Date Published: January 25, 2019
Publisher: Public Library of Science
Author(s): Endi Lanza Galvão, Mariana Junqueira Pedras, Gláucia Fernandes Cota, Ana Rabello, Taynãna César Simões, Kristien Verdonck.
Until now, few studies have evaluated the effect of cutaneous leishmaniasis (CL) on patients’ quality of life, and none have used a specific instrument to measure this effect. The objective of this study was to identify factors that may be associated with the high impact of CL and to assess patients’ satisfaction with treatment and health services by utilizing a disease-specific questionnaire.
Between December 2015 and May 2017, 100 patients with localized cutaneous leishmaniasis were interviewed at a leishmaniasis referral center in Brazil. Data were collected by two questionnaires. One questionnaire compiled the sociodemographic, economic, and clinical information related to the disease. The second questionnaire was the Cutaneous Leishmaniasis Impact Questionnaire (CLIQ), which consisted of two subscales that measured 1) the general impact of CL and 2) patients’ perceptions of treatment and health services. The median scores from each of these two subscales were used to dichotomize the dependent variables. Risk factors for the high impact of CL and for low patient satisfaction with treatment and health services were analyzed with a logistic regression analysis.
The chance of higher impact of CL was increased in patients with the presence of comorbidities (OR: 3.9; CI 1.25–12.36), in those with absences from work (OR: 12.0; CI 3.78–42.55), in those who relied on public transportation by a municipal bus (OR: 5.8; CI 1.27–26.77), and in those who had illness-related expenses greater than U$137 (OR: 3.5; CI 1.17–10.24). The chance of patient dissatisfaction with treatment and health services increased with higher education (OR: 5.0; CI 1.19–21.03) and with illness-related expenses exceeding U$137 (OR: 4.64; CI 1.49–14.48). Once the sample was non-probabilistic, findings are not representative of CL patients in general.
CL and its treatment have a negative impact on patients’ quality of life. Considering these effects during public health planning may help patients to confront the disease.
Currently, with changes in the biomedical paradigm, it is recognized that an individual’s subjective experiences should be included as indicators when evaluating the traditional epidemiology of diseases so as to improve health outcomes. In the last few decades, health status self-assessment has been a widely used indicator [1–7]. Individuals’ perceptions about their own health are usually assessed by asking a single question: “How do you rate your health: very good, fairly good, average, fairly poor, or poor?”. However, a deeper understanding of a particular health condition and of the impact of a disease contributes to guiding policy decisions considering the specific needs of the population.
The burden of CL on individuals has often been attributed to the physical disfigurement caused by the disease . However, broadening the focus of the problem by raising issues that extend beyond physical impairment and changes in patients’ appearance can refine the understanding of the disease as a public health problem and allow better allocation of public investments. In the present study, among the variables related to the clinical manifestations of CL, none of them were significantly associated with the impact of the disease in the univariate analysis. On the other hand, our study revealed that the presence of comorbidities, missing work, relying on public transportation by municipal bus and illness-related expenses greater than U$137 dollars were associated with high impact of CL on patients’ QoL. In the same sense, illness-related expenses greater than U$137 dollars and higher education status were factors associated with patients’ dissatisfaction with CL treatment and health services.