CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 2, May/June 2023 AFRICA 89 Positive impact of training rural health workers in identification and prevention of acute rheumatic fever in eastern Uganda Judith Namuyonga, Emma Ndagire, David Okumu, Oluwayomi Olugubuyi, Sulaiman Lubega, John Omagino, Peter Lwabi, Emmy Okello Abstract Background: Diagnosis of acute rheumatic fever (ARF) is mainly clinical. Delayed or missed diagnosis and failure to administer appropriate and timely treatment of ARF leads to rheumatic heart disease (RHD), which could necessitate expensive treatments such as open-heart surgery. Implementation of preventative guidelines depends on availability of trained healthcare workers. As part of the routine support supervision, the Uganda Heart Institute sent out a team to rural eastern Uganda to evaluate health workers’ knowledge level regarding management of ARF. Methods: Health workers from selected health facilities in Tororo district, eastern Uganda, were assessed for their knowledge on the clinical features and role of benzathine penicillin G (BPG) in the treatment and prevention of ARF recurrence. Using the RHD Action Needs assessment tool, we generated and administered a pre-test, then conducted training and re-administered a post-test. Eight months later, health workers were again assessed for knowledge retention and change in practices. Statistical analysis was done using Stata version 15. Results: During the initial phase, 34 of the 109 (31%) health workers passed the pre-test, indicating familiarity with clinical features of ARF. The level of knowledge of BPG use in ARF was very poor in all the health units [25/109 (22.6%)] but improved after training to 80%, as shown by the chi-squared test (χ2 = 0.000). However, retention of this knowledge waned after eight months and was not significantly different compared to pre-training (χ2 ≥ 0.2). Conclusion: A critical knowledge gap is evident among health workers, both in awareness and treatment of ARF, and calls for repetitive training as a priority strategy in prevention. Keywords: acute rheumatic fever, rheumatic heart disease, prevention, health-worker training, Uganda Submitted 19/3/22, accepted 28/5/22 Published online 23/9/22 Cardiovasc J Afr 2023; 34: 89–92 www.cvja.co.za DOI: 10.5830/CVJA-2022-029 Rheumatic heart disease (RHD) is the most serious complication of acute rheumatic fever (ARF). Although preventable, RHD is still a significant public health problem in limitedresource settings, with the majority of patients presenting with complications at first diagnosis.1,2 The unabated progression of RHD results from recurrences of ARF, triggered by frequent attacks of group A streptococcal pharyngitis.3 Those diagnosed with advanced valvar heart disease present with overt symptoms and the mortality rate is high at 17.8% in the first year of detection.1 Diagnosis of ARF remains clinical, based on the modified Jones criteria,4 and relies on the health worker having a high index of suspicion.5 Frontline healthcare providers need to have the knowledge and skills required to recognise and treat ARF,6,7 which includes prompt administration of benzathine penicillin G (BPG). Early recognition of ARF is essential in preventing progression of ARF to RHD. Our group has previously performed school screening for latent RHD in various regions of northern and western Uganda, to improve early detection of RHD.8 However, eastern Uganda has not had any of these programmes and it is unknown whether healthcare providers in this region have adequate knowledge on prevention, diagnosis and treatment of RHD. Training health workers in high-risk settings to detect ARF/RHD is a key strategy in preventing ARF.9 As a pilot study, we conducted an assessment on the knowledge level of ARF/RHD prevention among healthcare providers in Tororo district, eastern Uganda. This report will provide a scalable approach for training healthcare workers and effectively improving ARF detection in regional centres in Uganda. Department of Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda Judith Namuyonga, MB ChB, MMed, F Paed Cardiology, F Paed Echocardiography, jnamuyonga@gmail.com Emma Ndagire, MB ChB, MMed, F Paed Cardiology Sulaiman Lubega, MB ChB, MMed, F Paed Cardiology Peter Lwabi, MB ChB, MMed, F Paed Cardiology Department of Cardiac Surgery, Uganda Heart Institue, Kampala, Uganda John Omagino, MB ChB, MMed, F Cardiac Surgery Department of Adult Cardiology, Uganda Heart Institue, Kampala, Uganda Emmy Okello, MB ChB, F Adult Cardiology, PHD Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda Judith Namuyonga, MBChB, MMed, F Paed Cardiology, F Paed Echocardio Tororo District Local Government, Tororo, Uganda David Okumu, MB ChB, MPH Department of Child and Adolescent Health, University of West Indies, Mona Jamaica Oluwayomi Olugubuyi, MB ChB, MMed, F. Paed Cardiology
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