Health Related Quality of Life of Ugandan Children Following Valve Replacement Surgery for Rheumatic Heart Disease

Mohammed A. M. Ahmed; Twalib Aliku; Judith Namuyonga; Bernard Obongonyinge; Hilda Tumwebaze; Samalie M. Kitooleko; Tom Mwambu; Peter Lwabi; Sulaiman Lubega

doi:10.5334/gh.1205

Health Related Quality of Life of Ugandan Children Following Valve Replacement Surgery for Rheumatic Heart Disease

Volume 18 (2023): Issue 1

By: Mohammed A. M. Ahmed , Twalib Aliku , Judith Namuyonga , Bernard Obongonyinge , Hilda Tumwebaze , Samalie M. Kitooleko , Tom Mwambu , Peter Lwabi and Sulaiman Lubega

Open Access

|Jun 2023

Figures & Tables

Table 1

Socio-demographic characteristics of the participants.

VARIABLE (N = 83)	N(%)
Age, mean (SD), years	18.5(4.5)
<19	42(50.6)
> = 19	41(49.4)
Weight, mean (SD), kg	51.9(11.3)
Height, mean (SD), cm	158.6(8.6)
Gender
Female	49(59)
Male	34(41)
Level of education
Pre–primary	4(4.8)
Primary	36(43.4)
Secondary	39(47)
None	4(4.8)
SPO2, median (IQR), percentage	99(96–100)
Heart rate, mean (SD), BPM	84.5(10.8)
Duration of heart disease from 1^st diagnosis, median (IQR), years	6(2–25)
Duration from surgery, median (IQR), years	4(2–6)
Time to surgery from initial diagnosis, median (IQR) years	2(1–4.8)
Underweight (below 18.5)	26(31.3)
Normal weight (18.5–24.9)	46(55.4)
Overweight (25.0–29.9)	9(10.8)
Obese (30.0 and above)	2(2.4)
Country of surgery
India	2(2.5)
Uganda	6(7.5)
Sudan	71(88.8)
Type of valve replacement surgery
Single valve	58(71.6)
Double valve	23(28.4)
Age at surgery (years)	14(7–18)

Table 2

The feelings of the participant about warfarin use and regular blood testing (PT/INR).

VARIABLE (N = 83)	DEFINITELY TRUE	MOSTLY TRUE	NOT SURE	MOSTLY FALSE	DEFINITELY FALSE
Taking warfarin
I don’t mind taking warfarin	45(54.2)	0(0)	0(0)	0(0)	38(45.8)
I can’t always be bothered taking my tabs	21(25.3)	0(0)	0(0)	0(0)	62(74.7)
It interferes with my social life	15(18.1)	1(1.2)	0(0)	1(1.2)	66(79.5)
I don’t fully understand why I have to take them	4(5)	0(0)	3(3.8)	3(.3.8)	70(85.5)
I simply forget	7(8.5)	1(1.2)	2(2.4)	3(3.7)	69(84.2)
I am afraid I may get a bleed or bruise	24(29.3)	1(1.2)	1(1.2)	3(3.7)	53(64.6)
I don’t want my friends/colleagues to know I have an artificial valve	35(42.2)	1(1.2)	0(0)	0(0)	47(56.6)
DOING REGULAR BLOOD TESTS
I don’t mind having regular blood tests	44(53)	0(0)	0(0)	1(1.2)	38(45.8)
The tests are painful	40(48.2)	0(0)	2(2.4)	2(2.4)	39(47)
It interferes with my daily life	17(20.5)	0(0)	2(2.4)	1(1.2)	63(75.9)
I don’t understand why I have to have them	8(9.6)	0(0)	2(2.4)	1(1.2)	72(86.8)
It is expensive for me (I can’t afford it)	41(50)	1(1.2)	2(2.4)	0(0)	38(46.3)

Table 3

Health-related quality of life for all participants in the study.

DIMENSION	MEAN (SD)
Heart Problems and Treatment	85.1 (14.2)
Treatment Barriers	91.1 (14.8)
Perceived Physical Appearance	55.8 (41.8)
Treatment Anxiety	90.4 (20.5)
Cognitive Problems	90.6 (15.1)
Communication	87.5 (22.4)
Health-Related Quality of Life, Total Score	83.4 (12.9)
Health-Related Quality of Life, classification	Freq (%)
Optimal	50(60.2)
Sub-optimal	29(34.9)
Poor	4(4.8)

[i] Optimal mean HRQoL score ≥ 80%, Sub optimal ≥ 70% – ≤80% and poor HRQoL ≤ 70%.

