Factors, beliefs, and barriers associated with adherence to secondary prophylaxis amongst children and adolescents with rheumatic heart disease at public tertiary hospitals in Rwanda: A cross-sectional observational study

INTRODUCTION: Rheumatic heart disease (RHD) is the most prevalent cardiovascular disease among young people under 25 years. This study aimed to explore the factors, beliefs, and barriers associated with adherence to penicillin among children and adolescents with RHD undergoing secondary prophylaxis at public tertiary hospitals in Rwanda. METHODS: This cross-sectional observational study included children aged 5 to 18 years diagnosed with RHD and on secondary prophylaxis for at least six months, from two public tertiary hospitals in Rwanda. Regression analyses were performed to identify factors associated with adherence. RESULTS: Employment status was significantly associated with adherence to prophylaxis (OR [95% CI]: 12.17 [1.42-103.9], p=0.022). Living in an urban area also increased the likelihood of adherence compared to rural areas (OR [95% CI]: 9.05 [2.28-35.91], p=0.001). A long distance to the clinic was strongly associated with poor adherence (OR [95% CI]: 5.55 [1.94-15.89], p=0.001). Additionally, long waiting times at the clinic are also significantly associated with poor adherence (OR [95% CI]: 4.77 [1.69-13.43], p=0.003). Patients with good adherence have significantly higher belief scores than those with poor adherence (M ± SE: 1.56 ± 0.54, t=2.878, p=0.005), and patients with higher barrier scores are significantly less adherent than those with lower barrier scores (M ± SE: 4.6 ± 0.85, t=5.531, p<0.001). CONCLUSION: Factors negatively affecting adherence included parental unemployment and rural residence. Long travel distances and extended waiting times at clinics were the most common barriers to adherence. To improve adherence, educational efforts targeting RHD patients and their caregivers should be strengthened, and RHD prevention activities should be decentralized to health centers.