Patient adherence to secondary prophylaxis for rheumatic heart disease at hospitals in jimma zone, southwest Ethiopia

Abstract

Background: Rheumatic heart disease continues to create havoc in the developing countries even decades after its discovery. It is entirely preventable through primordial, primary, and secondary level intervention. Secondary prevention is a reasonable treatment option in patients in Ethiopia, but good adherence to the treatment is essential to achieve the desired objective. Information regarding prevalence of good adherence and factors associated with poor adherence is limited in Ethiopia. Objective: The aim of this study was to assess the prevalence of good adherence with secondary prophylaxis for rheumatic heart disease and identify factors associated with poor adherence among patients on treatment at hospitals in Jimma zone. Methods: A hospital based cross sectional study was conducted from August –November, 2019 on selected rheumatic heart disease patients on follow-up at Jimma Medical Center, Shenen Gibe Hospital, Agaro Hospital and Seka Chekorsa Hospital. Data was collected by face-to-face interview and record review using semi-structured questionnaire and checklist respectively. Adherence of the last consecutive 12 months before the interview was assessed as outcome. The collected data was entered into EpiData, and cleaned and analyzed using SPSS 23. Result: Results: A total of 253 patients with rheumatic heart disease taking Benzathine Penicillin were included in the analysis. One hundred seventy-eight (70.4%) of them were females. One hundred nine (43.1%) of them were in the age group of above 24 years. Our study showed that 36.8%of patients from the four hospitals in Jimma Zone receiving antibiotic prophylaxis for rheumatic heart disease had a rate of adherence <80% and were therefore at high risk of recurrence of acute rheumatic fever. The main reasons to miss their prophylaxis among Rheumatic heart disease patients were long distance from the treatment setting (56.9%) followed by lack of money (38%). Conclusion and recommendation: Multivariable analysis showed that lower education of the patients, living in rural areas, and low knowledge about the disease were independently associated with poor adherence to medication. Further research and solutions directly targeting these barriers can improve patient adherence and decrease their overall risk of rheumatic heart disease