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

Özet

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 subSaharan 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. Results: A total of 241 patients with RHD were interviewed, among those 224 (93.0%) were received the secondary prophylaxis at least once within last one year, despite frequency differs while 17 (7.0%) of them didn’t initiate the prophylaxis yet. The adherence rate of the assessed RHD patients to secondary prophylaxis was 55.2% while the left 108 RHD patients (44.8%) were generalized as non-adhered to the prophylaxis [can be who either don’t start the prophylaxis 17 (7.0%) or who missed the prophylaxis more than three times annually 86 (35.6%)]. The main reasons for poor adherence were lack of money 41 (38%), far distance from hospital 28 (26%), fear of medication side effects and painful injection 25 (23%), and lack of knowledge about the disease and prevention 14 (13%). Conclusion: RHD patients attending cardiac clinic of JMC had low adherence rate (55.2%) to the secondary prophylaxis due to lack of money, far distance from the setup, painful injection especially among children and lack of awareness about the disease.