The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study.
Adolescent
Adult
Antibiotic Prophylaxis
/ statistics & numerical data
Decision Making, Shared
Echocardiography
/ statistics & numerical data
Female
Follow-Up Studies
Health Services Accessibility
/ statistics & numerical data
Humans
Male
Mass Screening
/ methods
Maternal Age
Medication Adherence
/ psychology
Middle Aged
Mothers
/ psychology
Penicillin G Benzathine
/ therapeutic use
Postpartum Period
Pregnancy
Pregnancy Complications, Cardiovascular
/ diagnosis
Prospective Studies
Rheumatic Heart Disease
/ diagnosis
Risk Assessment
/ statistics & numerical data
Risk Factors
Severity of Illness Index
Social Stigma
Spouses
/ psychology
Uganda
/ epidemiology
Young Adult
Echocardiography
Health disparities
Maternal health
Rheumatic heart disease
Screening
Uganda
Journal
BMC pregnancy and childbirth
ISSN: 1471-2393
Titre abrégé: BMC Pregnancy Childbirth
Pays: England
ID NLM: 100967799
Informations de publication
Date de publication:
09 Oct 2020
09 Oct 2020
Historique:
received:
03
02
2020
accepted:
19
08
2020
entrez:
10
10
2020
pubmed:
11
10
2020
medline:
14
5
2021
Statut:
epublish
Résumé
Pre-existing maternal cardiac disease is a significant contributor to adverse maternal, fetal, and neonatal outcomes. In 2015-2017, our team conducted the first community-based study of maternal rheumatic heart disease (RHD) in sub-Saharan Africa and identified RHD in 88% of those with pre-existing heart disease. Here we conducted a follow up investigation of women previously identified with RHD, describing clinical and echocardiographic outcomes, identifying barriers to medical adherence and evaluating the personal impact of RHD. A 2 week prospective follow up was completed at sites in Central and Eastern Uganda. Participants underwent a three-step mixed methods study comprising of 1) direct structured interview targeting clinical history and medication adherence, 2) echocardiogram to evaluate left-sided heart valves, and 3) semi-structured guideline interview to elicit personal impacts of RHD. The team evaluated 40 (80%) of the original 51 mothers with RHD at a median post-partum time of 2.5 years after delivery (IQR 0.5). Echocardiographic data showed improvement in nine women with the remaining 31 women showing stable echocardiographic findings. Adherence to Benzathine penicillin G (BPG) prophylaxis was poor, with 70% of patients either poorly adherent or non-adherent. Three major themes emerged from interviews: 1) social determinants of health (World Health Organization, Social determinants of health, 2019) negatively affecting healthcare, 2) RHD diagnosis negatively affecting female societal wellbeing, 3) central role of spouse in medical decision making. Screening echocardiography can identify women with pre-existing rheumatic heart disease during pregnancy, but long-term follow-up in Uganda reveals adherence to medical care following diagnosis, including BPG, is poor. Additionally, mothers diagnosed with RHD may experience unintended consequences such as social stigmatization. As identification of occult RHD is critical to prevent adverse pregnancy outcomes, further research is needed to determine how to best support women who face a new diagnosis of RHD, and to determine the role of screening echocardiography in high-risk settings.
Sections du résumé
BACKGROUND
BACKGROUND
Pre-existing maternal cardiac disease is a significant contributor to adverse maternal, fetal, and neonatal outcomes. In 2015-2017, our team conducted the first community-based study of maternal rheumatic heart disease (RHD) in sub-Saharan Africa and identified RHD in 88% of those with pre-existing heart disease. Here we conducted a follow up investigation of women previously identified with RHD, describing clinical and echocardiographic outcomes, identifying barriers to medical adherence and evaluating the personal impact of RHD.
METHODS
METHODS
A 2 week prospective follow up was completed at sites in Central and Eastern Uganda. Participants underwent a three-step mixed methods study comprising of 1) direct structured interview targeting clinical history and medication adherence, 2) echocardiogram to evaluate left-sided heart valves, and 3) semi-structured guideline interview to elicit personal impacts of RHD.
RESULTS
RESULTS
The team evaluated 40 (80%) of the original 51 mothers with RHD at a median post-partum time of 2.5 years after delivery (IQR 0.5). Echocardiographic data showed improvement in nine women with the remaining 31 women showing stable echocardiographic findings. Adherence to Benzathine penicillin G (BPG) prophylaxis was poor, with 70% of patients either poorly adherent or non-adherent. Three major themes emerged from interviews: 1) social determinants of health (World Health Organization, Social determinants of health, 2019) negatively affecting healthcare, 2) RHD diagnosis negatively affecting female societal wellbeing, 3) central role of spouse in medical decision making.
CONCLUSIONS
CONCLUSIONS
Screening echocardiography can identify women with pre-existing rheumatic heart disease during pregnancy, but long-term follow-up in Uganda reveals adherence to medical care following diagnosis, including BPG, is poor. Additionally, mothers diagnosed with RHD may experience unintended consequences such as social stigmatization. As identification of occult RHD is critical to prevent adverse pregnancy outcomes, further research is needed to determine how to best support women who face a new diagnosis of RHD, and to determine the role of screening echocardiography in high-risk settings.
Identifiants
pubmed: 33036571
doi: 10.1186/s12884-020-03189-z
pii: 10.1186/s12884-020-03189-z
pmc: PMC7547429
doi:
Substances chimiques
Penicillin G Benzathine
RIT82F58GK
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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