Assessment of Health-Related Quality of Life among Tuberculosis Patients in a Public Primary Care Facility in Indonesia

Health-related quality of life among adults newly diagnosed with pulmonary tuberculosis in Lagos State, Nigeria: a prospective study

PURPOSE

Tuberculosis (TB) has far-reaching effects on the social, mental, and emotional well-being of patients and consequently, their health-related quality of life (HRQOL). Few studies in Nigeria have examined changes in quality of life over the course of treatment. changes in (PTB) and factors associated with HRQOL.

METHODS

A prospective cohort study was conducted with patients recruited from health facilities in Lagos State. The World Health Organization Quality of Life Instrument, Short-Form (WHOQOL-BREF) was used to assess HRQOL. A semi-structured questionnaire was also administered to elicit information on socio-demographic characteristics and the medical and social history of the respondents. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23. A repeated measures analysis of variance (ANOVA) test with polynomial contrasts was used to assess how domain scores varied over time. Multivariable analysis was conducted using generalized estimating equations (GEE) to assess change in HRQOL and its predictors.

RESULTS

Two hundred and ten patients, predominantly male [108 (63.3%)] were recruited. The mean age was 36.7 ± 12.3 years. The HRQOL was impaired in all four domains at baseline. However, HRQOL scores increased over the treatment period with the largest improvement being in the 'environment' domain, where mean scores increased from 45.27 ± 14.59 to 61.28 ± 15.86. The proportion of respondents that expressed satisfaction with their health increased from 13.5% at baseline to 55.7% at the end of treatment. Low socio-economic status, delay in presentation, and an HIV-positive status were found to be significantly associated with reduced HRQOL at baseline (p < 0.05). In the multivariable longitudinal analysis, patients who were employed had higher HRQOL scores while persistent symptoms and a delay in presentation (≥ 4 weeks) were negatively associated with change in HRQOL scores over the course of treatment.

CONCLUSION

The HRQOL of respondents progressively improved over the six-month treatment period. However, change in HRQOL was influenced by a delay in presentation and persistence of symptoms. The study also highlights the need for increased recognition of patient-reported outcomes as an adjunct outcome measure.

Effect of Yoga on Quality of Life in Patients with Pulmonary Tuberculosis: A Randomized Control Trial

Introduction

Yoga is emerging as one of the holistic approaches to respiratory diseases. The scope of yoga is expanding in communicable diseases with physical, mental, and societal benefits.

Aim and Objective

The present study aims to evaluate the effect of integrated yoga as an adjuvant therapy to the National Tuberculosis Elimination Programme (NTEP) on assessing health-related Quality of Life (QoL) in patients with pulmonary tuberculosis (PTB).

Setting and Design

A randomized controlled trail study was conducted in a tertiary care teaching hospital.

Methodology

The study screened 826 PTB patients; 72 patients were found suitable and agreed to participate. The PTB patients were randomly assigned to either a yoga group (n = 36) or a control group (n = 36) using the sequentially numbered opaque sealed envelope technique. The control group received standard-of-care treatment as per NTEP, and the yoga group practiced 45 min of integrated yoga for 8 weeks along with standard of care. The World Health Organization Quality of Life (WHOQOL-BREF) questionnaire was used to collect the data at baseline and after 8 weeks of intervention.

Results

The results of within-group comparisons in both the groups showed that there was a significant improvement in physical (P < 0.01), psychological (P < 0.01), and social (P < 0.01), with P ≤ 0.05 being considered statistically significant except environmental domain. Between groups, analysis shows that in the preintervention, there was no difference between the yoga and control group as P > 0.05. After the yoga intervention, there was an enhancement in QoL scores with three domains except the environmental domain (P = 0.28).

Conclusion

The study evidence supports the use of yoga as a complementary therapy for the NTEP in patients with PTB may improve their QoL.

Survey to measure the quality of life of patients with tuberculosis in Alexandria, Egypt: a cross-sectional study

BACKGROUND

Assessment of quality of life (QoL) in patients with tuberculosis (TB) may improve healthcare providers' understanding of the disease burden. This study aimed to investigate the QoL of patients with TB in Alexandria, Egypt.

METHODS

This cross-sectional study was conducted in chest clinics and main chest hospitals in Alexandria, Egypt. A structured interview questionnaire was used to collect data from participants through face-to-face interviews from November 20, 2021, until the June 30, 2022. We included all adult patients aged 18 years or above during the intensive or continuation phase of treatment. The World Health Organization (WHO) WHOQOL-BREF instrument was used to measure QoL, which includes the physical, psychological, social relationships, and environmental health domains. Using propensity score matching, a group of TB free population was recruited from the same setting and completed the questionnaire.

