Determinants of Health-Related Quality of Life in Chronic Hepatitis B Patients: A Study from SPHMMC, Ethiopia

Determinants of Health-Related Quality of Life in Chronic Hepatitis B Patients: A Study from SPHMMC, Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of Health-Related Quality of Life in Chronic Hepatitis B Patients: A Study from SPHMMC, Ethiopia Wolde Hailu Demissie, Molla Asnake Kebede, Alemayehu Baharu Tekle, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6002154/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Health-related quality of life (HRQoL) has emerged as an important consideration in the care of patients with chronic hepatitis B (CHB). There is limited evidence on HRQoL among CHB patients in Ethiopia, particularly in the study area. This study aimed to assess HRQoL and associated factors among patients with chronic hepatitis B in SPHMMC. Methods A cross-sectional study was conducted from March 2023 to September 2023 among patients with chronic hepatitis B in SPHMMC. The study participants were selected using a systematic random sampling technique. Two physicians collected data from patient interviews and chart reviews using a checklist. Data were entered into Epi-Data and exported to SPSS version 26 for analysis. Descriptive and inferential statistical analyses were conducted. Bivariable and multivariable binary logistic regression was used to assess associations between dependent and independent variables using adjusted odds ratio (AOR) with 95% confidence intervals (CI). A P-value of < 0.05 was considered statistically significant. Results Among the 190 patients with chronic hepatitis B, nearly two-thirds (126; 66.3% [95% CI: 61.1, 72.7]) had high HRQoL. The overall mean HRQoL score was 75.27 ± 20.62. The mean scores for the physical component summary (PCS) and mental component summary (MCS) were 77.50 ± 24.84 and 76.05 ± 17.29, respectively, showing minimal difference. Factors significantly associated with HRQoL included being currently married (AOR: 4.48, 95% CI: 1.56, 12.82), having a family size of 3–4 members (AOR: 3.67, 95% CI: 1.64, 8.23), presence of cirrhosis with portal hypertension (AOR: 0.173, 95% CI: 0.043, 0.692), and being older than 60 years (AOR: 0.19, 95% CI: 0.04, 0.85). No statistically significant difference in HRQoL was observed between cirrhotic and non-cirrhotic patients based on t -scores. Conclusion and Recommendation: HRQoL was significantly affected in unmarried individuals, those with larger family sizes, patients with cirrhosis and portal hypertension, and older adults. Early diagnosis and timely initiation of treatment are crucial for improving HRQoL among patients with chronic hepatitis B. Special attention should be given to unmarried individuals, those with larger family sizes, older adults, and patients with cirrhosis and portal hypertension to enhance their quality of life. chronic hepatitis B health-related quality of life SPHMMC Ethiopia Figures Figure 1 Figure 2 Background Chronic hepatitis refers to a group of liver disorders with varying causes and severity, characterized by ongoing hepatic inflammation and necrosis for at least six months [1] . Chronic hepatitis B virus (HBV) infection is a global public health threat, causing significant morbidity and mortality related to liver disease [2]. An estimated 250–290 million individuals worldwide are living with chronic HBV infection [3]. In Africa, intimate contact among toddlers is a key factor contributing to the high prevalence of hepatitis B in the population [4]. The prevalence, modes of transmission, and human behaviors shape geographically distinct patterns of HBV infection [4, 5]. In many patients with chronic HBV infection, a history of acute or symptomatic hepatitis is often absent [6, 7]. The World Health Organization (WHO) has set an ambitious goal of eliminating viral hepatitis as a major public health threat by 2030 [8]. The global pooled prevalence of HBV infection is estimated at 7.4% [9, 10]. Chronic viral hepatitis, including HBV, remains a significant global public health issue. It is a leading cause of liver-related morbidity and mortality, often resulting in chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC) [11, 12]. In 2019, the WHO reported 296 million HBV carriers, 1.5 million new infections annually, and 820,000 deaths, mostly due to cirrhosis and HCC [13, 14]. Although vaccination programs in many countries have decreased the incidence of new HBV infections, the disease continues to cause substantial morbidity and mortality [1]. Anti-viral therapies are a priority in managing HBV, as they can suppress HBV DNA replication, slow liver fibrosis progression, and reduce the risk of developing HCC [1, 15, 16]. Health-related quality of life (HRQoL) has become a crucial factor in managing chronic hepatitis B (CHB) [17]. Before initiating long-term nucleos(t)ide analog (NUC) therapy, it is essential to assess factors such as patient compliance, economic burden, and HRQoL [17]. However, the impact of chronic HBV infection on HRQoL has not been sufficiently explored in Ethiopia. Relying solely on clinical indicators like morbidity and mortality to understand the disease burden is inadequate. HRQoL, which reflects the patients' subjective experiences, offers valuable insight into the broader impact of the disease on patients' lives. Despite the growing recognition of HRQoL's importance, there is limited evidence on this aspect in Ethiopia. This study aims to evaluate HRQoL in patients with chronic hepatitis B undergoing antiviral treatment at SPHMMC. The findings will not only provide a clearer understanding of the HRQoL of these patients but also serve as a baseline for future research. Furthermore, the study may be used for the development of site-specific guidelines, ultimately enhancing the quality of care for individuals living with chronic hepatitis B in Ethiopia. Methods Study setting The study was conducted at Saint Paul’s Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia, from March 2023 to September 2023 G.C. SPHMMC, the second-largest governmental tertiary care hospital in Ethiopia, is located in Addis Ababa and was established in 1968. It serves a catchment area of more than 5 million people. With an inpatient capacity of over 700 beds, the hospital accommodates an average of 1,200 emergency and outpatient clients daily across various specialty and subspecialty units. Since 2007, SPHMMC has functioned as a medical school, training healthcare professionals in both undergraduate and postgraduate programs. It is the only institution in the country offering a Gastroenterology and Hepatology fellowship program, with endoscopic evaluation of the gastrointestinal tract being a key service provided by this unit since 2011. The Department of Internal Medicine comprises various subspecialties with outpatient services. The Gastroenterology and Hepatology unit provides outpatient and endoscopy services three times per week. This unit is also a pioneer in initiating treatment for chronic hepatitis B in alignment with the WHO’s 2030 elimination plan. The outpatient flow averages 50–60 patients per day, three times per week. Study Design A hospital-based cross-sectional study was conducted on all chronic hepatitis B patients receiving follow-up care in the Gastroenterology and Hepatology Unit at SPHMMC from March 2023 to September 2023 G.C. Populations Source Population : All hepatitis B patients on follow-up in the Gastroenterology and Hepatology Unit at SPHMMC. Study Population : All chronic hepatitis B patients who were on follow-up in the Gastroenterology and Hepatology Unit at SPHMMC during the data collection period and met the inclusion criteria. Eligibility Criteria Inclusion Criteria: All adult chronic hepatitis B patients on follow-up in the Gastroenterology and Hepatology Unit at SPHMMC during the study period. Exclusion Criteria: Patients with chronic hepatitis B who had been on follow-up for less than one year. Patients younger than 18 years or older than 80 years. Sample size determination and sampling technique Sample size determination To determine the sample size, a single population proportion formula was used by considering a 95% confidence interval, 5% margin of error, and 50% proportion as follows: n = 384 where: n = desired sample size for population Z = standard normal duration usually set as 1.96 (which corresponds to 95% confidence level) P = we use positive prevalence estimated. As there is no previous study on topic under study in the study area, to estimate prevalence a figure of 0.5 used to get the possible minimum large sample size. Since the total population is < 10,000 that is 311 patients are identified from HMIS we use the Correction formula to determine final sample size. \(\:nf=\frac{\text{n}}{1+\frac{\text{n}}{\text{N}}}\) \(\:=\) \(\:nf=\frac{384}{1+\frac{384}{311}}\) \(\:=\) 171.8 Which is nearly 172 N = final sample size when a population is 10,000 nf = estimated study population Then 10% non- response rate added: 172 + 18 = 190 Sampling technique and procedures The study participants were recruited as they come for the regular clinical visit using a systematic random sampling technique with a sampling interval of every second patients. During the data collection period, 311 chronic hepatitis patients expected to visit the hospital for follow-up. Sampling intervals, (K value) was calculated as 311/190 = 2. To determine the first-person, the lottery method was used on first day from the 10 patients who had under follow-up. Then, each second client was selected for an interview, chart review until 190 study participants recruited. If the second patient is not fulfilling the inclusion criteria, the next person was taken. Study variables The dependent variable in this study is Health-Related Quality of Life (HRQoL), which serves as the primary outcome measure. Several independent variables are considered to assess their potential impact on HRQoL among chronic hepatitis B patients. These include sociodemographic factors such as gender, age, residence, ethnicity, marital status, religion, income, occupation, and family size. Additionally, clinical and disease-related factors are examined, including the duration of diagnosis, duration of treatment, ultrasound findings, alanine aminotransferase (ALT) levels, viral load of hepatitis B virus (HBV), and the presence of comorbidities. By analyzing these variables, the study aims to determine how different factors influence the quality of life in patients undergoing antiviral treatment for chronic hepatitis B. Operational definition Health Survey Short Form-36 (SF-36) and the European quality of life questionnaire-5 dimensions (EQ-5D) are two of the most commonly employed HRQoL measurement tools for Health-related quality of life [35] . The SF-36 version 2 questionnaire is a self-administered questionnaire comprised of 36 items with two (physical and mental) components. The physical component summary includes the four domains of physical functioning (PF), physical role functioning (RP), bodily pain (BP), and general health (GH) [33 ,35, 36] . The mental component summary includes four domains of vitality (VT), social functioning (SF), emotional role (RE), and mental health (MH). Each raw domain score can be converted into a 0–100 scale, with a higher score indicating a higher health status [36] . SF-36 scores range from 0 (worst) to 100 (best) [35,36] . It consists of a questionnaire and (EQ-VAS). For this research, we use visual analogue scale only because the other component of EQ-5D questionnaire incorporated in SF 36. A VAS is usually a horizontal or vertical line with a scale from 0 (absence