Non adherence to secondary prophylaxis for rheumatic fever

Authors

  • Santosh K. Saha Department of Pediatric Cardiology, National Institute of Cardiovascular Diseases and Hospital, Dhaka, Bangladesh
  • Kamrun N. Choudhury Department of Epidemiology, National Centre for Control of Rheumatic Fever and Heart Disease, Dhaka, Bangladesh
  • Nihar R. Sarker Department of Pediatrics, Shaheed Suharawardy Medical College, Dhaka, Bangladesh
  • Gias U. Ahmed Department of Pediatrics, Faridpur Medical College, Faridpur, Bangladesh
  • Nazmul Hoque Department of Pediatrics, Union Hospital, Cox’s Bazar, Bangladesh

DOI:

https://doi.org/10.18203/2349-3291.ijcp20204536

Keywords:

Benzathine penicillin, Prophylaxis, Rheumatic fever, Rheumatic heart disease

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.

Author Biography

Santosh K. Saha, Department of Pediatric Cardiology, National Institute of Cardiovascular Diseases and Hospital, Dhaka, Bangladesh

Assistant Professor

Department of Pediatric Cardiology

National Institute of Cardiovascular Diseases

Dhaka, Bangladesh.

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Published

2020-10-21

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Original Research Articles