Article Text
PDF
Abstract
Objective This study aimed to assess the impairment of health-related quality of life (HRQoL) and its determinants among patients diagnosed with podoconiosis in East Wollega Zone, Oromia Regional State, Ethiopia.
Methods An institutional-based cross-sectional study design was used in the setting of primary healthcare facilities to assess impaired HRQoL among patients with podoconiosis in the East Wollega Zone from 1 March 2023 to 30 April 2023, using the Dermatologic Life Quality Index (DLQI). Data was collected from 494 patients with podoconiosis, and a multistage sampling technique was employed. The data was entered into EpiData V.4.6 and exported to SPSS V.27 for analysis. A linear regression model with a 95% cofidence interval (CI) was used to estimate level of HRQoL and to identify its determinants estimating beta (β) coefficient declaring the significance level at p<0.05.
Results The quality of life among patients was impaired on average by 9.6±6.1 with the lowest DLQI Score in the domain of treatment (0.8±0.97) and the highest in the domain of daily activity (2.3±1.72). The identified significant determinants of impairment of HRQoL associated with DLQI scores were duration of disease (95% CI, β=0.11 (0.08 to 0.15)), acute dermato-lymphangio-adenitis (ADLA) (95% CI, β=0.08 (0.01 to 0.16)), comorbidity (95% CI, β=1.26 (0.37 to 2.16)), consistently wearing shoes (95% CI, β=−0.06 (–0.09 to –0.03)), feeling of stigmatised (95% CI, β=0.21 (0.16 to 0.25)) and psychological distress (95% CI, β=0.17 (0.14 to 0.21)) and being female (95% CI, β=1.16 (0.19 to 2.12)).
Conclusion Overall, HRQoL among patients with podoconiosis was moderately impaired. The duration of disease, ADLA, comorbidity, stigma, psychological distress and being female in sex significantly impaired HRQoL, whereas consistently wearing shoes significantly improved HRQoL among the patients with podoconiosis. Therefore, healthcare providers and public health experts should work on educating communities and counselling patients to avoid stigma and psychological distress, wearing shoes consistently and treating podoconiosis and other comorbidities among these patients.
- Quality of Life
- Adult dermatology
- Tropical medicine
- Neglected Diseases
- Patient Reported Outcome Measures
Data availability statement
The datasets used and/or analysed during this study are available from the corresponding author on reasonable request.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
- Quality of Life
- Adult dermatology
- Tropical medicine
- Neglected Diseases
- Patient Reported Outcome Measures
Strengths and limitations of this study
The current study used the validated Dermatologic Life Quality Index instrument, which was specifically designed to measure the health-related quality of life (HRQoL) among adult patients suffering from various dermatological conditions such as podoconiosis. As a result, the study accurately assessed the HRQoL among the patients.
The study focused on only a single geographic location, the East Wollega Zone; the findings may not be generalised to the whole population of the country, Ethiopia, or beyond.
The cross-sectional study design is challenging to draw a cause-and-effect relationship, and social desirability might have led to an underestimation of the study’s findings.
