Factors Affecting Quality of Life of Patients Living with Stoma in a Tertiary Hospital in Rwanda.

Abstract

Background: A stoma is a surgical opening of the intestines through the abdominal wall. Quality of life (QoL) of patients with stomas constitutes a crucial public health challenge, generally in Low and Middle Income Countries (LMICs) and particularly in Rwanda. Objectives: This study had objectives to describe demographic characteristics, determine health related QoL, identify modifiable factors influencing QoL of patients living with stoma and explore patient perceptions about stoma and stomatherapy. Methods: This was a mixed-methods study with sequential explanatory design. 47 patients living with stoma have been included from January to June 2021. Demographics and other variables of interest were collected using a pre-established data collection sheet and QoL was assessed using Stoma QoL scale, a validated questionnaire for assessing health-related QoL of patients living with colostomy and ileostomy. Results: 47 patients living with stoma and followed in the outpatient clinics of CHUK and CHUB were included in this study. 57.4% of them were male, 51.1% aged 50 years and above, 51% were in low socio-economic class (second category of ubudehe), 57.4% were farmers and 89.4% had community based health insurance (CBHI). The majority of patients were married (78.8%) and still leaving with their partners. 72.3% had a “poor /worst” quality of life, 27,7% had “good” quality of life and no one (0%) had “best” QoL according to Stoma Quality of life Scale classification. age (p-value=0.001), Type of stoma (p-value=0.017), duration of stoma (p-value= 0.017), socio-economic status (p-value=0.027), level of education (p-value=0.007), availability of stoma bag (p-value= 0.008), patient’s education after surgery (p-value= 0.005) have been identified as factors influencing QoL. The main recurrent themes in qualitative analysis were “lack of special education and follow up near home for stoma therapy”, “stoma bags are neither available nor affordable” and “living with stigma in the society”. Conclusion: The majority of patients followed for stoma in Rwanda tertiary hospitals have poor /worst quality of life. Addressing different challenges including affordability and accessibility of stoma bags, lack of community based follow up and poor patient education on stoma and stoma-therapy may improve the QoL of patients living with stoma.