Economic Burden of Moderate to Severe Burns and its Association with Health-related Quality of Life of Nigerian Women

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Chinweuba, Faith C. Diorgu, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-24746/v2 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Feb, 2021 Read the published version in BMC Women's Health → Version 2 posted 7 You are reading this latest preprint version Show more versions Abstract Background Burns cases are frequent in Nigeria hospitals, however, literature on its economic burden and the association with health-related quality of life (HRQOL) of women in Nigeria is scarce. This study determined the burden of hospitalization after burns on women’s economic status and its associated HRQOL. Methods This was a three-month cross-sectional study of female patients ≥ 25 years, treated of mixed or full thickness burns in four teaching hospitals in south-east Nigeria, discharged between September-November, 2018. Study instruments were participants’ case notes for socio-demographic and disease history, interviewer-administered questionnaires, namely-economic-burden-of-burns questionnaire and English version of the EuroQol Five-Dimensions-Three-Level Health Questionnaire for Nigeria. Data were collected on second- or third-day post-discharge through home visits or phone calls. This lasted for thirteen weeks. Results A total of seventy-three female patients with burn were successfully enrolled. Most participants were married, fairly educated, mainly traders or housewives. Thirty-four (46.6%) had subjective estimated family monthly income below NGN 50,000 (low economic status). Participants’ average monthly income reduced drastically after hospitalization. Their average family monthly income was NGN110,439 (USD307), while their average total expenses incurred during hospitalization was NGN691,093 (USD1,920). Almost all (93.2%) had at least one surgical intervention during management. Their average length of hospital stay was 35.4 days; eleven consequently lost their job. Many had moderate to severe economic burden of treatment; only eleven could bear all the treatment expenses independently. Women in the low economic class were more inclined to extreme anxiety/depression (p = .001) and pain/discomfort (p = .002) dimensions of HRQOL. Low and middle-class women had poorer health state on the EQ VAS scale than the high class. Conclusion Burns places high level of economic burden on women and unfortunately, Nigerian government’s commitment to healthcare of burns patients is low. The long course of hospitalization and economic depletion impact negatively on the women’s HRQOL. Based on these findings, we recommend that government parastatals create special trust fund for burns treatment and the National Health Insurance Scheme be restructured for more accessibility. Preventive Medicine Internal Medicine Burns Economic Burden Economic Status Health Expenditure Hospitalization Quality of Life Figures Figure 1 Figure 1 Figure 2 Figure 2 Figure 3 Figure 3 Background Burn injury is a major public health concern. It is characterized as skin and/or other organic tissue injury caused primarily by extreme heat. Burn injury is ranked fourth in common traumatic conditions after traffic accident, falls and interpersonal violence [1]. An estimated 180,000 global annual deaths occur due to fire-related burn injuries, 95% of which were in low- and middle-income countries. [2]. Non-fatal burns have been noted to be leading cause of morbidity, prolonged hospitalization and disability [2], which may affect one’s health-related quality of life (HRQOL). Health-related quality of life represents a self-report of one’s perceived feeling of satisfaction with life, comfort and ability to realize one’s life potentials. HrQoL is closely linked with responsibilities of an individual. Cases of burn injury are frequently recorded in Nigeria hospital. Although few literatures have evaluated the impact and cost of managing burns in Nigeria [3,4], there is still dearth of literature on economic burden of burns and its association with HRQOL of burns, especially female patients in this part of the world where women are exposed to a lot of socio-economic challenges [5,6]. Enyioha [7] noted fast changing economic roles of African women as the world turns into a global village. These responsibilities translate to the amount of burden or difficulty the woman experiences. Severity of burn injury, depression, post-traumatic stress symptoms, inadequate social support, and loss of employment after hospitalization have been identified as predictors of poor HRQOL after burns [8], Economic hardship in women is directly proportional to their health trajectories [9]. Older women with lower socio-economic status and higher family/career responsibilities have lower HRQOL [10]. Similarly, homemakers who are often financially dependent experience more economic hardship than the career women that are relatively less financially dependent [11]. The economic drain on the patient’s purse due to burns treatment is huge especially in developing countries, with a mean hospital cost of about USD2,766 (NGN1,002,675) and a range from USD143 to USD33,566 (NGN51,480 – NGN12,083,760) [12,13,14]. Studies in Nigeria have shown that the average length of hospital stay (LHS) for burn management was 19 days, the average daily cost of treatment per patient was USD47.74 [15] and the total cost of management was USD7,123.28 per patient [5]. However, Nigeria’s average daily income per person is less than USD1 [16] and health insurance scheme is almost non-existent [17,18,19]. The Nigerian National Health Insurance Scheme (NHIS) is a social security system launched formally in 2006 the aim of which is to improve the health of all Nigerians by increasing access to universal healthcare, providing healthcare at an affordable cost through various prepayment systems. This scheme is meant to provide equal access to health care across different income classes and reduce the out of pocket expenditure on healthcare by the insured through contributions by the insurer, usually the federal government [20]. This high cost of care has been attributed to series of surgeries and long hospitalization with accompanying huge out-of-pocket expenditures [4,21,22,23]. The aim of the study was to determine the economic burden of hospitalization after burns on patients. Specific objectives were to: assess the cost of hospitalisation after burns; assess the sources of fund for medical and non-medical expenses available to the women; and, determine the women’s HRQOL based on the economic burden of burns management. It was hypothesized in this study that there is no significant association between the women’s socio-economic status and their HRQOL. This study will contribute to literature pools for economic evaluation of burns treatment.. Methods This was a three-month cross-sectional descriptive study of adult female patients admitted in hospitals, treated of burns and were discharged between 1 st September and 30 th November, 2018. Cross-sectional descriptive study had been used successfully in similar studies [10,24,25]. The study was carried out in four teaching hospitals in southeast Nigeria. Inclusion criteria were: women ≥ 25 years, treated of mixed or full thickness accidental burns ( > 30% total surface burn area according to the Rule of Nines for estimating burn percentage in adults), who were mentally stable and gave voluntary consent to participate. A total of 89 women with burn injury were on admission in the four hospital at the time of study. A sample size of 72 women was initially estimated using the Creative Research Systems survey software’s sample size calculator formula: ss = (Z 2 *(p)*(1-p))/C 2 ; where: Z=1.96, p=proportion of target population (women ≥ 25 years old, estimated to have > 30% total surface burn area) (expressed as 0.5), C=Confidence Interval (.04±4) [26]. Applying the adjusted sample size formula for anticipated 10% attrition rate: x = ss/1-f (where x is adjusted sample size; ss is original sample size; and, f is estimated non-response rate) [27], this initial sample size estimate was adjusted from 72 to 80 representing about 89.9% of the population. Instrument for data collection In this study, HRQOL is based on scores obtained on the European quality of life – five dimensions three levels instrument (EuroQol-5D-3L). Participants’ case notes and interview-administered questionnaire developed in three parts were used. Part A collected eleven data on socio-demographic profile of participants and their clinical parameters namely: phone number, residential address, age, marital status, parity, education, occupation, estimated family monthly income (FMI), pre-hospital treatment, number of surgeries done and other co-morbidities. Part B was economic burden of burns questionnaire (EBB-Q) adapted from Deshpande, Puri, Vora, Shende and Choudhary [28] with eleven items. Deshpande and colleagues formulated the EBB-Q to guide their data collection in a retrospective study on how families of patients cope with socio-economic burden of burns. To determine the existence of economic gradient in HRQOL of women who had burns, participants were assigned social status based on their estimated FMI. Thus, women with estimated FMI less than NGN50,000 (USD834)/month – high economic status (HES). Cost of hospitalization include direct medical and other (subjective) non-medical expenditures incurred as a result of the burn treatment. Direct medical costs include costs of medications and consumables, surgeries, investigations, blood products, nursing care and bed space. Indirect costs include dietary cost, transportation costs by caregivers and other incidental expenses. Direct costs are billable; hence, direct costs were obtained from respective patient’s case notes. Indirect costs were estimates provided by the respondent during interview. Part C was EuroQol Five-Dimensions-Three-Level (EQ-5D-3L) Health Questionnaire for face-to-face and telephone methods. English version of the EQ-5D-3L for Nigeria was obtained from the Euroqol Foundation through formal email. The EQ-5D-3L is a generic, preference-based measure of health with five dimensions, namely: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression; and three levels of health state coded 1-3. Where: 1 = no problem, 2 = Moderate problem and 3 = extreme problem. It also contains a EuroQol visual analogue scale (EQ VAS) that requires the respondent to indicate the point on the scale where she would put her ‘own health state today’ ranging from ‘0’ (the worst health she can imagine) to ‘100’ (the best health she can imagine). Validity of the EQ-5D-3L in burns patients was established by Oster, Willebrand, Dyster-Aas, Kildal and Ekselius [29]. The Head of Department of Health Administration and Management, University of Nigeria, Nsukka was requested to evaluate the readability, relevance and feasibility of the EBB-Q and the socio-demographic profiles /clinical parameters. Also, a professor in Medical-Surgical Nursing in the Department of Nursing Sciences, University of Nigeria, Nsukka and a plastic surgeon from Burns and Plastic Unit of the National Orthopaedic Hospital, Enugu were presented with the instrument and requested to help in ascertaining that all relevant items were included in the EBB-Q and socio-demographics. All necessary corrections were subsequently effected. For internal consistency reliability test of the instruments, copies were administered to eight newly discharged burns patients at the Burns and Plastic female ward of the University of Nigeria Teaching Hospital, Ituku-Ozalla between 4 th and 11 th of August, 2018, representing 10% of the sample size, after due consent. Applying split-half method, the scores were computed using Cronbach Alpha reliability test. Reliability coefficient (r) of .88 for Part A, .79 for Part B, and 0.93 for Part C were considered satisfactory. As some of the participants might not communicate effectively in English Language, an Ibo linguist was requested to translate the instrument to the local dialect ( Ibo ); another linguist was asked to translate the Ibo version to English Language without recourse to the original instrument. The translated English Language version was correlated with the original and discrepancies resolved in the local dialect version before use on the participants. Ethical consideration Ethical approval to conduct the study was obtained from the Health Research Ethics Committee of the National Orthopaedic Hospital, Enugu (IRB/HEC Number: RET/313/111/ 988). In addition, administrative permit was sought from Heads of Nursing Services and Ward Heads of female burns and plastic wards of the respective hospitals. Written informed consent was obtained from participants before enrolment. Purpose of the study and role of participants were fully explained to the prospective participants prior to the consent. They were also assured of anonymity and confidentiality in data collection and use. Only women who gave consent were enrolled into the study. Procedure for data collection With the assistance of clinicians in the female burns and plastic wards of the hospitals, researcher approached prospective participants already on admission. Purpose of the study and role of participants were explained to them while they were assured of confidentiality of information and non-maleficence. They were informed that researcher would visit them at their home two to three days after discharge from hospital for data collection. Cell phone numbers were exchanged with consenting patients to enhance communication. Data were collected at two points in time as follows: Point 1, participant’s socio-demographic and disease history were elicited from their case notes at the time of discharge. Participants were identified using serial numbers assigned to their hospital file numbers and cell phone numbers (where available) for confidentiality. Thereafter, participants were asked to indicate if they would prefer to be visited physically at home or to have telephone call interview for data collection after discharge home. Two could not supply their phone number and/or home address and were excluded. Point 2: Interviewer contacted participants between the 2 nd and 3 rd day after returning home for face-to-face or telephone call interview as pre-arranged. Only six opted for telephone calls. Member of the team visited the remaining seventy-two at their homes. For face-to-face method, interviewer established rapport, arranged for comfortable seats for the two, placed a copy of the questionnaire in front of him/her and gave a second copy to the participant for reference (where necessary). The interviewer read out contents of the questionnaire to the respondent item by item, using the preferred language version (English or Ibo ) and entered participant’s answers directly into the questionnaire. They were asked questions about their ‘own health state today’ and requested to rate their health on a measuring scale, emphasizing honesty. To avoid bias, a question was only repeated word for word when participant asked for clarification. Interviewer’s personal explanations were avoided; instead, participant was asked to use her own interpretation and answer in a way that most closely resembled her thoughts about her ‘health state today’. The interview took 15-30 minutes to complete. Seventy-eight (78) patients entered the study initially while seventy-three (73) were successfully interviewed representing 93.6% of the population. The remaining five declined participation when contacted for detailed data collection. Data collection lasted for twelve weeks and five days. Statistical analysis Data were analysed descriptively using frequencies, percentages, mean and standard deviation, and presented using contingency tables. Data collected on the estimated FMI and expenses due to burns and treatment were used to describe the economic burden of hospitalization after burns on the women’s economic life. To determine the economic burden of the burns, analysis of variance (ANOVA) was performed on the subjective degree of worsening of economic status due to burns and hospitalisation. Level of health state of participants was established by determining the Mean±SD of the utility scores on the scales. At three-points scale, any mean > 2 was considered a high level of problem and poor HRQOL. ANOVA was used to analyse the association between the scores on the EQ-5D-3L HRQOL of the women and their socio-economic status; and Tukey HSD applied for Post Hoc test of homogeneity of the scores where they existed. All statistical analyses were performed using the statistical package for social sciences version 23.0 computer software programme (SPSS inc., IL: Chicago, USA) at 95% confidence interval. Results Seventy-three (73) post burns patients finally entered the study (Figure I). Patient characteristics Table 1 