Key result
One-fourth (24.7%) of children with rheumatic heart disease had behavioral problems, and good medication adherence was associated with significantly lower odds of these abnormalities (AOR 0.29).
Why the study?
Children with RHD may be at increased risk for behavioral problems due to autoimmunity, but behavior disorders are not well studied in this population.
Cross-Sectional (n=166)
No
Odds Ratio: 0.29 (95% CI 0.09–0.94)
p-value: p=0.040
One-fourth of children with rheumatic heart disease experience behavioral problems, which are significantly less likely in those with good medication adherence and better physical symptom control (NYHA class I).
May support behavioral screening in pediatric RHD; hypothesis-generating for adherence interventions and requires prospective trials.
BACKGROUND: The behavioral disorder is characterized by a profound abnormality in an individual's cognition, emotion or behavior that reflects in psychological, biological or developmental dysfunction. Rheumatic heart disease (RHD) is a long-term sequel of single or recurrent acute rheumatic fever. Children with RHD are thought to be at increased risk for behavioral problems due to autoimmunity seen in pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Behavior disorder is not well studied among children with RHD. Hence, this study aimed to assess the pattern and predictors of behavioral problems among children with RHD enrolled in chronic care at a national cardiac referral Hospital. METHODS: This cross-sectional study used a validated parental-reported Amharic Strengths and Difficulties Questionnaire (SDQ) to assess behavior problems. Children with RHD aged 6-17 years on chronic outpatient cardiac care at Tikur Anbessa Specialized Hospital, Ethiopia between February and May 2023 were included. Factors associated with behavior problems were assessed using logistic regression models. RESULTS: The study included 166 children with a median age of 15 years [Interquartile range (IQR):13-17 years]. One-fourth of children, 24.7% (95% CI: 18.34-31.98), had behavioral problems. Of these, 46.4% (77) emotional, 35.5% (59) peer, 18.1% (30) conduct and 6.6% (11) hyperactivity problems were documented. Children who had good medication adherence, adjusted odds ratio AOR 0.29(95% CI: 0.09-0.94, P 0.040) and on New York Health Association (NYHA) class I, AOR 0.28(95% CI: 0.11-0.79, P 0.016) had lower odds for behavioral problems. CONCLUSION: One-fourth of children with RHD had behavioral abnormalities. Medication adherence and NYHA predicted behavioral abnormality. Better physical symptom control was associated with fewer behavioral problems. Behavioral abnormalities should be considered and assessed among children with RHD. Further multi-center mixed studies are recommended to uncover the unseen behavioral problem and guide health policy action on modalities of integration of behavioral problems assessment tools in clinical care.
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Melesse et al. (2024) conducted a cross-sectional in Rheumatic heart disease (n=166). Good medication adherence vs. Fair/poor medication adherence was evaluated on Behavioral problems (abnormal Strengths and Difficulties Questionnaire score) (AOR 0.29, 95% CI 0.09-0.94, p=0.040). One-fourth (24.7%) of children with rheumatic heart disease had behavioral problems, and good medication adherence was associated with significantly lower odds of these abnormalities (AOR 0.29).
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