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Secondary prevention of rheumatic heart disease in Ethiopia: a multicenter study.
Belay, Wubishet; Dessie, Azene; Ahmed, Hayat; Gedlu, Etsegenet; Mariyo, Abinet; Shehibo, Abdulkadir; Tigabu, Zemene; Aliyu, Muktar H; Soslow, Jonathan.
  • Belay W; Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way 5th Floor, Nashville, TN, 37232, USA. Wubishet.belay@vumc.org.
  • Dessie A; Cardiac Center Ethiopia, Addis Ababa, Ethiopia.
  • Ahmed H; Black Lion Specialized Referral Hospital, Addis Ababa University College of Medicine and Health Sciences, Addis Ababa, Ethiopia.
  • Gedlu E; Black Lion Specialized Referral Hospital, Addis Ababa University College of Medicine and Health Sciences, Addis Ababa, Ethiopia.
  • Mariyo A; College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
  • Shehibo A; College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
  • Tigabu Z; College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
  • Aliyu MH; Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA.
  • Soslow J; Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way 5th Floor, Nashville, TN, 37232, USA.
BMC Cardiovasc Disord ; 22(1): 26, 2022 02 02.
Article in English | MEDLINE | ID: covidwho-2153508
ABSTRACT

BACKGROUND:

Ethiopia has a high acute rheumatic fever (ARF) and rheumatic heart disease (RHD) prevalence, and to our knowledge, there are no data on the status of secondary prevention in children with RHD. This study describes the status of secondary RHD prevention.

METHODS:

A multicenter, prospective study was performed on children aged 5-17 years with RHD in Ethiopia. Good adherence was defined as at least 80% completion of benzathine penicillin (BPG) or oral Amoxicillin within the previous year. The primary outcome measure was adherence to prophylaxis, expressed as a proportion. Socio-demographics, severity of RHD, and ARF recurrence were evaluated.

RESULTS:

A total of 337 children with a mean age of 12.9 ± 2.6 years were included. The majority (73%) had severe aortic/mitral disease. Participants were on BPG (80%) or Amoxicillin (20%) prophylaxis. Female sex (P = 0.04) use of BPG (0.03) and shorter mean duration of prophylaxis in months (48.5 ± 31.5 vs. 60.7 ± 33, respectively, P < 0.008) predicted good adherence. Running out of medications (35%), interrupted follow-up (27%), and the COVID-19 pandemic (26%) were the most common reasons for missing prophylaxis. Recurrence of ARF was higher in participants on Amoxicillin compared with BPG (40% vs. 16%, P < 0.001) and in those with poor adherence compared with good adherence (36.8% vs. 17.9%, respectively, P = 0.005). Type and duration of prophylaxis (OR 0.5, CI = 0.24, 0.9, P = 0.02; OR = 1.1, CI = 1.1, 1.2, P = 0.04, respectively), and sex (OR = 1.9, CI = 1.1, 3.4, P = 0.03) were independent predictors of poor adherence.

CONCLUSION:

Poor adherence is prevalent in Ethiopian children living with RHD. Amoxicillin is a suboptimal option for prophylaxis as its use is associated with lower adherence and a higher rate of ARF recurrence.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Penicillin G Benzathine / Rheumatic Heart Disease / Secondary Prevention / Amoxicillin / Anti-Bacterial Agents Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Adolescent / Child / Child, preschool / Female / Humans / Male Country/Region as subject: Africa Language: English Journal: BMC Cardiovasc Disord Journal subject: Vascular Diseases / Cardiology Year: 2022 Document Type: Article Affiliation country: S12872-022-02473-4

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Penicillin G Benzathine / Rheumatic Heart Disease / Secondary Prevention / Amoxicillin / Anti-Bacterial Agents Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Adolescent / Child / Child, preschool / Female / Humans / Male Country/Region as subject: Africa Language: English Journal: BMC Cardiovasc Disord Journal subject: Vascular Diseases / Cardiology Year: 2022 Document Type: Article Affiliation country: S12872-022-02473-4