AN ASSESSMENT OF HEALTH-RELATED QUALITY OF LIFE AND ITS DETERMINANTS, AMONG ADULTS DIAGNOSED WITH PULMONARY TUBERCULOSIS ATTENDING DOTS FACILITIES IN LAGOS STATE

Abstract

Introduction
The physical symptoms and complications of tuberculosis have been described extensively in literature. However, diagnosis of tuberculosis may also be associated with far-reaching effects on the social, mental and emotional well-being of patients and consequently their health-related quality of life. There has been a shift in paradigm to define disease outcomes beyond morbidity and mortality measures and to include patient reported outcomes (PROs) as an important aspect of the management of diseases and their outcome.
Objectives This study assessed health-related quality of life (HRQOL) of patients diagnosed with Pulmonary tuberculosis and changes in HRQOL over the course of treatment. It also compared health-related quality of life between patients and controls.
Methods
It was an analytical cross-sectional study with a follow-up component for the patients. Two hundred and ten consenting patients were consecutively recruited from three local government areas selected in a two-stage sampling method. Age and gender-matched controls were recruited by systematic random sampling from communities served by the TB-DOTS centres. Patient recruitment took place over a twelve-month period between January and December 2016. A semi-structured interviewer-administered questionnaire was administered to both groups of respondents. Additional instruments included the WHOQOL-BREF (generic) and the DR-12 (tuberculosis-specific) health-related quality of life instruments; and a stigma tool. Lung function tests and clinical examinations were also conducted. Patients were assessed at baseline, two and six months. HIV results and Gene Xpert/ sputum smear microscopy results were abstracted from patients’ files.
2
Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 22. Ethical approval was obtained from the Health Research and Ethics Committee of the Lagos State University Teaching Hospital, LASUTH.
Results
The sample population was predominantly male [133 (63.3) % of controls and 108 (59.1%) of patients] . The age distribution ranged between 15 and 70 years, with a mean age of 36.4 ± 11.7 years for controls and 36.7 ± 12.3 years for patients. Female patients (36.4%) were more likely to be HIV-positive compared with males (11.6%) (OR = 4.5, CI = 2.2 – 9.1). Health-related quality of life was impaired in the four WHOQOL-BREF domains (physical, psychological, social and environment) at entry into the study but the values increased over the treatment period, with the largest improvement being in “environment” domain, where the mean scores increased from 45.27 ±14.59 to 61.28 ± 15.86 (F=83.46, p<0.001). The overall HRQOL scores increased from 190.55 ±59.45 to 248.66 ±13.29 by the end of treatment (F=830.55, p<0.001). Despite this appreciable improvement, it was still below an overall HRQOL score of 301.11± 47.00 reported in the controls. There was a marked improvement in DR-12 scores with mean DR-12 increasing from a median score of 26.00 to 36.00. Correlation between both tools was found to be statistically significant but moderately positive (r = 0.419, p<0.001). Unemployment, delay in presentation and HIV status were significantly associated with poorer HRQOL at the baseline (p<0.05). Impaired lung function was associated with significantly lower mean HRQOL scores at the end of the intensive phase.
Conclusion
Health-related quality of life of respondents with tuberculosis progressively improved across all domains over the treatment period. However, they had lower mean scores across all the domains when compared with controls, both at baseline and at the end of the treatment period.

AN ASSESSMENT OF HEALTH-RELATED QUALITY OF LIFE AND ITS DETERMINANTS, AMONG ADULTS DIAGNOSED WITH PULMONARY TUBERCULOSIS ATTENDING DOTS FACILITIES IN LAGOS STATE