Quality of life of adult individuals with intestinal stomas in Uganda: a cross sectional study

Stoma-related complications and quality-of-life assessment: A cross-sectional study with patients from Ethiopia and Sweden

BACKGROUND

The situation for patients with ostomy can be challenging, probably more in a resource-constrained environment. Our objective was to evaluate quality of life (QoL) (using EQ5D-5L) and stoma-specific QoL (using Stoma QoL) in a high- and low-income setting.

METHODS

In this cross-sectional study from the Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, and South General Hospital (SGH), Stockholm, patients with a permanent or temporary ostomy at TASH (EthioPerm), (EthioTemp), and patients with ostomy at SGH (SweSto) were included in October 2022-January 2023.

RESULTS

Patients N = 66 were included in groups: EthioPerm N = 28, EthioTemp N = 17, and SweSto N = 21. In EthioTemp, 88% used homemade stoma bags. Although morbidity related to the nipple itself was similar in the groups, the overall score from Stoma QoL was significantly lower in EthioPerm, 48/100 than in SweSto, 74/100. Scores were significantly lower for pouch-related problems and social interactions in Ethiopian patients. In EthioPerm, 71% of the patients worried that they were a burden to the people close to them compared to 14% in SweSto (p < 0.001). Leakage was over four times more common in EthioPerm than in SweSto. Mean overall EQ5D-5L score was 18 percentage points lower than the national mean score in EthioPerm and 2 percentage points lower in SweSto.

CONCLUSION

QoL was more affected in the Ethiopian study participants than in the Swedish, even when commercial stoma bags were available. The largest problems were leakage, embarrassment with social interactions, and pouch-related problems.

TRIAL REGISTRATION

NCT05970458 Clinicaltrials.gov, https://clinicaltrials.gov/study/NCT05970458?locStr=Ethiopia&country=Ethiopia&distance=50&cond=Stoma%20Ileostomy&rank=1.

Analysis on effect of psychological nursing combined with extended care for improving negative emotions and self-care ability in patients with colorectal cancer and enterostomy: A retrospective study

This study investigates the effectiveness of combining psychological nursing with extended nursing in patients with colorectal cancer who have undergone enterostomy. Conducted from January 2021 to January 2022, this retrospective study involved 78 patients split into 2 groups of 39 each. The control group received standard nursing care, while the observation group benefitted from both psychological and extended nursing. The evaluation focused on anxiety, depression, sleep quality, mental resilience, and self-care abilities. Results, 3 months postdischarge, indicated that the observation group had significantly lower scores in the Hamilton Depression Rating Scale and the Pittsburgh Sleep Quality Index, and higher scores in the Connor-Davidson Resilience Scale and the Enterostomal Self-Care Ability Scale, compared to the control group (P < .05). The findings suggest that integrating psychological nursing with extended care significantly improves mood, sleep quality, psychological resilience, and self-care capabilities in these patients.

Feasibility and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with long-term physical conditions: an exploratory non-controlled study in Bosnia and Herzegovina, Colombia and Uganda

INTRODUCTION

The management of long-term physical conditions is a challenge worldwide, absorbing a majority resources despite the importance of acute care. The management of these conditions is done largely in primary care and so interventions to improve primary care could have an enormous impact. However, very little data exist on how to do this. Mental distress is frequently comorbid with long term physical conditions, and can impact on health behaviour and adherence, leading to poorer outcomes. DIALOG+ is a low-cost, patient-centred and solution-focused intervention, which is used in routine patient-clinician meetings and has been shown to improve outcomes in mental health care. The question arises as to whether it could also be used in primary care to improve the quality of life and mental health of patients with long-term physical conditions. This is particularly important for low- and middle-income countries with limited health care resources.

METHODS

An exploratory non-controlled multi-site trial was conducted in Bosnia and Herzegovina, Colombia, and Uganda. Feasibility was determined by recruitment, retention, and session completion. Patient outcomes (quality of life, anxiety and depression symptoms, objective social situation) were assessed at baseline and after three approximately monthly DIALOG+ sessions.

RESULTS

A total of 117 patients were enrolled in the study, 25 in Bosnia and Herzegovina, 32 in Colombia, and 60 in Uganda. In each country, more than 75% of anticipated participants were recruited, with retention rates over 90% and completion of the intervention exceeding 92%. Patients had significantly higher quality of life and fewer anxiety and depression symptoms at post-intervention follow-up, with moderate to large effect sizes. There were no significant improvements in objective social situation.

CONCLUSION

The findings from this exploratory trial suggest that DIALOG+ is feasible in primary care settings for patients with long-term physical conditions and may substantially improve patient outcomes. Future research may test implementation and effectiveness of DIALOG+ in randomized controlled trials in wider primary care settings in low- and middle-income countries.

TRIAL REGISTRATION

All studies were registered prospectively within the ISRCTN Registry. ISRCTN17003451, 02/12/2020 (Bosnia and Herzegovina), ISRCTN14018729, 01/12/2020 (Colombia) and ISRCTN50335796, 02/12/2020 (Uganda).

