Quality of Life of Tuberculosis Patients Baghdad /2013

1. Quality of Life of Tuberculosis Patients Baghdad /2013 Presented by Dr. Ayad Kareem Huwaiz FETP Resident Supervised by Dr. Salih Jasim Alwan MB.CHB, MSc, PhD

2. Introduction • Tuberculosis (TB) is a serious disease caused by a bacterium called Mycobacterium TB. • This disease remains a major global health problem. • It ranks the second leading cause of death from an infectious disease worldwide. • There are 9 million new cases in 2011 and 1.4 million TB deaths.

3. Tuberculosis in Iraq • The burden of this disease in Iraq: • Estimated Prevalence : 74/100,000 • Estimated Incidence Rate: 45/100,000 (new & relapse) • Mortality Rate: 3/ 100,000 * In 2011 there were • 8837 new cases, • 358 relapse, • 74 newly confirmed MDR cases.

4. The WHO declared TB a global public health emergency in 1993. • (DOTS) aiming at detecting 70% of pulmonary cases and successfully treating at least 85% of them. • In 2006, a larger scoped “Stop TB strategy” was recommended by WHO to reduce TB cases and Death.

5. DOTS strategy was adopted by NTP in 1998 and achieved 100% coverage in all governorates by 2008. In 2011, Indicators for DOTS Strategy were: • CDR 60% • Treatment outcome was: Success Rate 89% Failure Rate 1% Death Rate 3% Default Rate 6-7% Though NTP has a good treatment outcome, yet it did not achieve the target of 70% CDR.

6. According to the World Health Organization, health is defined as a state of complete physical, mental, and social well-being and not a mere absence of disease or infirmity. • It has been seen that apart from physical symptoms, TB patients face various problems that are social and economic in nature.

7. Quality of life • Quality of life is defined as an individual' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns

8. Reasons for measuring QoL • Understanding the causes and consequences of differences in QoL between individuals or groups of individuals. • Assessing the impact of social and environmental conditions on QoL. • Estimating the needs of a given population. • Evaluating the efficiency or effectiveness of health interventions and/or the quality of the health care system. • Improving clinical decisions.

9. Quality of Life by World Health Organization (WHOQOL) • The World Health Organization Quality of Life (WHOQOL) project was initiated in 1991; the aim of the project was to develop an international cross-culturally comparable assessment instrument. • Quality of life that has several dimensions, the effect of disease on each dimension can be assessed using instruments, which are either generic or specific.

10. Objectives • To assess the quality of life of tuberculosis patients in terms of physical, psychological, social and environmental domains. • To describe demographic, socio-economic, and medical factors associated with QoL outcomes in TB patients.

11. Methodology Study Design: A cross sectional study of all TB patients from Al-Karkh part of Baghdad diagnosed during data collection period were interviewed using a structured questionnaire form to assess their quality of life. Settings: Settings of data collection were Chest and Respiratory Consultant Clinic and district TB coordinating units in Karkh side of Baghdad.

12. Period of data collection: Interviews were conducted for three months during the period April 1st to June 30th , 2013. Inclusion criteria: 1. All TB patients who are on anti-TB treatment. 2. Age 15-65 years. Exclusion criteria: 1. TB patients having any co-morbid disease. 2. TB patient who refuse to participate.

13. Tool of Data Collection: • The data of this study will be obtained through direct interview with patients using demographic information form about TB patient included name, sex, age, family size, education, marital status, type of TB ,while data concerned with QoL followed the standard questionnaire WHOQOL-BREF.

14. Scoring of WHO QOL for all domains

15. Transformation of scores

16. Data analysis • Statistical package for social sciences version 18 (SPSS v18) used for data input and analysis. • Scoring and Data analysis of QOL will be done according to WHO-BREF scoring and analysis. Type of QOL scoring which used is 0-100. • Variations of scoring of quality of life within each domain according to demographic and medical variables were analyzed using t test and ANOVA

17. Regarding generic part of WHOQOL instrument study, rating quality of life and general health which according to gender were analyzed using Fishers exact test and chi square test respectively. • For the correlations between the domain scores, Pearson's correlation coefficient r were applied to variables with normal distribution. • Statistical significance was accepted for P ≤ 0.05 (significant) and P > 0.05 (insignificant).

18. Results • The investigator interviewed 103 Patients and 100 accepted to participate and the response rate was 97%. • The results presented in this chapter were based on the analysis of 100 TB patients enrolled in the study.

19. Table 1:Description of study sample

20. Table 1:Description of study sample

21. Table 2: Quality of life of TB patient for different domains

22. Figure 1: Quality of Life with all domains for TB patients

23. Table3:Variation of scoring quality of life within each domain according to the demographic variables by t test

24. Table4:Variation of scoring quality of life within each domain according to demographic variables by ANOVA

25. Table 5: Variation in scoring quality of life according to medical variables

26. Table 6: Subjective Rating of TB patients for their quality of life according to gender.

27. Figure 2: Rating quality of life of TB patient by gender

28. Table 7: Subjective Rating of TB patients for their general health according to gender

29. Figure 3: Rating general health of TB patient by gender

30. Table 8: Correlation between domains of quality of life among TB patients.

31. Limitations of study:- 1- Absence of Arabic version of WHO QOL instrument. 2- Small study sample. 3- Lack of local information about quality of life in our country. 4- No previous study on quality of life of TB patients.

32. Conclusions: 1. Quality of life of TB patients is considerably affected by this disease. 2.Quality of life of TB patients differs according to demographic characteristics.

33. Recommendations: 1. It is mandatory to consider patients' quality of life besides clinical, radiological and bacteriological assessments. 2. Arabic version of the WHOQOL questionnaire is recommended to generalize it all over the country. 3. The TB control program should design strategies to improve the quality of life of TB patients.

34. Recommendations: 4. Psychological and self-stigma should be targeted for intervention to improve the quality of life of patients. 5. Invigoration the role of health education in collaboration with media 6. Further studies on quality of life of TB patients using case control study design are recommended.

35. THANK YOU