title: Blood pressure-measuring devices in rural South Africa: an audit conducted by the SASPI team in the Agincourt field site.
abstract: BACKGROUND
  Cardiovascular disease is an important cause of morbidity and mortality in South Africa. The Southern Africa Stroke Prevention Initiative (SASPI) found a high prevalence of stroke in the rural Agincourt subdistrict, Limpopo province. Hypertension is the commonest vascular risk factor in our population and it is essential that primary care services be adequately equipped to detect and treat hypertension. The aim of this study was to assess the number, accuracy and working condition of blood pressure measuring devices (BMD) in the clinics that serve the field site, and to assess the clinic sisters' perceptions of the availability of antihypertensive medication and aspirin.
  
  
  METHODS
  In each of the clinics serving the site we assessed the BMDs and cuffs using the following criteria: general condition, bladder size, state of rubber components, operation of the inlet valve and control of valve operation. The legibility of the gauge, level and condition of the mercury, and the condition of the glass tube were checked when relevant. The performance of the BMD was then assessed both with the cuff used in the clinic and with a new functioning cuff, against an accurate mercury sphygmomanometer. By interviewing the clinic sister we could assess the availability of antihypertensive medication and aspirin, as well as the state of the drug delivery system.
  
  
  RESULTS
  All BMDs were mercury sphygmomanometers. Four clinics had one BMD each, one clinic had two, and one clinic had four. In one clinic the device was not functional at all until the study cuff was used. None of the clinics had spare cuffs and only one clinic had access to a large cuff. Nine out of 10 (90%) cuffs tested had unsatisfactory valve function, and none was of the size recommended by the guidelines. Although the condition of the mercury was only considered satisfactory in 40% of BMDs, once a new cuff had been fitted to the BMDs all of them were accurate to within 4 mmHg between 50 and 250 mmHg. Fifty per cent of clinic sisters felt they always had sufficient stock of hydrochlorothiazide and alpha-methyldopa, but the supply of more expensive medication was less reliable. Only one clinic always had sufficient aspirin.
  
  
  CONCLUSIONS
  Although none of the primary care clinics had fully functioning BMDs, almost all the defects related to malfunctioning and inappropriately sized cuffs, which would be inexpensive to repair or replace. A procedure for routine servicing or replacement of both BMDs and cuffs is needed, as well as optimisation of medication delivery to remote areas.
authors.affiliation: Division of Neurology, Department of Neurosciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: M D
authors.initials: MD
authors.lastname: Connor
authors.forename: T
authors.initials: T
authors.lastname: Hopkins
authors.forename: S M
authors.initials: SM
authors.lastname: Tollman
authors.forename: M
authors.initials: M
authors.lastname: Thorogood
authors.forename: G
authors.initials: G
authors.lastname: Modi
mesh_terms: D000554:Ambulatory Care Facilities; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000295:instrumentation*; D003258:Consumer Behavior; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D003951:Diagnostic Errors; D006297:Health Services Accessibility; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D008485:Medical Audit; D012424:Rural Population; D012680:Sensitivity and Specificity; D013019:South Africa / Q000453:epidemiology; D019722:Sphygmomanometers; D020521:Stroke / Q000503:physiopathology / Q000517:prevention & control*
chemical_list: D000959:Antihypertensive Agents; D016861:Cyclooxygenase Inhibitors; D001241:Aspirin