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Stanton AM, Boyd RL, O’Cleirigh C, Olivier S, Dolotina B, Gunda R, Koole O, Gareta D, Modise TH, Reynolds Z, Khoza T, Herbst K, Ndung’u T, Hanekom WA, Wong EB, Pillay D, Siedner MJ. HIV, multimorbidity, and health-related quality of life in rural KwaZulu-Natal, South Africa: A population-based study. PLoS One 2024; 19:e0293963. [PMID: 38381724 PMCID: PMC10880982 DOI: 10.1371/journal.pone.0293963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/23/2023] [Indexed: 02/23/2024] Open
Abstract
Health-related quality of life (HRQoL) assesses the perceived impact of health status across life domains. Although research has explored the relationship between specific conditions, including HIV, and HRQoL in low-resource settings, less attention has been paid to the association between multimorbidity and HRQoL. In a secondary analysis of cross-sectional data from the Vukuzazi ("Wake up and know ourselves" in isiZulu) study, which identified the prevalence and overlap of non-communicable and infectious diseases in the uMkhanyakunde district of KwaZulu-Natal, we (1) evaluated the impact of multimorbidity on HRQoL; (2) determined the relative associations among infectious diseases, non-communicable diseases (NCDs), and HRQoL; and (3) examined the effects of controlled versus non-controlled disease on HRQoL. HRQoL was measured using the EQ-5D-3L, which assesses overall perceived health, five specific domains (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), and three levels of problems (no problems, some problems, and extreme problems). Six diseases and disease states were included in this analysis: HIV, diabetes, stroke, heart attack, high blood pressure, and TB. After examining the degree to which number of conditions affects HRQoL, we estimated the effect of joint associations among combinations of diseases, each HRQoL domain, and overall health. Then, in one set of ridge regression models, we assessed the relative impact of HIV, diabetes, stroke, heart attack, high blood pressure, and tuberculosis on the HRQoL domains; in a second set of models, the contribution of treatment (controlled vs. uncontrolled disease) was added. A total of 14,008 individuals were included in this analysis. Having more conditions adversely affected perceived health (r = -0.060, p<0.001, 95% CI: -0.073 to -0.046) and all HRQoL domains. Infectious conditions were related to better perceived health (r = 0.051, p<0.001, 95% CI: 0.037 to 0.064) and better HRQoL, whereas non-communicable diseases (NCDs) were associated with worse perceived health (r = -0.124, p<0.001, -95% CI: 0.137 to -0.110) and lower HRQoL. Particular combinations of NCDs were detrimental to perceived health, whereas HIV, which was characterized by access to care and suppressed viral load in the large majority of those affected, was counterintuitively associated with better perceived health. With respect to disease control, unique combinations of uncontrolled NCDs were significantly related to worse perceived health, and controlled HIV was associated with better perceived health. The presence of controlled and uncontrolled NCDs was associated with poor perceived health and worse HRQoL, whereas the presence of controlled HIV was associated with improved HRQoL. HIV disease control may be critical for HRQoL among people with HIV, and incorporating NCD prevention and attention to multimorbidity into healthcare strategies may improve HRQoL.
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Affiliation(s)
- Amelia M. Stanton
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Ryan L. Boyd
- The Obelus Institute, Washington, DC, United States of America
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stephen Olivier
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Brett Dolotina
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Resign Gunda
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Olivier Koole
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Zahra Reynolds
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Thandeka Khoza
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- DSI-MRC South African Population Research Infrastructure Network (SAPRIN), South African Medical Research Council, Durban, South Africa
| | - Thumbi Ndung’u
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Willem A. Hanekom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Emily B. Wong
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Deenan Pillay
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Mark J. Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Adebayo BI, Adejumo OA, Odusanya OO. Health-related quality of life among adults newly diagnosed with pulmonary tuberculosis in Lagos State, Nigeria: a prospective study. Qual Life Res 2024; 33:157-168. [PMID: 37672154 DOI: 10.1007/s11136-023-03506-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/07/2023]
Abstract
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.
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Affiliation(s)
- Bisola I Adebayo
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Lagos, Nigeria.
- Lagos State University Teaching Hospital, Lagos, Nigeria.
| | - Olusola A Adejumo
- Lagos State University Teaching Hospital, Lagos, Nigeria
- Lagos State Health Service Commission, Lagos, Nigeria
| | - Olumuyiwa O Odusanya
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Lagos, Nigeria
- Lagos State University Teaching Hospital, Lagos, Nigeria
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Fregna G, Rossi Raccagni S, Negrini A, Zaina F, Negrini S. Personal and Clinical Determinants of Brace-Wearing Time in Adolescents with Idiopathic Scoliosis. SENSORS (BASEL, SWITZERLAND) 2023; 24:116. [PMID: 38202978 PMCID: PMC10780905 DOI: 10.3390/s24010116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024]
Abstract
Adolescent idiopathic scoliosis (AIS) is a three-dimensional spine and trunk deformity. Bracing is an effective treatment for medium-degree curves. Thermal sensors help monitor patients' adherence (compliance), a critical issue in bracing treatment. Some studies investigated adherence determinants but rarely through sensors or in highly adherent cohorts. We aimed to verify the influence of personal and clinical variables routinely registered by physicians on adherence to brace treatment in a large cohort of consecutive AIS patients from a highly adherent cohort. We performed a cross-sectional study of patients consecutively recruited in the last three years at a tertiary referral institute and treated with braces for one year. To ensure high adherence, for years, we have provided specific support to brace treatment through a series of cognitive-behavioural interventions for patients and parents. We used iButton thermal sensor systematic data collection to precisely analyse the real brace-wearing time. We included 514 adolescents, age 13.8 ± 1.6, with the worst scoliosis curve of 34.5 ± 10.3° Cobb. We found a 95% (95CI 60-101%) adherence to the brace prescription of 21.9 ± 1.7 h per day. Determinants included gender (91% vs. 84%; females vs. males) and age < 14 years (92% vs. 88%). Brace hours prescription, BMI, and all clinical variables (worst curve Cobb degrees, angle of trunk rotation, and TRACE index for aesthetics) did not influence adherence.
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Affiliation(s)
- Giulia Fregna
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (S.R.R.); (A.N.); (F.Z.)
- Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, 44121 Ferrara, Italy
| | - Sara Rossi Raccagni
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (S.R.R.); (A.N.); (F.Z.)
| | - Alessandra Negrini
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (S.R.R.); (A.N.); (F.Z.)
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy; (S.R.R.); (A.N.); (F.Z.)
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University “La Statale”, 20122 Milan, Italy;
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy
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South A, Dhesi P, Tweed CD, Tsogt B, Staples S, Tukvadze N, Dorj G, Zaca S, Sanikidze E, Purev N, Esmail H, Burgess R. Patients' priorities around drug-resistant tuberculosis treatment: A multi-national qualitative study from Mongolia, South Africa and Georgia. Glob Public Health 2023; 18:2234450. [PMID: 37431789 PMCID: PMC7616316 DOI: 10.1080/17441692.2023.2234450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/04/2023] [Indexed: 07/12/2023]
Abstract
We conducted qualitative research exploring the treatment experience of people with DR-TB. We held nine focus group discussions with 57 adults undergoing/recently completed treatment for DR-TB in Georgia, Mongolia and South Africa. Translated transcripts were analysed using thematic analysis. We identified three higher order themes: (1) Treatment experience and the role of good relationships with healthcare providers: Treatment duration, pill burden and side-effects were challenging aspects of treatment. Side-effects/symptoms that were visible signs of illness were particularly troubling. Good relations with clinical staff helped combat fear and uncertainty regarding treatment. (2) Mental distress and opportunities for wellbeing: The shame, stigma and isolation people experienced as a result of their DR-TB diagnosis was an important cause of mental distress. No longer being infectious enabled people to resume work and socialising. Positive emotions emerged with good treatment outcomes. (3) Fear and worry along the treatment journey: Participants expressed fears about TB: infecting others; whether they would be able to endure treatment; side-effects; health consequences of treatment. Worries mostly disappeared with successful treatment. Alongside measuring side-effects, time to culture conversion and cure rates, future trials of DR-TB treatments should capture how quickly visible symptoms resolve, quality of life measures, and mental health outcomes.
