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Abstrict
To assess the quality of life of Covid- 19 survivors with co-morbidities, association with gender and impact on their physical, and mental health, pain, self-care, and social activities. An online descriptive study was carried out in Khyber Pukhtoon Khwa from 12th January- 2021 to 12th March- 2021, with a 377 sample size from Raosoft online calculator. All COVID-19-recovered individuals with co-morbidities, a negative PCR, aged 18 and above, literate, residents of Peshawar and having smartphone/laptop/ internet access were included while the ones having no consent, hospitalized and severe patients were excluded from the study. Descriptive statistics with frequency, percentage, mean and standard deviation however, inferential statistics were calculated for associations through Chi-square and paired t-tests with a significant p-value set at 0.05. The survey response rate was 51.4 % (n=193) out of 377. The participants had a mean age of 35 years (SD= 10.207, range= 16- 70 years). The highest responses were received from 22 years of age (26.3 %). The EQ5D mean score was 1.227 (SD= 1.89). The most frequently reported problem was anxiety/depression (54.8%) followed by pain/discomfort (46.8%), problems with usual activities (39.6%), mobility (26.7%) and self-care (15.1%). EQ5D showed a strong association with chronic diseases and significant p values for mobility, usual activities, and pain/discomfort (0.000) with 0.003 for anxiety/depression. COVID-19 survivors were associated with a substantial measurable decrease in their quality of life.
Keywords
COVID-19, Persistent Symptoms, Health-Related Quality of Life, Health Disparities, Disabilities, Mental Health
Introduction
Viral diseases continue to emerge and present a significant threat to public health. The coronavirus is an infectious disease in humans. The first case was reported in Wuhan-China in late December 2019. (WHO 2020) Soon after its emergence it became an outbreak and by mid-March 2020. WHO declared it as a global pandemic due to the rapid spread of this disease thereby affecting countries worldwide. (Cucinotta 2020) Covid-19 spread frequency was estimated to be at 4.08, and each individual case was responsible to add up four more cases further. Since its start, the cases reported so far have alarmingly increased by 21-fold and WHO claims the fatality rate of covid-19 to be 2%. WHO and the health care authorities worldwide took an active part in the control of its spread, as this crisis had a very significant effect on human health and wellbeing causing psychological distress, anxiety and panic in the masses. (Wang 2020) Covid- 19 in Pakistan became worse with time and reported 420, 000 people and more than 8, 300 attributed deaths. Pakistan faced the consequences of this pandemic with the poverty level at 33.7% further causing economic loss, changes in environmental factors and social effects. (Rasheed 2021).
A Chinese Survey of the elderly population depicted them as the most vulnerable population to Covid-19 with weak immune systems with high levels of psychological stress. Japanese individuals showed dismissal, accusation and segregation from society, which in turn deteriorated their physical health and lowered life expectancy. Every country during the pandemic situation tried to tackle the problem with their own resources and carried out research too for baseline data. A Moroccan study was carried out after two months of the quarantine period for Covid-19. Quality of life was measured and found to not only affected the diseased persons but healthy individuals as well. Many foreign types of research have been conducted on quality of life (QoL) among Covid-19 survivors. A Chinese online survey used the Euro Quality of Life 5- Dimension (EQ-5D) scale with five health dimensions and provided health-related quality of life during the pandemic situation. Another online health-related QoL survey also used EQ- 5D research tool. An Indian study was conducted through online applications and COVID-19 anxiety was measured through a six-item scale of five from never (0) to always (4). Higher scores indicated high anxiety and likewise. (Kharshiing 2020)
A Pakistani Online Survey used SF-12 (Short Form Health Survey) and analyzed post-Covid QoL and symptoms among 331 persons from all over Pakistan, and noted variables such as fever, diarrhoea, headache, body aches, loss of smell, low mood and cough. After the early Covid- 19 pandemic another Online Pakistani study was conducted in Punjab with 1002 adult participants of 19- 45 years of age, to determine the direct and indirect relationship between obsession, stress, satisfaction and purpose in life. A descriptive study conducted in Hyderabad in six months from 2021- 2022 used the Hamilton Depression Rating Scale (HDRS) and quality of life assessed through 16 items scale of 158 individuals.
