Impact Of Tuberculosis Upon Patients ‘ Quality Of Life Who Undergo Directly Observed Treatment Short Course(DOTS) In AL-Amarah City

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Impact Of Tuberculosis Upon Patients' Quality Of Life Who Undergo Directly Observed Treatment Short Course(DOTS)
In AL-Amarah City

INTRODUCTION
Tuberculosis (TB) is one of the oldest infectious diseases known to affect humankind.Robert Koch identified Mycobacterium tuberculosis (MTB) as the cause of infection during his research in 1882 and introduced it as an infectious disease.Almost one-third of the world population is infected with MTB and during the past decade even industrialized countries have faced resurgence of Tuberculosis (1) .
Effective drugs for TB have been available since the 1940s, but the problem still abounds.People with TB need to take the drugs for at least six months, but many patients do not complete their course of treatment.For this reason, services for people ٢ with Tuberculosis often use different approaches to encourage people to complete their course of treatment (2) .
Directly Observed Treatment, Short Course (DOTS) is the internationally recommended strategy, to ensure cure of tuberculosis; it has become the standard for the diagnosis, treatment, and monitoring of tuberculosis worldwide and has been implemented in (187) out of (211) countries, covering more than (89%) of world's population (3) .In addition, there are numerous aspects of Tuberculosis that may lead to a reduction in quality of life (QOL).Treatment of TB requires prolonged therapy (at least 6 months) with multiple, potentially toxic drugs that can lead to adverse reactions in a significant number of patients, and there is considerable social stigma (4) .
QOL, which can be defined as a person's perception of his or her physical and mental health, covers broad domains including physical, psychological, economic, spiritual and social wellbeing.QOL has become an accepted outcome measure in clinical research, and advances have been made in assessing the impact of many diseases on QOL (5) .

OBJECTIVE:
To find the effect of Tuberculosis disease upon quality of life of patients who undergo Directly Observed Treatment Short Course (DOTS).

METHODOLOGY Design of the study:
A descriptive design was carried out at Respiratory and Chest Diseases out Patients' Clinic, from Nov 20 th , 2012 to July 11 th , 2013, in order to find the impact of tuberculosis upon quality of life of patients who undergo directly observed treatment short course (DOTS).A non-probability (Purposive sample) of (60) tuberculosis patients.The data are collected through the use of constructed questionnaire, which consists of two parts.Part one; socio-demographic data form.Part two; main domains of the quality of life, which consist of six domains: physical, psychological, level of independence, social, environmental, and spiritual domain.Evaluation of the quality of life domain items by using grand mean of score (MS), through intervals (1-1.66)good, (1.67-2.33)moderate, and (2.34-3) poor, as well as (HS), (S), and (NS) respectively.The data collection process has been performed from February 13 th, 2012 until the April 6 th , 2012.

Statistical Analysis:
The data of present study were analyzed through the application of two statistical approaches.(1) Descriptive statistical approach that includes Frequency, Percentage Mean of Score, and Comparison Significant.(2) Inferential statistical approach that includes Chi-Square test , T. test.Results were determined as highly significant at (P<0.01) significant at (P<0.05) and non significant at (P<0.05).

Table (1): Distribution of the Tuberculosis Patients' Socio-Demographical Characteristics
Table (1) shows the observed frequencies, percentage, of the studied basic information and socio-demographical characteristics variables.Relative to subject of age groups, the majority of the sample were reported at age group (40-45 yrs), and they are accounted (30.0%).Female group are accounted (51.7%), while male group are recorded (48.3%).Most of them had urban residency (61.7%), while the rural residency (38.3%).Regarding to the marital status, the majority of the sample are married (68.3%).According to the level of education, the greater numbers of them (56.7%) are illiterate.Relative to subject of Occupation status, the results indicated that a highest percentage (51.7%)are housewife, regarding to the socioeconomic status the majority of the study sample were within Low category (76.7%).This table reveals in light of mean of scores that the subjects responses in regarding to the (discomfort, energy and sleep) sub-domain were through interval (1-1.66) of the mean of score (good) at all items.In addition to that the study subjects responses to the (signs and symptoms) sub-domain, were through interval (1.67-2.33) of the mean of scores (moderate) at all items.This table reveals in light of mean of scores that the study subjects responses in regarding to the (negative emotions) sub-domain was through interval (1.67-2.33) of the mean of scores (moderate) at the items that their numbers (1, 2, 3), while at item number (4) the responding was through interval (1-1.66) of the mean of scores (good).In addition to that the study subjects responses to the (self-esteem) sub-domain was through interval(1.67-2.33) of the mean of scores (moderate) at all items.In addition to that the subjects responses to the (thinking) sub-domain was through interval (1-٦ 1.66) of the mean of scores (good) at items numbers (2,4), while at items numbers (1,3,5) the responding was through interval (2.34-3) of the mean of scores (poor).