RESULTS

A total of 180 patients participated in the study: 74.4% were males, 54.4% were married, 60.0% were 18-40 years old, 83.3% lived in urban areas, 31.7% were illiterate, 69.5% reported insufficient income, and 10.0% had multidrug-resistant TB. The TB-free population group had higher QoL scores than the TB patients' group: (65.0 ± 17.5 vs. 42.4 ± 17.8) for the physical domain, (59.2 ± 13.6 vs. 41.9 ± 15.1) for the psychological domain, (61.8 ± 19.9 vs. 50.3 ± 20.6) for the social domain, (56.3 ± 19.3 vs. 44.5 ± 12.8) for the environment domain, (4.0(3.0-4.0) vs. 3.0(2.0-4.0)) for general health, and (4.0(3.0-4.0) vs. 2.0(2.0-3.0)) for the general QoL, P < 0.0001. Patients with TB aged 18-30 years had the highest environmental score compared with the other age groups (P = 0.021).

CONCLUSIONS

TB had a significant negative impact on QoL, with the physical and psychological domains being the most affected. This finding necessitates strategies to improve QoL of patients with to enhance their compliance to treatment.

A randomized controlled trial to evaluate the impact of pharmacist-led clinical interventions on the health-related quality of life among TB patients

Background: The study was designed to evaluate the impact of pharmacist-led clinical interventions on the health-related quality of life among tuberculosis patients in Pakistan. Methods: A randomized, controlled prospective study was carried out in a Pakistan Institute of Medical Sciences hospital tuberculosis (TB) control center. Participants who visited the TB center between September 2020 and December 2021 were randomly assigned to two clusters, the usual care group (UC group) vs. the intervention group (pharmaceutical care group), in a 1:1 ratio by a simple envelope technique. In the intervention group, a patient received centered care that encompassed informed decision-making, which can increase the quality of care and monitoring of adverse drug events. However, the control group received routine TB treatment at the hospital. The EuroQol-5D-3L instrument was used to assess the health-related quality of life (HRQoL) at the baseline and in the third and sixth months of the treatment time period. Results: A total of 503 patients were eligible, of which only 426 patients were included in this study. At the end of the study, n = 205 of the patients in the intervention group and n = 185 of those in the control group were analyzed. In the intervention group, the EQ-5D-3L health utility score improved significantly (p < 0.001) (from the baseline mean ± SD, 0.40 ± 0.36, to 6 months of treatment, 0.89 ± 0.09, while in the control group from 0.42 ± 0.35 to 0.78 ± 0.27). In multivariate regression analysis, the variables that remained statistically associated (p < 0.001) with the HRQoL (unstandardized β [95% confidence interval]) of the control group were as follows: gender, female vs. male (-0.039 [-0.076 to -0.003]); body weight, less than 40 kg vs. more than 40 kg (-0.109 [-0.195 to -0.024]); patients with any comorbidity vs. without comorbidity (-0.136 [-0.252 to -0.020]); and smokers vs. non-smokers (-0.204 [-0.291 to -0.118]). The study did not find any statistically significant associations between the intervention group's variables and the HRQoL. Conclusion: Patient-centered care interventions led by pharmacists as part of care coordination enhanced the HRQoL for TB patients significantly. According to this study, clinical pharmacists should be included in the interdisciplinary clinical staff for TB patient management.

Correlates of quality of life among persons living with tuberculosis: A cross-sectional study

Introduction

The correlates of quality of life originating from the demographic characteristics, comorbidities and sources of social support among persons living with tuberculosis remain underreported. The aim of this study was to examine the correlates of quality of life among persons living with tuberculosis within Greater Accra, Ghana.

Methods

A cross-sectional survey design was used to assess the correlates of quality of life among 250 randomly sampled persons living with tuberculosis. Quality of life was assessed with the Quality of Life Brief Version (WHOQOL-BREF) questionnaire and correlates were derived using Spearman rho correlations. Chi-square analyses assessed associations among respondent characteristics.

Results

All four quality of life domains (physical, psychological, social relationship and environmental) of persons living with tuberculosis were positively correlated. Furthermore, receiving social support from family or friends correlated positively with respondents’ quality of life. Human Immunodeficiency Virus (HIV) infection and receiving social support mainly from work colleagues or religious institutions correlated negatively with respondents’ quality of life domains. Other correlates of quality of life included age, pleuritis with pleural effusion, number of dependants and distance to tuberculosis treatment centres. Social support from family and friends corresponded with better quality of life among persons living with tuberculosis.

