Background: Rheumatic Fever (RF) and Rheumatic Heart Disease (RHD) are major public health problems in Fiji. This audit was conducted to determine adherence to secondary prophylaxis and identify factors associated with poor adherence among RF/RHD patients attending clinics in Tavua sub divisional hospital, Western Fiji
Methods: A mixed quantitative and qualitative methods were used. Twenty eight RF/RHD patients receiving prophylaxis during the period of 2014-2016 were included in the retrospective study. Demographic and medical information was extracted from patients’ folder and RHD clinic register book. Sixteen patients and care givers were interviewed to assess barriers to prophylaxis.
Results: Most patients were male (54%), 57% were iTaukei and the mean age was 26 years. Majority of patients (86%) were from the rural areas. Proportion of patients with good adherence (>80%) was 10%, 14% and 32% in 2014, 2015 and 2016, respectively. The overall adherence rate of >80% for the three years period was 14%. Poor adherence (<80%) was frequently reported among males, iTaukei ethnic groups, children <15 years of age and patients living in the rural areas. The common reasons for missing appointment were family emergency (31%), school/work commitments (16%), financial problems (16%), side effects (9%) and unfriendly medical staff (6%).
Conclusion: The study revealed poor adherence to secondary prophylaxis. Social and financial issues were cited as main barriers. Integrated and community based approach to address barriers and improve adherence should be considered. Furthermore, the development of national guidelines for secondary prophylaxis can improve and standardize treatment and care.