Quality of life, prevalence of depressive symptoms and factors associated with prolonged indwelling urinary catheterization at Mulago National Hospital
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Introduction: In the United States, 15% to 25% of hospitalized patients and 11% of home care patients have indwelling urinary catheters with their inappropriate use in acute care hospitals ranging from 21% to 63%. In Uganda, the magnitude of prolonged indwelling urinary catheterization (PIUC) following acute urine retention is not well documented. The focus of most urologists has been on the relief of symptoms with little/ no attention given to the quality of life (QOL) and psychological impact of the catheter. Objective: This study aimed to evaluate the QOL, prevalence of depressive symptoms and factors associated with PIUC in Mulago National Hospital (MNH). Methods: This was a descriptive cross-sectional study conducted from January 19th 2019 to March 13th 2019. We recruited patients attending the Urology clinic in MNH with urinary catheters for more than 28 days from initial placement irrespective of the number of replacements. A demographics question aire, Catheter-related QOL instrument (score >50 considered good and < 50 considered poor) and the Patient Health Questionnaire-9 for assessing depressive symptoms (a score of moderate to severe 20-27 was equivalent to severe depressive symptoms) were administered by the principal investigator and 2 research assistants. The data was cleaned, entered in EpiData and exported to STATA and SPSS for analysis. A binary logistic regression was used. At bivariate level, a chi-square p-value of ≤0.2 was used to select variables to be considered for multivariate analysis and a p-value (≤0.05) was considered significant to determine the factors associated with QOL of patients on PIUC. Results: 145 patients were enrolled, they were all male with a mean age (SD) of 59±20 years and a median duration of catheterization of 12 (IQR:3-36) months. The majority of patients on PIUC had a poor QOL 100 (69%). The mean QOL of the study participants was 44.2 ± 10.5%, participants in the younger age group, the single marital status and unemployed had worse scores on Catheter-related QOL instrument. There was a very high prevalence of depressive symptoms of 67.5% (constituted by those with moderately severe 50.3% and severe symptoms 17.2%) among patients on PIUC. There was a strong correlation with the patients’ duration of catheterization, type of urinary diversion and reason for PIUC. Conclusion: Patients on PIUC had a poor QOL with a very high prevalence rate of depressive symptoms. Therefore, counseling services should be extended to the Urology department for proper holistic service delivery among the patients on PIUC.