Introduction
Podoconiosis is a lymphatic disease that someone acquires through prolonged exposure of the bare foot to red clay and soils of volcanic origin, based on the current evidence, though the pathogenesis is not fully understood. In 1976, Price did extensive work on podoconiosis, which led him to identify that the cause of endemic non-filarial lymphedema was red clay soil.1–3 It is among the neglected tropical diseases (NTDs) and manifests as bilaterally asymmetric swelling of the lower legs with mossy and nodular changes to the skin, resulting in considerable disability.4 5
Based on the current evidence, mineral particles from irritant volcanic soils have some roles, and some families have additional genetic susceptibility to the condition. A genetic study identified the association between human leucocyte antigen class II types, suggesting podoconiosis is a T-cell-mediated inflammatory disease. However, with simple treatment, the condition is reversible at earlier stages.3 6–8
Quality of life is defined as how well a person functions in his or her life and his or her perceived well-being in physical, mental and social domains of health. The values assigned to different health states have gained considerable importance in recent years, especially in countries with the highest burden of podoconiosis.8 9
Worldwide, much has been done to assess health-related quality of life (HRQoL) among skin NTDs. These groups of diseases have similar effects on the quality of life of patients. Understanding the different dimensions of HRQoL that affect people with podoconiosis and factors that affect it will help health professionals go beyond addressing the clinical presentations to taking care of the psychological and social well-being of the infected persons.10 11
Furthermore, podoconiosis is a severely debilitating and disfiguring disease that impedes the socioeconomic and psychological well-being of infected persons, especially in areas of high endemicity, which includes the current study country, Ethiopia.12 13 One in six of the global patients with podoconiosis is found in Ethiopia, and the disease affects the socioeconomic status of the patients, poses stigma and discrimination to the patients and affects their mental health, which in turn affects their quality of life.5 14–19
Some previous studies have assessed the HRQoL among patients with podoconiosis in Ethiopia indicating that the disease significantly decreases quality of life among the patients.11 12 However, some factors like podoconiosis stages, duration of the disease and acute dermato-lymphangio-adenitis (ADLA) were not considered in the studies, and the current study used the standardised and validated Dermatologic Life Quality Index (DLQI) Questionnaire. The factors that were included in the current study and that might impair HRQoL in patients with podoconiosis were shown in the conceptual framework (figure 1). In addition, these previous studies recommended further study to include these missed factors. Despite East Wollega being one of the areas in which podoconiosis was endemic in Ethiopia, the impact of the disease on HRQoL was not well studied. Hence, the current study aimed to assess impaired HRQoL and its determinants among patients with podoconiosis in East Wollega Zone, Oromia Regional State, Ethiopia.
Conceptual framework to assess health-related quality of life (HRQoL) among patients with podoconiosis, 2023. ADLA, acute dermato-lymphangio-adenitis.
Methods and materials
Study setting
This study was carried out in the East Wollega Zone, Oromia Regional State, Ethiopia. The capital town of the zone, Nekemte, is located 328 km from Addis Ababa, the capital of the country. The zone was 1 of the 21 administrative zones of the Oromia Regional State and stretched from 9°5′ N to 36°33′ E. The total population of the zone was estimated to be 1 702 584 as forecasted by the 2007 census. Administratively, the zone had 17 districts and 1 city administration, Nekemte. It had 2 referral hospitals, 1 general hospital, 2 primary hospitals and 64 health centres.
According to the Soil Research Institute of the zone, the altitude of the zone ranges from 1740 to 2900 m above sea level, and it gains annual rainfall between 1000 and 15 000 mm3. The soil structure in the zone is mostly red clay soil, covering one-third of the total land.
Study design and period
A facility-based cross-sectional study was conducted from 1 March 2023 to 30 April 2023.
Population
All patients with podoconiosis who visited health facilities in East Wollega Zone during the data collection period were considered as the source population, whereas all patients in the selected seven districts included in the sample and interview during the data collection period were considered as the study population.
Eligibility criteria
Patients with podoconiosis aged more than 16 years (prevalence of podoconiosis is very low in those under 16 years, and DLQI was also developed for those aged ≥16 years) were included in the study, and patients with severe illness, who were severely sick when they visited study healthcare facilities, who were unable to provide adequate and quality responses and deaf, who were unable to hear the interview and to respond to it, who were unable to provide adequate and quality responses and patients aged <18 years in case there was no caregiver with them to give consent were excluded from the study.
Sample size determination and sampling technique
Single population mean was used to calculate the sample size.20 The sample size was calculated based on the findings of the previous study, which assessed HRQoL among patients diagnosed with podoconiosis in the Wolaita Zone of Ethiopia15 using the assumptions: 95% CI, σ=5.58 and margin of error (d)=0.87 (calculated from previous study using the formula: d=(Zα/2×σ)/√n), design effect (D)=3, α=0.05 and 10% non-response rate). Finally, the required sample size was determined using the formula: 
, 
.
