Health-related quality of life and its determinants among ambulatory patients with epilepsy at Ambo General Hospital, Ethiopia: Using WHOQOL-BREF

Autoři: Gosaye Mekonen Tefera aff001;  Worku Asefa Megersa aff001;  Diriba Alemayehu Gadisa aff002
Působiště autorů: Department of Pharmacy, Clinical Pharmacy Unit, Ambo University, Ambo, Ethiopia aff001;  Department of Pharmacy, Pharmacology Unit, Ambo University, Ambo, Ethiopia aff002
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227858



Health‐related quality of life (HRQOL) is used as a measure of treatment outcomes, in addition to seizure control. Hence, the study was aimed to assess HRQOL and its determinants among adult patients with epilepsy (PWE).


A hospital-based cross-sectional study was conducted from April 20 to June 27/2019, through patient interviews and patient’s chart review (medication and clinical information). Data were analyzed using SPSS version 20. The psychometric property was done using Cronbach’s alpha test value of >0.7 as accepted internal consistency and Kaiser-Meyer-Olkin (KMO) measure of sample size adequacy value of ≥0.5 as acceptable construct validity, for Afaan Oromo version questionnaire. Multivariate linear logistic regression analysis was done to find predictors for the HRQOL score.


Of 121 PWE included in the study, 24.4% had overall poor HRQOL with the overall mean ±SD score of 56.42±10.96. The predictors for low overall HRQOL score were: presence of co-morbidity (B = -5.620, SE = 1.531, p<0.0001, 95% C.I = -8.656 to -2.584), uncontrolled seizure for at least 2 years (B = -4.239, SE = 1.296, p = 0.001, 95% C.I = -6.809 to -1.670), divorced (B = -8.423, SE = 2.241, p<0.0001, 95%C.I = -12.867 to -3.978) relative to married, and no education (B = -8.715, SE = -8.15, SE = 2.604, p = 0.001, 95%C.I = -9.648 to -1.316) relative to who had level of education above tertiary. In addition, uncontrolled seizure (irrespective of time since seizure-free) (B = -10.083, SE = 2.104, p<0.0001, 95%C.I = -14.256 to -5.910), being widowed (B = -9.300, SE = 3.594, p = 0.011, 95%C.I = -16.429–2.170) relative to married and being illiterate/no education (B = -13.004, SE = 3.910, p = 0.001, 95%C.I = -20.760 to -5.248) relative to educational level of tertiary and above were found to be the strongest negative predictors of HRQOL of physical health. Moreover, uncontrolled seizure (irrespective of time since seizure-free) (B = -12.668, SE = 2.019, p<0.0001, 95%C.I = -16.671 to -8.664) and being divorced (B = -10.153, SE = 3.228, p = 0.002, 95%C.I = -16.556 to -3.751) compared to married were strong predictors for low HRQOL score of psychological health. Absence of Poly-pharmacy (B = 9.050, SE = 3.027, P = 0.003, 95%C.I = 3.047 to 15.054), being single (B = -9.551, SE = 2.095, p<0.0001, 95%C.I = -14.419 to -4.683), and divorced (B = -11.022, SE = 3.351, P = 0.001, 95%C.I = -17.668 to -4.376) relative to married were found to be strong predictors for HRQOL score of social health. Moreover, low HRQOL score of environmental health was predicted by rural residence (B = -5.795, SE = 2.101, p = 0.007, 95%C.I = -9.962 to -1.628), co-morbidity (B+ -4.230, SE = 2.125, p = 0.049, 95%C.I = -8.444 to -0.015) & uncontrolled seizure irrespective of time since seizure-free (B = -6.907, SE = 1.945, p = 0.001, 95%C.I = -10.765 to -3.049) and uncontrolled seizure of at least 2 years (B = -4.520, SE = 1.798, p = 0.014, 95%C.I = -8.088 to -0.953).


The majority of the study participants had a good overall HRQOL. In general, a low level of HRQOL score was significantly associated with the marital status of single/widowed/divorced, low level of education, low level of monthly income, co-morbidity, uncontrolled seizure, and poly-pharmacy; irrespective of HRQOL domains. Therefore, it is required to improve HRQOL, by avoiding modifiable factors for PWE to achieve the optimum HRQOL.

