The life quality of people living with chronic disease in Africa: a systematic narrative synthesis

¹Functional Ecology and Environment Engineering Laboratory, Faculty of Sciences and Technology, Sidi Mohamed Ben Abdellah University (USMBA), Fes, Morocco, ²Higher Institute of Nursing Professions and Health Techniques, Meknes, Morocco

^&Corresponding author
Badre Bakzaza, Functional Ecology and Environment Engineering Laboratory, Faculty of Sciences and Technology, Sidi Mohamed Ben Abdellah University (USMBA), Fes, Morocco

Introduction    

The World Health Organization (WHO) defines quality of life (QoL) as “an individual´s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns” [1]. Health-related quality of life (HRQoL) addresses health-related domains that are impacted by elements such as physical, psychological, social, and environmental aspects. HRQoL may thus be described as a person´s perceived quality of life, indicating satisfaction in areas of life that are likely to be impacted by health conditions. In other words, QoL is a complex concept that is influenced by an individual's physical and mental well-being, degree of autonomy, social relationship, personal convictions, and connection to prominent elements in the environment [2].

The word “chronic” is often used for a disease lasting over three months [3]. In the scholarly literature and professional societies, the term "chronic disease" is used to describe an extensive list of conditions. Common chronic diseases include arthritis, asthma, cancer, chronic obstructive pulmonary disease, diabetes, and viral diseases such as hepatitis C and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) [4]. Likewise, Chronic diseases are often associated with non-communicable diseases, which are distinguished by their non-infectious origins [5]. In fact, the most common cause of death globally is chronic disease, which is becoming more common in all age groups, genders, and racial/ethnic groups. Although they are a major health concern in developed countries as well, the majority of deaths from chronic diseases occur in middle-to-low-income countries (LMICs) [6]. The number of deaths worldwide from chronic diseases increased from 27 million in 1990 to 39.5 million in 2016 [7]. Changes in demographics are happening in tandem with the worldwide chronic disease crisis. According to estimates from the WHO, chronic disease causes 38 million (63%) of the deaths that occur each year [7]. In the United States, at least two chronic diseases affect 40% of adults [8].

Nowadays, the co-occurrence of two or more chronic diseases in one person is becoming increasingly common because of the growing senior population brought by higher life expectancies [9]. The burden of chronic diseases predominantly impacts LMICs, which also cause over three-quarters of chronic disease-related mortality [4]. Because of limited access to healthcare, low health literacy, and socioeconomic inequality among LMICs, health systems are becoming more worried about patients with chronic diseases. Moreover, the increased prevalence of multimorbidity makes patients suffer from an additional burden of therapy in addition to the weight of disease symptoms. In effect, patients with many medical conditions are more likely to confront complicated drug schedules, the use of multiple drugs, low adherence, and adverse drug-related events [10].

Numerous studies conducted in developed countries have shown that HRQoL with chronic diseases is a reliable indicator of mortality and hospitalizations. Thus, a major result of effective disease management is most often a reduction in deterioration or improving QoL [11]. Consequently, enhancing the QoL of individuals suffering from chronic disease is imperative to managing the evolution of the disease and preventing complications [12].

One of the primary goals of health research continues to be assessing the QoL in people with chronic diseases. So various techniques and instruments for assessing life quality have been created with the aim of obtaining a comprehensive assessment encompassing physical, emotional, psychological, and social facets [13]. This study contributed to enriching the existing literature on HRQoL in Africans with chronic diseases by conducting a comprehensive review of several studies conducted in Africa. It included studies examining the medical, psychological and social factors that affect quality of life. In effect, by synthesizing the findings from the selected studies, this review aimed to enhance our understanding about the complex of taking care of person with chronic diseases.

The main objective of this systematic narrative synthesis is to study the quality of life among people living with chronic diseases in Africa. In terms of specific objectives, this study has three specific objectives. First, decorticating all facets of HRQoL in patients with chronic diseases in Africa. Second, determining the tools used to measure the HRQoL in patients with chronic diseases through the selected studies. Third, providing a framework for developing interventions to increase HRQoL outcomes for patients living with chronic diseases in Africa.

Methods     

Review design: this systematic review was carried out in accordance with the guidelines of Preferred Reporting Items for the Systematic Review and Meta-Analysis (PRISMA).

Search strategy: we used the Scopus online database as our study source. We limited the study search to studies published between June 2019 and October 14^th, 2023. The study search was based on using appropriate keywords in English (“life quality” or “quality of life” or “health related quality of life”), and (“chronic disease”) and (“Africa”).

Study eligibility: to preserve articles for eligibility, certain inclusion and exclusion criteria were set. First, the date criteria are designed to keep all studies published between June 2019 and October 14^th, 2023. Second, the geographical criteria are designed to preserve all research conducted in Africa. Third, the matching designed to retain articles in line with the study objectives. Fourth, the type of study criteria designed to keep original articles. Fifth, the language criteria designed to preserve articles published as a full manuscript in English.

