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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 4, July/August 2017
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AFRICA
primary and secondary prevention of RHD are reliably delivered.
To achieve this, an RHD control programme was developed for
implementation in individual health facilities, which includes
an introductory on-site training workshop, dissemination of
educational materials for staff and patients, ongoing supportive
supervisory visits by UTH staff, and assessment of BPG stocks.
Largely as a result of the lessons learned in the initial workshop
described above, four main interventions were incorporated into
the RHD control programme in Zambia.
Creation of durable and accessible educational
materials
A user-friendly allergy-focused educational module, based on
presentations delivered in the original workshop, was developed
into a laminated paper flipchart format for subsequent teaching
and reference in the field without need for electronic audiovisual
support (Fig. 2). The flipchart reviews the topic of drug allergy;
how to recognise and manage a severe allergic reaction; how the
allergy kit is used (see below for description of allergy kit); and
which medicines are indicated for patients with a known allergy
to penicillin. A professionally produced video recording of the
allergy module content was also developed for free electronic
distribution, and a link to the video file was posted to the
PASCAR website for educational purposes.
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Compilation and provision of penicillin allergy kits
Every health centre that is enrolled in the RHD control
programme is provided with a bundled ‘penicillin-allergy kit’
that contains the key materials needed to initiate management
of a penicillin-induced allergic reaction (Fig. 3). The allergy kit
was conceived to be an additional mechanism that complements
training, to help physically prepare health workers to manage
drug allergy, to help build their confidence so that they could
successfully manage an allergic event, and to ultimately reduce
barriers to the administration of injectable penicillin.
The allergy kit contains a set of medications consistent with
World Allergy Organisation guidelines for treating drug allergy,
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including injectable epinephrine with a sterile syringe and
alcohol wipes; an oral non-sedating antihistamine; a short-acting
beta-agonist bronchodilator inhaler; and oral prednisone tablets.
These kits also include concise instructions for emergency steps
to be taken in the event of a serious allergic reaction, a photocopy
of figures from the World Allergy Organisation guidelines, a data
sheet to record clinical events, a pen to complete the data sheet,
and a patient handout. The components are packaged together
in a locally procured, conspicuously labelled plastic box that
was designed for ready availability and ease of transport. The
Fig. 1.
A skills-building, role-playing exercise was conducted
at the Lusaka workshop to help nurses and doctors
build confidence in their ability to successfully recog-
nise and manage medication-induced allergy. Placing
the patient on the back and elevating the lower extrem-
ities is recommended for management of anaphylaxis,
in addition to the immediate administration of adrena-
line.
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Fig. 2.
The BeatRHD Zambia team conducts an on-site intro-
ductory workshop during enrollment of new health
centres into the RHD control programme. The educa-
tional session was flipchart based and included
allergy training as a core component.
Fig. 3.
A specially designed, bundled allergy kit was assem-
bled and distributed to each health centre enrolled
in the RHD control programme. The kit contains
key medicines and other materials, including picto-
rial instructions, needed to initiate management of a
severe drug-allergy event.