Quality of life in patients with multidrug-resistant tuberculosis under programmatic condition using World Health Organization's Quality of Life Brief instrument: A case-control study

Abstract

Objective: To evaluate and compare the quality of life (QoL) in patients with multidrug-resistant (MDR-TB) and drug-sensitive (DS-TB) as well as to investigate factors associated with QoL among MDR-TB patients in real-world scenarios at the Haji Hospital, Surabaya.

Methods: We conducted a case-control study from June to December 2024. MDR-TB and DS-TB patients were classified into case and control groups, respectively. We used the World Health Organization’s Quality of Life Brief (WHOQOL-BREF) instrument and Patient Health Questionnaire-9 (PHQ-9) to assess QoL and depression levels, respectively. Multivariate analysis was used to analyze factors associated with QoL of patients with MDR-TB.

Results: Forty-one patients with MDR-TB and 43 with DS-TB were enrolled in the study. A mean score for all domains (physical, psychological, social relationship, environmental) and total mean score of WHOQOL-BREF was significantly lower in MDR-TB than those with DS-TB (P<0.05). The prevalence of depression and the mean score of PHQ-9 were significantly higher in MDR-TB than in DS-TB (P<0.05). PHQ-9 negatively correlates with the WHOQOL-BREF score (r=-0.502, P<0.05) among MDR-TB patients. MDR-TB patients with depression were significantly associated with low QoL in the physical (OR 3.611; 95% CI 2.393-6.951; P=0.029), psychological (OR 1.672; 95% CI 1.179-5.941; P=0.021), social relationship (OR 2.586; 95% CI 1.611-2.909; P=0.014), and environmental domains (OR 1.926; 95% CI 1.047-2.147; P=0.048).

Conclusions: MDR-TB patients had worse QoL than DS-TB. Those with depression were associated with low QoL. Strategies that identify and tackle alterations in the QoL for MDR-TB patients are necessary during TB treatment.

Keywords

Quality of life / MDR-TB / Tuberculosis / World Health Organization's Quality of Life Brief instrument / Depression

References

[1] World Health Organization. WHO consolidated guidelines on tuberculosis module 4: Treatment drug-resistant tuberculosis treatment 2022 update. Geneva: World Health Organization; 2022.

[2] World Health Organization. Global tuberculosis report 2022. Geneva: World Health Organization; 2022.

[3] Aggarwal AN. Quality of life with tuberculosis. J Clin Tuberc Other Mycobact Dis 2019; 17: 100121.

[4] Venkatesh U, Sharma A, Srivastava DK, Durga R. Health-related quality of life of multidrug-resistant tuberculosis patients: A study of eastern Uttar Pradesh, India. Indian J Tuberc 2022; 69(3): 347-353.

[5] Nurlaela S, Rahardjo S, Jayanti RD. Analysis of the quality of life of tuberculosis patients based on the SF-36 form (case study in Banyumas Regency). Indian J Tuberc 2024; 71(Suppl 2): 225-228.

[6] Yasobant S, Nazli Khatib M, Syed ZQ, Gaidhane AM, Shah H, Narkhede K, et al. Health-related Quality of Life (HRQoL) of patients with tuberculosis: A review. Infect Dis Rep 2022; 14(4): 509-524.

[7] Park HY, Cheon HB, Choi SH, Kwon JW. Health-related Quality of Life based on EQ-5D utility score in patients with tuberculosis: A systematic review. Front Pharmacol 2021; 12: 659675.

[8] Sineke T, Evans D, Schnippel K, Van Aswegen H, Berhanu R, Musakwa N, et al. The impact of adverse events on health-related quality of life among patients receiving treatment for drug-resistant tuberculosis in Johannesburg, South Africa. Health Qual Life Outcomes 2019; 17(1): 94.

[9] Araia ZZ, Mesfin AB, Mebrahtu AH, Tewelde AG, Tewelde AT, Ngusbrhan Kidane S. Health-related quality of life in tuberculosis patients in eritrea: Comparison among drug-susceptible and rifampicin/multidrug-resistant tuberculosis patients. Patient Relat Outcome Meas 2021; 12: 205-212.