Conclusion

The quality of life domains of persons living with tuberculosis are interrelated and can be enhanced by social support. Healthcare providers should involve the significant others of persons living with tuberculosis, human immunodeficiency virus and pleuritis with pleural effusion in their care to promote patients’ quality of life.

Pre-Diagnosis Health Seeking Behaviors and Experiences Post-Diagnosis, among Men Diagnosed with Tuberculosis in a District of Gauteng Metropolitan City, South Africa: In-Depth Interviews

BACKGROUND

Tuberculosis remains the number one killer among infectious diseases in South Africa. The TB disease burden is said to be higher among males, 1.6 times more than females in 2018. Moreover, men are reported to have poor healthcare-seeking behaviors. Loss in social and physical functioning, including reduced sexual desires and changes in family life, have been reported following a TB diagnosis. This study explored the meaning that male TB patients attach to their TB diagnosis and impact of TB infection in their lives and those of the people living with them.

METHODS

This exploratory qualitative study was conducted among 25 participants recruited among male patients seeking TB care from two clinics in informal settlements of the city of Johannesburg. In-depth interviews with open-ended questions were conducted using an audio recorder for the collection of data. Data analysis was conducted on the NVivo version 12 software following an inductive thematic approach.

RESULTS

The ages of the participants ranged between 18 and 61 years. Most were unemployed, and only a few were married or in steady relationships. From the two emerging themes, pre-TB diagnosis health-seeking behaviors and post TB-diagnosis experiences, several subthemes were identified. For the former theme, the subthemes include, seeking help from community-based healers and self-medicating, waiting for some period to see if the alternative medicine or treatment worked, taking time to visit a healthcare facility, triggers to seek healthcare, and symptoms reported on presentation to the healthcare facility. The post-TB diagnosis subthemes include making sense of the TB diagnosis, context of disclosing the TB status, fear of social exclusion and experiences of stigma, support received during illness, life changes after TB infection and diagnosis, and lessons learned from the TB experience and future healthcare-seeking behavior.

CONCLUSION

Secrecy about the TB diagnosis indicates fear of social exclusion, and this could be due to the highly stigmatized nature of TB. Waiting to see if alternative medication worked, delayed the TB diagnosis, with consequent late initiation of the anti-TB treatment. The life changes experienced post-TB diagnosis affect the quality of life of the participants and their families. The study recommends that these issues be addressed as a priority.

Quality of Life Amongst Multidrug-Resistant TB Patients: An Exploratory Study About Distributive Dimensions and Interactions

Background: Multidrug-resistant (MDR)-TB has emerged as a major challenge to eliminate TB as envisioned at policy level. Distinctive traits associated with the disease such as physical, psychosocial and environmental dimensions may influence the treatment outcome in both directions. Quality of life (QoL) indicators may capture these traits distinctively.

Objective: To quantify the differential effect of MDR-TB on specific QoL domains, their distributions across the strata and to check for possible interactions.

Method: This community-based cross-sectional study was conducted on 98 MDR-TB patients registered in the calendar year 2017 under National Tuberculosis Elimination Programme (NTEP) in a central Indian district using the WHO-QoL BREF Scale by patients in their vicinity. The transformed domain scores were descriptively summarized, stratified and exploratory visualised. Likert mapping for each item was done. A two-way ANOVA test was applied to check differences across strata and interaction effects were calculated.

Result: Participants perceived a higher QoL in the social domain (median score 69, IQR 56-75) while the psychological health domain (median 31 IQR 20.5-44) was professed as most negotiated by disease. More than 50% of participants were found to be dissatisfied with their assumed physical status in item-wise analysis. A statistically significant interaction (p=0.008) was detected with education strata to income tertile most evident in the physical domain while psychological domain alone (p=0.017) without significant interaction with treatment duration (p=0.316) was associated with the type of TB. Overall QoL scores were tilted in favour of an urban setting, male gender and towards a relatively younger population.

Conclusion: The overall deficits in QoL are evident in the study, per se in the psychological and physical domains. Moreover there is an inequitable distribution of these scores as revealed in the study. Inclusion of an additional parameter of periodical QoL assessment may thus predict the outcome at individual level and may address this inequity at policy level.

Health-related quality of life of persons living with tuberculosis: A cross-sectional study

Background

Tuberculosis is a chronic infectious disease that can affect the quality of life of persons living with tuberculosis in resource-limited settings. There is a dearth of research on the quality of life of persons living with tuberculosis within Greater Accra, Ghana.

Purpose

This study investigated the quality of life and its related factors among persons living with tuberculosis in the Greater Accra region of Ghana.

