DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20204536

Non adherence to secondary prophylaxis for rheumatic fever

Santosh K. Saha, Kamrun N. Choudhury, Nihar R. Sarker, Gias U. Ahmed, Nazmul Hoque

Abstract


Background: Secondary prophylaxis with benzathine penicillin G (BPG) is a cost-effective intervention for preventing morbidity and mortality related to rheumatic fever (RF). There is no reliable data available with regards to adherence to secondary prophylaxis and rates of recurrent RF in many developing countries, including Bangladesh. So, aim of this study was to estimate rate of non-adherence and find out risk of non-adherence to secondary prophylaxis for rheumatic fever.

Methods: Total 230, 5-30 years patients of both sexes with definite previous history of RF taking secondary prophylaxis with injection benzathine penicillin G (BPG) were enrolled by simple random fashion. Last one-year injection profile of the patient was collected from the injection card. Patients were then classified as “non-adherent” when the rate of adherence was <80% of the expected injections and as “adherent” when it was ≥80%. After collection of data selective patients were invited for blood tests and echocardiography to identify recurrence of rheumatic fever.  

Results: Out of 230 patients, male were 96 (41.7%) and female were 134 (58.3%). Male and female ratio was 0.7. 173 (75.2%) were adherent with benzathine penicillin and 57 (24.8%) patients not adherent with benzathine penicillin. In adherent group only 5 (2.2%) and in non-adherent group 19 (8.3%) patients develop rheumatic recurrence and this finding was statistically significant (p-value 0.001).  

Conclusions: Non adherence to secondary prophylaxis with BPG was found a major risk factor for recurrent rheumatic fever. The main reasons of non-adherence were lack of counselling, fare of pain and fail to remember.


Keywords


Benzathine penicillin, Prophylaxis, Rheumatic fever, Rheumatic heart disease

Full Text:

PDF

References


Rayamajhi A, Sharma D, Shakya U. First-episode versus recurrent acute rheumatic fever: is it different?. Pediatr Int. 2009;51:269-75.

Carapetis JR, McDonald M, Wilson NJ. Acute rheumatic fever. Lanc. 2005;366:155-68.

Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST, et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulati. 2009;119:1541-51.

Nordet P, Lopez R, Duenas A, Sarmiento L. Prevention and control of rheumatic fever and rheumatic heart disease: the Cuban experience (1986-1996-2002). Cardiovasc J Afr. 2008;19: 135-40.

Steer AC, Carapetis JR. Acute rheumatic fever and rheumatic heart disease in indigenous populations. Pediatr Clin North Am. 2009;56:1401-19.

Carapetis JR, Currie BJ. Preventing rheumatic heart disease in Australia. Med J Aust. 1998;168:428-9.

Carapetis JR, Mayosi BM, Kaplan EL. Controlling rheumatic heart disease in developing countries. Cardiovasc J S Afr. 2006;17:164-5.

Carapetis JR. Rheumatic heart disease in developing countries. N Engl J Med. 2007; 357:439-41.

Carapetis JR, Kilburn CJ, MacDonald KT, Walker AR, Currie BJ. Ten-year follow up of a cohort with rheumatic heart disease (RHD). Aust N Z J Med. 1997;27:691-7.

Manyemba J, Mayosi BM. Penicillin for secondary prevention of rheumatic fever. Cochra Databa Syst Rev 3. 2002;CD002227.

Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update: Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association. J Americ Medic Assoc. 1992;268:2069-73.

Saxena A. Diagnosis of rheumatic fever: current status of Jones Criteria and role of echocardiography. Indian J Pediatr. 2000;67:283-6.

Stewart T, McDonald R, Currie B: Acute rheumatic fever: adherence to secondary prophylaxis and follow up of Indigenous patients in the Katherine region of the Northern Territory. Aust J Rural Heal. 2007;15:234-40.

Tompkins DG, Boxerbaum B, Liebman J. Long term prognosis of rheumatic fever patients receiving intramuscular benzathine penicillin. Circulati. 1972; 45:543-51.

Lue HC, Tseng WP, Lin GJ, Hsieh KH, Hsieh RP, Chiou JF. Clinical and epidemiological features of rheumatic fever and rheumatic heart disease in Taiwan and the Far East. Indian Heart J. 1983;35.

Haynes RB, McDonald HP, Garg AX. Helping patients follow prescribed treatment: clinical applications. J Americ Medic Assoc. 2002;288: 2880-3.

Herdy GV. The challenge of secondary prophylaxis in rheumatic fever. Arq Bras Cardiol. 1996;67:317.

Kumar R, Thakur JS, Aggarwal A, Ganguly NK. Compliance of secondary prophylaxis for controlling rheumatic fever and rheumatic heart disease in a rural area of northern India. Indian Heart J. 1997;49(3):282-8.

Robertson KA, Volmink JA, Mayosi BM. Lack of adherence to the national guidelines on the prevention of rheumatic fever. S Afr Med J. 2005; 95:52-6.

Rheumatic fever and rheumatic heart disease. Worl Heal Organ Tech Rep Ser. 2004; 923:1-122.

Harrington Z, Thomas DP, Currie BJ, Bulkanhawuy J. Challenging perceptions of non-compliance with rheumatic fever prophylaxis in a remote Aboriginal community. Med J Aust. 2006;184(10):514-7.

Stewart T, McDonald R, Currie B. Acute rheumatic fever: adherence to secondary prophylaxis and follow up of Indigenous patients in the Katherine region of the Northern Territory. Aust J Rural Heal. 2007;15(4):234-40.

Charles Musoke et al. Benzathine penicillin adherence for secondary prophylaxis among patients affected with rheumatic heart disease attending mulago hospital. Cardiovasc J Afri. 2013;24(4): 124-9.

Bassili A, Zaher SR, Zaki A, Abdel-Fattah M, Tognoni G. Profile of secondary prophylaxis among children with rheumatic heart disease in Alexandria, Egypt. East Medit Heal J 2000;6:437-46.

Stewart T, McDonald R, Currie B. Acute rheumatic fever: adherence to secondary prophylaxis and follow up of Indigenous patients in the Katherine region of the Northern Territory. Aust J Rural Heal. 2007;15:234-40.