Availability and functionality of sphygmomanometers at health care institutions in Enugu, Nigeria.

Abstract

Our aim was to investigate the availability of functional blood pressure monitors at health care institutions in Enugu, Nigeria. 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. 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). 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.