showed that 34 (46.6%) out of the 73 women that entered the study had subjective estimated FMI below NGN50,000 (LES). Only 12 (16.4%) were classified as HES. Majority 45 (61.6%) were married. Half of the participants 37 (50.7%) were para 1-2, more than half of whom (20) had LES. As many as 46 (63.0%) were traders only four of whom were high-income earners. Majority had low educational attainment. Economic status appeared to be directly proportional to the women’s educational attainment as no participant with higher education had income below NGN50,000; Eight (11.0%) participants had received treatment elsewhere before reporting to the current hospital. Seven had one or more diagnosed co-morbidities. Significant post burn complications noted were unhealed wound/grafting 33 (45.2%) and contracture 21 (28.8%). More than half 39 (53.4%) had two or more surgical interventions during management; only 5 (6.8%) did not undergo surgery (Table 2). Monthly income and cost of hospitalization The women’s average subjective monthly income prior to admission reduced drastically after hospitalization. With the support of participants’ spouse and/or other family member(s) their average FMI before the burns marginally dropped at the end of hospitalization. The subjective average expenditure per day was NGN11,542 (USD32). With 35.4 days average LHS, the average total expenses incurred during hospitalization based on hospital bill at discharge and other estimated non-medical expenses related to hospitalization was NGN691,093 (USD1,920). (Table 3). Eleven women and two caregivers respectively lost their job as a result of hospitalization. Out of these, seven were self-employed while four were traders (Figure II). Source of fund As indicated in Figure III, only 11 participants could bear all expenses involved in their care at family levels, whereas more than half were assisted by relations and friends. As many as 46 (63.0%) sought loans from other sources for their treatment expenses. Twenty-six (35.6%) sold; while only 4 (5.5%) accessed the National Health Insurance Scheme (NHIS) for part payment of their cost of hospitalization. Not all values were exclusive as some participants had more than multiple source of fund. Economic burden Half of the participants 37 (50.7%) had their economy moderately worsened following hospitalisation, while 23 (31.5%) had severe degree of worsening. However, analysis of variance of the scores showed no significant difference in the degree of economic worsening the women had post hospitalization based on their economic status (F = 1.101; p = 0.355). Participants’ health-related quality of life Data from the seven (7) participants with clinically diagnosed co-morbidities (three participants had combine co-morbidities) were deliberately excluded before analysis to eliminate the possible confounding effect of these co-morbidities on their HRQOL scores; hence, data from 66 participants were analysed. Table 5 showed that anxiety/depression was the greatest problem reported by the women. irrespective of age, marital status and parity (Mean > 2.00). Similarly, the women reported high problems with self-care regardless of their parity, SES and education. Women with no formal education had high degree of anxiety/depression problems (Mean±SD = 3.07±.594). The least of their problems were mobility as most of the mean values were < 2.00; followed by usual activities and pain/discomfort. With overall EQ-5D mean score of .81, that is < 2, participants’ HRQOL was considered as generally poor. ANOVA of scores on the EQ-5D-3L HRQOL scale (Table 6) showed significant difference in the women’s SES and their pain/discomfort F(5.410, 32.985) p < .002 and anxiety/depression F(8.791, 44.667) p < .000 dimensions of HRQOL. Their EQ VAS ‘health state today’ also varied significantly according to their SES F(4.055, 64.439) p < .011. Multiple comparison of the scores on the EQ-5D-3L HRQOL using Tukey HSD Repeated Mean test show that the variations in SES were less for anxiety but were unequal guaranteeing Type 1 error (Table 7). Discussion Of Findings This study determined the burden of hospitalization after burns on women’s economic status and its associated HRQOL. The women had worsened economy post burn treatment due to high cost of hospitalization, loss of job and indebtedness. According to results of this study, a client spends as high as NGN691,093 (USD1,920) on the average on drugs, surgery, investigations, nursing care, bed space and other non-medical expenses (like feeding, transportation and procurement of toiletries). This is similar to $ 2,810 and $2,766 reported by Karimi [13] and Latifi et al [14] respectively, but far below $7,123.28 estimated by Okafor et al [4]. Meanwhile, the average LHS was 35.4 days – against the 19 days average found by Okafor et al [4]; and FMI before the burns was just about 11.1% of the hospital expenses. Unfortunately, only 5.5% accessed the services of the NHIS. The near non-existed NHIS as already demonstrated [17,18,19] is thus supported by findings of this study. Poor health financing has pitiable implications for achievement of goals of universal health coverage in Nigeria. Result of this study showed that although it was done in an urban setting, most of the participants were young, fairly educated, married women of low means, mainly traders or homemakers. Many of them had moderate to severe burden of treatment because of the high cost of treatment. Result indicated that as many as thirty-three were discharged home with open wounds and/or grafting possibly to avoid further accumulation of hospital bill. This finding directly reflects the low economic capacity of most of the women and the fact that most expenditure are out-of-pocket as they reported. Almost all the participants (68) had at least one surgical intervention during their burns management, meaning that burns patients will often need huge amount of money for operation and drugs deposits. In addition, they will require fund to procure the expensive modern dressing applications (like the Epigraft, Ex salt T7 and Therabond applications), high protein diet peculiar to burns treatment as well as pay for orthodox dressing change. If patient fails to pay for drugs, then drugs supply by the Pharmacy Department may be withdrawn. Unfortunately, antibiotics used in burns treatment are usually costly (like the injection Meronem that sells between N6,000.00 to N8,000.00 per vial) and procuring such may be challenging to the patient, resulting to more burden. The estimated family income can only yield about 20.89% of the average total expenses incurred during hospitalization, all things being equal; meaning that the remaining 79.11% must be sourced elsewhere. Our study showed that there was worsening of economy for most of the women following hospitalization irrespective of their economic status, and that up to eleven women, mostly traders and self-employed women, lost their job due to hospitalization. Since many of the participants were women of low means, they were most likely to be sole traders operating easy and inexpensive business with unstable customers and finance. The reported drop in estimated subjective monthly income supports the fact that even the usual meagre income will stop flowing in when the woman is hospitalised. Consequently, many would secure loans from friends, money lenders, bank, cooperative society, and the likes (with interest in some situations) and/or mortgage/sell assets such as lands, automobile, power generating set, television, jewelleries and clothes to raise fund for offsetting the huge hospital bills. Borrowing, selling personal assets and sometimes, loss of job are catastrophic results of the injury. Resultant stress and financial hardship/burden for the women and their family will deepen the pre-existing low economic standard. Further, the women’s HRQOL was poor as they reported anxiety/depression, self-care deficit and physical discomfort, thus aligning with Spronk [8]. Also, their EQ VAS and anxiety/depression scores differed significantly based on their occupation. Civil servants’ highest scores on the EQ VAS imply a better quality of life among them. Conversely, the highest anxiety/depression scores for the self-employed women mean poorer HRQOL. Civil servants work in domesticated organisations – they have little or no worry concerning the impact of hospitalization on their job because their job is secured. Self-employed women and traders, on the other hand, operate as ‘wild’ organisations because they always have to struggle for their own survival. Based on this, civil servants are more likely to have more positive assessment of their health state at any time than the self-employed and traders. The women’s anxiety/depression dimension and EQ VAS varied based on their economic status. Although there was no significant difference in other EQ-5D-3L dimensions, women in the LES appeared to be more inclined to extreme anxiety or depression than the middle and high economic class. Tucker et al [9] earlier reported this downward health trajectory for women with high economic hardship. With insufficient fund, making required deposits for treatments and surgeries, paying for expensive drugs, dressing packs and other medical and non-medical needs will become difficult. It is understandable that a good number of the women reported ‘extreme pain or discomfort’ or ‘confinement to bed after long stay in hospital’ or inability to perform usual activities independently because burns is ordinarily characterised with pain. Some women may have requested for ‘pre-mature’ discharge (even with open wound and partially healed grafting) to reduce further accumulation of hospital bill. Patients are not supposed to be discharged until they are fully recovered and capable of performing most activities of daily living unassisted. Sick patients in hospital have their sick role; the health conditions are continuously monitored while their skilled care providers institute necessary actions. When the individual is discharged home before full recovery, self-dependence and perhaps care by unskilled caregivers becomes the available option. This comes with its risk of wound breakdown, infection, pain and other complications, further worsening the already poor HRQOL and high economic burden of treatment. There was significant difference between the women’s age and their mobility, self-care and usual activities. As earlier observed by Chinweuba et al [10], the older women had poorer mobility and less ability to perform usual activities than the younger women did. This is understandable because people are physically stronger, more active and better able to self-manage their problems at their youthful age and become weaker as they get old. Young women may also have less social responsibilities and fewer challenges with self-care. Increasing level of education tends to reduce the women’s anxiety levels and improve their score on EQ VAS probably because it (education) will enhance better understanding of one’s challenges, better-informed decision making and more focused health actions. Educated women will be better able to study and understand their problem and its management than their less educated counterparts. Result showed significant difference in the women’s pain/discomfort dimension based on their parity. However, there was not any specific pattern in the differences. More studies may be required on this. Strengths and limitations One strength of this study is the choice of patients with moderate to severe degrees of burn which allowed for full range assessment of impact of burn injury and its management. Women with varying economic status entered the study. This served the opportunity to measure how SES predict the HRQOL of the patients. Although this study was done in Nigeria, the evident data may be resourceful in countries with similar "burn" problems for health policy decision making. However, the study was constrained by paucity of related literature especially from other low- to medium-income countries for a better view and understanding of economic burden of hospitalization after burns. Non-medical expenses related to hospitalization were estimates that were liable to personal factors of the participants. The values, therefore, cannot be used reliably as standard in similar studies. Conclusion Burns place high level of economic burden to the women who are predominantly of LES. It also has enormous negative impact on their quality of life. Many of them do not recover fully before leaving the hospital. The women’s HRQOL is directly proportional to their economic status and degree of economic burden. The long course of treatment and economic depletion through the huge out-of-pocket expenditure impact negatively on their HRQOL. Pain/discomfort, ‘reduced mobility and activities’ and anxiety/depression are commonly affected dimensions of the women’s HRQOL following burns. The women’s level of education is directly proportional to their HRQOL. Nigerian government’s commitment to healthcare of burns patients is low or non-existent. Based on the findings, we recommended that State and national governments create special trust fund for treatment, or at least subsidize treatment of burns particularly for indigent patients with severe burns, where free treatment is not possible. The NHIS needs to be made more accessible to all categories of the citizenry. We also recommend formation of non-profit burns foundations by non-governmental agencies with special endowment funds to assist financing of burns treatment. Finally, female education should be made free and compulsory in Nigeria with secondary school as the minimum. List of Abbreviations ANOVA = Analysis of Variance DALYS = Disability Adjusted Life Years EBB-Q = Economic Burden of Burns Questionnaire EQ VAS = Visual Analogue Scale EQ-5D-3L = EuroQol Five-Dimensions-Three-Level FMI = Family Monthly Income HES = High Economic Status HRQOL = Health-related Quality of Life LES = Low Economic Status LHS = Length of Hospital Stay MES = Middle Economic Status NGN = Nigeria Naira NHIS = National Health Insurance Scheme QALYs = Quality-Adjusted Life Years USD = United States Dollar WHO = World Health Organisation Declarations Ethics approval and consent to participate Ethical approval was obtained from the Ethical Review Committee of the National Orthopaedic Hospital, Enugu (IRB/HEC Number: RET/313/111/988). Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analysed during the current study are not publicly available because some parts of the data contain confidential personal information of respondents and their family, but are available from the corresponding author on reasonable request Competing interests The authors declare that they have no competing interests. Funding This study was not supported by any grant. The study design; data collection, analysis and interpretation of data; writing of the paper; and the decision to submit the paper for publication were, therefore, sole responsibility of the authors. Authors' contributions AUC conceived the paper, prepared the study protocol, designed the study, drafted the manuscript, and contributed to the statistical analysis and interpretation; ISC participated in project administration, data interpretation and critical revision of the manuscript; NEU contributed in drafting the manuscript and supervision of data analysis. KCW contributed in literature review, writing the manuscript and discussion; CSE assisted in interpretation of the data, contributed to the discussion and edited the manuscript; FCD participated in drafting the manuscript and the discussion. AIN participated in the acquisition of the data and contributed to supervision of data. All authors participated in data collection and critically reviewed the manuscript for important intellectual content and approved the final manuscript. Acknowledgements Not applicable References 1 Institute for Health Metrics and Evaluation. The Global Burden of Disease: 2010 Update. IHME, Seattle. www.healthmetricsand evaluation.org/gbd-compare/ Accessed 7 Jun 2019 2 WHO. Burns. https://www.who.int/news-room/fact-sheets/detail/burns (6 March 2018). Accessed 24 Aug 2019 3 Ogbogu CJ, Uduezue A, Anetekhai WI, Agunwa CC. Burn Injuries in Pregnancy in a Regional Burns Center in Nigeria: Presentation, Maternal and Fetal Outcome. 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BMC Family Practice. 2018;19:9. DOI: https://doi.org/10.1186/s12875-017-0691-4 . 13 Karimi H, Motevalian SA, Momeni M, Ghadarjani M. Financial burden of burn injuries in Iran: A report from the burn registry program. Ann Burns Fire Disasters. 2015 Dec 31;28(4):310–314. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5068900/ 14 Latifi NA, Karimi KF, Motevallian SA, Momeni M. Economical burden of burn injuries in a developing country. J Burn Care Res. 2017;38(6):e900-e905. DOI: 10.1097/BCR.0000000000000515 15 Onah II, Achebe JU, Iheuko SO. Burn disaster acute care management in a Nigerian hospital: any change 10 years after? Niger J Med. 2012;21(3):361-362. https://www.ncbi.nlm.nih.gov/pubmed/23304939 Accessed 8 Aug 2019 . 