Benzathine Penicillin injection for prevention of acute rheumatic heart disease: Assessment of knowledge and practice among healthcare providers

Background: Rheumatic fever and its sequel, rheumatic heart disease, continue to be major causes of morbidity and mortality in low-income regions, particularly in Sub-Saharan Africa. Prophylaxis with benzathine penicillin G is widely recommended as a key, cost-effective method for the prevention of the first episode or recurrent episode of rheumatic heart disease. More than 80% of the dose, the monthly dose, should be taken to effectively prevent rheumatic heart disease. Many studies showed a less than 80 percent adherence rate among rheumatic heart disease patients. The purpose of this study was to analyze nurses' knowledge, attitudes, and practice of administering benzathine penicillin at primary healthcare facilities in Jimma Zone, Ethiopia. Methods: A healthcare facility-based cross-sectional study was conducted on 252 nurses working in two hospitals and twenty-seven health centers in Jimma Zone in Ethiopia from the 21st of February, 2022, to the 20th of May, 2022. The data was collected using a structured self-administered English questionnaire, with the components intended to assess their knowledge, attitude, and practice regarding knowledge of benzathine penicillin G injection and attitudes toward its administration and practice. The collected data is checked for completeness, cleaned, and then entered into EpiData for analysis. Descriptive statistics were utilized, and multivariable logistic regression was conducted to identify independent factors associated with the level of knowledge, attitude, and practice, with a significance threshold set at P < 0.05. KAP scores were also compared between sex, age, profession, baseline reading, and in-service training groups using the Mann–Whitney U-test using the SPSS program. Results: The study analyzed 252 nurses involved in the administration of benzathine penicillin G, with a mean age of 30.35±5.47 years, and 65.5% of them were male. Experience in the healthcare setting ranged from five years to ten years. Fifty percent of the participants lacked knowledge about benzathine penicillin injection. The majority of participants (63.1%) had a bad attitude, while 82.6% had positive experiences with benzathine penicillin injections. 13.1% of participants are afraid of side effects, and 15.1% are afraid that a needle blockage during injection will interfere with their benzathine penicillin injection. The participant's level of knowledge (p-value < 0.012), year of practice, and attitude (p-values < 0.02 and < 0.01, respectively) were significantly associated with the practice of benzathine penicillin injection. Conclusion : The study showed that the majority of healthcare professionals had good practice with benzathine penicillin injection, about half of them had poor understanding, and the other half had a negative attitude toward benzathine penicillin G injection. This might limit the adequacy of primary and secondary prophylaxis, resulting in an increased risk of reinfection and early advancement of the damage, leading to higher morbidity and mortality in an already overburdened context, necessitating continual health professionals' awareness creation.