Implications for sustaining secondary prophylaxis for rheumatic heart disease in Ethiopia: Uptake and determinants in a multicentre cross-sectional study

@article{birru2026implications,
  title = {{Implications for sustaining secondary prophylaxis for rheumatic heart disease in Ethiopia: Uptake and determinants in a multicentre cross-sectional study}},
  author = {Eshetie Melese Birru and Zemikael Melese Birru and Yaschilal Muche Belayneh and Muluken Adela Alemu and Jane Oliver and Zemene Tigabu Kebede},
  journal = {PLOS Neglected Tropical Diseases},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pntd.0014703},
  url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014703},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Implications for sustaining secondary prophylaxis for rheumatic heart disease in Ethiopia: Uptake and determinants in a multicentre cross-sectional study
AU  - Eshetie Melese Birru
AU  - Zemikael Melese Birru
AU  - Yaschilal Muche Belayneh
AU  - Muluken Adela Alemu
AU  - Jane Oliver
AU  - Zemene Tigabu Kebede
PY  - 2026
DA  - 2026/09/11
JO  - PLOS Neglected Tropical Diseases
DO  - 10.1371/journal.pntd.0014703
UR  - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014703
AB  - Background: Rheumatic heart disease (RHD) remains a major public health problem in low- and middle-income countries. Long-term benzathine penicillin G (BPG) secondary prophylaxis prevents recurrent acute rheumatic fever (ARF) and progressive valve damage, but maintaining adequate uptake (i.e., ≥80% dose) remains challenging in high-burden settings. We assessed BPG uptake, factors associated with high uptake, and its association with reported recurrent ARF manifestations among people with RHD in Ethiopia. Methods: A multicentre facility-based cross-sectional study was conducted among 400 participants with echocardiography-confirmed RHD attending three referral hospitals in Ethiopia between November 2023 and November 2024. Demographic, socioeconomic, geographic, healthcare-service and treatment-related factors associated with high uptake were evaluated using logistic regression (R version 4.6.1) with exposure-specific adjustment sets selected according to plausible confounding relationships. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. Results: Overall, 305/400 participants (76.3%) achieved ≥80% BPG uptake. The odds of high uptake decreased with increasing age (aOR per 10-year increase 0.80, 95% CI 0.69–0.94) and were higher among males than females (aOR 2.64, 95% CI 1.62–4.42). Living >50 km from an RHD follow-up facility was strongly associated with lower uptake compared with living <30 km away (aOR 0.10, 95% CI 0.04–0.22). Rural (aOR 0.28, 95% CI 0.14–0.52) and suburban residence (aOR 0.42, 95% CI 0.19–0.93) were also associated with lower uptake than urban residence. Compared with 12–24 months of prophylaxis, progressively lower uptake was observed with longer treatment duration (2–3 years: aOR 0.26, 95% CI 0.11–0.56; 3–4 years: aOR 0.26, 95% CI 0.10–0.61; > 4 years: aOR 0.07, 95% CI 0.03–0.15). Frequent injection pain was associated with lower uptake (aOR 0.32, 95% CI 0.17–0.59), whereas family support was associated with higher uptake (aOR 2.89, 95% CI 1.24–6.71). BPG uptake ≥80% was associated with substantially lower odds of reported recurrent ARF manifestations (aOR 0.25, 95% CI 0.14–0.44). Conclusions: Approximately three-quarters of participants achieved ≥80% BPG uptake. Geographic access, longer prophylaxis duration, injection pain, and limited family support were important correlates of lower uptake. Decentralised BPG delivery, improved injection acceptability, and sustained patient and family support may increase long-term secondary prophylaxis uptake in Ethiopia. Author summary: Rheumatic heart disease (RHD) remains an important cause of preventable illness in Ethiopia. Regular benzathine penicillin G (BPG) injections can prevent recurrent acute rheumatic fever and further heart-valve damage, but maintaining injections over many years can be challenging. We studied 400 people with RHD attending three referral hospitals in Ethiopia to determine how consistently they received prescribed BPG injections and identify factors associated with higher uptake. Approximately three-quarters received at least 80% of their prescribed injections during the preceding year. Lower uptake was particularly associated with living farther from the follow-up facility, living in non-urban areas, longer duration of prophylaxis, and frequent injection pain, while family support was associated with higher uptake. Participants with higher BPG uptake reported fewer recurrent acute rheumatic fever manifestations during the preceding year, although the study design cannot establish that higher uptake caused this difference. These findings suggest that maintaining long-term BPG prophylaxis depends on both healthcare accessibility and the cumulative burden of treatment. Improving access to safe BPG delivery, injection acceptability, reliable BPG supply, longitudinal follow-up, and sustained patient and family support may strengthen RHD control in Ethiopia.
SN  - 1935-2735
ER  -