Health-related quality of life among smear positive pulmonary tuberculosis patients in Mbale District, Uganda

Abstract

Introduction: Drug therapy prevents tuberculosis (TB) spread, morbidity and mortality but it affects the patients’ health-related quality of life (HRQoL). Currently, TB case management guidelines focus so much attention on drug therapy and microbiological cure. The impact of therapy on HRQoL is rarely assessed in routine practice in Uganda. This is a major gap in TB patient care yet drug therapy remains an important pillar in disease management. Objective: To determine HRQoL and its associated factors in different phases of therapy among sputum smear positive pulmonary TB patients. Specifically physical composite scores (PCS), mental composite scores (MCS) and their associated factors in the specific therapy phases were investigated. Methods: It was a cross sectional study with a random sample of 210 sputum smear positive pulmonary tuberculosis patients reporting to Mbale Regional Referral Hospital in Mbale district. Means and standard deviations were used to express PCS and MCS. Multiple linear regression methods were used to model relationships between explanatory variables and HRQoL. Results: Generally, the HRQoL scores improved across the treatment phases. The overall PCS and MCS were 44.8±22.1 and 49.7±19.1 respectively. General health (38.8±17.5) and mental health (52.7±18.6) had the lowest and highest sub-scale scores respectively. The mean PCS scores in the pretreatment, intensive and continuous phases were 29.9±19.4, 41.9±14.2 and 62.2±18.8 respectively. Similarly, mean MCS scores in the pretreatment, intensive and continuous phases were 38.8±18.3, 49.4±13.1 and 60.6±18.8 respectively. Having a formal occupation (regression coefficient, r = 30.27, p = <0.001) in the pretreatment phases, being unmarried (r = 11.94, p = 0.028) and belonging to the highest tertile of socioeconomic status (SES) (r = 14.56, p = 0.007) in the intensive phase; whereas SES (r = 10.83, p = 0.021 for MCS and r = 13.14, p = 0.004 for PCS) in the continuous phase were positively correlated with HRQoL. Age (r = -0.39, p = 0.015 for PCS and r = -0.32, p = 0.050 for MCS) was negatively correlated with HRQoL. Conclusions and recommendations: Although HRQoL scores improved across treatment phases, both PCS and MCS were least in the initial phases of therapy. Having a formal occupation, high socioeconomic status and lower age were positively associated with physical health in the pre-treatment, intensive and continuous phases of PTB treatment respectively. Formal occupation in the intensive phase of therapy and lower age and higher socio-economic status in the continuous phase of therapy were positively associated with mental health of PTB patients. Economic activity should be encouraged amongst sputum smear positive PTB patients and additional special attention by healthcare providers and patient caretakers be paid to patients of older age in order to improve their perceived physical and mental health.