Women’s Health Academic Centre CRADLE Community Blood Pressure Monitoring in Rural Africa: cfaDetection of Underlying Pre-eclampsia Hezelgrave N, Irvine.

Slides:



Advertisements
Similar presentations
Hypertension Detector for Developing Countries
Advertisements

Saving a Generation: Maternal, Newborn and Child Health (MNCH) Eastern and Southern Africa Aga Khan Health Services.
Measuring harm in healthcare. Our demographics are changing…
The association between blood pressure, body composition and birth weight of rural South African children: Ellisras longitudinal study Makinta MJ 1, Monyeki.
Modelling the impact of service innovation in Stroke Care Tanaka Business School: Imperial College. Lead researcher: Dr Benita Cox Background Stroke is.
ESH 2004 Paris1 Blood Pressure Control by Home Monitoring A Meta-Analysis of Randomised Trials FP Cappuccio, SM Kerry, L Forbes, A Donald Published in:
Is Unintended Pregnancy Associated with Increased Blood Pressure during Pregnancy? Author Author Author Date PH 251A.
A guide for healthcare professionals Measuring Blood Pressure at Home Michigan Department of Community Health Heart Disease and Stroke Prevention Unit.
MANAGEMENT HTN IN PREGNANCY. DEFINITIONS The definition of gestational hypertension is somewhat controversial. Some clinicians therefore recommend close.
Factors associated with perinatal deaths in women delivering in a health facility in Malawi Lily C. Kumbani, Johanne Sundby and Jon Øyvind Odland.
Underweight pregnant women in low risk populations: Does a low BMI (
報 告 者 王瓊琦. postpartum depression : identification of women at risk.
Tt HRB Centre for Health and Diet Research The burden of hypertension Ivan J Perry, Dept. of Epidemiology and Public Health, University College Cork. Institute.
The State of Ohio Universal Prenatal Booking David S. McKenna, MD, RDMS Maternal-Fetal Medicine Miami Valley Hospital, Dayton OH.
Hypertension Guideline
TEMPLATE DESIGN © Perinatal mortality and associated risk factors in LUTH Dr. Gabriel Onyeka Ekekwe, Prof. Rose.I. Anorlu.
AUDIT OF MATERNAL DEATHS USING LONGITUDINAL DATA – CASE OF RUFIJI HDSS By Illah Evance.
The effects of initial and subsequent adiposity status on diabetes mellitus Speaker: Qingtao Meng. MD West China hospital, Chendu, China.
Association between Systolic Blood Pressure and Congestive Heart Failure in Hypertensive Patients Mrs. Sutheera Intajarurnsan Doctor of Public Health Student.
Women’s Health Academic Centre Impact of migration and stressful life events on women’s mental health Laura Nellums MSc, PhD Student Dr Stephani Hatch.
TEMPLATE DESIGN © Prevalence of educational qualifications and access to information technologies in patients with acute.
Effect of Hypertension and Dyslipidemia on glycemic control among Type 2 Diabetes patients in Thailand Dr. Mya Thandar Dr.PH. Batch 5 1.
TEMPLATE DESIGN © Diet Plus Insulin Compared to Diet Alone In The Treatment of GDM Mothers in HUSM, Kelantan. Wan Faizah.
Using Information for Project Design: mHealth in Mozambique Research for Improving Program Performance Alfonso Rosales, MD, MPH-TM Technical Specialist,
LOGO National Research Institute for Family Planning Preconception Blood Pressure and Risk of Preterm delivery in Chinese reproductive age women Yang Y,
The SCIN (Skin care intervention in nurses) Trial: A Cluster Randomised Trial Dr I. Madan (Guy’s & St Thomas’ NHS Foundation Trust), Dr V. Parsons (King’s.
Hypertension: Blood Pressure Measurement and the new NICE guideline Prof Richard McManus BHS Annual Meeting Cambridge 2011 NICE clinical guideline 127.
Current issues in healthcare
EFFECTIVENESS OF A MEDICAL EDUCATION INTERVENTION TO TREAT HYPERTENSION IN PRIMARY CARE Authors Institutions Authors: Silvia Martínez-Valverde MSc 1, Hortensia.
