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.
Highlights
Most tuberculosis (TB) case management guidelines emphasize microbiological cure as treatment goal without highlighting quality of life outcomes
Patient clinical and socio‐demographic characteristics A total of 210 patients were identified from the medical records and all accepted to participate in the study providing 100 % response level
Of importance to note is that unlike in many other studies [4, 12, 18], findings in this study show that family support, gender, alcohol and HIV co-infection were not significantly associated with health-related quality of life (HRQoL) in any category of the patients that participated
Summary
Most tuberculosis (TB) case management guidelines emphasize microbiological cure as treatment goal without highlighting quality of life outcomes. TB therapy presents some demerits that impact on patient’s health-related quality of life (HRQoL) This may be due to drug toxicity, adverse drug reactions [22], social stigma [10, 11] or the anxiety and a feeling of helplessness stimulated by the disease and its treatment processes [15]. These effects determine the way patients perceive their total health and wellbeing, which is defined as HRQoL [21]. Much as HRQoL is increasingly assessed in public health research and clinical practice as an appropriate indicator of intervention needs and outcomes in chronic diseases like TB, its incorporation into routine patient care and management protocols in Uganda is still limited
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