16 Omomia O. Lack of Mandatory Participation in the NHIS Act Impeding Growth of Health Insurance Coverage in Nigeria. Business Day Online. 2018 March 29. https://www.businessdayonline.com/research-reports/article/lack-mandatory-participation-nhis-act-impeding-growth-health-insurance-coverage-nigeria/ Accessed 8 Aug 2019 17 Olakunde BO. Public health care financing in Nigeria: Which way forward? Ann Nigerian Med. 2012;6(1):4-10. DOI : 10.4103/0331-3131.100199 18 Campbell C. Failures of Nigerian Health Insurance Scheme: the way forward. The Guardian. 2018, January 18 https://guardian.ng/features/science/failures-of-nigerian-health-insurance-scheme-the-way-forward/ Accessed 17 May 2019 19 Muanya C. Many lapses in NHIS implementation. The Guardian. 2017, June 29 https://guardian.ng/features/science/many-lapses-in-nhis-implementation/ Accessed 17 May 2019 20 Dokunmu TM, Adjekukor CU, Oladejo D, Amoo EO, Dataset on analysis of quality of health and social insurance subscription in different socio-economic class of workers in selected areas in southwest Nigeria. Data Brief 2018. 21:1286–1291. DOI: 10.1016/j.dib.2018.10.135 21 Abbott TEF, Fowler AJ, Dobbs TD, Harrison EM, Gillies MA, Pearse RM, Frequency of surgical treatment and related hospital procedures in the UK: A national ecological study using hospital episode statistics, BJA: British Journal of Anaesthesia. August 2017;119(2):249–257. https://doi.org/10.1093/bja/aex137 21 Bittner EA, Shank E, Woodson L, Jeevendra-Martyn JA. Acute and Perioperative Care of the Burn-Injured Patient. Anesthesiology. 2016;122(2):448–464. DOI: 10.1097/ALN.0000000000000559 22 Saaiq M., Zaib S, Ahmad S. The menace of post-burn contractures: a developing country's perspective. Ann Burns Fire Disasters. 2012;25(3):152–158. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3575141/ Accessed 24 May 2019. 23 Shahid F, Ismail M, Khan S. Assessment of quality of life in post burn survivors: A cross-sectional single-center first validation study from Pakistan. Burns Open. 2018;2(1):35-42. https://doi.org/10.1016/j.burnso.2017.08.003 Get rights and content 24 McCaffrey N, Kaambwa B, Currow DC, Ratcliffe J. Health-related quality of life measured using the EQ-5D–5L: South Australian population norms. Health Qual Life Outcomes. 2016;14:133. https://doi.org/10.1186/s12955-016-0537-0 25 Creative Research Systems Sample size calculator (n.d.). Your complete systems survey software solution n.d. Retrieved from https://www.surveysystem.com/sscalc.htm on 7/04/2020. 26 ANGEL STAT 509. Design and Analysis of Clinical Trials. Lesson 6: Sample Size and Power n.d.. Retrieved from https://onlinecourses.science.psu.edu/stat509/node/57 on 7/04/2020. 27 Deshpande ON, Puri V, Vora SS, Shende NN, Choudhary SC, Socio-economic burden of burns: How do the families of patients cope? Indian J burns. 2012;20(1):48-52. DOI: 10.4103/0971-653X.111783. 28 Oster C, Willebrand M, Dyster-Aas J, Kildal M, Ekselius L. Validation of the EQ-5D questionnaire in burn injured adults. Burns. 2009;35(5):723-32. doi: 10.1016/j.burns.2008.11.007 Tables Table 1: Socio-demographic characteristics of participants n = 73 Personal characteristics N % Age (years) 25 - 34 28 38.4 35-44 26 35.6 > 45 19 26.0 Marital status Married 45 61.6 Single 18 24.7 Widow 10 13.7 Parity Nulliparous 18 24.7 Para 1 – 2 37 50.7 Para 3 – 4 8 11.0 > 5 10 13.7 Occupation Civil Servant 4 5.5 Self employed 13 17.8 Trader 46 63.0 homemaker 10 13.7 Education No formal 18 24.7 Primary 27 37.0 Secondary 19 26.0 Socio-economic status Higher 9 12.3 Low (NGN 300,000) 12 16.4 Don’t Know 4 5.5 Table 2: Other clinical history of participants n = 73 Personal characteristics Total % Any treatment for the burns prior to present hospitalization Yes 8 11.0 No 65 89.0 Other co-morbidities (single or in combination) Hypertension 6 8.2 Diabetes mellitus 4 5.5 Asthma 1 1.4 Actual number of participants with co-morbidities 7 9.6 Post burns status Infection 6 8.2 Contracture 21 28.8 Itching at site of burn 14 19.2 Unhealed wound/grafting 33 45.2 Hypertrophic scar 5 6.8 Number of surgeries done None 5 6.8 1 29 39.7 > 2 39 53.4 Table 3: Estimated monthly income and expenses due to hospitalization Self Spouse/others in family Total Average income per month Before injury NGN48,388 (USD134) NGN62,051 (USD172) NGN110,439 (USD307) During admission NGN23,750 (USD66) NGN59,612 (USD166) NGN83,362 (USD234) Average expenses (N) † Subjective average expenditure per day - - NGN11,542 (USD32) Average medical expenses (A) - - NGN549,142 (USD1,526) Average of other (non-medical) expenses (B) - - NGN134,287 (USD373) Average total expenses (A+B) - - NGN691,093 (USD1,920) Average LHS - - 35.4 days † = Dollar equivalents are approximated to whole numbers (at NGN360/USD exchange rate) Table 4: ANOVA of subjective degree of economic worsening due to hospitalisation n = 73 Degree of economic worsening N Economic Status ANOVA Result Low 34 (%) Middle 24 (%) High 10 %) Don't know 5 (%) Sum of Squares df, F Sig Severe 23 (31.5) 15 (65.2) 5 (21.7) 1 (4.3) 2 (8.7) 2.801 3 1.101 0.355 Moderate 37 (50.7) 15 (40.5) 11 (29.70 8 (21.6) 3 (8.1) A little 9 (12.3) 2 (22.2) 6 (66.7) 1 (11.1) - Not at all 4 (5.5) 2 (50.0) 2 (50.0) - - Table 5: Mean( ± SD) of scores on EQ-5D-3L dimensions of participants’ HRQOL according to their socio-demographic characteristics n = 66 Mean ± SD of the EQ-5D-3L dimensions Mobility Self-care Usual activities Pain/ Discomfort Anxiety/ depression Age 25-34 1.13±.458 1.83±.887 1.44±.662 1.78±.671 2.09±.793 35-44 1.79±.658 2.42±.654 1.92±.881 2.13±.741 2.46±.833 >45 2.21±.713 2.21±.787 2.00±.817 2.16±.689 2.48±.841 Marital Status Married 1.65±.77 2.18±.844 1.70±.823 2.10±.778 2.28±.784 Single 1.82±.728 2.29±.686 2.06±.827 1.88±.600 2.18±.809 Widowed 1.56±.727 1.78±.833 1.56±.727 1.89±.601 2.89±.928 Parity Nulliparous 1.44±.629 2.00±.817 1.63±.806 1.56±.512 2.06±.854 1-2 1.84±.808 2.28±.813 1.91±.856 2.19±.738 2.44±.759 3-4 1.71±.756 2.14±.690 1.86±.690 2.29±.488 2.29±.488 >5 1.55±.688 2.00±.894 1.55±.820 2.00±.775 2.46±1.128 Socio-economic status Low 1.67±.736 2.30±.770 1.97±.810 2.30±.586 2.64±.699 Middle 1.65±.745 2.00±.858 1.60±.883 1.70±.657 1.95±.686 High 1.67±.866 2.00±.866 1.33±.500 1.56±.882 1.67±.707 Don’t know 2.00±.817 2.00±.817 2.00±.817 2.25±.500 3.25±.957 Occupation Civil Servant 2.00±.817 2.50±1.000 1.00±.000 1.25±.500 1.50±.577 Self employed 1.58±.793 2.42±.669 1.83±.835 1.58±.669 1.75±.622 Trader 1.63±.733 2.02±.821 1.83±.834 2.15±.691 2.51±.810 Housewife 1.89±.782 2.22±.833 1.78±.833 2.33±.500 2.67±.707 Education No formal 1.60±.737 2.07±.799 2.00±.845 2.47±.516 3.07±.594 Primary 1.70±.669 2.26±.712 1.85±.770 2.15±.602 2.44±.641 Secondary 1.77±.832 2.00±.913 1.77±.927 2.00±.707 2.15±.689 Higher 1.64±.924 2.18±.982 1.27±.647 1.09±.302 1.27±.467 Table 6: ANOVA of scores on the EQ-5D-3L and EQ VAS scale of HRQOL for SES n = 66 Dimension Economic Status ANOVA Total 66 (%) Low 33 (%) Middle 20 (%) High 9 (%) Don’t know 4 (%) Sum of Squares (F) P Mobility No problems in walking about 32 (48.5) 16 (50.0) 10 (31.3) 5 (15.6) 1 (3.1) 36.318 (.250) .861 Some problems in walking about 23 (34.8) 12 (52.2) 7 (30.4) 2 (8.7) 2 (8.7) Confined to bed 11 (16.7) 5 (45.5) 3 (27.3) 2 (18.2) 1 (9.1) Self-care No problems with self-care 17 ( 25.8 ) 6 ( 35.3 ) 7 ( 41.2 ) 3 (17.6) 1 (5.9) .42.485 (.764) .518 Some problems washing self or dressing self 22 (33.3) 11 (50.0) 6 (27.3) 3 (13.6) 2 (9.1) Unable to wash self or dress self 27 (40.9) 16 (59.3) 7 (25.9) 3 (11.1) 1 (3.7) Usual activities No problems with performing usual activities 31 (47.0) 11 (35.5) 13 (41.9) 6 (19.4) 1 (3.2) 43.591 (1.986) .125 Some problems with performing usual activities 19 (28.8) 12 (63.2) 2 (10.5) 3 (15.8) 2 (10.5) Unable to perform usual activities 16 (24.2) 10 (62.5) 5 (31.3) - 1 (6.2) Pain/discomfort No pain or discomfort 16 (24.2) 7 (43.8) 5 (31.2) 2 (12.5) 2 (12.5) 32.985 (5.410) .002* Moderate pain or discomfort 22 (33.3) 10 (45.5) 6 (27.3) 4 (18.2) 2 (9.1) Extreme pain or discomfort 28 (42.4) 16 (57.1) 9 (32.1) 3 (10.7) - Anxiety/ depression Not anxious or depressed 10 ( 15.2 ) 1 (10.0) 5 (50.0) 4 (40.0) - 44.667 (8.791) .000* Moderately anxious or depressed 29 ( 43.9 ) 13 (44.8) 11 (37.9) 4 (13.8) 1 (3.5 ) Extremely anxious or depressed 22 (33.3) 16 (72.7) 4 (18.2) 1 (4.5) 1 (4.5) Missing 5 (7.6 6 ) 3 (60.0) - - 2 (4 0.0 ) (∑fx)/n .81 EQ VAS Scale 0 – 25 10 (15.2) 7 (21.2) 2 (10.0) 1 (11.1) - 64.439 (4.055) .011* 26 – 50 27 (40.9) 18 (54.5) 6 (30.0) 1 (11.1) 2 (50.0) 51 – 75 19 (28.8) 6 (18.2) 10 (50.0) 2 (22.2) 1 (25.0) 76 – 100 8 (12.1) 1 (3.0) 2 (10.0) 5 (55.6) - Missing 2 (3.0) 1 (3.0) - - 1 (25.0) * = Significant Table 7: Tukey HSD Post-Hoc Test of homogeneity of the scores on EQ-5D-3L and EQ VAS of HRQOL Quality of life scale SES Subset for alpha on the EQ-5D-3L = 0.05 1 2 3 Pain/discomfort High SES (9) 1.556 - - Middle SES (20) 1.700 - - Low SES (33) 2.303 - - Don't Know (4) 2.250 - - Anxiety/depression High SES (9) 1.667 - - Middle SES (20) 1.950 1.950 - Low SES (33) - 2.636 2.636 Don't Know (4) - - 3.250 EQ VAS Scale High SES (9) 3.222 - - Middle SES (20) 2.600 - - Low SES (33) 2.121 - - Don't Know (4) 3.000 - - Cite Share Download PDF Status: Published Journal Publication published 28 Feb, 2021 Read the published version in BMC Women's Health → Version 2 posted Editorial decision: Major revision 21 Dec, 2020 Review # 1 received at journal 14 Dec, 2020 Reviewer # 1 agreed at journal 09 Dec, 2020 Reviewers invited by journal 06 Dec, 2020 Editor assigned by journal 30 Nov, 2020 Submission checks completed at journal 30 Nov, 2020 Editor invited by journal 30 Nov, 2020 You are reading this latest preprint version Show more versions 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. 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It is characterized as skin and/or other organic tissue injury caused primarily by extreme heat. Burn injury is ranked fourth in common traumatic conditions after traffic accident, falls and interpersonal violence [1]. An estimated 180,000 global annual deaths occur due to fire-related burn injuries, 95% of which were in low- and middle-income countries. [2]. Non-fatal burns have been noted to be leading cause of morbidity, prolonged hospitalization and disability [2], which may affect one\u0026rsquo;s health-related quality of life (HRQOL). Health-related quality of life represents a self-report of one\u0026rsquo;s perceived feeling of satisfaction with life, comfort and ability to realize one\u0026rsquo;s life potentials. HrQoL is closely linked with responsibilities of an individual.\u003c/p\u003e\n\u003cp\u003eCases of burn injury are frequently recorded in Nigeria hospital. Although few literatures have evaluated the impact and cost of managing burns in Nigeria [3,4], there is still dearth of literature on economic burden of burns and its association with HRQOL of burns, especially female patients in this part of the world where women are exposed to a lot of socio-economic challenges [5,6]. Enyioha [7] noted fast changing economic roles of African women as the world turns into a global village. These responsibilities translate to the amount of burden or difficulty the woman experiences. Severity of burn injury, depression, post-traumatic stress symptoms, inadequate social support, and loss of employment after hospitalization have been identified as predictors of poor HRQOL after burns [8], Economic hardship in women is directly proportional to their health trajectories [9]. Older women with lower socio-economic status and higher family/career responsibilities have lower HRQOL [10]. Similarly, homemakers who are often financially dependent experience more economic hardship than the career women that are relatively less financially dependent [11].\u003c/p\u003e\n\u003cp\u003eThe economic drain on the patient\u0026rsquo;s purse due to burns treatment is huge especially in developing countries, with a mean hospital cost of about USD2,766 (NGN1,002,675) and a range from USD143 to USD33,566 (NGN51,480 \u0026ndash; NGN12,083,760) [12,13,14]. Studies in Nigeria have shown that the average length of hospital stay (LHS) for burn management was 19 days, the average daily cost of treatment per patient was USD47.74 [15] and the total cost of management was USD7,123.28 per patient [5]. However, Nigeria\u0026rsquo;s average daily income per person is less than USD1 [16] and health insurance scheme is almost non-existent [17,18,19]. The Nigerian National Health Insurance Scheme (NHIS) is a social security system launched formally in 2006 the aim of which is to improve the health of all Nigerians by increasing access to universal healthcare, providing healthcare at an affordable cost through various prepayment systems. This scheme is meant to provide equal access to health care across different income classes and reduce the out of pocket expenditure on healthcare by the insured through contributions by the insurer, usually the federal government [20]. This high cost of care has been attributed to series of surgeries and long hospitalization with accompanying huge out-of-pocket expenditures [4,21,22,23].\u003c/p\u003e\n\u003cp\u003eThe aim of the study was to determine the economic burden of hospitalization after burns on patients. Specific objectives were to: assess the cost of hospitalisation after burns; assess the sources of fund for medical and non-medical expenses available to the women; and, determine the women\u0026rsquo;s HRQOL based on the economic burden of burns management. It was hypothesized in this study that there is no significant association between the women\u0026rsquo;s socio-economic status and their HRQOL. This study will contribute to literature pools for economic evaluation of burns treatment..\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis was a three-month cross-sectional descriptive study of adult female patients admitted in hospitals, treated of burns and were discharged between 1\u003csup\u003est\u003c/sup\u003e September and 30\u003csup\u003eth\u003c/sup\u003e November, 2018. Cross-sectional descriptive study had been used successfully in similar studies [10,24,25]. The study was carried out in four teaching hospitals in southeast Nigeria. Inclusion criteria were: women \u0026ge; 25 years, treated of mixed or full thickness accidental burns (\u003cu\u003e\u0026gt;\u003c/u\u003e 30% total surface burn area according to the Rule of Nines for estimating burn percentage in adults), who were mentally stable and gave voluntary consent to participate.