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Affiliation(s)
| | | | | | | | - Suzanne Staples
- THINK: TB and HIV Investigative Network, Durban, South Africa
| | - Nestani Tukvadze
- TB Clinical Research Unit, National Centre for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Gantsetseg Dorj
- TB Research and Surveillance Department, National Center for Communicable Diseases, Ulaanbaatar, Mongolia
| | - Sindisiwe Zaca
- THINK: TB and HIV Investigative Network, Durban, South Africa
| | | | - Nasanjargal Purev
- TB Research and Surveillance Department, National Center for Communicable Diseases, Ulaanbaatar, Mongolia
| | - Hanif Esmail
- MRC Clinical Trials Unit at UCL, UCL, London, UK
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Tornu E, Quarcoopome L. Correlates of quality of life among persons living with tuberculosis: A cross-sectional study. PLoS One 2022; 17:e0277192. [PMID: 36331938 PMCID: PMC9635747 DOI: 10.1371/journal.pone.0277192] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Eric Tornu
- Department of Adult Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Louisa Quarcoopome
- Department of Internal Medicine and Therapeutics, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
- * E-mail:
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Health-Related Quality of Life of Tuberculosis Patients during the COVID-19 Pandemic in Conakry, Guinea: A Mixed Methods Study. Trop Med Infect Dis 2022; 7:tropicalmed7090224. [PMID: 36136635 PMCID: PMC9506107 DOI: 10.3390/tropicalmed7090224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 01/13/2023] Open
Abstract
The COVID-19 pandemic has had a significant impact on all facets of life and has exacerbated many challenges faced by people living with tuberculosis (TB). This study aimed to assess the health-related quality of life (HRQoL) of TB patients in Guinea during the first wave of the COVID-19 pandemic. A mixed methods study was conducted using two validated tools to assess HRQoL and qualitative interviews among TB patients enrolled in treatment at 11 health centers in Conakry, Guinea. Logistic regression was used to identify factors associated with the deterioration of HRQoL. We included 439 participants in the study, among whom 44% and 31% experienced pain and anxiety, respectively. We found that an increase in the number of household size and the distance from participants' residence to the health centers were significantly associated with lower HRQoL. Qualitative interviews highlighted nutritional and financial issues, which were exacerbated during the COVID-19 pandemic and beliefs that the Guinean Government's assistance plan was insufficient. This study supports the implementation of specific relief plans for TB patients, which includes nutritional and psychological support, especially those whose movements are limited by travel restrictions, preventing access to TB care, reducing work opportunities and exacerbating financial needs and stress.
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Worgu GO, Onotai LO, Asuquo. EO. Medication Adherence among Pulmonary Tuberculosis Patients in Treatment Centers in a Southern Nigerian Local Government Area: Question Mark on Performance of DOTS Services. Niger Med J 2022; 63:418-424. [PMID: 38867749 PMCID: PMC11165329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
Background Directly observed treatment short-course (DOTS) offers free, accessible and effective treatments with high treatment success rate and retention. Despite this, evidence from Rivers State suggest a downward trend in tuberculosis (TB) cure rate and a high burden of drug resistance among pulmonary tuberculosis (PTB) patients. Medication adherence appears to play a key role in TB evolution. Aim: to assess medication adherence and its determinants among pulmonary TB clients in DOTS centers. Methodology A total of 225 adult PTB clients from eightactive DOTS centers in Obio/Akpor Local Government Area of Rivers State were selected. A validated questionnaire, Morisky Medication adherence Scale-8 was used to collect medication-taking behaviour of clients, dichotomised into adherent and non-adherent. Binary logistic regression was conducted to check crude association between medication adherence and client/treatment factors. Variables with p<0.2 were selected and subjected to multivariate logistic regression with alpha set at p<0.05. Results Non-adherence to medication was 35.1% with forgetfulness and stress with medication plan as top reasons for non-adherence. Factors associated with non-adherence included persisting sputum production (aOR: 2.951(1.027-8.482);p=0.045), past treatment history (aOR: 5.422(1.93-15.228);p=0.001) and smoking (aOR: 7.779(1.58-38.305);p=0.012). Conclusion Over one-thirds of PTB clients in DOTS centers in Obio/Akpor LGA were non-adherent to anti-TB medications. Factors associated with non-adherence included persisting sputum production, past treatment history and smoking. To attenuate these risk factors for non-adherence, training and retraining of DOTS center staff on counselling is a smart option that can be explored by the LGA, providers and managers of the DOTS programme.
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Affiliation(s)
- Glory Ovunda Worgu
- Department of Community Medicine, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria
| | - Lucky Obukowho Onotai
- Department of Ear Nose and Throat Surgery, University of Port HarcourtTeaching Hospital, Rivers State, Nigeria
| | - Eme Olukemi Asuquo.
- Department Preventive and Social Medicine, University of Port Harcourt, Rivers State, Nigeria
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Health-Related Quality of Life (HRQoL) of Patients with Tuberculosis: A Review. Infect Dis Rep 2022; 14:509-524. [PMID: 35893474 PMCID: PMC9326555 DOI: 10.3390/idr14040055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/29/2022] Open
Abstract
Tuberculosis (TB) is a major killer and cause of human suffering worldwide and imposes a substantial reduction in patients’ health-related quality of life (HRQoL). HRQoL indicates the consciousness of patients regarding their physical and mental health. It is, therefore, very relevant in comprehending and measuring the exact impact of the disease state. Therefore, we undertook this review to summarize the available evidence on the impact of TB and its treatment on HRQoL. An in-depth understanding of HRQoL in TB patients can identify the existing management gaps. We undertook a systematic search through PubMed and CENTRAL. Data were extracted and tabulated for study design, targeted population, QoL instrument used, QoL domain assessed, and key findings. We included studies that assessed the effect of TB on the QoL both during and after treatment. There are no specific HRQoL assessment tools for utilization among TB patients. HRQoL is markedly impaired in patients with TB. The factors affecting HRQoL differ with active and latent TB, socio-demographics, socio-economic status, presence of co-infections, etc. This review’s findings can help to frame appropriate policies for tackling HRQoL issues in TB patients.
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Tomeny EM, Nightingale R, Chinoko B, Nikolaidis GF, Madan JJ, Worrall E, Ngwira LG, Banda NP, Lönnroth K, Evans D, Chakaya J, Rylance J, Mortimer K, Squire SB, Meghji J. TB morbidity estimates overlook the contribution of post-TB disability: evidence from urban Malawi. BMJ Glob Health 2022; 7:e007643. [PMID: 35606014 PMCID: PMC9125716 DOI: 10.1136/bmjgh-2021-007643] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 04/19/2022] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Despite growing evidence of the long-term impact of tuberculosis (TB) on quality of life, Global Burden of Disease (GBD) estimates of TB-related disability-adjusted life years (DALYs) do not include post-TB morbidity, and evaluations of TB interventions typically assume treated patients return to pre-TB health. Using primary data, we estimate years of life lost due to disability (YLDs), years of life lost due to premature mortality (YLL) and DALYs associated with post-TB cardiorespiratory morbidity in a low-income country. METHODS Adults aged ≥15 years who had successfully completed treatment for drug-sensitive pulmonary TB in Blantyre, Malawi (February 2016-April 2017) were followed-up for 3 years with 6-monthly and 12-monthly study visits. In this secondary analysis, St George's Respiratory Questionnaire data were used to match patients to GBD cardiorespiratory health states and corresponding disability weights (DWs) at each visit. YLDs were calculated for the study period and estimated for remaining lifespan using Malawian life table life expectancies. YLL were estimated using study mortality data and aspirational life expectancies, and post-TB DALYs derived. Data were disaggregated by HIV status and gender. RESULTS At treatment completion, 222/403 (55.1%) participants met criteria for a cardiorespiratory DW, decreasing to 15.6% after 3 years, at which point two-thirds of the disability burden was experienced by women. Over 90% of projected lifetime-YLD were concentrated within the most severely affected 20% of survivors. Mean DWs in the 3 years post-treatment were 0.041 (HIV-) and 0.025 (HIV+), and beyond 3 years estimated as 0.025 (HIV-) and 0.010 (HIV+), compared with GBD DWs of 0.408 (HIV+) and 0.333 (HIV-) during active disease. Our results imply that the majority of TB-related morbidity occurs post-treatment. CONCLUSION TB-related DALYs are greatly underestimated by overlooking post-TB disability. The total disability burden of TB is likely undervalued by both GBD estimates and economic evaluations of interventions, particularly those aimed at early diagnosis and prevention.
