Socio-demographic profile of respondents
A total of 371 participant questionnaires were complete, and considered for a subsequent analysis. Mean (SD) of age was included in the study, 215 (58%) were from health centers, 200 (54%) were aged 43 years or below, 233(62.8%) were males, 225(60.6%) were either with primary or secondary education, 262(70.6%) were Orthodox Christian, 186(50%) were either government or private employees, 173(46.6%) were married and 343 (92.5%) do not have a current history of any substance use (table 1).
Table 1: Socio-demographic profiles of respondents, Addis Ababa, Ethiopia, August 2020 (n=371)
Variable
|
Label
|
Frequency
|
Percent
|
Facility
|
Health center
|
215
|
58.0
|
|
Hospital
|
156
|
42.0
|
Age (Yrs.)a
|
|
|
|
|
=<43
|
200
|
53.9
|
|
>43
|
171
|
46.1
|
Sex
|
|
|
|
|
Male
|
138
|
37.2
|
|
Female
|
233
|
62.8
|
Education level
|
|
|
|
|
Not/able to read and write
|
87
|
23.5
|
|
Primary/high school education
|
225
|
60.6
|
|
College/university education
|
59
|
15.9
|
Religion
|
|
|
|
|
Orthodox Christian
|
262
|
70.6
|
|
Protestant Christian
|
57
|
15.4
|
|
Muslim
|
46
|
12.4
|
|
Others b
|
6
|
1.6
|
Occupation
|
|
|
|
|
Merchant
|
17
|
4.6
|
|
Government /private employee
|
186
|
50.1
|
|
Student
|
17
|
4.6
|
|
Housewife/jobless
|
119
|
32.1
|
|
Others c
|
32
|
8.6
|
Marital status
|
|
|
|
|
Unmarried
|
89
|
24.0
|
|
Married
|
173
|
46.6
|
|
Widowed/separated
|
109
|
29.4
|
Current substance use history
|
|
|
|
|
No
|
343
|
92.5
|
|
Yes
|
28
|
7.5
|
Remark: a categorized based on mean age of respondents; b indicates: Catholic, Waqe feta and Jehovah witness; c indicates: prostitutes, daily laborers and ‘safety net’ aid receivers.
EQ-5D-3L functional health states
The descriptive presentation of EQ 5D items illustrate that majority of the clients had no problems. Yet, an increasing trend of affected health dimension was noted as moderate problems persist in self-care (15, 4%), usual activity (18, 4.9%), mobility (36, 9.7%), pain/discomfort (75, 20.2%) and depression /anxiety (89, 24%). Severe/extreme problems were apparent for pain/discomfort and depression/anxiety dimensions reported by 4(1.1%) and 10(2.7%) of the clients respectively (figure 1).
When an age-wise distribution of EQ 5D elements were assessed, level II to level III problems were more pronounced in the age group beyond 43 for mobility, self-care and usual activities. Frequent reports were noted on pain/discomfort (21.2%) and depression/anxiety (23.2%) in the lower age group. These dimensions have also accounted a relatively higher percentage of severe problems in the late age group (table 2).
Table 2: Age-wise classification of EQ 5D items among clients on ART in Addis Ababa, August, 2020
Age category (yrs.)
|
|
EQ-5D-3L scale
|
|
Mobility
n (%)
|
Self-care
n (%)
|
Usual activities
n (%)
|
Pain/ discomfort
n (%)
|
Depression/
anxiety
n (%)
|
<=43
(n=203)
|
Level 1
|
188(92.6)
|
197(97)
|
196(96.6)
|
159(78.3)
|
147(72.4)
|
Level 2
|
15(7.4)
|
6(3)
|
7(3.4)
|
43(21.2)
|
47(23.2)
|
Level 3
|
0(0)
|
0(0)
|
0(0)
|
1(0.5)
|
9(4.4)
|
|
|
|
|
|
>43
(n=168)
|
Level 1
|
146(86.9)
|
158(94)
|
156(92.9)
|
133(79.2)
|
125(74.4)
|
Level 2
|
21(12.5)
|
9(5.4)
|
11(6.5)
|
32(19)
|
42(25)
|
Level 3
|
1(0.6)
|
1(0.6)
|
1(0.6)
|
3(1.8)
|
21(0.6)
|
Remark: Level I=no problems, level II=some/moderate problems, level III=severe/extreme problems
Functional and current health status
A functional and current overall health status was derived from EQ 5D-3L and EQ VAS scores respectively. The mean (SD) score of EQ 5D index values was 0.87 (±0.05) ranging from 0.64 to 0.90. And, mean (SD) of EQ VAS was 81 (±15) ranging from 40 to 100. About 230 (62%) of the respondents scored an index value above the mean for functional health states on the EQ 5D dimensions whilst 213 (57.4%) scored above the mean for current overall health status (figure 2).
Correlates of functional and current health status
Multiple predictors have been tested for potential association with both functional and current overall quality of life. These two outcome variables, with a statistically significant positive correlation (r=0.5, p=0.000), reflect the functional and current overall health rating of clients respectively. Age, income and duration of disease did not show any correlation with both outcomes using the spearman’s test. The outcome variables showed a non-normal distribution hence, necessitating options in non-parametric statistics. Accordingly, the Kruskal Wallis test showed that no associations exist between the dependent variables versus education level, marital status and occupation of clients.
Meanwhile, a Mann Whitney test revealed that mean rank of EQ 5D and EQ VAS scores were higher among clients with no comorbidity, no sleep disturbance and those visiting health centers. A higher rank of EQ 5D index value, but not EQ VAS, score was noted among clients with least/neutral to issues for getting help from others and those with 8 years or less duration on ART medication. In the contrary, only EQ VAS score was higher among clients with no current history of any substance use (table 3).
Table 3: Correlates of functional and current overall health status among clients on ART in Addis Ababa, Ethiopia, August 2020 (n=371)
Characteristics
|
|
|
EQ 5D index values (0.4-0.9)
|
EQ VAS scores (40-100)
|
N
|
Mean rank
|
U
|
P-value
|
Mean rank
|
U
|
P-value
|
Comorbid condition
|
|
|
|
|
|
|
|
|
|
No
|
282
|
198.6
|
8997.0
|
0.000*
|
200.12
|
8568.0
|
0.000*
|
|
Yes
|
89
|
146.1
|
141.27
|
Current history of any substance use
|
|
|
|
|
|
|
|
|
|
No
|
343
|
185.99
|
4806.0
|
0.993
|
190.47
|
3267.5
|
0.004*
|
|
Yes
|
28
|
186.14
|
131.20
|
Presence of sleep disturbance
|
|
|
|
|
|
|
|
|
|
No
|
293
|
199.51
|
15385.0
|
0.000*
|
195.75
|
14284.0
|
0.001*
|
|
Yes
|
78
|
135.56
|
149.37
|
Facility type
|
|
|
|
|
|
|
|
|
|
Health center
|
215
|
203.35
|
13039.00
|
0.000*
|
219.07
|
9660.5
|
0.000*
|
|
Hospital
|
156
|
162.08
|
|
140.43
|
Getting help from others
|
|
|
|
|
|
|
|
|
|
Difficult
|
158
|
155.05
|
21716.5
|
0.000*
|
179.21
|
17900.0
|
0.286
|
|
Neutral/easy
|
213
|
208.96
|
191.04
|
ART duration (Yrs.)
|
|
|
|
|
|
|
|
|
|
<=8
|
213
|
194.46
|
15025.0
|
0.043*
|
180.20
|
18062.0
|
0.219
|
|
>8
|
158
|
174.59
|
193.82
|
*Indicates a significance level at P< 0.05.