Introduction Regular blood pressure (BP) monitoring is a cost-effective means of early identification and management of hypertensive disease in pregnancy. Yet in much of rural sub-Saharan Africa, the ability to measure BP is hindered by poorly functioning/inadequate or absent equipment, poor staff knowledge and low antenatal care attendance.

In Tanzania only 2/3 of women are reported to have their BP measured in pregnancy and the results are frequently inaccurate1. The introduction of a cheap, automated BP monitor suitable for use in low resource settings into rural clinics has the potential to increase detection of pre-eclampsia and reduce perinatal and maternal mortality.

Method 20 validated automated BP devices were distributed to 10 rural clinics in July 2008 together with training about their use. Quantitative and qualitative follow-up was conducted at 36 months.

Results At 36 months, tally of use was 12-21 times/month (median 19). 4/20 devices had broken (one cuff leak, 3 leakage of locally bought batteries) and 2 required new batteries). All devices were reported as useful for antenatal care, with good perceived reliability.

Discussion That all 10 clinics were still using a functional machine 3 years after their introduction is evidence of their acceptability. Batteries have been replaced from staff own wages, a sign of dedication to offering effective care and trust in the device. Concerns remain regarding the long term maintenance of devices; development of machines using solar power, wind-up chargers or sealed lithium batteries is a priority. Their impact of referrals for pre-eclampsia and effect on fetal and maternal morbidity and mortality must be assessed.