Determinants of health-related quality of life in drug-susceptible tuberculosis patients in Ghana: a prospective observational study.

Abstract

Background: Tuberculosis (TB) affects patients' quality of life due to symptoms and social stigma, especially in low-income settings like Ghana. However, data on factors influencing health-related quality of life (HRQOL) in such environments are limited. Identifying these factors is essential for improving treatment outcomes through holistic care.

Objective: This study determined the impact of sociodemographic and clinical factors on HRQOL at treatment initiation, and monitored changes until the end of treatment.

Design: Prospective observational study.

Methods: A cohort of 378 newly diagnosed patients with drug-susceptible TB (mean age: 45.3 ± 15.1 years) was followed across eight hospitals in the Ashanti and Eastern regions of Ghana. Patients received first-line antitubercular treatment, and HRQOL was assessed at baseline, month 2, and month 6 using an interviewer-administered SF-12v2 questionnaire. Associations between HRQOL and sociodemographic or clinical factors were examined using Chi-square or Fisher's exact tests, while logistic regression was used to estimate crude and adjusted odds ratios (p < 0.05).

Results: At baseline, 78.8% of participants had impaired physical HRQOL, and 25.7% were at risk of depression. At treatment completion, physical HRQOL impairment remained high (59.5%), with 15.0% still at risk of depression. Only 44.7% showed clinically significant improvement in physical HRQOL, while 39.8% improved in mental HRQOL. Employment, HIV-positive status, and alcohol use were associated with poorer mental HRQOL. Extrapulmonary TB patients demonstrated better physical HRQOL at both the beginning and end of treatment but exhibited poorer mental HRQOL at treatment completion. Widowed participants improved mentally despite poorer baseline health, while married individuals had better physical HRQOL. Higher education correlated with better baseline mental health but lower odds of significant HRQOL improvement.

Conclusion: Sociodemographic and clinical factors significantly influenced HRQOL in drug-susceptible TB patients after 6 months of treatment. These findings underscore the importance of targeted mental health support during and after treatment to improve patient well-being.