According to the East Wollega Zonal Health Department report of 2022, the total number of cases of podoconiosis in the zone was estimated to be 18 054.
7 out of 17 districts in the zone were selected first using simple random sampling. Then, out of the 26 healthcare facilities which were the treatment centres in the 7 selected districts, 16 of them were randomly selected. Using systematic random sampling, the eligible participants were selected according to their proportional allocation to each treatment centres and at the selected study health facilities, every ‘Kth’ interval was used to select the final study unit based on case load and patient flow for follow-up and new enrolment (figure 2).
Sampling technique to assess health-related quality of life among patients diagnosed with podoconiosis in East Wollega Zone, Oromia Regional State, Ethiopia, 2023. (A) At zonal level, 7 districts out of 17 districts were selected using simple random sampling. (B) At district level, 15 treatment centres (health centres) were selected using simple random sampling. (C) At treatment centres (study health centres), study participants were selected using systematic random sampling.
Study variables and measurements
Dependent variable
HRQoL Score was measured as a dependent variable using DLQI. The DLQI was originally developed for reverse-order responses. The 10 questions of the DLQI are negative questions regarding quality of life. The responses to each question were: 3=very, 2=a lot, 1=a little and 0=not at all, indicating that the highest value of DLQI was the poor quality of life the patients experienced. Based on the DLQI scores, the effect of living with podoconiosis disease on the health of patients was categorised into no effect on health (0–1), small effect on health (2–5), moderate effect on health (6–10), very large effect on health (11–20) and extremely large effect on health (21–30).21
Independent variables
The independent variables were socioeconomic and demographic factors (age, sex, religion, ethnicity, place of residence, occupation, marital status, households’ annual income and educational status), clinical-related factors (comorbidities, ADLA, presence of moss, presence of wounds, presence of nodules, stage of the disease, foot care and a history of leg swelling in the family), physical and behavioural-related factors (activities, consistently wearing shoes, frequency of foot washing and accessibility of healthcare) and psychosocial-related factors (psychological distress and stigma).
Operational definitions
Case of podoconiosis: Patients with clinically diagnosed bilateral lymphedema of the lower limbs among resident for more than 1 year in podoconiosis endemic area of the East Wollega Zone.
Psychological distress: A state of emotional suffering among patients with podoconiosis is associated with stressors and demands that are difficult to cope with in daily life, as measured using the Kessler Psychological Distress Scale (K10) in this study. The K10 Score was categorised based on severity of the disease: no disorder (10–19), mild disorder (20–24), moderate disorder (25–29) and severe disorder (30–50).22 23
Stigma: Negative attitude or discrimination against patients with podoconiosis. A stigma scale was used to measure the level of stigma. Stigma was categorised into two categories: felt and enacted. The stigma scale has 32 items, with a minimum score of 0 and a maximum score of 96. Felt stigma is an internal or self-stigmatisation in which people feel shame and refrain from seeking help and care. It is measured based on 15 items on the stigma scale. The score ranges from 0 to 45, and enacted stigma is external stigma in which people experience and feel they are unfairly treated by others. It is measured based on 17 items on the stigma scale. The score ranges from 0 to 51.24
Mossy lesions: Papillomatous horny lesions giving the skin a rough appearance as identified by observation.
Acute dermato-lymphangio-adenitis: The sudden onset of fever, localised pain, warmth and swelling in the axilla and groins, with or without swelling or redness in the limb or other affected parts of the body. It was measured as patients recall the episodes in the last month.
Mossy foot: Massive swelling of the feet and legs. It was recorded by the data collector during observation.
Nodules: A growth of abnormal tissue that may develop just below the skin and have a lump of at least 1 cm in size. It was recorded during data collection using observation.
Wound: Any open break in the skin of the legs and feet, as recorded by the data collectors.
