ABSTRACT
Human Immunodeficiency
Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) is an incurable disease
that makes the casualty susceptible and is associated with significant
morbidity and mortality despite the availability of treatment and care.HIV/AIDS
in Nigeria remains a vital public/ community health issue since Nigeria is a
base or environment with many people living with HIV unlike other countries
worldwide. The Quality of Life (QoL) of HIV/AIDS patient is crucial as well as
the disease progression because of their need for adaption to changes in their
lives which include financial & societal changes. Therefore, consideration
for improving their quality of life is paramount.Compounding the lack of cure
for HIV/AIDS, is the fact that PLWHA are still faced with social support
issues. It is in the light of these that the researcher carried out this study
to explore perceived social support, and socio demographic variables, as
correlates of QoL among Human
Immunodeficiency Syndrome Patients in a Teaching Hospital Ogun State.
This
study employed a descriptive correlational survey design. A total population
160 People living with HIV/AIDS (PLWHA) participated in the study. World Health
Organization Quality of Life Brief Instrument (WHOQOLHIV Bref) and
Multidimensional scale for perceived social support were used for data
collection. The questionnaire was validated and tested for reliability with
overall alpha coefficient 0.8. 160copies of the questionnaire was distributed
and 149 was returned making 93% return rate. The analysis involved descriptive
& inferential statistics.
The
findings from the analysis showed that participant disagree to the kind of
social support given (mean=3.65, SD=2.11).
Quality of life was moderate and participant averagely dissatisfied with
them (mean=3.48, SD=1.21).Spirituality domain has the highest mean score and
environment has the lowest mean score. The findings showed that gender,
occupation, educational level and HIV serostatus does not influence the QoL of
PLWHA. The tested hypotheses using PPMC showed that: there is a statistical
significant negative relationship between social support and Quality of life
(p<0.05), there is a statistical significant negative relationship between
educational level and social support (P=0.027), there is no statistical
significant relationship between socio-demographic variable and social support.
The
study concluded that social support significantly contributes to the QoL of
PLWHA. An improvement in the kind of social support will invariably result in a
better Quality of life.
Therefore,
it is recommended that appropriate intervention programs in the specific area
of social support of PLWHA which will in turn improve Quality of life especially environment aspect. Sectors like
housing, works environment should be involved in Quality of life improvement.
Also the result from this study may assist Policy makers, health workers, and
government in planning and improving overall Quality of life.
CHAPTER
ONE
INTRODUCTION
1.1 Background to the study
Human
Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) is a
pandemic disease in which the body’s defense mechanism is weak and this makes
the body unable to get rid of infection (NACA, 2001). HIV/AIDS is an incurable diseases
that makes the casualty susceptible (Rajeev, 2012), and is associated with
significant morbidity and mortality despite the availability of treatment and
care. (Smeltzer, Bare, Hinkle & Cheever, 2010).
As at the end of 2015 – 36.7 million
people probably were living with the virus, 2.1 million people were nearly
infected; 1.1 million people died from the disease; and 18.2 million people
were accessing ART as June 2016. Since the beginning of the epidemic, over 78
million people have become infected; and 3.5 million have died from AIDS
related diseases thus challenging improvements to world health today (UNAIDS,
2016). In sub Saharan Africa about 21 million people are living with HIV/AIDS
and 32% of this population are presently on ART as at 2012 (UNAIDS, 2013).
Also, in Nigeria, estimated 3.1 % adults within the ages of 15 – 49 are living
with HIV/AIDS which is equal to about 3.5 million people from about 141 million
of the total population (UNAIDS, 2016).
Nigeria
is Africa most populous country with 140,4311,790 population figure as at the
last census, and is also rated as tenth largest country in the world with the
approximate estimation of 55% literate and 70% poor in the population (UNAIDS,
WHO & Nigerian Population Comission 2009). Also, in Nigeria, estimated 3.1
% adults within the ages of 15 – 49 are living with HIV/AIDS which is equal to
about 2.6 million people from about 141 million of the total population (UNAIDS,
2008). Another report from NACA (2009) statistics shows average 4.6% prevalence
HIV rate among Nigerians (NACA, 2009). HIV/AIDS in Nigeria remains a vital
public/ community health issue since Nigeria is a base or environment with many
people living with HIV with South Africa prevalence 19.2% as at the end of 2015
(UNAIDS, 2016). The widespread of this disease has negative effect on the
psychosocial, cultural, and developmental aspects of life, which makes the
diseases a critical public health issue (UNAIDS, 2008).
