Treatment outcomes, adherence, and health-related quality of life of patients with immune thrombocytopenia in two teaching hospitals, Addis Ababa, Ethiopia: A retrospective cohort study.
| dc.contributor.advisor | Sisay,Eskindir Ayalew(Ass. Prof.) | |
| dc.contributor.advisor | Gebremedhin,Amha(Ass. Prof.) | |
| dc.contributor.author | Beyene,Dessale Abate | |
| dc.date.accessioned | 2024-04-23T10:59:35Z | |
| dc.date.available | 2024-04-23T10:59:35Z | |
| dc.date.issued | 2023 | |
| dc.description.abstract | Background: Treatment of immune thrombocytopenia (ITP) is challenging, and treatment outcomes depend on a variety of factors, most of which are unknown and specific to each patient. The severity and treatment outcomes of ITP are assessed clinically by platelet count, bleeding risk, and response to treatment. Corticosteroids are the cornerstone of ITP treatment but have many side effects, and long-term response is observed in only 25% of patients. More than 80% of ITP patients responded to corticosteroid treatment, but relapses were common after treatment was discontinued. ITP also affects the health-related quality of life (HRQoL) of affected patients. Treatment outcomes, treatment adherence, and HRQoL have not been studied in Ethiopian ITP patients. Objective: To assess treatment outcomes, treatment adherence, and HRQoL in patients with ITP at Tikur Anbessa Specialized Hospital (TASH) and St. Paul's Hospital Millennium Medical College (SPHMMC). Methods: The retrospective hospital-based cohort study design was conducted from September 15/2022 to January 15/2023. Convenient sampling was used to recruit 214 study participants. Ethical clearance and approval of the study protocol were obtained from the institutional ethics review board of the School of Pharmacy, and permission was obtained from the respective study sites. Descriptive statistics were used to summarize the sociodemographic data and clinical and treatment characteristics. Multinomial regression analysis models were used to identify Predictive factors for treatment outcomes and linear regression analysis models were also used to identify Predictive factors for HRQoL. A p- value of less than 0.05 was generally considered statistically significant. Results: Most of the study participants 161(75.5%) were female patients. During diagnosis, 166(77.6%) had epistaxis and wet purpura (mucosal bleeding). Regarding the treatment, the majority 172(80.4%) of study participants took prednisolone alone, and 143(66.8%) of the study participant have experienced at least one side effect of corticosteroids throughout the treatment period. Regarding medication adherence 178(83.2%) of study participants had good adherence to their ITP medications. The complete response rate at 3 months was 139 (65.0%) and the overall impact of ITP on HRQoL was 35.41±9.27. Predictive factors for partial response to treatment were increased impact of ITP on HRQoL (AOR =1.221, 95% CI: 1.096-1.360), study site TASH (AOR =0.431, 95% CI: 0.197-0.941), and presence of heavy Page II menstrual bleeding (AOR =2.255, 95% CI: 0.925-5.497) compared with complete response. Hepatitis B virus-infected ITP patients (AOR = 0.052, 95% CI: 0.004-0.621) was also a predictive factor for no response compared with complete response. Furthermore, predictive factors for an increasingly higher impact of ITP on HRQoL were the development of emotionally related corticosteroid side effects (β= 0.392, 95% CI: 5.160-9.961, P< 0.001), the presence of fatigue during the assessment (β= 0.326, 95% CI: 4.394-9.475, P< 0.001), patients not taking cotrimoxazole prophylaxis treatment (β= 0.236, 95% CI: 2.236-6.570, P< 0.001), living far from the hematology clinic (outside Addis Ababa) (β= 0166, 95% CI: 1.107-5.114 P=0.003), having epistaxis and wet purpura (mucosal bleeding) (β= 0.191, 95% CI: 0.091-4.259, P=0.001), and skin symptoms (petechiae and ecchymosis) (β= 0.041, 95% CI: 0.091-4.259 P=0.041) during diagnosis. Conclusion: The highest complete response rate was achieved at 12 months and the impact of ITP on HRQoL was high in terms of daily energy level and work capacity. The patients had good adherence to their ITP medications, and more than half of the study participants experienced at least one side effect of corticosteroids throughout the treatment period. | |
| dc.identifier.uri | https://etd.aau.edu.et/handle/123456789/2816 | |
| dc.language.iso | en_US | |
| dc.publisher | Addis Ababa University | |
| dc.subject | Immune thrombocytopenia | |
| dc.subject | treatment outcomes | |
| dc.subject | health-related quality of life | |
| dc.subject | Platelet count | |
| dc.subject | Immune thrombocytopenia life quality index | |
| dc.subject | corticosteroids | |
| dc.subject | Ethiopia. | |
| dc.title | Treatment outcomes, adherence, and health-related quality of life of patients with immune thrombocytopenia in two teaching hospitals, Addis Ababa, Ethiopia: A retrospective cohort study. | |
| dc.type | Thesis |