Depression after stoma surgery: a systematic review and meta-analysis

BACKGROUND

Depression is the leading cause of global disability and can develop following the change in body image and functional capacity associated with stoma surgery. However, reported prevalence across the literature is unknown. Accordingly, we performed a systematic review and meta-analysis aiming to characterise depressive symptoms after stoma surgery and potential predictive factors.

METHODS

PubMed/MEDLINE, Embase, CINAHL and Cochrane Library were searched from respective database inception to 6 March 2023 for studies reporting rates of depressive symptoms after stoma surgery. Risk of bias was assessed using the Downs and Black checklist for non-randomised studies of interventions (NRSIs), and Cochrane RoB2 tool for randomised controlled trials (RCTs). Meta-analysis incorporated meta-regressions and a random-effects model.

REGISTRATION

PROSPERO, CRD42021262345.

RESULTS

From 5,742 records, 68 studies were included. According to Downs and Black checklist, the 65 NRSIs were of low to moderate methodological quality. According to Cochrane RoB2, the three RCTs ranged from low risk of bias to some concerns of bias. Thirty-eight studies reported rates of depressive symptoms after stoma surgery as a proportion of the respective study populations, and from these, the median rate across all timepoints was 42.9% 42.9% (IQR: 24.2-58.9%). Pooled scores for respective validated depression measures (Hospital Anxiety and Depression Score (HADS), Beck Depression Inventory (BDI), and Patient Health Questionnaire-9 (PHQ-9)) across studies reporting those scores were below clinical thresholds for major depressive disorder according to severity criteria of the respective scores. In the three studies that used the HADS to compare non-stoma versus stoma surgical populations, depressive symptoms were 58% less frequent in non-stoma populations. Region (Asia-Pacific; Europe; Middle East/Africa; North America) was significantly associated with postoperative depressive symptoms (p = 0.002), whereas age (p = 0.592) and sex (p = 0.069) were not.

CONCLUSIONS

Depressive symptoms occur in almost half of stoma surgery patients, which is higher than the general population, and many inflammatory bowel disease and colorectal cancer populations outlined in the literature. However, validated measures suggest this is mostly at a level of clinical severity below major depressive disorder. Stoma patient outcomes and postoperative psychosocial adjustment may be enhanced by increased psychological evaluation and care in the perioperative period.

Effects of Socio-educational Interventions on the Quality of Life of People with a Digestive Ostomy

Introduction

The creation of digestive stomata is associated with a change in people's lives. Causing a strong impact that influences all dimensions of life. This paper reports on the effects of socio-educational interventions on the quality of life (QOL) of people with a digestive ostomy.

Objective

To describe the effect of a nursing intervention on the QOL of people with a digestive ostomy.

Methods

A quasiexperimental study was conducted whose sample consisted of 12 people who were ostomized in a public hospital in Colombia. Participants were selected through convenience sampling and randomly assigned to the intervention group and the control group. For the control group, an educational process was carried out through a theoretical session with virtual mediation (educational video). The QOL was evaluated before and after the interventions through the Montreux questionnaire.

Results

The average age was 57(+7) years. No statistical differences were found between the groups in the QOL index or for any of the dimensions that make up QOL. Pretest and post-test analysis for each intervention separately showed improvement in two dimensions of QOL for each group; in the intervention group body image dimension (p  =  .017) and the positive coping dimension (p  =  .027). In the control group, the physical well-being dimension (p  =  .037) and social concerns dimension (p  =  .034).

Conclusions

The personalized educational intervention or carried out through virtual pedagogical mediation, generated a clinically significant increase in the dimensions of QOL, without statistical differences. The study adds knowledge about the impact that digestive stomata have on the QOL, which is why it is necessary to establish specialized interdisciplinary teams to care for the person's new condition at home during the following months.

Telephone-based Support in Preventing Stoma and Peristomal Complications: A Review of Literature

A stoma is classified as either permanent or temporary depending on the time of anastomosis, and is referred to as a colostomy, ileostomy, or urostomy based on the organ to which it is anastomosed. The creation of a stoma poses many challenges to patients as they adapt to this profound life-changing event that affects fundamental aspects of quality of life. To reduce the risk of stoma and peristomal complications after discharge, telephone-based support (TBS) program which includes patient follow-up, counselling, and the benefits of group support activities including information sharing, health education and counselling, symptom management, early detection of problems, reassurance, and high-quality aftercare. This article narrates common stoma and peristomal complications as well as TBS program to support in reducing these complications.

Prevalence of depression in Uganda: A systematic review and meta-analysis

Background

Depression is one of the most studied mental health disorders, with varying prevalence rates reported across study populations in Uganda. A systematic review and meta-analysis was carried out to determine the pooled prevalence of depression and the prevalence of depression across different study populations in the country.

Methods

Papers for the review were retrieved from PubMed, Scopus, PsycINFO, African Journal OnLine, and Google Scholar databases. All included papers were observational studies regarding depression prevalence in Uganda, published before September 2021. The Joanna Briggs Institute Checklist for Prevalence Studies was used to evaluate the risk of bias and quality of the included papers, and depression pooled prevalence was determined using a random-effects meta-analysis.

