Long Aidan, Lungu Joyce Chipili, Machila Elizabeth, Schwaninger Sherri, Spector Jonathan, Tadmor Brigitta, Fishman Mark, Mayosi Bongani M, Musuku John
Massachusetts General Hospital, Boston, USA. Email:
University Teaching Hospital, Lusaka, Zambia.
Cardiovasc J Afr. 2017 Jul/Aug;28(4):242-247. doi: 10.5830/CVJA-2017-002.
Rheumatic heart disease is highly prevalent and associated with substantial morbidity and mortality in many resource-poor areas of the world, including sub-Saharan Africa. Primary and secondary prophylaxis with penicillin has been shown to significantly improve outcomes and is recognised to be the standard of care, with intra-muscular benzathine penicillin G recommended as the preferred agent by many technical experts. However, ensuring compliance with therapy has proven to be challenging. As part of a public-private partnership initiative in Zambia, we conducted an educational and access-to-medicine programme aimed at increasing appropriate use of benzathine penicillin for the prevention and management of rheumatic heart disease, according to national guidelines. The programme was informed early on by identification of potential barriers to the administration of injectable penicillin, which included concern by health workers about allergic events. We describe this programme and report initial signs of success, as indicated by increased use of benzathine penicillin. We propose that a similar approach may have benefits in rheumatic heart disease programmes in other endemic regions.
风湿性心脏病在世界上许多资源匮乏地区，包括撒哈拉以南非洲地区，都非常普遍，且与高发病率和死亡率相关。已证明青霉素的一级和二级预防可显著改善预后，并且被公认为是护理标准，许多技术专家推荐肌内注射苄星青霉素G作为首选药物。然而，事实证明确保治疗依从性具有挑战性。作为赞比亚公私伙伴关系倡议的一部分，我们根据国家指南开展了一项教育和药品获取计划，旨在增加苄星青霉素在风湿性心脏病预防和管理中的合理使用。该计划早期通过识别注射用青霉素给药的潜在障碍而制定，这些障碍包括卫生工作者对过敏事件的担忧。我们描述了这个计划，并报告了苄星青霉素使用增加所显示的初步成功迹象。我们建议类似的方法可能对其他流行地区的风湿性心脏病计划有益。
