埃塞俄比亚有较高的急性风湿热(ARF)和风湿性心脏病(RHD)患病率,根据我们的知识,没有关于RHD儿童二级预防状况的数据.本研究描述了继发性RHD预防的现状。
多中心,在埃塞俄比亚对5-17岁患有RHD的儿童进行了前瞻性研究。良好的依从性定义为前一年至少80%完成苄星青霉素(BPG)或口服阿莫西林。主要结果指标是坚持预防,以比例表示。社会人口统计,RHD的严重性,评估ARF复发。
共纳入337名儿童,平均年龄为12.9±2.6岁。大多数(73%)患有严重的主动脉/二尖瓣疾病。参与者接受BPG(80%)或阿莫西林(20%)预防。女性(P=0.04)使用BPG(0.03)和较短的平均预防持续时间(48.5±31.5vs.分别为60.7±33,P<0.008)预测良好的依从性。药物耗尽(35%)中断随访(27%),COVID-19大流行(26%)是错过预防的最常见原因。与BPG相比,服用阿莫西林的参与者ARF的复发率更高(40%vs.16%,P<0.001),在依从性差的人群中,与依从性好的人群相比(36.8%vs.17.9%,分别,P=0.005)。预防类型和持续时间(OR分别为0.5,CI=0.24,0.9,P=0.02;OR=1.1,CI=1.1,1.2,P=0.04),和性别(OR=1.9,CI=1.1,3.4,P=0.03)是依从性差的独立预测因素。
在患有RHD的埃塞俄比亚儿童中,依从性差很普遍。阿莫西林是一种次优的预防选择,因为它的使用与较低的依从性和较高的ARF复发率相关。
Ethiopia has a high acute rheumatic fever (
ARF) and rheumatic heart disease (RHD) prevalence, and to our knowledge, there are no data on the status of secondary prevention in children with RHD. This
study describes the status of secondary RHD prevention.
A multicenter, prospective
study was performed on children aged 5-17 years with RHD in Ethiopia. Good adherence was defined as at least 80% completion of benzathine penicillin (BPG) or oral Amoxicillin within the previous year. The primary outcome measure was adherence to prophylaxis, expressed as a proportion. Socio-demographics, severity of RHD, and
ARF recurrence were evaluated.
A total of 337 children with a mean age of 12.9 ± 2.6 years were included. The majority (73%) had severe aortic/mitral disease. Participants were on BPG (80%) or Amoxicillin (20%) prophylaxis. Female sex (P = 0.04) use of BPG (0.03) and shorter mean duration of prophylaxis in months (48.5 ± 31.5 vs. 60.7 ± 33, respectively, P < 0.008) predicted good adherence. Running out of medications (35%), interrupted follow-up (27%), and the COVID-19 pandemic (26%) were the most common reasons for missing prophylaxis. Recurrence of
ARF was higher in participants on Amoxicillin compared with BPG (40% vs. 16%, P < 0.001) and in those with poor adherence compared with good adherence (36.8% vs. 17.9%, respectively, P = 0.005). Type and duration of prophylaxis (OR 0.5, CI = 0.24, 0.9, P = 0.02; OR = 1.1, CI = 1.1, 1.2, P = 0.04, respectively), and sex (OR = 1.9, CI = 1.1, 3.4, P = 0.03) were independent predictors of poor adherence.
Poor adherence is prevalent in Ethiopian children living with RHD. Amoxicillin is a suboptimal option for prophylaxis as its use is associated with lower adherence and a higher rate of ARF recurrence.