Health-Related Quality of Life of Adults with Cutaneous Leishmaniasis at ALERT Hospital, Addis Ababa, Ethiopia

Background Cutaneous leishmaniasis (CL) is a growing public health threat in Ethiopia. Leishmania aethiopica is the predominant causative organism. Affected individuals develop chronic skin lesions on exposed parts of the body, mostly on the face, which are disfiguring and cause scarring. The effects of CL on the health-related quality of life (HRQoL) of affected individuals has not been formally assessed in Ethiopia. Objective To assess HRQoL in adults with active CL at ALERT Hospital, Addis Ababa, Ethiopia. Methods A cross-sectional study was done using the Amharic version of the Dermatology Life Quality Index (DLQI). Trained health staff administered the DLQI. Results Three hundred and two adults with active CL participated and all of them exhibited a reduced HRQoL. The median DLQI score was 10 (IQR 8). Almost half of the participants reported very poor HRQoL, 36.4% and 11.3% fell within the very large and extremely large effect categories respectively. DLQI scores were higher (median 18) in patients diagnosed with diffuse cutaneous leishmaniasis (DCL) compared to those with localized cutaneous leishmaniasis (LCL). The DLQI domain of ‘work and school’ was the most affected, scoring 73.3% and 66.6% of total possible core for female and male respectively, followed by that of ‘symptom and feeling’ (at 50.0% and 56.6% for female and male respectively). Men were more affected than women in the domains of ‘leisure’ (P=0.002) and ‘personal relationships’ (P=0.001). In the multivariate ordinal logistic regression site of lesion, clinical phenotype and age remained associated with significantly poor HRQoL. Conclusion The HRQoL impairment in people affected by CL is significant. This warrants improved care and treatment in Ethiopia, counseling on the nature of CL, therapeutic options as well as clinical outcomes and complications. Importantly, patient-reported outcome measures including the DLQI should be used to assess treatment efficacy patient care algorisms. Plain Language Summary Cutaneous leishmaniasis (CL) is an important public health problem in Ethiopia with an estimated incidence up to 50,000 cases per year. CL is predominately due to Leishmania aethiopica. The transmission is zoonotic by Phlebotomus longipes and Ph. pedifer , and hyraxes being the incriminated reservoir hosts. The lesion is chronic on the exposed part of the body, commonly on the face. Three main clinical phenotypes are recognized; localized (LCL), mucocutaneous (MCL), and diffuse CL (DCL) cutaneous leishmaniasis. The permanent damage and altered anatomy of the skin, nose, eyelids, ears and lips due to scarring is often associated with stigma. This study aimed to assess the health-related quality of life (HRQoL) using the Amharic version of the Dermatology Life Quality Index (DLQI) in adults diagnosed with active CL. Our results show that the impact on HRQoL associated with CL is large. There was no significant difference between men and women, and urban and rural dwellers. Participants with DCL, the more extensive form of CL, had lower HRQoL compared to those with other forms. Those with lesions on their head and neck regions and younger than 50 year (20 to 49 years age group) had significantly low HRQoL (P<0.05). The reduced HRQoL associated with CL in Ethiopia requires warrants improved, counseling on the nature of CL, therapeutic options as well as clinical outcomes and complications. Importantly, patient-reported outcome measures including the DLQI should be used to assess the efficacy of treatments and patient care algorisms.