Quality of life among adult Ostomates at Muhimbili National Hospital

Abstract

ABSTRACT Background: Intestinal stomas are an integral component of surgery as a means of diverting the bowel, either permanently or temporarily. Despite its significance, it is associated with adverse effects on the quality of life among ostomates. This negative impact has been argued to be cultural and context-dependent. Hence, it is crucial to comprehend the impact of intestinal stomas on the quality of life of ostomates in Tanzania and to devise interventions that mitigate negative effects and promote the well-being of patients. Aim: To study the clinical demography and its influence on stoma-specific quality of life among ostomates attending MNH. Methods: An analytical hospital-based cross-sectional study was conducted at MNH involving adult ostomates with intestinal stomas for at least 1 month. A stoma QoL-specific tool, validated through Swahili translation was employed. Participants were recruited from the ongoing ExLap study, theatre logs, and surgical outpatient department. The Chi-square test and logistic regression examined associations between clinical demographics and QoL scores. Additionally, Anova analysis was utilized to explore the relationships between clinical demography and various domains of stoma QoL. Results: This study involved 126 stoma patients with a male to female ratio of 1.4:1 and the majority were <65years of age in 80.2%. Malignant conditions were diagnosed in 76.2% with elective procedures being more common at 63.5%. The median stoma duration was 6.6 months, mostly temporary colostomies in 70.6%, with 71.4% receiving stoma care counseling? The median stoma-specific quality of life score was 50 (IQR 44-59) with majority, 66%, reporting suboptimal scores. Factors found to significantly influence QoL include: Age ≥ 65 years (AOR = 3.24, p = 0.009), and having received stoma care counseling (AOR = 3.23, p = 0.022). Elderly patients had higher self-esteem (14.04 ± 3.35, p = 0.001), having good family relations (26.76 ± 5.14, p= 0.028) influenced the other quality domains. Adjusting to stoma was significantly better among permanent ostomates (12.43 ± 3.09, p = 0.026). Conclusion: Majority of patients with stoma at Muhimbili National Hospital experience a suboptimal quality of life. Patients with advanced age and having stoma care counselling had a higher quality of life among ostomates. Patients with temporary stomas reported difficulties in managing their ostomy devices. More efforts such as pre and post-operative comprehensive stoma therapy services should be introduced to improve quality of life among ostomates in general.