{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T04:29:52Z","timestamp":1785644992857,"version":"3.56.0"},"reference-count":44,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T00:00:00Z","timestamp":1731542400000},"content-version":"unspecified","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,10,25]]},"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Worldwide, a number of studies have been conducted to assess the prevalence of adherence to secondary antibiotic prophylaxis and to identify the associated factors (reasons) for poor adherence among patients with rheumatic heart disease or acute rheumatic fever (RHD\/ARF). However, results were highly inconsistent with a prevalence ranging from 10% to 93%; and the reported reasons or associated factors have not been systematically reviewed. Therefore, this study aimed to assess the prevalence of adherence to secondary antibiotic prophylaxis among patients with RHD\/ARF; and to review the associated factors (reasons) for poor adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>PubMed\/Medline, Google Scholar, Cochrane Review and African Journals Online databases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Articles published in English from 1 January 2005 to 1 December 2022 and reported the prevalence of adherence using \u226580% cut-off points were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>Data were extracted using the Microsoft Excel and analysed by STATA V.11.0. A meta-analysis was conducted using the weighted inverse-variance random-effects model. Reasons for poor adherence were identified through thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      33 articles with a total sample size of 7158 patients were included. The pooled prevalence of adherence to secondary antibiotic prophylaxis among patients with RHD\/ARF was found to be 58.5% (95% CI: 48.2% to 68.7%; I\n                      <jats:sup>2<\/jats:sup>\n                      =99.2%; p&lt;0.001). Rural residency, lack of money, distance from the health institutions, inaccessibility, poor counselling, forgetting schedules, lack of disease knowledge and fear of injection pain were the reported factors or reasons for poor adherence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>About 41.5% of patients with RHD\/ARF were found to have poor adherence. Long distance from health institutions, forgetting schedules, poor counselling and lack of knowledge and skill among healthcare workers were some of the modifiable reasons for poor adherence. Therefore, decentralisation of the follow-up care, creating schedule reminding systems and providing targeted health education might help to improve adherence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-082191","type":"journal-article","created":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T07:15:50Z","timestamp":1731568550000},"page":"e082191","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Adherence to secondary antibiotic prophylaxis among patients with acute rheumatic fever and\/or rheumatic heart disease: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6525-2645","authenticated-orcid":false,"given":"Melaku","family":"Bimerew","sequence":"first","affiliation":[{"name":"Pediatric and Child Health Nursing, Injibara University, Injibara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1060-3385","authenticated-orcid":false,"given":"Freweyni Gebreegziabher","family":"Araya","sequence":"additional","affiliation":[{"name":"Nursing, Woldia University, Woldia, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2919-2010","authenticated-orcid":false,"given":"Manay","family":"Ayalneh","sequence":"additional","affiliation":[{"name":"Pediatric and Child Health Nursing, Injibara University, Injibara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,11,14]]},"reference":[{"key":"2025121400433996000_14.11.e082191.1","doi-asserted-by":"crossref","DOI":"10.3389\/fcvm.2020.612716","article-title":"Rheumatic Heart Valve Disease Pathophysiology and Underlying Mechanisms","volume":"7","author":"Passos","year":"2020","journal-title":"Front Cardiovasc Med"},{"key":"2025121400433996000_14.11.e082191.2","doi-asserted-by":"crossref","DOI":"10.1007\/s11936-017-0513-y","article-title":"Group A Streptococcus, Acute Rheumatic Fever and Rheumatic Heart Disease: Epidemiology and Clinical Considerations","volume":"19","author":"Z\u00fchlke","year":"2017","journal-title":"Curr Treat Options Cardiovasc Med"},{"key":"2025121400433996000_14.11.e082191.