Factors Determining Rheumatic Fever Recurrence Among Rheumatic Heart Disease Patients Who Are Taking Monthly Benzanthine G Penicillin Prophylaxis

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Addis Ababa University


Introduction: Rheumatic fever is a major cause of acquired heart disease in children worldwide, with the disease occurring most frequently in underdeveloped countries. ARF and its chronic sequela RHD remain significant causes of morbidity and mortality in Ethiopia. The main priority of long-term management of ARF or RHD is to ensure secondary prophylaxis is adhered to. Despite its importance, the rate and risk factors of rheumatic fever recurrence is not known in Ethiopian children with ARF/RHD. This study will identify ARF recurrence rates and the extent to which ARF is concentrated in certain populations based on age, sex, education, income, and types of valves involved. Objectives: The objective of this study was to identify risk factors for rheumatic recurrence in patients receiving monthly benzanthine G penicillin prophylaxis. Method: We conducted a retrospective review of medical records of 211 eligible patients with rheumatic heart disease at TASH, pediatric cardiac clinic from April /2014 to Aug. 2014. A descriptive and analytic statistics was used as applicable. Statistically significant associations were set at P-value of <0.05. Results: A total of 211 children’s medical records were reviewed. Rheumatic fever recurrence occurred in 22 (10.4%) of the 211 patients. Patients with recurrence of RF were less adherent to monthly BGP prophylaxis than patients without recurrence of RF the odds of nonadherent patients was 19.42 (odds ratio= 19.42, CI= (6.885, 54.766) P= 0.000). Non-adherence to BGP prophylaxis at any time during follow up was detected in 10.9% (23 of the 211) of study subjects. Rates of non-adherence were higher in the group of patients that were younger (27.3%, 9.6%, and 7.4% for children less than or equal to 5 year, 6 to 10 year, and 11 to 15 year of age, respectively) than in the group of patients who were older (p=0.046). Conclusion: We recommend implementation of a registry, and a system of active search of missing patients in every service responsible for the follow-up of RHD/RF patients. Measures to increase adherence to secondary prophylaxis need to be implemented formally, once non-adherence to secondary prophylaxis is the main cause of RF recurrence. Key words: Rheumatic fever recurrence, rheumatic heart disease.



Rheumatic fever recurrence; rheumatic heart disease