One
of the variables to be measured in this study is social support which has been
associated to better Quality of Life among PLWHA in different studies
(Khumaseen, Aoup-por & Thammachak, 2012). Social support is defined as “the
view or experience that one is loved and cared for by others, esteemed and
valued, and part of a social network of mutual assistance and obligations”
(Taylor, 2007, p. 145). Social support assistance, user fees friendly, good
patient – health workers relationship can help to curb non-adherence. An
in-depth knowledge of the multifaceted interrelationship of the biological
sociological factors is required to understand non-adherence, and Quality of
life thus creating avenue for more effective non-adherence intervention
programs (Olowookere, et al, 2012).
Also, Adedimeji & Odutolu (2007) in a quantitative research to determine
the extent to which certain factors contribute to improvement in QoL of PLWHA
reported that availability of care and social support from spouse friends and
family members yielded good QoL with 93%. Social support services is limited
and lacking in this country and this makes evaluation of the wellbeing and
longetivity of PLWHA important as to how individual perceive their own health
using different instrument such as WHOQOL HIV BREF version instrument.
(Folasire, Irabor & Folasire 2013).
The incurable and pandemic nature of
HIV/AIDS calls for mobilization of resources such as human, money &
material resources to improve quality of life among PLWHA. HIVAIDS is a serious
humanitarian problem that could affect the physical, psychological, social
status of PLWHA. The Quality of Life (QoL) of HIV/AIDS patient is crucial as
well as the disease progression because of their need for adaption to changes
in their lives which include financial & societal changes. Therefore,
consideration for improving their quality of life is paramount (Fan, Kuo, Kao,
Morisky & Chen 2011). According to World
Health Organization (2005) quality of life is described as individual's
perceptions of their position in the life in the context of culture and value
systems in which they live and in relation to their goals, standards,
expectations, and concerns.
The indicator of physical, mental,
social, and spiritual, wellbeing is Health Related Quality of life and this
could serve as means of measuring the total wellbeing of PLWHA which include
their functions and perceptions based on life experiences (Malucclo, Palemo,
Kadliyala, & Rawat, 2015). However,
the HRQOL is regarded as non-medical aspect of living example psychosocial,
socio economic aspect etc (Trana, Ohinmaaa, Nguyen, Nguyen & Nguyen,
2011). Advances in the management of
HIV/AIDS makes it a chronic condition thereby causing reduction in morbidity
and mortality thus improves QoL (Millard, Elliott, Slavin, McDonald, Rowell, & Girdler
2014). As HIV treatment and care worldwide is moving
from emergency to longer term strategies management, there are structural and
contextual factors that influence the outcome of this intervention. The factors
include individual, facility based, environmental/cultural etc (Aidala, Wilson,
Shubert, Gogolishvili, Globerman, Rueda, et
al, 2016).
The changes that result from HIV
care and Management conote that individual with the diseases should take
responsibility for themselves since it is now a chronic condition. Thus this
will help to prevent disability and improve QoL (Millard et al, 2014). In the care
and management of HIV/AIDS wholistic approach is needed to promptly address
issues since it remains a chronic diseases. The stress and fear that accompany
the diseases has been reduced since it has been addressed in relation to other
aspects of life. Focus should now be shifted or adjusted to how individual
adjusts to symptoms (Buseh, Kelber, Stevens, & Park, 2008), and Health
related QOL which is a determinant of overall personal health (Krause, Butler,
& May, 2013).
According to United States
Department of Health and Human Services (HHS) (2011), The two overarching goals
of Healthy people 2020 include (1.) Improving the overall quality of life (2.)
Improving the health of all groups. The
QoL of PLWHA can be traced to the increase in life span of infected individuals
due to availability and access to ART. Socio economic conditions of individuals
with HI/AIDS can alter QoL thereby affecting health-seeking behaviours (Mawar,
Katendra, Bagul,.Bembalker, Vedamurthachar,
Tripathy, et al., 2015). Another
variable of interest in this study is demographic factors which have been
proven to improve quality of life and are seen as determinant of quality of
life. Socio demographic charasteristics
like income level, Marital status, educational level, occupation when
investigated among PLWHA in China was found to influence quality of life which
means people with higher income and are married tend to show positive quality
of life.( Rajeev etal.., 2012). The explanation for this could be as a result
of the knowledge gained from the exposure in the workplace which could impact
quality of life. Also employment among other demographic factors like gender,
higher income, and gender are associated with improved quality of life as seen
among PLWHA in India (Basavaraj etal.., 2010). The reason for the employment
may be a source of income, care and
social support to the individual that are affected which means having a good
job may directly or indirectly improve QoL.
1.2 Statement of the Problem
In
Nigeria, Joint United Program on HIV/AIDS (2014) reported estimated National
HIV prevalence of 4.6% and Nigeria is said to be the 2nd in Africa in terms of People
Living with HIV/AIDS (PLWHA) Africa with over 3.2 million (UNAIDS, 2014).
