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Health-related quality of life and healthcare consultations among adult patients before and after diagnosis with rheumatic heart disease in Namibia
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Clara Barton School of Nursing, Welwitchia Health Training Centre, Pelican Square, Windhoek, Namibia.ORCID iD: 0000-0002-0899-2185
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.ORCID iD: 0000-0001-9225-1306
Clara Barton School of Nursing, Welwitchia Health Training Centre, Pelican Square, Windhoek, Namibia.
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.ORCID iD: 0000-0002-1633-2179
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2023 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 23, no 1, article id 456Article in journal (Refereed) Published
Abstract [en]

Background: Rheumatic Heart Disease (RHD) causes high morbidity and mortality rates among children and young adults, impacting negatively on their health-related quality of life (HRQoL). This study aimed to evaluate the HRQoL and healthcare consultations of adult patients with RHD in Namibia.

Methods: From June 2019 to March 2020, a questionnaire was administered to 83 RHD patients during routine follow-ups. The EQ-5D-5L instrument was used to assess the health-related quality of life before diagnosis and at the time of the survey. The Ethiopian value set for EQ-5D-5L was used to calculate Quality-Adjusted Life Years (QALY).

Results: Most respondents were women (77%), young adults below the age of 30 years (42%), and individuals who grew up in rural areas (87%). The mean QALY statistically significantly improved from 0.773 pre-diagnosis to 0.942 in the last 12 months (p < 0.001). Sixty-six patients who had surgery reported a better QALY. Healthcare visits statistically significantly increased from on average 1.6 pre-diagnosis to 2.7 days in the last 12 months (p < 0.001). The mean distance to the nearest facility was 55 km, mean cost of transport was N$65, and mean time spent at the clinic was 3.6 h. The median time from diagnosis to the survey was 7 years (quartiles 4 and 14 years).

Conclusion: Treatment and surgery can improve HRQoL substantially among RHD patients. Being diagnosed with RHD affects patients living in socioeconomically disadvantaged rural areas through cost and time for healthcare visits. It would be valuable with further research to understand differences between disease severities.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023. Vol. 23, no 1, article id 456
Keywords [en]
Health-related quality of life, RHD, QALY, EQ-5D-5L, Namibia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-214434DOI: 10.1186/s12872-023-03504-4Scopus ID: 2-s2.0-85171150062OAI: oai:DiVA.org:umu-214434DiVA, id: diva2:1797480
Funder
Familjen Erling-Perssons StiftelseAvailable from: 2023-09-14 Created: 2023-09-14 Last updated: 2024-04-02Bibliographically approved
In thesis
1. Rheumatic heart disease in Namibia: evaluating the burden and the cost-effectiveness of a preventive strategy
Open this publication in new window or tab >>Rheumatic heart disease in Namibia: evaluating the burden and the cost-effectiveness of a preventive strategy
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Rheumatic Heart Disease (RHD) is a neglected public health problem, which is most prevalent in low-and middle-income countries. It affects over 460 million people and causes about 390,000 deaths annually, predominantly children, young adults, and women. This thesis aimed to assess the burden of Rheumatic Heart Disease in Namibia and to evaluate the cost-effectiveness of a preventive strategy.

Methods: Data was obtained from primary and secondary sources in four distinct studies. The first study analysed the RHD outpatient and inpatient data from 2010-2020. The second employed a cross-sectional survey, incorporating a questionnaire with the EQ-5D-5L tool, to assess the health-related quality of life and healthcare usage pre- and post-RHD diagnosis. A systematic review was conducted in the third study synthesising preventive interventions, while the fourth study used a Markov model to evaluate the cost-effectiveness of a secondary prevention strategy in Namibia.

Results: The clinical RHD prevalence was estimated at 28 per 100,000 cases. From the survey, 83 RHD patients participated, predominantly women (77%) and primarily young adults aged 20-29 (41%). The majority (84%) had received surgical treatment. Notably, there was a significant increase in mean QALY from 0.773 pre-diagnosis to 0.941 post-diagnosis (p<0.001). The systematic review underscored the effectiveness of school and nurse-led prevention programmes. The health economic evaluation demonstrated that echocardiographic RHD screening was cost-effective, with an Incremental Cost-Effectiveness Ratio of N$ 28,516.75 per QALY gained, which falls below Namibia’s GDP per capita.

Conclusions: The findings highlight a significant gap in RHD data, particularly in high-endemic regions like Sub-Saharan Africa, emphasising the need for enhanced data quality and surveillance. The effectiveness of school-based and community-led programmes is apparent, but the scarcity of data from diverse regions limits a comprehensive understanding of optimal prevention strategies. Echocardiographic screening is identified as a feasible component of RHD secondary prevention in Africa, pointing towards a policy need for improved surveillance and data quality. Future research should investigate the impact of various interventions on RHD incidence and prevalence.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2024. p. 49
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2292
Keywords
Rheumatic Heart Disease, Prevention, Cost-effectiveness, Namibia
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Research subject
cardiovascular disease; Public health; Epidemiology
Identifiers
urn:nbn:se:umu:diva-222916 (URN)978-91-8070-330-7 (ISBN)978-91-8070-331-4 (ISBN)
Public defence
2024-04-26, Universitetsledningshuset (ULED), Triple Helix, Umeå, 09:00 (English)
Opponent
Supervisors
Funder
Familjen Erling-Perssons Stiftelse
Available from: 2024-04-05 Created: 2024-04-02 Last updated: 2024-04-08Bibliographically approved

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Shimanda, Panduleni PenipawaSöderberg, StefanLindholm, LarsNorström, Fredrik

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