{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:35:26Z","timestamp":1787016926137,"version":"build-2736575974"},"reference-count":22,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T00:00:00Z","timestamp":1650585600000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Nepal Health Research Council Provincial Health Research Grant 2020","award":["1584"],"award-info":[{"award-number":["1584"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,3,29]]},"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Rheumatic fever (RF) and rheumatic heart disease (RHD) remain among the major heart problems among children in Nepal. Although these conditions are preventable and treatable, the lack of proper knowledge and resources to diagnose and manage these conditions in rural health centres is a key concern. This study assessed the impact of educational sessions to improve the knowledge of healthcare workers in the early recognition, diagnosis, and management of RF and RHD in rural far-western Nepal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting and participants<\/jats:title>\n                    <jats:p>This study used a pretest and post-test interventional design and was conducted among 64 healthcare workers in two primary healthcare centres and a peripheral district-level hospital in Achham district in the far-western region of Nepal. A self-administered questionnaire was used before and after the educational sessions. Data were analysed using SPSS V.21.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The overall test scores increased from 10 (SD=2.4) pre-intervention to 13.8 (SD=1.9) post-intervention (p&lt;0.001). Similarly, participant confidence (graded 1\u20135) in differentiating bacterial from viral sore throat rose from 3.6 (SD=1.08) pre-intervention to 3.98 (SD=1.09) post-intervention (p&lt;0.05). Confidence in managing RF increased from 3.9 (SD=0.88) pre-intervention to 4.30 (SD=0.8) post-intervention (p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings suggest that the investigated educational sessions are promising with respect to improving the knowledge and confidence of healthcare workers in the early recognition, diagnosis, and management of RF and RHD at the primary healthcare level. Further studies with a larger sample size and conducted in different parts of the country are warranted to assess the effectiveness and impact of scaling up such educational interventions in Nepal.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-059942","type":"journal-article","created":{"date-parts":[[2022,5,17]],"date-time":"2022-05-17T08:06:13Z","timestamp":1652774773000},"page":"e059942","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Effectiveness of an educational intervention in improving healthcare workers\u2019 knowledge of early recognition, diagnosis and management of rheumatic fever and rheumatic heart disease in rural far-western Nepal: a pre\/post-intervention study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2260-373X","authenticated-orcid":false,"given":"Navin","family":"Bhatt","sequence":"first","affiliation":[{"name":"Bayalpata Hospital, Nyaya Health Nepal, Achham, Nepal"},{"name":"Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashmita","family":"Karki","sequence":"additional","affiliation":[{"name":"Central Department of Public Health, Tribhuvan University Institute of Medicine, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biplav","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Bayalpata Hospital, Nyaya Health Nepal, Achham, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amul","family":"Singh","sequence":"additional","affiliation":[{"name":"Bayalpata Hospital, Nyaya Health Nepal, Achham, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lal B","family":"Rawal","sequence":"additional","affiliation":[{"name":"School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjib Kumar","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,4,22]]},"reference":[{"key":"2025121400132402000_12.4.e059942.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61171-9"},{"key":"2025121400132402000_12.4.e059942.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603693"},{"key":"2025121400132402000_12.4.e059942.3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3126\/njh.v13i2.15554","article-title":"Rheumatic heart disease in Nepal: current scenario","volume":"13","author":"KC","year":"2016","journal-title":"Nepalese Heart J."},{"key":"2025121400132402000_12.4.e059942.4","doi-asserted-by":"crossref","first-page":"621668","DOI":"10.3389\/fmed.2021.621668","article-title":"Acute rheumatic fever: where do we stand? an epidemiological study in northern Italy","volume":"8","author":"Marino","year":"2021","journal-title":"Front Med"},{"key":"2025121400132402000_12.4.e059942.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2011.10.009"},{"key":"2025121400132402000_12.4.e059942.6","doi-asserted-by":"crossref","first-page":"88","DOI":"10.3126\/njh.v6i1.18603","article-title":"Rheumatic fever (RF) and rheumatic heart disease (RHD) prevention and control program in Nepal","volume":"6","author":"Regmi","year":"2017","journal-title":"Nepalese Heart Journal"},{"key":"2025121400132402000_12.4.e059942.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp078039"},{"key":"2025121400132402000_12.4.e059942.8","doi-asserted-by":"crossref","first-page":"e717","DOI":"10.1016\/S2214-109X(14)70310-9","article-title":"Active surveillance for rheumatic heart disease in endemic regions: a systematic review and meta-analysis of prevalence among children and adolescents","volume":"2","author":"Rothenb\u00fchler","year":"2014","journal-title":"Lancet Glob Health"},{"key":"2025121400132402000_12.4.e059942.9","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.gheart.2013.08.001","article-title":"Prevention of rheumatic fever and heart disease: Nepalese experience","volume":"8","author":"Regmi","year":"2013","journal-title":"Glob Heart"},{"key":"2025121400132402000_12.4.e059942.10","doi-asserted-by":"crossref","DOI":"10.1542\/peds.142.1MA6.511","article-title":"Health systems strengthening for prevention of rheumatic heart disease in Zambia: a novel clinic-based curriculum to help advance knowledge and skills of health workers","volume":"142","author":"Daouda","year":"2018","journal-title":"Pediatrics"},{"key":"2025121400132402000_12.4.e059942.11","first-page":"37","article-title":"Evaluation of physicians' knowledge about prevention of rheumatic fever and rheumatic heart disease before and after a teaching session","volume":"15","author":"Osman","year":"2015","journal-title":"Sudan J Paediatr"},{"key":"2025121400132402000_12.4.e059942.12","unstructured":"WHO Study Group on Rheumatic Fever and Rheumatic Heart Disease . 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