Does health-related quality of life among adults with pulmonary tuberculosis improve across the treatment period? A hospital-based cross sectional study in Mbale Region, Eastern Uganda

Abstract

BackgroundMost tuberculosis (TB) case management guidelines emphasize microbiological cure as treatment goal without highlighting quality of life outcomes. This study assessed health-related quality of life (HRQoL) and related factors in the pre-treatment, intensive and continuation phases of anti-TB therapy among sputum smear positive pulmonary TB patients in Mbale region, Eastern Uganda.MethodsIn this cross-sectional study, questionnaires and 36-Item Short-Form Health Survey Version 2.0 (UK English SF36v2) forms were administered to 210 participants of whom 64.8 % were males. The mean age was 35.48 ± 12.21 years. For each of the three treatment phases, different patients were studied. Responses were translated into the standard 00–100 scale. Means and standard deviations were used to express HRQoL as physical composite scores (PCS) and mental composite scores (MCS). Analysis of variance was used to compare scores across phases. Multiple linear regression methods were used to model relationships between predictor variables and HRQoL for each treatment phase.ResultsHRQoL scores were different across treatment phases. General health (38.8 ± 17.5) and mental health (52.7 ± 18.6) had the lowest and highest sub-scale scores respectively. Mean PCS scores in pretreatment, intensive and continuation phases were 29.9 ± 19.4, 41.9 ± 14.2 and 62.2 ± 18.8 respectively. Mean MCS scores in the pretreatment, intensive and continuation phases were 38.8 ± 18.3, 49.4 ± 13.1 and 60.6 ± 18.8 respectively. Prior to treatment initiation, having an informal occupation (β = −28.66 (<0.001) was associated with poor HRQoL. Being unmarried (β = 11.94, p = 0.028) and belonging to the highest tertile of socioeconomic status (SES) (β = 14.56, p = 0.007) were associated with good HRQoL in the intensive phase. In the continuation phase, SES (β = 10.83, p = 0.021 for MCS and β = 13.14, p = 0.004 for PCS) predicted good HRQoL. Older age (β = −0.43 p = 0.013 for PCS and β = −0.36 p = 0.040 for MCS) was associated with poor HRQoL.ConclusionsTB treatment improved patients’ perceived health and having means of income was particularly associated with high HRQoL. Strategies to strengthen treatment support that include income generation and specific close monitoring of older patients may help improve overall TB treatment experience, by sustaining acceptable levels of physical, social and emotional functioning.

Multidimensional Health-Related Quality-of-Life Among Patients with Pulmonary Tuberculosis in Saudi Arabia

“…This result adds to the existing evidence which have documented and reported impairment in the quality of life among tuberculosis patients with significant deficits in physical, as well as psychological components [5,13]. The findings of the study therefore conformed to other studies that physical aspect of tuberculosis patients influences their quality life [2,14] However, the present findings revealed that the HRQOL of the TB patient in Saudi Arabia were lower compared to previous study using the same tool in Iraq [8]. Several factors were identified in the literature that may influence the HRQOL of this population, such as exposure to secondhand smoke, unemployment, having lower educational attainment, numbers of symptoms and drug reactions, low perceived social support, lower body mass index, and having positive sputum smear result [13].…”

“…Those having no formal education displayed poorer functional well-being compared to those with higher level of educational attainment. This finding could be explained and supported by others reports [14] that stated that people who are well-educated have the tendency to have better financial status and comprehend better about the disease process and its treatment, thus adapt better and individuals with higher income may have better ways of life.…”

SYSTEMATIC REVIEW OF DETERMINANTS OF HEALTH-RELATED QUALITY OF LIFE (HRQoL) AFFECTING WELL-BEING OF PULMONARY TUBERCULOSIS (PTB) PATIENTS

“…Age of PTB patients was significantly associated with HRQoL as reported by nine studies (Suzuki et al, 2019;Dhelaimi et al, 2018;Malik et al, 2018;Hilka et al, 2017;Ting-Li et al, 2017;Kisaka et al, 2016;Atif et al, 2014;Aggarwal et al, 2013;Chamla, 2004). A lower scores in elderly patients might be associated with their old age and the expected decline in physical health with increasing age (Atif et al, 2014).…”

“…Highly educated patients tend to have better health-seeking behavior and thus likely to report for treatment earlier than those who are less educated. They also integrate healthrelated information at a deeper level (Kisaka et al, 2016). Moreover, high literacy can lead to improved employment status and financial and social matters.…”

Health-related Quality of Life Among Patients With Bipolar Disorder in Rural Southwestern Uganda: A Hospital Based Cross Sectional Study

“…The tool has been used in Uganda and other East Africa countries with good reliability measures [49][50][51]. The tool was translated into Runyankore, the local language in southwestern Uganda), using recommended guidelines (Maxwell, 1996;Peters and Passchier, 2006;Gudmundsson, 2009).…”