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603693"},{"key":"2025121400433996000_14.11.e082191.4","unstructured":"World Health Organization . What quantitative and qualitative methods have been developed to measure community empowerment at a national level? 2018."},{"key":"2025121400433996000_14.11.e082191.5","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2013.34"},{"key":"2025121400433996000_14.11.e082191.6","unstructured":"Carapetis J , Brown A , Maguire GP , et al . The australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease. 2012."},{"key":"2025121400433996000_14.11.e082191.7","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2009.162"},{"key":"2025121400433996000_14.11.e082191.8","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1093\/trstmh\/trx035","article-title":"Secondary prevention for screening detected rheumatic heart disease: opportunities to improve adherence","volume":"111","author":"Engelman","year":"2017","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"2025121400433996000_14.11.e082191.9","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1111\/tmi.12796","article-title":"Adherence to secondary antibiotic prophylaxis for patients with rheumatic heart disease diagnosed through screening in Fiji","volume":"21","author":"Engelman","year":"2016","journal-title":"Trop Med Int Health"},{"key":"2025121400433996000_14.11.e082191.10","unstructured":"Dagmawi F . Factors determining rheumatic fever recurrence among rheumatic heart disease patients who are taking monthly benzanthine g penicillin prophylaxis. Addis Ababa University; 2014."},{"key":"2025121400433996000_14.11.e082191.11","doi-asserted-by":"crossref","DOI":"10.1186\/s13643-021-01626-4","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"10","author":"Page","year":"2021","journal-title":"Syst Rev"},{"key":"2025121400433996000_14.11.e082191.12","unstructured":"Wells G , Shea BO , Connell D , et al . The newcastle ottawa scale (nos) for assessing the quality if nonrandomized studies in meta\u2010analyses. 2014."},{"key":"2025121400433996000_14.11.e082191.13","doi-asserted-by":"crossref","first-page":"22","DOI":"10.32596\/ejcm.galenos.2019.00004","article-title":"Adherence of Rheumatic Heart Disease Patients to Secondary Prophylaxis and Main Reasons for Poor Adherence at Jimma Medical Center","volume":"7","author":"Mohammed","year":"2019","journal-title":"ejcm"},{"key":"2025121400433996000_14.11.e082191.14","doi-asserted-by":"crossref","first-page":"343","DOI":"10.2147\/PPA.S238423","article-title":"Adherence to Benzathine Penicillin G Secondary Prophylaxis and Its Determinants in Patients with Rheumatic Heart Disease at a Cardiac Center of an Ethiopian Tertiary Care Teaching Hospital","volume":"14","author":"Mekonen","year":"2020","journal-title":"Pat Prefer Adherence"},{"key":"2025121400433996000_14.11.e082191.15","doi-asserted-by":"crossref","first-page":"2399","DOI":"10.2147\/PPA.S281413","article-title":"Rheumatic Heart Disease Patients\u2019 Adherence to Secondary Prophylaxis and Associated Factors at Hospitals in Jimma Zone, Southwest Ethiopia: A Multicenter Study","volume":"14","author":"Adem","year":"2020","journal-title":"Pat Prefer Adherence"},{"key":"2025121400433996000_14.11.e082191.16","unstructured":"Shimekit M . Adherence for Benzanthine Penicillin as Secondary Prophylaxis and Factors Associated with It among Children with Rheumatic Heart Disease Attending the Cardiac Clinic of Jimma University Specialized Hospital from 2011-2015 GC. Ethiopia: Jimma University Repository, 2016. Available: https:\/\/repository.ju.edu.et\/handle\/123456789\/2312"},{"key":"2025121400433996000_14.11.e082191.17","unstructured":"Zewde L . Utilization and Barriers to Secondary Prophylaxis for Rheumatic Heart Disease at Tikur Anbessa Specialized