\u003c/p\u003e\n\u003cp\u003eA total of 89 women with burn injury were on admission in the four hospital at the time of study. A sample size of 72 women was initially estimated using the Creative Research Systems survey software\u0026rsquo;s sample size calculator formula: ss = (Z\u003csup\u003e2\u003c/sup\u003e*(p)*(1-p))/C\u003csup\u003e2\u003c/sup\u003e; where: Z=1.96, p=proportion of target population (women \u0026ge; 25 years old, estimated to have \u0026gt; 30% total surface burn area) (expressed as 0.5), C=Confidence Interval (.04\u0026plusmn;4) [26]. Applying the adjusted sample size formula for anticipated 10% attrition rate: \u003cem\u003ex\u003c/em\u003e = ss/1-f (where \u003cem\u003ex\u003c/em\u003e is adjusted sample size; ss is original sample size; and, f is estimated non-response rate) [27], this initial sample size estimate was adjusted from 72 to 80 \u0026nbsp;representing about 89.9% of the population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eInstrument for data collection\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, HRQOL is based on scores obtained on the European quality of life \u0026ndash; five dimensions three levels instrument (EuroQol-5D-3L). Participants\u0026rsquo; case notes and interview-administered questionnaire developed in three parts were used. Part A collected eleven data on socio-demographic profile of participants and their clinical parameters namely: phone number, residential address, age, marital status, parity, education, occupation, estimated family monthly income (FMI), pre-hospital treatment, number of surgeries done and other co-morbidities. Part B was economic burden of burns questionnaire (EBB-Q) adapted from Deshpande, Puri, Vora, Shende and Choudhary [28] with eleven items. Deshpande and colleagues formulated the EBB-Q to guide their data collection in a retrospective study on how families of patients cope with socio-economic burden of burns. To determine the existence of economic gradient in HRQOL of women who had burns, participants were assigned social status based on their estimated FMI. Thus, women with estimated FMI less than NGN50,000 (\u0026lt;USD139) were classified as low economic status (LES), NGN50,000 \u0026ndash; NGN300,000 (USD139 to USD834)/month \u0026ndash; middle economic status (MES), and more than NGN 300,000 (\u0026gt;USD834)/month \u0026ndash; high economic status (HES). Cost of hospitalization include direct medical and other (subjective) non-medical expenditures incurred as a result of the burn treatment. Direct medical costs include costs of medications and consumables, surgeries, investigations, blood products, nursing care and bed space. Indirect costs include dietary cost, transportation costs by caregivers and other incidental expenses. Direct costs are billable; hence, direct costs were obtained from respective patient\u0026rsquo;s case notes. Indirect costs were estimates provided by the respondent during interview. \u0026nbsp;Part C was EuroQol Five-Dimensions-Three-Level (EQ-5D-3L) Health Questionnaire for face-to-face and telephone methods. English version of the EQ-5D-3L for Nigeria was obtained from the Euroqol Foundation through formal email. The EQ-5D-3L is a generic, preference-based measure of health with five dimensions, namely: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression; and three levels of health state coded 1-3. Where: 1 = no problem, 2 = Moderate problem and 3 = extreme problem. It also contains a EuroQol visual analogue scale (EQ VAS) that requires the respondent to indicate the point on the scale where she would put her \u0026lsquo;own health state today\u0026rsquo; ranging from \u0026lsquo;0\u0026rsquo; (the worst health she can imagine) to \u0026lsquo;100\u0026rsquo; (the best health she can imagine). Validity of the EQ-5D-3L in burns patients was established by Oster, Willebrand, Dyster-Aas, Kildal and Ekselius [29]. The Head of Department of Health Administration and Management, University of Nigeria, Nsukka was requested to evaluate the readability, relevance and feasibility of the EBB-Q and the socio-demographic profiles /clinical parameters. Also, a professor in Medical-Surgical Nursing in the Department of Nursing Sciences, University of Nigeria, Nsukka and a plastic surgeon from Burns and Plastic Unit of the National Orthopaedic Hospital, Enugu were presented with the instrument and requested to help in ascertaining that all relevant items were included in the EBB-Q and socio-demographics. All necessary corrections were subsequently effected. For internal consistency reliability test of the instruments, copies were administered to eight newly discharged burns patients at the Burns and Plastic female ward of the University of Nigeria Teaching Hospital, Ituku-Ozalla between 4\u003csup\u003eth\u003c/sup\u003e and 11\u003csup\u003eth\u003c/sup\u003e of August, 2018, representing 10% of the sample size, after due consent. Applying split-half method, the scores were computed using Cronbach Alpha reliability test. Reliability coefficient (r) of .88 for Part A, .79 for Part B, and 0.93 for Part C were considered satisfactory.\u003c/p\u003e\n\u003cp\u003eAs some of the participants might not communicate effectively in English Language, an Ibo linguist was requested to translate the instrument to the local dialect (\u003cem\u003eIbo\u003c/em\u003e); another linguist was asked to translate the \u003cem\u003eIbo\u003c/em\u003e version to English Language without recourse to the original instrument. The translated English Language version was correlated with the original and discrepancies resolved in the local dialect version before use on the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical consideration\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval to conduct the study was obtained from the Health Research Ethics Committee of the National Orthopaedic Hospital, Enugu (IRB/HEC Number: RET/313/111/ 988). In addition, administrative permit was sought from Heads of Nursing Services and Ward Heads of female burns and plastic wards of the respective hospitals. Written informed consent was obtained from participants before enrolment. Purpose of the study and role of participants were fully explained to the prospective participants prior to the consent. They were also assured of anonymity and confidentiality in data collection and use. Only women who gave consent were enrolled into the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eProcedure for data collection\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWith the assistance of clinicians in the female burns and plastic wards of the hospitals, researcher approached prospective participants already on admission. Purpose of the study and role of participants were explained to them while they were assured of confidentiality of information and non-maleficence. They were informed that researcher would visit them at their home two to three days after discharge from hospital for data collection. Cell phone numbers were exchanged with consenting patients to enhance communication. Data were collected at two points in time as follows:\u003c/p\u003e\n\u003cp\u003ePoint 1, participant\u0026rsquo;s socio-demographic and disease history were elicited from their case notes at the time of discharge. Participants were identified using serial numbers assigned to their hospital file numbers and cell phone numbers (where available) for confidentiality. Thereafter, participants were asked to indicate if they would prefer to be visited physically at home or to have telephone call interview for data collection after discharge home. Two could not supply their phone number and/or home address and were excluded.\u003c/p\u003e\n\u003cp\u003ePoint 2: Interviewer contacted participants between the 2\u003csup\u003end\u003c/sup\u003e and 3\u003csup\u003erd\u003c/sup\u003e day after returning home for face-to-face or telephone call interview as pre-arranged. Only six opted for telephone calls. Member of the team visited the remaining seventy-two at their homes. For face-to-face method, interviewer established rapport, arranged for comfortable seats for the two, placed a copy of the questionnaire in front of him/her and gave a second copy to the participant for reference (where necessary). The interviewer read out contents of the questionnaire to the respondent item by item, using the preferred language version (English or \u003cem\u003eIbo\u003c/em\u003e) and entered participant\u0026rsquo;s answers directly into the questionnaire. They were asked questions about their \u0026lsquo;own health state today\u0026rsquo; and requested to rate their health on a measuring scale, emphasizing honesty. To avoid bias, a question was only repeated word for word when participant asked for clarification. Interviewer\u0026rsquo;s personal explanations were avoided; instead, participant was asked to use her own interpretation and answer in a way that most closely resembled her thoughts about her \u0026lsquo;health state today\u0026rsquo;. The interview took 15-30 minutes to complete. Seventy-eight (78) patients entered the study initially while seventy-three (73) were successfully interviewed representing 93.6% of the population. The remaining five declined participation when contacted for detailed data collection. Data collection lasted for twelve weeks and five days.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical analysis \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analysed descriptively using frequencies, percentages, mean and standard deviation, and presented using contingency tables. Data collected on the estimated FMI and expenses due to burns and treatment were used to describe the economic burden of hospitalization after burns on the women\u0026rsquo;s economic life. To determine the economic burden of the burns, analysis of variance (ANOVA) was performed on the subjective degree of worsening of economic status due to burns and hospitalisation. Level of health state of participants was established by determining the Mean\u0026plusmn;SD of the utility scores on the scales. At three-points scale, any mean \u003cu\u003e\u0026gt;\u003c/u\u003e 2 was considered a high level of problem and poor HRQOL. ANOVA was used to analyse the association between the scores on the EQ-5D-3L HRQOL of the women and their socio-economic status; and Tukey HSD applied for Post Hoc test of homogeneity of the scores where they existed. All statistical analyses were performed using the statistical package for social sciences version 23.0 computer software programme (SPSS inc., IL: Chicago, USA) at 95% confidence interval.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eSeventy-three (73) post burns patients finally entered the study (Figure I).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePatient characteristics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 showed that 34 (46.6%) out of the 73 women that entered the study had subjective estimated FMI below NGN50,000 (LES). Only 12 (16.4%) were classified as HES. Majority 45 (61.6%) were married. Half of the participants 37 (50.7%) were para 1-2, more than half of whom (20) had LES. As many as 46 (63.0%) were traders only four of whom were high-income earners. Majority had low educational attainment. Economic status appeared to be directly proportional to the women\u0026rsquo;s educational attainment as no participant with higher education had income below NGN50,000;\u003c/p\u003e\n\u003cp\u003eEight (11.0%) participants had received treatment elsewhere before reporting to the current hospital. Seven had one or more diagnosed co-morbidities. Significant post burn complications noted were unhealed wound/grafting 33 (45.2%) and contracture 21 (28.8%). More than half 39 (53.4%) had two or more surgical interventions during management; only 5 (6.8%) did not undergo surgery (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMonthly income and cost of hospitalization \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe women\u0026rsquo;s average subjective monthly income prior to admission reduced drastically after hospitalization. With the support of participants\u0026rsquo; spouse and/or other family member(s) their average FMI before the burns marginally dropped at the end of hospitalization. The subjective average expenditure per day was NGN11,542 (USD32). With 35.4 days average LHS, the average total expenses incurred during hospitalization based on hospital bill at discharge and other estimated non-medical expenses related to hospitalization was NGN691,093 (USD1,920). (Table 3).\u003c/p\u003e\n\u003cp\u003eEleven women and two caregivers respectively lost their job as a result of hospitalization. Out of these, seven were self-employed while four were traders (Figure II).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSource of fund\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs indicated in Figure III, only 11 participants could bear all expenses involved in their care at family levels, whereas more than half were assisted by relations and friends. As many as 46 (63.0%) sought loans from other sources for their treatment expenses. Twenty-six (35.6%) sold; while only 4 (5.5%) accessed the National Health Insurance Scheme (NHIS) for part payment of their cost of hospitalization. Not all values were exclusive as some participants had more than multiple \u0026nbsp;source of fund.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEconomic burden\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHalf of the participants 37 (50.7%) had their economy moderately worsened following hospitalisation, while 23 (31.5%) had severe degree of worsening. However, analysis of variance of the scores showed no significant difference in the degree of economic worsening the women had post hospitalization based on their economic status (F = 1.101; p = 0.355).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eParticipants\u0026rsquo; health-related quality of life\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData from the seven (7) participants with clinically diagnosed co-morbidities (three participants had combine co-morbidities) were deliberately excluded before analysis to eliminate the possible confounding effect of these co-morbidities on their HRQOL scores; hence, data from 66 participants were analysed. Table 5 showed that anxiety/depression was the greatest problem reported by the women. irrespective of age, marital status and parity (Mean \u003cu\u003e\u0026gt;\u003c/u\u003e 2.00). Similarly, the women reported high problems with self-care regardless of their parity, SES and education. Women with no formal education had high degree of anxiety/depression \u0026nbsp;problems (Mean\u0026plusmn;SD = 3.07\u0026plusmn;.594). The least of their problems were mobility as most of the mean values were \u0026lt; 2.00; followed by usual activities and pain/discomfort. With overall EQ-5D mean score of .81, that is \u0026lt; 2, participants\u0026rsquo; HRQOL was considered as generally poor.\u003c/p\u003e\n\u003cp\u003eANOVA of scores on the EQ-5D-3L HRQOL scale (Table 6) showed significant difference in the women\u0026rsquo;s SES and their pain/discomfort F(5.410, 32.985) p \u0026lt; .002 and anxiety/depression F(8.791, 44.667) p \u0026lt; .000 dimensions of HRQOL. Their EQ VAS \u0026lsquo;health state today\u0026rsquo; also varied significantly according to their SES F(4.055, 64.439) p \u0026lt; .011.\u003c/p\u003e\n\u003cp\u003eMultiple comparison of the scores on the EQ-5D-3L HRQOL using Tukey HSD Repeated Mean test show that the variations in SES were less for anxiety but were unequal guaranteeing Type 1 error (Table 7).\u003c/p\u003e"},{"header":"Discussion Of Findings","content":"\u003cp\u003eThis study determined the burden of hospitalization after burns on women\u0026rsquo;s economic status and its associated HRQOL. The women had worsened economy post burn treatment due to high cost of hospitalization, loss of job and indebtedness. According to results of this study, a client spends as high as NGN691,093 (USD1,920) on the average on drugs, surgery, investigations, nursing care, bed space and other non-medical expenses (like feeding, transportation and procurement of toiletries). This is similar to $ 2,810 and $2,766 reported by Karimi [13] and Latifi et al [14] respectively, but far below $7,123.28 estimated by Okafor et al [4]. Meanwhile, the average LHS was 35.4 days \u0026ndash; against the 19 days average found by Okafor et al [4]; and FMI before the burns was just about 11.1% of the hospital expenses. Unfortunately, only 5.5% accessed the services of the NHIS. The near non-existed NHIS as already demonstrated [17,18,19] is thus supported by findings of this study. Poor health financing has pitiable implications for achievement of goals of universal health coverage in Nigeria.\u003c/p\u003e\n\u003cp\u003eResult of this study showed that although it was done in an urban setting, most of the participants were young, fairly educated, married women of low means, mainly traders or homemakers. Many of them had moderate to severe burden of treatment because of the high cost of treatment. Result indicated that as many as thirty-three were discharged home with open wounds and/or grafting possibly to avoid further accumulation of hospital bill. This finding directly reflects the low economic capacity of most of the women and the fact that most expenditure are out-of-pocket as they reported. Almost all the participants (68) had at least one surgical intervention during their burns management, meaning that burns patients will often need huge amount of money for operation and drugs deposits. In addition, they will require fund to procure the expensive modern dressing applications (like the Epigraft, Ex salt T7 and Therabond applications), high protein diet peculiar to burns treatment as well as pay for orthodox dressing change. If patient fails to pay for drugs, then drugs supply by the Pharmacy Department may be withdrawn. Unfortunately, antibiotics used in burns treatment are usually costly (like the injection Meronem that sells between N6,000.00 to N8,000.00 per vial) and procuring such may be challenging to the patient, resulting to more burden.\u003c/p\u003e\n\u003cp\u003eThe estimated family income can only yield about 20.89% of the average total expenses incurred during hospitalization, all things being equal; meaning that the remaining 79.11% must be sourced elsewhere. Our study showed that there was worsening of economy for most of the women following hospitalization irrespective of their economic status, and that up to eleven women, mostly traders and self-employed women, lost their job due to hospitalization. Since many of the participants were women of low means, they were most likely to be sole traders operating easy and inexpensive business with unstable customers and finance. The reported drop in estimated subjective monthly income supports the fact that even the usual meagre income will stop flowing in when the woman is hospitalised. Consequently, many would secure loans from friends, money lenders, bank, cooperative society, and the likes (with interest in some situations) and/or mortgage/sell assets such as lands, automobile, power generating set, television, jewelleries and clothes to raise fund for offsetting the huge hospital bills. Borrowing, selling personal assets and sometimes, loss of job are catastrophic results of the injury. Resultant stress and financial hardship/burden for the women and their family will deepen the pre-existing low economic standard.