of the characteristic measured) to 100 (extreme value). The patient marks on the line the point that they feel represents their current state [37] . High HRQoL It is defined as participants who scored greater than or equal to the mean value of of SF-36 scale Low HRQoL It is defined as participants who scored less than mean value of SF-36 scale Data collection procedure and tools Data was collected by using pretested semi-structured checklist. Those who are graduates in respective Language translated it to Amharic and Oromiffa language. The checklist had four parts including: Part 1: Socio-demographic and socio-economic related factors (8 items); part 2: Clinical related characteristics (6 items); part 3: SF-36 health survey (36 items) and part 4: Visual analogue scale (1 item): The SF-36 was used to measure HRQoL. SF-36 health survey is widely validated tools which is one of the most generally used HrQoL scale in the world. It is validated in different languages. It measures four domains in the area of physical health (Physical Functioning(10 items), Role Limitation–Physical(5items), Bodily Pain(2 items), and General Health (4 items) and four domains in the area of mental health (Role Limitation–Emotional(3 items, Vitality(4 items), Mental Health(5 items), Social Functioning(2 items) and one health perception (health change item). Each item was transformed to 0-100 value to computed mean, frequency of each domain, summary component and overall HRQoL. Data was collected by 2 general physician and supervised by primary investigator after taking a one training. The training was focused on the objective of the study, interview technique and clarification of each question in order to keep the quality of data. Data quality assurance Standard questionnaire for the study of quality life medical outcome study short form 36 (MOS SF-36) questionnaire which is prepared in English was translated to local language which then was translated back to English by another translator in order to keep its consistency (Annexed separately). Pretest was done to improve clarity, understandability, and simplicity of the messages of the tools before actual data collection. Data collectors and supervisors were trained for one day on the objective, method, sampling technique, ethical issues, data collection instrument, and data collection procedure prior to data collection. The collected data were checked manually for completeness and consistency daily by the supervisors and principal investigator. The internal consistency of the SF-36 scale was checked using Cranach’s alpha (0.96). Data processing and analysis The collected questionnaires were coded and entered into Epi Data Version 3.1. After the entry was completed, then data was exported to SPSS version 22.0 for analysis. Descriptive statistics (frequency, mean, standard deviation and Percentage) was used to describe socio-demographic characteristics of the study, participants and tables were used for data presentation. All items of SF-36 were transformed to zero (0) to hundred (100) values, in which 0 were given to maximum limitation or disabilities and whereas 100 given no limitation or no disabilities. To estimate the association between associated factors and Health related Quality of Life, odds ratio (OR) with 95% confidence intervals (CIs) was used. Bivariable binary logistic regression analysis was made to determine the association of each independent variable with the outcome variable HrQoL. Variables with p-value of less than 0.2 in bivariable binary logistic regressions were candidate for multivariable binary logistic regression analysis to identify significant factors for outcome variable. Variables with p-value of less than 0.05 were used to declare statistical significance and strength of association was determined by adjusted odd ratio (AOR) with (95%) confidence interval. The model fitness was checked using Homer-Lemeshow goodness of fit test and it was fitted (P = 0.46). Finally, the findings presented using tables, graphs, and text. Result Socio-Demographic Characteristics In this study, 190 patients with chronic hepatitis B virus were participated with the response rate of 100%. The age of participants ranged from 19–78 years, with mean age of 37.85 ± 11.1years. Nearly two-third of participants 121 (64%) were females and the majority of them 134 (70.5%) and 150 (79.4) were younger adults (18–40 years) and married respectively. The majority of the participants 140 (74.1%), and 114(60.3%) were urban residents and orthodox respectively. Nearly four-fifth of the participants 75(39.7%), and 76 (40.2) were Amhara and Oromo respectively. Two-fifth of the participants, 79 (41.6%) and 76 (40%) had family size of ≥ 5 in their home and private work respectively. Nearly one-third, 63(33.3%) had monthly income of 5,000–10,000 Ethiopian birr. (Table 1) Table 1 Socio-demographic and socio-economic characteristics of chronic hepatitis B patients receiving follow-up care in the Gastroenterology and Hepatology Unit at SPHMMC from March 2023 to September 2023 G.C. Variable Frequency Percent Male 68 36.0 Female 121 64.0 Age 18–40 134 70.5 41–60 48 25.3 > 60 8 4.2 Residence Urban 140 74.1 Rural 49 25.9 Ethnicity Amhara 75 39.7 Oromo 76 40.2 Tigre 9 4.8 Gurage 16 8.5 Others 13 6.9 Marital status Married 150 79.4 Not married 39 20.6 Religion Orthodox 114 60.3 Muslim 36 19.0 Catholic 24 12.7 Others 15 7.9 Income Not mentioned 75 39.7 1000–4000 38 20.1 5000–10000 63 33.3 > 100000 13 6.9 Occupation private work 76 40 Government employee 41 21.7 House wife 62 32.8 Others 10 5.3 Family size 1–2 35 18.4 3–4 76 40.0 ≥ 5 79 41.6 *student, Non-governmental organization Clinical characteristics The majority of the participants145 (76.3%) were diagnosed for CHBV infection less than five years and 133 (70%) of patients started treatment four or more years duration. The ultra sound finding revealed that 95(50%), 29 (15.3%), and 16(8.4%) were normal, cirrhosis, and cirrhosis with portal hypertension respectively. Additionally, the laboratory investigation showed that most of participants 177(93.2%) had below upper limit Alanine Aminotransferase level ,which means two times of 25 and 35 for female and male respectively. More than half 102(53.7%) and nearly one-fourth of the participants’ viral load was 20-2000 and ≥ 2000 respectively (Table 2). Table 2 Clinical characteristics of participants of chronic hepatitis B patients receiving follow-up care in the Gastroenterology and Hepatology Unit at SPHMMC from March 2023 to September 2023 G.C. Variable Frequency Percent Duration of diagnosis 10 20 10.5 Duration of Treatment 1–3 years 57 30.0 ≥ 4 years 133 70.0 Ultra sound Finding Cirrhosis 29 15.3 Cirrhosis with PHTN 16 8.4 Fatty liver or mass 26 13.7 Report not found 24 12.6 Normal 95 50.0 ALT level Below upper limit* 177 93.2 Above upper limit** 13 6.8 Viral load of HBV Not reported 34 17.9 <20 10 5.3 20-2000 102 53.7 ≥ 2000 44 23.2 *<50 for female and < 70 for male, **≥50 for female and ≥ 70 for male, PHTN: Portal hypertension, ALT: Alanine Aminotransferase. Comorbidity related characteristics Thirty-five (18.4%) participants had comorbidity, of which nearly one-fourth (31.42%) and one-fifth (25.71%) were diabetic and hypertensive respectively (Table 3). Table 3 Comorbidity related characteristics of chronic hepatitis B patients receiving follow-up care in the Gastroenterology and Hepatology Unit at SPHMMC from March 2023 to September 2023 G.C. . Variable Frequency Percent Comorbidity No 155 81.6 Yes 35 18.4 Type of comorbidity (N = 35) DM 11 31.42 RVI 6 17.14 HTN 9 25.71 CKD and renal disease 3 8.57 Others* 6 17.14 *Asthma, transverse myelitis, cholelithiasis Mean score of health-related quality of life Scale The HRQOL measured using SF-36 scale with eight domains and the overall mean score was 75.27 ± 20.62. The mean score physical health component summary (PHCS) and mental health component summary (MHCS) of SF-36 scale were 77.50 ± 24.84 and76.05 ± 17.29 respectively. The highest mean scores were observed in social function and bodily pain domains with mean score of 91.64 ± 18.01and 85.20 ± 25.44 respectively. Whereas, the lowest mean scores observed in vitality/energy and general health domains that revealed 60.84 ± 14.247 and67.02 ± 24.16 respectively. (Table 4) Table 4 The mean score of the domains of HRQL of chronic hepatitis B patients receiving follow-up care in the Gastroenterology and Hepatology Unit at SPHMMC from March 2023 to September 2023 G.C. Domains in HQLQ No of Items Mean ± SD Cronach’s alpha (α) PHC Physical Functioning 10 80.84 ± 28.275 .951 Role limitation/physical 4 76.97 ± 39.583 .955 General health 5 67.02 ± 24.16 .897 Bodily pain 2 85.20 ± 25.44 .927 MHC Role limitation/emotional 3 78.42 ± 39.34 .952 Vitality 4 60.84 ± 14.247 .390 Emotional wellbeing 5 73.33 ± 13.78 .730 social functioning 2 91.64 ± 18.01 .770 Health change (perception) 1 59.61 ± 25.39 ---- Physical component summary 21 77.50 ± 24.84 .960 Mental component summary 14 76.05 ± 17.29 .864 Overall mean of SF 36 scale 36 75.27 ± 20.62 .963 PHCS: Physical health components, MHC: Mental health component Magnitude of health-related quality of life In this study nearly two-third of the study participants 126 (66.3% (95% CI61.1, 72.7)) had low HRQOL (below mean score) (Fig. 1). When comparing each domain, the lowest and highest HQRQOL was observed in vitality and Social functioning domains respectively (Fig. 2). PF: Physical Functioning, RF: Role Functioning, RE: Role Emotional, Vitality, EH: Emotional Health, SF: Social Functioning, BP: Bodily Pain, GH: General Health Figure 2: The magnitude of HRQOL among eight domains of SF-36 scale of chronic hepatitis B patients receiving follow-up care in the Gastroenterology and Hepatology Unit at SPHMMC from March 2023 to September 2023 G.C. Factors associated with HRQoL In bivariable binary logistic regression analysis, sex, residence, comorbidity, alanine aminotransferase, duration of treatment, marital status, ultra sound finding, family size and age were candidate variables (P < 0.2) to fit multivariable binary logistic regression analysis. However, in multivariable binary logistic regression analysis only marital status, ultra sound finding, family size and age were significantly associated. Patients with chronic hepatitis who were married currently nearly fivefold (AOR: 4.48, 95% CI (1.56, 12.82) increase the health related quality of life compared with not currently married. Patient who had 3–4 family size were four fold (AOR = 3.67, 95% CI(1.64, 8.23 )increase quality of life compared to those not have and greater than 5 family members. In contrast, Patients having ultra sound finding of cirrhosis with portal hypertension were nearly 83% (AOR = .173, 95% CI (.043, .692) less likely to have high health related quality of life compared with normal ultra sound finding and those aged greater than 60 year 80% (AOR = .19, 95% CI (.04,.85)) less likely to have high health related quality of life compared to those 18–40 years.