Blood pressure measurement techniques: Assessing performance in outpatient settings of a tertiary-level hospital in Rwanda

Temporal trends in coverage, quality and equity of maternal and child health services in Rwanda, 2000-2015

INTRODUCTION

Achieving the maternal and child health (MCH)-related Sustainable Development Goals (SDG) will require equitable and effective (quality-adjusted) coverage of recommended health interventions in low- and middle-income countries. We assessed effective coverage and equity of MCH services in Rwanda in the Millennium Development Goal (MDG) era to help guide policy decisions to improve equitable health gains in the SDG era and beyond.

METHODS

Using four rounds of Rwanda demographic and health surveys conducted from 2000 to 2015, we identified coverage and quality indicators for five MCH services: antenatal care (ANC), delivery care, and care for child diarrhoea, suspected pneumonia and fever. We calculated crude coverage and quality in each survey and used these to estimate effective coverage. The effective coverage should be regarded as an upper bound because there were few available quality measures. We also described equity in effective coverage of these five MCH services over time across the wealth index, area of residence and maternal education using equiplots.

RESULTS

A total of 48 910 women aged 15-49 years and 33 429 children under 5 years were included across the four survey rounds. In 2015, average effective coverage was 33.2% (range 19.9%-44.2%) across all five MCH services, 30.1% (range 19.9%-40.2%) for maternal health services (average of ANC and delivery) and 35.3% (range 27.3%-44.2%) for sick child care (diarrhoea, pneumonia and fever). This is in contrast to crude coverage which averaged 56.5% (range 43.6%-90.7%) across all five MCH services, 67.3% (range 43.9%-90.7%) for maternal health services and 49.2% (range 43.6%-53.9%) for sick child care. Between 2010 and 2015 effective coverage increased by 154.2% (range 127.3%-170.0%) for maternal health services and by 27.4% (range 4.2%-79.6%) for sick child care. These increases were associated with widening socioeconomic inequalities in effective coverage for maternal health services, and narrowing inequalities in effective coverage for sick child care.

CONCLUSION

While effective coverage of common MCH services generally improved in the MDG era, it still lagged substantially behind crude coverage for the same services due to low-quality care. Overall, effective coverage of MCH services remained suboptimal and inequitable. Policies should focus on improving effective coverage of these services and reducing inequities.

Comparison of multiple blood pressure frequency methods with optimum blood pressure measurement among Iranian individuals

Background:

Proper blood pressure (BP) measurement frequency method is less evaluated to optimize hypertension (HTN) status among different nations due to cultural patience variations. The aim of this study was to compare the first (BP₁), second (BP₂), and the mean of first and second (BP_1,2) and all the three (BP_1,2,3) with the second and third BP measurements in Iranian individuals.

Materials and Methods:

This cross-sectional study was done on 2264 individuals aged 18 years or more living in Isfahan city, Iran. Their BPs were assessed from right arms by the standard tools and methods after 5 min of rest in a quiet room by a trained staff. The mean second and third readings were considered as reference, and the other aforementioned variables were compared with it.

Results:

The mean age of total population was 40.9 ± 16.1 years (males: 52%). Men had significant higher means of systolic BP (SBP) and diastolic BP (DBP) with any measurement frequency methods than women (P < 0.001 and P = 0.009). Considerable clinical significant (≥5 mmHg) ranges were mostly observed in BP₁ compared with BP_2,3. SBP₂ and DBP₂ indices showed insignificant differences compared with reference mean. Moreover, abnormal BP levels (≥140/90 mmHg) were mostly observed in terms of BP₁ measurement with no remarkable variability in BP₂ reading in comparison to the reference.

Conclusion:

Our considerable data suggested that BP₂ could appropriately categorize BP status similar to BP_2,3 and it may be rational for physicians considering this mean and excluding the first BP measurement as a sole criterion for HTN assessment in Iranian adults. Multiple researches are necessary quantifying appropriate frequencies of BP reading.

Effect of a community health worker mHealth monitoring system on uptake of maternal and newborn health services in Rwanda

Background

In an effort to improve access to proven maternal and newborn health interventions, Rwanda implemented a mobile phone (mHealth) monitoring system called RapidSMS. RapidSMS was scaled up across Rwanda in 2013. The objective of this study was to evaluate the impact of RapidSMS on the utilization of maternal and newborn health services in Rwanda.

Methods

Using data from the 2014/15 Rwanda demographic and health survey, we identified a cohort of women aged 15–49 years who had a live birth that occurred between 2010 and 2014. Using interrupted time series design, we estimated the impact of RapidSMS on uptake of maternal and newborn health services including antenatal care (ANC), health facility delivery and vaccination coverage.

Results

Overall, the coverage rate at baseline for ANC (at least one visit), health facility delivery and vaccination was very high (> 90%). The baseline rate was 50.30% for first ANC visit during the first trimester and 40.57% for at least four ANC visits. We found no evidence that implementing RapidSMS was associated with an immediate increase in ANC (level change: -1.00% (95% CI: -2.30 to 0.29) for ANC visit at least once, -1.69% (95% CI: -9.94 to 6.55) for ANC (at least 4 visits), -3.80% (95% CI: -13.66 to 6.05) for first ANC visit during the first trimester), health facility delivery (level change: -1.79, 95% CI: -6.16 to 2.58), and vaccination coverage (level change: 0.58% (95%CI: -0.38 to 1.55) for BCG, -0.75% (95% CI: -6.18 to 4.67) for polio 0). Moreover, there was no significant trend change across the outcomes studied.

Conclusion

Based on survey data, the implementation of RapidSMS did not appear to increase uptake of the maternal and newborn health services we studied in Rwanda. In most instances, this was because the existing level of the indicators we studied was very high (ceiling effect), leaving little room for potential improvement. RapidSMS may work in contexts where improvement remains to be made, but not for indicators that are already very high. As such, further research is required to understand why RapidSMS had no impact on indicators where there was enough room for improvement.