This study is the first study done in the Gambia to assess the quality of life among patients undergoing haemodialysis using the KDQOL-SF12. Since Haemodialysis started relatively late in the Gambia compared to other West African countries, it is important to conduct this study to find out the quality of life of patients which can serve as tool for assessment of their wellbeing. The findings showed that the majority of the respondents were females (68.2%), this may be due to the fact the women are mostly affected by overweight, eclampsia in late pregnancy and non-communicable diseases like hypertension and diabetes mellitus and also CKD, which are risk factors for ESRD (Kidney Failure Risk Factor, 2020; Piccoli et al., 2018).
The mean scores for each of the domains of the KDQOL-SF were on a scale of 0-49 (poor quality), and 50-100 (good quality). The mean score for all the domain for patients receiving haemodialysis care in the Gambia was poor. It has been reported that the quality of life score for dialysis patient is generally quite low compared to healthy human(Al Salmi et al., 2021). The overall quality of life score of patients in our study setting is significantly lower (34.8) compared to the quality of life scores find among patients in other studies(Al Salmi et al., 2021; Mahato et al., 2020). The cause of poor quality of life might be due to under treatment as a result of inadequate availability of materials, medications, proper laboratory test to analyse the effectiveness of haemodialysis treatment.
The kidney disease summary component (KDSC), physical component summary (PCS) and mental component summary (MCS) are summary scores that determine the quality of life. The higher the score the higher the quality of life. We found a poor composite score for all the three domain among the patients undergoing haemodialysis in this centre. The MCS and KDCS scores were significantly higher in males compared to the female respondents. This may due to the fact that generally men has higher income than the female population in the Gambia and evidence as shown that unemployment and low income are associated with low MCS and PCS (Alhaji et al., 2018; AL-Jumaih et al., 2011). The PCS score of the patients was poor which indicates that they have a higher risk of dying as compared to those with good quality because mortality was found to be associated with poor physical health among dialysis patients (Østhus et al., 2012). The poor MCS scores can also lead to depression, which was also found to be a positive predictor of morality (Østhus et al., 2012). The MCS was significantly higher in unmarried patients than the married patients. This may be due to the fact that married women in the Gambia have higher responsibility especially in breeding children and also the burden of family care among men may have some mental effect on the male patients. However in our study we did not find any difference in PCS, MCS and KDCS scores between educated and uneducated patients. This finding is in contrast with others studies done in Saudi Arabia (AL-Jumaih et al., 2011), Nepal (Mahato et al., 2020) and United States of America (Alhaji et al., 2018) where attainment of higher education was found to be associated with a better quality of life score. A significant number of our study population were having hypertension and diabetes, with quite a number of the patients having the cause of their kidney disease unknown. The MCS score was significantly higher among patients with diabetes and hypertension than those with unknown causes of ESRD. These diseases are found to be associated with worst outcome for haemodialysis patients (Mandoorah et al., 2014).
The strength of this study was that it is the first study that looks at the quality of life of patients undergoing haemodialysis in the Gambia. The study population was highly representative as the study included all the patients that were undergoing haemodialysis since it is the only centre providing this service.
The limitation of this study included that we could not determine whether the low quality of life was due to the kidney disease process or inadequacy of haemodialysis treatment due to inadequate laboratory services. The study did not measure the effectiveness of the dialysis treatment.