Data collection tools and procedure
In this study, HRQoL was assessed using the validated DLQI Scale.25 Originally, DLQI was divided into six sections: symptoms and feelings, daily activities, leisure, work and school, personal relationships and treatment. The data collectors explained the aim of the study using an information sheet and obtained informed written consents from the study participants. The K10 Psychological Distress Scale was used to measure psychological distress among the populations. A stigma scale was also used to measure stigma among the participants. An observation checklist was also used to identify physically observable signs of podoconiosis. Seven health professionals who were previously trained and who were working on lymphedema morbidity management at health centres were recruited for data collection, and the seven district NTD focal persons supervised the overall data collection.
Four of the data collectors were experienced BSc public health officers and three were experienced BSc nurses. All the data collectors were working in the clinical management of lymphedema, and they had previously received training and certification on the topic. The investigators, collaborating with zonal health department NTD experts, provided 2 days of training to the data collectors and supervisors on the overview of podoconiosis and the different tools and questionnaires. In addition, colour prints of stages of the disease, mosses and nodules were distributed during the training and for further use in the data collection. To ensure the quality of data collection and minimise bias, all the supervisors and data collectors were assigned to different districts other than their working healthcare facilities.
Data quality assurance and analysis
The DLQI Questionnaire was validated to measure HRQoL among patients with podoconiosis in Ethiopia.15 and the tool was translated into Afan Oromo and pretested among 5% (n=16) of the sample size before actual use. The translation was performed by four experienced language experts (two independent translations from the original language, two independent retranslations and one harmonised translation). Data collectors were trained and involved in the pretest. They were trained how to stage podoconiosis, how to identify moss, wounds and nodules, measure the largest leg circumference and identify the presence of comorbidity. They also identified whether the respondent has been enrolled in a podoconiosis-specific treatment programme.
The collected questionnaires were reviewed and checked daily for completeness and consistency by the supervisors and investigators. The necessary feedback was offered to data collectors daily. Data were entered into EpiData software V.4.6, exported into SPSS V.27 and analysed. Data quality was ensured during data entry, coding and cleaning, and the internal consistency of the tool was checked using Cronbach’s alpha, which was 0.80. The multicollinearity was checked using variance inflation factor (VIF), which was 1.3, and the Q–Q plot (figure 3) showed a normal distribution of the DLQI Score.
Q–Q plot for Dermatologic Life Quality Index (DLQI) among patients diagnosed with podoconiosis in East Wollega, Oromia Regional State, Ethiopia, 2023.
In addition, the model fitness was checked in the final model summary, which showed an R2 of 0.667, indicating that 66.7% of the impairment of HRQoL life among patients diagnosed with podoconiosis was explained by the predictor variables that were identified in the current study (p value<0.001).
Each item of the DLQI was scored on a linear scale. The DLQI Score for each respondent was the sum of the responses to the 10 questions. If one question was unanswered, it was scored 0, and the scores were summed up and expressed out of a maximum of 30. If two or more questions were unanswered, the questionnaire was not scored. The DLQI was calculated by summing the score of each question, resulting in a minimum of 0 and a maximum of 30. During analysis, the independent variables were analysed against the DLQI Score, and then HRQoL was inferred from the score of the DLQI. The higher the score, the more the quality of life is impaired.26
In descriptive analysis; frequency, percentage, mean, SD and median were performed for each variable as a socioeconomic and demographic variable, and clinical-related factors, psychological distress and stigma score were tested. The unstandardised beta (β) coefficient was used to examine the association between participants’ characteristics and overall DLQI scores. In simple linear regression, the β coefficient was calculated, and those variables with a p value≤0.20 were used for multivariate linear regression. The statistical significance level was declared at a p value˂0.05 in the final model, multivariate linear regression.
Patient and public involvement
Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Results
Socioeconomic and demographic characteristics
A total of 494 participants, representing a 94.6% response rate, participated in the study, out of which seven questionnaires were incomplete in at least two items of the DLQI and not included in data entry for further analyses, and the data collected from 487 participants was analysed and reported in this study.
