Education: The prevention of acute rheumatic fever and rheumatic heart disease in Malawi

Background
With an estimated prevalence of 183,200 cases, rheumatic heart disease (RHD) is a major public health problem in Malawi. However, patients in Malawi with advanced RHD are left with substantial and life-threatening disability because there are no surgical options available in our country at present. In order to tackle this epidemic, it is critical to provide appropriate education and attempt to diagnose the disease earlier. In this study, we aimed to pilot a RHD education program that could be subsequently adopted countrywide.
Methods
We designed and piloted a RHD educational program targeting health providers at Kamuzu Central Hospital in Lilongwe, Malawi. This involved three half-day workshops. These workshops were facilitated by a paediatric cardiologist and a paediatric nurse. Tests were administered before and after the workshops; we also provided questionnaires and requested feedback evaluations. A total of sixty-five participants (51 nurses, 3 doctors, 9 clinical officers and 2 unspecified personnel) participated in our workshops.
Results
Concerns were voiced and addressed relating to the safety of benzathine penicillin. Post-workshop questionnaires revealed that participants were much more comfortable prescribing or injecting benzathine penicillin after the workshop, as indicated by an improvement in the comfort level from 2.8 to 4.5 in nurses, and from 3.4 to 5 in clinicians (using a Likert scale of 1 to 5, p< 0.01). Pre-test knowledge scores improved from 43.8% to 78.5% (p< 0.01). Overall, the workshops received good feedback with an overall rating of 4.8 out of 5 (n=61, range 3–5).
Conclusion
Our analysis showed that practical sessions relating to acute rheumatic fever and RHD in Malawi must address the safety and administration of penicillin. Our pilot workshops could serve as the educational backbone for a national RHD prevention program in Malawi.

Keywords
Rheumatic heart disease; paediatrics; education; paediatric cardiology; acute rheumatic fever; Malawi