\u003c/p\u003e\n\u003cp\u003eFurther, the women\u0026rsquo;s HRQOL was poor as they reported anxiety/depression, self-care deficit and physical discomfort, thus aligning with Spronk [8]. Also, their EQ VAS and anxiety/depression scores differed significantly based on their occupation. Civil servants\u0026rsquo; highest scores on the EQ VAS imply a better quality of life among them. Conversely, the highest anxiety/depression scores for the self-employed women mean poorer HRQOL. Civil servants work in domesticated organisations \u0026ndash; they have little or no worry concerning the impact of hospitalization on their job because their job is secured. Self-employed women and traders, on the other hand, operate as \u0026lsquo;wild\u0026rsquo; organisations because they always have to struggle for their own survival. Based on this, civil servants are more likely to have more positive assessment of their health state at any time than the self-employed and traders.\u003c/p\u003e\n\u003cp\u003eThe women\u0026rsquo;s anxiety/depression dimension and EQ VAS varied based on their economic status. Although there was no significant difference in other EQ-5D-3L dimensions, women in the LES appeared to be more inclined to extreme anxiety or depression than the middle and high economic class. Tucker et al [9] earlier reported this downward health trajectory for women with high economic hardship. With insufficient fund, making required deposits for treatments and surgeries, paying for expensive drugs, dressing packs and other medical and non-medical needs will become difficult.\u003c/p\u003e\n\u003cp\u003eIt is understandable that a good number of the women reported \u0026lsquo;extreme pain or discomfort\u0026rsquo; or \u0026lsquo;confinement to bed after long stay in hospital\u0026rsquo; or inability to perform usual activities independently because burns is ordinarily characterised with pain. Some women may have requested for \u0026lsquo;pre-mature\u0026rsquo; discharge (even with open wound and partially healed grafting) to reduce further accumulation of hospital bill. Patients are not supposed to be discharged until they are fully recovered and capable of performing most activities of daily living unassisted. Sick patients in hospital have their sick role; the health conditions are continuously monitored while their skilled care providers institute necessary actions. When the individual is discharged home before full recovery, self-dependence and perhaps care by unskilled caregivers becomes the available option. This comes with its risk of wound breakdown, infection, pain and other complications, further worsening the already poor HRQOL and high economic burden of treatment.\u003c/p\u003e\n\u003cp\u003eThere was significant difference between the women\u0026rsquo;s age and their mobility, self-care and usual activities. As earlier observed by Chinweuba et al [10], the older women had poorer mobility and less ability to perform usual activities than the younger women did. This is understandable because people are physically stronger, more active and better able to self-manage their problems at their youthful age and become weaker as they get old. Young women may also have less social responsibilities and fewer challenges with self-care. Increasing level of education tends to reduce the women\u0026rsquo;s anxiety levels and improve their score on EQ VAS probably because it (education) will enhance better understanding of one\u0026rsquo;s challenges, better-informed decision making and more focused health actions. Educated women will be better able to study and understand their problem and its management than their less educated counterparts.\u003c/p\u003e\n\u003cp\u003eResult showed significant difference in the women\u0026rsquo;s pain/discomfort dimension based on their parity. However, there was not any specific pattern in the differences. More studies may be required on this.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne strength of this study is the choice of patients with moderate to severe degrees of burn which allowed for full range assessment of impact of burn injury and its management. Women with varying economic status entered the study. This served the opportunity to measure how SES predict the HRQOL of the patients. Although this study was done in Nigeria, the evident data may be resourceful in countries with similar \"burn\" problems for health policy decision making. However, the study was constrained by paucity of related literature especially from other low- to medium-income countries for a better view and understanding of economic burden of hospitalization after burns. Non-medical expenses related to hospitalization were estimates that were liable to personal factors of the participants. The values, therefore, cannot be used reliably as standard in similar studies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBurns place high level of economic burden to the women who are predominantly of LES. It also has enormous negative impact on their quality of life. Many of them do not recover fully before leaving the hospital. The women\u0026rsquo;s HRQOL is directly proportional to their economic status and degree of economic burden. The long course of treatment and economic depletion through the huge out-of-pocket expenditure impact negatively on their HRQOL. Pain/discomfort, \u0026lsquo;reduced mobility and activities\u0026rsquo; and anxiety/depression are commonly affected dimensions of the women\u0026rsquo;s HRQOL following burns. The women\u0026rsquo;s level of education is directly proportional to their HRQOL. Nigerian government\u0026rsquo;s commitment to healthcare of burns patients is low or non-existent.\u003c/p\u003e\n\u003cp\u003eBased on the findings, we recommended that State and national governments create special trust fund for treatment, or at least subsidize treatment of burns particularly for indigent patients with severe burns, where free treatment is not possible. The NHIS needs to be made more accessible to all categories of the citizenry. We also recommend formation of non-profit burns foundations by non-governmental agencies with special endowment funds to assist financing of burns treatment. Finally, female education should be made free and compulsory in Nigeria with secondary school as the minimum.\u003c/p\u003e"},{"header":"List of Abbreviations","content":"\u003cp\u003eANOVA \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; =\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Analysis of Variance\u003c/p\u003e\n\u003cp\u003eDALYS \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; =\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Disability Adjusted Life Years\u003c/p\u003e\n\u003cp\u003eEBB-Q \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; =\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Economic Burden of Burns Questionnaire\u003c/p\u003e\n\u003cp\u003eEQ VAS \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; =\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Visual Analogue Scale\u003c/p\u003e\n\u003cp\u003eEQ-5D-3L\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; =\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; EuroQol Five-Dimensions-Three-Level\u003c/p\u003e\n\u003cp\u003eFMI \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; =\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Family Monthly Income\u003c/p\u003e\n\u003cp\u003eHES\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; =\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; High Economic Status\u003c/p\u003e\n\u003cp\u003eHRQOL\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; =\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Health-related Quality of Life\u003c/p\u003e\n\u003cp\u003eLES\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; =\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Low Economic Status\u003c/p\u003e\n\u003cp\u003eLHS \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; =\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Length of Hospital Stay\u003c/p\u003e\n\u003cp\u003eMES\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; =\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Middle Economic Status\u003c/p\u003e\n\u003cp\u003eNGN\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; =\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Nigeria Naira\u003c/p\u003e\n\u003cp\u003eNHIS\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; =\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; National Health Insurance Scheme\u003c/p\u003e\n\u003cp\u003eQALYs \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; =\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Quality-Adjusted Life Years\u003c/p\u003e\n\u003cp\u003eUSD\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; =\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; United States Dollar\u003c/p\u003e\n\u003cp\u003eWHO\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; =\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; World Health Organisation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Ethical Review Committee of the National Orthopaedic Hospital, Enugu (IRB/HEC Number: RET/313/111/988).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available because some parts of the data contain confidential personal information of respondents and their family, but 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\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was not supported by any grant. The study design; data collection, analysis and interpretation of data; writing of the paper; and the decision to submit the paper for publication were, therefore, sole responsibility of the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAUC conceived the paper, prepared the study protocol, designed the study, drafted the manuscript, and contributed to the statistical analysis and interpretation; ISC participated in project administration, data interpretation and critical revision of the manuscript; NEU contributed in drafting the manuscript and supervision of data analysis. KCW contributed in literature review, writing the manuscript and discussion; CSE assisted in interpretation of the data, contributed to the discussion and edited the manuscript; FCD participated in drafting the manuscript and the discussion. AIN participated in the acquisition of the data and contributed to supervision of data. All authors participated in data collection and critically reviewed the manuscript for important intellectual content and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e1\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Institute for Health Metrics and Evaluation. The Global Burden of Disease: 2010 Update. IHME, Seattle. \u003ca href=\"http://www.healthmetricsand\"\u003ewww.healthmetricsand\u003c/a\u003e evaluation.org/gbd-compare/ Accessed 7 Jun 2019\u003c/p\u003e\n\u003cp\u003e2\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; WHO. Burns. \u003ca href=\"https://www.who.int/news-room/fact-sheets/detail/burns\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/burns\u003c/a\u003e (6 March 2018). 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Ann Burns Fire Disasters. 2015 Dec 31;28(4):310\u0026ndash;314. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5068900/\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5068900/\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003e14\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Latifi NA, Karimi KF, Motevallian SA, Momeni M. Economical burden of burn injuries in a developing country. J Burn Care Res. 2017;38(6):e900-e905. DOI: 10.1097/BCR.0000000000000515\u003c/p\u003e\n\u003cp\u003e15\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Onah II, Achebe JU, Iheuko SO. Burn disaster acute care management in a Nigerian hospital: any change 10 years after? Niger J Med. 2012;21(3):361-362. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23304939%20Accessed%208%20Aug%202019\"\u003ehttps://www.ncbi.nlm.nih.gov/pubmed/23304939 Accessed 8 Aug 2019\u003c/a\u003e.\u003c/p\u003e\n\u003cp\u003e16\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Omomia\u0026nbsp; O. 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The Guardian. 2018, January 18 \u003ca href=\"https://guardian.ng/features/science/failures-of-nigerian-health-insurance-scheme-the-way-forward/\"\u003ehttps://guardian.ng/features/science/failures-of-nigerian-health-insurance-scheme-the-way-forward/\u003c/a\u003e Accessed 17 May 2019\u003c/p\u003e\n\u003cp\u003e19\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Muanya C. Many lapses in NHIS implementation. The Guardian. 2017, June 29 \u003ca href=\"https://guardian.ng/features/science/many-lapses-in-nhis-implementation/\"\u003ehttps://guardian.ng/features/science/many-lapses-in-nhis-implementation/\u003c/a\u003e \u0026nbsp;Accessed 17 May 2019\u003c/p\u003e\n\u003cp\u003e20\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Dokunmu TM, Adjekukor CU, Oladejo D, Amoo EO, Dataset on analysis of quality of health and social insurance subscription in different socio-economic class of workers in selected areas in southwest Nigeria. Data Brief 2018. 21:1286\u0026ndash;1291. DOI: 10.1016/j.dib.2018.10.135\u003c/p\u003e\n\u003cp\u003e21\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Abbott TEF, Fowler AJ, Dobbs TD, Harrison EM, Gillies MA, Pearse RM, Frequency of surgical treatment and related hospital procedures in the UK: A national ecological study using hospital episode statistics, \u003cem\u003eBJA: \u003c/em\u003eBritish Journal of Anaesthesia. August 2017;119(2):249\u0026ndash;257. \u003ca href=\"https://doi.org/10.1093/bja/aex137\"\u003ehttps://doi.org/10.1093/bja/aex137\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003e21\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Bittner EA, Shank E, Woodson L, Jeevendra-Martyn JA. Acute and Perioperative Care of the Burn-Injured Patient. Anesthesiology. 2016;122(2):448\u0026ndash;464. DOI:\u0026nbsp;\u003ca href=\"https://dx.doi.org/10.1097%2FALN.0000000000000559\"\u003e10.1097/ALN.0000000000000559\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003e22\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Saaiq M., Zaib S, Ahmad S. The menace of post-burn contractures: a developing country's perspective. Ann Burns Fire Disasters. 2012;25(3):152\u0026ndash;158. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3575141/\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3575141/\u003c/a\u003e Accessed 24 May 2019.\u003c/p\u003e\n\u003cp\u003e23\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Shahid F, Ismail M, Khan S. Assessment of quality of life in post burn survivors: A cross-sectional single-center first validation study from Pakistan. Burns Open. 2018;2(1):35-42. \u003ca href=\"https://doi.org/10.1016/j.burnso.2017.08.003\"\u003ehttps://doi.org/10.1016/j.burnso.2017.08.003\u003c/a\u003e\u003ca href=\"https://s100.copyright.com/AppDispatchServlet?publisherName=ELS\u0026amp;contentID=S2468912217300391\u0026amp;orderBeanReset=true\"\u003eGet rights and content\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003e24\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; McCaffrey N, Kaambwa B, Currow DC, Ratcliffe J. Health-related quality of life measured using the EQ-5D\u0026ndash;5L: South Australian population norms. Health Qual Life Outcomes. 2016;14:133. \u003ca href=\"https://doi.org/10.1186/s12955-016-0537-0\"\u003ehttps://doi.org/10.1186/s12955-016-0537-0\u003c/a\u003e\u003c/p\u003e\n\u003cp\u003e25\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Creative Research Systems Sample size calculator (n.d.). Your complete systems survey software solution n.d. Retrieved from \u003ca href=\"https://www.surveysystem.com/sscalc.htm\"\u003ehttps://www.surveysystem.com/sscalc.htm\u003c/a\u003e on 7/04/2020.\u003c/p\u003e\n\u003cp\u003e26\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; ANGEL STAT 509. Design and Analysis of Clinical Trials. Lesson 6: Sample Size and Power n.d.. Retrieved from \u003ca href=\"https://onlinecourses.science.psu.edu/stat509/node/57\"\u003ehttps://onlinecourses.science.psu.edu/stat509/node/57\u003c/a\u003e on 7/04/2020.\u003c/p\u003e\n\u003cp\u003e27\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Deshpande ON, Puri V, Vora SS, Shende NN, Choudhary SC, Socio-economic burden of burns: How do the families of patients cope? Indian J burns. 2012;20(1):48-52. DOI:\u0026nbsp;10.4103/0971-653X.111783.\u003c/p\u003e\n\u003cp\u003e28\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Oster C, Willebrand M, Dyster-Aas J, Kildal M, Ekselius L. Validation of the EQ-5D questionnaire in burn injured adults. Burns. 