Klíčová slova:

Environmental health – Epilepsy – Charts – Mental health and psychiatry – Psychometrics – Quality of life – Socioeconomic aspects of health – Tonic-clonic seizures


1. Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475–82. doi: 10.1111/epi.12550 24730690

2. Organization WH. Atlas: epilepsy care in the world, 2005. Atlas: epilepsy care in the world, 2005. 2005.

3. Epilepsy key facts [Internet]. World health organization. 2018 [cited October/ 1/2018]. Available from:

4. Ngugi AK, Bottomley C, Kleinschmidt I, Sander JW, Newton CR. Estimation of the burden of active and life-time epilepsy: a meta-analytic approach. Epilepsia. 2010;51(5):883–90. doi: 10.1111/j.1528-1167.2009.02481.x 20067507

5. Singh A, Trevick S. The epidemiology of global epilepsy. Neurologic clinics. 2016;34(4):837–47. doi: 10.1016/j.ncl.2016.06.015 27719996

6. Espinosa-Jovel C, Toledano R, Aledo-Serrano Á, García-Morales I, Gil-Nagel A. Epidemiological profile of epilepsy in low income populations. Seizure. 2018;56:67–72. doi: 10.1016/j.seizure.2018.02.002 29453113

7. Hong Z, Qu B, Wu XT, Yang TH, Zhang Q, Zhou D. Economic burden of epilepsy in a developing country: a retrospective cost analysis in China. Epilepsia. 2009;50(10):2192–8. doi: 10.1111/j.1528-1167.2009.02185.x 19583782

8. ATLAS epilepsy care in world 2005 [Internet]. 2005 [cited October/1/2018]. Available from:

9. Newton CR, Garcia HH. Epilepsy in poor regions of the world. The Lancet. 2012;380(9848):1193–201.

10. Diop A, Hesdorffer D, Logroscino G, Hauser W. Epilepsy and mortality in Africa: a review of the literature. Epilepsia. 2005;46:33–5.

11. Annual Report 2003 for the Global Campaign against Epilepsy [Internet]. 2003 [cited October/1/2018]. Available from:

12. Epilepsy in African region: Bridging the Gap [Internet]. ILAE. [cited October/ 01/2018]. Available from:

13. Worku DK. Review Article: Epilepsy in Ethiopia. American academy of neurology. 2013;80(7). doi: 10.1212/WNL.0b013e3182823361

14. Kinyanjui DW, Kathuku DM, Mburu JM. Quality of life among patients living with epilepsy attending the neurology clinic at Kenyatta National Hospital, Nairobi, Kenya: a comparative study. Health and quality of life outcomes. 2013;11(1):98.

15. Djibuti M, Shakarishvili R. Influence of clinical, demographic, and socioeconomic variables on quality of life in patients with epilepsy: findings from Georgian study. Journal of Neurology, Neurosurgery & Psychiatry. 2003;74(5):570–3.

16. Lim Y-J, Chan S-Y, Ko Y. Stigma and health-related quality of life in Asian adults with epilepsy. Epilepsy research. 2009;87(2–3):107–19. doi: 10.1016/j.eplepsyres.2009.08.014 19782536

17. Tegegne MT, Muluneh NY, Wochamo TT, Awoke AA, Mossie TB, Yesigat MA. Assessment of quality of life and associated factors among people with epilepsy attending at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. Science Journal of Public Health. 2014;2(5):378–83.

18. Rathor MY, Shahar MA, Omar AMB, Shah AS, Hasmoni MH, Draman CR, et al. Assessment of Knowledge, attitude and practices of Epilepsy Patients towards their illness and treatment in a tertiary care hospital in Kuantan Pahang Malaysia. Bangladesh Journal of Medical Science. 2017;16(4):545–53.

19. Shakir M, Al-Asadi JN. Quality of life and its determinants in people with epilepsy in Basrah, Iraq. Sultan Qaboos University medical journal. 2012;12(4):449. 23275841

20. Ashwin M, Rakesh P, Pricilla RA, Manjunath K, Jacob K, Prasad J. Determinants of quality of life among people with epilepsy attending a secondary care rural hospital in south India. Journal of neurosciences in rural practice. 2013;4(Suppl 1):S62. doi: 10.4103/0976-3147.116467 24174803

21. De Boer HM, Moshé SL, Korey SR, Purpura DP. ILAE/IBE/WHO Global Campaign Against Epilepsy: a partnership that works. Current opinion in neurology. 2013;26(2):219–25. doi: 10.1097/WCO.0b013e32835f2037 23449175

22. Alsaadi T, El Hammasi K, Shahrour TM, Shakra M, Turkawi L, Nasreddine W, et al. Depression and anxiety among patients with epilepsy and multiple sclerosis: UAE comparative study. Behavioural neurology. 2015;2015.

23. Tiki T, Birhanu A, Mamo K. Assessment of the Prevalence and Factors Associated to Perceived Stigma among Epileptic Patient who are on Follow up at Hospitals in West Shewa Zone, Central Ethiopia, Institutional Based Cross-Sectional Study, 2017. J Neurol Neurobiol. 2018;4(2).

24. Rakesh P, Ramesh R, Rachel P, Chanda R, Satish N, Mohan V. Quality of life among people with epilepsy: a cross-sectional study from rural southern India. Natl Med J India. 2012;25(25):261–4.