Data collection process: the records of articles, published between June 2019 and October 14^th, 2023, identified through Scopus were exported to the Zotero software, which allowed for the removal of redundant studies and the download of their complete texts (no duplicate results were identified). After two authors (BB and LH) independently screened the title and abstract from the collected articles to identify studies conducted in Africa and studies that align with the objective of our review. Once these two criteria have been applied, the studies that have passed the screening stage are then evaluated through a careful reading of the full manuscripts with reference to the remaining eligibility criteria. Indeed, studies that met the eligibility criteria were then included in the data extraction and synthesis. All the process of selection studies were carried out using The Preferred Reporting Items for the Systematic Review and Meta-Analysis (PRISMA) diagram, as seen in Figure 1. Ultimately, twenty-three articles n=23 were selected following a thorough screening of titles, abstracts as well as an in-depth reading.

Synthesis of the study: the selected articles that complied with the eligibility were extracted using some tools namely: Nvivo software and EXCEL software. The database extracted from the studies selected was based on author, year of publication, title, country of study, study type, study design, study method, sample, purpose design, findings, and study reference. Consequently, extracted data were used to complete the narrative synthesis. Thus, as qualitative research, this systematic review collects study information on the quality of life among people living with chronic diseases in Africa.

Results     

Despite the importance that all health systems give to the QoL, especially for people with chronic disease, few studies have drawn attention to this subject. This review led to bring out the recent studies turning around factors that can influence the QoL in patients living with chronic disease (Table 1, Table 1.1, Table 1.2, Table 1.3, Table 1.4). In general, there are 23 studies from 10 countries in Africa (Figure 2), inter alia, 10 in Ethiopia, 4 in Nigeria, and 2 in Morocco (Table 2).

The distribution per year of the studies selected for this review is as follows: 7 in 2023, 6 in 2022, 1 in 2021, 6 in 2020, and 3 in 2019 (Figure 3).

For the subject of articles retained in this review were: 8 studies about QoL in diabetic patients, 6 about QoL in people living with HIV, 4 studies about QoL in people with two or more chronic diseases, 2 studies about renal failure, and 1 study for each of blood pressure, epilepsy, and breast cancer.

Discussion     

Quality of life (QoL) in diabetic patients: every study on diabetes that was retrieved for this review showed that patients with diabetes in Africa experience daily declines in their QoL [14-21]. To measure the HRQoL in diabetic people, the majority of searchers employed the Audit of Diabetes Dependent Quality of Life scale (ADDQoL) and World Health Organization Quality of Life-Brief 26 (WHOQoL-bref 26) with the exception of one that used in-person interviews to gather information on sociodemographics, behavioral, clinical, and HRQoL factors.

This study revealed factors that influence the life quality of diabetic people in Africa such as old age, longer-term diabetes fasting blood sugar level, poor socioeconomic status, living in a rural area, human insulin treatment, higher prevalence of hospitalization for ketoacidosis and infectious complications had a significant association with lower QoL. In contrast, freedom from diabetes-related complications, physical exercise, general diet, and foot care were significantly associated with a better quality of life for patients. This synthesis's recommendations to improve the QoL for diabetic patients were emphasized, including the availability of standard treatments and the avoidance of complications from the disease. Furthermore, it is essential to provide diabetic patients with accurate lifestyle advice, paying particular attention to elderly patients and those living in rural areas.

Quality of life (QoL) in people living with HIV/AIDS: regarding studies that brought out the QoL in people living with HIV/AIDS in Africa, results showed that the HRQoL in these people is worse either physical or psychological [22-27]. The searchers in this review used many instruments to evaluate QoL and to correlate it with some variables. Most of the authors used the questionnaire WHOQoL bref-HIV and others combined this tool with standardized scales to evaluate fatigue, insomnia, stigma, and post-traumatic stress symptoms.

Overall, the studies included in this review found that the poor life quality of people living with HIV/AIDS is related to unemployment, comorbidity, traumatic stress, stigma, poor physical fitness, fatigue, insomnia, and the lack of social support from family. On the other hand, the study that correlated HRQoL in patients with HIV/AIDS to physical activity identified the positive impact of this variable on people living with HIV/AIDS. Additionally, the study that aim to explore the HRQoL in subjects aged 8-14 years identified slow growth as the principal factor that influence negatively the QoL in this group of patients. This result was found by combining some tools as follows: height, weight, mid-arm circumference and skin folds, body mass index activity pedometer, and HRQoL questionnaire. Therefore, younger patients may need mental health services to manage their illness.