Table 4a

Socio-demographic factors associated with optimal health-related quality of life of the participants at bivariate analysis.

VARIABLE	ALL (N = 83) FREQ (%)	HEALTH RELATED QUALITY OF LIFE (TOTAL SCORE)			P-VALUE
VARIABLE	ALL (N = 83) FREQ (%)	OPTIMAL (N = 50) FREQ (%)	SUB OPTIMAL (N = 29) FREQ (%)	POOR (N = 4) FREQ (%)	P-VALUE
Age, mean (SD), years	18.5(4.5)	18.2(4.7)	18.7(4.3)	19(2.7)	0.536
<19	42(50.6)	25(50)	14(48.3)	3(75)	0.600
>19	41(49.4)	25(50)	15(51.7)	1(25)
Weight, mean (SD), kg	51.9(11.3)	49.4(11.3)	56.5(10.7)	50.8(7.1)	0.630
Height, mean (SD), cm	158.6(8.6)	158.3(8.8)	159.5(8.8)	156(7.1)	0.902
Sex
Female	49(59)	26(52)	20(69)	3(75)	0.269
Male	34(41)	24(48)	9(31)	1(25)
Level of education
Pre–primary	4(4.8)	4(8)	0(0)	0(0)	0.344
Primary	36(43.4)	19(38)	090)	0(0)	0.344
Secondary	39(47)	23(46)	14(48.3)	3(75)
None	4(4.8)	4(8)	15(51.72)	1(25)
Duration of heart disease from 1^st diagnosis, median (IQR) years	6(2–25)	11.5(8.8–15)	11(7–15.5)	14.5(11–18)	0.341
Duration from surgery, median (IQR), years	4(2–6)	4(2–6)	4(3–6.5)	3(1–5.8)	0.313
Time to surgery, median (IQR)	2(1–4.8)	2(1–4)	2(0.8–5)	2(0–3)	0.604
Body mass index (BMI), median (IQR)	20.1(12.7–31.6)	19(12.7–27.7)	20.7(16.9–31.6)	19.4(18.1–27.1)	0.008
Underweight (BMI<18.5)	26(31.3)	21(42)	4(13.8)	1(25(	0.044
Normal weight (18.5–24.9)	46(55.4)	25(50)	19(65.5)	2(50)
Overweight (25.0–29.9)	9(10.8)	4(8)	4(13.8)	1(25)
Obese (≥30.0)	2(2.4)	0(0)	2(6.9)	0(0)
Country
India	2(2.5)	1(2)	1(3.7)	0(0)	0.837
Uganda	6(7.5)	5(10.3)	1(3.7)	0(0)	0.837
Sudan	71(88.8)	42(85.7)	25(92.6)	4(100)
Valve replacement
Single valve	58(28.4)	35(72.9)	20(69)	3(75)	0.922
Double valve	23(71.6)	13(27.1)	9(31)	1(25)
Age of the surgery (IQR), years	14(7–18)	13.5(8–18)	7(3–20)	17(11–18)	0.120

Table 4b

Socio-demographic factors associated with optimal health-related quality of life of the participants at bivariate analysis.

