Determinants of poor adherence to secondary antibiotic prophylaxis for rheumatic fever recurrence on Lifou, New Caledonia: a retrospective cohort study

Abstract

BackgroundIncidence of acute rheumatic fever (ARF) and prevalence of rheumatic heart disease (RHD) in the Pacific region, including New Caledonia, are amongst the highest in the world. The main priority of long-term management of ARF or RHD is to ensure secondary prophylaxis is adhered to. The objectives of this study were to evaluate rates of adherence in people receiving antibiotic prophylaxis by intramuscular injections of penicillin in Lifou and to determine the factors associated with a poor adherence in this population.MethodsWe conducted a retrospective cohort study and we included 70 patients receiving injections of antibiotic prophylaxis to prevent ARF recurrence on the island of Lifou. Patients were classified as “good-adherent” when the rate of adherence was ≥80% of the expected injections and as “poor-adherent” when it was <80%. Statistical analysis to identify factors associated with adherence was performed using a multivariate logistic regression model.ResultsOur study showed that 46% of patients from Lifou receiving antibiotic prophylaxis for ARF or RHD had a rate of adherence <80% and were therefore at high risk of recurrence of ARF. Three independent factors were protective against poor adherence: a household with more than five people (odds ratio, 0.25; 95% confidence interval [CI], 0.08 to 0.75), a previous medical history of symptomatic ARF (odds ratio, 0.20; 95% CI, 0.04 to 0.98) and an adequate healthcare coverage (odds ratio, 0.21; 95% CI 0.06 to 0.72).ConclusionsTo improve adherence to secondary prophylaxis in Lifou, we therefore propose the following recommendations arising from the results of this study: i) identifying patients receiving antibiotic prophylaxis without medical history of ARF to strengthen their therapeutic education and ii) improving the medical coverage in patients with ARF or RHD. We also recommend that the nurse designated for the ARF prevention program in Lifou coordinate an active recall system based on an updated local register. But the key point to improve adherence among Melanesian patients is probably to give appropriate information regarding the disease and the treatment, taking into account the Melanesian perceptions of the disease.

Low adherence to secondary prophylaxis among clients diagnosed with rheumatic fever, Jamaica

“…8 However, adherence levels in the current study were comparable to reports from the island of Lifou, New Caledonia, where 46% of patients receiving antibiotic prophylaxis for ARF or rheumatic heart disease (RHD) studied had a rate of adherence ,80%. 4 Additionally, the median number of injections reported for the clients in Lifou was 14 and ranged from 2 to 18, while the current study recorded 12 and ranged from 3 to 13. 4 Poor adherence to secondary prophylaxis for rheumatic fever was observed in the face of poor knowledge.…”

“…4 Additionally, the median number of injections reported for the clients in Lifou was 14 and ranged from 2 to 18, while the current study recorded 12 and ranged from 3 to 13. 4 Poor adherence to secondary prophylaxis for rheumatic fever was observed in the face of poor knowledge. According to Eissa et al, 'Knowledge and understanding of the rheumatic fever are…”

“…1 Targeted education for clients who have had rheumatic fever and those recently diagnosed is required and should include specific therapeutic information. 4 Another possible barrier to adherence to secondary prophylaxis was fear of receiving injections. More than 75% of children and 50% of adults admitted to missing their appointments because of fear of injections.…”

“…3 Global incidence of rheumatic fever is estimated to be 470 000 new cases per year, while rheumatic heart disease affect 15.6-19.6 million persons globally. [3][4][5][6] In addition, deaths from rheumatic heart disease are estimated between 250 000 and 468 000 annually. [4][5][6] Furthermore, over 330 000 children between the ages of 5 and 14 years are affected by rheumatic fever each year with global prevalence rates of 0.3/1000-5.7/ 1000.…”

“…[3][4][5][6] In addition, deaths from rheumatic heart disease are estimated between 250 000 and 468 000 annually. [4][5][6] Furthermore, over 330 000 children between the ages of 5 and 14 years are affected by rheumatic fever each year with global prevalence rates of 0.3/1000-5.7/ 1000. 3,7 Recurrent attacks of rheumatic fever can have devastating outcomes; therefore, regular administration of antibiotics is recommended to prevent reinfection with group A streptococci and subsequent possible acute rheumatic fever.…”