Benzathine penicillin adherence for secondary prophylaxis among patients affected with rheumatic heart disease attending Mulago Hospital.
BACKGROUND
Rheumatic heart disease (RHD) frequently occurs following recurrent episodes of acute rheumatic fever (ARF). Benzathine penicillin (benzapen) is the most effective method for secondary prophylaxis against ARF whose efficacy largely depends on adherence to treatment. Various factors determine adherence to therapy but there are no data regarding current use of benzapen in patients with RHD attending Mulago Hospital. The study aims were (1) to determine the levels of adherence with benzapen prophylaxis among rheumatic heart disease patients in Mulago Hospital, and (2) establish the patient factors associated with adherence and, (3) establish the reasons for missing monthly benzathine penicillin injections.


METHODS
This was a longitudinal observational study carried out in Mulago Hospital cardiac clinics over a period of 10 months; 95 consecutive patients who satisfied the inclusion criteria were recruited over a period of four months and followed up for six months. Data on demographic characteristics and disease status were collected by means of a standardised questionnaire and a card to document the injections of benzapen received.


RESULTS
Most participants were female 75 (78.9%). The age range was five to 55 years, with a mean of 28.1 years (SD 12.2) and median of 28 years. The highest education level was primary school for most patients (44, 46.3%) with eight (8.4%) of the patients being illiterate. Most were either NYHA stage II (39, 41.1%) or III (32, 33.7%). Benzathine penicillin adherence: 44 (54%) adhered to the monthly benzapen prophylaxis, with adherence rates ≥ 80%; 38 (46%) patients were classified as non-adherent to the monthly benzapen, with rates less than 80%. The mean adherence level was 70.12% (SD 29.25) and the median level was 83.30%, with a range of 0-100%; 27 (33%) patients had extremely poor adherence levels of ≤ 60%. Factors associated with adherence: higher education status, residing near health facility favoured high adherence, while painful injection was a major reason among poor performers.


CONCLUSIONS
The level of non-adherence was significantly high (46%). Residence in a town/city and having at least a secondary level of education was associated with better adherence, while the painful nature of the benzapen injections and lack of transport money to travel to the health centre were the main reasons for non-adherence among RHD patients in Mulago.
Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Charles
C
Musoke
Charles Kiiza
CK
Mondo
Emmy
E
Okello
Wanzhu
W
Zhang
Barbara
B
Kakande
Wilson
W
Nyakoojo
Juergen
J
Freers
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004522:Educational Status; D005239:Fear; D005260:Female; D006761:Hospitals; D006801:Humans; D007267:Injections / Q000009:adverse effects; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000523:psychology; D010401:Penicillin G Benzathine / Q000008:administration & dosage / Q000627:therapeutic use*; D011203:Poverty; D012111:Residence Characteristics; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000188:drug therapy*; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014454:Uganda; D055815:Young Adult
D000900:Anti-Bacterial Agents; D010401:Penicillin G Benzathine