Department of Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda. Email:
Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.
Cardiovasc J Afr. 2023;34(2):89-92. doi: 10.5830/CVJA-2022-029. Epub 2022 Sep 23.
Diagnosis of acute rheumatic fever (ARF) is mainly clinical. Delayed or missed diagnosis and failure to administer appropriate and timely treatment of ARF leads to rheumatic heart disease (RHD), which could necessitate expensive treatments such as open-heart surgery. Implementation of preventative guidelines depends on availability of trained healthcare workers. As part of the routine support supervision, the Uganda Heart Institute sent out a team to rural eastern Uganda to evaluate health workers' knowledge level regarding management of ARF.
Health workers from selected health facilities in Tororo district, eastern Uganda, were assessed for their knowledge on the clinical features and role of benzathine penicillin G (BPG) in the treatment and prevention of ARF recurrence. Using the RHD Action Needs assessment tool, we generated and administered a pre-test, then conducted training and re-administered a post-test. Eight months later, health workers were again assessed for knowledge retention and change in practices. Statistical analysis was done using Stata version 15.
During the initial phase, 34 of the 109 (31%) health workers passed the pre-test, indicating familiarity with clinical features of ARF. The level of knowledge of BPG use in ARF was very poor in all the health units [25/109 (22.6%)] but improved after training to 80%, as shown by the chi-squared test ( = 0.000). However, retention of this knowledge waned after eight months and was not significantly different compared to pre-training ( ≥ 0.2).
A critical knowledge gap is evident among health workers, both in awareness and treatment of ARF, and calls for repetitive training as a priority strategy in prevention.
急性风湿热（ARF）的诊断主要基于临床症状。如果对 ARF 的诊断延迟或误诊，或者未能及时给予适当的治疗，可能会导致风湿性心脏病（RHD），这可能需要昂贵的治疗，如心脏直视手术。预防性指南的实施取决于是否有经过培训的医疗保健工作者。乌干达心脏研究所作为常规支持监督的一部分，派出一个小组前往乌干达东部农村，评估卫生工作者在管理 ARF 方面的知识水平。
对来自 Tororo 区选定卫生机构的卫生工作者进行评估，了解他们对 ARF 的临床特征以及苄星青霉素 G（BPG）在治疗和预防 ARF 复发中的作用的了解程度。我们使用 RHD 行动需求评估工具生成并进行了预测试，然后进行培训并重新进行了后测试。八个月后，再次评估卫生工作者的知识保留和实践变化。使用 Stata 版本 15 进行统计分析。
在初始阶段，109 名卫生工作者中有 34 名（31%）通过了预测试，表明他们熟悉 ARF 的临床特征。所有卫生单位的 BPG 在 ARF 中的使用知识水平都非常低[109/25（22.6%）]，但培训后提高到 80%，卡方检验（ = 0.000）。然而，八个月后，这种知识的保留率下降，与培训前相比没有显著差异（ ≥ 0.2）。
卫生工作者在 ARF 的意识和治疗方面都存在明显的知识差距，需要重复培训作为预防的优先策略。