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Affiliation(s)
- Ewan M Tomeny
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Rebecca Nightingale
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Beatrice Chinoko
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | | | - Jason J Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Eve Worrall
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lucky Gift Ngwira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Ndaziona Peter Banda
- University of Malawi College of Medicine, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Knut Lönnroth
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Denise Evans
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeremiah Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - S Bertel Squire
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jamilah Meghji
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Oladele RO, Gbajabimiala T, Irurhe N, Skevington SM, Denning DW. Prospective Evaluation of Positivity Rates of Aspergillus-Specific IgG and Quality of Life in HIV-Negative Tuberculosis Patients in Lagos, Nigeria. Front Cell Infect Microbiol 2022; 12:790134. [PMID: 35186788 PMCID: PMC8851390 DOI: 10.3389/fcimb.2022.790134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Pulmonary tuberculosis (PTB) often results in residual anatomical and functional changes despite microbiological cure and may be complicated by chronic pulmonary aspergillosis (CPA). In this study, we determined the perceived health-related quality of life (HRQoL) of patients during and after PTB therapy and compared it with their quantitative Aspergillus-specific IgG positivity rates. Methodology We conducted a longitudinal study among TB patients attending two directly observed therapy short-course (DOTS) clinics in Lagos, Nigeria. Two hundred and four confirmed TB patients were recruited over 9 months, with five visits at baseline and 3, 6, 9, and 12 months. They were all acid-fast bacilli smear, GeneXpert, or culture positive for Mycobacterium tuberculosis. Two HRQoL questionnaires translated into Yoruba were self-administered. Chest X-ray and Aspergillus IgG were collected at each visit. Results A total of 204 participants were recruited into this study. Most (70.6%) were age 18–39 years, and only 3.9% were above 60 years; 66.7% of all participants were males. A total of 189 (92.6%) participated in the 3-month assessment, 174 (85.3%) at 6 months, 139 (68.1%) at 9 months, and 99 (48.5%) at 12 months. At baseline, only 60.9% scored “good” or “very good” QoL and health on the WHOQOL-Bref, which improved to 77% at 6 months. At baseline, 10.4% had positive Aspergillus IgG levels, 15.1% at 3 months, 11.5% at 6 months, 16.7% at 9 months, and 19.3% at 12 months. Those with a positive Aspergillus IgG at 6 months had worse physical health (p = 0.001), psychological state (p = 0.002), social relationships (p = 0.006), and environmental QoL (p = 0.001) domains of the WHOQOL-Bref. Probable CPA was 10.4% at baseline and 19.3% at 6 months post-PTB therapy. Thirty-eight (18.6%) relocated after 6 months of treatment, 16 (7.8%) were lost to follow-up, and 11 (5.4%) died. Conclusion Our findings reveal a significant relationship between the QoL and Aspergillus IgG levels of TB patients. Further follow-up studies and additional imaging are required to determine when patients develop CPA and its clinical impact.
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Affiliation(s)
- Rita O. Oladele
- Department of Medical Microbiology & Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
- *Correspondence: Rita O. Oladele,
| | - Titi Gbajabimiala
- Clinical Sciences Department, National Institute for Medical Research, Lagos, Nigeria
| | - Nicholas Irurhe
- Department of Radiology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Suzanne M. Skevington
- Manchester Centre for Health Psychology, Division of Psychological Science and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - David W. Denning
- Manchester Fungal Infection Group, Core Technology Facility, The University of Manchester, Manchester, United Kingdom
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11
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The relationship among social support, experienced stigma, psychological distress, and quality of life among tuberculosis patients in China. Sci Rep 2021; 11:24236. [PMID: 34931006 PMCID: PMC8688519 DOI: 10.1038/s41598-021-03811-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/10/2021] [Indexed: 01/17/2023] Open
Abstract
The complex relationships among social support, experienced stigma, psychological distress, and quality of life (QOL) among tuberculosis (TB) patients are insufficiently understood. The purpose of this study was to explore the interrelationships among social support, experienced stigma, psychological distress, and QOL and to examine whether experienced stigma and psychological distress play a mediating role. A cross-sectional survey was conducted between November 2020 and March 2021 in Dalian, Liaoning Province, Northeast China. Data were obtained from 473 TB patients using a structured questionnaire. Structural equation modelling was used to examine the hypothetical model. The research model provided a good fit to the measured data. All research hypotheses were supported: (1) social support, experienced stigma and psychological distress were associated with QOL; (2) experienced stigma fully mediated the effect of social support on psychological distress; (3) psychological distress fully mediated the effect of experienced stigma on QOL; and (4) experienced stigma and psychological distress were sequential mediators between social support and QOL. This study elucidated the pathways linking social support, experienced stigma, and psychological distress to QOL and provides an empirical basis for improving the QOL of TB patients.
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12
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Febi AR, Manu MK, Mohapatra AK, Praharaj SK, Guddattu V. Psychological stress and health-related quality of life among tuberculosis patients: a prospective cohort study. ERJ Open Res 2021; 7:00251-2021. [PMID: 34476253 PMCID: PMC8405877 DOI: 10.1183/23120541.00251-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/21/2021] [Indexed: 11/14/2022] Open
Abstract
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
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Affiliation(s)
- Ann Roy Febi
- Dept of Respiratory Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mohan K Manu
- Dept of Psychiatry, Kasturba Medical College, Manipal, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Aswini Kumar Mohapatra
- Dept of Respiratory Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Dept of Data Science, Prasanna School of Public health, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Samir Kumar Praharaj
- Dept of Psychiatry, Kasturba Medical College, Manipal, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vasudeva Guddattu
- Dept of Data Science, Prasanna School of Public health, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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13
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Wademan DT, Mainga T, Gondwe M, Ayles H, Shanaube K, Mureithi L, Bond V, Hoddinott G. 'TB is a disease which hides in the body': Qualitative data on conceptualisations of tuberculosis recurrence among patients in Zambia and South Africa. Glob Public Health 2021; 17:1713-1727. [PMID: 34187320 DOI: 10.1080/17441692.2021.1940235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The WHO estimates 58 million people experienced one or more TB disease episodes between 2000 and 2018. These 'former TB patients' are at greater risk of future TB infection and death than TB naïve people. Additionally, former TB patients experience social, psychological, and physiological difficulties after microbiological cure. Drawing on semi-structured interviews collected with 28 people from communities in Zambia (n = 8) and South Africa (n = 2) between October 2018 and March 2019, we describe their perceptions of having two or more TB episodes. Utilising a discursive analytic approach, we interrogated how participants conceptualise their risk of disease recurrence. Despite being surprised by subsequent TB episodes, participants utilised their bodily experiences of TB signs and symptoms alongside their experiential knowledge of health systems processes to procure timely diagnosis and care. Yet, many participants were unable to resume social and economic participation. Experiences of multiple TB episodes and correlating social, economic, and physiological vulnerabilities, challenged participants biomedical understanding of TBs curability. Through notions of dirt and 'staining', participants conceptualise TB as a sinister, malicious presence they are bound to encounter time and again. Health providers should discuss the risk of TB recurrence with patients and promote prevention, early detection, and diagnosis of TB disease.
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Affiliation(s)
- Dillon T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Tila Mainga
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Melleh Gondwe
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Helen Ayles
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Kwame Shanaube
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Linda Mureithi
- Health Systems Research Unit, Health Systems Trust, Cape Town, South Africa
| | - Virginia Bond
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia.,Department of Global Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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14
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Araia ZZ, Mesfin AB, Mebrahtu AH, Tewelde AG, Tewelde AT, Ngusbrhan Kidane S. Health-Related Quality of Life in Tuberculosis Patients in Eritrea: Comparison Among Drug-Susceptible and Rifampicin/Multidrug-Resistant Tuberculosis Patients. PATIENT-RELATED OUTCOME MEASURES 2021; 12:205-212. [PMID: 34234605 PMCID: PMC8254609 DOI: 10.2147/prom.s316337] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/16/2021] [Indexed: 01/22/2023]
Abstract
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.
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Affiliation(s)
- Zenawi Zeramariam Araia
- National TB and Leprosy Control Program, Communicable Disease Control Division, Ministry of Health, Asmara, Eritrea
| | | | - Amanuel Hadgu Mebrahtu
- National TB and Leprosy Control Program, Communicable Disease Control Division, Ministry of Health, Asmara, Eritrea
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15
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Huang R, Fan JG, Shi JP, Mao YM, Wang BY, Zhao JM, Lu LG, Zhong BH, Zou ZS, Xu YQ, Ye YN, Liu LG, Lin LJ, Li JP, Rao HY, Wei L. Health-related quality of life in Chinese population with non-alcoholic fatty liver disease: a national multicenter survey. Health Qual Life Outcomes 2021; 19:140. [PMID: 33962617 PMCID: PMC8106221 DOI: 10.1186/s12955-021-01778-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/22/2021] [Indexed: 12/25/2022] Open
Abstract
Background Health Related Quality of Life (HRQL) is a multi-dimensional construct that can comprehensively evaluate the patient’s health status, including physical, emotional, mental and social well-being. In this study, we aimed to evaluate the impact of non-alcoholic fatty liver disease (NAFLD) on HRQL in a Chinese population. Methods In this national multicenter cross-sectional survey, patients with NAFLD were enrolled. Chronic Liver Disease Questionnaire (CLDQ)-NAFLD was used to qualify HRQL. Univariate and multivariate analysis were used to identify independent risk factors of HRQL. Results A total of 5181 patients with NAFLD from 90 centers were enrolled in this study (mean age, 43.8 ± 13.3 years; male, 65.8%). The overall CLDQ score was 5.66 ± 0.89. Multivariate logistic regression analysis showed that body mass index (BMI: HR, 1.642; 95% CI, 1.330–2.026), alanine transaminase (ALT: HR, 1.006; 95% CI, 1.001–1.011), triglyceride (HR, 1.184; 95% CI, 1.074–1.305), disease severity (HR, 3.203; 95% CI, 1.418–7.232) and cardiovascular disease (HR, 4.305; 95% CI, 2.074–8.939) were independent risk factors for overall CLDQ score. In the logistic analyses of individual domain, BMI and triglyceride were independent risk factors of all domains. ALT, disease severity, diabetes, depression and cardiovascular disease were influencing factors for the CLDQ score of several domains. Conclusions This national multicenter cross-sectional survey in China indicated that the HRQL in patients with NAFLD was impaired. HRQL was found to be significantly associated with sociodemographic and clinical factors. Attention should be paid to the optimally managing care of patients with NAFLD to improve their HRQL.
