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Benzathine penicillin adherence for secondary prophylaxis among patients affected with rheumatic heart disease attending Mulago Hospital.
[acute rheumatic fever]
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
.
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
.
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
.
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
.
Diseases
Validation
Diseases presenting
"heart disease"
symptom
22q11.2 deletion syndrome
achondroplasia
acute rheumatic fever
adrenal incidentaloma
child syndrome
classical phenylketonuria
cohen syndrome
congenital diaphragmatic hernia
dentinogenesis imperfecta
esophageal adenocarcinoma
fabry disease
familial mediterranean fever
heparin-induced thrombocytopenia
hirschsprung disease
holt-oram syndrome
homocystinuria without methylmalonic aciduria
kabuki syndrome
monosomy 21
omenn syndrome
phenylketonuria
sneddon syndrome
systemic capillary leak syndrome
wiskott-aldrich syndrome
wolf-hirschhorn syndrome
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