Factors Associated with Poor Health-Related Quality of Life Among Patients with Epilepsy at Mulago National Referral Hospital

Humphrey Atwijukiire,1 Juliana Namutundu,1 David Lubogo,2 Mark Kaddumukasa,3 Martha Sajatovic4 1Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda; 2Department of Community Health, Makerere University School of Public Health, Kampala, Uganda; 3Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda; 4Neurological and Behavioural Outcomes Centre, University Hospitals Cleveland Medical Centre & Case Western Reserve University School of Medicine, Cleveland, OH, USACorrespondence: Humphrey Atwijukiire, Department of Epidemiology and Biostatistics, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda, Tel +256775131535, Email hatwijukiire@gmail.comBackground: People with epilepsy (PWE) frequently experience reduced health-related quality of life (HRQOL) due to clinical, psychological, and social challenges. In Uganda, epilepsy is increasingly recognised as a public health issue; however, interventions have mainly focused on seizure control, with little attention to psychosocial determinants of well-being.Objective: To determine the frequency of poor HRQOL and associated factors among adult patients with epilepsy at Mulago National Referral Hospital (MNRH).Methods: We conducted a hospital-based cross-sectional study among adult PWE attending the mental health unit at MNRH. We enrolled participants using consecutive sampling. HRQOL was measured using the Quality of Life in Epilepsy Inventory (QOLIE-31). We defined Poor HRQOL as a score below the global mean score. We used modified Poisson regression with robust variance to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for factors associated with poor HRQOL.Results: A total of 190 participants were included. The frequency of poor HRQOL was 50.53% (96/190). Poor HRQOL was independently associated with being married (aPR 1.37, 95% CI 1.02– 1.85), primary education (aPR 2.01, 95% CI 1.27– 3.16), secondary education (aPR 1.61, 95% CI 1.03– 2.53), experiencing 6– 10 seizures per year (aPR 1.53, 95% CI 1.08– 2.17), borderline depressive symptoms (aPR 1.58, 95% CI 1.21– 2.05), abnormal depressive symptoms (aPR 1.92, 95% CI 1.38– 2.65), moderate stigma (aPR 4.07, 95% CI 1.75– 9.43), and severe stigma (aPR 4.10, 95% CI 1.72– 9.81). Self-employment was negatively associated with poor HRQOL (aPR 0.52, 95% CI 0.34– 0.79).Conclusion: Poor HRQOL is common among adults with epilepsy receiving tertiary care in Uganda and is associated with seizure burden, depressive symptoms, stigma, and social characteristics. Integrating psychosocial screening for depression with HADS, stigma with SSE, and psychosocial support into routine epilepsy care may improve patient-centred outcomes.