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Determinants of poor adherence to secondary antibiotic prophylaxis for rheumatic fever recurrence on Lifou, New Caledonia: a retrospective cohort study.
[acute rheumatic fever]
Incidence
of
acute
rheumatic
fever
(
ARF
)
and
prevalence
of
rheumatic
heart
disease
(
RHD
)
in
the
Pacific
region
,
including
New
Caledonia
,
are
amongst
the
highest
in
the
world
.
The
main
priority
of
long
-term
management
of
ARF
or
RHD
is
to
ensure
secondary
prophylaxis
is
adhered
to
.
The
objectives
of
this
study
were
to
evaluate
rates
of
adherence
in
people
receiving
antibiotic
prophylaxis
by
intramuscular
injections
of
penicillin
in
Lifou
and
to
determine
the
factors
associated
with
a
poor
adherence
in
this
population
.
We
conducted
a
retrospective
cohort
study
and
we
included
70
patients
receiving
injections
of
antibiotic
prophylaxis
to
prevent
ARF
recurrence
on
the
island
of
Lifou
.
Patients
were
classified
as
"
good-adherent
"
when
the
rate
of
adherence
was
≥
80
%
of
the
expected
injections
and
as
"
poor
-adherent
"
when
it
was
<
80
%
.
Statistical
analysis
to
identify
factors
associated
with
adherence
was
performed
using
a
multivariate
logistic
regression
model
.
Our
study
showed
that
46
%
of
patients
from
Lifou
receiving
antibiotic
prophylaxis
for
ARF
or
RHD
had
a
rate
of
adherence
<
80
%
and
were
therefore
at
high
risk
of
recurrence
of
ARF
.
Three
independent
factors
were
protective
against
poor
adherence
:
a
household
with
more
than
five
people
(
odds
ratio
,
0
.
25
;
95
%
confidence
interval
[
CI
]
,
0
.
08
to
0
.
75
)
,
a
previous
medical
history
of
symptomatic
ARF
(
odds
ratio
,
0
.
20
;
95
%
CI
,
0
.
04
to
0
.
98
)
and
an
adequate
healthcare
coverage
(
odds
ratio
,
0
.
21
;
95
%
CI
0
.
06
to
0
.
72
)
.
To
improve
adherence
to
secondary
prophylaxis
in
Lifou
,
we
therefore
propose
the
following
recommendations
arising
from
the
results
of
this
study
:
i
)
identifying
patients
receiving
antibiotic
prophylaxis
without
medical
history
of
ARF
to
strengthen
their
therapeutic
education
and
ii
)
improving
the
medical
coverage
in
patients
with
ARF
or
RHD
.
We
also
recommend
that
the
nurse
designated
for
the
ARF
prevention
program
in
Lifou
coordinate
an
active
recall
system
based
on
an
updated
local
register
.
But
the
key
point
to
improve
adherence
among
Melanesian
patients
is
probably
to
give
appropriate
information
regarding
the
disease
and
the
treatment
,
taking
into
account
the
Melanesian
perceptions
of
the
disease
.
Diseases
Validation
Diseases presenting
"fever"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
alexander disease
allergic bronchopulmonary aspergillosis
canavan disease
carcinoma of the gallbladder
child syndrome
congenital toxoplasmosis
cushing syndrome
cystinuria
dracunculiasis
erdheim-chester disease
esophageal adenocarcinoma
esophageal carcinoma
familial mediterranean fever
focal myositis
hodgkin lymphoma, classical
lamellar ichthyosis
legionellosis
locked-in syndrome
malignant atrophic papulosis
neonatal adrenoleukodystrophy
neuralgic amyotrophy
oculocutaneous albinism
papillon-lefèvre syndrome
pyomyositis
pyruvate dehydrogenase deficiency
scrub typhus
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
typhoid
waldenström macroglobulinemia
wolf-hirschhorn syndrome
This symptom has already been validated