[10] Izhar MD, Butar MB, Hidayati F, Ruwayda R. Predictors and health-related quality of life with short form-36 for multidrug-resistant tuberculosis patients in Jambi, Indonesia: A case-control study. Clin Epidemiol Glob Health 2021; 12: 1-6.

[11] Fuady A, Arifin B, Yunita F, Rauf S, Fitriangga A, Sugiharto A, et al. Stigma, depression, quality of life, and the need for psychosocial support among people with tuberculosis in Indonesia: A multi-site cross-sectional study. PLoS Global Public Health 2024; 4(1): e0002489.

[12] Abbasi-Ghahramanloo A, Soltani-Kermanshahi M, Mansori K, Khazaei-Pool M, Sohrabi M, Baradaran HR, et al. Comparison of SF-36 and WHOQOL-BREF in measuring quality of life in patients with type 2 diabetes. Int J Gen Med 2020; 13: 497-506.

[13] Sofiana L, Adi MS, Martini M, Rahaijo M. Psychometric attributes of WHOQOL-BREF among tuberculosis patients: Rasch model analysis. Int J Publ Health Sci 2023; 12(4): 1402-1412.

[14] Kodical SP, Roy R, Shetty D, Up N, Rajesh V, Chand S, et al. Exploring factors influencing the health-related quality of life of tuberculosis patients: A WHOQOL-BREF-based study. Monaldi Arch Chest Dis 2025; 95(1): 2913. doi: 10.4081/monaldi.2024.2913.

[15] Anisah SN, Djuwita R. Reliability and validity of WHOQOL-BREF into Indonesian version as a measure of quality of life of tuberculosis patients. Indian J Public Health Res Dev 2019; 10(12): 1972-1977.

[16] Dian CN, Effendy E, Amin MM. The validation of indonesian version of patient health Questionnaire-9. Open Access Maced J Med Sci 2022; 10(T7): 193-198.

[17] Lee EH, Kang EH, Kang HJ, Lee HY. Measurement invariance of the patient health questionnaire-9 depression scale in a nationally representative population-based sample. Front Psychol 2023; 14: 1217038.

[18] Khan AS, Phelan JE, Khan MT, Ali S, Qasim M, Napier G, et al. Characterization of rifampicin-resistant Mycobacterium tuberculosis in Khyber Pakhtunkhwa, Pakistan. Sci Rep 2021; 11(1): 14194.

[19] Izudi J, Engoru S, Bajunirwe F. Malnutrition is a risk factor for tuberculosis disease among household contacts: A case-control study in Uganda. Int J Infect Dis Regions 2024; 12: 100409.

[20] Putra ON, Yulistiani Y, Soedarsono S, Subay S. Early efficacy of individual regimens containing bedaquiline in patients with drug resistant tuberculosis. Asian Pac J Trop Med 2023; 16(4): 169-175.

[21] Wagnew F, Gray D, Tsheten T, Kelly M, Clements AC, Alene KA. Effectiveness of nutritional support to improve treatment adherence in patients with tuberculosis: A systematic review. Nutr Rev 2023; 82(9): 1216-1225.

[22] Soedarsono S, Mertaniasih NM, Kusmiati T, Permatasari A, Ilahi WK, Anggraeni AT. Characteristics of previous tuberculosis treatment history in patients with treatment failure and the impact on acquired drug-resistant tuberculosis. Antibiotics 2023; 12(3): 598.

[23] Setyawan MF, Mertaniasih NM, Soedarsono S, Nuha Z, Maladan Y, Matsumoto S. Mycobacterium tuberculosis-AtpE gene profile of bedaquiline-treated pulmonary tuberculosis patients at the referral hospital Dr. Soetomo, Indonesia. Int J Mycobacteriol 2023; 12(2): 122-128.

[24] Singh K, Hussain T, Gupta B, Pati S. A comparative investigation on cytokine expression in pulmonary tuberculosis and comorbidity with type 2 diabetes mellitus. Int J Mycobacteriol 2024; 13(2): 165-170.

[25] Chauhan A, Kumar M, Kumar A, Kanchan K. Comprehensive review on mechanism of action, resistance and evolution of antimycobacterial drugs. Life Sci 2021; 274: 119301.

