| dc.description.abstract | Background A World Health Organization-endorsed
algorithm, widely published in international guidance
documents and distributed in the form of a ‘pregnancy
checklist’, has become a popular tool for ruling out
pregnancy among family planning clients in developing
countries. The algorithm consists of six criteria excluding
pregnancy, all conditional upon a seventh ‘master
criterion’ relating to signs or symptoms of pregnancy. Few
data exist on the specificity to pregnancy among family
planning clients of long-accepted signs and symptoms of
pregnancy. The aim of the present study was to assess
whether reported signs and symptoms of pregnancy add
to the predictive value of an algorithm to rule out
pregnancy.
Methods Data from a previous observational study were
used to assess the performance of the algorithm with and
without the ‘signs and symptoms’ criterion. The study
group comprised 1852 new, non-menstruating family
planning clients from seven clinics in Kenya.
Results Signs and symptoms of pregnancy were rare
(1.5%) as was pregnancy (1%). Signs and symptoms
were more common (18.2%) among the 22 clients who
tested positive for pregnancy than among the 1830 clients
(1.3%) who tested negative, but did not add significantly to
the predictive value of the algorithm. Most women with
signs or symptoms were not pregnant and would have
been unnecessarily denied a contraceptive method using
the current criteria.
Conclusions The ‘signs and symptoms’ criterion did not
substantially improve the ability of the algorithm to exclude
pregnant clients, but several reasons (including use of the
algorithm for intrauterine device clients) render it unlikely
that the algorithm will be changed | en |