2009;35(5):723-32. doi: 10.1016/j.burns.2008.11.007\u003c/p\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Socio-demographic characteristics of participants\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/strong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003cem\u003en = 73\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"609\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"437\"\u003e\n\u003cp\u003e\u003cstrong\u003ePersonal characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"138\"\u003e\n\u003cp\u003eAge (years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003e25 - 34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e38.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003e35-44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e35.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003e\u003cu\u003e\u0026gt; \u003c/u\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e26.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"138\"\u003e\n\u003cp\u003eMarital status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e61.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003eSingle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e24.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003eWidow\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e13.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003eParity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003eNulliparous\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e24.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003ePara 1 \u0026ndash; 2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e50.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003ePara 3 \u0026ndash; 4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e11.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003e\u003cu\u003e\u0026gt;\u003c/u\u003e 5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e13.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003eOccupation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003eCivil Servant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e5.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003eSelf employed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e17.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003eTrader\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e63.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003ehomemaker\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e13.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003eEducation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003eNo formal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e24.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003ePrimary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e37.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003eSecondary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e26.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"138\"\u003e\n\u003cp\u003eSocio-economic status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003eHigher\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e12.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003eLow (\u0026lt;NGN 50,000)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e46.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003eMiddle (NGN50,000-NGN300,000)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e31.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003eHigh (\u0026gt;NGN 300,000)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e16.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"299\"\u003e\n\u003cp\u003eDon\u0026rsquo;t Know\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e5.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: \u003c/strong\u003e\u003cstrong\u003eOther \u003c/strong\u003e\u003cstrong\u003eclinical history of \u003c/strong\u003e\u003cstrong\u003eparticipants\u003c/strong\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003cem\u003en = 73\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"635\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"427\"\u003e\n\u003cp\u003e\u003cstrong\u003ePersonal characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"219\"\u003e\n\u003cp\u003eAny treatment for the burns prior to present hospitalization\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e11.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e89.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"219\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"219\"\u003e\n\u003cp\u003eOther co-morbidities (single or in combination)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eHypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e8.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eDiabetes mellitus\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e5.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"219\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eAsthma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e1.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"219\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eActual number of participants with co-morbidities\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e9.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"219\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"219\"\u003e\n\u003cp\u003ePost burns status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eInfection\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e8.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eContracture\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e28.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"219\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eItching at site of burn\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e19.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"219\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eUnhealed wound/grafting\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e45.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"219\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eHypertrophic scar\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e6.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"219\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"219\"\u003e\n\u003cp\u003eNumber of surgeries done\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e6.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"219\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e39.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"219\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"208\"\u003e\n\u003cp\u003e\u003cu\u003e\u0026gt;\u003c/u\u003e 2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e53.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Estimated monthly income and expenses due to hospitalization \u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"595\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u003cstrong\u003eSelf\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e\u003cstrong\u003eSpouse/others in family\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003eAverage income per month\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003eBefore injury\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003eNGN48,388 (USD134)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eNGN62,051\u003c/p\u003e\n\u003cp\u003e(USD172)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eNGN110,439\u003c/p\u003e\n\u003cp\u003e(USD307)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003eDuring admission\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003eNGN23,750 (USD66)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003eNGN59,612\u003c/p\u003e\n\u003cp\u003e(USD166)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eNGN83,362\u003c/p\u003e\n\u003cp\u003e(USD234)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003eAverage expenses (N)\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003eSubjective average expenditure per day\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eNGN11,542\u003c/p\u003e\n\u003cp\u003e(USD32)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003eAverage medical expenses (A)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eNGN549,142\u003c/p\u003e\n\u003cp\u003e(USD1,526)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003eAverage of other (non-medical) expenses (B)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eNGN134,287\u003c/p\u003e\n\u003cp\u003e(USD373)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003eAverage total expenses (A+B)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e\u0026nbsp;-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eNGN691,093\u003c/p\u003e\n\u003cp\u003e(USD1,920)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003eAverage LHS\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"113\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e35.4 days\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/strong\u003e = Dollar equivalents are approximated to whole numbers (at NGN360/USD exchange rate)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr /\u003e \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: ANOVA of subjective degree of economic worsening due to hospitalisation\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/strong\u003e\u003cem\u003en = 73\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"604\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"85\"\u003e\n\u003cp\u003e\u003cstrong\u003eDegree of economic worsening\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"53\"\u003e\n\u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" width=\"287\"\u003e\n\u003cp\u003e\u003cstrong\u003eEconomic Status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"179\"\u003e\n\u003cp\u003e\u003cstrong\u003eANOVA Result\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Low \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e34 (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003eMiddle 24 (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e\u003cstrong\u003eHigh 10 %)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Don't know\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5 (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u003cstrong\u003eSum of Squares\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u003cstrong\u003edf,\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"51\"\u003e\n\u003cp\u003e\u003cstrong\u003eSig\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003eSevere\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"53\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(31.5)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(65.2)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(21.7)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(4.3)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(8.7)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e2.801\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003cp\u003e1.101\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"51\"\u003e\n\u003cp\u003e0.355\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003eModerate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"53\"\u003e\n\u003cp\u003e37\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(50.7)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(40.5)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(29.70\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(21.6)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(8.1)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"51\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003eA little\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"53\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(12.3)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(22.2)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(66.7)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(11.1)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"51\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003eNot at all\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"53\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(5.5)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(50.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(50.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"73\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"51\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Mean(\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u003cstrong\u003eSD)\u003c/strong\u003e\u003cstrong\u003e of scores on EQ-5D-3L dimensions of participants\u0026rsquo; HRQOL \u003c/strong\u003e\u003cstrong\u003eaccording to\u003c/strong\u003e\u003cstrong\u003e their socio-demographic characteristics\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/strong\u003e\u003cem\u003en = 66\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"629\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"5\" width=\"431\"\u003e\n\u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u003cstrong\u003eSD of the \u003c/strong\u003e\u003cstrong\u003eEQ-5D-3L dimensions\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u003cstrong\u003eMobility\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e\u003cstrong\u003eSelf-care\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eUsual activities\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e\u003cstrong\u003ePain/\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscomfort\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u003cstrong\u003eAnxiety/\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003edepression\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e25-34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.13\u0026plusmn;.458\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e1.83\u0026plusmn;.887\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.44\u0026plusmn;.662\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e1.78\u0026plusmn;.671\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e2.09\u0026plusmn;.793\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e35-44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.79\u0026plusmn;.658\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.42\u0026plusmn;.654\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.92\u0026plusmn;.881\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e2.13\u0026plusmn;.741\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e2.46\u0026plusmn;.833\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e\u0026gt;45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e2.21\u0026plusmn;.713\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.21\u0026plusmn;.787\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e2.00\u0026plusmn;.817\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e2.16\u0026plusmn;.689\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e2.48\u0026plusmn;.841\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"88\"\u003e\n\u003cp\u003eMarital Status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.65\u0026plusmn;.77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.18\u0026plusmn;.844\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.70\u0026plusmn;.823\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e2.10\u0026plusmn;.778\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e2.28\u0026plusmn;.784\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003eSingle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.82\u0026plusmn;.728\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.29\u0026plusmn;.686\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e2.06\u0026plusmn;.827\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e1.88\u0026plusmn;.600\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e2.18\u0026plusmn;.809\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003eWidowed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.56\u0026plusmn;.727\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e1.78\u0026plusmn;.833\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.56\u0026plusmn;.727\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e1.89\u0026plusmn;.601\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e2.89\u0026plusmn;.928\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003eParity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003eNulliparous\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.44\u0026plusmn;.629\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.00\u0026plusmn;.817\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.63\u0026plusmn;.806\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e1.56\u0026plusmn;.512\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e2.06\u0026plusmn;.854\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e1-2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.84\u0026plusmn;.808\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.28\u0026plusmn;.813\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.91\u0026plusmn;.856\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e2.19\u0026plusmn;.738\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e2.44\u0026plusmn;.759\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e3-4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.71\u0026plusmn;.756\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.14\u0026plusmn;.690\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.86\u0026plusmn;.690\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e2.29\u0026plusmn;.488\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e2.29\u0026plusmn;.488\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e\u0026gt;5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.55\u0026plusmn;.688\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.00\u0026plusmn;.894\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.55\u0026plusmn;.820\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e2.00\u0026plusmn;.775\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e2.46\u0026plusmn;1.128\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"88\"\u003e\n\u003cp\u003eSocio-economic