A Comparative Study on the Quality of Life of Leprosy Patients in Kilifi and Kwale Counties in Kenya

Abstract

Background:Kenya at present is in the post-elimination phase of leprosy having achieved a prevalence of <1 case per 10,000 persons in 1989. In 2019 Kenya notified 163 leprosy patients, highest being in Kilifi and Kwale counties. About a quarter (26%) of the notified leprosy patients had grade 2 disability at the time of diagnosis, this being the most severe form of disability that may indicate a late diagnosis. This study aimed at assessing the quality of life of leprosy patients to guide policies and programs intended to enhance the health and well-being of leprosy patients.
Materials and Methods:This was a case-control study conducted in Kilifi and Kwale Counties. For every leprosy index patient enrolled, two controls were identified within the same village to match the case. Descriptive statistics were used to summarise demographic and clinical variables. The World Health Organisation (WHOQOL-BREF) tool was used to measure the quality of life. The tool derived four (4) domains of physical health, psychological status, social relationship, and environmental profile. These were transformed into a scale between 0 to 100 for analysis. The F-test was used to compare mean scores in the four domains between cases and controls. The quality of life among the index cases against their controls was further analysed using conditional logistic regression models.
Results: A total of 98 leprosy patients and 167 controls were evaluated for quality of life. On the perception of quality of life, leprosy patients had significantly lower mean transformed scores of 39 (SD 25) versus 49 (SD 25) p= <0.0001 compared to controls. Similarly, index cases had lower health satisfaction scores of 42 (SD 26) compared to controls scoring 61(SD 27) p=<0.001. Overall leprosy patients had statistically significant poorer scores on physical health, psychological health, social relationships and environmental QoL domains. Differences were most remarkable in the psychological domain, with a mean transformed score of 53 (SD 20) versus 68 (SD 16) p= < 0.0001 for controls. The overall quality of life model revealed that leprosy patients who were found to have either diabetes or hypertension enjoyed a better overall quality of life with OR of 10.98 and 1.22 respectively with a p-value <0.00001. Patients with tuberculosis and HIV presented the poorest quality of life with ORs of 0.49 and 0.14 respectively.
Conclusion: The quality of life of the leprosy patients was significantly lower than that of the community controls in all the domains. Governments and communities need to prioritize rehabilitation measures such as the provision of artificial limbs, cataract surgery, and social protection disbursements to help leprosy victims improve their quality of life.