Quality of life and its determinants among pulmonary TB patients taking DOT therapy in Karachi, Pakistan

Date of Award

2014

Document Type

Thesis

Degree Name

Master of Science in Nursing (MScN)

Department

School of Nursing and Midwifery, Pakistan

Abstract

Pakistan ranks sixth on the global list of high tuberculosis countries and has contributes about 63% of the TB burden in the Eastern Mediterranean Region. According to WHO, the estimated prevalence and incidence of TB in Pakistan is 310/100 000 and 231/100 000 population, respectively. Literature extensively supports that TB significantly destroys the quality of life (QoL) of the patients. DOT was introduced by WHO in1993 to enhance the effectiveness of treatment and compliance. This program uses sputum negativity and weight gain as prognostic indicators but does not consider any other dimension of health including QoL. The purpose of this study was to assess the QoL among Pulmonary Tuberculosis (PTB) patients of > 18 years of age, taking the DOT therapy. Methodology: An analytical cross-sectional study was conducted to answer the study questions. Through convenient sampling, 302 PTB patients (age >18 years) were selected from MALC DOT clinics for interviewing, based on the WHOQoL-BREF tool. Analysis: Descriptive and inferential statistics were used for data analysis. Mean and standard deviations were computed for continuous variables and proportions were computed for categorical variables. Univariate regression was carried out on the data and 95% confidence interval (CI) was estimated. Multivariable linear regression analysis was further run to see the independent relationship of variables with the mean QoL score. Findings: This cross-sectional study estimated the mean score of QoL as 25.61 among the participants. The participants showed that environmental (23+15.03) and physical (24.4 + 13.3) domains were most affected after PTB. The study presented 36.8% associated factors that affect Background: Pakistan ranks sixth on the global list of high tuberculosis countries and has contributes about 63% of the TB burden in the Eastern Mediterranean Region. According to WHO, the estimated prevalence and incidence of TB in Pakistan is 310/100 000 and 231/100 000 population, respectively. Literature extensively supports that TB significantly destroys the quality of life (QoL) of the patients. DOT was introduced by WHO in1993 to enhance the effectiveness of treatment and compliance. This program uses sputum negativity and weight gain as prognostic indicators but does not consider any other dimension of health including QoL. The purpose of this study was to assess the QoL among Pulmonary Tuberculosis (PTB) patients of > 18 years of age, taking the DOT therapy. Methodology: An analytical cross-sectional study was conducted to answer the study questions. Through convenient sampling, 302 PTB patients (age >18 years) were selected from MALC DOT clinics for interviewing, based on the WHOQoL-BREF tool. Analysis: Descriptive and inferential statistics were used for data analysis. Mean and standard deviations were computed for continuous variables and proportions were computed for categorical variables. Univariate regression was carried out on the data and 95% confidence interval (CI) was estimated. Multivariable linear regression analysis was further run to see the independent relationship of variables with the mean QoL score. Findings: This cross-sectional study estimated the mean score of QoL as 25.61 among the participants. The participants showed that environmental (23+15.03) and physical (24.4 + 13.3) domains were most affected after PTB. The study presented 36.8% associated factors that affect the QoL of PTB patients independently in the multivariate regression. Among the participants, the ones who were satisfied with the DOT therapy (p=0.003) and had good knowledge about the disease (p=0.01) possesed good QoL. Whereas, participants who were on the intensive phase of CAT-2 (p=<0.001), had kidney disorders (p=0.03), intensive cough which hindered prayers (p=<0.001), nausea initiating pain (13=9.0, p= 0.02), lost their significant other in the last one year (p=0.002), and facing financial difficulties (p=0.01) had poor QoL. Moreover stigmatization stood out as the biggest problem for the PTB patients in the society, especially when it affected the relationship with siblings (p=-0.001), and other kept a distance (p=0.001). Conclusion: This study showed a very poor QoL among adult PTB patients in Karachi, Pakistan. Cough, pain stigmatization, knowledge related to disease, financial difficulties, support by parents, and loss of significant other were significantly associated with QoL among PTB patients. Broad interventions at the institutional and governmental level are needed to address the problems of the PTB sufferers.

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