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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015
24
AFRICA
associated with adherence and the reasons for missing monthly
benzapen injections.
Methods:
This was a longitudinal, observational study carried
out at Mulago Hospital cardiac clinics over a period of 10
months; 95 consecutive RHD patients who satisfied the inclu-
sion criteria were recruited over a period of four months and
followed up for six months. Data on demographic characteris-
tics and disease status were collected by means of a standard-
ised questionnaire and a card to document the injections of
benzapen received.
Results:
Most participants were female (75; 78.9%). The age
range was five to 55 years with a median of 28 years. The mean
age was 28.1 years (SD 12.2). The highest education level was
primary school for most patients (44, 46.3%) with eight (8.4%)
of the patients being illiterate. Most were in either NYHA stage
II (39, 41.1%) or III (32, 33.7%).
Benzathine penicillin adherence: at least 44 (54%) adhered to
the monthly benzapen prophylaxis, with adherence rates
≥
80%;
38 (46%) patients were classified as non-adherent to the monthly
benzapen, with rates less than 80%. The mean adherence level
was 70.12% (SD 29.25) and the median level was 83.30%.
Factors associated with adherence: higher education status,
and residing near a health facility favoured high adherence.
Painful benzapen injection was the main reason for missed doses.
Conclusion:
The level of non-adherence was significantly high
(46%).The painful nature of the benzapen injections and lack
of transport money to travel to the health centre were the main
reasons for non-adherence among RHD patients in the Mulago
Hospital.
TEACHERS’ KNOWLEDGE AND ATTITUDES RELATED
TO RHEUMATIC HEART DISEASE IN ZAMBIA
Musuku John*
1
, Chipili Joyce
1
, Long Aidan
2
, Tadmor Brigitta
3
,
Spector Jonathan
3
1
University Teaching Hospital, Lusaka; jmusuku2001@yahoo.
co.uk2
Massachusetts General Hospital, USA
3
Novartis Institutes of Biomedical Research
Introduction:
Rheumatic heart disease (RHD) is a major public
health problem in Africa affecting 1–5% of school children.
Community and school involvement is increasingly recognised
to be an essential component of national strategies to control
RHD, but very little is known about teachers’ knowledge and
attitudes about the disease. As part of a public–private partner-
ship to combat RHD in Zambia, school-based screening of up
to 10 000 school children will be conducted in Lusaka for the
first time, using portable echocardiography. In preparation, we
sought to characterise teachers’ knowledge of RHD, explore
their willingness to participate in RHD screening programmes
at their schools, and assess their general interest in participating
in advocacy efforts related to RHD.
Methods:
A workshop was conducted for primary and secondary
school teachers in Lusaka in February 2014. The curriculum was
developed from educational materials produced by the World
Health Organisation and World Heart Federation, and included
a focus group session and written attitude survey. Participants
also completed an eight-item multiple-choice questionnaire
before and after the course to evaluate basic knowledge about
RHD. Mean test scores were compared using paired Wilcoxon
signed rank sum testing (SOFA software, version 1.3.4).
Results:
Fifty-three teachers from more than 45 schools partici-
pated. Most were female. All but threre had been teachers for
at least five years and 26% had taught for more than 15 years.
Approximately half of the teachers also served as their school’s
health officer. Only 55% had ever heard of RHD before the
workshop, and 24% reported that they had known a student
with RHD. Forty-nine per cent of teachers were unaware that
RHD is caused by a bacterial infection of the throat and few
(less than 25%) knew that children with RHD require continual
antibiotics to prevent progression of their heart disease. Pre–
post knowledge scores improved from 3.8/8 (SD 0.9) to 5.9/8
(SD 1.2;
p
<
0.001). In the focus group discussion, teachers
were overwhelmingly eager to help facilitate RHD screening
programmes at their schools. They also expressed interest in
learning more about how to prevent and treat RHD in order to
help keep their students healthy.
Conclusion:
Teachers’ baseline awareness of RHD was poor
and few had first-hand exposure to students with RHD despite
the high prevalence of the disease in Africa. Notwithstanding,
teachers were eager to learn about RHD and they demonstrated
significantly improved knowledge after the workshop. Teachers
in Lusaka appear poised to be vital partners in school-based
screening programmes and may also play important roles in
long-term efforts to control RHD in Zambia.
IMPROVING ACCESS TO SECONDARY PREVENTION
FOR RHEUMATIC HEART DISEASE: KNOWLEDGE AND
SKILLS TRAINING TO ADDRESS FEAR OF ANAPHY-
LACTIC PENICILLIN ALLERGY IN ZAMBIA
Musuku John*
1
, Long Aidan
2
, Spector Jonathan
3
, Tadmor
Brigitta
3
, Habanyama Gloria
1
1
University Teaching Hospital, Lusaka; jmusuku2001@yahoo.
co.uk2
Massachusetts General Hospital, USA
3
Novartis Institutes of Biomedical Research
Introduction:
Identifying barriers to penicillin administration
is vital to the success of secondary prevention programmes for
rheumatic heart disease (RHD). In Zambia we discovered that
fear of anaphylactic penicillin allergy among health workers
was preventing their adherence to standard treatment guide-
lines, which negatively impacted on patient care. To address this
concern, we designed and implemented a city-wide penicillin
allergy workshop. This is, to our knowledge, the first report of
such a workshop in Africa.
Objective:
We sought to characterise changes in knowledge and
skills after implementation of a novel penicillin allergy train-
ing workshop in Lusaka, Zambia, and to determine trainees’
perceptions of the utility of the course.