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Abstract
BackgroundAs the burden of cardiovascular disease increases in sub-Saharan Africa, there is a growing need for low-cost interventions to mitigate its impact. Providing self-care health education to patients with chronic heart failure (CHF) is recommended as an intervention to prevent complications, improve quality of life, and reduce financial burdens on fragile health systems. However, little is known about health education’s effectiveness at improving CHF self-management adherence in sub-Saharan Africa. Therefore the present study aimed to assess the effectiveness of an educational intervention to improve self-care adherence among patients with CHF at Debre Markos and Felege Hiwot Referral Hospitals in Northwest Ethiopia.MethodsTo address this gap, we adapted a health education intervention based on social cognitive theory comprising of intensive four-day training and, one-day follow-up sessions offered every four months. Patients also received illustrated educational leaflets. We then conducted a clustered randomized control trial of the intervention with 186 randomly-selected patients at Debre Markos and Felege Hiwot referral hospitals. We collected self-reported data on self-care behavior before each educational session. We analyzed these data using a generalized estimating equations model to identify health education's effect on a validated 8-item self-care adherence scale.ResultsSelf-care adherence scores were balanced at baseline. After the intervention, patients in the intervention group (n = 88) had higher adherence scores than those in the control group (n = 98). This difference was statistically significant (β = 4.15, p < 0.05) and increased with each round of education. Other factors significantly associated with adherence scores were being single (β = − 0.25, p < 0.05), taking aspirin (β = 0.76, p < 0.05), and having a history of hospitalization (β = 0.91, p < 0.05).ConclusionsWe find that self-care education significantly improved self-care adherence scores among CHF patients. This suggests that policymakers should consider incorporating self-care education into CHF management.Trial registration number: PACTR201908812642231
Highlights
The burden of cardiovascular diseases (CVD) is increasing rapidly in sub-Saharan Africa (SSA) [1]
Study area and period The study was conducted from November 1, 2018, to November 1, 2019, in two public referral hospitals located in the Amhara region of Ethiopia: Debre Markos Referral Hospital and Felege Hiwot Referral Hospital
20,000 patients are admitted to these facilities each year, where they are served by 576 healthcare providers
Summary
Background The burden of cardiovascular diseases (CVD) is increasing rapidly in sub-Saharan Africa (SSA) [1]. Heart failure is a complex clinical syndrome characterized by a structural or functional cardiac disorder that impairs the ventricle’s ability to fill or pump blood [5]. It develops when the heart’s pumping ability is insufficient to maintain adequate tissue perfusion [6, 7]. Several risk factors such as ischemic heart disease, hypertension, smoking, obesity, diabetes increase heart failure incidence and severity [8].
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