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Affiliation(s)
- Rui Huang
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology On NAFLD Diagnosis, No.11 Xizhimen South Street, Beijing, 100044, China
| | - Jian-Gao Fan
- Department of Digestive, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun-Ping Shi
- Department of Hepatology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Yi-Min Mao
- Department of Digestive, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing-Yuan Wang
- Department of Digestive, The First Hospital of China Medical University, Shenyang, China
| | - Jing-Min Zhao
- Department of Pathology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Lun-Gen Lu
- Department of Digestive, The First People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bi-Hui Zhong
- Department of DigestiveThe First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zheng-Sheng Zou
- Department of Pathology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - You-Qing Xu
- Department of DigestiveBeijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Nong Ye
- Department of Infectious Disease, The First Hospital of Fushan, Fushan, China
| | - Long-Gen Liu
- Department of Hepatology, The Third People's Hospital, Changzhou, China
| | - Lian-Jie Lin
- Department of Digestive, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jian-Ping Li
- China Resources Sanjiu Medical and Pharmaceutical Co., Ltd, Shenzhen, China
| | - Hui-Ying Rao
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology On NAFLD Diagnosis, No.11 Xizhimen South Street, Beijing, 100044, China.
| | - Lai Wei
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, No.168, Litang Road, Changping District, Beijing, 102218, China.
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16
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Opollo V, Sun X, Lando R, Miyahara S, Torres TS, Hosseinipour MC, Bisson GP, Kumwenda J, Gupta A, Nyirenda M, Katende K, Suryavanshi N, Beulah F, Shah NS. The effect of TB treatment on health-related quality of life for people with advanced HIV. Int J Tuberc Lung Dis 2021; 24:910-915. [PMID: 33156757 DOI: 10.5588/ijtld.19.0716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Study A5274 was an open-label trial of people with HIV (PLHIV) with CD4 cell count <50 cells/µL who were randomized to empirical TB treatment vs. isoniazid preventive therapy (IPT) in addition to antiretroviral therapy (ART). We evaluated health-related quality of life (HRQoL) by study arm, changes over time, and association with sociodemographic and clinical factors.METHODS: Participants aged >13 years were enrolled from outpatient clinics in 10 countries. HRQoL was assessed at Weeks 0, 8, 24 and 96 with questions about daily activity, hospital or emergency room visits, and general health status. We used logistic regression to examine HRQoL by arm and association with sociodemographic and clinical factors.RESULTS: Among 850 participants (424 empiric arm, 426 IPT arm), HRQoL improved over time with no difference between arms. At baseline and Week 24, participants with WHO Stage 3 or 4 events, or those who had Grade 3 or 4 signs/symptoms, were significantly more likely to report poor HRQoL using the composite of four HRQoL measures.CONCLUSION: HRQoL improved substantially in both arms during the study period. These findings show that ART, TB screening, and IPT can not only reduce mortality, but also improve HRQoL in PLHIV with advanced disease.
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Affiliation(s)
- V Opollo
- Kenya Medical Research Institute, HIV-Research Branch, Kisumu, Kenya
| | - X Sun
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - R Lando
- Kenya Medical Research Institute, HIV-Research Branch, Kisumu, Kenya
| | - S Miyahara
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - T S Torres
- Instituto Nacional de Infectologia Evandro Chagas (INI-FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - M C Hosseinipour
- University of North Carolina School of Medicine, Chapel Hill, NC, USA, University of North Carolina Project, Lilongwe, Malawi
| | - G P Bisson
- Perlman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - A Gupta
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - K Katende
- Joint Clinical Research Centre Clinical Research Site, Kampala, Uganda
| | - N Suryavanshi
- Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India
| | - F Beulah
- YR Gaitonde Centre for AIDS Research and Education, Chennai Antiviral Research and Treatment Clinical Research Site, Chennai, India
| | - N S Shah
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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17
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Yadav RK, Kaphle HP, Yadav DK, Marahatta SB, Shah NP, Baral S, Khatri E, Ojha R. Health related quality of life and associated factors with medication adherence among tuberculosis patients in selected districts of Gandaki Province of Nepal. J Clin Tuberc Other Mycobact Dis 2021; 23:100235. [PMID: 33997309 PMCID: PMC8095181 DOI: 10.1016/j.jctube.2021.100235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Tuberculosis is one of the significant public health problems of Nepal. Adherence to medication is very important for improving quality of life and preventing complication. Adherence to tuberculosis medications has significant economic and therapeutic consequences as non-adherence patients are at greater risk of developing complications which affect their health status and overall quality of life. The study aims to determine the factors associated with medication adherence and its effect on health related quality of life among tuberculosis patients in selected districts of Gandaki Province. Methods A health facility based cross-sectional study was carried out among 180 tuberculosis patients registered under DOTS and receiving treatment more than or equal to 60 days. WHOQOL-BREF tools to assess quality of life and Morisky medication adherence scale (MMAS-8) was adopt to assess medication adherence. Data was entered in Epi-data and analysis was performed with the help of the Statistical Package for Social Science (SPSS). The odds ratio with a 95% CI was calculated and p-value of <0.05 was considered as cutoff for statistical significance. Results A total 180 TB patients were participated in this study. Overall quality of life ranges from 10.75 to 89.25 with Mean ± SD as 55.96 ± 14.65. More than three-fourth (79.4%) respondents were adhere to medication. Medication adherence and health related quality of life was found statistically significant with relationship with health workers, favourable time at DOTS centre, absence of co-infection. Participants who were highly adhered to medication had good quality of life. Conclusion Majority of tuberculosis patients adhering to medication had good quality of life. Especial emphasis should be given to tuberculosis patients with co-infection, health workers should behave friendly and provide appropriate counselling in order to maintain the medication adherence and quality of life.
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Affiliation(s)
- Rajesh Kumar Yadav
- School of Health and Allied Sciences, Pokhara University, 33700 Pokhara, Nepal.,Health Research Together Initiative (HeaRT: Initiative), 44600 Kathmandu, Nepal
| | - Hari Prasad Kaphle
- School of Health and Allied Sciences, Pokhara University, 33700 Pokhara, Nepal
| | | | - Sujan Babu Marahatta
- Health Research Together Initiative (HeaRT: Initiative), 44600 Kathmandu, Nepal.,Manmohan Memorial Institute of Health Sciences, Tribhuvan University, 44600 Kathmandu, Nepal.,Nepal Open University, 44700 Lalitpur, Nepal
| | - Naveen Prakash Shah
- National Tuberculosis Centre, Ministry of Health and Population, 44800 Bhaktapur, Nepal
| | - Sushila Baral
- Health Research Together Initiative (HeaRT: Initiative), 44600 Kathmandu, Nepal
| | - Elina Khatri
- Health Research Together Initiative (HeaRT: Initiative), 44600 Kathmandu, Nepal
| | - Renuka Ojha
- Australian Catholic University, 3002 Melbourne, Australia
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18
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Mishra R, Krishan S, Siddiqui AN, Kapur P, Khayyam KU, Rai PK, Sharma M. Impact of metformin therapy on health-related quality of life outcomes in tuberculosis patients with diabetes mellitus in India: A prospective study. Int J Clin Pract 2021; 75:e13864. [PMID: 33236505 DOI: 10.1111/ijcp.13864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/02/2020] [Accepted: 11/18/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To assess the impact of metformin use on health-related quality of life (HRQoL) in tuberculosis (TB) patients who are presented with type 2 diabetes mellitus (T2DM). METHODOLOGY In this community-based prospective study, TB patients attending Hakeem Abdul Hameed Centenary Hospital, New Delhi (India) and had comorbidity of T2DM between April 2018 and July 2019 were enrolled. Patients were divided into metformin users and metformin non-users on the basis of the presence of metformin in their routine as antidiabetic drug(s). HRQoL was determined using a validated TB-specific tool (Dhingra and Rajpal-12 scale ie, DR-12) consists of symptom and socio-psychological and exercise adaptation domains. The HRQoL scores were compared at pretreatment (1st visit), end of intensive phase (2nd visit) and end of treatment (3rd visit) between the two groups. RESULTS A total of 120 patients were enrolled, of which 24 were excluded as they did not respond at follow-up visits. Among the metformin users (n = 48) the mean age of patients was 47.56 years and 62.50% was males. Among the metformin non-users (n = 48), the mean age of patients was 49.02 years and 54.10% was males. The baseline characteristics were similar in both groups except for the substance used history (P = .025), literacy level (P = .048) and BMI (P = .028). Metformin users demonstrated significant improvement in symptom scores (2nd visit: P < .001; 3rd visit: P = .001) and socio-psychological and exercise adaptation scores (2nd visit: P < .0001; 3rd visit: P < .0001) as compared with metformin non-users at 2nd visit and 3rd visit. Overall, scores were also found to be significantly improved in metformin users (2nd visit: P < .001; 3rd visit: P = .001). CONCLUSION Metformin therapy exerted favourable effects on HRQoL in patients with TB and T2DM and can be recommended as an adjuvant antitubercular drug in TB patients with co-morbidity of T2DM, unless contraindicated.
