In developing countries the morbidity of epilepsy was increased significantly including Ethiopia. The increased population in developing countries affects the health system and adds socioeconomic burden requiring urgent attention. Many people in Africa believe that epilepsy is contagious; because of these unwilling to help or to touch the person who has fallen during a seizure lead to enormous social stigmas and lower QOL (3). Epilepsy affects life in multi-faced ways which should be studied in every community’s cultural conditions and psycho social makeup. It is to be framed within the literature considering quality of life has an important role in the disease management quality outcome (14), (15). In order to measure success of the services delivery system that patient’s quality of life is essential to provide opportunity for improvement of health services since feedback from patient side is a bench mark for health care quality improvement and continued the treatment protocol.
The present study reveals that the mean score overall level of epileptic patient’s quality of life treated at out-patient psychiatry clinic of Dessie referral hospital were 51.98 (95% CI:41.9–62.06) and this study was aligned studies done in Uganda and Kenya 58 and 49.9 respectively (16), (17). It was also aligned studies done in Ethiopia at Jimma University Medical Center (58.8) (7), Addis Ababa Amanuel Mental Specialized Hospital were 56.36 (3), Ambo general hospital (56.43) (5), Public hospitals of Wollega zones (60.47) (18), but it was differed studies done in Mekelle City (77.97%) (2). This may be due to research done in Mekelle city was used QOLIE-31 tool that was focus on the seizure worry, wellbeing, energy/fatigue, cognitive functioning and medication effect. This finding also lower than studies done in Brazil (68.73) (11) and Malaysia (68.9) (8). This difference might be due to those countries had better quality of health services, good socioeconomic status of the population than Africa population. On the other hand in Africa including the present study population there was low socioeconomic status and the number and level of the health care institutions was less when compared to the population size; that may be affected the quality of life for PLWE.
On this findings quality of life on physical domain mean ranked relatively higher (58.6) in the WHOQOL-BRIEF scaled scores when compared to the social (53.3), psychological (50.25%) and environmental domain mean (48.75), however the finding of this study on physical domain mean was lower than studies done in Brazil (72.76) (11). This might be due to the management approach for epilepsy in this hospital might not be focus on adopting a holistic approach that also incorporates their psychological, social and environmental needs rather than focusing only seizure control.
The finding shows that the mean values of psychological domain mean of WHOQOL-BRIEF scale were 50.25 like the meaningfulness of life, the capacity of concentrating on daily activity the ability of accepting their body appearance and environmental domain mean were 48.75; those were healthy condition of living environment, the availability of information about their daily life and the accessibility of health service including transportation, are lower than the physical domain mean 58.6 and social domain mean 53.3. This difference may be due to most of the study participant marital status was single; their educational level was also unable to read and write and most of study participant had no job (unemployed) those factors might had been effect on the psychological perspective of epileptic patients. On the other hand 12.2% and 37% of study participant had depression and anxiety respectively this might had their own contribution on the psychological domain of WHOQOL-BRIEF scale. For environmental domain almost half of (47.9%) the study participant were live in rural area, that may be affected the healthy condition of living environment, the availability of information about their daily life and the accessibility of health service and transportation.
Educational status had negatively association for good quality of life those patients who had completed Secondary school were 83.3% less likely good quality of life when compared to unable to read and write patients (AOR = 0.167, 95% CI: 0.061, 0.455). But other studies done in Uganda, Kenya, Georgia shows that high educational level had strongly associated with good quality of life scores (16), (17), (19). In Ethiopia also studies done in Amanuel Mental Specialized Hospital, Ambo General Hospital and Mekelle city high education was associated with good quality of life in epileptic patient (3), (5), (2). This might be due educated patients had good understand about the natural disease history of epilepsy and they were good adherence about the treatment. Current study reviles that Age of the participant had association for good quality of life those patients age group between 25–34 years were about 59.1% less likely to have good quality of life as age group between 18–24 years (AOR = 0.409, 95% CI: 0.192, 0.875). This study was aligned studies done in Malaysia, Italy and Georgian (8), (20), (19).
Occupational status had association for good quality of life. Patients who had self-employed was 1.155 times more likely good quality of life when compared to unemployed (AOR = 2.155, 95% CI: 1.001, 4.638). This studies was supported by studies done in Kenya (17) and in Ethiopia at Jimma University Medical Center (7). This might be due to patients who had job can be cover their treatment cost, transportation and other health related costs by themselves. The second justification employed patients had also relatively enough money to meet their daily needs when compared to unemployed patients.
The present research was indicated that patients who were living in urban area had 7.07 times more likely to have good quality of life as compared to patient who were living in rural area (AOR = 7.074, 95% CI: 3.573, 14.005). This study was aligned studies done in Kenya (17) and studies done in Ethiopia at Jimma University Medical Center (7). This might be due to patients who had live in rural area can be unable to get completed information about their health status, access health institutions nearby their location, and they cannot be get the opportunity to participate in leisure activities.
Marital status was association for good quality of life those patients who were married had 2.5 times more likely to have good quality of life (AOR = 2.525, 95%CI: 1.619, 3.940) as compared to patient who were single. This study was similar study done in Uganda (16). The possible reasons of this difference may be married patients had stable life condition. They can be get psychological support from their partners and can be feel comfortable about their personal relationships.
History of co-morbid illness was another factor associated with quality of life. Those who had no history of co-morbid illness had 3.566 times more likely good quality of life as compared to patients who had history of comorbid illness (AOR = 3.566, 95% CI: 1.298, 9.798). This study was aligned to studies done in India (1). In Ethiopia also studies done at Jimma University Medical Center, Ambo General Hospital and public hospitals of Wollega zones indicates that absence of comorbid illness were good predicators of good quality of life (7) (5), (18). The possible reasons of this difference adopted from different literatures patients who had no comorbid illness like depression, anxiety, cognitive impairments, and psychosocial issue were good quality of life as compared to patients who had comorbid illness.
Patients who had family support had 9.275 times more likely good quality of life (AOR = 9.275 95% CI: 1.073, 80.176) than patients who had no family support on their life. On the other hand epileptic patients participating on recreational activity had 2.229 times more likely good quality of life (AOR = 2.229, 95% CI: 1.184, 4.196). Different literatures indicate personal characteristics like self-esteem, family support, doing regular physical activity and participating on recreational activities were strong predictors of good quality of life. This might be due to persons who had good personal character can be the capacity of avoiding negative feelings on their personal life, concentrate on their daily activities, enjoy with their life and they can be made their life meaningful.