Makondo, Rulani2024-11-152024-11-152023Makondo, Rulani. (2023). The impact of childhood atopic dermatitis on caregiver quality of life at Rahima Moosa Mother and Child Hospital [Master’s dissertation , University of the Witwatersrand, Johannesburg]. WireDSpace.https://hdl.handle.net/10539/42590A research report (in the format of a “submissible” paper) submitted in partial fulfillment of the requirements for the degree Master of Science in Medicine (Dermatology) to the Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg,. Johannesburg, 2023Background. Atopic dermatitis (AD) is the most common childhood skin disorder with a rising prevalence in developing countries, likewise South Africa. It is characterized by recurring pruritic cutaneous lesions, the control of which necessitates specific skin care measures and avoidance of triggers. The resultant impact on the quality of life (QOL) of the affected child is well established. Moreover, it places an added burden on caregivers as they have to allocate time and resources in activities aimed at achieving disease control to make the affected child comfortable. Objectives. The primary objective of this study was to determine the psychosocial impact of childhood AD on caregiver QOL at Rahima Moosa Mother and Child Hospital (RMMCH) and to describe the association with disease severity and sociodemographic factors. Methods. This was a cross-sectional study conducted at RMMCH, Coronationville, Johannesburg, South Africa from February to June 2022. Children aged 3 months to 16 years fulfilling the Hanifin and Rajka clinical diagnostic criteria for AD diagnosis presenting to the outpatient dermatology clinic with their primary caregiver were recruited into the study. Caregiver QOL was measured using the Dermatitis Family Impact (DFI) questionnaire which assesses the family impact of atopic dermatitis through a series of 10 lifestyle questions that are scored from 0 to 3. The overall DFI score ranges from 0 (no impact on family life) to 30 (maximum impact on family life). The score was further defined as follows; 0-5 = normal QOL; 6-10 = minor caregiver impact; 11-20 = moderate impact and greater than 20 = high impact. Disease severity was classified as per the scoring atopic dermatitis (SCORAD) index into either mild (score of at least 25), moderate (25-50) or severe (above 50) based on lesion extent, intensity and subjective patient symptoms. Patient demographics (age, gender, race, comorbidities, disease duration and treatment duration) and caregiver sociodemographic characteristics (relationship to the patient, gender, age, marital status, family set-up, other dependents, educational level, source of income and medical history) were recorded on the data collection sheet. Statistical tests were concluded at 5% level of significance. Results. A total of 180 AD patient-caregiver pairs were recruited into the study. The median patient age (interquartile range (IQR)) was 60 months (36, 84) while the caregiver mean age (standard deviation (SD)) was 36 years (9). The mean QOL (SD) was 9.8 (7.3). Based on our suggested classification, 64 (35.6%) had a normal quality of life, 49 (27.2%) suffered a mild impact, 47 (26.1%) had moderate impact and 20 (11.1%) recorded the highest impact on their QOL. Most (72%) of the participants had mild disease while 20% had moderate and 8% had severe disease. There was positive association between the disease severity score and QOL score at 5% level of significance (p<0.001). The QOL perspectives reported by most as worst affected were emotional distress, expenditure, sleep disturbance, food preparation and housework interruption respectively. Patient age, disease duration and treatment duration inversely correlated with QOL scores. Except for marital status, the QOL impact score was independent of caregiver sociodemographic factors. Conclusion. The study showed that childhood AD impacts negatively on caregiver QOL at a tertiary hospital in South Africa. The magnitude of which correlates with disease severity. The effect was independent of all caregiver sociodemographic factors except marital status. Patient treatment outcomes are dependent on the caregiver. Therefore, patient monitoring should incorporate caregiver QOL assessments.en© 2023 University of the Witwatersrand, Johannesburg. All rights reserved. The copyright in this work vests in the University of the Witwatersrand, Johannesburg. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of University of the Witwatersrand, Johannesburg.Atopic dermatitisQuality of lifeDermatitis family impact questionnaireScoring atopic dermatitisUCTDSDG-3: Good health and well-beingDissertationUniversity of the Witwatersrand, Johannesburg