The mean age of the respondents was 50.1±20.7 years. 283 (58.1%) were males, 314 (64.5%) were from male-headed households and 311 (63.9%) were from rural areas. Regarding the occupation status of the respondents, 284 (58%) were farmers and 77 (16%) were daily labourers. The average annual income of the respondents was US$802.10±633.94. Only 168 (34.5%) of the participants attended elementary school, 64 (13.1%) attended secondary education and 55 (11.3%) completed some college or university education (table 1).
Sociodemographic characteristics among patients with podoconiosis in East Wollega Zone, Oromia Regional State, Ethiopia, 2023
Clinical and psychosocial characteristics
More than half of the participants, 255 (52.4%), sought treatment for their condition in their lifetime, which means they sought treatment by visiting the treatment centres at least two times during the study period, whereas the rest were newly enrolled and sought treatment by visiting the treatment centre for the first time during the study period. More than two-thirds of the respondents, 327 (67.1%), had comorbidity. The average ADLA in the month prior to the data collection was 6.9±5.9 episodes. On average, the respondents stayed with the condition for 14.4±12.8 years. The stages of the podoconiosis conditions from which the patients were suffering were also assessed (table 2).
The stages of the podoconiosis conditions among patients in East Wollega Zone, Oromia Regional State, Ethiopia, 2023
More than half of the patients, 282 (57.9%), were enrolled in the follow-up treatment. Regarding the activities of the patients; 129 (26.5%), 216 (44.4%) and 142 (29.2%) patients were unable to perform any activities (inactive), were able to perform daily activities sometimes and were able to perform daily activities all the time, respectively. More than half of the patients, 300 (61.6%), were supported by their families, and about one-third of the patients, 139 (28.3%), were drug dependent for their daily lives. The average number of days in the last month in which the patients could not perform any activities was 7.2±6.1.
The mean K10 Score of the respondents was 29.2±10.6. The lower score was in felt nervous, and the highest score was in felt worthless. The minimum and maximum K10 scores were 10 and 50, respectively. The psychological distress was classified into four categories: 108 (22.2%) no distress (well), 71 (14.6%) mild distress, 68 (14%) moderate distress and 240 (49.5%) severe distress.
Both felt and enacted stigmas were calculated independently, and their sum was used to calculate the total stigma score. The mean scores of felt stigma and enacted stigma were 19.3±5.7 and 18.5±7.3, respectively. In this study, the minimum and maximum stigma scores were 15 and 82, respectively. The sum of the felt and enacted stigma scores was the total stigma score. The mean score of stigma was 37.8±10.1.
DLQI scores
The total DLQI Score was calculated by adding each item of the DLQI. The minimum and maximum DLQI scores in this study were 0 and 27, respectively. The mean DLQI Score was 9.6±6.1. The highest score was found in daily activities, and the lowest score was found in the treatment dimension (table 3). The level of the effects of podoconiosis on the health of the patients was measured in terms of DLQI over all scores. Accordingly, among 12 (2.5%) patients there was no effect on health, among 144 (29.6%) patients there was a small effect on health, among 112 (23%) patients there was a moderate effect on health, among 195 (40%) patients there was a very large effect on health and among 24 (4.9%) patients there was an extremely large effect on health. Across the sex difference, in univariate analysis (independent t-test), the mean score of DLQI was significantly higher among female patients compared with male patients which was 2.40, 95% CI=1.32 to 3.49, p≤0.001.
DLQI item scores patients with podoconiosis in East Wollega Zone, Oromia Regional State, Ethiopia, 2023
Determinants of impairment of HRQoL
The study identified the determinants of impairment of HRQoL among patients diagnosed with podoconiosis. Accordingly, after performing all necessary descriptive statistics, bivariate analysis was performed to identify individual variables as candidates for multivariate analysis. 14 variables with p˂0.20 were transferred to multivariate linear regression analysis (table 4).