Methods

This descriptive cross-sectional survey assessed the physical, psychological, social relationship and environmental quality of life of 250 persons living with tuberculosis in four public health facilities using the World Health Organization’s Quality of Life Brief Questionnaire instrument.

Results

Respondents’ mean (standard deviation) physical, psychological, social relationship and environmental health-related quality of life domain scores were 46.19 (21.27), 50.67 (23.95), 40.9 (21.74) and 51.91 (20.13) respectively out of 100. Sociodemographic factors which influenced all four quality of life domains were their marital and employment statuses. Respondents’ site of TB infection (pulmonary or extrapulmonary) and phase of treatment influenced their physical, psychological and social domains. Other determinants of the quality of life were their sex, highest level of education and average monthly income.

Conclusions

The quality of life of persons living with tuberculosis was found to be poor and influenced by the patients’ socioeconomic status. Strategies that identify and address any deterioration in the quality of life of persons living with TB are required throughout their management.

The lived experiences and psychosocial impact of hearing loss on the quality of life of adults with Multidrug-Resistant Tuberculosis

Background

Aminoglycosides used in the treatment of Multidrug-Resistant Tuberculosis (MDR-TB) are known to result in hearing loss. The effects of an acquired hearing loss with an MDR-TB diagnosis may have an increased adverse impact on the overall quality of life of an individual; however, there is minimal research in the area.

Objectives

This study explores the psychological and emotional impact of hearing loss in adults with MDR-TB; and describes the experiences of the social, economic, and vocational impact of hearing loss in adults with MDR-TB.

Method

A qualitative research study was conducted on 10 participants, with a confirmed diagnosis of MDR-TB and hearing loss. The researcher used a semi-structured questionnaire to collect data during face-to-face, audio-recorded interviews.

Results

Hearing loss in patients diagnosed with MDR-TB has a significant adverse impact on the lived experiences of patients. Stigma, discrimination, psychological distress, adverse changes in family status and family relationships, financial constraints, and social challenges were some of the common issues reported by participants. Unemployment posed a significant challenge, resulting in participants having no economic stability because of MDR-TB, which was then worsened by the hearing loss; consequently, generating a great deal of stress. Participants reported feelings of worthlessness, a loss of identity, lack of motivation, feelings of embarrassment, and loss of independence.

Conclusion

There is a significant irreversible social, psychological, and economic impact of hearing loss that has a direct impact on the lived experiences of MDR-TB patients and their families even after cure of MDR-TB. There is a need for improved treatment methods with psychosocial intervention strategies that equip patients to alleviate the adverse effects they experience.

Psychological stress and health-related quality of life among tuberculosis patients: a prospective cohort study

Economic, social and psychological distress is common in individuals affected by tuberculosis (TB). However, the magnitude of distress, psychological interventions and their effect on the treatment outcomes are often under-evaluated. We examined the level of psychological stress and health-related quality of life (HRQoL) of such patients and the effect of antituberculosis therapy on them.

 Our prospective cohort study included newly diagnosed adult pulmonary and extrapulmonary TB patients. Assessment of psychological stress was done using the seven-item Generalised Anxiety Disorder questionnaire for anxiety and the nine-item Patient Health Questionnaire for depression. HRQoL was assessed by using the WHOQOL-BREF questionnaire.

 Of the 86 patients studied, 21 (24.4%) had anxiety symptoms at the baseline, which reduced to 5.8% and 1.2% at 2 months and treatment completion, respectively (p<0.001). Among the subjects, 18 (20.9%) patients had depression, which reduced to 7% and 2.3% at 2 months and treatment completion, respectively (p<0.001). All the mean domain scores of HRQoL were poor at the baseline, which showed improvement at treatment completion (p<0.001).

 Anxiety and depression were common among TB patients, and there was significant progressive reduction during and after treatment. TB had remarkable negative impacts on HRQoL, with the physical domain being the most affected, and all the domain scores showed significant improvement at treatment completion. Routine screening for depression and anxiety and timely referral to a psychiatrist are required in TB patients to improve the outcome of the disease and quality of life.

Tuberculosis patients experience significant psychological stress that can negatively impact their quality of life and warrants proper screening and intervention.https://bit.ly/3jfMEjA

Health-Related Quality of Life in Tuberculosis Patients in Eritrea: Comparison Among Drug-Susceptible and Rifampicin/Multidrug-Resistant Tuberculosis Patients

Background

Despite the negative impact of tuberculosis (TB) on patients’ quality of life, TB control programs focus on biological and clinical parameters to manage and monitor TB patients. In our setting, patients’ perception of their experience with TB and the impacts of TB on patients’ physical, mental, and social wellbeing remain unknown.

