Health-Related Quality of Life Outcomes and Associated Factors for Young Adults with Experience of Severe Malaria in Uganda: A Cross-Sectional Comparison with Community Controls

OBJECTIVES: Evidence suggests long-term impact of severe malaria (SM) on patient’s learning, cognitive and behavioral functions yet, little is known about the impact of SM on the health-related quality of life (HRQoL) of survivors. We compared HRQoL between young adults that experienced different forms of SM with community controls (CC) in Uganda.

METHODS: We gathered cross-sectional data from a longitudinal cohort of SM patients and CC using EuroQol EQ-5D-3L and EQ-VAS tools. Data included socioeconomic and clinical information. Distribution of EQ-5D and EQ-VAS values were presented as means and percentages based on respondent’s characteristics between two groups. Analysis; Pearson chi-square test for association and non-parametric tests for mean difference; a two-stage Instrumental variable regression analysis to establish causal-effect of SM on HRQoL. We obtained approval from relevant research ethics committees in Uganda and Norway.

RESULTS: 189 respondents aged ≥12years were included. 121 of 189 experienced SM, majority of respondents were; males (55%), age range 12-14years (60%) while 19% aged ≥18years. Compared to CC, more respondents in SM reported having moderate problems with mobility (12% vs 3%), Pain (36% vs 26%) and anxiety (12% vs 10%) dimensions. Mean EQ-5D index (0.900±0.11 vs 0.924±0.11, p>0.05) and EQ-VAS scores (83.50±21.63 vs 86.84 ±14.9, p>0.05) were lower for respondents in SM group compared to CC respectively. In regression analysis, in reference to CC, experience of SM in forms of; cerebral malaria (-0.18, 95% CI -0.34, -0.02, P=0.025) and severe malaria anemia (-0.16, 95% CI -0.29, -0.04, P=0.008) was associated with reduced EQ-5D index. Doing a paid work increased EQ-5D index, while previous hospital admission reduced EQ-5D index.

CONCLUSIONS: We found a negative causal-effect of SM experience on HRQoL outcomes in children and young adults in reference to CCs. SM can undermine long-term individual HRQoL through its impact on individual learning, cognitive and behavioral abilities.