25. Choi-Kwon S, Chung C, Kim H, Lee S, Yoon S, Kho H, et al. Factors affecting the quality of life in patients with epilepsy in Seoul, South Korea. Acta Neurol Scand. 2003;108(6):428–34. doi: 10.1046/j.1600-0404.2003.00151.x 14616296

26. Bautista RE, Glen ET. Seizure severity is associated with quality of life independent of seizure frequency. Epilepsy Behav. 2009;16(2):325–9. doi: 10.1016/j.yebeh.2009.07.037 19713158

27. Thomas SV, Koshy S, Nair CS, Sarma SP. Frequent seizures and polytherapy can impair quality of life in persons with epilepsy. Neurology India. 2005;53(1):46. doi: 10.4103/0028-3886.15054 15805655

28. Gurshaw M, Agalu A, Chanie T. Anti-epileptic drug utilization and treatment outcome among epileptic patients on follow-up in a resource poor setting. Journal of Young Pharmacists. 2014;6(3):47.

29. MekonenTefera G, Woldehaimanot TE, Tarekegn M. Poor treatment outcomes and associated factors among epileptic patients at Ambo Hospital, Ethiopia. EUROPEAN JOURNAL OF THERAPEUTICS. 2015;21(1):9–16.

30. Niriayo YL, Mamo A, Kassa TD, Asgedom SW, Atey TM, Gidey K, et al. Treatment outcome and associated factors among patients with epilepsy. Scientific reports. 2018;8(1):17354. doi: 10.1038/s41598-018-35906-2 30478263

31. Chen Z, Brodie MJ, Liew D, Kwan P. Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic drugs: a 30-year longitudinal cohort study. JAMA neurology. 2018;75(3):279–86. doi: 10.1001/jamaneurol.2017.3949 29279892

32. Organization WH. WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment: field trial version, December 1996. Geneva: World Health Organization, 1996.

33. Birbeck GL, Hays RD, Cui X, Vickrey BG. Seizure reduction and quality of life improvements in people with epilepsy. Epilepsia. 2002;43(5):535–8. doi: 10.1046/j.1528-1157.2002.32201.x 12027916

34. Yue L, Yu P-m, Zhao D-h, Wu D-y, Zhu G-x, Wu X-y, et al. Determinants of quality of life in people with epilepsy and their gender differences. Epilepsy & Behavior. 2011;22(4):692–6.

35. Santos JRA. Cronbach’s alpha: A tool for assessing the reliability of scales. Journal of extension. 1999;37(2):1–5.

36. Lin C-Y, Chen H, Pakpour AH. Correlation between adherence to antiepileptic drugs and quality of life in patients with epilepsy: a longitudinal study. Epilepsy & Behavior. 2016;63:103–8.

37. Lin C-Y, Burri A, Fridlund B, Pakpour AH. Female sexual function mediates the effects of medication adherence on quality of life in people with epilepsy. Epilepsy & Behavior. 2017;67:60–5.

38. Reba K, Birhane BW, Gutema H. Validity and Reliability of the Amharic Version of the World Health Organization’s Quality of Life Questionnaire (WHOQOL-BREF) in Patients with Diagnosed Type 2 Diabetes in Felege Hiwot Referral Hospital, Ethiopia. Journal of diabetes research. 2019;2019.

39. O’brien RM. A caution regarding rules of thumb for variance inflation factors. Quality & quantity. 2007;41(5):673–90.

40. Taylor RS, Sander JW, Taylor RJ, Baker GA. Predictors of health‐related quality of life and costs in adults with epilepsy: A systematic review. Epilepsia. 2011;52(12):2168–80. doi: 10.1111/j.1528-1167.2011.03213.x 21883177

41. Viteva E. Impact of social factors on the quality of life of patients with refractory epilepsy. Acta Neurol Taiwan. 2013;22(2):51–8. 24030036

42. Asadi-Pooya AA, Sperling MR. Depression and anxiety in patients with epilepsy, with or without other chronic disorders. Iran Red Crescent Med J. 2011;13(2):112–6. 22737444

43. Alsaadi T, Kassie S, El Hammasi K, Shahrour TM, Shakra M, Turkawi L, et al. Potential factors impacting health-related quality of life among patients with epilepsy: Results from the United Arab Emirates. Seizure. 2017;53:13–7. doi: 10.1016/j.seizure.2017.10.017 29096164

44. Alexander HB, Broshek DK, Quigg M. Quality of life in adults with epilepsy is associated with anticonvulsant polypharmacy independent of seizure status. Epilepsy Behav. 2018;78:96–9. doi: 10.1016/j.yebeh.2017.11.006 29179106

Článek vyšel v časopise


2020 Číslo 1