Implementation of the hypertension network in Mali (RHYTM)

: In view of the rising prevalence of arterial hypertension and its complications throughout sub-Saharan Africa including in rural areas, the Association of the Rural Doctors of Mali asked its NGO partner, Sant6 Sud, for assistance in setting up a medical network dedicated to hypertension. This report describes the implementation of the Mali Hypertension Network (French acronym, RHYTM) that involved three stages, i.e., physician training, development of appropriate protocols and field trials. The physician training stage was carried out over a one-week period and covered all the aspects of hypertension. In the second stage international guidelines were used as a basis for development of appropriate protocols for the rural setting. Field trials were conducted in the villages to verify the feasibility of the protocols and functionality of the network. Treatment of hypertension depends mainly on lifestyle and dietetic measures with emphasis on reducing salt intake. Drug treatment is based primarily on first-intention use of thiazidic diuretics. Management of this chronic pathology runs up against socio-cultural, economic and logistic obstacles. These problems are discussed and possible solutions are proposed. This preliminary experience will provide epidemiologic and clinical data on a sample population including more than 80000 people and explore the possibility of extending the network to other zones in this area of Africa.