<p>Adherence to Benzathine Penicillin G Secondary Prophylaxis and Its Determinants in Patients with Rheumatic Heart Disease at a Cardiac Center of an Ethiopian Tertiary Care Teaching Hospital</p>

Abstract

Purpose: Benzathine penicillin G (BPG) monthly administration is the most effective method for secondary prophylaxis against acute rheumatic fever (ARF). BPG's efficacy largely depends on adherence to treatment. This study was aimed at assessing adherence to BPG prophylaxis and its determinants among adult patients with rheumatic heart disease. Patients and Methods: An institutional cross-sectional study design was used. One hundred and forty-five patients receiving monthly BPG at the Adult Cardiac Clinic of Tikur Anbessa Specialized Hospital (TASH) were interviewed. Their 1-year BPG prophylaxis administration record was also reviewed. The rate of adherence to BPG injection was determined by calculating the percentage of the administered drug from the total expected doses. Data were entered and analyzed using Statistical Package for Social Sciences (SPSS) software version 25. Both descriptive and logistic regression analyses were computed to describe different variables and assess factors associated with adherence, respectively. A p-value <0.05 was used to declare association. Results: Among a total of 145 study participants involved, the majority (76.6%) of them had been receiving BPG for the last 10 years. The average adherence rate to monthly BPG injection was 80.60% with a range of 0% to 100%. However, only 101 (69.7%) of participants were taking ≥80% of their prescribed monthly BPG prophylaxis doses. Study participants with informal education 1.10 (0.023-46.96) and secondary school education 0.89 (0.10-8.11) were more and less likely to adhere to BPG injection, respectively, when compared with those who attended higher education programs. The regression analysis showed patients who were not admitted to the hospital (AOR: 26.22; CI: 2.55-269.70; p=0.006) and once admitted patients (AOR: 50.08; CI: 2.87-873.77; p=0.007) were more likely to adhere to their BPG injections than those admitted twice or more. The study participants who waited until the next appointment were also less adherent (AOR: 0.02; CI: 0.00-0.13; p=0.000) than those who went a few days later for receiving the missed/late dose. Conclusion: The adherence rate to BPG injection among RHD patients was found to be high (80.60%). Patients' admission status and their action on missed and/or late doses were found to be important determinants of adherence in this study.

Secondary prevention of rheumatic heart disease in Ethiopia: a multicenter study

“…Our study demonstrates that Ethiopian children with RHD have a high prevalence of self-reported poor adherence to secondary prophylaxis of RHD. The adherence rate is better in this study compared to adult studies in a similar setting, but comparable studies in children are lacking [ 14 , 15 , 23 ]. Although the median age is higher (24 years) than our study participants, the Global Rheumatic Heart Disease Registry (REMEDY) study showed 78% of their participants had good adherence, similar to our findings [ 24 ].…”

“…As surgical care of RHD is unavailable or prohibitively expensive for most patients in Ethiopia, effective prevention is paramount. Findings from studies on adult patients in Ethiopia with RHD indicate that adherence to secondary prophylaxis is variable [ 14 ]. Factors affecting adherence in adults include distance from health facilities, lack of finances, and affordability [ 15 , 16 ].…”

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

“…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%). 55 Abbreviations: RHD, rheumatic heart disease; NYHA, New York Heart Association.…”

“…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 in a major referral cardiology clinic in Ethiopia: A retrospective cross-sectional study

“…It is reported that medical care provision was generally steadily improving in Ethiopia and the adherence of RHD patients to taking the monthly penicillin prophylaxis is improving [ 37 ], perhaps this can be considered light at the end of the tunnel.…”