Adem Alinur, Dukessa Gemechu Tadesse, Jarso Habtemu, Reta Wondu
Department of Internal Medicine, Institute of Health Science, Jimma University, Jimma, Oromia, Ethiopia.
Department of Biostatistics and Epidemiology, Institute of Health Science, Jimma University, Jimma, Oromia, Ethiopia.
Patient Prefer Adherence. 2020 Dec 4;14:2399-2406. doi: 10.2147/PPA.S281413. eCollection 2020.
Rheumatic heart disease (RHD) is a major cause of preventable premature cardiovascular-related death in developing countries. However, information regarding adherence rates and associated factors is limited and inconsistent in Ethiopia.
A cross-sectional study was conducted from August to November 2019 among selected RHD patients on follow-up at four hospitals in Jimma zone. Data were collected using a structured questionnaire. Adherence of RHD patients to secondary prophylaxis in the previous consecutive 12 months was assessed based on the annual frequency of received prophylaxis (monthly injection of benzathine penicillin). Good adherence was considered the patient receiving >80% of the annual dose. The collected data were entered into Epidata 3.1 and analysed using SPSS 23.
A total of 253 RHD patients taking prophylaxis were included in the analysis, and of those 178 (70.4%) were female, giving a male:female ratio of 1:2.4. The mean age was 24±11 (6-65) years. About 63% had good adherence to benzathine penicillin prophylaxis. New York Heart Association functional class I and II, rural residence, >30 km from health facility, and duration of prophylaxis >5 years were associated with poor adherence (respectively: AOR 12.6 [95% CI 2.5-63], =0.016; AOR 6.8 [95% CI 1.9-24.4], =0.003; AOR 5.5 [95% CI 1.2-26.7], =0.046; AOR 1.2 [95% CI 1.1-3.2], =0.021). Leading barriers to good adherence were long distance from the treatment setting (56.9%), followed by lack of money (38%).
Patients with class I and II heart failure and those living in rural areas, especially >30 km from a hospital, were identified to be poorly adherent to secondary prophylaxis.
风湿性心脏病（RHD）是发展中国家可预防的过早心血管相关死亡的主要原因。然而，在埃塞俄比亚，关于依从率及相关因素的信息有限且不一致。
2019年8月至11月，在吉马地区的四家医院对选定的接受随访的风湿性心脏病患者进行了一项横断面研究。使用结构化问卷收集数据。根据苄星青霉素的年度注射频率（每月注射苄星青霉素）评估风湿性心脏病患者在过去连续12个月内二级预防的依从性。良好依从性被定义为患者接受的剂量超过年度剂量的80%。收集的数据录入Epidata 3.1并使用SPSS 23进行分析。
共有253名接受预防治疗的风湿性心脏病患者纳入分析，其中178名（70.4%）为女性，男女比例为1:2.4。平均年龄为24±11（6 - 65）岁。约63%的患者对苄星青霉素预防有良好依从性。纽约心脏协会心功能I级和II级、农村居民、距离医疗机构>30公里以及预防时间>5年与依从性差有关（分别为：调整后比值比12.6 [95%可信区间2.5 - 63]，P = 0.016；调整后比值比6.8 [95%可信区间1.9 - 24.4]，P = 0.003；调整后比值比5.5 [95%可信区间1.2 - 26.7]，P = 0.046；调整后比值比1.2 [95%可信区间1.1 - 3.2]，P = 0.021）。良好依从性的主要障碍是距离治疗地点远（56.9%），其次是缺钱（38%）。
心功能I级和II级的患者以及农村地区的患者，尤其是距离医院>30公里的患者，二级预防依从性较差。
