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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
"secondary level"
symptom
acute rheumatic fever
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