(Table 5). Table 5 Bivariable and multivariable analysis to identify factors associated with HRQOL of chronic hepatitis B patients receiving follow-up care in the Gastroenterology and Hepatology Unit at SPHMMC from March 2023 to September 2023 G.C. Variable HRQOL COR(95%CI) AOR (95% C.I.) P high low Sex Male 40 29 .56 (.30, 1.04) .76(.35, 1.66) .501 Female 86 35 1 1 Residence Urban 97 43 1.63 (.83, 3.18) 1.77(.81, 3.84) .148 Rural 29 21 1 1 Comorbidity No 104 51 1.20(.56, 2.58) .37 (.11, 1.17) .092 Yes 22 13 1 1 Alanine Aminotransferase Below upper limit 120 57 1 1 Above upper limit 6 7 .40(.13, 1.26) .49(.13, 1.85) .296 Duration of treatment 1–3 29 28 1 1 ≥ 4 97 36 2.6(1.36, 4.95) 1.89(.78, 4.53) .154 Marital status Married 108 43 2.93(1.42, 6.03) 4.48 (1.56, 12.82)* .005 not married 18 21 1 1 Ultra Sound finding Cirrhosis 16 13 .41(.17, .98) .59(.20, 1.77) .353 Cirrhosis with PHN 5 11 .15 (.04, .48) .173 (.043, .692)* .013 Fatty liver or mass 17 9 .63(.25, 1.62) .70(.24, 2.04) .517 Not reported 17 7 .82(.30, 2.21) .81(.26, 2.50) .720 Normal US 71 24 1 1 Family size 1–2 22 13 1.41(.62, 3.20) 3.17 (.98, 10.19) .053 3–4 61 15 3.4(1.66, 6.97) 3.67(1.64, 8.23)* .002 ≥ 5 43 36 1 1 Age 18–40 90 39 1 1 41–60 30 15 .86(.42, 1.78) .72(.29, 1.79) .491 > 60 6 10 .26(.08, .76) 19(.04, .85)* .030 AOR: Adjusted Odds ratio, COR: Crude Odds ratio Discussion In this study nearly two-third of participants 126 (66.3% (95% CI61.1, 72.7)) had high HRQOL. The overall mean score of HRQOL was 75.27 ± 20.62. The mean score of physical component summary (PCS) and mental component summary (MCS) were nearly similar that was 77.50 ± 24.84 and 76.05 ± 17.29 respectively. This finding was significantly higher than the study done in Italy that revealed mean score of 42.6 ± 10.142.5 ± 11.5 for PCS and MCS respectively [38, 39] . This variation could be explained by, unlike our study that include all patients with chronic hepatitis, the Italy study was done among patients with cirrhosis that might decrease the HRQoL. Our finding is also inconsistent with the study done in china that found PCS scores have a more significant decrease than MCS scores [17] . Moreover, the variation might be due to socioeconomic and health care system difference. From the eight domains of F-36, the highest mean scores were observed in social function and bodily pain domains. Whereas, the lowest mean scores observed in vitality/energy and general health domains. The mean score of EQ5D visual analogue scale (VAS) was 78.94 ± 17.28 with a minimum of five to maximum of hundred which is relatively higher than the SF-36 scale. Patients with chronic hepatitis B who were married currently fivefold increase health related quality of life compared to unmarried and those having 3–4 family size were nearly four folds increase the health-related quality of life compared with having five or more families. This finding is consistent with previous study in China that found being without a life partner (unmarried or separated) was inversely correlated with HRQoL [40] . This might be due to currently married patients have better family and social support compared with the counterparts. This can be also supported with evidence that found being married was positively associated with perceived social support [41] . Similarly, patients with chronic hepatitis B who had 3–4 family size were nearly four folds increase the health-related quality of life compared with having five or more families. This could be due to the higher family size can adversely affect the overall family basic needs; in turn can affect their health and quality of life. In contrast, patients having cirrhosis with portal hypertension were nearly 83% less likely to have high health related quality of life. This is in agreement with the study in United States and others site found stage of chronic hepatitis B correlated significantly with worsening HRQL [ 42–44] . This could be due to patients having cirrhosis with portal hypertension might have different complication including upper GI bleeding and infection and downstream complication of decompensated cirrhosis than compensated one. Additionally, the HRQoL was significantly reduced among patients with sixty years and above. This is consistent with previous studies in China and Turkey that found older age was associated with poorer HRQOL in CLD patients [ 43, 45, 46, 47] . This might be due to elders have low physiological function and productivity than young adults in turn reduce the quality of life. However, our finding contradicts with another Chinese study that found younger age were significantly associated with poorer HRQoL [44] . This can be due to the tool difference that unlike this study that used 8 domains, Chinese study used SF-6D to measure HRQoL that consists of six dimensions namely physical functioning (PF), role limitation (RL), social functioning (SF), bodily pain (PL), mental health (MH) and vitality (VT). Similarly, the study in Italy found that the overall, physical health was poorer in younger patients with cirrhosis [38] . This variation from our finding could be explained unlike our study, the Italy study was done among patients with cirrhosis. Additionally, it could be due to socioeconomic and sociocultural difference. Conclusion and Recommendations Patients with chronic hepatitis B infection had relatively high HRQOL. The overall mean score of SF-36 and EQ5D VAS was 75.27 and 78.94 respectively. The mean score of PCS and MCS were nearly similar, 77.50 and 76.05 respectively. The overall HRQoL was associated with marital status, family size, cirrhosis with portal hypertension and age. It’s better to diagnose and start treatment for physician for patients with hepatitis B infection to have better HRQol. More emphasis is needed to provide better care for unmarried, higher family size, elders and cirrhotic with portal hypertension patients. Further study with a bigger sample size involving multi-center is recommended. Limitations of the study This study was conducted with small sample size in a single institution, which is less representative to generalize for other areas in Ethiopia. However, this is the first study that can be baseline for future scholars. Abbreviations BP =Bodily pain CHB =chronic hepatitis B DNA: Deoxyribonucleic acid EQ-5D: European Quality of Life-5 Dimensions EQ-VAS: V isual analogue scale HBsAG: Hepatitis surface antigen HBV : Hepatitis B Virus HCC: Hepatocellular carcinoma HRQoL: Health related quality of life MH: Mental health NUC: Nucleos(t)ides analogies PF: Physical function SF-36: 36-Item Short-Form Health Survey questionnaires, SF: Social functioning SPHMMC: Saint Paul Hospital millennium medical college RE: Role limitation due to emotional problem VT: Vitality Declarations Ethics approval and consent to participate Ethical clearance letter was obtained from review board of Saint Paul Millennium Medical College (SPHMMC). In addition, informed consent was obtained from the study participants. Participants were informed that their names will not be mentioned and information provided by them will be kept confidential. The study was conducted according to the declaration of Helsinki. They were given the chance to ask anything about the study and were free to refuse or stop the response at any moment they want. Data collected was stored and confidentiality maintained. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding The Research, authorship, and/or publication of this work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions Wolde Hailu Demissie , MD Involved in the conception and design of the study, drafting and revising of the article and final approval of the version to be submitted. Molla Asnake Kebede, MD Involved in the conception and design of the study, drafting and revising of the article and final approval of the version to be submitted. Alemayehu Beharu Tekle, MD Involved in the conception and design of the study, drafting and revising of the article and final approval of the version to be submitted. Mehariw Wondim Netsered , MD Involved in the conception and design of the study, drafting and revising of the article and final approval of the version to be submitted. Tadele Demilew Chekole, MD Involved in the conception and design of the study, drafting and revising of the article and final approval of the version to be submitted. Erkihun Pawlos Shahsb, MD Involved in the conception and drafting and revising of the article and final approval of the version to be submitted. Adugnaw Worku Bogalef, MD Involved in the conception and drafting and revising of the article and final approval of the version to be submitted. Hazrone Adinew Adi, MD Involved in the conception and drafting and revising of the article and final approval of the version to be submitted . Henok Birhanu Kassa, MD Involved in the conception and drafting and revising of the article and final approval of the version to be submitted. Acknowledgments The authors would like to thank Saint Paul’s Hospital Millennium Medical College and Department of Internal Medicine for an opportunity to conduct this research. Authors' information WHD is Assistant Professors of Internal Medicine. WH is Medical Doctors and has Specialty Certificate in Internal Medicine. MAK is an assistant Professor. MA is a Medical Doctor and specialty certificate in Drug resistant tuberculosis management. He is ECFMG certified physician. ABT is assistant Professors of Emergency and Critical care medicine. AB is Medical Doctors and has Specialty Certificate in Emergency and critical care medicine. MWN : is Assistant Professors of Internal Medicine. MW is Medical Doctors and has Specialty Certificate in Internal Medicine. TDC is Assistant Professors of Internal Medicine. TD is Medical Doctors and has Specialty Certificate in Internal Medicine. EPS is Assistant Professors of Internal Medicine. EP is Medical Doctors and has Specialty Certificate in Internal Medicine. AWB is Assistant Professors of orthopedics and trauma surgeon. A W is Medical Doctors and has Specialty Certificate in orthopedics and trauma. HAA is Assistant Professors of Radiology. HA is Medical Doctors and has Specialty Certificate in Radiology. HBK is Assistant Professors of General Practitioner. HB is Medical Doctors. References EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection q. National Clinical Guideline Centre Hepatitis B (chronic) Diagnosis and management of chronic hepatitis B in children, young people and adults Clinical guideline Methods, evidence and recommendations. 2013. 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Hepatitis B Virus: Advances in Prevention, Diagnosis, and Therapy [Internet]. 2020. Available from: https://journals.asm.org/journal/cmr Mercy Jelagat K, Fatuma Faraj S, Hellen Irusa Lukhaka D, Eric Wang’welo D, Laban Kipkemei M, Adrian G. Burden of Hepatitis B Infection among High Risk Populations in Western Kenya. Journal of Infectious Diseases and Epidemiology. 2020 Jun 13;6(3). Yazie TD, Tebeje MG. An updated systematic review and meta-analysis of the prevalence of hepatitis B virus in Ethiopia. Vol. 19, BMC Infectious Diseases. BioMed Central Ltd.; 2019. Kinfe H, Sendo EG, Gebremedhin KB. Prevalence of hepatitis b virus infection and factors associated with hepatitis b virus infection among pregnant women presented to antenatal care clinics at adigrat general hospital in northern ethiopia. Int J Womens Health. 2021;13:119–27. Tan M, Bhadoria AS, Cui F, Tan A, Van Holten J, Easterbrook P, et al. Estimating the proportion of people with chronic hepatitis B virus infection eligible for hepatitis B antiviral treatment worldwide: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021 Feb 1;6(2):106–19. Illiam W, Ee ML. Review Articles Medical Progress H EPATITIS B V IRUS I NFECTION. Vol. 337, MEDICAL PROGRESS. 1997. Kafeero HM, Ndagire D, Ocama P, Kudamba A, Walusansa A, Sendagire H. Prevalence and predictors of hepatitis B virus (HBV) infection in east Africa: evidence from a systematic review and meta-analysis of epidemiological studies published from 2005 to 2020. Archives of Public Health. 2021 Dec 1;79(1). Spearman CW, Afihene M, Ally R, Apica B, Awuku Y, Cunha L, et al. Hepatitis B in sub-Saharan Africa: strategies to achieve the 2030 elimination targets. Vol. 2, The Lancet Gastroenterology and Hepatology. Elsevier Ltd; 2017. p. 900. Breakwell L, Tevi-Benissan C, Childs L, Mihigo R, Tohme R. The status of hepatitis B control in the African region. 