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While mostly eradicated in developed nations, rheumatic heart disease (RHD) is still the leading cause of preventable cardiovascular disease in children. RHD and its antecedent acute rheumatic fever remain endemic in many low to middle income countries, as well as in vulnerable communities in wealthy ones. Evidence-based interventions are particularly important in resource-poor settings. We sought to determine if efforts directed at patient and family education impact degree of participation in community-based prevention measures, and with short-term disease progression. We performed an observational, cross-sectional study of children with RHD aged 5-19 years, along with their parents, in American Samoa. A survey was administered in November 2016 to assess patient and parent knowledge of RHD. Scores were compared to percent timeliness of penicillin prophylaxis via chart review. We collected a total of 70 surveys of child-parent dyads with a patient mean age of 14.28 years ±2.71. An increased knowledge score was predictive of increased penicillin compliance for both children (12.70% increase in compliance per 1-unit increase in score (P = 0.0004)) and parents (10.10% increase in compliance per 1-unit increase in score (P = 0.0012)). A clear relationship exists between patient and parent knowledge of RHD and timeliness of penicillin prophylaxis doses. This study was the first to link patient understanding of RHD to engagement with preventative measures. © 2020 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).


Jennifer H Huang, Callia Elkhal, Ipuniuesea Eliapo-Unutoa, Laurie R Armsby, Erin J Madriago. Relationship between patient understanding and timeliness of penicillin prophylaxis in rheumatic heart disease prevention programmes in American Samoa. Journal of paediatrics and child health. 2021 Apr;57(4):513-518

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PMID: 33099838

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