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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 20  |  Issue : 4  |  Page : 149-154

Health-related quality of life of people living with HIV/AIDS accessing care in a tertiary health-care center in North West Nigeria


1 Department of Community Health, Usmanu Danfodiyo University, Sokoto, Nigeria
2 Department of Medicine, Usmanu Danfodiyo University, Sokoto, Nigeria
3 Department of Community Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Date of Web Publication17-Apr-2018

Correspondence Address:
Dr. Mansur Olayinka Raji
Department of Community Health, Usmanu Danfodiyo University, Sokoto
Nigeria
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DOI: 10.4103/1118-8561.230261

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  Abstract 


Background: Worldwide, human immunodeficiency virus (HIV) continues to be a major public health issue. The vast majority of people living with HIV/AIDS (PLWHA) resides in low- and middle-income countries, such as Nigeria, and they suffer the impact of the disease with serious effect on their health-related quality of life (HRQoL). Aim: This study aimed at assessing the HRQoL of PLWHA attending retroviral clinic of a tertiary health care center. Methodology: The study was conducted at the retroviral clinic of a tertiary health institution, having about 4500 clients. PLWHA were recruited into the study using systematic sampling technique. The instrument of data collection was modified from the World Health Organization QoL HIV bref questionnaire. The questionnaires were analyzed with IBM software package version 20. Results: The overall domain scores for the respondents were; physical domain 62.8 ± 16.3; psychological domain 57.7 ± 15.8; social relationship domain 55.6 ± 17.5; environmental domain 59.2 ± 12.1; while the overall QoL and general health of all the respondents were 65 ± 21.8. The overall QoL and general health status of respondent were only significantly positively correlated with place of residence (P = 0.01). Respondents' perception of their current illness was negatively correlated with physical (r = −0.483), psychological (r = −0.393), social relationship (r = −0.397), environment (r = −0.329), and overall QoL scores (r = −0.530). Conclusion: Generally, the mean QoL domain scores for the respondents were high (>50). Very low QoL scores were seen in the social domain, suggesting that more social interventions are required in this population.

Keywords: Human immunodeficiency virus/AIDS, Nigeria, quality of life


How to cite this article:
Raji MO, Liman HM, Raji IA, Kaoje AU. Health-related quality of life of people living with HIV/AIDS accessing care in a tertiary health-care center in North West Nigeria. Sahel Med J 2017;20:149-54

How to cite this URL:
Raji MO, Liman HM, Raji IA, Kaoje AU. Health-related quality of life of people living with HIV/AIDS accessing care in a tertiary health-care center in North West Nigeria. Sahel Med J [serial online] 2017 [cited 2018 Aug 19];20:149-54. Available from: http://www.smjonline.org/text.asp?2017/20/4/149/230261




  Introduction Top


Worldwide, human immunodeficiency virus (HIV) continues to be a major public health issue. In 2014, an estimated 36.9 million people were living with HIV (including 2.6 million children) giving a global HIV prevalence of 0.8%.[1] The vast majority of this number live in low- and middle-income countries,[2] such as Nigeria, which accounts for 9% of all people living with HIV globally.[3] Individuals people living with HIV/AIDS (PLWHA) continue to suffer the effect of the disease, with a serious impact on their health-related quality of life (HRQoL).

The concept of HRQoL and its determinants has evolved since the 1980s to encompass those aspects of overall QoL that can be clearly shown to affect health – either physical or mental.[4],[5],[6] HRQoL questions have become an important component of health surveillance and are generally considered valid indicators of service needs and intervention outcomes. Self-assessed health status also proved to be more powerful predictor of mortality and morbidity than many objective measures of health.[4],[5],[6] HRQoL measures make it possible to demonstrate scientifically the impact of health on QoL, going well beyond the old paradigm that was limited to what can be seen under a microscope.

This study aimed at assessing the HRQoL of PLWHA attending the retroviral clinic of a tertiary health-care center as no such assessment has been conducted since inception free care at the study site.


  Methodology Top


The study was conducted at a tertiary hospital in North West Nigeria. The hospital serves as a referral center to several hospitals within the North West region of Nigeria. A multidisciplinary team of specialists from (community health, internal medicine, pediatrics and hematology departments of the hospital) runs the antiretroviral therapy (ART) clinic. Institute of Human Virology of Nigeria in conjunction with management of the hospital commenced free HIV care at the site in 2007; currently the site has about 4500 clients.

