title: Impact of Chikungunya on health related quality of life Chennai, South India.
abstract: BACKGROUND
  Chikungunya Virus (CHIKV) infection affects large populations and leads to prolonged and debilitating pain affecting health related quality of life (HRQoL). We assess the impact of CHIKV on HRQoL of clinical CHIKV (C-CHIKV) patients in a suburban locality of Chennai City, South India. Further, we determined factors associated with clinical recovery among C-CHIKV patients.
  
  
  METHODS
  We followed-up 403 of 425 adult C-CHIKV cases identified during an outbreak. On the basis of a reassessment of their current clinical status through self-reporting, we categorized them as 'clinically recovered' (n = 308) or 'not recovered' (n = 95). In the absence of base-line information on HRQoL, we included a comparison group of healthy normal's recruited by frequency matching for age and sex from the neighbourhood (n = 308). We conducted a comparative cross-sectional study of these three groups and estimated HRQoL scores using SF-36 questionnaire. We tested the differences in the median scores by Kruksall Wallistest. We identified factors associated with 'recovery' as compared to not-recovery by calculating Adjusted Odds Ratio (AOR) and 95% Confidence Intervals through multiple regression analysis.
  
  
  RESULTS
  As compared to 'normals', we observed a 20 and five-fold reductions in HRQoL scores for C-CHIKV patients 'not recovered' and 'recovered' respectively. Differences in HRQoL scores for all the domains were statistically significant between three groups (p<0·001). Younger age, male, absence of rashes, affliction of less than five types of joints and two weeks of joint swelling were significantly associated with recovery. HRQoL scores improved with time among those 'clinically recovered'.
  
  
  CONCLUSIONS
  This study provides evidence for sharp reductions in quality of life not only during active C-CHIKV associated illness but also for several months after clinical recovery compared to healthy normals. This has implications for developing intervention programmes in countries with high risk of CHIKV outbreaks.
authors.affiliation: Training Division, National Institute of Epidemiology, Indian Council of Medical Research, Chennai, Tamil Nadu, India. doctorvidya@gmail.com
authors.forename: Vidya
authors.initials: V
authors.lastname: Ramachandran
authors.forename: Muniyandi
authors.initials: M
authors.lastname: Malaisamy
authors.forename: Manickam
authors.initials: M
authors.lastname: Ponnaiah
authors.forename: Kanagasabai
authors.initials: K
authors.lastname: Kaliaperuaml
authors.forename: Selvaraj
authors.initials: S
authors.lastname: Vadivoo
authors.forename: Mohan Digambar
authors.initials: MD
authors.lastname: Gupte
mesh_terms: D000293:Adolescent; D000328:Adult; D018354:Alphavirus Infections / Q000191:economics / Q000453:epidemiology* / Q000821:virology*; D065632:Chikungunya Fever; D002646:Chikungunya virus / Q000502:physiology*; D002648:Child; D003710:Demography; D004196:Disease Outbreaks; D005260:Female; D005500:Follow-Up Studies; D006262:Health; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D011788:Quality of Life; D055815:Young Adult