status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003eLow\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.67\u0026plusmn;.736\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.30\u0026plusmn;.770\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.97\u0026plusmn;.810\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e2.30\u0026plusmn;.586\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e2.64\u0026plusmn;.699\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003eMiddle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.65\u0026plusmn;.745\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.00\u0026plusmn;.858\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.60\u0026plusmn;.883\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e1.70\u0026plusmn;.657\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e1.95\u0026plusmn;.686\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003eHigh\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.67\u0026plusmn;.866\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.00\u0026plusmn;.866\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.33\u0026plusmn;.500\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e1.56\u0026plusmn;.882\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e1.67\u0026plusmn;.707\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e2.00\u0026plusmn;.817\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.00\u0026plusmn;.817\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e2.00\u0026plusmn;.817\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e2.25\u0026plusmn;.500\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e3.25\u0026plusmn;.957\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003eOccupation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003eCivil Servant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e2.00\u0026plusmn;.817\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.50\u0026plusmn;1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.00\u0026plusmn;.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e1.25\u0026plusmn;.500\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e1.50\u0026plusmn;.577\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003eSelf employed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.58\u0026plusmn;.793\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.42\u0026plusmn;.669\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.83\u0026plusmn;.835\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e1.58\u0026plusmn;.669\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e1.75\u0026plusmn;.622\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003eTrader\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.63\u0026plusmn;.733\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.02\u0026plusmn;.821\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.83\u0026plusmn;.834\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e2.15\u0026plusmn;.691\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e2.51\u0026plusmn;.810\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003eHousewife\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.89\u0026plusmn;.782\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.22\u0026plusmn;.833\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.78\u0026plusmn;.833\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e2.33\u0026plusmn;.500\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e2.67\u0026plusmn;.707\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003eEducation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003eNo formal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.60\u0026plusmn;.737\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.07\u0026plusmn;.799\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e2.00\u0026plusmn;.845\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e2.47\u0026plusmn;.516\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e3.07\u0026plusmn;.594\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003ePrimary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.70\u0026plusmn;.669\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.26\u0026plusmn;.712\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.85\u0026plusmn;.770\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e2.15\u0026plusmn;.602\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e2.44\u0026plusmn;.641\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003eSecondary\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.77\u0026plusmn;.832\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.00\u0026plusmn;.913\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.77\u0026plusmn;.927\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e2.00\u0026plusmn;.707\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e2.15\u0026plusmn;.689\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"110\"\u003e\n\u003cp\u003eHigher\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e1.64\u0026plusmn;.924\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e2.18\u0026plusmn;.982\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e1.27\u0026plusmn;.647\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e1.09\u0026plusmn;.302\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e1.27\u0026plusmn;.467\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr /\u003e \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6: ANOVA of \u003c/strong\u003e\u003cstrong\u003escores on the EQ-5D-3L and EQ VAS scale of HRQOL for SES\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/strong\u003e \u003cem\u003en = 66 \u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"607\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" width=\"219\"\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eDimension\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"57\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"7\" width=\"216\"\u003e\n\u003cp\u003e\u003cstrong\u003eEconomic Status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"114\"\u003e\n\u003cp\u003e\u003cstrong\u003eANOVA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"57\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e66 \u003cem\u003e(%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u003cstrong\u003eLow\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e33\u003cem\u003e(%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"55\"\u003e\n\u003cp\u003e\u003cstrong\u003eMiddle\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e20\u003cem\u003e(%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e\u003cstrong\u003eHigh\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e9\u003cem\u003e(%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003eDon\u0026rsquo;t know 4\u003cem\u003e(%)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"68\"\u003e\n\u003cp\u003e\u003cstrong\u003eSum of \u0026nbsp;Squares (F)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003eMobility\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eNo problems in walking about\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(48.5)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(50.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(31.3)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(15.6)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(3.1)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e36.318 (.250)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e.861\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eSome problems in walking about\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(34.8)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(52.2)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(30.4)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(8.7)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(8.7)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eConfined to bed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(16.7)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(45.5)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(27.3)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(18.2)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(9.1)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003eSelf-care\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eNo problems with self-care\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e17 \u003cem\u003e(\u003c/em\u003e\u003cem\u003e25.8\u003c/em\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e6 \u003cem\u003e(\u003c/em\u003e\u003cem\u003e35.3\u003c/em\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e7 \u003cem\u003e(\u003c/em\u003e\u003cem\u003e41.2\u003c/em\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e3 \u003cem\u003e(17.6)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(5.9)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e.42.485 (.764)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e.518\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eSome problems washing self or dressing self\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e22 \u003cem\u003e(33.3)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e11 \u003cem\u003e(50.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e6 \u003cem\u003e(27.3)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e3 \u003cem\u003e(13.6)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(9.1)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eUnable to wash self or dress self\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e27 \u003cem\u003e(40.9)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e16 \u003cem\u003e(59.3)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e7 \u003cem\u003e(25.9)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e3 \u003cem\u003e(11.1)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(3.7)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"78\"\u003e\n\u003cp\u003eUsual activities\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eNo problems with performing usual activities\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e31 \u003cem\u003e(47.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e11 \u003cem\u003e(35.5)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e13 \u003cem\u003e(41.9)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e6 \u003cem\u003e(19.4)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(3.2)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e43.591\u003c/p\u003e\n\u003cp\u003e(1.986)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e.125\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eSome problems with performing usual activities\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e19 \u003cem\u003e(28.8)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e12\u003cem\u003e (63.2)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e2 \u003cem\u003e(10.5)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e3 \u003cem\u003e(15.8)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(10.5)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eUnable to perform usual activities\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e16 \u003cem\u003e(24.2)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e10 \u003cem\u003e(62.5)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e5 \u003cem\u003e(31.3)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(6.2)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"78\"\u003e\n\u003cp\u003ePain/discomfort\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eNo pain or discomfort\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e16 \u003cem\u003e(24.2)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e7 \u003cem\u003e(43.8)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e5 \u003cem\u003e(31.2)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e2 \u003cem\u003e(12.5)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(12.5)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e32.985 (5.410)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e.002*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eModerate pain or discomfort\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e22 \u003cem\u003e(33.3)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e10 \u003cem\u003e(45.5)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e6 \u003cem\u003e(27.3)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e4 \u003cem\u003e(18.2)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(9.1)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eExtreme pain or discomfort\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e28 \u003cem\u003e(42.4)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e16 \u003cem\u003e(57.1)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e9 \u003cem\u003e(32.1)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e3 \u003cem\u003e(10.7)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"78\"\u003e\n\u003cp\u003eAnxiety/ depression\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eNot anxious or depressed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e10 \u003cem\u003e(\u003c/em\u003e\u003cem\u003e15.2\u003c/em\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(10.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e5 \u003cem\u003e(50.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e4 \u003cem\u003e(40.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e44.667 (8.791)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e.000*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eModerately anxious or depressed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e29 \u003cem\u003e(\u003c/em\u003e\u003cem\u003e43.9\u003c/em\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e13 \u003cem\u003e(44.8)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e11 \u003cem\u003e(37.9)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e4 \u003cem\u003e(13.8)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(3.5\u003c/em\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eExtremely anxious or depressed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e22 \u003cem\u003e(33.3)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e16 \u003cem\u003e(72.7)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e4 \u003cem\u003e(18.2)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(4.5)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(4.5)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e5 \u003cem\u003e(7.6\u003c/em\u003e\u003cem\u003e6\u003c/em\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(60.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(4\u003c/em\u003e\u003cem\u003e0.0\u003c/em\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e(\u0026sum;fx)/n\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e.81\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003eEQ VAS Scale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e0 \u0026ndash; 25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e10 \u003cem\u003e(15.2)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e\u003cem\u003e7\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(21.2)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e2 \u003cem\u003e(10.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e1 \u003cem\u003e(11.1)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e64.439 (4.055)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e.011*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e26 \u0026ndash; 50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e27 \u003cem\u003e(40.9)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e18 \u003cem\u003e(54.5)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e6 \u003cem\u003e(30.