Quality of life (QoL) in hypertensive patients: the searcher in the study that looked into the factors that influence HRQoL in hypertensive people used WHOQoL bref-26 questionnaire [28]. So, this study reveals that age, duration of antihypertensive treatment, low social support, physical inactivity, co-morbidity, being a widow, khat chewing, and being single were the principal predictors of lower QoL in hypertensive people in Africa. Indeed, the study suggests that, in order to improve the QoL, government, non-governmental organizations, and health professionals should give careful attention to hypertensive people, and the healthcare system should introduce a new more relevant therapeutic approach [28].

Quality of life (QoL) in patients with renal failure: authors in studies retrieved for this review used The Kidney Disease Quality Of Life scale (KDQoL) to determine the quality of life in people suffering from kidney disease [11,29]. The study participants conveyed that their quality of life is declining in certain areas due to various factors, including age, gender, familial relationships, educational attainment, the existence of a transplant plan, the presence of comorbidities, and the length of time they receive hemodialysis. It was discovered that there was a relationship between the overall quality of life score, the "Burdens of Kidney Disease" score, and the "Effects of Kidney Disease on Daily Living" score. There is not, however, any conclusive link with caregiver support. Therefore, the family and the medical staff must be more actively involved in the management of these patients in order to preserve their high quality of life. This management must be based on the psychological support process.

Quality of life (QoL) in epileptic patients: the author of the study that explores QoL in epileptic patients chose interviews using WHOQoL-BREF [30]. This study revealed that the factors which have an impact on the quality of life of epileptic patients are perceived stigmatisation, frequent crises, comorbid depression, and anxiety, non-adherence to anti-epileptic drugs, side-effects of anti-epileptic drugs, and lack of social support.

Quality of life (QoL) in women with breast cancer: the study that explored the QoL in women with breast cancer showed that perceived social support, religiosity, hope, optimism, and discovery of benefits were positively associated with post-traumatic growth. Likewise, religiosity and post-traumatic growth were positively associated with HRQoL [31]. To prove that, the author used questionnaires on social support, religiosity, hope, optimism, benefit-seeking, post-traumatic growth, and WHOQoL scale.

Quality of life (QoL) in patients with two or more chronic diseases: for studies targeting QoL in people with two or more chronic diseases, the results revealed that these individuals have low HRQoL overall [32-35]. In summary, the investigations indicated that a number of clinical and sociodemographic variables either directly or indirectly affected QoL. In fact, there is a strong correlation between comorbidity, insomnia, social support, and quality of life as well as common mental health disorders and occupation. In general, the authors in these studies used WHOQoL scale.

Conclusion     

This systematic narrative synthesis assessed the life quality of people living with chronic diseases in Africa. In fact, all studies included in this synthesis show that chronic disease affects various parameters such as physical well-being, psychological status, social relationship, and economic status in a patient´s life, thus touching the QoL. It is for these reasons that the management of these patients must include not only homeostasis, and the treatment of somatic complications, but also the evaluation of individual patient satisfaction, which results in an improvement in their quality of life. Thereby, findings of the present synthesis showed the need to investigate further the QoL of patients with chronic diseases and it is necessary to include the recommendations of the investigation of HRQoL as part of the routine care system.

Competing interests     

The authors declare no competing interests.

Authors' contributions     

Badre Bakzaza, Hanane Lemmih, and Sidi Mohammed Raoui conceptualized and designed the study. Badre Bakzaza and Hanane Lemmih selected the relevant studies, collected, and interpreted data. All authors contributed to the draft of the work. Saad Rachiq and Faouzi Errachidi and Omaima El Bouazzi reviewed the work critically for important intellectual content. Saad Rachiq and Sidi Mohammed Raoui gave the last approval for the version to be published. All the authors read and approved the final version of this manuscript.

Tables and figures     

Table 1: key findings of African studies, carried out from January 1^st, 2019 to October 14^th, 2023, included in the systematic review

Table 1.1: key findings of African studies, carried out from January 1^st, 2019 to October 14^th, 2023, included in the systematic review

Table 1.2: key findings of African studies, carried out from January 1^st, 2019 to October 14^th, 2023, included in the systematic review

Table 1.3: key findings of African studies, carried out from January 1^st, 2019 to October 14^th, 2023, included in the systematic review

Table 1.4: key findings of African studies, carried out from January 1^st, 2019 to October 14^th, 2023, included in the systematic review

Table 2: number of African studies, carried out from January 1^st, 2019 to October 14^th, 2023, included in this systematic review per country

Figure 1: PRISMA flow diagram

Figure 2: geographical distribution of African studies, carried out from January 1^st, 2019 to October 14^th, 2023, included in this systematic review

Figure 3: distribution per year of African studies, carried out from January 1^st, 2019 to October 14^th, 2023, included in this systematic review

References