Setting: Three district hospitals (DHs) and seven health centers (HCs) in rural Rwanda.Objective: To describe follow-up and treatment outcomes in stage 1 and 2 hypertension patients receiving care at HCs closer to home in comparison to patients receiving care at DHs further from home.Design: A retrospective descriptive cohort study using routinely collected data involving adult patients aged 18 years in care at chronic non-communicable disease clinics and receiving treatment for hypertension at DH and HC between 1 January 2013 and 30 June 2014.Results: Of 162 patients included in the analysis, 36.4% were from HCs. Patients at DHs travelled significantly further to receive care (10.4 km vs. 2.9 km for HCs, P < 0.01). Odds of being retained were significantly lower among DH patients when not adjusting for distance (OR 0.11, P = 0.01). The retention effect was consistent but no longer significant when adjusting for distance (OR 0.18, P = 0.10). For those retained, there was no significant difference in achieving blood pressure targets between the DHs and HCs.Conclusion: By removing the distance barrier, decentralizing hypertension management to HCs may improve long-term patient retention and could provide similar hypertension outcomes as DHs.
may have competing influences on intrapartum thermoregulation. Frölich et al attempt to identify contributing factors by investigating the association of maternal temperature with BMI, duration of labor, oxytocin dose, and length of time from ROM to delivery. Unfortunately, it is very difficult to make meaningful assertions about a specific factor when other variables are uncontrolled. To unambiguously define the contribution of epidural anesthesia to fluctuations in maternal temperature, parturients should be randomized to receiving either intravenous or neuraxial analgesia. Because this withholding of epidural analgesia would be considered unethical in current practice, studies such as that of Frölich et al must serve as an informative, if imperfect, surrogate. The results provide further evidence that although maternal intrapartum temperature regulation is multifaceted, neuraxial analgesia does not appear to contribute to maternal hyperpyrexia. Comment by Emily J. Baird, MD, PhD Disclosure: The author declares no conflict of interest. 2. Camann WR, Hortvet LA, Hughes N, et al. Maternal temperature regulation during extradural analgesia for labour. Br J Anaesth. 1991;67: 565Y568. 3. Impey LW, Greenwood CE, Black RS, et al. The relationship between intrapartum maternal fever and neonatal acidosis as risk factors for neonatal encephalopathy. Am J Obstet Gynecol. 2008;198(1):49 e41Y46. 4. Goetzl L, Korte JE. Interaction between intrapartum maternal fever and fetal acidosis increases risk for neonatal encephalopathy. Am J Obstet Gynecol. 2008;199:e9; author reply e9. 5. Lieberman E, Lang JM, Frigoletto F Jr, et al. Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation. Pediatrics. 1997;99(3):415Y419. 6. Goetzl L, Evans T, Rivers J, et al. Elevated maternal and fetal serum interleukin-6 levels are associated with epidural fever. Am J Obstet Gynecol.
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