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e1 \u003cem\u003e(11.1)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(50.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e51 \u0026ndash; 75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e19 \u003cem\u003e(28.8)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(18.2)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e10 \u003cem\u003e(50.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e2 \u003cem\u003e(22.2)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(25.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e76 \u0026ndash; 100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(12.1)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(3.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e2 \u003cem\u003e(10.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e5 \u003cem\u003e(55.6)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(3.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(3.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"56\"\u003e\n\u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(25.0)\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* = Significant\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7: Tukey HSD Post-Hoc Test of homogeneity of the scores on EQ-5D-3L and EQ VAS of HRQOL\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"623\"\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 70px;\" rowspan=\"2\" width=\"151\"\u003e\n\u003cp\u003e\u003cstrong\u003eQuality of life scale\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 70px;\" rowspan=\"2\" width=\"142\"\u003e\n\u003cp\u003e\u003cstrong\u003eSES\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" colspan=\"3\" width=\"331\"\u003e\n\u003cp\u003e\u003cstrong\u003eSubset for alpha on the \u003c/strong\u003e\u003cstrong\u003eEQ-5D-3L\u003c/strong\u003e\u003cstrong\u003e = 0.05\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"132\"\u003e\n\u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"95\"\u003e\n\u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"151\"\u003e\n\u003cp\u003ePain/discomfort\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"142\"\u003e\n\u003cp\u003eHigh SES (9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"132\"\u003e\n\u003cp\u003e1.556\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"104\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"95\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"142\"\u003e\n\u003cp\u003eMiddle SES (20)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"132\"\u003e\n\u003cp\u003e1.700\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"104\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"95\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"142\"\u003e\n\u003cp\u003eLow SES (33)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"132\"\u003e\n\u003cp\u003e2.303\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"104\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"95\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"142\"\u003e\n\u003cp\u003eDon't Know (4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"132\"\u003e\n\u003cp\u003e2.250\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"104\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"95\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"151\"\u003e\n\u003cp\u003eAnxiety/depression\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"142\"\u003e\n\u003cp\u003eHigh SES (9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"132\"\u003e\n\u003cp\u003e1.667\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"104\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"95\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"142\"\u003e\n\u003cp\u003eMiddle SES (20)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"132\"\u003e\n\u003cp\u003e1.950\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"104\"\u003e\n\u003cp\u003e1.950\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"95\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"142\"\u003e\n\u003cp\u003eLow SES (33)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"132\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"104\"\u003e\n\u003cp\u003e2.636\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"95\"\u003e\n\u003cp\u003e2.636\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"142\"\u003e\n\u003cp\u003eDon't Know (4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"132\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"104\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"95\"\u003e\n\u003cp\u003e3.250\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"151\"\u003e\n\u003cp\u003eEQ VAS Scale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"142\"\u003e\n\u003cp\u003eHigh SES (9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"132\"\u003e\n\u003cp\u003e3.222\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"104\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"95\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"142\"\u003e\n\u003cp\u003eMiddle SES (20)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"132\"\u003e\n\u003cp\u003e2.600\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"104\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"95\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"142\"\u003e\n\u003cp\u003eLow SES (33)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"132\"\u003e\n\u003cp\u003e2.121\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"104\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"95\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"151\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"142\"\u003e\n\u003cp\u003eDon't Know (4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"132\"\u003e\n\u003cp\u003e3.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"104\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"95\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Burns, Economic Burden, Economic Status, Health Expenditure, Hospitalization, Quality of Life","lastPublishedDoi":"10.21203/rs.3.rs-24746/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-24746/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003eBurns cases are frequent in Nigeria hospitals, however, literature on its economic burden and the association with health-related quality of life (HRQOL) of women in Nigeria is scarce. This study determined the burden of hospitalization after burns on women’s economic status and its associated HRQOL.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eThis was a three-month cross-sectional study of female patients ≥ 25 years, treated of mixed or full thickness burns in four teaching hospitals in south-east Nigeria, discharged between September-November, 2018. Study instruments were participants’ case notes for socio-demographic and disease history, interviewer-administered questionnaires, namely-economic-burden-of-burns questionnaire and English version of the EuroQol Five-Dimensions-Three-Level Health Questionnaire for Nigeria. Data were collected on second- or third-day post-discharge through home visits or phone calls. This lasted for thirteen weeks. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eA total of seventy-three female patients with burn were successfully enrolled. Most participants were married, fairly educated, mainly traders or housewives. Thirty-four (46.6%) had subjective estimated family monthly income below NGN 50,000 (low economic status). Participants’ average monthly income reduced drastically after hospitalization. Their average family monthly income was NGN110,439 (USD307), while their average total expenses incurred during hospitalization was NGN691,093 (USD1,920). Almost all (93.2%) had at least one surgical intervention during management. Their average length of hospital stay was 35.4 days; eleven consequently lost their job. Many had moderate to severe economic burden of treatment; only eleven could bear all the treatment expenses independently. Women in the low economic class were more inclined to extreme anxiety/depression (p = .001) and pain/discomfort (p = .002) dimensions of HRQOL. Low and middle-class women had poorer health state on the EQ VAS scale than the high class. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eBurns places high level of economic burden on women and unfortunately, Nigerian government’s commitment to healthcare of burns patients is low. The long course of hospitalization and economic depletion impact negatively on the women’s HRQOL. Based on these findings, we recommend that government parastatals create special trust fund for burns treatment and the National Health Insurance Scheme be restructured for more accessibility.\u003c/p\u003e","manuscriptTitle":"Economic Burden of Moderate to Severe Burns and its Association with Health-related Quality of Life of Nigerian Women","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2020-12-13 18:48:11","doi":"10.21203/rs.3.rs-24746/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-12-22T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-12-15T00:00:00+00:00","index":1,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n\nComments to Author:\n---\nThe authors have improved the paper.\nHowever, there is one major issue, related to the EQ-5D-3L data. The data presentation on the EQ-5D-3l is not following the guidelines / usual data reports on the EQ.\nThese guidelines are included in\nhttps://euroqol.org/wp-content/uploads/2019/10/EQ-5D-3L-User-Guide_version-6.0.pdf.\nAlso an open aces book is available:\nhttps://www.springer.com/gb/book/9783030476212.\nThe authors state in the analysis section to present the utility score, but they only report raw mean scores based on the 1-3 score per domain. With this data presentation , the results of the paper cannot be compared to other work and therefore the paper loses it relevance.\nAlso the EQ-VAS scores are presented in categories (0-25,25- etc). The preferred presentation is a mean vas.\n\n\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **No**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **No**\n* Is the use of statistics and treatment of uncertainties appropriate?: **No**\n* Is the presentation of the work clear?: **No**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-12-10T00:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-12-07T00:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-12-01T00:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-11-30T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-11-30T23:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-05-05 18:48:10","doi":"10.21203/rs.3.rs-24746/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-11-02T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-10-13T12:00:00+00:00","index":2,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\nI think it is an important article mainly in countries like Nigeria but it can show readers how to analyse and how to push political progress by putting evident data to policy makers which is for countries like Nigeria but also to countries that have similar \"burn\" problems as shown in this article.\nMaybe some emphasising should be made about this in the conclusion in a macro or wide point of view for the readers.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **i do not have anything to disclaim**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"editorInvitedReview","content":"","date":"2020-09-24T12:00:00+00:00","index":1,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n\nComments to Author:\n---\nBMC WH 424\n\nThe authors provide an interesting paper on the economic burden of burn injuries, and its relation to HRQOL. This is a highly relevant topic and deserves publication.\nHowever, the paper is not yet ready for publication.\n\n\nAbstract:\nA\nThe number of participants is a result and should be presented in the result section.\n\nIntroduction:\nThe formulation of the aim of the study can be improved. What is meant with: 'the weight of cost of hospitalization? I suggest to use the economic burden of hospitalization after burns The research questions then are threefold: 1) the costs of hospitalization\n2) the sources of fund\n3) HRQOL, and its relation to SES\n\nThe hypotheses are not derived from the literature and in this way meaningless. Please rewrite. Or delete these hypotheses and present the study as a study exploring the relationship between economic burden and HRQL at one side and related socio demographic characteristics on the other.\n\nMethods:\nPlease move results on number of admission and participants to results section.\nPower analysis is unclear: on what outcome is this analysis built?\nPlease present instruments and their validity in the same paragraph. Please add some more information on the EBB-Q (content)\nPlease specify the cost analysis. What are the type of cost categories (direct medical and non medical costs?), and costs components (hospital days,surgery?) and sources for cost calculations?\nPlease specify the source of the income data: who provided this estimate at which moment?\nThe procedure for data collection is quite lengthy, please be more concise.\nPlease include subheading: statistical analysis, p9\n\nResults:\nPlease include a flowchart of eligible patients and participants (see STROBE for examples).\nPlease use subheading to present the different parts of the results (patient characteristics- economic burden, sources, HRQOL.\nA major issue is the extensive data presentation: The authors present very extensive tables with multiple subgroups and testing. In addition, details are repeated in the text. However, the overall EQ-5D for the total population is not presented?\nPlease check the necessity of the details and the tables and limit the description in the text to the main findings.\n\nDiscussion\nThe structure of the discussion needs adaptation. The 1st paragraph should present the aim of the study and the main findings.\nNext, the main findings should be discussed in relation to the literature. This should not be confined to the Nigerian literature but to other LMIC countries as well, to inform a broad public of readers. The HRQL results should be compared to other studies; this will result in a clear view on the very low cores of the participating women.\nI would expect a short discussion of the strengths and limitations of the study.\n\nP3. Line 19 death due to burns?\nP3. Line 23: the instrument should preferably be introduced in the methods section\nP4 line 23: why do the authors use thrust? Instead of aim?\nP5: the authors state that his study will add to QUALY information. This is not the case, please omit.\nP6, line 23 Please add reference EQ.\nP7, procedure face and construct validity rather vague\nP7 reliability: procedure is unclear Please add type of reliability testing. Why is n=8 sufficient?\nP12line 14 Since differences between groups are not tested, one cannot state that x is higher than y.\nP13, t7: please analyse mean health scores instead of comparing health status groups.\nP15, please introduce NHIS. I suggest to include a short introduction to the national health system of Nigeria in the methods section.\n\n\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **No**\n* Declaration of competing interests: **Not applicable**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **No**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **No**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-09-21T12:00:00+00:00","index":2,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-07-01T12:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-05-16T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-04-26T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-04-25T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-04-25T12:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2020-04-23T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3e2ab6c0-e0e9-4e6f-bb48-7d77a357af61","owner":[],"postedDate":"December 13th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":94232,"name":"Preventive Medicine"},{"id":94233,"name":"Internal Medicine"}],"tags":[],"updatedAt":"2021-03-07T15:06:57+00:00","versionOfRecord":{"articleIdentity":"rs-24746","link":"https://doi.org/10.1186/s12905-021-01232-5","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2021-02-28 15:05:35","publishedOnDateReadable":"February 28th, 2021"},"versionCreatedAt":"2020-12-13 18:48:11","video":"","vorDoi":"10.1186/s12905-021-01232-5","vorDoiUrl":"https://doi.org/10.1186/s12905-021-01232-5","workflowStages":[]},"version":"v2","identity":"rs-24746","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-24746","identity":"rs-24746","version":["v2"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}