A programme to increase appropriate usage of benzathine penicillin for management of streptococcal pharyngitis and rheumatic heart disease in Zambia

Abstract

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.

Fig. 1.

A skills-building, role-playing exercise was conducted at the Lusaka workshop to help nurses and doctors build confidence in their ability to successfully recognise and manage medication-induced allergy. Placing the patient on the back and elevating the lower extremities is recommended for management of anaphylaxis, in addition to the immediate administration of adrenaline.

Fig. 2.

The BeatRHD Zambia team conducts an on-site introductory workshop during enrollment of new healthcentres into the RHD control programme. The educationalsession was flipchart based and included allergy training as a core component.

Fig. 3.

A specially designed, bundled allergy kit was assembled and distributed to each health centre enrolled in the RHD control programme. The kit containskey medicines and other materials, including pictorialinstructions, needed to initiate management of asevere drug-allergy event.