Daniel Engelman1,2,3, Reapi L Mataika4, Joseph H Kado4,5,6, Maureen Ah Kee6, Susan Donath1,2, Tom Parks7, Andrew C Steer1,2,3. 1. Department of Paediatrics, University of Melbourne, Parkville, Vic, Australia. 2. Murdoch Childrens Research Institute, Parkville, Vic, Australia. 3. Royal Children's Hospital, Parkville, Vic, Australia. 4. Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji. 5. College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji. 6. Fiji Rheumatic Heart Disease Control Program, Suva, Fiji. 7. Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK.
Abstract
OBJECTIVES: Echocardiographic screening for rheumatic heart disease (RHD) can detect subclinical cases; however, adequate adherence to secondary antibiotic prophylaxis (SAP) is required to alter disease outcomes. We aimed to investigate the adherence to SAP among young people with RHD diagnosed through echocardiographic screening in Fiji and to investigate factors associated with adherence. METHODS: Patients diagnosed with RHD through echocardiographic screening in Fiji from 2006 to 2014 were included. Dates of benzathine penicillin G injections were collected from 76 health clinics nationally from December 2011 to December 2014. Adherence was measured using the proportion of days covered (PDC). Multivariate logistic regression analysis was used to identify characteristics associated with any adherence (≥1 injection received) and adequate adherence (PDC ≥0.80). RESULTS: Of 494 patients, 268 (54%) were female and the median age was 14 years. Overall, 203 (41%) had no injections recorded and just 33 (7%) had adequate adherence. Multivariate logistic regression showed increasing age (OR 0.93 per year, 95% CI 0.87-0.99) and time since diagnosis ≥1.5 years (OR 0.53, 95% CI 0.37-0.79) to be inversely associated with any adherence. Non-iTaukei ethnicity (OR 2.58, 95%CI 1.04-6.33) and urban residence (OR 3.36, 95% CI 1.54-7.36) were associated with adequate adherence, whereas time since diagnosis ≥1.5 years (OR 0.38, 95%CI 0.17-0.83) was inversely associated with adequate adherence. CONCLUSIONS: Adherence to SAP after screening in Fiji is currently inadequate for individual patient protection or population disease control. Secondary prevention should be strengthened before further screening can be justified.
OBJECTIVES: Echocardiographic screening for rheumatic heart disease (RHD) can detect subclinical cases; however, adequate adherence to secondary antibiotic prophylaxis (SAP) is required to alter disease outcomes. We aimed to investigate the adherence to SAP among young people with RHD diagnosed through echocardiographic screening in Fiji and to investigate factors associated with adherence. METHODS: Patients diagnosed with RHD through echocardiographic screening in Fiji from 2006 to 2014 were included. Dates of benzathine penicillin G injections were collected from 76 health clinics nationally from December 2011 to December 2014. Adherence was measured using the proportion of days covered (PDC). Multivariate logistic regression analysis was used to identify characteristics associated with any adherence (≥1 injection received) and adequate adherence (PDC ≥0.80). RESULTS: Of 494 patients, 268 (54%) were female and the median age was 14 years. Overall, 203 (41%) had no injections recorded and just 33 (7%) had adequate adherence. Multivariate logistic regression showed increasing age (OR 0.93 per year, 95% CI 0.87-0.99) and time since diagnosis ≥1.5 years (OR 0.53, 95% CI 0.37-0.79) to be inversely associated with any adherence. Non-iTaukei ethnicity (OR 2.58, 95%CI 1.04-6.33) and urban residence (OR 3.36, 95% CI 1.54-7.36) were associated with adequate adherence, whereas time since diagnosis ≥1.5 years (OR 0.38, 95%CI 0.17-0.83) was inversely associated with adequate adherence. CONCLUSIONS: Adherence to SAP after screening in Fiji is currently inadequate for individual patient protection or population disease control. Secondary prevention should be strengthened before further screening can be justified.
Authors: Daniel Engelman; Gavin R Wheaton; Reapi L Mataika; Joseph H Kado; Samantha M Colquhoun; Bo Remenyi; Andrew C Steer Journal: Heart Asia Date: 2016-11-28
Authors: Mohammed M Mougrabi; Raghad Sami Aljuaid; Aeshah Dakhel Alrabie; Nouran Khalid Althumali; Lama Humaied Alkhaldi; Waad Dhaifallah Alotaibi Journal: J Family Med Prim Care Date: 2021-08-27
Authors: Renato Pedro de Almeida Torres; Rômulo Francisco de Almeida Torres; Gabrielle de Crombrugghe; Scarllet Palacin Moraes da Silva; Sarah Leticia Veroneze Cordeiro; Karine Alessandra Bosi; Pierre R Smeesters; Rosângela Stadnick Lauth de Almeida Torres Journal: Front Cardiovasc Med Date: 2021-06-23