WHAT
This prospective cohort study examined changes in health-related quality of life (HRQOL) among patients with pulmonary tuberculosis (PTB) during six months of standard treatment in Lagos State, Nigeria. A total of 210 newly diagnosed PTB patients aged 15–70 years were recruited, with 194 (92.4%) completing the six-month follow-up. Most participants were male (63.3%), under 45 years of age (79.1%), and had low income, with 81.9% earning ≤45,000 Naira monthly. Nearly half (44.7%) were unemployed, and 10% reported losing employment due to illness, highlighting the socioeconomic burden associated with TB.
Clinical symptoms at baseline were common and included cough (80.5%), anorexia (68.6%), weight loss, breathlessness, fever, and chest pain. These symptoms progressively improved during treatment, although approximately one in five participants still reported cough at six months. About 80.5% of patients had bacteriologically confirmed PTB, and roughly one-fifth were HIV-positive. Nutritional status also improved over time, with underweight prevalence decreasing from 27.6% at baseline to 12.7% at six months.
Across the six-month treatment period, HRQOL scores improved significantly in all four WHOQOL-BREF domains: physical, psychological, social, and environmental. At baseline, the lowest score was observed in the environmental domain (45.27 ± 14.59), while the social domain had the highest score (50.98 ± 17.37), which remained the highest at treatment completion. Repeated-measures ANOVA demonstrated statistically significant improvements across all domains, with partial eta squared values ranging from 0.178 to 0.295, indicating moderate to large effect sizes.
The most substantial improvements in HRQOL occurred during the first two months of treatment, particularly in overall satisfaction with health, physical health, and psychological domains. Improvements between months two and six were smaller, suggesting that the intensive treatment phase contributed most to quality-of-life gains. Notably, although social domain scores were consistently highest, they showed the smallest magnitude of improvement across the treatment period.
General satisfaction with health improved substantially during treatment, increasing from 13.5% at baseline to 55.7% at six months. Effect size analysis showed large improvements between baseline and six-month measurements across most domains, while changes between the second and sixth months were smaller. A statistically significant linear trend across time points indicated steady improvement in HRQOL during treatment.
Multivariable analysis identified key factors influencing HRQOL improvement. Employment status was positively associated with better HRQOL across all domains. Persistent symptoms were negatively associated with quality of life, while improvement in body mass index (BMI) was linked to better physical, psychological, and social outcomes. Delayed presentation negatively affected social domain scores but showed a positive association with environmental domain changes. Overall, clinical recovery, improved nutrition, and socioeconomic stability were important determinants of HRQOL improvement.
HOW
This study used a prospective cohort design conducted in publicly owned TB-DOTS centers across Lagos State, Nigeria, to ensure consistent treatment guidelines and facility characteristics. Participants were recruited immediately after diagnosis and followed for six months, with assessments conducted at baseline, after the two-month intensive treatment phase, and within two weeks after completing treatment. The overall study duration was 15 months.
Eligibility criteria included individuals aged 15 years or older who were newly diagnosed with pulmonary tuberculosis and had received less than four weeks of prior TB treatment. Patients with severe illness, pre-existing chronic respiratory diseases such as asthma or COPD, or prior TB treatment were excluded. Facilities were selected based on their capacity to diagnose and treat TB and HIV and at least two years of TB service provision.
A two-stage sampling method was applied. First, one local government area from each of three senatorial districts in Lagos State was selected using simple random sampling. Then, one eligible TB treatment facility was randomly selected within each district. Patients were consecutively recruited at each facility until the required sample size was reached.
Data collection used interviewer-administered questionnaires capturing socio-demographic characteristics, clinical history, employment status, and symptoms. Height and weight were measured, and body mass index (BMI) calculated. All participants were offered HIV counseling and testing. Sputum microscopy results were extracted from patient records during follow-up visits.
Health-related quality of life was assessed using the WHOQOL-BREF instrument, which evaluates four domains: physical, psychological, social relationships, and environmental wellbeing. The instrument includes 26 items scored on a Likert scale from 1 to 5, with higher scores indicating better quality of life. Both English and Yoruba versions were used, with translation and back-translation procedures conducted to ensure accuracy.
The WHOQOL-BREF demonstrated strong reliability and validity in this study. Cronbach’s alpha exceeded 0.80 across all domains, indicating high internal consistency. Convergent validity was assessed using Pearson correlation coefficients between domain scores and global quality-of-life items, with values ranging from 0.433 to 0.801, indicating moderate to strong correlations. Statistical analysis included repeated-measures ANOVA, effect size estimation, and multivariable regression to identify predictors of HRQOL change.
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