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Affiliation(s)
- Ritu Mishra
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Shri Krishan
- Department of Drug Safety and Pharmacovigilance, Syneos Health, Gurgaon, India
| | - Ali Nasir Siddiqui
- Department of Pharmaceutical Medicine, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Prem Kapur
- Department of Medicine, Hamdard Institute of Medical Sciences and Research & Hakeem Abdul Hameed Centenary Hospital, Jamia Hamdard, New Delhi, India
| | - Khalid Umer Khayyam
- Department of Epidemiology & Public Health, National Institute of Tuberculosis & Respiratory Diseases, New Delhi, India
| | | | - Manju Sharma
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
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19
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Wong YJ, Noordin NM, Keshavjee S, Lee SWH. Impact of latent tuberculosis infection on health and wellbeing: a systematic review and meta-analysis. Eur Respir Rev 2021; 30:30/159/200260. [PMID: 33408089 DOI: 10.1183/16000617.0260-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/25/2020] [Indexed: 12/29/2022] Open
Abstract
The impact of latent tuberculosis infection (LTBI) on health and wellbeing is not well understood. This review aims to evaluate the health and wellbeing of individuals with LTBI. A systematic literature search was performed to assess studies reporting patient-reported outcomes in LTBI management including health-related quality of life (HRQoL), health utilities, disease burden and experience of individuals with LTBI. A pooled analysis was performed to estimate the effect of LTBI on HRQoL.A total of 4464 studies were screened, of which 13 eligible articles describing nine unique studies were included for review. The HRQoL of individuals with LTBI and without tuberculosis (TB) infection were comparable, and better than patients with active TB disease. However, individuals with LTBI reported poorer mental health compared with individuals without TB infection (mean difference -4.16, 95% CI -7.45- -0.87; p=0.01). Qualitative studies suggest the presence of fear, anxiety and stigma in individuals with LTBI.This review highlights potential psychosocial challenges in individuals with LTBI despite the absence of clinical symptoms. While their quality of life was marginally affected, this could be evidence to support LTBI management in preventing TB re-activation and the severe consequences of active TB disease that affect all domains of HRQoL.
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Affiliation(s)
- Yen Jun Wong
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | | | - Salmaan Keshavjee
- Dept of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia .,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Subang Jaya, Malaysia.,Gerontechnology Laboratory, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Subang Jaya, Malaysia.,School of Pharmacy, Taylor's University Lakeside Campus, Subang Jaya, Malaysia
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20
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Dires A, Hagos T, Yitayal M, Amare G, Aschalew AY. Quality of life and associated factors among patients with tuberculosis at the University of Gondar comprehensive specialized hospital, Ethiopia. Qual Life Res 2020; 30:1173-1181. [PMID: 33249540 DOI: 10.1007/s11136-020-02717-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Alemayehu Dires
- University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Tsega Hagos
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Yitayal
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getasew Amare
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Andualem Yalew Aschalew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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21
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Yohannes K, Mokona H, Abebe L, Feyisso M, Tesfaye A, Tesfaw G, Ayano G. Prevalence of depressive symptoms and associated factors among patients with tuberculosis attending public health institutions in Gede'o zone, South Ethiopia. BMC Public Health 2020; 20:1702. [PMID: 33187488 PMCID: PMC7666498 DOI: 10.1186/s12889-020-09794-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/29/2020] [Indexed: 11/22/2022] Open
Abstract
Background Depression is a common mental disorder among patients with tuberculosis and it is associated with a greater risk of suicide, multidrug-resistant tuberculosis, and poor quality of life. Evidence suggests the early identification of depression among patients with tuberculosis is important to decrease adverse outcomes. However, there are limited studies that examined the prevalence and determinants of depressive symptoms among patients with tuberculosis. This study aimed to assess the prevalence and associated factors of depressive symptoms among patients with tuberculosis attending public health institutions in Gede’o zone, South Ethiopia. Methods An institution-based a cross-sectional study was conducted from November 1 to December 30, 2018, among a randomly selected sample of 415 patients with tuberculosis attending public health institutions in Gede’o zone, South Ethiopia. Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms. Logistic regression was used to identify the potential risk factors of depressive symptoms. The strength of the association was presented by crude odds and adjusted odds ratio with their corresponding 95% CI. Finally, the statistical significance was set at p < 0.05. Results The prevalence of depressive symptoms was found to be 45.5% (95% CI; 41.1–50.1%) among patients with tuberculosis; 33.3% had moderate, 9.8% had moderately severe, and 2.4% had severe depression. After adjusting for the possible confounders, being on re-treatment for tuberculosis (AOR = 2.47, 95% CI: 1.17–5.22), aged ≥45 years (AOR = 2.41, 95% CI: 1.09–5.32), having poor social support (AOR = 4.21, 95% CI: 2.10–8.47), and Tuberculosis/Human Immunodeficiency Virus (TB/HIV) co-infection) (AOR = 3.96, 95% CI 2.0, 7.84) were significantly associated with depressive symptoms among patients with TB. Conclusions This study suggests that a substantial percentage of patients with TB had depressive symptoms (45.5%). TB/HIV coinfection, being on re-treatment for tuberculosis, those having poor social support, patients aged 45 and above were factors associated with depressive symptoms. Routine screening of depression among patients with TB is warranted. Moreover, patients with TB falling into the risk categories should be more carefully monitored for depression and when possible referred to mental health professionals.
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Affiliation(s)
- Kalkidan Yohannes
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, P.O. Box 419, Dilla, Ethiopia.
| | - Hirbaye Mokona
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, P.O. Box 419, Dilla, Ethiopia
| | - Lulu Abebe
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, P.O. Box 419, Dilla, Ethiopia
| | - Mohammed Feyisso
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Adane Tesfaye
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Getachew Tesfaw
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getinet Ayano
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.,School of Public Health, Curtin University, Bentley, Perth, Western Australia
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22
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Juliasih NN, Mertaniasih NM, Hadi C, Soedarsono, Sari RM, Alfian IN. Factors Affecting Tuberculosis Patients' Quality of Life in Surabaya, Indonesia. J Multidiscip Healthc 2020; 13:1475-1480. [PMID: 33177833 PMCID: PMC7649212 DOI: 10.2147/jmdh.s274386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/28/2020] [Indexed: 01/26/2023] Open
Abstract
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.
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Affiliation(s)
- Ni Njoman Juliasih
- Laboratory of Tuberculosis, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Ni Made Mertaniasih
- Department of Medical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Cholichul Hadi
- Department of Industrial and Organizational Psychology, Faculty of Psychology, Universitas Airlangga, Surabaya, Indonesia
| | - Soedarsono
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Reny Mareta Sari
- Laboratory of Tuberculosis, Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia
| | - Ilham Nur Alfian
- Department of Personality and Social Psychology, Faculty of Psychology, Universitas Airlangga, Surabaya, Indonesia
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23
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Putra MM, Sari NPWP. Model Theory of Planned Behavior to Improve Adherence to Treatment and the Quality of Life in Tuberculosis Patients. JURNAL NERS 2020. [DOI: 10.20473/jn.v15i2.17958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Tuberculosis (TB) is a global public health problem and a leading cause of death from infectious diseases. The research objective was to determine the relationship between the theory of planned behavior, adherence and quality of life using the path model.Methods: This study employed a cross-sectional design with 154 tuberculosis patients. The research was conducted in all community health centers in the Buleleng, Bali. Data on subjective norms, attitudes, perceived behavior control, intention, physical and mental HRQoL domains and medical adherence were collected. Data were analyzed using a descriptive and structural equation model feature using structural equation model.Results: Most respondents have attitudes in the positive category and subjective norms in the good category. Perceived behavior is control in the good category, intentions in the good category and physical health in the good category. Almost all respondents have mental health in the good category and are married. All respondents in this study had adherence to treatment. The influence of subjective norms on intentions (p = <0.01), the influence of intentions on adherence (p = <0.01) and the effect of adherence on quality of life (p = <0.01) were found.Conclusion:Subjective norms are the most important part to influence intention. Adequate TB treatment causes HRQoL to improve.