VARIABLE	ALL (N = 83) FREQ (%)	HEALTH RELATED QUALITY OF LIFE (TOTAL SCORE)			P-VALUE
VARIABLE	ALL (N = 83) FREQ (%)	OPTIMAL (N = 50) FREQ (%)	SUB OPTIMAL (N = 29) FREQ (%)	POOR (N = 4) FREQ (%)	P-VALUE
Taking warfarin (n = 83)
I don’t mind taking warfarin
Definitely false	38(45.8)	22(44)	15(51.7)	1(25)	0.556
Definitely true	45(54.2)	28(56)	14(48.3)	3(75)
I can’t always be bothered taking my tabs
Definitely false	62(74.7)	36(72)	22(75.9)	4(100)	0.457
Definitely true	21(25.3)	14(28)	7(24.1)	0(0)
It interferes with my social life
Definitely false	66(79.5)	41(82)	22(74.9)	3(75)	0.815
Definitely true	15(18.1)	8(16)	6(20.7)	1(25)	0.815
Mostly false	1(1.2)	1(2)	0(0)	0(0)
Mostly true	1(1.2)	0(0)	1(3.5)	0(0)
I don’t fully understand why I have to take them
Definitely false	70(87.5)	43(89.6)	23(82.1)	4(100)	0.774
Definitely true	4(5)	2(4.2)	2(7.1)	0(0)	0.774
Mostly false	3(3.8)	1(2.1)	2(1.1)	0(0)
Not sure	3(3.8)	2(4.2)	1(3.7)	0(0)
I simply forget
Definitely false	69(84.2)	45(91.8)	21(72.4)	3(75)	0.116
Definitely true	7(8.5)	2(4.1)	4(13.8)	1(25)	0.116
Mostly false	3(3.7)	2(4.1)	1(3.5)	0(0)
Mostly true	1(1.2)	0(0)	1(3.5)	0(0)
Not sure	2(2.4)	0(0)	2(6.9)	0(0)
I am afraid I may get a bleed or bruise
Definitely false	53(64.6)	39(78)	13(46.4)	1(25)	0.017
Definitely true	24(29.3)	10(20)	11(39.3)	3(75)
Mostly false	3(3.7)	1(2)	2(7.1)	0(0)
Mostly true	1(1.2)	0(0)	1(3.6)	0(0)
Not sure	1(1.2)	0(0)	1(3.6)	0(0)
I don’t want my friends/colleagues to know I have an artificial valve
Definitely false	47(56.6)	40(80)	7(24.2)	0(0)	<0.001
Definitely true	35(42.2)	10(20)	21(72.1)	4(100)	<0.001
Mostly true	1(1.2)	0(0)	1(3.5)	0(0)
Doing regular blood tests (n = 83)
I don’t mind having a regular blood test
Definitely false	38(45.8)	22(44)	13(44.8)	3(75)	0.504
Definitely true	44(53.0)	28(56)	15(51.7)	1(25)	0.504
Mostly false	1(1.2)	0(0)	1(3.5)	0(0)
The tests are painful
Definitely false	39(47)	26(52)	11(37.9)	2(50)	0.495
Definitely true	40(48.2)	20(40)	18(62.1)	2(50)	0.495
Mostly false	2(2.4)	2(4)	0(0)	0(0)
Not sure	2(2.4)	2(4)	0(0)	0(0)
It interferes with my daily life
Definitely false	63(75.9)	41(82)	20(69)	2(50)	0.303
Definitely true	17(20.5)	8(16)	7(24.1)	2(50)	0.303
Mostly false	1(1.2)	0(0)	1(3.5)	0(0)
Not sure	2(2.4)	1(2)	1(3.5)	0(0)
I don’t understand why I have to have them
Definitely false	72(86.8)	45(90)	23(79.3)	4(100)	0.322
Definitely true	8(9.6)	5(10)	3(10.3)	0(0)	0.322
Mostly false	1(1.2)	0(0)	1(3.5)	0(0)
Not sure	2(2.4)	0(0)	2(6.9)	0(0)
It is expensive to me (I can’t afford it)
Definitely false	38(46.3)	28(56)	8(28.6)	2(50)	0.089
Definitely true	41(50)	20(40)	19(67.9)	2(50)	0.089
Mostly true	1(1.2)	0(0)	1(3.6)	0(0)
Not sure	2(2.4)	2(4)	0(0)	0(0)

Table 5

Factors associated with optimal health-related quality of life of the participants at multivariable analysis.

VARIABLE	ODDS RATIO	95% CI	P-VALUE
BMI, median(range)	1.2	1.1–1.3	0.006
Underweight (<18.5)	1.0
Normal weight (18.5–24.9)	1.3	0.68–2.66 0.162–2.42	0.001 0.025
Overweight (25.0–29.9)	1.6
Obese (>30.0)	N/A
I am afraid I may get a bleed or bruise
Definitely false	1.0
Definitely true	1.5	1.21–2.47	0.004
Mostly false	1.5	-0.82–3.75	0.208
Mostly true	2.4	-1.54–6.36	0.231
Not sure	2.4	-1.54–6.36	0.231
I don’t want my friends/colleagues to know that i have an artificial valve
Definitely false	1.0
Definitely true	2.7	1.64–3.81	<0.001
Mostly true	3.3	-.0.83–7.5	0.116

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DOI: https://doi.org/10.5334/gh.1205 | Journal eISSN: 2211-8179

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Language: English

Submitted on: Aug 30, 2022

Accepted on: May 2, 2023

Published on: Jun 23, 2023

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

Rheumatic heart disease,

valve replacement surgery,

health related quality of life,

Uganda

© 2023 Mohammed A. M. Ahmed, Twalib Aliku, Judith Namuyonga, Bernard Obongonyinge, Hilda Tumwebaze, Samalie M. Kitooleko, Tom Mwambu, Peter Lwabi, Sulaiman Lubega, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 18 (2023): Issue 1

Health Related Quality of Life of Ugandan Children Following Valve Replacement Surgery for Rheumatic Heart Disease

Figures & Tables

Figure 1

Table 1

Table 2

Table 3

Table 4a

Table 4b

Table 5

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