{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T19:10:30Z","timestamp":1789758630150,"version":"4.0.1"},"update-to":[{"DOI":"10.1371\/journal.pntd.0014703","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000}}],"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.,\u2009\u226580% 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 305\/400 participants (76.3%) achieved \u226580% BPG uptake. The odds of high uptake decreased with increasing age (aOR per 10-year increase 0.80, 95% CI 0.69\u20130.94) and were higher among males than females (aOR 2.64, 95% CI 1.62\u20134.42). Living &gt;50 km from an RHD follow-up facility was strongly associated with lower uptake compared with living &lt;30 km away (aOR 0.10, 95% CI 0.04\u20130.22). Rural (aOR 0.28, 95% CI 0.14\u20130.52) and suburban residence (aOR 0.42, 95% CI 0.19\u20130.93) were also associated with lower uptake than urban residence. Compared with 12\u201324 months of prophylaxis, progressively lower uptake was observed with longer treatment duration (2\u20133 years: aOR 0.26, 95% CI 0.11\u20130.56; 3\u20134 years: aOR 0.26, 95% CI 0.10\u20130.61;\u2009&gt;\u20094 years: aOR 0.07, 95% CI 0.03\u20130.15). Frequent injection pain was associated with lower uptake (aOR 0.32, 95% CI 0.17\u20130.59), whereas family support was associated with higher uptake (aOR 2.89, 95% CI 1.24\u20136.71). BPG uptake \u226580% was associated with substantially lower odds of reported recurrent ARF manifestations (aOR 0.25, 95% CI 0.14\u20130.44).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Approximately three-quarters of participants achieved \u226580% 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0014703","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:52:31Z","timestamp":1789149151000},"page":"e0014703","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implications for sustaining secondary prophylaxis for rheumatic heart disease in Ethiopia: Uptake and determinants in a multicentre cross-sectional study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7613-0384","authenticated-orcid":true,"given":"Eshetie Melese","family":"Birru","sequence":"first","affiliation":[{"name":"Medical School, Curtin University","place":["Bentley, Australia"]},{"name":"Wesfarmers Centre for Vaccines and Infectious Diseases, The Kids Research Institute Australia","place":["Nedlands, Australia"]},{"name":"UWA Centre for Child Health Research, The University of Western Australia","place":["Nedlands, Australia"]},{"name":"College of Medicine and Health Sciences, University of Gondar","place":["Gondar, Ethiopia"],"department":["Department of Pharmacology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zemikael Melese","family":"Birru","sequence":"additional","affiliation":[{"name":"Medical Teams International","place":["Gondar, Ethiopia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaschilal Muche","family":"Belayneh","sequence":"additional","affiliation":[{"name":"College of Medicine and Health Sciences, Wollo University","place":["Dessie, Ethiopia"],"department":["Department of Pharmacy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muluken Adela","family":"Alemu","sequence":"additional","affiliation":[{"name":"College of Medicine and Health Sciences, Debre Tabor University","place":["Debre Tabor, Ethiopia"],"department":["Department of Pharmacy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Oliver","sequence":"additional","affiliation":[{"name":"Wesfarmers Centre for Vaccines and Infectious Diseases, The Kids Research Institute Australia","place":["Nedlands, Australia"]},{"name":"UWA Centre for Child Health Research, The University of Western Australia","place":["Nedlands, Australia"]},{"name":"The Peter Doherty Institute for Infection and Immunity, The University of Melbourne","place":["Parkville, Australia"],"department":["Department of Infectious Diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zemene Tigabu","family":"Kebede","sequence":"additional","affiliation":[{"name":"College of Medicine and Health Sciences, University of Gondar","place":["Gondar, Ethiopia"],"department":["Department of 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