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24
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Qiu L, Tong Y, Lu Z, Gong Y, Yin X. Depressive Symptoms Mediate the Associations of Stigma with Medication Adherence and Quality of Life in Tuberculosis Patients in China. Am J Trop Med Hyg 2019; 100:31-36. [PMID: 30398139 DOI: 10.4269/ajtmh.18-0324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Stigma has been associated with health-related outcomes such as medication adherence and quality of life (QOL) in patients with tuberculosis (TB); however, the mechanisms via which TB-related stigma interferes with specific outcomes are unclear. This study aimed to determine whether depressive symptoms were one of the mechanisms that mediated the associations between TB-related stigma and both medication adherence and QOL in patients with TB. A cross-sectional survey was conducted between October 1, 2013, and March 31, 2014, in Hubei Province, central China, and data were collected from 1,342 patients with TB, using a structured questionnaire that measured TB-related stigma, depressive symptoms, medication adherence, and QOL. Multiple imputation was used to account for missing data. Structural equation modeling was performed to assess the mediating effect of depressive symptoms on the associations of TB-related stigma with medication adherence and QOL. Mediation analyses showed that depressive symptoms partially mediated the association between TB-related stigma and medication adherence (standardized indirect effect = -0.16, 95% bias-corrected confidence interval [CI] [-0.19, -0.13], P < 0.01). Moreover, depressive symptoms fully mediated the association between TB-related stigma and QOL (standardized indirect effect = -0.17, 95% bias-corrected CI [-0.21, -0.14], P < 0.01). The results suggest that depressive symptoms played a key role in the relationships among TB-related stigma, medication adherence, and QOL in patients with TB. Therefore, the alleviation of depressive symptoms could be an important strategy for improving medication adherence and QOL in patients with TB.
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Affiliation(s)
- Lei Qiu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China.,School of management, Hainan Medical University, Haikou, P. R. China
| | - Yeqing Tong
- Center for Disease Control and Prevention of Hubei Province, Wuhan, P. R. China
| | - Zuxun Lu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Yanhong Gong
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Xiaoxv Yin
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
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25
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Abstract
Tuberculosis diagnosis and treatment currently revolves around clinical features and microbiology. The disease however adversely affects patients’ psychological, economic, and social well-being as well, and therefore our focus also additionally needs to shift towards quality of life (QOL). The disease influences all QOL domains and substantially adds to patient morbidity, and these complex and multidimensional interactions pose challenges in accurately quantifying impairment in QOL. For this review, PubMed database was queried using keywords like quality of life, health status and tuberculosis, and additional publications identified by a bibliographic review of shortlisted articles. Both generic and specific QOL scales show a wide variety of derangements in scores, and results vary across countries and patient groups. In particular, diminished capacity to work, social stigmatization, and psychological issues worsen QOL in patients with tuberculosis. Although QOL has been consistently shown to improve during standard anti-tubercular therapy, many patients continue to show residual impairment. It is also not clear if specific situations like presence of comorbid illnesses, drug resistance, or co-infection with human immunodeficiency virus additionally worsen QOL in these patients. There is a definite need to incorporate QOL assessment as adjunct outcome measures in tuberculosis control programs. Governments and program managers need to step up socio-cultural reforms and health education, and provide additional incentives to patients, to counter impairment in QOL.
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Affiliation(s)
- Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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26
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Appiah B, Poudyal A, Burdine JN, Asamoah-Akuoko L, Anum DA, Kretchy IA, Sabblah G, Dodoo AN, McKyer ELJ. Factors that influence the intention to use mobile phone caller tunes for patient reporting of adverse drug reactions: a qualitative study. Ther Adv Drug Saf 2019; 10:2042098619871190. [PMID: 35173950 PMCID: PMC8842108 DOI: 10.1177/2042098619871190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 08/01/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Patient reporting of adverse drug reactions (ADRs) is low in low- and
middle-income countries, in part because of poor awareness to report. With
the increase in mobile subscription, mobile phones can be used as a platform
to disseminate information on ADRs. The aim of this study was to
qualitatively assess the potential of using mobile phone caller tunes (the
message or sound the caller hears before the receiver answers the call) to
encourage patient reporting of ADRs. Methods: A total of 38 key informant interviews and 12 focus group discussions (57
participants in groups of 4–5) were conducted in Accra, Ghana. The
transcripts were analysed using key constructs of the Technology Acceptance
Model (TAM) including perceived usefulness, perceived ease of use, and
behavioural intention to use caller tunes for patient reporting of ADRs. Results: Respondents mentioned lack of knowledge on reporting ADRs, and their
willingness to use mobile phone caller tunes to promote patient reporting of
ADRs. Many respondents pointed out how ADRs usually led to discontinuity in
medication use, usually without consultation with health professionals.
Caller tunes were regarded an innovative, accessible and convenient platform
to disseminate information on ADRs. Most respondents intended to use caller
tunes with drug safety information to promote ADR reporting, particularly to
help their friends and family members. Simplicity of the message, use of
songs or messages in local languages and price of downloading the caller
tunes were important considerations. Conclusion: There is a need for the creation and testing of caller tunes on ADRs in Ghana
to promote patient or consumer reporting of ADRs. Further studies are needed
to assess factors that could influence the creation and use of caller tunes
to disseminate information on drug safety.
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Affiliation(s)
- Bernard Appiah
- Research Program on Public and International Engagement for Health, Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, 1266 TAMU, College Station, TX, 77843, USA Centre for Science and Health Communication, Accra, Ghana
| | - Anubhuti Poudyal
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX, USA
| | - James N. Burdine
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Lucy Asamoah-Akuoko
- Centre for Science and Health Communication, Accra, Ghana
- National Blood Service Ghana, Research and Development, Accra, Ghana
| | | | - Irene Akwo Kretchy
- School of Pharmacy, University of Ghana, Department of Pharmacy Practice and Clinical Pharmacy, Legon, Accra, Ghana
| | - George Sabblah
- Food and Drugs Authority, Safety Monitoring Department, Accra, Ghana
| | - Alexander N.O. Dodoo
- African Collaborating Centre for Pharmacovigilance and Surveillance, Accra, Ghana
| | - E. Lisako J. McKyer
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX, USA
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27
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Mahassadi AK, Ebela PC, Bangoura AD, Attia AK. The burden of irritable bowel syndrome and chronic constipation on health-related quality of life in black Africans: a comparison with healthy control subjects in Côte d'Ivoire, West Africa. Clin Exp Gastroenterol 2019; 12:355-365. [PMID: 31447575 PMCID: PMC6684486 DOI: 10.2147/ceg.s192563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 04/30/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Although patients with irritable bowel syndrome (IBS) and chronic constipation (CC) have an impaired health-related quality of life (HRQoL), little is known in black African patients compared with control subjects. This study provided the magnitude and the influencing factors of HRQoL impairment in black African outpatients with IBS or CC compared with control subjects using the generic SF-36 questionnaire. Materials and methods: One hundred and four consecutive black African outpatients complaining with IBS (n=72, mean age=38.9 years, female=62.5%) and CC (n=32, mean age=37.4 years, female=75%) met Rome 3 criteria were compared with 210 control subjects (mean age=37.4 years, 63.8% male). The SF-36 scores in all domains of HRQoL with the corresponding physical (PCS) and mental (MCS) composite scores between groups were compared with post hoc analysis and multivariate linear regression analysis for the assessment of the influencing factors. Results: Overall, IBS and CC patients exhibited low SF-36 scores in the 8 domains of HRQoL in comparison with control subjects. IBS patients scored less in mental health (mean difference=-10.3, p=0.001), bodily pain (mean difference=-23.5, p≤0.0001), and social functioning domains (mean difference =-15.1, p=0.01) in comparison with CC patients. Post hoc analysis demonstrated a trend down of PCS (mean difference=-12.9, p<0.0001) and MCS (mean difference=-11.2, p=0.01) disfavoring IBS patients than those with CC in comparison with control subjects. In multivariate linear regression analysis, besides the negative impact of IBS and CC, factors influencing PCS were BMI (β=0.4; p=0.01) and comorbidities (β=-5.9; p=0.002). Those influencing MCS were the presence of remunerated activity (β=2.7, p=0.02), and patient living alone (β=9.4; p=0.04). Conclusion: IBS and CC impact negatively on the HRQoL in black African subjects and more importantly in those with IBS than CC.
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Affiliation(s)
- Alassan Kouamé Mahassadi
- Hepatology and Gastroenterology Unit, Centre Hospitalier et Universitaire de Yopougon, Abidjan, Côte d’Ivoire
| | - Paulin Christian Ebela
- Hepatology and Gastroenterology Unit, Centre Hospitalier et Universitaire de Yopougon, Abidjan, Côte d’Ivoire
| | - Aboubacar Demba Bangoura
- Hepatology and Gastroenterology Unit, Centre Hospitalier et Universitaire de Yopougon, Abidjan, Côte d’Ivoire
| | - Alain Koffi Attia
- Hepatology and Gastroenterology Unit, Centre Hospitalier et Universitaire de Yopougon, Abidjan, Côte d’Ivoire
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28
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Zhang K, Wang X, Tu J, Rong H, Werz O, Chen X. The interplay between depression and tuberculosis. J Leukoc Biol 2019; 106:749-757. [PMID: 31254317 DOI: 10.1002/jlb.mr0119-023r] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/19/2019] [Accepted: 06/07/2019] [Indexed: 02/06/2023] Open
Abstract
Depression is a major mental health condition and is expected be the most debilitating and widespread health disorder by 2030. Tuberculosis (TB) is also a leading cause of morbidity and mortality worldwide and interestingly, is a common comorbidity of depression. As such, much attention has been paid to the association between these 2 pathologies. Based on clinical reports, the association between TB and depression seems to be bidirectional, with a substantial overlap in symptoms between the 2 conditions. TB infection or reactivation may precipitate depression, likely as a consequence of the host's inflammatory response and/or dysregulation of the hypothalamic-pituitary-adrenal axis. Nevertheless, few studies have considered whether patients with depression are at a higher risk for TB. In this review, we discuss the hypotheses on the association between depression and TB, highlighting the immuno-inflammatory response and lipid metabolism as potential mechanisms. Improving our understanding of the interplay between these 2 disorders should help guide TB clinical care and prevention both in patients with comorbid depression and in the general population.