The study population comprised PLWHA attending the clinic. Using the formula for cross-sectional study.[7] A total of 256 respondents were recruited into the study using systematic sampling technique. The instrument of data collection was modified from the World Health Organization QoL HIV (WHOQoL-HIV) bref questionnaire, it consisted of 31 items and sought information on the sociodemographic and HIV characteristics of the clients and also sought information on 4 domains of QoL (physical health, psychological health, social relationships, and environment domains). The questionnaires were manually checked for completeness and subsequently entered into and analyzed with IBM SPSS statistics version 22 developed by IBM corporation. Analysis of data began with descriptive statistics followed by analysis and scoring of the four domains.

The domain scores were scaled in a positive direction with higher scores indicating a higher QoL. Three items of the bref were reversed before scoring. After item recoding, a raw score was computed by a simple algebraic sum of each item in each of the four domains. Then, the raw scale scores were transformed to a scale that ranges from 0 to 100, which subsequently could be used to interpret and compare other validated instrument tools, such as the WHOQoL-100. Steps in computing domains were ascertained from the WHO administering and scoring tool.[8]

Mean and standard deviations were computed for domain scores. Correlations between respondents domain score and sociodemographics were computed. The Point biserial correlation (rpb) was computed for bivariate correlation that involved one continuous variable and a binary categorical variable, and a Pearson correlation coefficient (r) was computed for bivariate correlation involving two continuous variables.


  Results Top


Most of the respondents were females (51%) and Muslims (59%). Hausa tribe was the most prevalent (39.5%) followed by Yoruba (27.3). Majority of respondents were urban residents (71.9) and had formal education (80.5%). Majority of the respondents (76.6%) reported having symptoms of HIV/AIDS. In addition, most of the respondents (70.7%) when asked if they consider themselves currently ill reported “no” [Table 1].
Table 1: Sociodemographics of respondents

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The physical domain score for the respondents range from 17.9 to 96.4 with a mean of 62.8 ± 16.3, that for psychological domain range from 16.7 to 100 with mean of 57.7 ± 15.8, the social relationship domain range from 0 to 100 with a mean of 55.6 ± 17.5 while that of environmental domain range from 15.6 to 90.6 with a mean of 59.2 ± 12.1. The overall HRQoL and general health of all the respondents range from 0 to 100 with a mean of 65 ± 21.8 [Table 2].
Table 2: Domains and overall quality of life scores for male and female respondents

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When the domain scores were analyzed by gender, it was observed that females had slightly higher scores for all domains as well as overall QoL compared with the males although the difference was not statistically significant. The mean physical domain score for females was 63.5 compared with 61.9 for males (P = 0.45), the mean psychological domain score was 58.7 for females compared with 56.6 for males (P = 0.29), the mean social relationship score was 56.5 for females compared with 54.7 for males (P = 0.4), the mean environment domain score was 59.4 for females compared with 58.9 for males (P = 0.72) while the overall mean QoL score was 65 for females compared with 64.9 for males (P = 0.99) [Table 3].
Table 3: Gender distribution of domains and overall quality of life scores

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There was statistically significant correlation between respondents' physical domain and their place of resident (P = 0.01). However, respondents' age, sex, and educational status were not significantly correlated with their physical domain scores. Respondents' age, sex, educational status, or place of resident was not significantly correlated with their psychological domain scores. Respondents' social relationship domain score was significantly correlated with their ages (P < 0.01) and places of residence (P < 0.01). Environment domain scores were significantly correlated with respondents' place of residence (P < 0.01) and educational status (P < 0.01). The overall QoL and general health status of respondent were only significantly correlated with place of residence (P = 0.01) [Table 4].
Table 4: Correlation between domain scores and respondents age, gender, place of residence, and educational status

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Analysis of the result by gender revealed that for female respondents, there was significant correlation between their places of resident and physical domain score (r = 0.211), there was also significant correlation between their respondents ages (r = 0.187) and their places of resident (r = 0.286) with social relationship domain scores. In addition, there was statistically significant correlation between their places of resident with environment domain score (r = 0.306). For male respondents, there was significant correlation between their educational statuses with physical domain scores (r = 0.268); there was significant correlation between their place of residence (r = 0.188) and educational status (r = 0.184) with their social relationship domain scores; there was also statistically significant correlation between educational status of respondents with environment (r = 0.196) and overall QoL scores (r = 0.180) [Table 5].
Table 5: Correlation between domain scores and respondents age, educational status and place of residence

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Respondents' perception of their current illness was negatively correlated with physical (r = −0.483), psychological (r = −0.393), social relationship (r = −0.397), environment (r = −0.329), and overall QoL scores (r = −0.530) [Table 6].
Table 6: Correlation between domain scores and consideration of current illness, treatment status and duration of treatment

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Analysis by gender also showed that all the domain scores and the overall and general health score were significantly correlated with consideration of current illness [Table 7].
Table 7: Correlation between domain scores and consideration of current illness, treatment status, and duration of treatment by gender