Can pharmacists improve outcomes in hypertensive patients? Sookaneknun P (1), Richards RME (2), Sanguansermsri J(1), Teerasut C (3) : (1)Faculty of Pharmacy,
Objectives Methods ‘ Whooley’ questions were provided to all clinical staff from July Retrospectively, a random sample of patients who presented.
Association between Systolic Blood Pressure and Congestive Heart Failure Complication among Hypertensive and Diabetic Hypertensive Patients Mrs. Sutheera.
Age Adjusted Prevalence of Hypertension* Among Adults by Education in NYC, 2004 Data from: New York City Department of Health and Mental Hygiene, EpiQuery.
Audit of outcomes in HIV BHIVA Audit and Standards Sub-Committee E Ong (chair), J Anderson, D Churchill, M Desai, S Edwards, S Ellis, A Freedman, P Gupta,
Achieving Coverage and Compliance of Antenatal Calcium Supplementation for Prevention of Pre-eclampsia/Eclampsia– Findings from Nepal Dr Kusum Thapa FRCOG,
Prevalence and risk factors for self-reported sexually transmitted infections among adults in the Diepsloot informal settlement, Johannesburg, South Africa.
Women’s Health Academic Centre Impact of stressful life events on migrant women’s mental health and well-being Laura Nellums MSc, PhD Student Dr Stephani.
The evidence for going to scale with Calcium supplementation Harshad Sanghvi Vice-President & Medical Director, Jhpiego Senior Advisor, Accelovate/USAID,
Dr. Yagya Bahadur Karki Population, Health and Development (PHD) Group Date: 9 th December, 2013 Hotel Himalaya, Lalitpur Evaluation of a Program to Prevent.
Reducing health inequalities among children and young people Director of Public Health Report 2012/13.
Precepting the Prenatal Patient: A Curriculum for Non OB Family Medicine Physicians.
Antenatal care (ANC): Quality vs quantity – it’s the content that counts for improving pre-eclampsia /eclampsia (PEE) outcomes Sheena Currie, Senior Maternal.
Do Adolescents Equally Utilize PMTCT Services as Adult Women? Data from Patient Tracking Database in Zimbabwe 18 th ICASA, Harare 3 December 2015 Reuben.
UOG Journal Club: January 2016 Clinical implementation of routine screening for fetal trisomies in the UK NHS: cell-free DNA test contingent on results.
Yousef I. Aljeesh, PhD, RN Said Abusalem, PhD, RN Naeem Alkariri, MSN, RN John A. Myers, PhD, MSPH Fawwaz Alaloul, PhD, RN Staff Developed IP Program Increases.
Powered by Infomedica Infomedica Conference Coverage* of 26 th European Meeting on Hypertension and Cardiovascular Protection Paris (France), June 10-13,
UOG Journal Club: June 2017 Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11–13 weeks’ gestation: comparison with NICE.
UOG Journal Club: October 2017
Author: Conzuelo-Rodriguez G.1 Advisor: Lisa M. Bodnar1
Severity of Anemia and its association with Socio-Demographic characteristics in pregnant women of rural areas DR. AMMARA ZAIDI MBBS, (Masters in maternal.
Inonu University, Turgut Ozal Medical Centre
From ESH 2016 | POS 4C: A. Power, MD
Hypertension November 2016
Preterm birth < 37 weeks
HYPERTENSIVE DISORDERS OF PREGNANCY
MATERNITY WARD NPH.
Defining hypertension
John Weeks1, MD Candidate 2017, Justin Hickman1, MD Candidate 2017
Impact and costing of cardiovascular disease treatmentin Kwara State Health Insurance (KSHI) program. University of Ilorin Teaching Hospital (UITH) Amsterdam.
Increasing Awareness of Hypertension in Africa : Road to Success
Tabassum Firoz MD MSc FRCPC University of British Columbia
Introduction Materials and Methods Results Conclusions
Alternative Clinical Trial Designs for Research on Hypertensive Disorders of Pregnancy in Low Resource Settings Dr Shivaprasad S Goudar MD, MHPE Professor.
