235-POS

Abstract

Objectives In developing countries, pre-eclampsia is frequently under-detected, partly due to inadequate training in accurate blood pressure (BP) measurements and insufficient equipment. CRADLE aims to improve the detection of pre-eclampsia through the introduction of novel, low-cost BP devices at community level. Phase one evaluated whether the introduction of devices to clinics in Tanzania, Zimbabwe and Zambia influenced the mean BP amongst all pregnant hospital admissions, a surrogate marker for improved referrals from periphery for suspected pre-eclampsia. Methods Prospective longitudinal pre- and post-intervention study. BP measurements were taken from consecutive women ⩾20 week’s gestation accessing care at referral sites over 3 months ( n = 694). Intervention: 20 BP devices were distributed to 20 rural antenatal clinics in each country. Post-intervention data was collected a year on ( n = 547). Results After adjustment for confounders, there was a significant increase in post-intervention mean diastolic BP (2.39 mmHg, p p = 0.001, CI 0.42–0.79). Conclusions Equipping low-skilled community healthcare providers (cHCPs) with novel BP devices is feasible and widely accepted, resulting in a significant rise in mean diastolic BP and improved antenatal BP screening. Phase two will evaluate the adapted device, which incorporates a traffic light early warning system that alerts cHCPs to both hypertension and shock, improving the detection of compromise from obstetric haemorrhage and sepsis, as well as pre-eclampsia. A multi-center institutional-level prospective study in South Africa will evaluate the value of the thresholds used for the traffic light early warning system to predict adverse outcome, prior to a large community cluster RCT to evaluate the introduction of the devices at a community-level on maternal and perinatal mortality and morbidity. Disclosures N.L. Hezelgrave: None. H.L. Nathan: None. K.E. Duhig: None. P.T. Seed: None. A.H. Shennan: None.