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Affiliation(s)
- Kehong Zhang
- Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Department of Pathogen Biology, Shenzhen University School of Medicine, Shenzhen, China.,Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, Friedrich-Schiller-University Jena, Jena, Germany
| | - Xin Wang
- Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Department of Pathogen Biology, Shenzhen University School of Medicine, Shenzhen, China
| | - Jie Tu
- The Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institutes of Advanced Technology, Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, Chinese Academy of Sciences, Shenzhen, China
| | - Han Rong
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Oliver Werz
- Department of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy, Friedrich-Schiller-University Jena, Jena, Germany
| | - Xinchun Chen
- Guangdong Provincial Key Laboratory of Regional Immunity and Diseases, Department of Pathogen Biology, Shenzhen University School of Medicine, Shenzhen, China
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29
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Banerjee S, Bandyopadhyay K, Taraphdar P, Dasgupta A. Effect of DOTS on quality of life among tuberculosis patients: A follow-up study in a health district of Kolkata. J Family Med Prim Care 2019; 8:1070-1075. [PMID: 31041253 PMCID: PMC6482798 DOI: 10.4103/jfmpc.jfmpc_347_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context and Aims: This study was carried out to assess quality of life (QoL) of tuberculosis patients receiving treatment from DOTS centres, to find out its change with treatment, and to ascertain its determinants. Materials and Methods: An institution based follow-up study was conducted in Bagbazar Urban Health District (UHD), Kolkata where all the tuberculosis patients registered within 1st 4 months of data collection were followed up for their current course of treatment. Quality of Life (QoL) was assessed using SF36v2 questionnaire at the start of treatment and after continuation phase (CP) (within 14 days). Statistical Analysis Used: General Linear Model was used to assess the predictors of change of QoL with treatment. Results: 61.4% and 16.4% patients were at the risk of depression at the start and end of their TB treatment respectively. Patient's per-capita monthly Income (PCI) and current smoking status interacted with time to predict trends in the Physical component scores. Similarly, PCI and educational status interacted with time to predict trends in the mental component scores. PCI and unemployment were found to be predictor of differences of Physical and mental component scores (between subject effects) respectively. Conclusions: QoL assessment in different stages of treatment should be incorporated in the ongoing RNTCP to make the programme more client-oriented and comprehensive, and to provide social support to those who need it most. Directly observed treatment should be supplemented with economic support, de-addiction campaign and Inter-personal counselling by the DOTS providers.
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Affiliation(s)
- Sitikantha Banerjee
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Kajari Bandyopadhyay
- Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Pranita Taraphdar
- Department of Community Medicine, NRS Medical College, Kolkata, West Bengal, India
| | - Aparajita Dasgupta
- Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
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30
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Zarova C, Chiwaridzo M, Tadyanemhandu C, Machando D, Dambi JM. The impact of social support on the health-related quality of life of adult patients with tuberculosis in Harare, Zimbabwe: a cross-sectional survey. BMC Res Notes 2018; 11:795. [PMID: 30400994 PMCID: PMC6219075 DOI: 10.1186/s13104-018-3904-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/01/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Tuberculosis (TB) is the second prime cause of mortality in Sub-Saharan Africa and remains a major worldwide public health problem. Unfortunately, patients with TB are at risk of poor mental health. However, patients who receive an adequate amount of social support are likely to have improved health outcomes. The study was done to establish how social support influences the health-related quality of life (HRQoL) of patients with TB in Harare, Zimbabwe. Data were collected from 332 TB patients and were analysed through structural equation modelling. RESULTS The mean age of the participants was 40.1 (SD 12.5) years and most were; males (53%), married (57.8%), educated (97.3%), unemployed (40.7%), stayed with family (74.4%), and reported of less than average levels of income (51.5%). Patients received the most significant amount of social support from the family. Patients also presented with lower HRQoL as they considerably reported of pain, anxiety and depression. The final model accounted for 68.8% of the variance. Despite methodological limitations, the study findings suggest that social support optimises patients' HRQoL. Based on the patients' responses, it was noted that patients presented with lower mental health, therefore, there is a need to develop and implement patient wellness interventions.
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Affiliation(s)
- Calvin Zarova
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, P.O Box A178, Avondale, Harare, Zimbabwe
| | - Matthew Chiwaridzo
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, P.O Box A178, Avondale, Harare, Zimbabwe.,School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town Observatory, Cape Town, 7700, South Africa
| | - Catherine Tadyanemhandu
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, P.O Box A178, Avondale, Harare, Zimbabwe.,Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Debra Machando
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, P.O Box A178, Avondale, Harare, Zimbabwe.,Department of Psychology, University of Cape Town, Rondebosch, Cape Town, 7701, South Africa
| | - Jermaine M Dambi
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, P.O Box A178, Avondale, Harare, Zimbabwe. .,School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town Observatory, Cape Town, 7700, South Africa.
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31
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Silavanich V, Nathisuwan S, Phrommintikul A, Permsuwan U. Relationship of medication adherence and quality of life among heart failure patients. Heart Lung 2018; 48:105-110. [PMID: 30384984 DOI: 10.1016/j.hrtlng.2018.09.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 09/19/2018] [Accepted: 09/22/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known regarding the relationship between medication adherence and quality of life in heart failure patients. We therefore aimed to examine the nature of relationship between medication adherence and quality of life. METHODS A prospective, cross-sectional study of chronic heart failure patients with reduced ejection fraction was performed at a tertiary-care, university hospital in Thailand. Quality of life and medication adherence were assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and Morisky Medication Adherence Scale-8 (MMAS-8), respectively. Relationship of MLHFQ and MMAS-8 were examined using Spearman's correlation coefficient and multiple regression analysis for covariates adjustment. RESULTS Among 180 patients, 38.3%, 50.0% and 11.7% were found to have high, medium and poor adherence, respectively. For quality of life, the overall median score on the MLHFQ was relatively low. A positive relationship was identified between medication adherence and quality of life. After covariate adjustment, medication adherence was found to have the strongest relationship with quality of life, compared to other covariates. CONCLUSIONS Medication adherence has a small and positive relationship with quality of life among heart failure patients.
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Affiliation(s)
- Voratima Silavanich
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; Faculty of Pharmacy, Chiang Mai University, Suthep, Muang, Chiang Mai, Chiang Mai 50200, Thailand
| | - Surakit Nathisuwan
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Arintaya Phrommintikul
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Unchalee Permsuwan
- Faculty of Pharmacy, Chiang Mai University, Suthep, Muang, Chiang Mai, Chiang Mai 50200, Thailand.
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32
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Roba AA, Dasa TT, Weldegebreal F, Asfaw A, Mitiku H, Teklemariam Z, Naganuri M, Geddugol BJ, Mesfin F, Befikadu H, Tesfaye E. Tuberculosis patients are physically challenged and socially isolated: A mixed methods case-control study of Health Related Quality of Life in Eastern Ethiopia. PLoS One 2018; 13:e0204697. [PMID: 30321189 PMCID: PMC6188627 DOI: 10.1371/journal.pone.0204697] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/12/2018] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Aklilu Abrham Roba
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | | | - Fitsum Weldegebreal
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Abyot Asfaw
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Habtamu Mitiku
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Zelalem Teklemariam
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Mahantash Naganuri
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | | | - Frehiwot Mesfin
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Hilina Befikadu
- Haramaya University, College of Social Sciences and Humanities, Dire Dawa, Ethiopia
| | - Eden Tesfaye
- Haramaya University, College of Natural and Computational Sciences, Dire Dawa, Ethiopia
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33
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Buchanan-Hughes AM, Buti M, Hanman K, Langford B, Wright M, Eddowes LA. Health state utility values measured using the EuroQol 5-dimensions questionnaire in adults with chronic hepatitis C: a systematic literature review and meta-analysis. Qual Life Res 2018; 28:297-319. [PMID: 30225787 DOI: 10.1007/s11136-018-1992-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE Chronic hepatitis C infection and its treatment can considerably affect patients' health-related quality-of-life (HRQoL). This study aimed to identify and summarise the current evidence base for health state utility values (HSUVs) in patients with chronic hepatitis C infection, generated using the EuroQol 5-dimensions (EQ-5D) questionnaire. METHODS MEDLINE, Embase, the Cochrane Library and EconLit were searched from database inception through 31 August 2017. Eligible studies reported HSUVs elicited using the EQ-5D questionnaire in adults with chronic hepatitis C infection. Study quality and risk of bias were assessed. RESULTS Of 1480 records identified, 26 studies were included. The most commonly defined health states described different stages of chronic hepatitis C infection and specific liver-related disease states, including METAVIR score, compensated and decompensated cirrhosis, hepatocellular carcinoma and liver transplantation. Patients with higher METAVIR scores tended to have lower EQ-5D scores compared to patients with lower METAVIR scores. Patients that achieved sustained virologic responses tended to have higher EQ-5D scores compared to those that did not. A meta-analysis conducted on three studies confirmed that patients with decompensated cirrhosis have significantly lower HSUVs than patients with compensated cirrhosis [mean difference - 0.11 (95% CI - 0.19 to - 0.04)], implying worse HRQoL. However, there was not sufficient evidence to compare how different treatments for chronic hepatitis C infection affect EQ-5D scores. CONCLUSIONS This study provides a summary of EQ-5D HSUVs for patients with chronic hepatitis C infection, and demonstrates that clinically important disease stages associated with treatment decisions are associated with differences in HRQoL.
