This is the first study to determine the general quality of life of lymphatic filariasis patients living in Ghana, even though a similar study has been conducted in India1. From our results, the overall mean QoL score for the LF subjects was 68.24, which is almost the same as the study conducted in India 19 at the baseline. Nevertheless, the quality of life of LF participants in this study was slightly lower than a previous study conducted in the urban area of Tiruchirappalli in India where an overall mean QoL score of 69.811 using the same LFSQQ instrument. Even though, a score of 100 is the highest quality of life, our study participants’ overall QoL of 68.24 present a good quality of life. Notwithstanding, a higher QoL could be achieved if LF patients are taken through regular skin wash activities, exercises and other requisite hygienic practices. A six (6) months camp set up for LF patients in three endemic communities in Kerala province of India showed a significant upsurge in the QoL of the patients from 68.23 to 74.5719.
Moreover, more than half of our LF participants responded that they had no financial assistance from any relation. This was not surprising since the environment domain was observed to have the least domain QoL score. There are apparent reasons for such observations. First of all, the observation can be due to the dilapidating consequences of lymphatic filariasis on the patients, which rendered most of our study participants jobless or had reduced working days; making them wholly dependent on relatives and friends. This finding corroborates other result from this study where 29% of the respondents indicated that their condition had a negative effect on their ability to engage fully in economic activities. In addition, the stigma associated with the disease prevented some of the study participants from embarking on their jobs particularly those who were engaged in fish mongering and petty trading. The situation is further complicated as the LF usually affects poorer communities12,20 where most LF patients’ mainstay financial support (relatives and friends) is most often limited. This reason is corroborated by responses given by LF infected individuals in a different study conducted in Togo21. It is worth noting from our results that 78% of the respondents felt insecure in their routine life. Although the reason for this insecurity was not immediately clear from our study, this may be due to the accustomed dejection and infamy most individual who suffer neglected tropical disease face in their respective communities12.
A community-level analysis of the overall quality of life also revealed that the QoL score did not depend on which community the LF patients resided as it tends not to show any wide differences across the communities of study. This may be due to similar economic statuses of the patients across the communities which tend to be an upshot of the impact of LF disease which makes them to depend on peasant farming and/or fishing activities for their livelihood. An observed general pattern of the specific domains i.e. Psychological, Disease burden and Environment domains in LFSQQ across the communities also consolidate the impression that the LF patients in this study experienced almost the same impact of the infection irrespective of the community origin. Therefore, any intervention developed to alleviate the suffering and/or to increase the quality of life of LF patients can be generalized for all and possibly replicated in other similar settings.
The severity of the disease was defined by the stage of the lymphoedema. The worth of wellness of the study participants presenting the late stages of the infection was abysmal as the indicators observed declined in their overall mean QoL index. The negative Pearson’s correlation (r = -0.504, p-value=0.001) between the severity of the disease and the quality of life of the study participant was in divergent with the positive correlation (r = 0.74, p-value <0.001) of severity of disease and quality of life score in a different study1. Nevertheless, erstwhile study using modified Dermatology Life Quality index (mDLQI) also revealed that the severity of the filarial lymphoedema had a considerable negative repercussion on the QoL of the individuals22. A possible explanation for the negative effect of the stage of the lymphoedema on the quality of the respondents in our study may lie in the fact that as the swelling of their affected limbs worsened, the less productive they become and so a toiling effect on the wellbeing of LF patients. In addition, the stage of LF is in a close association with the Gender of the study participants using the logistic regression model (p-value = 0.015).
For further analysis on how the disease impact the physical abilities of the LF participants, we used the mobility, daily activities, pain/discomfort and self-care domains in assessing this as used elsewhere12. The physical ability of LF participants have been widely reported to be hampered as compared to healthy individuals without the condition 5,12,15,16 and this was expected in this study. On the other hand, other studies1,19 have also shown a higher level of self-care among LF patients which happen to corroborate with our current study where the self-care domain had the highest average QoL score of 85.03. This finding reflects the composition of our LF patients in the study where 36% of them are living with stage two (2) lymphoedema and as a result could still take care of themselves.
Mobility of LF patients is also considered a key factor in assessing the physical capabilities of the patients as the various manifestations of the disease (ADL, hydrocele, lymphoedema and elephantiasis). This situation has a cascading effects on the employment and income status of persons living with the condition23,24. Our study participants, however, averagely had mobility domain score of 68.86 which is comparatively higher to previous studies of 43.120, 54.92 (baseline score)19 and 52.321. Nevertheless, this finding does not undermine the finding that 77% of the respondents had some form of difficulty in sitting and getting out of a chair or a challenge in walking a long distance. As an earlier study have also detailed the mobility of LF patients by using a 10 m walking test (10mWT) and a timed ‘up and go’ (TUG) test revealed LF patients were slower than controls (10WT: cases=0.828 m/s, controls = 1.104 m/s, TUG: cases =14.7s, controls =11.2s).
This study was conducted in the rural areas along the western coast of Ghana with a higher proportion of female participants. While this observation is not uncommon in LF endemic communities, care must be taken when the study’s findings are generalized to other LF endemic communities particularly outside Ghana. As a previous study has posit women or girls to be more prone to neglected tropical diseases (NTD) which may due to higher poverty levels, higher illiteracy rates and lower social status8.