Measurements In this study, blood samples will be collected from participants using the
syringe technique, and the samples will be analyzed using a five-differential cellular
analysis system machine manufactured by Beckman Coulter in Ireland. The machine will generate
flags indicating certain abnormalities in the blood parameters. To confirm these flags and
assess the performance of the automated hematology analyzer, a peripheral blood morphology
examination will be conducted. For this examination, a thin blood smear will be prepared from
the CBC sample, air-dried, and then stained with Wright stain. Laboratory technologists will
carefully examine the stained smear using a 100X oil immersion objective to assess the
morphology of red blood cells.
To evaluate anxiety and depressive symptoms among patients with rheumatic heart disease
(RHD), the participants will be provided with the Amharic version of the Hospital Anxiety and
Depression Scale (HADS). This scale consists of 14 items, which are divided into two
subscales: one for depression and the other for anxiety. Each item on the scale is scored
from 0 to 3, with 0 representing the lowest severity and 3 indicating the highest severity of
anxiety or depression. The scores on the subscales will be summed up to obtain a final score,
ranging from 0 to 21. Based on the score counts, three levels will be established: normal
(0-7), borderline (8-10), and abnormal (11-21). These levels provide guidance for assessing
the severity of anxiety and depression symptoms in the participants.
Weight and height will be measured using a combined height and weight scale (made in India,
manufactured on March 17, 2017). Weight will be measured to the nearest 0.1 kg with the
participant not wearing shoes and heavy clothes, whereas height will be measured to the
nearest 0.1 cm with the participant standing upright with the heel, buttock, and upper back
along the same vertical plane, arms at the side, and looking straight forward. Blood pressure
will be measured on the left arm in mmHg using a calibrated sphygmomanometer (Yton
sphygmomanometer, Italy, model 10220060) while the participant is in a sitting position with
his/her back supported, legs uncrossed, arm supported, and cubital fossa at heart level after
5 minutes of resting arms at the side and looking straight forward.
Tools and protocols for chronic disease self-management education The self-management
education program includes information about the structure and function of the heart, disease
risk factors, symptoms management, prophylaxis (penicillin/oral antibiotics) and/or
medication compliance, nutrition and dietary management, as well as maintaining a healthy
daily lifestyle. The education session will be developed based on heart failure management
guidelines produced by the American Heart Failure Society, the Joanna Briggs Institute's
(JBI) evidence-based manual, and the Ethiopian Ministry of Health. All the patients to be
enrolled in a series of educational sessions will be led by experienced nurse educators.
The contents of the program will be reviewed by experts in cardiology, nutrition, and public
health. Face-to-face education methods will be established, and the participants will be
provided with an educational leaflet with information about RHD, heart failure, self-reported
symptoms, and self-care behavior.
Understanding rheumatic heart disease and self-management of heart failure 1.
Introduction Education 2. Knowledge about RHD and heart failure Definition, etiology,
symptoms, complications, diagnosis, and treatment 3. Updating the patient's current
disease status Medications, complications 4. Self-management of heart failure in
patients with RHD
- Management of symptoms, medication, nutrition, emotions, and daily life
Symptoms Monitor the symptoms of patients on a monthly basis and during their
unscheduled follow-up visits.
Assess the factors that worsen and alleviate the symptoms. 2. Verify the use of
self-symptom checklists and self-care behavior calendar.
Evaluate and implement strategies for managing and retraining Education
Symptoms of heart failure, measure
Signs of heart failure requiring immediate attention, assessment
Discussion, question, and answer
Prophylaxis and medication Education 1. Importance of Prophylaxis in preventing the
recurrence of Acute rheumatic fever and disease severity
Schedule regular follow-up visits, Injection site care Common side effect of
benzathine penicillin 2. Types of medication, effects, and side effects 3. Side
effects and toxicity of the drug of heart failure 4. Providing information about
the medication's details and purpose. 5. Assessing the challenges and potential
adverse reactions associated with the medication/prophylaxis.
Establish a routine follow-up for consistent medication and prophylaxis usage
through the utilization of a self-care behaviors calendar 7. Question and answer 4.
Nutrition
Education
Dietary considerations for individuals with heart failure.
Restrictions on dietary intake of salt, fluid
Importance of a balanced diet and meal plan
Important dietary factors to consider for individuals taking warfarin medication.
Develop a routine of regularly monitoring weight as frequently as possible.
Question and answer 5.Routine, daily living Education Relaxation, stress
management, Avoid alcohol intake, khat chewing, and smoking Incorporate a regular
physical activity routine by utilizing a self-care behaviors calendar.
Question and answer