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Efficacy and Safety of Bepirovirsen in Chronic Hepatitis B Infection. New England Journal of Medicine. 2022 Nov 24;387(21):1957–68. Zhang Q, Zhong C, Cai S, Yu T, Xu X, Yin J. Risk Factors Associated With Quality of Life in Patients With Hepatitis B Virus Related Cirrhosis. Front Psychol. 2022 Jan 6;12. Karacaer Z, Cakir B, Erdem H, Ugurlu K, Durmus G, Ince NK, et al. Quality of life and related factors among chronic hepatitis B-infected patients: A multi-center study, Turkey. Health Qual Life Outcomes. 2016 Nov 3;14(1). Balbinot JC, Souza AW, Pontarolo R, Junior ODB, Silva EAA da, Junges DSB, et al. Validation of the Brazilian version of the hepatitis B quality of life evaluation instrument-HBQOL, and its application to patients with chronic hepatitis B in Cascavel – PR. Brazilian Journal of Pharmaceutical Sciences. 2022;58. Brazier JE, Harper R, B Jones NM, Thomas KJ, Usherwood T, Westlake L. GENERAL PRACTICE Validating the SF-36 health survey questionnaire: new outcome measure for primary care. Rolfson O, Eresian Chenok K, Bohm E, Lübbeke A, Denissen G, Dunn J, et al. Patient-reported outcome measures in arthroplasty registries: Report of the Patient-Reported Outcome Measures Working Group of the International Society of Arthroplasty Registries: Part I. Overview and rationale for patient-reported outcome measures. Acta Orthop. 2016 Jun 15;87:3–8. Marchesini G, Bianchi G, Amodio P, Salerno F, Merli M, Panella C, et al. Factors associated with poor health-related quality of life of patients with cirrhosis. Gastroenterology. 2001 Jan 1;120(1):170–8. Karaivazoglou K, Iconomou G, Triantos C, Hyphantis T, Thomopoulos K, Lagadinou M, et al. Fatigue and depressive symptoms associated with chronic viral hepatitis patients’ health-related quality of life (HRQOL). Vol. 9. 2010. Chen P, Zhang F, Shen Y, Cai Y, Jin C, Li Y, et al. Health-Related Quality of Life and Its Influencing Factors in Patients with Hepatitis B: A Cross-Sectional Assessment in Southeastern China. Can J Gastroenterol Hepatol. 2021;2021. Vaingankar JA, Abdin E, Chong SA, Shafie S, Sambasivam R, Zhang YJ, et al. The association of mental disorders with perceived social support, and the role of marital status: results from a national cross-sectional survey. Archives of Public Health. 2020 Dec 1;78(1). Afendy A, Kallman JB, Stepanova M, Younoszai Z, Aquino RD, Bianchi G, et al. Predictors of health-related quality of life in patients with chronic liver disease. Aliment Pharmacol Ther. 2009 Sep;30(5):469–76. Zhang Q, Zhong C, Cai S, Yu T, Xu X, Yin J. Risk Factors Associated With Quality of Life in Patients With Hepatitis B Virus Related Cirrhosis. Front Psychol. 2022 Jan 6;12. Ashrafi M, Malekzadeh R, Poustchi H. A Review of Psychosocial Issues in Patients with Chronic Data · July 2013 CITATIONS 0 702 PUBLICATIONS 18,139 CITATIONS SEE PROFILE [Internet]. Available from: https://www.researchgate.net/publication/253233384 Gutteling JJ, De Man RA, Van Der Plas SM, Schalm SW, Busschbach JJV, Darlington ASE. Determinants of quality of life in chronic liver patients. Aliment Pharmacol Ther. 2006 Jun;23(11):1629–35. Zhang M, Li Y, Fan Z, Shen D, Huang X, Yu Q, et al. Assessing health-related quality of life and health utilities in patients with chronic hepatitis B-related diseases in China: A cross-sectional study. BMJ Open. 2021 Sep 15;11(9). Karacaer Z, Cakir B, Erdem H, Ugurlu K, Durmus G, Ince NK, et al. Quality of life and related factors among chronic hepatitis B-infected patients: A multi-center study, Turkey. Health Qual Life Outcomes. 2016 Nov 3;14(1). Lam ETP, Lam CLK, Lai CL, Yuen MF, Fong DYT, So TMK. Health-related quality of life of Southern Chinese with chronic hepatitis B infection. Health Qual Life Outcomes. 2009 Jun 5;7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6002154","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":449372942,"identity":"5c9cac9b-eb8e-4f9a-9f68-b49f7cb68187","order_by":0,"name":"Wolde Hailu Demissie","email":"","orcid":"","institution":"Saint Paul Hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Wolde","middleName":"Hailu","lastName":"Demissie","suffix":""},{"id":449372943,"identity":"b294925c-b7f4-4b0f-a869-af8d90a874ce","order_by":1,"name":"Molla Asnake Kebede","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYFAC5sYDYJqHgf33jwqQAHMDAS2MDTAtDNIMZ0BaGEnRwtgGEcGrQbe9seHAj5q6PP6ewweMC+fVRvO3A7X8qNiGU4vZmYMNB3uOHS6WONuWkDxz2/HcGYcZGxh7ztzGreVGYsMBHrYDiQ3neQwO8G47ltsA1MLM2IZfy8E//+oS55/n/9jAO+dY7nxitBzmbWNO3HC2h5mZt6EmdwNBLUC/HJbtO5y48cwxM8YZxw7kbgRqOYjXL8ebDz58860ucd6Z5GcMH2rqcuedP3zwwY8K3FrQwWEweYBo9UBQR4riUTAKRsEoGCEAAI0xaUMgoOzyAAAAAElFTkSuQmCC","orcid":"","institution":"Mizan - 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Chronic hepatitis B virus (HBV) infection is a global public health threat, causing significant morbidity and mortality related to liver disease \u003csup\u003e\u003cb\u003e[2].\u003c/b\u003e\u003c/sup\u003e An estimated 250\u0026ndash;290\u0026nbsp;million individuals worldwide are living with chronic HBV infection \u003csup\u003e\u003cb\u003e[3].\u003c/b\u003e\u003c/sup\u003e In Africa, intimate contact among toddlers is a key factor contributing to the high prevalence of hepatitis B in the population \u003csup\u003e\u003cb\u003e[4].\u003c/b\u003e\u003c/sup\u003e The prevalence, modes of transmission, and human behaviors shape geographically distinct patterns of HBV infection \u003csup\u003e\u003cb\u003e[4, 5].\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn many patients with chronic HBV infection, a history of acute or symptomatic hepatitis is often absent \u003csup\u003e\u003cb\u003e[6, 7].\u003c/b\u003e\u003c/sup\u003e The World Health Organization (WHO) has set an ambitious goal of eliminating viral hepatitis as a major public health threat by 2030 \u003csup\u003e\u003cb\u003e[8].\u003c/b\u003e\u003c/sup\u003e The global pooled prevalence of HBV infection is estimated at 7.4% \u003csup\u003e\u003cb\u003e[9, 10].\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eChronic viral hepatitis, including HBV, remains a significant global public health issue. It is a leading cause of liver-related morbidity and mortality, often resulting in chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC) \u003csup\u003e\u003cb\u003e[11, 12].\u003c/b\u003e\u003c/sup\u003e In 2019, the WHO reported 296\u0026nbsp;million HBV carriers, 1.5\u0026nbsp;million new infections annually, and 820,000 deaths, mostly due to cirrhosis and HCC \u003csup\u003e\u003cb\u003e[13, 14].\u003c/b\u003e\u003c/sup\u003e Although vaccination programs in many countries have decreased the incidence of new HBV infections, the disease continues to cause substantial morbidity and mortality \u003csup\u003e\u003cb\u003e[1].\u003c/b\u003e\u003c/sup\u003e Anti-viral therapies are a priority in managing HBV, as they can suppress HBV DNA replication, slow liver fibrosis progression, and reduce the risk of developing HCC \u003csup\u003e\u003cb\u003e[1, 15, 16].\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHealth-related quality of life (HRQoL) has become a crucial factor in managing chronic hepatitis B (CHB) \u003csup\u003e\u003cb\u003e[17].\u003c/b\u003e\u003c/sup\u003e Before initiating long-term nucleos(t)ide analog (NUC) therapy, it is essential to assess factors such as patient compliance, economic burden, and HRQoL \u003csup\u003e\u003cb\u003e[17].\u003c/b\u003e\u003c/sup\u003e However, the impact of chronic HBV infection on HRQoL has not been sufficiently explored in Ethiopia. Relying solely on clinical indicators like morbidity and mortality to understand the disease burden is inadequate. HRQoL, which reflects the patients' subjective experiences, offers valuable insight into the broader impact of the disease on patients' lives. Despite the growing recognition of HRQoL's importance, there is limited evidence on this aspect in Ethiopia.\u003c/p\u003e \u003cp\u003eThis study aims to evaluate HRQoL in patients with chronic hepatitis B undergoing antiviral treatment at SPHMMC. The findings will not only provide a clearer understanding of the HRQoL of these patients but also serve as a baseline for future research. Furthermore, the study may be used for the development of site-specific guidelines, ultimately enhancing the quality of care for individuals living with chronic hepatitis B in Ethiopia.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy setting\u003c/h2\u003e \u003cp\u003eThe study was conducted at Saint Paul’s Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia, from March 2023 to September 2023 G.C. SPHMMC, the second-largest governmental tertiary care hospital in Ethiopia, is located in Addis Ababa and was established in 1968. It serves a catchment area of more than 5\u0026nbsp;million people. With an inpatient capacity of over 700 beds, the hospital accommodates an average of 1,200 emergency and outpatient clients daily across various specialty and subspecialty units. Since 2007, SPHMMC has functioned as a medical school, training healthcare professionals in both undergraduate and postgraduate programs. It is the only institution in the country offering a Gastroenterology and Hepatology fellowship program, with endoscopic evaluation of the gastrointestinal tract being a key service provided by this unit since 2011. The Department of Internal Medicine comprises various subspecialties with outpatient services. The Gastroenterology and Hepatology unit provides outpatient and endoscopy services three times per week. This unit is also a pioneer in initiating treatment for chronic hepatitis B in alignment with the WHO’s 2030 elimination plan. The outpatient flow averages 50–60 patients per day, three times per week.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003e A hospital-based cross-sectional study was conducted on all chronic hepatitis B patients receiving follow-up care in the Gastroenterology and Hepatology Unit at SPHMMC from March 2023 to September 2023 G.C.\u003c/p\u003e\n\u003ch3\u003ePopulations\u003c/h3\u003e\n\u003cp\u003e \u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eSource Population\u003c/b\u003e: All hepatitis B patients on follow-up in the Gastroenterology and Hepatology Unit at SPHMMC.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eStudy Population\u003c/b\u003e: All chronic hepatitis B patients who were on follow-up in the Gastroenterology and Hepatology Unit at SPHMMC during the data collection period and met the inclusion criteria.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eEligibility Criteria\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eInclusion Criteria:\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eAll adult chronic hepatitis B patients on follow-up in the Gastroenterology and Hepatology Unit at SPHMMC during the study period.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eExclusion Criteria:\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003ePatients with chronic hepatitis B who had been on follow-up for less than one year.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePatients younger than 18 years or older than 80 years.