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Multicenter Study
. 2025 Aug 9;25(1):594.
doi: 10.1186/s12872-025-05069-w.

Adherence to benzathine penicillin prophylaxis and associated factors in patients with rheumatic heart disease attending two public hospitals in Bahir dar, Ethiopia

Gubaynew Getie Kelemu  1 , Yohannes Tekleab Yihun  2 , Destaw Endeshaw  3 , Eyob Ketema Bogale  4
Affiliations
Multicenter Study

Adherence to benzathine penicillin prophylaxis and associated factors in patients with rheumatic heart disease attending two public hospitals in Bahir dar, Ethiopia

Gubaynew Getie Kelemu et al. BMC Cardiovasc Disord. .

Abstract

Background: Regular intramuscular injection of benzathine penicillin every two to four weeks is a critical and cost-effective secondary prevention strategy for reducing morbidity and mortality from rheumatic heart disease (RHD), particularly in resource-limited settings like Ethiopia. However, there is limited evidence of adherence to this prophylaxis. Therefore, this study aimed to assess adherence to benzathine penicillin prophylaxis used for secondary prevention and its associated factors among patients with RHD attending follow-up clinics at two public referral hospitals in Bahir Dar, Ethiopia.

Methods: A hospital-based cross-sectional study was conducted among 346 patients with RHD attending the follow-up clinic at Tibebe Ghion and Felege Hiwot specialized hospitals from October 1st, 2023 to January 20, 2024. Data was collected through questionnaire-based face-to-face interviews and a review of medical records. The data was entered into EpiData version 3.1 and exported to SPSS version 27 for analysis. Binary logistic regression analysis was performed to identify factors associated with good adherence to benzathine penicillin prophylaxis. Adjusted odds ratio at a p-value of less than 0.05 was used to assess the strength of the statistical association.

Results: Among 346 patients with RHD (97% response rate), the study found an overall adherence rate of 63.6% (95% CI, 58.6-68.8) to benzathine penicillin G (BPG) prophylaxis. Factors associated with good adherence included mild to moderate pain at the injection site (AOR = 2.44; 95% CI 1.45-4.09), good awareness of the purpose of BPG (AOR = 1.99; 95% CI, 1.11-3.59), urban residence of patients (AOR = 3.58, 95% CI 1.99-6.41), prophylaxis duration of ≤ 5 years (AOR = 4.15, 95% CI 1.58-10.88), prophylaxis duration 5-10 years (AOR = 3.83, 95% CI 1.32-11.13), and no history of admission in the last year (AOR = 3.05; 95% CI 1.67-5.54).

Conclusions: The level of good adherence in this study is sub-optimal. Factors positively associated with adherence included urban residence, mild to moderate injection site pain, awareness of BPG purpose, shorter prophylaxis duration, and absence of recent hospital admissions. To improve adherence, healthcare providers should implement targeted patient education programs and adopt effective pain management strategies as part of routine follow-up care.

Keywords: Adherence; Benzathine penicillin g; Rheumatic heart disease; Secondary prophylaxis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The research has been performed in accordance with the Declaration of Helsinki. Ethical clearance was obtained from the Bahir Dar University College of Medicine and Health Sciences Institutional Review Board (Ref. No: 800/2023). Permission was also secured from the FHCSH and TGSH outpatient departments. Informed consent was taken from each adult patient with RHD and consent was taken from attendants/family for patients under 18 years old. Data obtained in the course of the study was handled by the research team. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable.

Figures

Fig. 1
Fig. 1
Adherence to BPG secondary prophylaxis among RHD patients in Tibebe-Ghion and Felege-Hiwot specialized Hospitals, Bahir Dar, Northwest Ethiopia, 2024 (n = 346)
Fig. 2
Fig. 2
Reasons for missed doses of BPG among RHD patients receiving BPG prophylaxis in Tibebe-Ghion and Felege-Hiwot Specialized Hospitals, Bahir Dar, Northwest Ethiopia, 2024 (n = 180)
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