Determinants of impaired of HRQoL in terms of DLQI among patients with podoconiosis in East Wollega Zone, Oromia Regional State, Ethiopia, 2023
The study showed that being female and having a female-headed household increased the total score of DLQI by 1.16, 95% CI of β=0.19 to 2.12 and by 1.56, 95% CI of β=0.63 to 2.55, respectively. In addition, an increase in 1 year of duration of disease significantly increases the score DLQI by 0.11, 95% CI of β=0.08 to 0.15.
The frequency of ADLA was also significantly associated with DLQI Score. An increase in one episode of ADLA per month significantly resulted in increasement of the DLQI Score by 0.08 95% CI of β=0.01 to 0.16. Among the patients who had comorbidities, the DLQI Score was increased by 1.26, 95% CI of β=0.37 to 2.16, compared with patients with podoconiosis who had no comorbidities.
The stigma among patients with podoconiosis was the factor that significantly impaired HRQoL. As a result, an increase in one unit of stigma increased DLQI by 0.21, 95% CI of β=0.17 to 0.25, and an increase in one unit of psychological distress increased DLQI by 0.17, 95% CI of β=0.14 to 0.21). The duration of consistently wearing shoes was the significant factor that improved HRQoL by 0.06, which indicated that as the duration of consistently wearing of shoes increased by 1 year, the DLQI Score decreased by 0.06, 95% CI of β=−0.09 to –0.03.
Discussion
The current study showed that podoconiosis had significantly impaired the HRQoL and identified the significant determinants of the impairment of quality of life among the patients. Accordingly, the overall HRQoL was moderately impaired among the study participants compared with other study findings. The daily activities domain of quality life was highly impaired, while the domains of work and school, personal relationships and treatment were less impaired. In the current study, the level of impairment of quality of life was lower when compared with studies conducted in southern Ethiopia.15 26 This discrepancy might be due to the difference in the socioeconomic status of the patients, the accessibility and availability of diagnosis and treatment, the year of study and the cultural differences across different regions.
The study found that almost all individuals with podoconiosis had impaired HRQoL because of the disease. Of all the patients, one-third had a small effect on their quality of life due to the disease, while one-fourth and one-fifth had moderate to major effects, respectively. Merely 5% of the patients experienced a significantly negative impact on their quality of life due to podoconiosis. This result is in line with the study conducted in Ethiopia, which showed podoconiosis negatively affected the quality of life in the majority of patients diagnosed with the disease.26
The quality of life was significantly impaired among the patients who lived with the disease for long years compared with the patients who lived with the disease for a shorter duration. In addition, as the duration of living with the disease increased, the patients also felt more stigma due to the diseases in society, which resulted in a significant impairment of quality of life. Similarly, the studies conducted in Ethiopia showed that the duration of living with podoconiosis and the stigma score among the patients significantly impaired their quality of life.27–30
In this study, regular follow-up and care at health facilities were not found to be significantly associated with HRQoL among patients, as it was shown in different studies where patients were enrolled in treatment and followed up.15 27 This difference may be due to the recent implementation of lymphedema morbidity management. In addition, the quality of the healthcare provided could be poor due to the lack of attention paid to the care provided by healthcare providers. Other studies also revealed poor knowledge and an unfavourable attitude of health workers towards patients with podoconiosis negatively affect HRQoL.28 31
The ADLA rate was high among the patients with podoconiosis, and almost half of the patients visited the treatment centres for the first time. This indicated that these patients had not received treatments in the past. Only two-thirds of the patients were enrolled in lymphedema morbidity management. The more frequently the patient had ADLA, the more likely the patient was to develop complications and a reduction in HRQoL. An increase in one episode of ADLA significantly resulted in impairment of HRQoL. Similar findings were reported by other studies, which indicated that individuals with podoconiosis who had a high rate of ADLA also had lower HRQoL.29 31 32
The quality-of-life score decreased significantly when comorbidity was present. Hence, compared with individuals who were suffering from podoconiosis as the only health problem, patients who complained of other health-related problems in addition to their podoconiosis had a significantly impaired HRQoL. Similarly, the study conducted in Northern Ethiopia revealed that patients with podoconiosis who were also diagnosed with other medical conditions had a lower quality of life compared with those whose only medical problem was podoconiosis.27
The current study revealed that there was a significant difference in HRQoL scores between males and females indicating that female patients with podoconiosis had a significantly lower HRQoL compared with male patients. This result agrees with other studies conducted in Ethiopia and other countries24 26 30 33 and the study conducted in Lahore and Central Saudi Arabia showed that significant differences were observed in HRQoL across sex differences.34 35 This difference could be due to the fact that the majority of the female patients were not enrolled in regular treatment; only two-fifths were enrolled, whereas three-fifths of the male patients were enrolled in regular treatment, and the majority of the female patients did not wear shoes consistently.
