WOLLEGA UNIVERSITY

INSTITUTE OF HEALTH SCIENCE

DEPARTMENT OF CLINICAL PHARMACY

ASSESSMENT OF HEALTH-RELATED QUALITY OF LIFE AND ITS

DETERMINANT AMONG AMBULATORY EPILEPTIC ADULTS
PATIENTS AT WOLLEGA UNIVERSITY REFERRAL HOSPITAL, WEST
ETHIOPIA

By; Abdi Edosa Beyena

Advisor; Daniel M (B. Pharm)

A RESEACH PAPER TO BE SUBMITTED TO SCHOOL OF PHARMACY, INSTITUTE

OF HEALTH SCIENCES, WOLLEGA UNIVERSITY IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR BACHELOR DEGREE IN PHARMACY (B. PHARM).

JANAUARY 2021

NEKEMTE, ETHIOPIA

a
This is to certify that this research paper prepared by Abdi Edosa, entitled “ASSESSMENT OF
HEALTH-RELATED QUALITY OF LIFE AND ITS DETERMINANT AMONG
AMBULATORY EPILEPTIC ADULTS PATIENTS AT WOLLEGA UNIVERSITY
REFERRAL HOSPITAL, WEST ETHIOPIA” submitted in partial fulfillment of the
requirements for the bachelor degree of pharmacy complies with the regulations of the university
and meets the accepted standards with respect to originality and quality.

Signed by the Examining Committee:

Examiner: __________________ Sig._________ Date __________

Advisor: ____________________Sig._________Date ___________

Investigator: ________________Sig._________Date ___________

_____________________________________________

Head Department of Pharmacy

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Abstract
Background: Epilepsy is a chronic brain disorder characterized by repetitive unprovoked
seizures more than two times 24 hours apart in a year. It can be associated with profound
physical, psychological and social consequences and its impact on a person’s quality of life can
be greater than that of many other chronic diseases because of different factors.

Objective: To assess health-related quality of life and its determinant among ambulatory
epileptic adult patients at Wollega University Referral Hospital

Methods and patients: A hospital based cross – sectional study was conducted from April 20 to
June 27, 2019, through patient interview and patient chart review to assess health-related quality
of life andits determinant among ambulatory epileptic adult patients at Wollega University
Referral Hospital. Among 121 samples of epileptic adult patients from outpatient department of
Wollega University Referral Hospital. Structured standard interview questionnaires were
prepared to collect data and data was processed and analyzed by using a statistical package for
social science (SPSS). Pre-testing of the questionnaire was done on 5% of total sample size.
Verbal consent from participants was taken before the interview.

Result: A total of 121 epileptic patients were included in this cross-sectional study. Out of
which, 24.4% of the study participants had poor quality of life. Respondents being widowed and
divorced was 44 times (AOR=43.89, P value= 0.002) and 11 times (AOR=11.09, P value
=0.024) more likely to have poor physical quality of life as compared to respondents who have
married. Similarly, co morbidity was significantly associated with poor physical QOL
(AOR=13.34, P value= 0.001). In regards to psychological health co morbidity was the factors
that associated with poor psychological QOL (AOR=9.48, P value=0.001). In the case of social
health being ages above 55 years, respondents who were single, divorced, who took poly
pharmacy and whose seizure were not controlled years (AOR=14.94, P value= 0.018),
(AOR=14.32, P value=0.01), (AOR=12.95, P value=0.028), (AOR=10.17, P value=0.002) and
(AOR=5.35, P value=0.037) respectively were strongly associated with poor social QOL as
compared to with their counterparts. And also poor QOL of environmental health was
significantly associated with being rural in residency (AOR=15.20, P value=0.001), being
divorced (AOR=49.47, P value=0.004) and having uncontrolled seizure (AOR=3.94, P
value=0.029) in relative to their counterpart.

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Conclusion: Minority of study participants had poor overall quality of life in this study. The
various socio-demographic and clinical characteristics affect the QOL. Ages above 55 years,
being female, divorce and widowed in marital status, co morbidity, poly pharmacy and
uncontrolled seizure were significantly associated with poor quality of life of each domain.

Recommendation: Health professional staffs of WURH should manage patients with epilepsy to
become seizure free, educating epileptic patients about their social life and treating of co-morbid
disorders properly may help to improve quality of life in patients with epilepsy.

Keywords: Adults, Epilepsy, Quality of life, Seizure, Wollega University Referral Hospital

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Acknowledgement
Praise and thanks be to the Almighty God who made me possible to prepare this research paper. I
would like to acknowledge Wollega University College of Health science Department of
pharmacy for giving me chance for conducting this study. My heart full gratitude goes to my
advisor Mr. Daniel. M (B. Pharm) for his constructive and supportive comments on the
preparation of this research paper and various aspects from the very beginning of topic selection.
Finally, my acknowledgement also goes to all staffs of Wollega University Referral Hospital and
study participants for their co-operation and provides me necessary information.