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample size determination and sampling technique\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSample size determination\u003c/h2\u003e \u003cp\u003eTo determine the sample size, a single population proportion formula was used by considering a 95% confidence interval, 5% margin of error, and 50% proportion as follows:\u003c/p\u003e \u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\u003cp\u003en = 384\u003c/p\u003e \u003cp\u003ewhere:\u003c/p\u003e \u003cp\u003e \u003cb\u003en =\u003c/b\u003e desired sample size for population\u003c/p\u003e \u003cp\u003e \u003cb\u003eZ =\u003c/b\u003e standard normal duration usually set as 1.96 (which corresponds to 95% confidence level)\u003c/p\u003e \u003cp\u003e \u003cb\u003eP =\u003c/b\u003e we use positive prevalence estimated. As there is no previous study on topic under study in the study area, to estimate prevalence a figure of 0.5 used to get the possible minimum large sample size.\u003c/p\u003e \u003cp\u003eSince the total population is \u0026lt; 10,000 that is 311 patients are identified from HMIS we use the Correction formula to determine final sample size.\u003c/p\u003e \u003cp\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\(\\:nf=\\frac{\\text{n}}{1+\\frac{\\text{n}}{\\text{N}}}\\)\u003c/span\u003e \u003c/span\u003e \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:=\\)\u003c/span\u003e\u003c/span\u003e \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:nf=\\frac{384}{1+\\frac{384}{311}}\\)\u003c/span\u003e\u003c/span\u003e \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:=\\)\u003c/span\u003e\u003c/span\u003e 171.8 Which is nearly \u003cb\u003e172\u003c/b\u003e\u003c/p\u003e \u003cp\u003eN = final sample size when a population is \u0026lt; 10,000\u003c/p\u003e \u003cp\u003en = initial sample size when the population is \u0026gt; 10,000\u003c/p\u003e \u003cp\u003enf = estimated study population\u003c/p\u003e \u003cp\u003eThen 10% non- response rate added: 172 + 18 = 190\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSampling technique and procedures\u003c/h2\u003e \u003cp\u003eThe study participants were recruited as they come for the regular clinical visit using a systematic random sampling technique with a sampling interval of every second patients. During the data collection period, 311 chronic hepatitis patients expected to visit the hospital for follow-up. Sampling intervals, (K value) was calculated as 311/190 = 2. To determine the first-person, the lottery method was used on first day from the 10 patients who had under follow-up. Then, each second client was selected for an interview, chart review until 190 study participants recruited. If the second patient is not fulfilling the inclusion criteria, the next person was taken.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStudy variables\u003c/h2\u003e \u003cp\u003eThe dependent variable in this study is Health-Related Quality of Life (HRQoL), which serves as the primary outcome measure. Several independent variables are considered to assess their potential impact on HRQoL among chronic hepatitis B patients. These include sociodemographic factors such as gender, age, residence, ethnicity, marital status, religion, income, occupation, and family size. Additionally, clinical and disease-related factors are examined, including the duration of diagnosis, duration of treatment, ultrasound findings, alanine aminotransferase (ALT) levels, viral load of hepatitis B virus (HBV), and the presence of comorbidities. By analyzing these variables, the study aims to determine how different factors influence the quality of life in patients undergoing antiviral treatment for chronic hepatitis B.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eOperational definition\u003c/h2\u003e \u003cp\u003eHealth Survey Short Form-36 (SF-36) and the European quality of life questionnaire-5 dimensions (EQ-5D) are two of the most commonly employed HRQoL measurement tools for Health-related quality of life\u003csup\u003e\u003cb\u003e[35]\u003c/b\u003e\u003c/sup\u003e. The SF-36 version 2 questionnaire is a self-administered questionnaire comprised of 36 items with two (physical and mental) components. The physical component summary includes the four domains of physical functioning (PF), physical role functioning (RP), bodily pain (BP), and general health (GH)\u003csup\u003e\u003cb\u003e[33 ,35, 36]\u003c/b\u003e\u003c/sup\u003e. The mental component summary includes four domains of vitality (VT), social functioning (SF), emotional role (RE), and mental health (MH). Each raw domain score can be converted into a 0–100 scale, with a higher score indicating a higher health status \u003csup\u003e\u003cb\u003e[36]\u003c/b\u003e\u003c/sup\u003e. SF-36 scores range from 0 (worst) to 100 (best)\u003csup\u003e\u003cb\u003e[35,36]\u003c/b\u003e\u003c/sup\u003e. It consists of a questionnaire and (EQ-VAS). For this research, we use visual analogue scale only because the other component of EQ-5D questionnaire incorporated in SF 36. A VAS is usually a horizontal or vertical line with a scale from 0 (absence of the characteristic measured) to 100 (extreme value). The patient marks on the line the point that they feel represents their current state\u003csup\u003e\u003cb\u003e[37]\u003c/b\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHigh HRQoL\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eIt is defined as participants who scored greater than or equal to the mean value of of SF-36 scale\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLow HRQoL\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eIt is defined as participants who scored less than mean value of SF-36 scale\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eData collection procedure and tools\u003c/h2\u003e \u003cp\u003eData was collected by using pretested semi-structured checklist. Those who are graduates in respective Language translated it to Amharic and Oromiffa language.\u003c/p\u003e \u003cp\u003eThe checklist had four parts including:\u003c/p\u003e \u003cp\u003ePart 1: Socio-demographic and socio-economic related factors (8 items);\u003c/p\u003e \u003cp\u003epart 2: Clinical related characteristics (6 items);\u003c/p\u003e \u003cp\u003epart 3: SF-36 health survey (36 items) and\u003c/p\u003e \u003cp\u003epart 4: Visual analogue scale (1 item):\u003c/p\u003e \u003cp\u003eThe SF-36 was used to measure HRQoL. SF-36 health survey is widely validated tools which is one of the most generally used HrQoL scale in the world. It is validated in different languages. It measures four domains in the area of physical health (Physical Functioning(10 items), Role Limitation–Physical(5items), Bodily Pain(2 items), and General Health (4 items) and four domains in the area of mental health (Role Limitation–Emotional(3 items, Vitality(4 items), Mental Health(5 items), Social Functioning(2 items) and one health perception (health change item). Each item was transformed to 0-100 value to computed mean, frequency of each domain, summary component and overall HRQoL.\u003c/p\u003e \u003cp\u003eData was collected by 2 general physician and supervised by primary investigator after taking a one training. The training was focused on the objective of the study, interview technique and clarification of each question in order to keep the quality of data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eData quality assurance\u003c/h2\u003e \u003cp\u003eStandard questionnaire for the study of quality life medical outcome study short form 36 (MOS SF-36) questionnaire which is prepared in English was translated to local language which then was translated back to English by another translator in order to keep its consistency (Annexed separately). Pretest was done to improve clarity, understandability, and simplicity of the messages of the tools before actual data collection. Data collectors and supervisors were trained for one day on the objective, method, sampling technique, ethical issues, data collection instrument, and data collection procedure prior to data collection. The collected data were checked manually for completeness and consistency daily by the supervisors and principal investigator. The internal consistency of the SF-36 scale was checked using Cranach’s alpha (0.96).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eData processing and analysis\u003c/h2\u003e \u003cp\u003eThe collected questionnaires were coded and entered into Epi Data Version 3.1. After the entry was completed, then data was exported to SPSS version 22.0 for analysis. Descriptive statistics (frequency, mean, standard deviation and Percentage) was used to describe socio-demographic characteristics of the study, participants and tables were used for data presentation. All items of SF-36 were transformed to zero (0) to hundred (100) values, in which 0 were given to maximum limitation or disabilities and whereas 100 given no limitation or no disabilities.\u003c/p\u003e \u003cp\u003eTo estimate the association between associated factors and Health related Quality of Life, odds ratio (OR) with 95% confidence intervals (CIs) was used. Bivariable binary logistic regression analysis was made to determine the association of each independent variable with the outcome variable HrQoL. Variables with p-value of less than 0.2 in bivariable binary logistic regressions were candidate for multivariable binary logistic regression analysis to identify significant factors for outcome variable. Variables with p-value of less than 0.05 were used to declare statistical significance and strength of association was determined by adjusted odd ratio (AOR) with (95%) confidence interval. The model fitness was checked using Homer-Lemeshow goodness of fit test and it was fitted (P = 0.46). Finally, the findings presented using tables, graphs, and text.\u003c/p\u003e \u003c/div\u003e "},{"header":"Result","content":"\u003ch2\u003eSocio-Demographic Characteristics\u003c/h2\u003e\n\u003cp\u003eIn this study, 190 patients with chronic hepatitis B virus were participated with the response rate of 100%. The age of participants ranged from 19–78 years, with mean age of 37.85 ± 11.1years. Nearly two-third of participants 121 (64%) were females and the majority of them 134 (70.5%) and 150 (79.4) were younger adults (18–40 years) and married respectively. The majority of the participants 140 (74.1%), and 114(60.3%) were urban residents and orthodox respectively. Nearly four-fifth of the participants 75(39.7%), and 76 (40.2) were Amhara and Oromo respectively. Two-fifth of the participants, 79 (41.6%) and 76 (40%) had family size of ≥ 5 in their home and private work respectively. Nearly one-third, 63(33.3%) had monthly income of 5,000–10,000 Ethiopian birr. (Table 1)\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eSocio-demographic and socio-economic characteristics of chronic hepatitis B patients receiving follow-up care in the Gastroenterology and Hepatology Unit at SPHMMC from March 2023 to September 2023 G.C.