Reliability of self reported form of female genital mutilation and WHO classification: cross sectional study
Reliability of self reported form of female genital mutilation and WHO classification: cross sectional study
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DOI：
10.1136/bmj.38873.649074.55
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发表时间：
2006-07-15
影响因子：
--
通讯作者：
Almroth, Lars
中科院分区：
文献类型：
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作者：
Elmusharaf, Susan;Elhadi, Nagla;Almroth, Lars
目的评估自报女性生殖器切割(FGM)表的可靠性，并将临床检查证实的切割范围与世界卫生组织(WHO)的相应分类进行比较。设计横断面研究：在苏丹喀土穆设立1所儿科医院和1所妇科门诊，调查对象为255名4~9岁的女孩和282名年龄在17~35岁的妇女。主要结果衡量妇女报告的女性生殖器切割的实际解剖范围和按WHO分类的相应类型。结果所有报告接受切割的女孩和妇女均经生殖器检查证实。那些声称没有接受过女性生殖器切割的人中，没有一人被发现患有女性生殖器切割。许多据说接受过“Sunna包皮环切术”(切除包皮和部分或全部阴蒂，相当于世卫组织1型)的女性生殖器切割的形式超出了阴蒂(10/23(43%)女孩和20/35(57%)妇女)。在那些自称经历过这种形式的人中，9名女孩(39%)和19名妇女(54%)实际上患有世卫组织III型(阳萎和切除部分或全部外生殖器)。被归类为WHO E11类型的形式的解剖范围差异很大。在被归类为世卫组织III型的12/32名女孩(38%)和27/245名妇女(11%)中，大阴唇没有受累。因此，在解剖学意义上，世界卫生组织的U型和ELL型之间有很大的重叠。对这一程度有相当大的漏报。世卫组织的分类未能将定义的表格与手术的严重程度联系起来。在进行流行病学和临床研究的中期解释时，重要的是要意识到这些方面。世卫组织应修改其分类。
Objective To assess the reliability of self reported form of female genital mutilation (FGM) and to compare the extent of cutting verified by clinical examination with the corresponding World Health Organization classification.Design Cross sectional study.Settings One paediatric hospital and one gynaecological outpatient clinic in Khartoum, Sudan, 2003-4.Participants 255 girls aged 4-9 and 282 Women aged 17-35.Main outcome measures The women's reports of FGM,the actual anatomical extent of die mutilation and the corresponding types according to the WHO classification.Results All girls and women reported to have undergone FGM had this verified by genital inspection. None of those who said they had not undergone FGM Were found to have it. Many said to have undergone "sunna circumcision" (excision of prepuce and part or all of clitoris, equivalent to WHO type 1) had a form of FGM extending beyond the clitoris (10/23 (43%) girls and 20/35 (57%) women). Of those who said they had undergone this form, nine girls 39%) and 19 women (54%) actually had WHO type III (infibulation and excision of part or all of external genitalia). The anatomical extent of forms classified as WHO type Ell varies widely. In 12/32 girls (38%) and 27/245 women (11%) classified as having WHO type III, the labia majora were not involved. Thus there is a substantial overlap, in an anatomical sense, between WHO types U and Ell.Conclusion The reliability of reported form of FGM is low. There is considerable under-reporting of the extent. The WHO classification fails to relate the defined forms to the severity of the operation. It is important to be aware of these aspects in the conduct mid interpretation of epidemiological and clinical studies. WHO should revise its classification.