Physicians’ knowledge of and commitment to the national protocol for acute rheumatic fever and rheumatic heart disease management in Khartoum

Abstract

Background: Rheumatic Heart Disease (RHD) imposes a significant health problem in Sudan. Guidelines
for management of rheumatic fever (RF) and rheumatic heart disease (RHD) have been introduced and
workshops for physicians were conducted recently. Health professionals’ practices are key elements in
achieving implementation of a comprehensive program for controlling RHD. This study was conducted
to assess the physicians’ knowledge of, and adherence to, the implementation of the national protocol for
control of RF and RHD.
Methods: The study was a descriptive, cross-sectional, facility- based survey carried- out in three main
hospitals in Khartoum State in the period from July to October 2015, involving physicians of different
professional levels and junior doctors working in the paediatric units. A structured pre-coded questionnaire
focussing on awareness and adherence to the national guidelines was used. A scoring system for the
physicians’ adherence was set and data were analysed using SPSS software version 20.0.
Results: A total of 140 participants responded to the questionnaire (78% response rate): 10 paediatric
physicians, 68 paediatric registrars, and 62 junior doctors. Of these, 53.6% were not aware of the existence
of a national protocol for the management of RHD. Of the total 65respondents aware of the existence of
the protocol, 60 (92.3%) believed that the protocol provided appropriate measures for the control of RHD.
Adherence scoring showed that 19% had poor adherence; 50% had an average adherence and about 31%
had a high adherence score. Benzathine penicillin G (BPG) was not available in the emergency department
at any of the three hospitals.
Conclusion: The study identified gaps in physicians’ knowledge of ,and adherence to, the RHD Control
Program. There is a need to consolidate training programs especially for junior doctors and to provide BPG
in the emergency departments.