Masters Degrees (Health Systems and Public Health)

Permanent URI for this collection

https://scholar.sun.ac.za/handle/10019.1/100767

Browse

Browsing Masters Degrees (Health Systems and Public Health) by browse.metadata.advisor "Heine, Martin"

Now showing 1 - 1 of 1
  • Thumbnail Image
    Item
    A study of comorbidities, lifestyle risk factors and fatigue of patients with multiple sclerosis in South Africa
    (Stellenbosch : Stellenbosch University, 2018-12) Maartens, Desiree; Heine, Martin; Derman, Wayne; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems & Public Health.
    ENGLISH ABSTRACT: Background: Multiple Sclerosis (MS) affects approximately 2.3 million people globally with the majority of the patients living in Europe and North America and the lowest in sub-Saharan Africa. The research on MS in sub-Saharan Africa is therefore limited, and even less research is available that has focussed on the experiences and symptoms of patients with MS (pwMS) in this geographical region. A particular complex symptom that is experienced often by majority of pwMS (70-80%) is severe fatigue. Yet, the study of severe fatigue in pwMS, its quantification and the management thereof is difficult due to its subjective and multidimensional nature. This complexity hampers the methodological rigour (e.g. identify appropriate patient population and selection of primary outcomes) in studies that evaluate management programs for fatigue. Objective: The main aims of this dissertation were to; 1) scope the existing literature focussing on MS in originating from sub-Saharan Africa in a systematic fashion, 2) to evaluate the characteristics and key symptoms of pwMS in South Africa(SA), and 3) investigate the agreement between the reported cut-off values for categorising severe fatigue in three commonly used questionnaires in order to determine new cut-offs values to classify a participant as severely fatigued across all three questionnaires. Methods: A scoping review of the literature on MS from sub-Saharan Africa was undertaken as the first part of the dissertation. For the second part of the dissertation, a cross-sectional survey was sent out to about 1000 pwMS affiliated with the Multiple Sclerosis Society of SA. Outcomes were included across all domains of the International Classification of Functioning model (Health condition, Body Function, Activity, Participation, Environmental- and Personal factors). The third part of the dissertation used the fatigue questionnaires from the cross-sectional study to determine the agreement between the questionnaires and to determine new cut-off values to classify a participant as severely fatigued. The three questionnaires used were: The Fatigue Severity Scale (FSS), The Fatigue Scale for Motor and Cognitive Functions (FSMC) and the PROMIS Fatigue Short Form (SF). Results: There were 33 studies from sub-Saharan Africa included for the scoping review. Four themes could be derived to group the included studies; aetiology (n = 6), epidemiology (n = 9), haemotology (n = 13) and other (n = 5). Majority of the studies (88%) were conducted in South Africa. However, no detailed study on the characteristics and symptom experience of pwMS in sub-Saharan Africa was identified. Subsequently, 122 of 1000 pwMS (12.2%) completed the survey (Age=47±10 years, Male (%) =14, disease duration=11±9 years). PwMS were generally moderately disabled (30.2%) according to the Patient Determined Disease Steps. Comorbidity was frequent, with 39.3% of PwMS reporting three or more comorbidities. Detrimental lifestyle behaviour was prevalent, with 64% of pwMS being inactive and 66% reported having smoked at some time in their lives. The FSS and FSMC categorised 73.9% and 78.9% respectively as severely fatigued. The PROMIS Fatigue SF categorised only 30% as severely fatigued. Using Cohen’s Kappa, a significantly moderate agreement was found between FSS and FSMC, (k = 0.563, p = 0.000), and not the PROMIS Fatigue SF. Cut-off values of 5.8 out of 7 for the FSS would provide 100% certainty that the “hypothetical” patient with these values would have qualified as severely fatigued on the FSMC. Conversely, a value 88.5 out of 100 for FSMC would provide 100% certainty that this same patient would have qualified as severe fatigued on the FSS. Conclusion: Despite an increased reporting of MS in sub-Saharan Africa, there is very little research of patient experiences and management conducted in this specific context. The characteristics and symptom experience of pwMS in in SA were much in line with those for developed countries. A triad of poor lifestyle behaviour, low levels of physical activity, and high burden of comorbidity are concerning and warrant future research. We argue for higher than the conventional cut-off values for indication of the presence of severe fatigue are used in the further study of fatigue specifically, to facilitate more accurate estimates of the effect of fatigue management programs.