Research Article: Tuberculosis patients are physically challenged and socially isolated: A mixed methods case-control study of Health Related Quality of Life in Eastern Ethiopia

Date Published: October 15, 2018

Publisher: Public Library of Science

Author(s): Aklilu Abrham Roba, Tamirat Tesfaye Dasa, Fitsum Weldegebreal, Abyot Asfaw, Habtamu Mitiku, Zelalem Teklemariam, Mahantash Naganuri, Bahubali Jinnappa Geddugol, Frehiwot Mesfin, Hilina Befikadu, Eden Tesfaye, Jennifer Furin.

http://doi.org/10.1371/journal.pone.0204697

Abstract

Pulmonary tuberculosis (TB) impairs respiratory physiology and functional ability, resulting in economic and social dependence upon others. Patients with tuberculosis especially multi drug resistant (MDR-TB) suffer from social isolation, stigma, lack of support and economic constraints. In Ethiopia, the trend of MDR TB is increasing and becoming a serious public health problem. However, little is known about patients except treatment outcomes, financial burden and psychological distress with serious deficiency of data on Health Related Quality of Life (HRQOL). Hence, the aim of this study was to assess HRQOL of MDR TB patients in comparison with drug sensitive pulmonary TB (DSTB) patients.

We included 100 cases of MDR and 300 controls with DSTB who were matched by sex. Data were collected using SF- 36v2 TM questionnaire and analysed with SPSS version 20. Independent t-test and conditional logistic regression analysis was done considering P-values of less than 0.05 statistically significant. Eight in-depth interviews were also conducted with both groups and represented with verbatim quotations and narrative texts.

There were no statistically significant differences in mean scores for health related quality of life between cases and controls (57.61±16.42 and 59.13±22.10) nor were there significant differences in physical functioning, role disruption due to physical problems, vitality, social functioning, role disruption due to emotional distress, or overall mental health. Individuals with MDR-TB were significantly more likely to be single, a current student, and with lower education and families with more than 5 people than individuals with Drug sensitive TB, all of which were significantly associated with poorer HRQOL (p<0.05). There was good internal consistency of the scale scores, with a Cronbach's alpha value of 0.73. Individuals with MDR-TB reported statistically worse general health but less bodily pain than individuals with Drug sensitive TB. To regain the role function they lost, we recommend that health facilities, media and all other stakeholders educate the community, households and students about pulmonary tuberculosis, treatment, prevention methods and therapeutic approaches towards TB patients, specifically MDR-TB.

Partial Text

Tuberculosis (TB) is one of the leading causes of infectious disease that resulted in 10.4 million infections and 1.7 million deaths in 2016 [1]. Multidrug-resistant tuberculosis (MDR TB) is a form of TB caused by bacteria that do not respond to the two most powerful first line anti-TB drugs: isoniazid and rifampicin. Ethiopia has one of the highest TB burdens in the world [2,3]. Health Related Quality of Life (HRQOL) is defined as a person’s perception of his or her physical and mental health domains, which is then divided into eight sub domains: physical function, physical role, bodily pain, general health, vitality, social functioning, role–emotion and mental health [4].

Health related quality of life of MDR-TB and DS-TB patients can be contextualized with respect to healthy population for interpreting the average mean scores. We found that some of the scores for MDR-TB and DSTB were 2–3 times lower than healthy population in southern Ethiopia with mean scores of Physical function 93.1 vs 65/64 in this sample; physical role 90 vs. 30/35; bodily pain 90 vs. 61/67; vs General health 72 vs 77/72; Vitality 60 vs 60/56, Social functioning 91 vs 70/72; emotional role 92 vs. 34/40 and Mental health 71 vs 63/65 where the first mean scores denote healthy population, MDR-TB and DS-TB respectively. In other words, although there were very few differences between patients with MDR-TB and DSTB, both had significantly worse HRQOL when compared to the general population in rural Ethiopia[39].

Health related quality of life was low for both MDR-TB and DSTB groups even if they have no statistically significant differences in mean scores. Individuals with MDR-TB reported statistically worse general health but less bodily pain than individuals with DSTB. Individuals with MDR-TB were significantly more likely to be single, a current student, have only primary education and family size of more than 5. To regain the role function they lost, we recommend that health facilities, media and all other stakeholders educate the community, households whether they are large family or single, and students about pulmonary TB, treatment, prevention methods and therapeutic approaches towards TB patients, specifically MDR-TB. We also recommend that there should be future interventional studies related to improving the physical and psychosocial role to enhance HRQOL of TB patients. Patient centered care and therapeutic counselling may contribute more towards meeting the United Nations Sustainable Development Goal 3 (SDG3) target and the End TB strategy of the WHO rather treating only the disease by anti-TB drugs only. Early diagnosis and easy access to MDR-TB treatment is critical to end TB infection and related sequel.

 

Source:

http://doi.org/10.1371/journal.pone.0204697

 

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