Adherence to Benzathine Penicillin G Secondary Prophylaxis and Its Determinants in Patients with Rheumatic Heart Disease at a Cardiac Center of an Ethiopian Tertiary Care Teaching Hospital

Figures & data

Table 1 Socio-Demographic Characteristics of Study Participants Receiving BPG, TikurAnbessa Specialized Hospital (N=145)

Variables		N(%)
Sex	Male	35(24.1)
	Female	110(75.9)
Age in years	14–28	73(50.3)
	29–58	72(49.7)
Marital status	Single	68(46.9)
	Married	68(46.9)
	Divorced	7(4.8)
	Widowed	2(1.4)
Education status	Unable to write and read	11(7.6)
	Able to write and read	2(1.4)
	Primary school (grade 1–8)	59(40.7)
	Secondary school (grade 9–12)	47(32.4)
	Certificate/diploma	18(12.4)
	Degree and above	8(5.5)
Place of residence	Addis Ababa	84(57.9)
	Outside of Addis Ababa	61(42.1)
Religion	Orthodox	99(68.3)
	Muslim	28(19.3)
	Protestant	18(12.4)
Employment status	Employed	31(21.4)
	Housewife	24(16.6)
	Farmer	3 (2.1)
	Merchant (Self-employed)	22(15.2)
	Student	23(15.9)
	Not working	42(29)
With whom do you live	Family	134(92.4)
	Alone	11(7.6)
Family size in numbers	1–4	76(52.4)
	5–8	63(43.4)
	9–13	6(4.2)
Monthly income (in Birr)	<1000	33(22.8)
	1001–3000	35(24.1)
	3001–5000	20(13.8)
	>5001	15(10.3)
	No income	42(29.0)
How do you get the medicine?	Cash	82(56.6)
	Free	62(42.8)

Table 2 Clinical Characteristics of the Patients with RHD Receiving BPG Prophylaxis, Tikur Anbessa Specialized Hospital (N=145)

Variables		N(%)
Duration since diagnosis of RHD in years	≤10	98(67.6)
	11–20	30(20.7)
	21–33	13(9.0)
	Do not know	4(2.7)
Number of admissions to hospital in the last 1 year	No admission	91(62.8)
	Once	35(24.1)
	Twice	12(8.3)
	Three times	1(0.7)
	Four times	6(4.1)
Co-morbidities	Hypertension	7(4.8)
	Heart failure	15(10.3)
	Stroke	4(2.8)
	Atrial fibrillation	35(24.1)
	Gastric illness	21(14.5)
	Renal disease	7(4.8)
	Diabetes mellitus	2(1.4)

Table 3 BPG-Related Factors in Patients with RHD at Tikur Anbessa Specialized Hospital Addis Ababa, Ethiopia, 2019 (N= 145)

Variables		N(%)
Duration since start of receiving BPG prophylaxis in years	≤10	111(76.6)
	11–20	17(11.7)
	21–33	8(5.5)
	Do not know	9(6.2)
How many drug(s) are you receiving?	One (only BPG)	14(9.7)
	Two	23(15.9)
	Three	33(22.8)
	Four	47(32.4)
	Five and above	28(19.3)
Where did you take BPG injection?	Health center/hospital	76(52.4)
	Private clinic/hospital	67(46.2)
	At home	2(1.4)
In the last 6 months, in how many healthcare facilities have you got BPG injection?	One	106(73.1)
	Two	29(20)
	More than two	8(5.5)
	At home	2(1.4)
Transportation used for going to facility for BPG injection	Taxi/bus	63(43.4)
	Private car	2(1.4)
	By walking	80(55.2)
How long does it take to get to health facility for monthly BPG injection	Less than 20 mins	71(49.0)
	20–40 mins	53(36.6)
	>40 mins–1 hr	8(5.5)
	>1–2 hrs	7(4.8)
	>2 hrs	6(4.1)
Average waiting time for administration of BPG at health facility	<20 mins	90(62.1)
	20–40 mins	38(26.2)
	41 min–1 hour	14(9.6)
	>1–2 hrs	3(2.1)
Experienced side effect related to BPG in recent administration(s)	Twitching or muscle spasm	36(24.8)
	Skin rash around injection site	7(4.8)
	Fever	6(4.1)
	Pain at injection site	80(55.2)
Knowledge on purpose of receiving monthly BPG injection	Yes	75(51.7)
	No	70(76.6)

Note: NB, for some variables, percentage could not add to 100.

