CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 4, May 2013
AFRICA
127
five to 55 years, with a mean age of 28.1 years (SD 12.2) and
median 28 years. The majority of patients were over 18 years
(73, 76.8%) and 57 (60%) patients were town/city residents
compared to 38 (40%) from rural areas. The majority (44,
46.3%) had primary educational level while eight (8.4%) were
illiterate. Most of the patients were either NYHA class II (39,
41.1%) or III (32, 33.7%). The majority (49, 51.6%) were in the
Baganda tribe.
Fig. 2 shows the levels of adherence after six months of follow
up. Of the 82 patients who completed the six-month follow up,
44 (54%) had adhered to the monthly benzathine penicillin
prophylaxis, with adherence rates
≥
80%; 38 (46%) patients were
classified as non-adherent to the monthly benzathine penicillin,
with rates less than 80%. The mean adherence rate was 70.12%
(SD 29.25) and the median rate was 83.30% with a range of
0–100%. Fig. 3 shows the number of patients across different
adherence levels; 27 (33%) of the patients had extremely poor
adherence rates of
≤
60%.
Of the 82 patients who completed the six-month follow up, 71
(86.6%) presented their cards at follow up and their adherence
rates were assessed objectively by counting the number of
injections received over the follow-up time, compared to the
11(13.4%) who gave a self-report of the number of injections
received. Table 2 shows a lack of significant difference between
adherence levels as measured among these two groups of
patients.
Table 3 shows the patient factors associated with adherence
to the monthly benzathine penicillin prophylaxis. Although
statistically significant associations with adherence were not
found, trends towards adherence were demonstrated among
patients who resided in a town/city (OR 1.73; CI 0.64–4.72) and
those with at least secondary levels of education (OR 2.21; CI
0.83–5.93). There was no difference in the levels of adherence
between those under 18 compared with
≥
18 years. The lack of
previous exposure to benzathine penicillin was not associated
with better adherence.
Table 4 shows the commonest reasons by the respondents for
missing a benzathine penicillin dose. These reasons included
those given by patients who had adherence levels above 80% but
not reaching 100%. The commonest reason for missing a dose
was the painful nature of the benzathine penicillin injection,
reported by 27 respondents (29% of all reasons given). This was
closely followed by lack of transport money to the health facility
to receive the injection. The other reasons included injection
abscesses, attendant too busy at home with children and unable
to go for the injection, they thought it was acceptable to miss
a few times, one patient had valvular surgical repair and was
advised by the local health practitioner that there was no need
for any more injections.
Fig. 3. Bar graph showing the number of patients across
different adherence levels.
50
45
40
35
30
25
20
15
10
5
0
0
1–20 21–40 41–60 61–80 81–100
Number of patients
Adherence levels
3
4
9
11
11
44
TABLE 3. PATIENT FACTORSASSOCIATEDWITHADHERENCE TO
MONTHLY BENZATHINE PENICILLIN PROPHYLAXIS
Variable
≥
80%
adherence
n
=
44
(%)
<
80%
adherence
n
=
38
(%) OR
(95% CI)
p
-value
Age
<
18 years
10 (22.7) 8 (21.1) 1.10 (0.34–3.58) 0.855
≥
18 years
34 (77.3) 30 (78.9)
Patients’ home
Town/city
30 (68.2 21(55.3) 1.73 (0.64–4.72) 0.229
Rural
14 (31.8 17 (44.7)
Gender
Female
33(75.0) 33(86.8) 0.45 (0.12–1.63) 0.177
Male
11(25.0)
5(13.2)
Level of education
1
Secondary and above
26(59.1) 15 (39.5) 2.21 (0.83–5.93) 0.076
Less than secondary
18 (40.9) 23 (60.5)
Employment status
2
Currently employed
13(29.5) 13(34.2) 0.81 (0.29–2.26) 0.651
Unemployed
31(70.5) 25(65.8)
NYHA stage
I and II
22(50.0) 21(55.3) 0.81 (0.31–2.12) 0.634
III and IV
22(50.0) 17(44.7)
Tribe
Ganda
21(47.7) 19(50.0) 0.91 (0.35–2.38) 0.837
Other
23(52.3) 19 (50.0)
Previous use of benzathine
3
No
41(93.2) 37(97.4) 0.37 (0.01–4.28) 0.380
Yes
3(6.8)
1(2.6)
1
Employment status for the attendants was considered for children and students.
2
For patients
<
13 years, education level of primary caretaker was considered.
3
Fisher’s exact test was used. OR
=
odds ratio, CI
=
confidence interval.
TABLE 4. REASONS FOR MISSING MONTHLY BENZATHINE
PROPHYLAXIS INJECTIONS
Reasons
for missing
Frequency
Percentage of
responses
(93
responses)
Injection painful
27
29
Did not have transport money
25
26.9
Felt healthy and well
11
11.8
Away from home
7
7.5
Friends advised me otherwise
4
4.3
Felt sick and unable to take the injection
3
3.2
Other
16
17.2
Total
93
100
TABLE 2. COMPARISON BETWEEN OBJECTIVEAND SUBJECTIVE
ASSESSMENT OFADHERENCE
Variable
<
80%
adherence
(
n
=
38)
≥
80%
adherence
(
n
=
44)
OR
(95% CI)
p
-value
Came with card 32 (84.2) 39 (88.6) 0.684 (0.191–2.448) 0.558
Self report
6 (15.8)
5 (11.4)