Quality of life assessment in post covid recovered patients and especially with comorbidities has been a neglected subject and very scarce data is available in this province. Such a study has not been done in Pakistan to the best of the researcher's knowledge and internet browsing. To get information and baseline data, this present study was planned to assess the quality of life among the Covid- 19 survivors with comorbidities, determine an association with gender, and the impact on their physical, and mental health, pain, self-care and social activities.
Methodology
A descriptive study was conducted as an online survey in Peshawar- Khyber Pukhtoon Khwa in two months duration from 12th January- 2021 to 12th March- 2021. The sample size of 377 was calculated from an online calculator, with a 5% margin of error, 50 % distribution rate and 95% confidence interval. Among the total only 194 participants completed it, and one went missing with a response rate of 51.4 %. Ethical approval was taken from Institutional Ethical Review Board Committee (IERC) (ERC Approval Number: Prime/ERC/2020- 05).
Euro Quality of Life 5-dimension (EQ- 5D) was used to assess the quality of life with mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The scores for this scale range from 0 meant for death and 1 for perfect health. The EQ-5D questionnaire had a Visual Analog Scale (VAS), ranging from 0 (the worst possible health status) to 100 (the best possible health status) for the overall health status. Another also tool used was HRQOL, which was for adults, designed for clinical use, short and easy to administer for social, physical and psychosocial domains with easy scoring criteria.
All COVID-19-recovered individuals with negative PCR, aged 18 and above, literate, having smartphone/laptop/ internet access and KPK residents with an agreement to participate were recruited through a purposive sampling technique. Whereas, all Post COVID- 19 recovered individuals with negative PCR who refused or did not consent to participate; hospitalized, post-COVID-19
Serious persons, admitted in ICUs (Intensive Care Units) and
CCUs (Cardiac Care Units) were excluded from the study.
The variables assessed were age, sex, educational status, occupation, monthly income, location, marital status, any chronic disease, any fear of Covid- 19, when covid test is done, covid influence on social activities, marital life, diet patterns, sleep, working stability, exercise, relations with parents, learning, income, relations with friends and on children education. More variables assessed in terms of health status were mobility, self-care, activities, pain/discomfort and depression/ anxiety. Ethical considerations were duly taken care of with the voluntary induction of the participants. Informed consent and confidentiality were maintained at all levels regarding consent, data storage and management. The 4th Year MBBS students collected the data through the Whatsapp link online. The data was entered and analyzed in SPSS Version- 21 through descriptive statistics such as frequency, percentages, mean and standard deviation. Whereas, inferential statistics for association and comparison were done through chi-square and t-test application keeping 0.05 as the significant limit.
Results
The questionnaire of this study was distributed online, all over KPK. Out of the total 194 responses, 99.4% (n= 193) were valid whereas 1% (n= 1) were missing with a response rate of 51.19 %. The participants had a mean age of 35 years (SD= 10.207, range= 16- 70 years). The highest number of responses were received from 22 years' age persons with 26.3 %.
As per gender analysis, 65.28 % (n= 126) were females, 34.71 % (n= 67) were men and all from KPK. The male-to-female ratio was almost 1:2 with 34.71 % males and 65. 28 % females. Among the total respondents, 25.9 % (n= 50) were married, 0.5 % (n= 1) were divorced and 74.09 % (n= 143) were single/ unmarried.
University-level education was completed by 183 respondents (94.5 %), primary education by only 1 (0.51 %), secondary education by (n= 7; 3.6 %) and matriculates were (n= 3; 1.6 %). Full-time employed came out to be 36.9% (n= 65), retired individuals were 1.7 % (n= 3), people residing at home were 27.3 % (n= 48) and jobless were 34.1 % (n= 60).
