Penicillin prophylaxis adherence and associated factors among children aged 59 months and below attending the Mulago hospital sickle cell clinic.

Abstract

Background: Sickle cell disease (SCD) is the commonest inherited haemoglobinopathy worldwide. In Uganda, approximately 25,000 children are born with sickle cell disease annually. Infections with encapsulated organisms especially pneumococcus is one of the major complications of sickle cell disease. For prevention of pneumococcal infection, twice daily penicillin V and pneumococcal vaccination are recommended. However, adherence to penicillin prophylaxis was found to be low. There is paucity of data in Uganda about adherence to penicillin prophylaxis in sickle cell children. Objectives: To determine the level of penicillin prophylaxis adherence and associated factors among SCD children aged 59 months and below attending Mulago hospital Sickle Cell Clinic (SCC). Methods: This was a cross-sectional study with mixed methods. It was carried out at Mulago hospital SCC. A total of 428 children aged 59 months and below were enrolled. Quantitative data was collected using a semi-structured questionnaire. Qualitative data was collected from 6 health workers and 10 care givers using in-depth interviews. Informed consent was sought from the study participants before enrollment into the study. Adherence to penicillin was calculated as the percentage of doses taken out of the total prescribed in the previous 2 weeks. Optimal adherence was defined as taking 95% or more of the prescribed doses. Quantitative data was analysed using logistic regression. Qualitative data was coded then themes and subthemes generated. Results: Of the 428 children, 191 (45%) had optimal adherence to penicillin prophylaxis. Factors associated with optimal adherence included having been given a prescription of penicillin (Adjusted Odds Ratios (AOR) 3.59, 95% Confidence Interval (CI) 1.14-11.28, p=0.028), child taking hydroxyurea (AOR 1.77, 95% CI 1.15-2.73, p=0.009), good health-worker patient relationship and peer support. Factors found to impede adherence included forgetting, unavailability of the drugs, lack of finances and stigma. Conclusion and recommendations: Forty five percent of children aged below 5 years attending the sickle cell clinic are optimally adherent to penicillin prophylaxis. Having been given a prescription of penicillin and the child being on hydroxyurea therapy improved adherence to penicillin prophylaxis. Prescription of, availability of penicillin and community support for sickle cell children should be strengthened to improve adherence to penicillin prophylaxis.