Reliability

of
CHW
in
Blood
pressure
measurement as compared to doctors in
community settings: a validation study
Running title:
Asma Gulab, Zoya Butt
Aga Khan University, Pediatrics Department
Conflict of interest statement :
Ethical review committee statement :
Field Site: Rehri Goath, Ibrahim Hyderi
Complete author address:
Introduction: CHWs are an important resource in delivering interventions
especially in countries like Pakistan with weak health setups. We compared
their blood pressure readings with Digital BP measuring device to see their
reliability

of

readings

as

compared

to

clinicians

with

Manual

sphygmomanometer
Method: 100 females between the ages of (20-60) volunteered to participate
in this research. Data was collected by two clinicians and two CHWs
consecutively for their B.P measurements.
Results:
Conclusion:
Keywords: CHWs, Blood pressure, Hypertension

Introduction: The incidence of Pre-eclampsia is 19%[1] in the rural area of

Pakistan which is adding significantly to the burden of disease and also impacting
the morbidity and mortality. It also influences the outcome of the pregnancies.
Keeping this in mind the reliability of B.P measurement in community settings is
very significant. Community health workers are the main resource doing this job in
the rural areas and its important to find out how reliable their measurements are,
so as to find out whether they over estimate or underestimate the readings
compared with those of Doctors in the same settings. This is of prime importance
in a country like Pakistan where the health system is fragmented; the role of CHW
becomes pivotal as they can be a strong source to deliver necessary interventions
in the hour of need. They also have a positive influence on the maternal and
neonatal mortality [2].Also in communities in the rural areas of Pakistan where
people dont usually go for screening visits to clinic, these could be used to
monitor blood pressure in hypertensive patient by the frequently visiting CHWS.As
different BP measuring devices are available it is important to validate the digital
device used in the community .Such validation studies have already been
performed[3], but no effect on increasing the burden of disease has been
described .As mercury sphygmomanometer has a potential to cause environmental
toxicity these validations are increasingly becoming important.[4]
Materials and Method.
Device:

The

device

used

by

the

doctor

was

ABN

Precision

Mercurial

sphygmomanometer (Model no: 646243). The device used by CHW was Watch
home B.P, which was properly calibrated
Setting: The Research was carried out in two separate locations of Karachi i.e
Ibrahim Hayedari and Rehri Goth. Both the places have a center for routine visits
by women enrolled in the AMANHI program.
Data Collectors: Two Doctors with required clinical experience were using the
Mercury sphygmomanometer to collect Blood pressures. Simultaneously, two
CHWs were using the digital devices to get Blood pressure readings. The CHWs

were adequately trained by the Health center to ensure precision and accurate
readings.
Participants: The participants of the research were men and women ranging
between age (20-60). All of them were healthy individuals with no known Co
Morbids. The readings were taking 2 hours after the previous meal and it was
made sure that they werent engaged in any sort physical exertion before the
measurement of the blood pressure.
Procedure: Data collection was done during two consecutive days in the morning.
Every participant had their Blood Pressure measured 4 times in total, twice by the
Doctor measuring Mercury Sphygmomanometer on the right arm and twice by the
CHW using Digital device. First the Doctor took the consecutive readings which
were at least one minute apart. This was followed by readings of the CHWs which
were also taken one minute apart. The CHW took the B.P from left arm. The inter
arm B.P difference was accounted for because of this[5]. Participants were
randomly allocated to have their blood pressure measured
It was made sure that proper protocol for Blood Pressure measurement was
followed by both, Doctors and CHWs. A checklist was provided to both the doctors
and CHWs. The checklist was created by the authors keeping in reference the
protocol (insert protocol).
Any Participant with readings above 140 Systolic and 100 diastolic was advised to
get his/her B.P checked again in clinic.
Data Analysis:
Results:
Discussion:

Acknowledgments:

References.
1.
2.
3.
4.
5.

Aziz, R. and T. Mahboob, Pre-eclampsia and lipid profile. Pakistan

Journal of Medical Sciences, 2007. 23(5): p. 751.
Haines, A., et al., Achieving child survival goals: potential
contribution of community health workers. The Lancet, 2007.
369(9579): p. 2121-2131.
Reidpath, D.D., et al., Community-based blood pressure
measurement by non-health workers using electronic devices: a
validation study. Glob Health Action, 2012. 5: p. 14876.
O'Brien, E., Has conventional sphygmomanometry ended with
the banning of mercury? Blood Press Monit, 2002. 7(1): p. 37-40.
Clark, C.E., et al., Prevalence and clinical implications of the
inter-arm blood pressure difference: A systematic review. J Hum
Hypertens, 2006. 20(12): p. 923-31.