3.1 Demography of Study Participants
Together, 155 study participants were recruited. Three-quarters (115, 74.19%) of the study participants were females and the remaining (40, 25.81%) males. The mean age of the study participants was 52.84 (SD= 15.62) with the age range of (18-86). The majority of the study subjects (97, 62.58%) were involved in agrarian and/or fishing activities while occupations such as service workers, sales workers, and professional related workers (5, 3.23%; 12, 7.74%; 2, 1.29%), respectively, was less common among the LF cohorts. Thirty-nine (39) of LF subjects representing 25.16%, were unemployed, as Table 1. A greater number of LF patients (84, 54.19%) in this study had stage 2 lymphoedema (swelling not reversible overnight). The patients with stage 1 and stage 3 were 17 (10.98%) and 28 (18.06%), respectively. Two (2) of the study participants with stage 7 were incapacitated and could not care for themselves, whereas the remaining were with other stages, as shown in Table 2.
Table 1. Demography of Study Participants
SEX
|
n (%) a
|
Female
|
115 (74.19)
|
Male
|
40 (25.81)
|
AGE
|
|
(mean±SD)
|
52.84±15.62 95%CI (50.34-55.33)
|
Occupation
|
|
Agricultural/Fishman/Fishmonger/Farmer
|
97 (62.58)
|
Service workers
|
5 (3.23)
|
Sales workers
|
12 (7.74)
|
Professionals/Pensioner /teacher
|
2 (1.29)
|
Unemployed
|
39 (25.16)
|
Community
|
|
Achowa
|
4 (2.58)
|
Akatakyi
|
37 (23.87)
|
Ampatano
|
21 (13.55)
|
Asemkow
|
24 (15.48)
|
Busua
|
13 (8.39)
|
Butre
|
14 (9.03)
|
Cape 3 points
|
10 (6.45)
|
Dixcove
|
16 (10.32)
|
Princess Town
|
16 (10.32)
|
This table shows the various sections of the demography of the study participants with CI as a Confidence interval, a Percentage (%) is the number (n) divided by 155 (total N).
Table 2. Clinical profile of the patients
Stages of Lymphoedema n(%)a
|
1
|
Swelling reversible overnight
|
17(10.98)
|
2
|
Swelling not reversible overnight
|
84(54.19)
|
3
|
Shallow skin folds
|
28(18.06)
|
4
|
Skin knobs
|
6(3.87)
|
5
|
Deep skin folds
|
10(6.45)
|
6
|
Presence of “mossy lesions”
|
8(5.16)
|
7
|
Unable to care for self
|
2(1.29)
|
This table depicts the staging of the lymphoedema of the study participants, a Percentage (%) is the number (n) divided by 155 (total N).
3.2 Quality of life Score of LFSQQ Domains among study participants
The average overall quality of life score among the LF cohort was 68.24 (SD = 9.76). Among the domains used in the study, LF pathology patients recorded the Environment domain as the lowest quality of life score (45.94), while the self-care domain being the highest quality of life score (85.03). The study instrument's Daily activities domain and Disease burden domain had a slight difference in their scores of 75.54 and 75.25, respectively. A similar trend was also observed between the Mobility domain and Pain/Discomfort domain (Figure 1).
In addition, over 80% of the study participants responded to not having "no problem with their ability to take care of themselves" (self-care). In contrast, over 50% of LF patients complained of severe to most severe effects of the disease on their work and loss of strength or fatigue. In the Mobility domain, the study participants had severe problems when they sat and got out of a chair or standing for a long time. With regard to their daily activities, the majority of LF patients (74%) did not have any challenge with cooking or cleaning the floors, but they had difficulties in carrying out activities such as fishing or farming. Moreover, from the Social relationship domain's responses, an average of 58% do not have any issue interacting with people, identifying a potential spouse, or having the disease affecting their relationships with their family members or neighbors. The Environment domain response showed that 67% of respondents indicated little or no financial assistance when asked "how often do they get financial assistance from their relations due to their conditions"?
