College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.
Clinical Services, Apunipima Cape York Health Council, Cairns, Queensland, Australia.
J Paediatr Child Health. 2021 Mar;57(3):419-424. doi: 10.1111/jpc.15239. Epub 2020 Dec 19.
Secondary prophylaxis with 3-4 weekly benzathine penicillin G injections is necessary to prevent disease morbidity and cardiac mortality in patients with acute rheumatic fever (ARF) and rheumatic heart disease (RHD). This study aimed to determine secondary prophylaxis adherence rates in the Far North Queensland paediatric population and to identify factors contributing to suboptimal adherence.
A retrospective analysis of data recorded in the online RHD register for Queensland, Australia, was performed for a 10-year study period. The proportion of benzathine penicillin G injections delivered within intervals of ≤28 days and ≤35 days was measured. A multi-level mixed model logistic regression assessed the influence of age, gender, ethnicity, suburb, Accessibility and Remoteness Index of Australia class, number of people per dwelling, Index of Relative Socio-economic Advantage and Disadvantage, Index of Education and Occupation, year of inclusion on an ARF/RHD register and individual effect.
The study included 277 children and analysis of 7374 injections. No children received ≥80% of recommended injections within a 28-day interval. Four percent received ≥50% of injections within ≤28 days and 46% received ≥50% of injections at an extended interval of ≤35 days. Increasing age was associated with reduced delivery of injections within 35 days. Increasing year of inclusion was associated with improved delivery within 28 days. The random effect of individual patients was significantly associated with adherence.
Improved timely delivery of secondary prophylaxis for ARF and RHD is needed as current adherence is very low. Interventions should focus on factors specific to each individual child or family unit.
对于急性风湿热（ARF）和风湿性心脏病（RHD）患者，需要每 3-4 周进行苄星青霉素 G 肌内注射进行二级预防，以预防疾病发病和心脏死亡。本研究旨在确定北昆士兰儿科人群的二级预防依从率，并确定导致依从性不佳的因素。
对澳大利亚昆士兰州 RHD 在线注册数据库进行了为期 10 年的回顾性数据分析。测量了在≤28 天和≤35 天的间隔内注射苄星青霉素 G 的比例。多水平混合模型逻辑回归评估了年龄、性别、种族、郊区、澳大利亚可达性和偏远指数分类、每户人数、相对社会经济优势和劣势指数、教育和职业指数、纳入 ARF/RHD 登记册的年份以及个体效应等因素对青霉素 G 注射的影响。
研究纳入了 277 名儿童，分析了 7374 次注射。没有儿童在 28 天的间隔内接受了≥80%的推荐注射。4%的儿童在≤28 天内接受了≥50%的注射，46%的儿童在≤35 天的延长间隔内接受了≥50%的注射。年龄增加与 35 天内注射次数减少有关。纳入年份的增加与 28 天内注射次数的增加有关。个体患者的随机效应与依从性显著相关。
需要改善 ARF 和 RHD 的二级预防及时给药，因为目前的依从率非常低。干预措施应针对每个儿童或家庭单位的具体因素。