Table 4 Practice of Receiving BPG Prophylaxis of Study Participants (N=145)

Variables		N(%)
Number of expected doses per patient	6–8	102(70.3)
	9–11	9(6.2)
	12–13	34(23.4)
Received number of doses per patient	1–3	10(6.9)
	4–6	96(66.92)
	7–8	13(9.0)
	9–12	12(8.3)
	13	13(9.0)
Missed number of doses per patient	1–4	48(33.1)
	5–8	14(9.7)
	>9	3(2.1)
	Never missed	80(55.2)
Amount of late doses per patient	1–4	65(44.8)
	5–8	13(9.0)
	>9	5(3.4)
	Never late	62(42.8)
Uncovered days by BPG due to missing and/or late doses per patient	<28	88(60.7)
	29–112	34(23.4)
	113–225	17(11.7)
	>226	6(4.1)
Patient action on missed/late dose of BPG injection	Wait until the next appointment	39(26.9)
	Go a few days later	67(46.2)

Figure 1 Reasons for missed and/or late doses of BPG.

Abbreviations: HF, health facility; HCPs, healthcare professionals.

Table 5 Adherence Rate in Percentage to BPG Prophylaxis Among Patients Attending Cardiac Adult Clinic of TASH (N=145)

Adherence rate in %	0.00	7.69	16.67	25.00	30.0	33.33	38.46	45.45	50.00	53.85
N(%)	1(0.7)	1(0.7)	1(0.7)	2(0.4)	1(0.7)	5(3.4)	2(1.4)	2(1.4)	8(5.5)	3(2.1)
Cumulative %	0.7	1.4	2.1	3.4	4.1	7.6	9.0	10.3	15.9	17.9
Adherence rate in %	58.33	62.50	66.67	76.92	83.33	84.62	87.50	91.67	92.31	100
N(%)	1(0.7)	7(4.8)	10(6.9)	2(1.4)	13(9)	2(1.4)	1(0.7)	1 (0.7)	2(1.4)	80(55.2)
Cumulative %	18.6	23.4	30.3	31.7	40.7	42.1	42.8	43.4	44.8	100

Table 6 Factors Associated with Adherence to BPG Secondary Prophylaxis Among Study participants (N=145)

Variables/Item Description		COR (95% CI)	AOR (95% CI)	p-value
Educational status	Informal education	7.32 (0.49–110.06)	1.10 (0.023–46.96)	0.961
	Primary school education	1.46(0.40–5.36)	2.60 (0.17–3.83)	0.325
	Secondary school education	0.74 (0.22–2.50)	0.89 (0.10–8.11)	0.918
	Diploma, degree and above	1	1
Religion	Orthodox	0.26 (0.05–1.43)	0.02 (0.00–1.88)	0.094
	Muslim	0.19 (0.03–1.36)	0.03 (0.00–4.24)	0.169
	Protestant	1	1
Number of hospital admissions	Never admitted	5.54 (1.75–17.54)	26.22(2.55–269.70)	0.006
	Once	5.70 (1.47–22.04)	50.08 (2.87–873.77)	0.007
	Twice and above	1	1
Duration since started taking BPG	≤10 years	2.37 (0.49–11.44)	2.34 (0.20–27.03)	0.496
	11–20 years	11.17 (1.27–97.99)	15.12 (0.60-385-21)	0.100
	21–33 years	1	1
Average waiting time for taking BPG at HF	<20 mins	1.21 (0.33–4.50)	0.20(0.01–3.0)	0.252
	20–40 mins	3.92 (0.81–19.00)	1.68 (0.09–29.63)	0.723
	>40 mins	1	1
Knowledge on purpose of receiving BPG	The patient knows the purpose	0.53 (0.23–1.22)	0.32 (0.04–2.48)	0.274
	The patient did not know the purpose	1	1
Action on missed and or late dose	Waiting until the next appointment	0.05 (0.02–0.14)	0.02 (0.00–0.13)	0.000
	Go a few days later	1	1
Reasons for missing/taking late dose	Forgetting to go to health facility	2.15 (0.86–5.35)	1.97(0.40–9.67)	0.402
	Fear of side effect(s)	82.21(9.87–684.35)	0.00 (0.00–0.00)	1.000
	Unwilling for healthcare professionals to administer the drug	4.25 (1.42–12.67)	0.70 (−0.12–3.93)