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PM.53 CRADLE: Community Blood Pressure Monitoring in Rural Africa: Detection of underLying Pre-Eclampsia
  1. NL Hezelgrave1,
  2. L Irvine1,
  3. S Radford1,
  4. P Seed1,
  5. P Mazanhi3,
  6. S Edmunds2,
  7. D Basira3,
  8. K Chikwezveru3,
  9. AH Shennan1
  1. 1Division of Women’s Health KCL, Women’s Health Academic Centre, Kings Health Partners, London, UK
  2. 2Hospitali Teule, Muheza, Tanga, United Republic of Tanzania
  3. 3Morganster Mission Hospital, Morganster, Zimbabwe

Abstract

Introduction In developing countries pre-eclampsia is under-detected partly due to inadequate training in accurate blood pressure (BP) measurements and insufficient equipment. CRADLE is an international study to evaluate whether the introduction of novel, low-cost, automated BP devices into rural clinics in Tanzania, Zimbabwe and Zambia increases referrals for suspected pre-eclampsia to a central referral hospital. This will be reflected in an increased mean BP in pregnant women presenting centrally.

Methods Prospective longitudinal pre- and post-intervention study. BP measurements were taken from consecutive women ≥20 weeks gestation who accessed care at a referral site (N = 694). Intervention: 20 BP devices were distributed to 20 rural antenatal clinics in each country. Post-intervention data was collected the following year (N = 547).

Results After adjustment for confounders, there was a significant increase in our primary outcome, post-intervention mean diastolic BP, for all women, implying an increased proportion of referred hypertensive women (2.39 mmHg, p < 0.001, 95% CI 0.97–3.8) and a reduction in proportion of women (median gestation 35 weeks) who had never previously had a BP in pregnancy, (25.1% to 16.9%, OR 0.58, p = 0.001, CI 0.42–0.79). In Zimbabwe there was an additional significant increase in the proportion of women who had sustained hypertension (12.8% to 21.3%, OR 1.09, p = 0.03, CI 1.06–3.43).

Conclusion Equipping low-skilled community health providers with a novel BP device is feasible and widely accepted, and increased community referrals for suspected pre-eclampsia. A cluster RCT to evaluate the effect of these monitors equipped with traffic light early warning systems, on maternal and fetal outcomes is planned.

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