Health-related quality of life of adults with cutaneous leishmaniasis at ALERT Hospital, Addis Ababa, Ethiopia.

ETHIOPIA; ADDIS Ababa (Ethiopia)

Background: Cutaneous leishmaniasis (CL) is a growing public health threat in Ethiopia. Leishmania aethiopica is the predominant causative organism. Affected individuals develop chronic skin lesions on exposed parts of the body, mostly on the face, which are disfiguring and cause scarring. The effects of CL on the health-related quality of life (HRQoL) of affected individuals has not been assessed in Ethiopia. Objective: To assess HRQoL in adults with active CL at ALERT Hospital, Addis Ababa, Ethiopia. Methods: A cross-sectional study was done using the Amharic version of the Dermatology Life Quality Index (DLQI). Trained health staff administered the DLQI. Results: Three hundred and two adults with active CL participated and all of them exhibited a reduced HRQoL. The median DLQI score was 10 (IQR 8). Almost half of the participants reported very poor HRQoL, 36.4% and 11.3% fell within the very large and extremely large effect categories respectively. DLQI scores were higher (median 18) in patients diagnosed with diffuse cutaneous leishmaniasis (DCL) compared to those with localized cutaneous leishmaniasis (LCL). The DLQI domain of 'work and school' was the most affected, scoring 73.3% and 66.6% of total possible score for female and male respectively, followed by that of 'symptom and feeling' (at 50.0% and 56.6% for female and male respectively). Men were more affected than women in the domains of 'leisure' (P = 0.002) and 'personal relationships' (P = 0.001). In the multivariate ordinal logistic regression site of lesion, clinical phenotype and age of participant remained associated with significantly poor HRQoL. Conclusion: The HRQoL impairment associated with CL is significant. Thus, patient-reported outcome measure should be used to assess the efficacy of treatments along with clinical outcome measures. Author summary: Cutaneous leishmaniasis (CL) is an important public health problem in Ethiopia with an estimated incidence up to 50,000 cases per year. CL is predominately due to Leishmania aethiopica. The transmission is by sandflies, with hyraxes being reservoir hosts. Lesions are chronic on the exposed part of the body, commonly on the face. Three main clinical phenotypes are recognized; localized (LCL), muco-cutaneous (MCL), and diffuse (DCL) cutaneous leishmaniasis. The permanent damage and altered anatomy of the skin, nose, eyelids, ears and lips due to scarring is often associated with stigma. This study aimed to assess the health-related quality of life (HRQoL) using the Amharic version of the Dermatology Life Quality Index (DLQI) in adults diagnosed with active CL. Trained interviewers administered the DLQI to participants prior to treatment. Our results show that the impact on HRQoL associated with CL is large. There was no significant difference between men and women, and urban and rural dwellers. Participants with DCL, the more extensive form of CL, had lower HRQoL compared to those with other forms. Those with lesions on their head and neck regions and younger than 50 years (20 to 49 years age group) had significantly lower HRQoL. The observed HRQoL associated with CL calls for improved support for affected individuals as part of CL care and treatment to improve outcomes. Importantly, patient-reported outcome measures including the DLQI should be used to assess the efficacy of treatments. [ABSTRACT FROM AUTHOR]

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