The Utilization of Sequential Compression Devices Among Pregnant Women
Minimum prevalence of non-compliance recorded in an audit of antenatal care in a district general hospital joint obstetric epilepsy clinic Smyth C, Gornall.
mLearning in the DR Congo
AUDIT of maternal deaths using longitudinal data – case of rufiji hdss
BUILDING A WATER TOWER FOR THE HMCC NANGA-EBOKO
HaMpton Home monitoring of Hypertension in Pregnancy.
Hypertension November 2016
Presentation transcript:

Women’s Health Academic Centre CRADLE Community Blood Pressure Monitoring in Rural Africa: cfaDetection of Underlying Pre-eclampsia Hezelgrave N, Irvine L, Radford S, Seed P, Edmunds S, Basira D, Chicwezveru K, Mazanhi P, Horst M, Shennan A Introduction  Hypertensive diseases in pregnancy are a significant cause of morbidity and mortality, particularly in the low resource setting (LRS).  Pre-eclampsia and eclampsia alone claim up to 50,000 women’s lives globally each year, with an estimated fetal case fatality of 7-25% in Africa.  Pre-eclampsia is frequently underdetected due to inadequate training in accurate BP measurements, complex or poorly functioning BP monitors.  We have previously developed and validated in pregnancy a BP device suitable for use in low resource settings  These have shown to acceptable and useful to healthcare workers in rural Tanzania in formative research  The CRADLE study aims to evaluate the introduction of this low cost, automated BP monitors into rural antenatal clinics and among community health workers.  The introduction of of automated blood pressure devices in rural health centers will increase the detection and referral of asymptomatic hypertension in pregnant women from 20 weeks gestation. This will be reflected in an increased mean BP in pregnant women presenting to a secondary referral centre Hypothesis.  International prospective longitudinal multi-centre pre- and post-intervention pilot study.  Population: antenatal (>20 weeks) who accessed care at referral site in Tanzania (Hospitali Teuli), Zimbabwe (Morganster Mission Hospital) and Zambia (Ndola Hospital).  Intervention: 20 validated microlife AS1-2 BP devices were distributed to 20 peripheral rural health clinics together with training in their use and guidelines on referral thresholds. Methods No significant difference was found between mean age gestation or parity of participants pre and post intervention  The CRADLE intervention was associated with a significant increase in mean diastolic blood pressure (dBP) (2.39 mmHg, p< 0.05, 95% CI ) representing a higher proportion of women referred with high BP from the community.  The CRADLE intervention was associated with a significant reduction in proportion of women seen in the central referral hospital who had previously never had a BP measured in their pregnancy (25.1% to 16.9%, OR 0.58, p< 0.001, CI ).  No significant difference was found between mean systolic blood pressure (sBP) (0.97mmHg, P= 0.274, CI ), nor proportion of women presenting with sustained BP >140mmHg systolic or 90mmHg diastolic (16.1%-17.1%, OR 1.08, p= 0.6, CI ). Results CountryPre- intervention Post intervention Zimbabwe Zambia16497 Tanzania Total Table 1: Participant numbers per site  Data collection: Systematic BP’s (2 readings) were taken using the automated, validated in pregnancy BP device in the central referral site before and after them implementation of the BP monitors, with a time lag of 12 months to exclude seasonal variation in presentation.  Results were adjusted for age, parity and gestation using logistic regression  The CRADLE intervention was associated with a significant increase in both mean systolic (3.16 mmHg, p<0.05, CI ) and dBP (4.73mm Hg, p<0.001, CI )  The CRADLE intervention was also associated with a significant increase in the proportion of women who had a sustained systolic BP of ≥140 or diastolic BP ≥90 (12.8% to 21.3%, OR 1.09, p=0.03, CI ). Zimbabwe Conclusions Equipping low-skilled community health providers with a novel BP device is feasible and widely accepted, resulting in a significant rise in mean dBP, a proxy for increased referrals fo hypertension from rural clinics. A cluster RCT to evaluate their effect, together with community management of pre- eclampsia, on maternal and fetal outcomes is planned The introduction of a cheap, automated BP monitor suitable for use in low resource settings into rural clinics/health posts has the potential to increase detection of pre-eclampsia and reduce perinatal and maternal mortality. This research was supported by The Gates Foundation Grand Challenges Explorations, Tommy’s Charity and the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London.