Hospital Adults Outpatient Clinic, Addis Ababa. Ethiopia: Addis Ababa University repository, 2020. Available: http:\/\/etd.aau.edu.et\/handle\/123456789\/25016"},{"key":"2025121400433996000_14.11.e082191.18","doi-asserted-by":"publisher","DOI":"10.5830\/CVJA-2013-022"},{"key":"2025121400433996000_14.11.e082191.19","doi-asserted-by":"crossref","unstructured":"Longenecker CT , Morris SR , Aliku TO , et al . Rheumatic Heart Disease Treatment Cascade in Uganda. Circ: Cardiovascular Quality and Outcomes 2017;10. doi:10.1161\/CIRCOUTCOMES.117.004037","DOI":"10.1161\/CIRCOUTCOMES.117.004037"},{"key":"2025121400433996000_14.11.e082191.20","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-020-03189-z","article-title":"The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study","volume":"20","author":"Voleti","year":"2020","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121400433996000_14.11.e082191.21","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.gheart.2014.10.001","article-title":"A qualitative examination of secondary prophylaxis in rheumatic heart disease: factors influencing adherence to secondary prophylaxis in Uganda","volume":"10","author":"Huck","year":"2015","journal-title":"Glob Heart"},{"key":"2025121400433996000_14.11.e082191.22","unstructured":"Janvier D . Factors, beliefs and barriers associated with adherence to secondary prophylaxis amongst children and adolescents with rheumatic heart disease at public tertiary hospitals in rwanda\u2013a cross-sectional study. University of Rwanda; 2019."},{"key":"2025121400433996000_14.11.e082191.23","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0178264","article-title":"Adherence to secondary prophylaxis for rheumatic heart disease is underestimated by register data","volume":"12","author":"de Dassel","year":"2017","journal-title":"PLoS ONE"},{"key":"2025121400433996000_14.11.e082191.24","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-842X.2005.tb00243.x"},{"key":"2025121400433996000_14.11.e082191.25","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-13-1"},{"key":"2025121400433996000_14.11.e082191.26","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.118.009308","article-title":"Improving Delivery of Secondary Prophylaxis for Rheumatic Heart Disease in a High-Burden Setting: Outcome of a Stepped-Wedge, Community, Randomized Trial","volume":"7","author":"Ralph","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"2025121400433996000_14.11.e082191.27","unstructured":"Culliford-Semmens N , Tilton E , Webb R , et al . Adequate adherence to benzathine penicillin secondary prophylaxis following the diagnosis of rheumatic heart disease by echocardiographic screening. N Z Med J (Online) 2017;130."},{"key":"2025121400433996000_14.11.e082191.28","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-13-1"},{"key":"2025121400433996000_14.11.e082191.29","unstructured":"Sial JA , Farman MT , Batra MK , et al . Adherence to secondary prophylaxis of rheumatic fever in patients with rheumatic heart disease in rural areas. Pak Heart J 2018;51."},{"key":"2025121400433996000_14.11.e082191.30","doi-asserted-by":"crossref","first-page":"2101","DOI":"10.18203\/2349-3291.ijcp20204536","article-title":"Non adherence to secondary prophylaxis for rheumatic fever","volume":"7","author":"Saha","year":"2020","journal-title":"Int J Contemp Pediatr"},{"key":"2025121400433996000_14.11.e082191.31","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.4103\/jfmpc.jfmpc_1056_19","article-title":"Compliance to the secondary prophylaxis and awareness of rheumatic heart disease: A cross-sectional study in low-income province of India","volume":"9","author":"Prasad","year":"2020","journal-title":"J Family Med Prim Care"},{"key":"2025121400433996000_14.11.e082191.32","doi-asserted-by":"crossref","first-page":"5","DOI":"10.4103\/JCPC.JCPC_25_17","article-title":"A Cross-sectional study to look at the determinants of poor adherence to secondary penicillin prophylaxis for rheumatic heart disease at a tertiary care center in South India","volume":"7","author":"Nemani","year":"2018","journal-title":"J Clin Prev