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Affiliation(s)
| | - M Buti
- Hospital Universitario Valle Hebron, Barcelona, Spain.,Ciberehd del Instituto Carlos III, Madrid, Spain
| | - K Hanman
- Costello Medical Consulting Ltd, Cambridge, UK
| | - B Langford
- Costello Medical Consulting Ltd, Cambridge, UK
| | - M Wright
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - L A Eddowes
- Costello Medical Consulting Ltd, Cambridge, UK
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Kastien-Hilka T, Rosenkranz B, Schwenkglenks M, Bennett BM, Sinanovic E. Association between Health-Related Quality of Life and Medication Adherence in Pulmonary Tuberculosis in South Africa. Front Pharmacol 2017; 8:919. [PMID: 29326591 PMCID: PMC5741974 DOI: 10.3389/fphar.2017.00919] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/04/2017] [Indexed: 02/01/2023] Open
Abstract
Background: Health-related quality of life (HRQOL) and adherence to treatment are two often inter-related concepts that have implications for patient management and care. Tuberculosis (TB) and its treatment present a major public health concern in South Africa. The study aimed to evaluate the association between HRQOL and adherence in TB patients in South Africa. Methods: Four self-reported HRQOL and one self-reported adherence measures were used in an observational longitudinal multicentre study during 6-month standard TB treatment. These included the generic Short-Form 12 items (SF-12) and European Quality of Life 5 dimensions 5 levels (EQ-5D-5L), the disease-specific St. George's Respiratory Questionnaire (SGRQ) and the condition-specific Hospital Anxiety and Depression Scale (HADS) for HRQOL. Adherence was measured by the Morisky Medication Adherence Scale 8 items (MMAS-8). The relationship between both concepts was examined in 131 patients using Spearman's rho correlations, and linear regression models. Results: HRQOL improved over 6-month TB treatment, whereas adherence mean scores stayed constant with participants attaining a medium average level. Around 76% of patients reported to be high adherers and 24% were reporting a medium or low adherence. Associations between HRQOL and adherence were mainly weak. High adherence at treatment start was positively related to improvements in anxiety and depression after 6-month treatment. The overall improvement in pain and discomfort, and psychosocial health aspects over treatment time was positively, but weakly associated with adherence at 6 months of treatment. Conclusion: A positive relationship exists between adherence and HRQOL in TB in a South African setting, but this relationship was very weak, most likely because HRQOL is affected by a number of different factors and not limited to effects of adherence. Therefore, management of TB patients should, besides adequate drug treatment, address the specific mental and psychosocial needs.
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Affiliation(s)
- Tanja Kastien-Hilka
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Bernd Rosenkranz
- Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Fundisa African Academy of Medicines Development, Cape Town, South Africa
| | - Matthias Schwenkglenks
- Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland
| | - Bryan M. Bennett
- Patient Centered Outcomes, Adelphi Values, Bollington, United Kingdom
| | - Edina Sinanovic
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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35
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Kastien-Hilka T, Rosenkranz B, Sinanovic E, Bennett B, Schwenkglenks M. Health-related quality of life in South African patients with pulmonary tuberculosis. PLoS One 2017; 12:e0174605. [PMID: 28426759 PMCID: PMC5398494 DOI: 10.1371/journal.pone.0174605] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 03/10/2017] [Indexed: 12/16/2022] Open
Abstract
Background The evaluation of patient-reported health-related quality of life (HRQOL) in pulmonary tuberculosis (TB) contributes to a comprehensive understanding of the burden associated with this disease. The aim of this study was to assess the overall impact of TB on the health status and on single health domains identified in the WHO definition of health, including physical, mental and social health aspects. Methods Four instruments for HRQOL evaluation were applied in a longitudinal multicentre study during six-month standard TB treatment in South Africa. These included the generic SF-12 and EQ-5D-5L, the disease-specific St. George´s Respiratory Questionnaire (SGRQ) and the condition-specific Hospital Anxiety and Depression Scale (HADS). Statistical analysis included significance testing, univariable and multivariable analysis, and repeated measures ANOVA. Change over time in the physical component score (PCS) of SF-12 was defined as primary endpoint. A target sample size of 96 patients was estimated. Results HRQOL of the study participants was impaired in all physical, mental and psycho-social health domains at treatment start. HRQOL improved significantly and in a clinically meaningful manner during the course of standard TB treatment, over the period of the study. The greatest improvement (95%) was observed in mental health. Younger patients with higher education and who were employed had a better HRQOL. Discussion This study demonstrates the need for an integrative understanding of TB with HRQOL as core element to inform gaps in current TB management. Improvements in the management of TB following an integrative patient-centred approach will contribute towards meeting the United Nations Sustainable Development Goal 3 (SDG3) target and will support the End TB strategy of the WHO.
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Affiliation(s)
- Tanja Kastien-Hilka
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,University of Basel, Basel, Switzerland.,Health Economics Unit, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Bernd Rosenkranz
- Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Fundisa African Academy of Medicines Development, Cape Town, South Africa
| | - Edina Sinanovic
- Health Economics Unit, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Bryan Bennett
- Patient Centered Outcomes, Adelphi Values, Bollington, United Kingdom
| | - Matthias Schwenkglenks
- University of Basel, Basel, Switzerland.,Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland.,Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
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36
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Kastien-Hilka T, Rosenkranz B, Bennett B, Sinanovic E, Schwenkglenks M. How to Evaluate Health-Related Quality of Life and Its Association with Medication Adherence in Pulmonary Tuberculosis - Designing a Prospective Observational Study in South Africa. Front Pharmacol 2016; 7:125. [PMID: 27303294 PMCID: PMC4886690 DOI: 10.3389/fphar.2016.00125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 05/03/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction: Health-related quality of life (HRQOL) has become an important measure to identify and shape effective and patient-relevant healthcare interventions innovations through outcomes. Adherence to tuberculosis (TB) treatment is a public health concern. The main objective of this research is to develop a study design for evaluation of HRQOL and its association with medication adherence in TB in South Africa. Methodology: A conceptual framework for HRQOL in TB has been developed to identify Patient-Reported Outcomes and Quality of Life Database (PROQOLID), (n.d.) measures for HRQOL and adherence and to generate an endpoint model. Two generic (SF-12 and EQ-5D-5L), one disease-specific (St. George’s Respiratory Questionnaire) and one condition-specific (Hospital Anxiety and Depression Scale) measure for HRQOL and Morisky Medication Adherence Scale for adherence assessment were identified. All measures are applied in a longitudinal multi-center study at five data collection time points during standard TB treatment. Statistical analysis includes multivariable analysis. Change over time in the physical component score of SF-12 is defined as primary endpoint. Sample size estimation based thereupon has led to a recruitment target of 96 patients. This study is on-going. Discussion: This is the first longitudinal study in South Africa which evaluates HRQOL and its association with medication adherence in TB in a comprehensive manner. Results will help to improve current treatment programs and medication adherence and will support the identification of sustainable health innovations in TB, determining the value of new products, and supporting decision making with regard to health policy and pricing.
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Affiliation(s)
- Tanja Kastien-Hilka
- Swiss Tropical and Public Health InstituteBasel, Switzerland; University of BaselBasel, Switzerland; Health Economics Unit, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
| | - Bernd Rosenkranz
- Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences, Stellenbosch UniversityCape Town, South Africa; Fundisa African Academy of Medicines DevelopmentCape Town, South Africa
| | - Bryan Bennett
- Patient Centered Outcomes, Adelphi Values Bollington, UK
| | - Edina Sinanovic
- Health Economics Unit, Faculty of Health Sciences, University of Cape Town Cape Town, South Africa
| | - Matthias Schwenkglenks
- University of BaselBasel, Switzerland; Institute of Pharmaceutical Medicine, University of BaselBasel, Switzerland; Epidemiology, Biostatistics and Prevention Institute, University of ZürichZürich, Switzerland
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