The findings from this study showed that tuberculosis had a telling effect on TB patients' physical and mental health-related quality of life even though these improved with treatment. However, clinically significant improvement was observed only in physical strength at the end of treatment. Both the PCS score (44.9 ± 4.4) and MCS score (46.3 ± 3.7) at the end of treatment were still less than the lower limit of the population norm. Indeed, more than half of the study participants still had some physical impairment after completing their treatment. The lower-than-optimum mean PCS scores observed throughout the treatment period and the proportions of patients who reported reduced physical well-being indicated that physical impairment was the primary concern of the patients in this study, contrary to findings from Malaysia [14], Pakistan [15], and the UK [8], where psychological and emotional impairment was mainly reported. Physical impairment at the end of treatment was predicted by those aged > 45, unemployed, with pulmonary TB, and females.
Ageing is known to be associated with diminishing physical strength, and hence it was expected for older patients to complain of decreased physical strength than their younger counterparts, similar to findings from studies carried out in Taiwan [16], Canada [4], Pakistan [15] and Malaysia [14]. Females naturally seem to be more sensitive to changes in their physical strength than males, and this finding reiterates similar findings from a study in the USA [17]. Regular income alleviates economic hardships through access to nutritious food and quality healthcare. Therefore, it is unsurprising that employed patients perceived better physical health than findings from other studies elsewhere [14, 15]. The National Tuberculosis Control Programme (NTP) should make provisions for vulnerable TB patients like widows, homeless people and residents of destitute homes who may not be resourceful for adequate nutrition and transportation to visit clinics for their medication refills and clinical reviews. They could also be enrolled on the national health insurance scheme so that they could enjoy free healthcare for other comorbidities that they might have.
In the current study, 25%, 17.2%, and 15.5% of participants had reduced mental well-being and were at risk of depression at the beginning of treatment and second and third follow-ups, respectively. This finding confirms those from studies in Canada [4], Malaysia [14], and the UK [18]. The mental-related quality of life was reduced by alcohol and HIV infection but increased in patients older than 45. Alcohol tends to decrease the quality of life through its effect on both the physical and emotional social relationship domains [19] and HIV, with its associated stigma debilitatingly impacting the patient's quality of life by increasing stress, anxiety and depression. Counselling to reduce their alcohol consumption to clinically acceptable levels would therefore be beneficial [20]. Some opportunistic infections in HIV also attack the nervous system, affecting some patients' behaviour [21, 22]. The routine offering of tests and adequate monitoring of HIV-coinfected TB patients to offer HAART at the appropriate time would be beneficial to improve their HRQOL.
At each point of treatment, extrapulmonary TB (EPTB) patients had better PCS scores than pulmonary TB (PTB) patients, contrary to findings from another study done in Ghana [23]. The physical strength of EPTB patients increased rapidly to the extent that at the end of treatment, their PCS score was higher than the lower limit of the population norm. On the other hand, PTB patients had a higher MCS score than EPTB patients, similar to studies done in Nigeria [24] and Ghana [23]. In the current study, while physical impairment is a more significant concern for pulmonary TB patients, impaired psychological, emotional and social problems were more critical for extrapulmonary TB patients. Generally, most PTB patients lose considerable weight and reduce physical strength compared to their EPTB counterparts, which accounted for this observation.
Interventional strategies to diagnose and correct any worsening quality of life of people living with tuberculosis are essential to improve medication adherence and achieve higher treatment success rates.
Limitation And Strength
The prospective nature of the study enabled the monitoring of patients’ HRQOL throughout their treatment. The comparatively higher number of study sites (8) allowed for the monitoring of individuals from diverse backgrounds. However, because all of the research sites only comprised primary and secondary hospitals, TB patients undergoing treatment at higher- and lower-level health facilities such as tertiary hospitals and health centres were not evaluated. Nonetheless, this study offers academics, policymakers, and healthcare practitioners caring for people living with tuberculosis (TB) more information about HRQOL and its associated determinants in Ghana and other low-resource settings throughout the world.