Cardiol"},{"key":"2025121400433996000_14.11.e082191.33","doi-asserted-by":"crossref","DOI":"10.1016\/S0735-1097(15)62019-8","article-title":"ADHERENCE TO BENZATHINE PENICILLIN IN CHILDREN WITH RHEUMATIC FEVER\/ RHEUMATIC HEART DISEASE: RESULTS FROM AN INDIAN PEDIATRIC RHD REGISTRY","volume":"65","author":"Saxena","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"2025121400433996000_14.11.e082191.34","doi-asserted-by":"publisher","DOI":"10.1186\/1546-0096-8-1"},{"key":"2025121400433996000_14.11.e082191.35","doi-asserted-by":"crossref","first-page":"859","DOI":"10.31128\/AJGP-07-19-4987","article-title":"Clinic factors associated with better delivery of secondary prophylaxis in acute rheumatic fever management","volume":"48","author":"Quinn","year":"2019","journal-title":"Aust J Gen Pract"},{"key":"2025121400433996000_14.11.e082191.36","doi-asserted-by":"crossref","DOI":"10.1186\/s12872-021-02308-8","article-title":"Rheumatic heart disease in The Gambia: clinical and valvular aspects at presentation and evolution under penicillin prophylaxis","volume":"21","author":"Jaiteh","year":"2021","journal-title":"BMC Cardiovasc Disord"},{"key":"2025121400433996000_14.11.e082191.37","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1111\/jpc.15239","article-title":"Adherence rates and risk factors for suboptimal adherence to secondary prophylaxis for rheumatic fever","volume":"57","author":"Kevat","year":"2021","journal-title":"J Paediatr Child Health"},{"key":"2025121400433996000_14.11.e082191.38","doi-asserted-by":"crossref","DOI":"10.1016\/j.hlc.2021.06.387","article-title":"Retrospective Study Assessing Compliance of Secondary Prophylaxis in Paediatric Patients at Risk of Recurrent Acute Rheumatic Fever in a Western Australian Metropolitan Hospital Setting","volume":"30","author":"Jeyaseelan","year":"2021","journal-title":"Heart Lung Circ"},{"key":"2025121400433996000_14.11.e082191.39","doi-asserted-by":"crossref","DOI":"10.1186\/s12872-022-02473-4","article-title":"Secondary prevention of rheumatic heart disease in Ethiopia: a multicenter study","volume":"22","author":"Belay","year":"2022","journal-title":"BMC Cardiovasc Disord"},{"key":"2025121400433996000_14.11.e082191.40","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1016\/j.ijcard.2016.08.259","article-title":"Characteristics and outcomes of Indian children enrolled in a rheumatic heart disease registry","volume":"222","author":"Mehta","year":"2016","journal-title":"Int J Cardiol"},{"key":"2025121400433996000_14.11.e082191.41","first-page":"73","article-title":"Adherence to Secondary Prophylaxis and Risk Factors Among Patients with Rheumatic Heart Disease at Public Hospitals in Addis Ababa, Ethiopia, 2021\u20132022","volume":"13","author":"Adal","year":"2022","journal-title":"Res Rep Clin Cardiol"},{"key":"2025121400433996000_14.11.e082191.42","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.2012.02838.x"},{"key":"2025121400433996000_14.11.e082191.43","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1111\/1753-6405.13250","article-title":"Adherence to secondary prevention of rheumatic fever and rheumatic heart disease in young people: an 11-year retrospective study","volume":"46","author":"Liaw","year":"2022","journal-title":"Aust N Z J Public Health"},{"key":"2025121400433996000_14.11.e082191.44","doi-asserted-by":"crossref","unstructured":"Dougherty S , Essop MR , Webb R , et al . Complications of Rheumatic Heart Disease and Acute Emergencies. Acute Rheum Fever Rheum Heart Dis Elsevier 2021;301\u201336. doi:10.1016\/B978-0-323-63982-8.00016-7","DOI":"10.1016\/B978-0-323-63982-8.00016-7"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-082191","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T08:43:53Z","timestamp":1765701833000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-082191"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11]]},"references-count":44,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11,14]]},"published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1136\/bmjopen-2023-082191"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-082191","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11]]}}}