Results

A total of 127 studies comprising 123,859 individuals were identified. Most studies were conducted among individuals living with HIV (n = 43; 33.9%), and the most frequently used instrument for assessing depression was the Depression sub-section of the Hopkins Symptom Checklist (n = 34). The pooled prevalence of depression was 30.2% (95% confidence interval [CI]: 26.7–34.1, I² = 99.80, p<0.001). The prevalence of depression was higher during the COVID-19 pandemic than during the pre-pandemic period (48.1% vs. 29.3%, p = 0.021). Refugees had the highest prevalence of depression (67.6%; eight studies), followed by war victims (36.0%; 12 studies), individuals living with HIV (28.2%; 43 studies), postpartum or pregnant mothers (26.9%; seven studies), university students (26.9%; four studies), children and adolescents (23.6%; 10 studies), and caregivers of patients (18.5%; six studies).

Limitation

Significantly high levels of heterogeneity among the studies included.

Conclusion

Almost one in three individuals in Uganda has depression, with the refugee population being disproportionately affected. Targeted models for depression screening and management across various populations across the country are recommended.

Trial registration

Protocol registered with PROSPERO (CRD42022310122).

Psychometrics of the Patient Health Questionnaire (PHQ-9) in Uganda: A Systematic Review

BACKGROUND

Depression is screened by many psychological tools, whereas the Patient Health Questionnaire-9 (PHQ-9) is one of the most commonly used self-administered tools. Uganda is a culturally diverse country with a wide variety of tribes, ethnic groups, languages, and disease conditions; it is urgent to know the psychometrics of the used PHQ-9 across different cohorts. However, there is no prior review to assess its reliability in this culturally diverse country, where this review fulfills the knowledge gap.

METHODS

Adhering to the PRISMA guideline, a systematic search was performed in several databases (i.e., PubMed, Africa-Wide Information, AJOL, and PsycINFO, among others), and a total of 51 articles were included in this review, confirming the study inclusion criteria (e.g., using the PHQ-9).

RESULTS

The PHQ-9 has been used among individuals above 10 years and both genders, and the tool has been used most among the HIV patient group (n = 28). The tool is frequently administered by interviews and has been translated into several languages (mostly Luganda, n = 31). A cutoff of 10 was commonly used to identify clinical or major depression (n = 23), and its prevalence ranged from 8 to 67%. It has been validated for use in two populations, (i) HIV-positive participants and (ii) the general population attending a health facility. The sensitivity and specificity were 92 and 89%, respectively, at a cutoff score of 10, whereas 67 and 78%, respectively, at a cutoff score of 5. The Cronbach alpha ranged between 0.68 and 0.94.

CONCLUSION

The PHQ-9 has been used in several studies in Uganda but validated in only two populations and is commonly used in one language. Thus, validation of the tool in various populations and languages is warranted to improve the tool's acceptance in Uganda.

Prevalence of depression and its potential contributing factors in patients with enterostomy: A meta-analytical review

OBJECTIVE

In patients with intestinal pathologies, the placement of a stoma bag affects multiple aspects of their perceived quality of life. This meta-analysis aims to evaluate the prevalence of depression among patients with enterostomy and to determine the underlying factors that could explain the potential heterogeneity of this prevalence.

METHODS

Relevant published studies were identified by searching PubMed, Embase, PsycINFO, Cochrane, CINAHL, Scopus, and Web of Science until May 2022. The random-effects model was used to determine the pooled prevalence of depression among patients with enterostomy using cross-sectional studies from various countries. Meta-regression and subgroup analysis were performed to identify factors contributing to heterogeneity. Quality assessment of the included studies was conducted using the Newcastle-Ottawa scale for nonrandomized studies.

RESULTS

The pooled prevalence of depressive symptoms among patients with enterostomy, as calculated using the random-effects model, was 41.6% (95% confidence interval [CI]: 25.4-59.7%, Q-value = 145.794, df = 8, p < 0.001, tau^∧2 = 1.124, I^∧2 = 94.513). The meta-regression found that mean age and gender were not significant moderators for the observed heterogeneity in prevalence. Subgroup analysis according to the indications for enterostomy formation showed that the prevalence of depression was highest in patients with colorectal cancer, at 34.4% (95% CI: 27.2-42.4%). Subgroup analysis by region showed that patients in Africa had the highest prevalence of depression, at 88.2% (95% CI: 76.1-94.6%), compared to other regions. Subgroup analysis by stoma indication was not significant.

CONCLUSION

This meta-analysis reports that the pooled prevalence of depression among patients with enterostomy is 41.6%. Indications for enterostomy formation, as well as geographical region, were identified as potential sources of heterogeneity. These findings highlight the need for appropriate psychosocial support and interventions at different stages of enterostomy placement.

Non communicable diseases persist despite being overshadowed by Covid-19 globally

Nil