Rheumatic Heart Disease Patients’ Adherence to Secondary Prophylaxis and Associated Factors at Hospitals in Jimma Zone, Southwest Ethiopia: A Multicenter Study

Figures & data

Table 1 Sociodemographic characteristics of patients with rheumatic heart disease on monthly benzathine penicillin at four hospitals in Jimma zone from August to November 2019

		n	%
Hospital	Jimma Medical Center	197	77.9
	Agaro	8	3.2
	Shenen Gibe	37	14.6
	Seka Chekorsa	11	4.3
Age (years)	<15	47	18.6
	15–24	97	38.3
	>24	109	43.1
Sex	Male	75	29.6
	Female	178	70.4
Ethnicity	Oromo	185	73.1
	Amhara	30	11.9
	Kafa/Dawuro	19	7.5
	Gurage	14	5.5
	Silte	4	1.6
	Kimant	1	0.4
Religion	Muslim	191	75.5
	Orthodox	41	16.2
	Protestant	21	8.3
Residence	Rural	167	66.0
	Urban	86	34.0
Distance from health facility (km)	1–5	62	24.5
	6–10	10	4.0
	11–20	49	19.4
	21–30	37	14.6
	>30	95	37.5
Family size	≤5	72	28.5
	>5	181	71.5
Monthly household income (US$)	≤33.3	85	38.1
	33.3–66.67	88	39.5
	>66.67	50	22.4

Table 2 Clinical characteristics of participants with RHD on monthly benzathine penicillin at four hospitals in Jimma zone from August to November, 2019

	Categories	n	%
Any hospitalization history for RHD	Yes	188	74.3
	No	65	25.7
Duration on medication (years)	≤5	144	56.9
	>5	109	43.1
Condition of patient (NYHA class)	NYHA class I	89	35.2
	NYHA class II	143	56.5
	NYHA class III	13	5.1
	NYHA class IV	8	3.2
Other cases of RHD in the family	Yes	14	5.5
	No	239	94.5

Abbreviations: RHD, rheumatic heart disease; NYHA, New York Heart Association.

Figure 1 Adherence status of RHD patients to secondary prophylaxis.

Table 3 Factors associated with adherence status of RHD patients to secondary prophylaxis by cross-tabulation and logistic regression

		Adherence, n (%)		COR (95% CI)	P-value	AOR (95% CI)	P-value
		Poor	Good
Residence	Rural	87 (34.4)	80 (31.6)	14.5 (5.9–35)	<0.001^+	6.8 (1.9–24.4)	0.003*
	Urban	6 (2.4)	80 (31.6)	1		1
Sex	Male	22 (8.7)	53 (20.9)	1	0.113	1	0.071
	Female	71 (28.1)	107 (42.3)	1.6 (0.9–2.8)		2.1 (0.9–4.6)
Age (years)	<15	12 (4.7)	35 (13.8)	0.5 (0.2–1.0)	0.079	0.4 (0.1–1.4)	0.164
	15–24	37 (14.6)	60 (23.7)	0.9 (0.5–1.3)	0.740	1.1 (0.5–2.6)	0.836
	>24	44 (17.4)	65 (25.7)	1		1
Distance from health facility (km)	≤5	3 (1.2)	59 (23.3)	1		1
	6–10	5 (2.0)	5 (2.0)	19.7 (3.6–107)	<0.001^+	10 (1.1–96)	0.056*
	11–20	22 (8.7)	27 (10.7)	16.0 (4.4–58)	<0.001^+	4.2 (0.7–22.9)	0.098
	21–30	14 (5.5)	23 (9.1)	11.9 (3.1–45)	<0.001^+	2.9 (0.5–16.1)	0.230
	>30	49 (19.4)	46 (18.2)	20.9 (6.1–71)	<0.001^+	5.5 (1.2–26.7)	0.031*
Family size	≤5	18 (7.1)	54 (21.3)	1		1
	>5	75 (29.6)	106 (41.9)	2.1 (1.1–3.9)	0.016^+	1.5 (0.7–3.4)	0.313
Income category ($US)	≤33.3	38 (17.0)	47 (21.1)	4.9 (2.0–12.2)	<0.001^+	1.1 (0.3–3.8)	0.830
	33.3–66.67	37 (16.6)	51 (22.9)	4.4 (1.8–11)	<0.001^+	2.1 (0.6–6.6)	0.227
	>66.67	7 (3.1)	43 (19.3)	1		1
Duration of prophylaxis	≤5 years	42 (16.6)	102 (40.3)	1		1
	>5 years	51 (20.2)	58 (22.9)	2.1 (1.2–3.6)	0.004^+	1.2 (1.1–3.2)	0.021*
Duration of disease	<5 years	42 (16.6)	101 (39.9)	1		1
	≥5 years	51 (20.2)	59 (23.3)	2.1 (1.2–3.5)	0.006^+	1.1 (1.0–3.3)	0.061*
Hospitalization history	Yes	73 (28.9)	115 (45.5)	1.4 (0.7–2.6)	0.247	1.4 (0.6–3.3)	0.390
	No	20 (7.9)	45 (17.8)	1		1
Family history of RHD	Yes	8 (3.2)	6 (2.4)	1		1
	No	85 (33.6)	154 (60.9)	0.4 (0.1–1.2)	0.113	0.4 (0.1–1.7)	0.231
Condition of patient (NYHA)	I and II	91 (36.0)	141 (55.7)	6.1 (1.4–26)	0.002^+	12.6 (2.5–63)	0.016*
	III and IV	2 (0.8)	19 (7.5)	1		1
Injection pain	Mild	43 (17.0)	69 (27.3)	1		—
	Moderate	45 (17.8)	78 (30.8)	0.9 (0.5–1.5)	0.775	—
	Severe	5 (2.0)	13 (5.1)	0.6 (0.2–1.8)	0.390

Notes: *Statistically significant; ⁺statistically significant on logistic regression analysis.

Abbreviations: RHD, rheumatic heart disease; NYHA, New York Heart Association.

Figure 2 Distribution of reasons for missing monthly benzathine penicillin injections among RHD patients on follow-up at the four hospitals in Jimma zone, August to November 2019.