Adherence to secondary prophylaxis and associated factors among patients with Rheumatic Heart Disease at Jakaya Kikwete Cardiac Institute

Background : In areas of socioeconomic deprivation, rheumatic heart disease (RHD) is a significant cause of morbidity and mortality. Secondary prophylaxis is the most important entity for preventing complications related to rheumatic fever and RHD. Little is known on factors affecting adherence to secondary prophylaxis for RHD in Tanzania. Objective: We aimed to determine the level of self-reported adherence to secondary prophylaxis and its associated factors at Jakaya Kikwete Cardiac Institute (JKCI). Methodology : A hospital-based cross-sectional study was conducted among patients aged 5 years or older with RHD attending JKCI between October 2022 to January 2023. Demographic and clinical information was collected using patient interview and structured questionnaires. Multivariate modified Poisson regression analysis was used to identify independent factors associated with poor adherence to secondary prophylaxis. A P value of <0.05 was considered to indicate statistical significance. Results: A total of 180 patients were enrolled . The mean age (±SD) was 31.0 (±9.9) years. The majority were female (n=125, 69.4%), outpatients (n=132, 73.3%), attained a secondary level of education or higher (n=96, 53.3%) and insured (n=120, 66.7%). A total of 80 (≈44%) participants were on secondary prophylaxis for RHD, of whom 59 (≈74%) had poor adherence. Being older than 18 years (adjusted prevalence ratio (aPR) 2.1, p=0.01), having a longer duration of prophylaxis (aPR 1.7, p=0.01), a lack of awareness of the importance of prophylaxis (aPR 1.4, p=0.003), a lack of awareness on consequence of missing prophylaxis (aPR 1.6, p=0.01), and the painful nature of BPG injection (aPR 1.5, p=0.02) were independently associated with poor adherence to secondary prophylaxis. Conclusion and Recommendation: Uptake and adherence to secondary prophylaxis were poor. Most of the factors affecting secondary prophylaxis adherence were patient-related. Providing health education to patients on the importance of secondary prophylaxis is of paramount importance.