Among the patients with podoconiosis, the study additionally estimated an association between wearing shoes and HRQoL. Similarly, patients’ HRQoL was much better when they wore shoes more often than when they did not. Similarly, the study conducted in Ethiopia showed that patients who reported that they wore shoes most of the day for many years after their condition started had higher scores in their quality of life.15 32 36
Furthermore, the study revealed that psychological distress and stigma were significant variables that contributed to an impairment of quality of life experienced by individuals with podoconiosis. Accordingly, HRQoL was significantly impaired in the podoconiosis patients with high psychological distress scores, and patients who had higher stigma total scores exhibited a poorer quality of life. Similarly, other studies showed that an increase in both psychological distress and stigma scores resulted in an impairment of HRQoL in patients with podoconiosis.11 13 37
The current study accurately assessed the HRQoL using the valiadated dermatologic life quality index instrument, wich was specifically designed to measure health-related quality of life among adult patients suffering from various dermatological conditions such as podoconiosis. However, the study focused on a single geographic location, East Wollega zone, so the findings may not be generalized to whole population of the country or beyond. Additionally, due to the very nature of the used cross-sectional study design, it is diffuct to enfer the cause-effect relationship and social desirability might have led to an underestimation of the study findings.
Conclusions
Overall, the quality of life among patients with podoconiosis was moderately impaired. In the domains of quality of life, daily activities were highly impaired, whereas work and school, personal relationships and treatment were less impaired. The duration of disease, ADLA, presence of comorbidity, stigma, psychological distress and being female patients were the significant determinants of the impairment of HRQoL, whereas consistently wearing shoes significantly improved HRQoL among the patents diagnosed with podoconiosis. Therefore, healthcare providers and public health experts should work on educating the communities and counselling the patients to avoid stigmatisation and psychological distress, consistently wearing shoes and treat the podoconiosis and other comorbidities among these patients.
Supplemental material
Data availability statement
The datasets used and/or analysed during this study are available from the corresponding author on reasonable request.
Ethics statements
Patient consent for publication
Ethics approval
Ethical clearance was obtained from the research ethics review committee of Wallaga University with reference number WU/RD/636. Information sheets and consent forms were used where the respondents were literate; otherwise, the purpose of the study was explained orally, in the style of a conversation rather than reading out an information sheet, and they gave their informed written consent verbally and then signed with their fingerprint in front of a witness as confirmation. In addition to consent, assent was asked from parents for those aged ˂18 years after explaining the purpose of the study. The participants were informed that they had the right not to participate at all, to withdraw at any time from participating in the study or to skip any question they do not want to answer. The names of the respondents were not written on the questionnaire. The data was kept secure in a locked drawer.
Acknowledgments
The authors would like to thank Wollega University, East Wollega Zonal Health Department, district health offices, the health centres and participants.
References
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Contributors ETG contributed to data analysis, interpretation, report writing and manuscript preparation and acting as guarantor and corresponding author. TOG contributed to data collection and supervision, analysis and report writing. GT contributed to developing the data collection tools and analysis. The study concept and design were developed by all authors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.