3.3 Quality of life Score of LFSQQ Domains in the Community Level
The nine (9) communities where the study was conducted had a varied number of LF patients, as shown in Table 1. To determine the overall quality score in the various LF endemic communities, a bar graph of the overall quality score among the communities was done, as demonstrated in figure 2. The graph showed marginal changes in the overall quality of life scores of LF patients residing in the communities. However, the Achowa community, which had only four (4) LF patients, was excluded from the analysis to give more representative data. Moreover, considering that the Disease Burden Domain (DBD), Psychological Domain (PD), and Environment Domain (ED) were the lowest domains in the LFSQQ, a community-level distribution of these domains scores, i.e., DBD, PD, and ED were analyzed. As shown in (figure 3), there was generally a higher score in the DBD within the range 76-80 except for Dixcove, where the DBD score of 66. A similar trend is also observed in ED and PD with the ranges of 41-53 and 56-63, respectively. However, to determine whether there was any statistical difference among the DBD, PD, and ED in the communities, a one-way analysis of variance (ANOVA) was conducted, which showed statistical difference in these domains in the community (F (2,24) = 73.06, p-value < 0.001) as shown in Table 3. In addition, the overall quality score in the female and male was 68.42 and 67.61, respectively.
Table 3. One-Way Analysis of Variance (ANOVA) of Domain Score
|
df
|
Sum_sq
|
Mean_sq
|
F
|
P-value
|
C (Domain score)
|
2
|
3870.888889
|
1935.444
|
73.06117
|
<0.001
|
Residuals
|
24
|
635.7777778
|
26.49074
|
|
|
3.4 Correlation of LF Responses on LFSSQ Domains
To determine the relationship among the various LFSSQ domains, we performed Pearson's correlation, as illustrated in Table 4. The domains of pain/discomfort and disease burden were positively correlated with a Pearson’s correlation coefficient of r=0.71 and a p-value <0.001 as depicted in Figure 4. A number of the domains were moderately correlated with Pearson's correlation coefficient (r), ranging from 0.60 – 0.66. The weakest correlation coefficient was observed between the domains of environment and pain/discomfort. Moreover, the linear regression model for the stage of LF (severity of the disease) and the overall quality of life score showed a negative regression with a Pearson's correlation coefficient (r= -0.504) and p-value < 0.001 (Figure 5). In addition, to predict how the stage of LF (severity of the disease) and the overall QoL of participants influence the sex outcome. We performed a logistic regression analysis using the sex of the study participants as the dependent variable (y) and the stage of LF and overall QoL as the two independent variables (x). The p-values of the LF stage and the overall QoL as the two independent variables in the model were 0.015 and 0.419, respectively, as shown in Table 5. Thus, the association between the dependent variable (Sex) and the independent variable (stage of LF) is significant.
Table 4. Pearson’s Correlation for the Domains of Quality of Life Scores LF Patients.
Variables
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
1. Mobility
|
-
|
|
|
|
|
|
|
|
|
2. Daily Activities
|
0.62**
|
-
|
|
|
|
|
|
|
|
3. Self-care
|
0.65**
|
0.60**
|
-
|
|
|
|
|
|
|
4. Disease/ Burden
|
0.65**
|
0.56*
|
0.58*
|
-
|
|
|
|
|
|
5. Pain/Discomfort
|
0.66**
|
0.50*
|
0.56*
|
0.71***
|
-
|
|
|
|
|
6. Work/Fatigue
|
0.63**
|
0.62**
|
0.64**
|
0.63**
|
0.58*
|
-
|
|
|
|
7. Psychological Health
|
0.43
|
0.41
|
0.50*
|
0.40
|
0.45
|
0.48
|
-
|
|
|
8. Social Relationships
|
0.49
|
0.53*
|
0.54*
|
0.53*
|
0.46
|
0.56*
|
0.53*
|
-
|
|
9. Environment
|
0.24
|
0.32
|
0.23
|
0.16
|
0.09
|
0.23
|
0.47
|
0.51*
|
-
|
***Strong Correlation, ** Moderate Correlation and *Weak Correlation.
Table 5. Logistic regression model for dependent variable Sex
Variable
|
coef
|
Std. Error
|
z
|
P> |z|
|
[0.025
|
0.975]
|
const
|
3.2185
|
1.686
|
1.909
|
0.056
|
-0.087
|
6.524
|
QoL
|
-0.0168
|
0.021
|
-0.808
|
0.419
|
-0.058
|
0.024
|
Stage of LF
|
-0.3540
|
0.145
|
-2.436
|
0.015
|
-0.639
|
-0.069
|