The chronic disease sufferers among the 188 respondents were 21.3% (n= 40.04) only. Among the 53 chronic disease respondents, 45.3% (n= 24) were suffering from hypertension, respiratory diseases were seen 22.6% (n= 11.978), 11.3% (n= 5.89) had diabetes, 9.4 (n= 4.98) with kidney problems, 7.5% (n= 3.97) had neurological issues and 3.9% (n= 2) with cardiac problems.
All the respondents were worried about COVID-19 and its recurrence. When asked from 156 participants, 14.1% (n= 21.9) were very much worried about this, 11.55 (n= 17.94) were worried, 29.5% (n= 46) were slightly worried and 44.9% (n= 70) were not worried at all.
In relation to the health dimensions, among the total participants (n=184) 73.4% had no problem in walking around however, 8.2% were confined to bed with 18.5% with some problem in walking and activities performances. Self-care in post covid survivors with co-morbidities was answered by a total of 186 participants, out of which 1.7% were unable to wash themselves and dress up. Some problem was faced by 13.4% however, 84.9% had no problem at all. The usual activities including work, housework and leisure activities were answered by (n=187) people. Such activities were unable to be performed by 5.9%, 33.7% faced some problems and 60.4% had no issue with the performance of these activities. Extreme pain and discomfort were felt by 3.2%, moderate pain and discomfort by 43.6% and 53.2% were without any pain and discomfort. Anxiety and depression were the hallmark of post-covid survivors but 11.2% were extremely depressed, 43.6% had moderate anxiety and depression whereas, 45.2% were devoid of any anxiety and depression.
The association of post-covid persons with chronic diseases in relation to the five health dimensions i. e mobility, self-care, usual activities, pain/ and anxiety/ depression is shown in detail under Table-1.
Table 1
Association of COVID Survivors with Chronic Diseases with Health Dimensions.
| width="234" colspan="5"> Paired Differences width="48" rowspan="3">t width="36" rowspan="3">DF width="65" rowspan="3">Sig. (2-tailed) | > Mean width="42" rowspan="2">S. D width="48" rowspan="2">Std. Error Mean width="96" colspan="2">95% Confidence Interval of the Difference | > Lower width="48">Upper | > Pair 1 width="120" valign="top">q8 – mobility width="48" nowrap="">1.981 width="42" nowrap="">2.110 width="48" nowrap="">0.293 width="48" nowrap="">1.393 width="48" nowrap="">2.568 width="48" nowrap="">6.771 width="36" nowrap="">51 width="65" nowrap="">0.000 | > Pair 2 width="120" valign="top">q8 – self-care width="48" nowrap="">1.327 width="42" nowrap="">1.779 width="48" nowrap="">0.247 width="48" nowrap="">.832 width="48" nowrap="">1.822 width="48" nowrap="">5.378 width="36" nowrap="">51 width="65" nowrap="">0.000 | > Pair 3 width="120" valign="top">q8 – usual activities width="48" nowrap="">1.038 width="42" nowrap="">1.815 width="48" nowrap="">0.252 width="48" nowrap="">.533 width="48" nowrap="">1.544 width="48" nowrap="">4.127 width="36" nowrap="">51 width="65" nowrap="">0.000 | > Pair 4 width="120" valign="top">q8 – pain/discomfort width="48" nowrap="">0.942 width="42" nowrap="">1.809 width="48" nowrap="">0.251 width="48" nowrap="">.439 width="48" nowrap="">1.446 width="48" nowrap="">3.757 width="36" nowrap="">51 width="65" nowrap="">0.000 | > Pair 5 width="120" valign="top">q8 –anxiety/depression width="48" nowrap="">0.846 width="42" nowrap="">1.954 width="48" nowrap="">0.271 width="48" nowrap="">.302 width="48" nowrap="">1.390 width="48" nowrap="">3.122 width="36" nowrap="">51 width="65" nowrap="">0.003 | |