Compounding the lack of cure for HIV/AIDS is the fact that PLWHA are still
faced with social support issues even being a predictor of QoL. PLWHA are also
faced with Poor Quality of Life which has been attributed to certain socio
demographic variables like lack of social support system or dissatisfaction
with the perceived social support given. Kehinde,
Fatiregun, & Osagbemi (2013) reported that certain sociodemographic/
economic factors like occupation, income, educational level have been proven to
impact QoL where low income and low educational level brings about poor QoL
among the HIV/AIDS patient in Kogii state of Nigeria (Kehinde, Fatiregun &
Osagbemi, 2013). Also, gender difference has been documented to influence QoL
being a major predictor of QoL where statistical result revealed lower score of
QoL among men (Sanyang, 2011). People
still struggle with coping with AIDS and related diseases in the recent times
and this called for evaluating QoL among PLWHA (Oliveira, Moura, Araujo, &
Andrade, 2015). Moreover, limited information about QoL is a major problem in
African setting even with ART in place for PLWHA. Little or no information on
QoL has been documented in Ogun state despite the high prevalence of 6.1 %
which is believed to be one of the highest in the south west Geopolitical zone
in Nigeria (NACA, 2014).
It
is in the light of these that the researcher is carrying out this study to
explore perceived social support, and socio demographic variables as correlates
of Quality of life among Human Immunodeficiency Syndrome patients in a teaching
hospital, Ogun State.
1.3 Objective of the Study
The main objective of this study is to
explore perceived social support, and socio demographic variables as correlates
of Quality of life among Human Immunodeficiency Syndrome patients in a teaching
hospital, Ogun State.
The specific objectives are to:
1. determine
the level of social support as perceived bypatients with HIV/AIDS;
2. assess
the QoL of the patients with HIV/AIDS;
3. determine
the influence of gender on quality of life;
4. examine
the influence of educational level on QoL of patients with HIV/AIDS;
5. investigate
the influence of occupation on quality of life and
6. explore
the influence of HIV serostatus on quality of life.
1.4 Research Questions
1. What is the level of
social support as perceived by the patients with HIV/AIDS?
2. What is the quality
of life of patients with HIV/AIDS?
3. How does gender
influence Qol of patients with HIV/AIDS?
4. How does educational level affect QoL?
5. How does occupation influence quality of
life?
6. What is the effect
of HIV serostatus on QoL?
1.5 Hypotheses
1. There is a significant relationship
between social support and Quality of Life.
2. There is a significant relationship
between socio demographic variables and Quality of life
3. There is a significant relationship
between socio demographic variables and social support.
1.6
Significance of the Study
The
findings of this study could contribute to what is known and create an avenue
for future research especially in settings with high prevalence rate. To inform
healthcare practitioner on the importance of quality of life assessment and
ways for improvement. Also, findings from this study should guide in practice
especially in developing sustainable intervention program that would improve
Quality of Life of PLWHA. This study would help to combat HIV pandemic and its
associated problem by exploring perceived social support, socio demographic
variables as correlates of Quality of life among Human Immunodeficiency
Syndrome Patients. Also, the results of this study would provide more
information to healthcare practitioners and the general public about the
physical & total wellbeing / overall functionality of PLWHA and provide
more evidence regarding the use of the WHO HIV Quality of Life Brief version
tool in the study setting.
1.7
Scope of the Study
This study is looking into People living
with HIV/AIDS (PLWHA) and to accomplish the objective stated above the
Researcher’s consideration is based on quality of life and associated
factors. The study tends to cover
Quality of life, factors that influence or impact the QOL among PLWHA.
It is only limited to HIV positive
patient in Olabisi Onabanjo University Teaching Hospital excluding
children.
1.8 Operational Definition of Terms
Social
Support: Any direct or indirect support or assistance
gotten from family, friends or significant orders like colleagues, healthcare
workers etc. for example someone that provide help when the person is in need.
Socio
demographic Variables: They are socio economic
characteristics like gender, educational level, occupation, marital staus and
income
Quality
of Life (QOL): Perceived quality assessment of individual
wellbeing that includes all emotional, social, physical aspects of life. OR
degree to which individual enjoys important possibities of his /her life OR is
the product of interplay among social health economic and environmental
conditions which affect human and social development.
Human
immunodeficiency syndrome Patient: They are individuals
male and female that are diagnosed of HIV/Acquired Immune deficiency Syndrome
excluding children also PLWHA.
A Teaching Hospital: This is Olabisi
Onabanjo University Teaching Hospital Sagamu Ogun State. Precisely the virology
clinic set aside for treating and addressing the needs of HIV positive patients ================================================================
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