Missed Opportunities in Primary Prevention of Rheumatic Heart Disease: Evidence from Nigerian Clinical Practice

Abstract Introduction : Primary prevention of rheumatic heart disease by medical practitioners is doable and more cost effective than managing the eventual chronic morbidities that can ensue if diagnosis of group A beta-haemolytic Streptococcus pharyngitis is missed or poorly treated. Aim to determine the knowledge of, and primary preventive practices of rheumatic heart disease among paediatricians and junior doctors in Nigeria. Methods A cross-sectional descriptive study conducted among doctors in Nigeria, recruited via several professional WhatsApp platforms using an electronic self-administered questionnaire. Data was analysed using IBM SPSS version 29. Results Total of 153 eligible medical practitioners in Nigeria participated in this study, 75(49%) being paediatricians while 78(51%) are junior doctors. While paediatricians were significantly more aware of the modified Centor’s score- 58(77.3% vs 47(60.3%); p = 0.02, score adherence was not significantly so- 6(8.0%) vs 2(2.6%); p = 0.17. Frequency of “always” throat examination for febrile children aged 5–15 yrs with sore throat differed significantly between paediatricians and junior 38(50.6%) vs 24(30.8%); p = 0.01, but there was no significant difference between paediatricians and junior doctors with respect to “always taking” a throat swab for microscopy, culture and sensitivity in a febrile child with hyperaemic pharynx”- 24(42.1%) vs 22(28.2%); p = 0.09. Frequency of throat swabbing was uniformly poor in both participant groups (χ 2  = 1.67, p = 0.87). Oral amoxicillin is commonest empiric antibiotic prescribed for acute exudative pharyngitis, but largely with suboptimal duration. Conclusion Clinico-laboratory diagnostic knowledge of Streptococcal pharyngitis, diagnostic practices, and antibiotic therapy as primary preventive strategy against rhematic heart disease by medical practitioners in Nigeria is suboptimal.