[26] Li X, Fang X, Zhou L, Mao Y. Prevalence and factors associated with depression in patients with diabetes mellitus and pulmonary tuberculosis (DM-PTB): A hospital-based cross-sectional study. Int J Gen Med 2023; 16: 3465-3472.

[27] Suryaputri IY, Mubasyiroh R, Idaiani S, Indrawati L. Determinants of depression in indonesian youth: Findings from a community-based survey. J Prev Med Public Health 2022; 55(1): 88-97.

[28] Thampy P, Rupani A, Chullithala A, Pawar N. Prevalence of depression among drug-resistant tuberculosis patients in South Asia: A systematic review and meta-analysis. Indian J Psychiatry 2024; 66(10): 875-886.

[29] Shen R, Zong K, Liu J, Zhang L. Risk factors for depression in tuberculosis patients: A meta-analysis. Neuropsychiatr Dis Treat 2022; 18: 847-866.

[30] Louw J, Peltzer K, Naidoo P, Matseke G, Mchunu G, Tutshana B. Quality of life among tuberculosis (TB), TB retreatment and/or TB-HIV co-infected primary public health care patients in three districts in South Africa. Health Qual Life Outcomes 2012; 10: 77.

[31] Jo Y, Gomes I, Shin H, Tucker A, Ngwira LG, Chaisson RE, et al. Health-related quality of life of inpatients and outpatients with TB in rural Malawi. Int J Tuber Lung Dis 2020; 24(11): 1165-1171.

[32] Pang Y, Liu R, Song Y, Lv Z, Gao M, Nie L, et al. High incidence of psychiatric disorders associated with cycloserine treatment of multidrug-resistant tuberculosis patients: A cohort study in Beijing, China. Infect Drug Resist 2022; 15: 3725-3732.

[33] Theingi P, Kamiya Y, Myat Moe M, Cho San C, Cox SE. Depression and its associated factors among people with multidrug-resistant tuberculosis in Myanmar. Trop Med Int Health 2021; 26(9): 1117-1126.

[34] Susanto TD, Widysanto A, Cipta DA, Tanara A, Wirawan GR, Kosim AB, et al. Anxiety and depression level of patients with multidrug-resistant tuberculosis (MDR-TB) in two hospitals in Banten province, Indonesia. Dialogues Health 2023; 2: 100115.

[35] Azam M, Fibrina AI, Indrawati F, Septiani I. Prevalence and determinant of depression among multi-drug resistance tuberculosis: Study in Dr. Kariadi General Hospital. J Respir Indo 2020; 40(2): 88-96.

[36] Hamsaveni G, Amrutha AM, Sidenur B, Mangasuli V, Vijeth SB. Assessment of quality of life and social correlates among drug sensitive and multidrug-resistant tuberculosis patients. J Assoc Pulmonol Tamil Nadu 2024; 7(3): 100-104.

[37] Sartika I, Insani W, Abdulah R. Assessment of health-related quality of life among tuberculosis patients in a public primary care facility in Indonesia. J Glob Infect Dis 2019; 11(3): 102-106.

[38] Redwood L, Mitchell EMH, Viney K, Snow K, Nguyen TA, Dung LAT, et al. Depression, stigma and quality of life in people with drugs-usceptible TB and drug-resistant TB in Vietnam. Int J Tuberc Lung Dis 2021; 25(6): 461-467.

[39] Wang H, Gu J, Zhang L, Song Y. Assessing the quality of life in patients with drug-resistant tuberculosis: A cross-sectional study. BMC Pulm Med 2024; 24(1): 303.

[40] Laxmeshwar C, Stewart AG, Dalal A, Kumar AMV, Kalaiselvi S, Das M, et al. Beyond ‘cure’ and ‘treatment success’: Quality of life of patients with multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2019; 23(1): 73-81.

[41] Vaidya S, Bajaj E, Khurana AK, Gupta S. Change in psychological parameters and quality of life among individuals with pulmonary and extrapulmonary tuberculosis following the intensive phase of therapy: A longitudinal observational study from central India. Indian J Tuberc 2024; 71: 208-213.

[42] Rouf A, Masoodi MA, Dar MM, Khan MS, Bilquise R. Depression among tuberculosis patients and its association with treatment outcomes in district Srinagar. J Clin Tuberc Other Mycobact Dis 2021; 25: 100281.