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18–40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41–60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt; 60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eResidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003eEthnicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmhara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOromo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTigre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGurage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eReligion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCatholic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eIncome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot mentioned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1000–4000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5000–10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt; 100000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eprivate work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGovernment employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHouse wife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eFamily size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1–2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3–4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch2\u003e*student, Non-governmental organization\u003c/h2\u003e\n\u003ch2\u003eClinical characteristics\u003c/h2\u003e\n\u003cp\u003eThe majority of the participants145 (76.3%) were diagnosed for CHBV infection less than five years and 133 (70%) of patients started treatment four or more years duration. The ultra sound finding revealed that 95(50%), 29 (15.3%), and 16(8.4%) were normal, cirrhosis, and cirrhosis with portal hypertension respectively. Additionally, the laboratory investigation showed that most of participants 177(93.2%) had below upper limit Alanine Aminotransferase level ,which means two times of 25 and 35 for female and male respectively. More than half 102(53.7%) and nearly one-fourth of the participants’ viral load was 20-2000 and ≥ 2000 respectively (Table 2).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eClinical characteristics of participants of chronic hepatitis B patients receiving follow-up care in the Gastroenterology and Hepatology Unit at SPHMMC from March 2023 to September 2023 G.C.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eDuration of diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5–10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt; 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eDuration of Treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1–3 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 4 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e70.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003eUltra sound\u003c/p\u003e\n \u003cp\u003eFinding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCirrhosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCirrhosis with PHTN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFatty liver or mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReport not found\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eALT level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBelow upper limit*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e93.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbove upper limit**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eViral load of HBV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20-2000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 2000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003e*\u0026lt;50 for female and \u0026lt; 70 for male, **≥50 for female and ≥ 70 for male, PHTN: Portal hypertension, ALT: Alanine Aminotransferase.\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003eComorbidity related characteristics\u003c/h2\u003e\n\u003cp\u003eThirty-five (18.4%) participants had comorbidity, of which nearly one-fourth (31.42%) and one-fifth (25.71%) were diabetic and hypertensive respectively (Table 3).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eComorbidity related characteristics of chronic hepatitis B patients receiving follow-up care in the Gastroenterology and Hepatology Unit at SPHMMC from March 2023 to September 2023 G.C. .\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003eType of comorbidity (N = 35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRVI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHTN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCKD and renal disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch2\u003e*Asthma, transverse myelitis, cholelithiasis\u003c/h2\u003e\n\u003ch2\u003eMean score of health-related quality of life Scale\u003c/h2\u003e\n\u003cp\u003eThe HRQOL measured using SF-36 scale with eight domains and the overall mean score was 75.27 ± 20.62. The mean score physical health component summary (PHCS) and mental health component summary (MHCS) of SF-36 scale were 77.50 ± 24.84 and76.05 ± 17.29 respectively.\u003c/p\u003e\n\u003cp\u003eThe highest mean scores were observed in social function and bodily pain domains with mean score of 91.64 ± 18.01and 85.20 ± 25.44 respectively. Whereas, the lowest mean scores observed in vitality/energy and general health domains that revealed 60.84 ± 14.247 and67.02 ± 24.16 respectively. (Table 4)\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eThe mean score of the domains of HRQL of chronic hepatitis B patients receiving follow-up care in the Gastroenterology and Hepatology Unit at SPHMMC from March 2023 to September 2023 G.C.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eDomains in HQLQ\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo of Items\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean ± SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCronach’s alpha (α)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003ePHC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysical Functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80.84 ± 28.275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.951\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRole limitation/physical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76.97 ± 39.583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.955\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGeneral health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67.02 ± 24.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.897\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBodily pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e85.20 ± 25.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.927\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eMHC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRole limitation/emotional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e78.42 ± 39.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.952\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVitality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60.84 ± 14.247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.390\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmotional wellbeing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73.33 ± 13.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.730\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003esocial functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e91.64 ± 18.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.770\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHealth change (perception)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e59.61 ± 25.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e----\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysical component summary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e77.50 ± 24.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.960\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMental component summary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76.05 ± 17.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.864\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverall mean of SF 36 scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75.27 ± 20.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.963\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch2\u003ePHCS: Physical health components, MHC: Mental health component\u003c/h2\u003e\n\u003ch2\u003eMagnitude of health-related quality of life\u003c/h2\u003e\n\u003cp\u003eIn this study nearly two-third of the study participants 126 (66.3% (95% CI61.1, 72.7)) had low HRQOL (below mean score) (Fig. 1).\u003c/p\u003e\n\u003cp\u003eWhen comparing each domain, the lowest and highest HQRQOL was observed in vitality and Social functioning domains respectively (Fig. 2).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePF: Physical Functioning, RF: Role Functioning, RE: Role Emotional, Vitality, EH: Emotional Health, SF: Social Functioning, BP: Bodily Pain, GH: General Health\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFigure 2: \u003cem\u003eThe magnitude of HRQOL among eight domains of SF-36 scale\u003c/em\u003e of chronic hepatitis B patients receiving follow-up care in the Gastroenterology and Hepatology Unit at SPHMMC from March 2023 to September 2023 G.C.\u003c/p\u003e\n\u003ch2\u003eFactors associated with HRQoL\u003c/h2\u003e\n\u003cp\u003eIn bivariable binary logistic regression analysis, sex, residence, comorbidity, alanine aminotransferase, duration of treatment, marital status, ultra sound finding, family size and age were candidate variables (P \u0026lt; 0.2) to fit multivariable binary logistic regression analysis. However, in multivariable binary logistic regression analysis only marital status, ultra sound finding, family size and age were significantly associated.\u003c/p\u003e\n\u003cp\u003ePatients with chronic hepatitis who were married currently nearly fivefold (AOR: 4.48, 95% CI (1.56, 12.82) increase the health related quality of life compared with not currently married.\u003c/p\u003e\n\u003cp\u003ePatient who had 3–4 family size were four fold (AOR = 3.67, 95% CI(1.64, 8.23 )increase quality of life compared to those not have and greater than 5 family members. In contrast, Patients having ultra sound finding of cirrhosis with portal hypertension were nearly 83% (AOR = .173, 95% CI (.043, .692) less likely to have high health related quality of life compared with normal ultra sound finding and those aged greater than 60 year 80% (AOR = .19, 95% CI (.04,.85)) less likely to have high health related quality of life compared to those 18–40 years.(Table 5).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 5\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eBivariable and multivariable analysis to identify factors associated with HRQOL of chronic hepatitis B patients receiving follow-up care in the Gastroenterology and Hepatology Unit at SPHMMC from March 2023 to September 2023 G.C.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHRQOL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCOR(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAOR (95% C.I.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ehigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003elow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.56 (.30, 1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.76(.35, 1.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.501\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eResidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.63 (.83, 3.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.77(.81, 3.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.148\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.20(.56, 2.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.37 (.11, 1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.092\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAlanine Aminotransferase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBelow upper limit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbove upper limit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.40(.13, 1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.49(.13, 1.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.296\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eDuration of treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1–3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.6(1.36, 4.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.89(.78, 4.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.154\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.93(1.42, 6.