Graduation Year

2004

Document Type

Thesis

Degree

M.S.P.H.

Degree Granting Department

Public Health

Major Professor

Jeannine Coreil, Ph.D.

Committee Member

Melinda Forthofer, Ph.D.

Committee Member

Eknath Naik, M.D., Ph.D.

Keywords

global health, morbidity control, gender, health behavior, reliability and validity

Abstract

The worldwide eradication of lymphatic filariasis has recently started with two strategies, interruption of transmission and morbidity control. One of the most endemic countries, Haiti has experienced successful interventions through national and international efforts, but the morbidity control is still hindered by a lack of adequate information on quality of life (QOL) issues among those suffering from the chronic manifestations of the disease such as lymphedema. In addition, previous interventions have been focused primarily in a single community where an established lymphedema treatment clinic serves as a national reference center, so it is critical to expand programs to other areas in Haiti.

The purpose of the study was to understand the issues of morbidity control and QOL among lymphedema patients due to lymphatic filariasis in three rural Haitian towns. Secondary data (n = 316) collected in an ongoing filariasis support group project was analyzed in terms of socio-demographic characteristics, including gender age, and regional perspectives. Also, two different commercial QOL instruments (EuroQol, CDC Healthy Days) and a subjective well-being assessment tool (CES-D) were introduced to describe their QOL and mental health status, respectively. The reliability and validity of the measurements were established at the same time.

Regional differences were evident in patients illness history, knowledge of the illness, self-care and self-efficacy for legs, and major QOL indicators related to physical and mental health. Age of patients also influenced foot size, illness stage, and the QOL scores. However, other socio-demographic factors were poorly associated with filariasis related variables, including gender. The commercial QOL instruments and a standardized mental health tool satisfied a reasonable level of reliability and validity. Though additional discussion is needed regarding the validation of the mental health scales between EuroQol and the other instruments, they nevertheless offer utility for enhancing the quality of morbidity control programs.

These findings offer a significant contribution for the development of filariasis prevention programs such as community-based morbidity control and support group activities in Haiti, as well as other areas of the filariasis-endemic world.

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