The present study assesses the knowledge level of nurses towards Rheumatic Heart Disease (RHD) and associated factors in Addis Ababa public hospitals with cardiac units. Consequently, the mean correct answer response of the nurses for knowledge of RHD questions is 12.2 ± 5.2, with minimum 0 and maximum score 23 out of 24 question items.
This is consistent compared to a study conducted in four medical schools in Cameroon from February to April 2019 among 509 medical students which showed that the overall knowledge level of the study participants on Rheumatic heart disease was moderate 296 (58.2%), with 159 (31.2%) having a good knowledge level. The mean knowledge score was 11.97 out of 22 36.
Better knowledge of study subjects was scored on RHD in the current study compared to a prospective hospital based cross sectional study conducted among 87 health care providers in Sudan Khartoum State Gaafar Ibnauf Children’s Hospital (GICH) which assessed knowledge about prevention of rheumatic fever and rheumatic heart disease before a teaching session was 38% 35. This discrepancy may be due to better work experience in Cardiac clinics in the current study or exposure to rheumatic disease inflicts a memory towards RHD care knowledge.
According to a prospective follow-up study conducted in Suva, Fiji, in the South Pacific on health workers on teaching focused echocardiography for rheumatic heart disease screening, explored that mean knowledge scores increased from 8.1 prior to training (range 5–15) to 14.9 (range 14–15) after training 40. This is congruent compared to our study as the level of mean knowledge.
The current study finds out that 75(48.7%) nurses have scored above mean to knowledge of RHD questions and 79(51.3%) have scored below mean to nurses knowledge questions. This is consistent compared to a cross-sectional and interventional study conducted in Gezira State, Al Managil locality from Nov 2016 to February 2018 on handheld echocardiography for screening and control of rheumatic heart disease study in Gezira state, Sudan: the study assessed knowledge attitude and practice of health care providers regarding RHD and found that majority of the health worker’s knowledge towards RHD were found to be poor 39.
However, the current study contradicts A prospective hospital based cross sectional study conducted among 87 health care providers in Sudan Khartoum State Gaafar Ibnauf Children’s Hospital (GICH) on knowledge about rheumatic heart disease revealed that before and after a teaching session, the nurses’ knowledge about RHD and rheumatic fever was increased to 93% after lectures. Knowledge about the different aspects of management had shown significant improvement after the teaching sessions. The average knowledge of these health care providers level of knowledge was average before lecture provision 35. This discrepancy may be due to difference in research methodology as the later study is prospective interventional study.
According to a study conducted in Sudan the minimum duration of secondary prophylaxis was known by 14.5% of students, and 84.7% responded that Benzathine penicillin is the drug of choice for the treatment of sore throat to prevent acute rheumatic fever 36. This is congruent compared to our study in which What the drug of choice for secondary prophylaxis 87(56.5%), and the frequency of prophylaxis with Benzathine Penicillin 96(62.3%).
Regarding knowledge on prevention of RHD up to 30.1% of students thought that amoxicillin was the drug of choice for secondary prophylaxis for acute rheumatic fever or rheumatic heart disease in the Sudan’s study. However, 114(74%), in the current study thought amoxicillin is appropriate for a bacterial sore throat for prevention of acute rheumatic fever and rheumatic heart disease. This discrepancy may be due to difference in socioeconomic status, lack of in-service training and RHD education in their university in the Sudan’s study.
According to the world heart federation an Rheach second edition report, health worker training has a central role in RHD control programs that needs to be instituted to all levels of health care personnel including physicians and non-physicians. The study also concludes that provision of training whether in the job or scheduled to health care providers on rheumatic heart diseases have shown to increase the knowledge level of the professionals on rheumatic heart disease 41. This agrees with the current study as taking formal education in university or collage about RHD, taking in-service training on RHD, having higher wok experience, have found significantly associated with higher odds of nurses’ good knowledge towards RHD at p values less or equal to 0.05.
In this study male nurses working in the cardiac unit of the current study area were having 4.6 times higher odds of good knowledge towards RHD compared to female nurses ([AOR = 4.6, 95% CI (1.33-16.045)) P = 0.017)]. Most literatures (37–41) didn’t support this idea. This may be due to the fact that difference in socio cultural background of the nurses in the studies.
In this study Nurses who had formal education towards RHD in college or university have 4.3 times more likely higher odds of better knowledge towards RHD ([AOR = 4.3, 95% CI (1.07,17.5)) P = 0.039)]. This finding agrees with studies conducted in Sudan Khartoum State Gaafar Ibnauf Children’s Hospital35. And cross-sectional study conducted in Cameroon having a formal lecture on RHD 36.
A cross-sectional and interventional study conducted in Gezira State, to assess knowledge attitude and practice of health care providers regarding RHD showed that health workers knowledge towards ARF/RHD were significantly associated with taking training on RHD, public education about RHD. There was nothing mentioned if age, sex occupation salary and other socio demographic variables could associate with higher knowledge of RHD knowledge or not 39. This is consistent compared to the current study except being male nurse have associated with better knowledge to RHD in the current study.
Nurses participants who had history of sore throat had scored more than 5 hands higher knowledge level compared to those who have never feel sore throat previously [AOR = 5.8: 95% CI (2.04–16.53) P = 0.001)]. This is not consistent compared to studies conducted in Fuji, Sudan or Cameron. This inconsistency may be due to the fact that all nurses in the later studies may have been taking the prophylactic treatment before exposed to RHD.
According to a prospective follow-up study conducted in Suva, Fiji, in the South Pacific on health workers on teaching focused echocardiography for rheumatic heart disease screening, explored that training health workers without prior experience to perform basic echocardiography can facilitate RHD screening in settings with limited resources. In addition on the job training of health workers may contribute for higher levels of knowledge scores after training which further can help in better screening of RHD performance 40. This is congruent compared to the recent study as expressed by participants with in service training towards RHD related courses had nearly 11 times more likely to have higher odds of better knowledge on RHD ([AOR = 10.9: 95% CI (2.93,40.6)) P = 0.001]).
Study participants with short work experience period/ time/ have associations with low level of good nurses’ knowledge of RHD. Participants with less work experience had 0.57 times less probability of having better knowledge towards RHD compared to those who had higher long period of work experience [AOR = 0.57: 95% CI (0.57(.011,0.3)) P = 0.001)]. This may be due to work experience may expose nurse to multi professional experience exchange, knowing the disease more extensively and knowing more about the disease.