Introduction: Rheumatic fever is a major cause of acquired heart disease in children worldwide, with the disease occurring most frequently in underdeveloped countries. ARF and its chronic sequela RHD remain significant causes of morbidity and mortality in Ethiopia. The main priority of long-term management of ARF or RHD is to ensure secondary prophylaxis is adhered to. Despite its importance, the rate and risk factors of rheumatic fever recurrence is not known in Ethiopian children with ARF/RHD. This study will identify ARF recurrence rates and the extent to which ARF is concentrated in certain populations based on age, sex, education, income, and types of valves involved. Objectives: The objective of this study was to identify risk factors for rheumatic recurrence in patients receiving monthly benzanthine G penicillin prophylaxis. Method: We conducted a retrospective review of medical records of 211 eligible patients with rheumatic heart disease at TASH, pediatric cardiac clinic from April /2014 to Aug. 2014. A descriptive and analytic statistics was used as applicable. Statistically significant associations were set at P-value of