Adherence of Rheumatic Heart Disease Patients to Secondary Prophylaxis and Main Reasons for Poor Adherence at Jimma Medical Center

Abstract

Objectives: Rheumatic heart disease (RHD) is the major long-term sequel of acute rheumatic fever (ARF), which involves the cardiac valves leading to stenosis or regurgitation with resultant hemodynamic disturbance. The incidence of ARF and prevalence RHD in the sub-Saharan Africa including Ethiopia are amongst the highest in the world. The main priority of long-term management of ARF or RHD is to ensure that patients are adherent to the secondary prophylaxis which is monthly benzathine penicillin injection to prevent recurrent attacks of ARF. Materials and Methods: A cross-sectional study was conducted among sampled 241 RHD patients having at least one year follow-up at cardiac clinic of Jimma Medical Center (JMC) who appointed every month to receive injections of antibiotic prophylaxis. The data was collected for 4 months (from June 1-September 30, 2018) by asking their follow-up status of last one year retrospectively and assessing related variables by using face to face interview. After the data was collected using structured questionnaires, it was coded, entered into Epi data and exported to SPSS for further analysis. The adherence rate of RHD patients was determined by frequency of annual injections of prophylaxis.

<p>Rheumatic Heart Disease Patients’ Adherence to Secondary Prophylaxis and Associated Factors at Hospitals in Jimma Zone, Southwest Ethiopia: A Multicenter Study</p>

“…This finding was almost comparable with Pelajo et al, who reported an adherence rate of 65% among RHD patients in Brazil. 31 However, our figure was considerably higher than that found by Sayed (29.5%), 44 Thompson et al (48.7%), 48 Prasad et al (50%), 46 Musoke et al (54%), 53 Gasse et al (54%), 38 Mohammed et al (55.2%), 29 Huck et al (58%), 43 and Harrington et al (59%). 34 On the other hand, it was considerably less than of Saxena et al (93.6%), 52 Culliford-Semmens et al (92%), 54 Kumar et al (90%), 45 Mekonnen et al (80.6%), 37 and Sial et al (73.5%).…”

“…RHD patients were regarded as having good adherence when the rate of adherence to secondary prophylaxis was ≥80% of the expected injections (if injected more than ten times per year) while good adherence was egarded as the patient missing prophylaxis at least three times per year. 29 , 36 , 49 In Ethiopia, adherence to secondary prophylaxis is focused to eradicate/prevent the disease by promoting injections for patients every 4 weeks. 50 Benzathin penicillin G injection is given, in accordance with the WHO 2003 guideline recommendation.…”

“…Otherwise, there is a higher risk of recurrent ARF and its complications. 29,30 However, ensuring adequate adherence to secondary prophylaxis has been a challenge, and the adherence rate is poor among adolescents and chronic patients, [31][32][33][34][35][36] due to different factors 34,[37][38][39][40][41][42] and barriers. [43][44][45][46][47][48] There are no reliable and consistent data in Ethiopia, asstudies have been conducted only at a single institution.…”

Prevalence of rheumatic heart disease among school children in East Africa: a systematic review and meta-analysis

“…But, the predisposing condition to RHD (strep throat) is considered as a mild, self-limiting illness by most of the communities, especially in developing countries. Health seeking behavior and adherence to primary or secondary prevention of RHD remain low in those countries [ 13 - 16 ]. As a result, about 84% of RHD cases and 80% of estimated deaths are contributed from Africa, South-East Asia and Western Pacific regions [ 9 ].…”

Factors Leading to Poor Adherence to Secondary Prophylaxis of Rheumatic Fever

“…This result is consistent with that observed (23%) in a similar study conducted in past. 20 However, Sheron et al reported that 75% of children and 50% of adults missed their appointments because of fear of painful injections. 21 Several measures can be taken to reduce the pain.…”