Knowledge, attitude, and experiences of using penicillin G, as a prophylaxis for rheumatic fever and rheumatic heart diseases among nurses in Addis Ababa, Ethiopia: A cross-sectional survey

Abstract

Background: The rate of benzathine penicillin G (BPG) injection to prevent rheumatic heart disease (RHD) is insufficient owing to poor knowledge and the negative attitude of health workers. We aim to investigate the gap of knowledge, attitude, and experience of clinical nurses at the primary health-care level who had not received training on rheumatic fever (RF)/RHD prevention to get information on their training need. Methods: A cross-sectional survey was conducted on clinical nurses at randomly selected health centers in Addis Ababa. After interviewing with semi-structured questionnaires, the data were analyzed on SPSS software version 25. Results: A total of 278 nurses (92% response) with a mean age of 28 years were analyzed. The knowledge scores on “organisms causing tonsillopharyngitis (TP),” “the route of administration of penicillin,” and “when to give BPG after preparation” were good (≥75%). Participants' score was poor (<50% score) in the knowledge of “duration of treatment of tonsillopharyngitis, frequency of chemoprophylaxis of RF/RHD, and the relationship between throat infection and RF.” Knowledge on “prevention of pain using lidocaine,” “warming the syringe and allowing alcohol to dry from the swab before injecting” were also good. In contrast, knowledge of “delivering injection very slowly,” “using vibration before/during injection, and “distracting patient using conversation” was poor. Attitude was positive to statements such as “single dose BPG injection given every 3–4 weeks,” “BPG injection is effective in the treatment of streptococcal pharyngitis and the prevention of RF/RHD,” “good patient – health provider relationship enables the success of prophylaxis.” and “educating patients, health-care providers and their caregivers help adherence to BPG prophylaxis. Fear of anaphylactic reaction, pain at the injection site, and blockage of the syringe during injection were the negative experiences reported. Conclusions: The knowledge of clinical nurses on the prevention of RF/RHD was generally good. However, their knowledge of safe injection techniques was partial. On the other hand, most attitude statements were positive. Fear of anaphylactic shock while injecting BPG, pain, and blockade of the syringe was the common barriers experienced.