title: Does health-related quality of life among adults with pulmonary tuberculosis improve across the treatment period? A hospital-based cross sectional study in Mbale Region, Eastern Uganda.
abstract: BACKGROUND
  Most tuberculosis (TB) case management guidelines emphasize microbiological cure as treatment goal without highlighting quality of life outcomes. This study assessed health-related quality of life (HRQoL) and related factors in the pre-treatment, intensive and continuation phases of anti-TB therapy among sputum smear positive pulmonary TB patients in Mbale region, Eastern Uganda.
  
  
  METHODS
  In this cross-sectional study, questionnaires and 36-Item Short-Form Health Survey Version 2.0 (UK English SF36v2) forms were administered to 210 participants of whom 64.8 % were males. The mean age was 35.48 ± 12.21 years. For each of the three treatment phases, different patients were studied. Responses were translated into the standard 00-100 scale. Means and standard deviations were used to express HRQoL as physical composite scores (PCS) and mental composite scores (MCS). Analysis of variance was used to compare scores across phases. Multiple linear regression methods were used to model relationships between predictor variables and HRQoL for each treatment phase.
  
  
  RESULTS
  HRQoL scores were different across treatment phases. General health (38.8 ± 17.5) and mental health (52.7 ± 18.6) had the lowest and highest sub-scale scores respectively. Mean PCS scores in pretreatment, intensive and continuation phases were 29.9 ± 19.4, 41.9 ± 14.2 and 62.2 ± 18.8 respectively. Mean MCS scores in the pretreatment, intensive and continuation phases were 38.8 ± 18.3, 49.4 ± 13.1 and 60.6 ± 18.8 respectively. Prior to treatment initiation, having an informal occupation (β = -28.66 (<0.001) was associated with poor HRQoL. Being unmarried (β = 11.94, p = 0.028) and belonging to the highest tertile of socioeconomic status (SES) (β = 14.56, p = 0.007) were associated with good HRQoL in the intensive phase. In the continuation phase, SES (β = 10.83, p = 0.021 for MCS and β = 13.14, p = 0.004 for PCS) predicted good HRQoL. Older age (β = -0.43 p = 0.013 for PCS and β = -0.36 p = 0.040 for MCS) was associated with poor HRQoL.
  
  
  CONCLUSIONS
  TB treatment improved patients' perceived health and having means of income was particularly associated with high HRQoL. Strategies to strengthen treatment support that include income generation and specific close monitoring of older patients may help improve overall TB treatment experience, by sustaining acceptable levels of physical, social and emotional functioning.
authors.affiliation: Department of Epidemiology and Biostatistics, Makerere University School of Public Health, P.O.BOX 7072, Kampala, Uganda. bmks@dr.com.|College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda. bmks@dr.com.
authors.forename: Stevens M B
authors.initials: SM
authors.lastname: Kisaka
authors.affiliation: Department of Health Policy, Planning and ManagementMakerere University School of Public Health, Kampala, Uganda.
authors.forename: Elizeus
authors.initials: E
authors.lastname: Rutebemberwa
authors.affiliation: Department of Epidemiology and Biostatistics, Makerere University School of Public Health, P.O.BOX 7072, Kampala, Uganda.
authors.forename: Simon
authors.initials: S
authors.lastname: Kasasa
authors.affiliation: Department of Epidemiology and Biostatistics, Makerere University School of Public Health, P.O.BOX 7072, Kampala, Uganda.
authors.forename: Francis
authors.initials: F
authors.lastname: Ocen
authors.affiliation: Department of Epidemiology and Biostatistics, Makerere University School of Public Health, P.O.BOX 7072, Kampala, Uganda.
authors.forename: Joan
authors.initials: J
authors.lastname: Nankya-Mutyoba
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology* / Q000523:psychology; D014454:Uganda; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Health-related quality of life; SF-36v2 health survey form; Smear-positive pulmonary tuberculosis; Tuberculosis; Uganda