Rheumatic Heart Disease Patients’ Adherence to Secondary Prophylaxis and Associated Factors at Hospitals in Jimma Zone, Southwest Ethiopia: A Multi-Center Study

Abstract

Background: Rheumatic heart disease is a major cause of premature cardiovascular related death in the developing countries. It is preventable disease by secondary prophylaxis injection if good adherence is maintained. But, information regarding adherence rate and its associated factors is limited and inconsistent in Ethiopia. Objective: The study was aimed to assess the adherence rate of rheumatic heart disease patients to secondary prophylaxis and its associated factors in multiple hospitals Jimma zone, Southwest Ethiopia. Methods: A cross sectional study was conducted from August –November, 2019 among selected rheumatic heart disease patients on follow-up at four hospitals in Jimma zone. Data was collected by face-to-face interview and record review using semi-structured questionnaire. Adherence status of rheumatic heart disease patients to secondary prophylaxis in the last consecutive 12 months was assessed based on the annual frequency of received prophylaxis (monthly injection of Benzathine Penicillin). Good adherence was considered if the patient was covered >80% of annual dose. The collected data was entered into Epidata 3.1 and analysed using SPSS 23. Results: A total of 253 rheumatic heart disease patients taking prophylaxis were finally included in the analysis. About 178 (70.4%) of them were females with male to female ratio of 1:2.4. The mean age was 24 ± 11 years that ranged from 6 to 65 years. The adherence rate of the rheumatic heart disease patients was 63.2% while the remaining 36.8% were considered as poor adherent for missing more than three times of the annual dose. New York Heart Association functional class I and II; rural residency, distance >30 km from health facility and duration of prophylaxis (>5 years)) were associated with poor adherence (AOR(95%CI) and P-value of 12.6(2.5-63), 0.016; 6.8(1.9-24.4), 0.003;5.5(1.2-26.7), 0.046; and 1.2(1.1-3.2), 0.021 respectively. The main reasons to miss prophylaxis more than three times were long distance from the treatment setting (56.9%) followed by lack of money (38%). Conclusion: Patients with class I and II heart failure and those living in rural areas especially at distance of >30 kms from the hospitals were identified to be poor adherent to secondary prophylaxis. Funding Statement: Jimma University provided fund for data collectors. Declaration of Interests: The authors declared that there is not conflict of interests. Ethics Approval Statement: Institutional ethics approval was obtained from the research and the ethics committee of institute of health of Jimma University. Before data collection, informed consent and assent (for those unable to give consent) was obtained.