34-3) poor, as well as (HS), (S), and (NS) respectively
This table show in light of mean of scores that the study subjects responses to the (mobility and travel) sub-domain were through interval (1-1.66) of the mean of scores (good) at item number (1), while at item number (2) the responding was through interval (1.67-2.33) of the mean of scores (moderate).

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This table reveals in the light of mean of scores, that the study responses to the (recreation) sub-domain was through interval (2.34-3) of the mean of scores (poor) at the items numbers (2, 3), while at item number (1) the responding was through interval (1.67-2.33) of the mean of scores (moderate).Also the subject's responses to the (social relationships) sub-domain was through interval (2.34-3) of the mean of scores (poor) at the items that their numbers (2,3, 4), while at items numbers (1,5) the responding was through interval (1-1.66) of the mean of scores (good).The study subjects responses to the (sexual relationships) sub-domain were through interval (1.67-2.33) of the mean of scores (moderate).Concerning the subjects responses to the (social support) sub-domain was through interval (1-1.66) of the mean of scores (good) at all items.Finally, in this table the study subjects responses to the financial status sub-domain were through interval (1-1.66) of the mean of scores (good).The table shows, in light of mean of score that the study subjects responses to the (house environment) were through interval (1.67-2.33) of the mean of score (moderate), at the items numbers (1,2), while at items numbers (3,4) the responding was through interval (1-1.66) of the mean of scores (good).In addition, regarding to the (physical environment) sub-domain the responses were through interval (1-1.66) of the mean of scores (good) at all items.The table shows in light of mean of scores that the study subjects respondents to both (negative and positive thinking) sub-domains were through interval (1-1.66) of the mean of scores (good) at the all items.

DISCUSSION
The findings of the present study indicated that the majority of the sample (51.7%) were females.This result comes along with Othman et.al., reported that the majority of the study sample were female (57.4%) (6) .We know that the most of TB patients living in the community rather than in hospital or their own center (isolated), and because female (Mother, wife, sister, etc) are more contact with the patient in terms of caring, treatment, catering.The majority of the study sample (61.7%) living at urban residential area.This result agree with Amare et.al., reported that the result of this study indicated that the majority of study sample (61.8%) living in urban (7) .Because urban area characterized by abundance crowded and environmental pollution such as (smolder of factories and cars, etc.)All of these factors help to prevalence of TB.

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Relative to marital status, the majority of study sample (68.3%) were married.This result agree with Masood et.al., reported that study findings indicated that the majority of the study sample are married (78.3%) (8) .The high casualty rate among married couples means that the disease is the result of transmission between spouses.
The majority of the study sample was illiterate (56.7%).This result is agrees with Dhuria et.al., reported that the majority of the study subjects are illiterate (48%) (9) .People who are not educated they have not health awareness, which leads to a lack of compliance to vaccination, health advices, and health programs.
Regarding occupational status, the majority of study sample (51.7%) are housewife.this result agree with Hussain et.al., which reported that the majority of sample were house wife (41%) (10) .most patients with TB treated at home that is means the housewife is more susceptible to infection than others.
Relative to socio-economic status, the majority of the study sample is within Low category (76.7%).this result agree with Jethani et.al., the findings of this study indicate that the majority of the study sample (90.3%) were belonged to low socioeconomic status (11) .So-called TB (poor people disease).
The result of the present study show that the response of sample regarding to the physical domain were good evaluation.Many studies results such Guo, et.al., indicated that the first positive effect during treatment appears on the physical domain (12) .In addition moderate evaluation for social, psychological and level of independency domains in light of study subject responses having moderate evaluation.Moreover the environment and spiritual domains, having good evaluation.In fact when we examine something among the Iraqis people, we must stand with respect for those people who are being patience against all of wars and conflicts, and the specific reason for this, we think that because they are still characterized by some morals and believe which direct their feelings and behavior.Present study agrees with Guo, et.al. (2009), that the tuberculosis had a substantial and encompassing impact on patients' quality of life (12) .Overall, the anti-tuberculosis treatment had a positive effect of improving patients' quality of life; their physical health tended to recover more quickly than the mental well-being.However, after the patients successfully completed treatment and were microbiologically cured, their quality of life remained significantly worse than the general population.
Aggarwal (2010), the impact of any disease, especially a chronic illness like tuberculosis, on an individual patient is therefore often all-encompassing, affecting not only his physical health but also his psychological, economic, and social wellbeing.Our findings suggest that HRQoL is markedly impaired across all domains in patients of pulmonary tuberculosis and improves rapidly and substantially with antitubercular therapy (13) .

CONCLUSION:
The present study concludes that tuberculosis affect on the patients quality of life domains, the maximum effect presented by the social domain, followed by the psychological domain, level of independence domain, then the physical domain.Tuberculosis most common occurs among persons in urban residential area than in those in rural, females more than males.Tuberculosis most common occur among persons low level of socio-economic status, and education.