzinger, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland, E-mails: thomas.fuerst@unibas.ch and juerg.utzinger@unibas.ch. Kigbafori D. Silué, Mamadou Ouattara, Eliézer K. N'Goran, Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire, E-mails: kigbafori.silue@csrs.ci, mamadou_ouatt@yahoo.fr, and eliezerngoran@yahoo.fr. Kigbafori D. Silué, Siaka Koné, and Eliézer K. N'Goran, Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire, E-mail: kone_siaka0@yahoo.fr. Lukas G. Adiossan, Hôpital Général de Taabo Cité, Taabo Cité, Côte d'Ivoire, E-mail: adiossanlukas@yahoo.fr. Dje N. N'Goran, Programme National de Lutte contre la Schistosomiase, les Géohelminthiases et la Filariose Lymphatique, Abidjan, Côte d'Ivoire, E-mail: ngorannobert@gmail.com. Azragnou J. Yao, Unité de Formation et de Recherche Sciences Médicales, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire, E-mail: yaojoel@yahoo.fr. Isaac I. Bogoch, Divisions of Internal Medicine and Infectious Diseases, Toronto General Hospital, Toronto, Canada, E-mail: isaac.bogoch@uhn.ca.

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