Barriers to Effective Follow-Up Treatment for Rheumatic Heart Disease in Jmma, Ethiopia: A Grounded Theory Analysis of the Patient Experience

Rheumatic fever (RF) and rheumatic heart disease (RHD) are a major public health concern for many developing countries (1, 2, 3). While epidemiological trends of RF and RHD have progressively declined in economically developed countries over the past 50 years, they continue to increase at a striking rate in the developing world (4). Linked to poverty and poor access to health care facilities, estimates suggest that roughly 50% of cardiac patients in less developed countries have RF or RHD(5). To limit the progression of the disease, the World Health Organization recommends that patients take monthly treatment of penicillin (5). However, adherence to monthly treatment is not easy for poor populations who struggle to meet the costs and constraints required to seek treatment. In Ethiopia, RF/RHD are the major cause of cardiac pathology (6). Rates continue to increase as a result of minimal diagnostic assessments and low attendance for monthly follow-up treatment; issues which are further exacerbated in rural areas (5). To improve health service provision, this study sought to identify the factors that influence RF and RHD patients‟ decision to seek treatment in Jimma, Ethiopia. The principles of grounded theory were used to heighten the understanding of patient treatment seeking in this context. It is intended that these results will provide an in-depth understanding of patient needs and experiences related to seeking treatment and guide the improvement of health care services for RF/RHD patients in rural areas.