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.48 (1.56, 12.82)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003enot married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003eUltra\u003c/p\u003e\n \u003cp\u003eSound finding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCirrhosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.41(.17, .98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.59(.20, 1.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.353\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCirrhosis with PHN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.15 (.04, .48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.173 (.043, .692)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFatty liver or mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.63(.25, 1.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.70(.24, 2.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.517\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.82(.30, 2.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.81(.26, 2.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.720\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal US\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eFamily size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1–2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.41(.62, 3.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.17 (.98, 10.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.053\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3–4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.4(1.66, 6.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.67(1.64, 8.23)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e≥ 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18–40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41–60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.86(.42, 1.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.72(.29, 1.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.491\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt; 60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.26(.08, .76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19(.04, .85)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAOR: Adjusted Odds ratio, COR: Crude Odds ratio\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study nearly two-third of participants 126 (66.3% (95% CI61.1, 72.7)) had high HRQOL. The overall mean score of HRQOL was 75.27 ± 20.62. The mean score of physical component summary (PCS) and mental component summary (MCS) were nearly similar that was 77.50 ± 24.84 and 76.05 ± 17.29 respectively. This finding was significantly higher than the study done in Italy that revealed mean score of 42.6 ± 10.142.5 ± 11.5 for PCS and MCS respectively \u003csup\u003e\u003cb\u003e[38, 39]\u003c/b\u003e\u003c/sup\u003e. This variation could be explained by, unlike our study that include all patients with chronic hepatitis, the Italy study was done among patients with cirrhosis that might decrease the HRQoL. Our finding is also inconsistent with the study done in china that found PCS scores have a more significant decrease than MCS scores \u003csup\u003e\u003cb\u003e[17]\u003c/b\u003e\u003c/sup\u003e. Moreover, the variation might be due to socioeconomic and health care system difference. From the eight domains of F-36, the highest mean scores were observed in social function and bodily pain domains. Whereas, the lowest mean scores observed in vitality/energy and general health domains. The mean score of EQ5D visual analogue scale (VAS) was 78.94 ± 17.28 with a minimum of five to maximum of hundred which is relatively higher than the SF-36 scale.\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003ePatients with chronic hepatitis B who were married currently fivefold increase health related quality of life compared to unmarried and those having 3–4 family size were nearly four folds increase the health-related quality of life compared with having five or more families. This finding is consistent with previous study in China that found being without a life partner (unmarried or separated) was inversely correlated with HRQoL\u003csup\u003e\u003cb\u003e[40]\u003c/b\u003e\u003c/sup\u003e. This might be due to currently married patients have better family and social support compared with the counterparts. This can be also supported with evidence that found being married was positively associated with perceived social support \u003csup\u003e\u003cb\u003e[41]\u003c/b\u003e\u003c/sup\u003e. Similarly, patients with chronic hepatitis B who had 3–4 family size were nearly four folds increase the health-related quality of life compared with having five or more families. This could be due to the higher family size can adversely affect the overall family basic needs; in turn can affect their health and quality of life.\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e \u003cp\u003eIn contrast, patients having cirrhosis with portal hypertension were nearly 83% less likely to have high health related quality of life. This is in agreement with the study in United States and others site found stage of chronic hepatitis B correlated significantly with worsening HRQL [\u003csup\u003e\u003cb\u003e42–44]\u003c/b\u003e\u003c/sup\u003e. This could be due to patients having cirrhosis with portal hypertension might have different complication including upper GI bleeding and infection and downstream complication of decompensated cirrhosis than compensated one. Additionally, the HRQoL was significantly reduced among patients with sixty years and above. This is consistent with previous studies in China and Turkey that found older age was associated with poorer HRQOL in CLD patients \u003csup\u003e[\u003cb\u003e43, 45, 46, 47]\u003c/b\u003e\u003c/sup\u003e. This might be due to elders have low physiological function and productivity than young adults in turn reduce the quality of life.\u003c/p\u003e \u003cp\u003eHowever, our finding contradicts with another Chinese study that found younger age were significantly associated with poorer HRQoL\u003csup\u003e\u003cb\u003e[44]\u003c/b\u003e\u003c/sup\u003e. This can be due to the tool difference that unlike this study that used 8 domains, Chinese study used SF-6D to measure HRQoL that consists of six dimensions namely physical functioning (PF), role limitation (RL), social functioning (SF), bodily pain (PL), mental health (MH) and vitality (VT). Similarly, the study in Italy found that the overall, physical health was poorer in younger patients with cirrhosis \u003csup\u003e\u003cb\u003e[38]\u003c/b\u003e\u003c/sup\u003e. This variation from our finding could be explained unlike our study, the Italy study was done among patients with cirrhosis. Additionally, it could be due to socioeconomic and sociocultural difference.\u003c/p\u003e "},{"header":"Conclusion and Recommendations","content":"\u003cp\u003ePatients with chronic hepatitis B infection had relatively high HRQOL. The overall mean score of SF-36 and EQ5D VAS was 75.27 and 78.94 respectively. The mean score of PCS and MCS were nearly similar, 77.50 and 76.05 respectively. The overall HRQoL was associated with marital status, family size, cirrhosis with portal hypertension and age. It’s better to diagnose and start treatment for physician for patients with hepatitis B infection to have better HRQol. More emphasis is needed to provide better care for unmarried, higher family size, elders and cirrhotic with portal hypertension patients. Further study with a bigger sample size involving multi-center is recommended.\u003c/p\u003e\u003ch2\u003eLimitations of the study\u003c/h2\u003e\u003cp\u003eThis study was conducted with small sample size in a single institution, which is less representative to generalize for other areas in Ethiopia. However, this is the first study that can be baseline for future scholars.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eBP\u003c/strong\u003e=Bodily pain\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCHB\u003c/strong\u003e=chronic hepatitis B\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDNA:\u0026nbsp;\u003c/strong\u003eDeoxyribonucleic acid\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEQ-5D:\u0026nbsp;\u003c/strong\u003eEuropean Quality of Life-5 Dimensions \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEQ-VAS: V\u003c/strong\u003eisual analogue scale\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHBsAG:\u0026nbsp;\u003c/strong\u003eHepatitis surface antigen\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHBV :\u003c/strong\u003eHepatitis B Virus\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHCC:\u0026nbsp;\u003c/strong\u003eHepatocellular carcinoma\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHRQoL:\u003c/strong\u003eHealth related quality of life\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMH:\u0026nbsp;\u003c/strong\u003eMental health\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNUC:\u0026nbsp;\u003c/strong\u003eNucleos(t)ides analogies\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePF:\u0026nbsp;\u003c/strong\u003ePhysical function\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSF-36:\u0026nbsp;\u003c/strong\u003e36-Item Short-Form Health Survey questionnaires,\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSF:\u0026nbsp;\u003c/strong\u003eSocial functioning\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSPHMMC:\u0026nbsp;\u003c/strong\u003eSaint Paul Hospital millennium medical college\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRE:\u0026nbsp;\u003c/strong\u003eRole limitation due to emotional problem\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVT:\u0026nbsp;\u003c/strong\u003eVitality\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance letter was obtained from review board of Saint Paul Millennium Medical College (SPHMMC). In addition, informed consent was obtained from the study participants. Participants were \u0026nbsp;informed \u0026nbsp; that \u0026nbsp;their \u0026nbsp;names \u0026nbsp; will \u0026nbsp;not \u0026nbsp;be \u0026nbsp; mentioned \u0026nbsp;and \u0026nbsp;information provided by them will be kept confidential. The study was conducted according to the declaration of Helsinki. They were given the chance to ask \u0026nbsp; anything \u0026nbsp;about \u0026nbsp;the \u0026nbsp; study \u0026nbsp;and \u0026nbsp;were \u0026nbsp; free \u0026nbsp;to \u0026nbsp;refuse \u0026nbsp; or \u0026nbsp;stop \u0026nbsp;the \u0026nbsp; response \u0026nbsp;at \u0026nbsp;any \u0026nbsp; moment \u0026nbsp;they want. Data collected was stored and confidentiality maintained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThe Research, authorship, and/or publication of this work\u0026nbsp;did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eWolde Hailu Demissie\u003c/strong\u003e\u003cstrong\u003e, MD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInvolved in the conception and design of the study, drafting and revising of the article and final approval of the version to be submitted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMolla Asnake Kebede, MD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInvolved in the conception and design of the study, drafting and revising of the article and final approval of the version to be submitted.