Objective

The objective of this study was to evaluate the health-related quality of life (HRQOL) among rifampicin/multidrug-resistant TB (RR/MDR-TB) in comparison to drug-susceptible TB (DS-TB) patients in Eritrea.

Methods

A cross-sectional study was conducted in RR/MDR-TB and DS-TB patients under treatment. Anonymized data collected using the WHOQOL-BREF questionnaire were analyzed using SPSS version 23. Frequency, mean and standard deviation were used to describe the data. Mean group score comparison and relationship between variables were assessed using t-test. Domain score was calculated with a mean score of items within each domain and scaled positively, a higher (increasing) score denoting a higher quality of life. Internal consistency was measured using Cronbach’s alpha and statistical significance was set at p < 0.05.

Results

A total of 92 patients (46 RR/MDR-TB and 46 DS-TB) participated in the study. Environmental (40.63 ± 10.72) and physical domains (61.80 ±17.18) were the two most affected domains in RR/MDR-TB and DS-TB patients, respectively. The psychological domain was the least affected domain in RR/MDR-TB (48.28 ± 20.83) and DS-TB patients (76.63 ±15.32). RR/MDR-TB patients had statistically lower mean scores in all domains than DS-TB patients.

Conclusion

HRQOL was impaired in both groups, but RR/MDR-TB patients had a worse health-related quality of life.

Quality of life and associated factors among patients with tuberculosis at the University of Gondar comprehensive specialized hospital, Ethiopia

PURPOSE

Clinical outcomes have failed to capture the impact of tuberculosis (TB) on patients; consequently, a comprehensive measure is required. This study's objective was to determine the level of quality of life (QOL) and associated factors among patients with TB at the University of Gondar comprehensive specialized hospital, TB clinic.

METHODS

A cross-sectional study was conducted from April to June 2019. A total of 400 patients were selected. The world health organization quality-of-life (WHOQOL-Bref) questionnaire was used to measure QOL. Linear regression analysis was done to investigate potential predictors, and variables with a P value of <0.05 were considered statistically significant.

RESULTS

The participants had a mean age of 38.04 ± 13.53 years; the percentage of patients with pulmonary TB (PTB) was 52.71% and 57.36% were male. The QOL scores for physical, psychological, social and environmental domains were 43.54 ± 10.18, 46.67 ± 7.93, 39.79 ± 15.30 and 41.22 ± 12.90, respectively. PTB was associated with physical, psychological, social, and environmental domains (B = -3.99, P value <0.001), (B = -2.03, P value = 0.027), (B = -4.44, P value = 0.008), and (B = -2.83, P value = 0.029), individually; likewise, drug adherence was associated with physical (B = -10.36), psychological (B = -4.48), social (B = -14.46), and environmental (B = -8.44) domains at a P value <0.001. Education (B = 2.39, P value = 0.018), and co-morbidity (B = -4.28, P value = 0.023) were associated with the psychological domain. Finally, occupation was significantly associated with the environmental domain (B = -4.53, P value = 0.008).

CONCLUSION

This study revealed that the QOL of patients was relatively low compared to that of other studies. Notably, social domains were affected more than other domains. Non-adherence and PTB were negatively associated with all domains. Therefore, health professionals should emphasize patients' drug adherence.

Factors Affecting Tuberculosis Patients' Quality of Life in Surabaya, Indonesia

PURPOSE

Patients with tuberculosis need to religiously take medication daily. However, they experience several side effects from these medications. The main reason for measuring the quality of life is to explain closely related factors that affect the patient's daily life that have been compromised with illness, while considering a patients' well-being that has associations with individual characteristics.

PATIENTS AND METHODS

This study included 157 patients with tuberculosis at 5 primary health-care centers and 2 hospitals in Surabaya. Quality of life is determined based on eight domains: general health, pain, social functioning, physical functioning, role limitation due to physical health, role limitation due to emotional problems, energy, and emotional well-being. The research instrument used to measure the quality of life is the RAND-36 Item Health Survey, whereas that used to measure mental distress is the Self-Reporting Questionnaire.

RESULTS

Our study results show that, of the eight domains measuring the quality of life, only age exhibited a significant effect on general health (P = 0.018); sex did not significantly affect the quality of life in all domains. The level of education exhibited a significant effect only on role limitation due to emotional problems (P = 0.014). Mental distress demonstrated a significant effect on the quality of life in all domains.

CONCLUSION

There are several factors affecting TB patients' quality of life. The study found that age, level of education, and comorbidity affect quality of life in several domains. However, mental distress affects quality of life in all domains.