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  Discussion Top


Most of our respondents were young women living with HIV-AIDS during their economically active years. This finding is similar to the previous studies.[9],[10] Some previous similar studies have reported males as the predominant respondents.[11],[12] The age of our respondents was also similar to that of previous studies.[11],[12] Most of the respondents had some formal education; this is similar to a previous study.[13] A better educated person may understand the disease better, leading to better-coping attitude, and interact with other people in a harmonious way, with higher education, the standard of living also improves.[14]

The overall mean physical domain score for the respondents was lower than that of a previous study which reported 72, psychological domain was also lower than that of same study which reported 67, the social relationship domain score was, however, higher than that reported by previous study 47 while environmental domain was also lower that 65 reported in the same study.[13] Overall, among the four domains assessed, the social relationship domain had the lowest score, this is consistent with the result of previous studies [12],[13],[15],[16] and it may be because PLWHA are usually affected by societal discrimination and stigmatization leading to some degree of isolation.[13],[16] Social domain also examines the sexual relation perception. HIV infection status largely alters the sexual desire mentally and socially. This may account for the low scores in the social domain.[14]

The high score observed in the physical domain score may be attributed to the free HIV care services being delivered at the center.

When the domain scores were analyzed by gender, it was observed that females had slighter higher scores for all domains as well as overall QoL compared with the males, although the difference was not statistically significant. Another previous study corroborated the finding that differences in domain scores by gender were not statistically significant.[12],[15] Some studies have reported males having slightly higher scores in physical,[16],[17] social,[11],[17] environment,[16],[17] and psychological domains,[12],[16] although the differences were also not statistically significant.[16],[17]

There was a statistically significant correlation between respondents' physical domain and their place of resident. Those living in urban areas were more likely to report higher physical domain score than those living in rural areas. Another study reported that respondents residing in rural areas had poorer HRQoL in the overall perception of QoL than those residing in urban areas hypothesizing that it may be due to fewer HIV support services in rural areas.[11] However, respondents' age, sex, and educational status were not significantly correlated with their physical domain scores.

Respondents' age, sex, educational status or place of resident was not significantly correlated with their psychological domain scores. Psychological domains assess influence of factors such as positive feeling, cognitive performance, self-esteem, body image, and negative feeling.

Respondents' social relationship domain score was significantly correlated with their age and place of residence. The older the respondents the more likely the respondents will have higher social score (P < 0.01), also, respondents living in urban areas were more likely to have higher social score than those living in rural areas (P < 0.01). Environment domain scores were significantly correlated with respondents' place of residence (P < 0.01) and educational status (P < 0.01). Those living in the urban areas and those with formal education were more likely to have a higher score for environment domain of the HRQoL.

The overall QoL and general health status of respondent were significantly correlated with their place of residence. Those living in the urban areas were more likely to have a higher overall QoL and general health compared with those living in rural areas. This is not surprising as PLWHA living in urban areas may have more access to support services and better-living conditions compare with their colleagues in rural areas. However, for female respondents, those living in urban areas had significantly higher physical domain scores compared with those living in rural areas. Older respondents had significantly higher social relationship domain scores; also respondents living in urban areas had significantly higher environmental domain scores. However, for male respondents, those with some formal education had significantly higher physical domain scores; respondents living in urban areas, as well as those with some formal education, had significantly higher social relationship domain scores.

All the domain scores and the overall and general health score were significantly correlated with consideration of current illness. Those who consider themselves not currently ill were more likely to have higher domain scores and overall and general health score. Duration on ART and whether the patient is currently on ART were not significantly correlated with all the domain scores and overall and general health score.

Although this is the first study that will be conducted to assess the HRQoL of patients assessing care in the study center since the inception of care at the site in 2007, the study has some limitations that should be acknowledged. It was a cross-sectional study, which does not allow drawing conclusion about the direction of relationship or causal relationship between outcome variables and independent variables. The respondents were one who was actively seeking routine medical care. Those who do not attend clinic regularly may not have been included; therefore, the result of study may not be generalizable to all of the HIV clients attending the health-care center. In addition, data on CD4 count of respondents were not obtained; correlation between CD4 and HRQoL, therefore, was not done.


  Conclusion Top


Generally, the mean QoL domain scores for the respondents were high (>50). Very low QoL scores were seen in the social domain, suggesting that more social interventions are required in this population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Bello SI, Bello IK. Quality of life of HIV/AIDS patients in a secondary health care facility, Ilorin, Nigeria. Proc (Bayl Univ Med Cent) 2013;26:116-9.  Back to cited text no. 13
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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