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

Abstract

Background Ethiopia has a high acute rheumatic fever (ARF) and rheumatic heart disease (RHD) prevalence, and to our knowledge, there are no data on the status of secondary prevention in children with RHD. This study describes the status of secondary RHD prevention. Methods A multicenter, prospective study was performed on children aged 5–17 years with RHD in Ethiopia. Good adherence was defined as at least 80% completion of benzathine penicillin (BPG) or oral Amoxicillin within the previous year. The primary outcome measure was adherence to prophylaxis, expressed as a proportion. Socio-demographics, severity of RHD, and ARF recurrence were evaluated. Results A total of 337 children with a mean age of 12.9 ± 2.6 years were included. The majority (73%) had severe aortic/mitral disease. Participants were on BPG (80%) or Amoxicillin (20%) prophylaxis. Female sex (P = 0.04) use of BPG (0.03) and shorter mean duration of prophylaxis in months (48.5 ± 31.5 vs. 60.7 ± 33, respectively, P < 0.008) predicted good adherence. Running out of medications (35%), interrupted follow-up (27%), and the COVID-19 pandemic (26%) were the most common reasons for missing prophylaxis. Recurrence of ARF was higher in participants on Amoxicillin compared with BPG (40% vs. 16%, P < 0.001) and in those with poor adherence compared with good adherence (36.8% vs. 17.9%, respectively, P = 0.005). Type and duration of prophylaxis (OR 0.5, CI = 0.24, 0.9, P = 0.02; OR = 1.1, CI = 1.1, 1.2, P = 0.04, respectively), and sex (OR = 1.9, CI = 1.1, 3.4, P = 0.03) were independent predictors of poor adherence. Conclusion Poor adherence is prevalent in Ethiopian children living with RHD. Amoxicillin is a suboptimal option for prophylaxis as its use is associated with lower adherence and a higher rate of ARF recurrence.

Infective Endocarditis in High-Income Countries

“…The disease occurs in young adult patients who develop the infection starting from oropharyngeal foci of penicillin-sensitive streptococci. Evidence of IE in high-income countries suggests a reduction in cases of rheumatic heart disease due to improved living standards and prophylactic administration of antibiotics to counter the spread of streptococcal pharyngitis [ 52 , 53 ]. A detailed evaluation of IE trends suggests that the main risk factors are represented by the increase in degenerative valve disease, diabetes, cancer, PWID, and congenital heart disease, which have replaced rheumatic heart disease.…”

Impact of COVID‐19 measures on the health and healthcare of children in East‐Africa: Scoping review

“…Table 2 and Table 3 present the characteristics of these 70 studies 6,10–78 . Scale level: national ( n = 49), regional ( n = 21).…”

“…The 70 studies mention 7 indirect effects of COVID‐19 containment measures on the health and healthcare of children in 12 East‐African countries: economic damage ( n = 26), limited access to education ( n = 21), food insecurity ( n = 22), child abuse ( n = 12), limited access to healthcare ( n = 39), disrupted health‐programs (28), mental health challenges ( n = 13) 6,10–78 …”

“…The impact of COVID‐19 containment measures on the access to healthcare for East‐African children has been addressed in 39 studies 6,10,11,13–15,17,18,21,23,25,31,33–35,38–40,43–48,50,53,54,59,64–74 . Scale level: national ( n = 26) regional ( n = 13).…”

Pathophysiology of Infective Endocarditis in High-Income Countries

“…The disease occurs in young adult patients who develop the infection starting from oropharyngeal foci of penicillin-sensitive streptococci. Evidence of IE in high-income countries suggests a reduction in cases of rheumatic heart disease due to improved living standards and prophylactic administration of antibiotics to counter the spread of streptococcal pharyngitis [52,53]…”