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAlemayehu Beharu Tekle, MD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInvolved in the conception and design of the study, drafting and revising of the article and final approval of the version to be submitted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMehariw Wondim Netsered , MD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInvolved in the conception and design of the study, drafting and revising of the article and final approval of the version to be submitted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTadele Demilew Chekole, MD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInvolved in the conception and design of the study, drafting and revising of the article and final approval of the version to be submitted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eErkihun Pawlos Shahsb, MD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInvolved in the conception and drafting and revising of the article and final approval of the version to be submitted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdugnaw Worku Bogalef, MD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInvolved in the conception and drafting and revising of the article and final approval of the version to be submitted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Hazrone Adinew Adi, MD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInvolved in the conception and drafting and revising of the article and final approval of the version to be submitted\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHenok Birhanu Kassa, MD\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInvolved in the conception and drafting and revising of the article and final approval of the version to be submitted.\u003c/p\u003e\n\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Saint Paul\u0026rsquo;s Hospital Millennium Medical College and Department of Internal Medicine for an opportunity to conduct this research.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; information\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWHD is\u003c/strong\u003e Assistant Professors of Internal Medicine. \u003cstrong\u003eWH\u003c/strong\u003e is Medical Doctors and has Specialty Certificate in Internal Medicine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMAK\u0026nbsp;\u003c/strong\u003eis an assistant Professor. \u003cstrong\u003eMA\u003c/strong\u003e is a Medical Doctor and specialty certificate in Drug resistant tuberculosis management. He is ECFMG certified physician.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eABT is\u003c/strong\u003e assistant Professors of Emergency and Critical care medicine. \u003cstrong\u003eAB\u003c/strong\u003e is Medical Doctors and has Specialty Certificate in Emergency and critical care medicine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMWN\u003c/strong\u003e: \u003cstrong\u003eis\u003c/strong\u003e Assistant Professors of Internal Medicine. \u003cstrong\u003eMW\u003c/strong\u003e is Medical Doctors and has Specialty Certificate in Internal Medicine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTDC\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;is\u003c/strong\u003e Assistant Professors of Internal Medicine. \u003cstrong\u003eTD\u003c/strong\u003e is Medical Doctors and has Specialty Certificate in Internal Medicine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEPS\u003c/strong\u003e \u003cstrong\u003eis\u003c/strong\u003e Assistant Professors of Internal Medicine. \u003cstrong\u003eEP\u003c/strong\u003e is Medical Doctors and has Specialty Certificate in Internal Medicine.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u003cstrong\u003eAWB\u003c/strong\u003e \u003cstrong\u003eis\u003c/strong\u003e Assistant Professors of orthopedics and trauma surgeon. A\u003cstrong\u003eW\u0026nbsp;\u003c/strong\u003eis Medical Doctors and has Specialty Certificate in orthopedics and trauma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHAA\u003c/strong\u003e \u003cstrong\u003eis\u003c/strong\u003e Assistant Professors of Radiology. \u003cstrong\u003eHA\u0026nbsp;\u003c/strong\u003eis Medical Doctors and has Specialty Certificate in\u0026nbsp;Radiology.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHBK\u003c/strong\u003e \u003cstrong\u003eis\u003c/strong\u003e Assistant Professors of General Practitioner. \u003cstrong\u003eHB\u0026nbsp;\u003c/strong\u003eis Medical Doctors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection q.\u003c/li\u003e\n\u003cli\u003eNational Clinical Guideline Centre Hepatitis B (chronic) Diagnosis and management of chronic hepatitis B in children, young people and adults Clinical guideline Methods, evidence and recommendations. 2013. \u003c/li\u003e\n\u003cli\u003eJohannessen A, Tadesse Gebremedhin L, Desalegn H. 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Efficacy and Safety of Bepirovirsen in Chronic Hepatitis B Infection. New England Journal of Medicine. 2022 Nov 24;387(21):1957\u0026ndash;68. \u003c/li\u003e\n\u003cli\u003eZhang Q, Zhong C, Cai S, Yu T, Xu X, Yin J. Risk Factors Associated With Quality of Life in Patients With Hepatitis B Virus Related Cirrhosis. Front Psychol. 2022 Jan 6;12. \u003c/li\u003e\n\u003cli\u003eKaracaer Z, Cakir B, Erdem H, Ugurlu K, Durmus G, Ince NK, et al. Quality of life and related factors among chronic hepatitis B-infected patients: A multi-center study, Turkey. Health Qual Life Outcomes. 2016 Nov 3;14(1). \u003c/li\u003e\n\u003cli\u003eBalbinot JC, Souza AW, Pontarolo R, Junior ODB, Silva EAA da, Junges DSB, et al. Validation of the Brazilian version of the hepatitis B quality of life evaluation instrument-HBQOL, and its application to patients with chronic hepatitis B in Cascavel \u0026ndash; PR. 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Gastroenterology. 2001 Jan 1;120(1):170\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eKaraivazoglou K, Iconomou G, Triantos C, Hyphantis T, Thomopoulos K, Lagadinou M, et al. Fatigue and depressive symptoms associated with chronic viral hepatitis patients\u0026rsquo; health-related quality of life (HRQOL). Vol. 9. 2010. \u003c/li\u003e\n\u003cli\u003eChen P, Zhang F, Shen Y, Cai Y, Jin C, Li Y, et al. Health-Related Quality of Life and Its Influencing Factors in Patients with Hepatitis B: A Cross-Sectional Assessment in Southeastern China. Can J Gastroenterol Hepatol. 2021;2021. \u003c/li\u003e\n\u003cli\u003eVaingankar JA, Abdin E, Chong SA, Shafie S, Sambasivam R, Zhang YJ, et al. The association of mental disorders with perceived social support, and the role of marital status: results from a national cross-sectional survey. Archives of Public Health. 2020 Dec 1;78(1). \u003c/li\u003e\n\u003cli\u003eAfendy A, Kallman JB, Stepanova M, Younoszai Z, Aquino RD, Bianchi G, et al. Predictors of health-related quality of life in patients with chronic liver disease. Aliment Pharmacol Ther. 2009 Sep;30(5):469\u0026ndash;76. \u003c/li\u003e\n\u003cli\u003eZhang Q, Zhong C, Cai S, Yu T, Xu X, Yin J. Risk Factors Associated With Quality of Life in Patients With Hepatitis B Virus Related Cirrhosis. Front Psychol. 2022 Jan 6;12. \u003c/li\u003e\n\u003cli\u003eAshrafi M, Malekzadeh R, Poustchi H. A Review of Psychosocial Issues in Patients with Chronic Data \u0026middot; July 2013 CITATIONS 0 702 PUBLICATIONS 18,139 CITATIONS SEE PROFILE [Internet]. Available from: https://www.researchgate.net/publication/253233384\u003c/li\u003e\n\u003cli\u003eGutteling JJ, De Man RA, Van Der Plas SM, Schalm SW, Busschbach JJV, Darlington ASE. Determinants of quality of life in chronic liver patients. Aliment Pharmacol Ther. 2006 Jun;23(11):1629\u0026ndash;35. \u003c/li\u003e\n\u003cli\u003eZhang M, Li Y, Fan Z, Shen D, Huang X, Yu Q, et al. Assessing health-related quality of life and health utilities in patients with chronic hepatitis B-related diseases in China: A cross-sectional study. BMJ Open. 2021 Sep 15;11(9). \u003c/li\u003e\n\u003cli\u003eKaracaer Z, Cakir B, Erdem H, Ugurlu K, Durmus G, Ince NK, et al. Quality of life and related factors among chronic hepatitis B-infected patients: A multi-center study, Turkey. Health Qual Life Outcomes. 2016 Nov 3;14(1). \u003c/li\u003e\n\u003cli\u003eLam ETP, Lam CLK, Lai CL, Yuen MF, Fong DYT, So TMK. Health-related quality of life of Southern Chinese with chronic hepatitis B infection. Health Qual Life Outcomes. 2009 Jun 5;7. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"chronic hepatitis B, health-related quality of life, SPHMMC, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-6002154/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6002154/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHealth-related quality of life (HRQoL) has emerged as an important consideration in the care of patients with chronic hepatitis B (CHB). There is limited evidence on HRQoL among CHB patients in Ethiopia, particularly in the study area. This study aimed to assess HRQoL and associated factors among patients with chronic hepatitis B in SPHMMC.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted from March 2023 to September 2023 among patients with chronic hepatitis B in SPHMMC. The study participants were selected using a systematic random sampling technique. Two physicians collected data from patient interviews and chart reviews using a checklist. Data were entered into Epi-Data and exported to SPSS version 26 for analysis. Descriptive and inferential statistical analyses were conducted. Bivariable and multivariable binary logistic regression was used to assess associations between dependent and independent variables using adjusted odds ratio (AOR) with 95% confidence intervals (CI). A P-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong the 190 patients with chronic hepatitis B, nearly two-thirds (126; 66.3% [95% CI: 61.1, 72.7]) had high HRQoL. The overall mean HRQoL score was 75.27\u0026thinsp;\u0026plusmn;\u0026thinsp;20.62. The mean scores for the physical component summary (PCS) and mental component summary (MCS) were 77.50\u0026thinsp;\u0026plusmn;\u0026thinsp;24.84 and 76.05\u0026thinsp;\u0026plusmn;\u0026thinsp;17.29, respectively, showing minimal difference. Factors significantly associated with HRQoL included being currently married (AOR: 4.48, 95% CI: 1.56, 12.82), having a family size of 3\u0026ndash;4 members (AOR: 3.67, 95% CI: 1.64, 8.23), presence of cirrhosis with portal hypertension (AOR: 0.173, 95% CI: 0.043, 0.692), and being older than 60 years (AOR: 0.19, 95% CI: 0.04, 0.85). No statistically significant difference in HRQoL was observed between cirrhotic and non-cirrhotic patients based on \u003cem\u003et\u003c/em\u003e-scores.\u003c/p\u003e\u003ch2\u003eConclusion and Recommendation:\u003c/h2\u003e \u003cp\u003eHRQoL was significantly affected in unmarried individuals, those with larger family sizes, patients with cirrhosis and portal hypertension, and older adults. Early diagnosis and timely initiation of treatment are crucial for improving HRQoL among patients with chronic hepatitis B. Special attention should be given to unmarried individuals, those with larger family sizes, older adults, and patients with cirrhosis and portal hypertension to enhance their quality of life.\u003c/p\u003e","manuscriptTitle":"Determinants of Health-Related Quality of Life in Chronic Hepatitis B Patients: A Study from SPHMMC, Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 16:49:49","doi":"10.21203/rs.3.rs-6002154/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"67098985-bb8b-4062-a040-6d08227c0605","owner":[],"postedDate":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-05T17:38:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-07 16:49:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6002154","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6002154","identity":"rs-6002154","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}