title: Availability and functionality of sphygmomanometers at health care institutions in Enugu, Nigeria.
abstract: OBJECTIVE
  Our aim was to investigate the availability of functional blood pressure monitors at health care institutions in Enugu, Nigeria.
  
  
  METHODS
  During repeated surveys of 15 (primary, secondary and tertiary) health care institutions in Enugu between 2007 and 2012, records were made of the availability and functional status of sphygmomanometers in the clinics and wards. We also assessed the degree of agreement between measurements by institutional staff and measurements by trained observers using the same or the standard sphygmomanometer.
  
  
  RESULTS
  Apart from three institutions, there was inadequate availability of fully functional sphygmomanometers: 61 staff attending to outpatients were sharing 35 sphygmomanometers, 6 of which were faulty i.e. needing repairs. Wards invariably had only one or two functional sphygmomanometers, regardless of bed occupancy. Institutional staff ignored recommended guidelines for blood pressure measurement. The overall mean difference in blood pressure measurements between institutional staff and a trained observer (1.6 mmHg; 95% confidence interval, CI: -0.3 to 3.4; P=0.1) was greater and more significant than the mean difference between the two observers (0.1 mmHg; CI: -1.5 to 1.7; P=0.9) and the mean difference between institutional and standard sphygmomanometers (-0.2 mmHg; CI: -1.7 to 1.3; P=0.8).
  
  
  CONCLUSIONS
  There has been a notable lack of reporting on the availability of blood pressure measuring devices in third world health care institutions. Our surveys have shown inadequate availability of functional sphygmomanometers in the institutions, but satisfactory agreement between measurements by institutional staff and trained observers. In view of recent guidelines and recommendations, there is need to supplement office readings with mercury devices with oscillometric home or automated office blood pressure recording.
authors.affiliation: Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu; Department of Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria.
authors.forename: C P
authors.initials: CP
authors.lastname: Chijioke
authors.forename: T O
authors.initials: TO
authors.lastname: Okolo
authors.forename: K I
authors.initials: KI
authors.lastname: Nwadike
authors.forename: E C
authors.initials: EC
authors.lastname: Ejim
authors.forename: F C
authors.initials: FC
authors.lastname: Ekochin
authors.forename: G N
authors.initials: GN
authors.lastname: Aronu
authors.forename: S I
authors.initials: SI
authors.lastname: Ghasi
authors.forename: O U
authors.initials: OU
authors.lastname: Chijioke
mesh_terms: D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000295:instrumentation*; D004867:Equipment Design; D006268:Health Facilities / Q000600:supply & distribution*; D006801:Humans; D009549:Nigeria; D010045:Outpatients; D019722:Sphygmomanometers / Q000592:standards* / Q000706:statistics & numerical data*