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Table of Contents page
Abstract............................................................................................................................................ii

Acknowledgement..........................................................................................................................iv

Abbreviations & acronomys..........................................................................................................vii

1. Introduction.................................................................................................................................1

1.1 Background information........................................................................................................1

1.2 Statement of the Problem.......................................................................................................2

1.3. Significance of the study.......................................................................................................3

2. Literature review.........................................................................................................................4

2.1 Prevalence and Burden of Epilepsy.......................................................................................4

2.2 Psychiatric co-morbidity........................................................................................................4

2.3 Treatment Modality and Treatment Outcome........................................................................5

2.4 Quality of life and factor affecting QOL among PLWE........................................................6

3. Objectives of the study...............................................................................................................8

3.1 General Objective..................................................................................................................8

3.2 Specific Objectives................................................................................................................8

4. Methodology...............................................................................................................................9

4.1 Study area...............................................................................................................................9

4.2 Study period...........................................................................................................................9

4.3 Study designs.........................................................................................................................9

4.4 Population..............................................................................................................................9

4.4.1 Source of population.......................................................................................................9

4.4.2 Study population............................................................................................................9

4.5 Inclusion and Exclusion criteria.............................................................................................9

4.5.1 Inclusion Criteria...........................................................................................................9

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 4.5.2 Exclusion criteria........................................................................................................10

4.6. Sample size determination..................................................................................................10

4.7. Sampling procedures...........................................................................................................11

4.8. Data Collection procedure and Tools..................................................................................11

4.9. Study variables....................................................................................................................12

4.9.1 Dependent variable........................................................................................................12

4.9.2 Independent variables....................................................................................................12

4.10. Standard & Operational Definition...................................................................................12

4.11. Data Quality Assurance....................................................................................................13

4.12. Data Processing and Analysis...........................................................................................13

4.13. Ethical Consideration........................................................................................................13

5. Results........................................................................................................................................14

5.1. Socio-Demographic Characteristics of the Respondents....................................................14

5.2. Clinical Characteristics of the Respondents........................................................................15

5.3. WHOQOL-BREF (0-100) Characteristics of Respondents................................................17

6. Discussion..................................................................................................................................23

7. Limitation of the study...............................................................................................................26

8. Conclusion................................................................................................................................27

9. Recommendation.......................................................................................................................28

10. References................................................................................................................................29

11. Annexes...................................................................................................................................34

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List of tables

Table 1. Distribution of participants by socio-demographic characteristics at Wollega university

referral hospital nakamte (2021)(n= 121).....................................................................................14
Table 2. Distribution of participants by clinical characteristics at WURH, Nekemte, 2021(n=
121)................................................................................................................................................16
Table 3. Distribution of four domains of WHO QOL- BREF among epileptic patients at WURH,
Nekemte Ethiopia, 2021 (n= 121).................................................................................................18
Table 4. Bivariate analysis of variables associated with quality of life among epileptic patients at
WURH, Nekemte Ethiopia, 2021 (n= 121)...................................................................................18
Table 5. Backward Multivariate logistic regression analysis of variables associated with quality
of life among epileptic patients at WURH, Nekemte Ethiopia, 2021 (n= 121).............................23

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List of figures
Figure 1. The conceptual framework encompasses factor affecting QOL among PLWE..............7
Figure 2. Frequency of co morbid conditions (psychiatric and non-psychiatric) and non co
morbid condition among epileptic patients attending at WURH, 2021.........................................17

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Abbreviations & acronomys
AEDs: Antiepileptic drugs

WURH: Wollega University Referral Hospital

PWE: Person with epilepsy.

PLWE: People living with epilepsy

QOL: Quality of Life.

WHO: World Health Organization

WHOQOL-100: World Health Organization Quality of Life – 100 Questionnaires

WHOQOLBREF: World Health Organization Quality of Life BREF Questionnaire.

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1. Introduction
1.1 Background information
Epilepsy is a disorder of the brain characterized by two or more unprovoked seizures occurring
more than 24 hours apart or one unprovoked seizure when the risk for another is known to be
high (>60%) [1]. It is a medical condition resulting in repeated often times debilitating seizures
that can lead to injury and death. Despite the advances in the various treatment modalities around
one-third of person with epilepsy (PWE) continue to have difficult to control seizures [2].
Epilepsy is not a single disease, but rather an expression of many different brain disorders, and as
a consequence investigations and treatment must be individualized [3]. It is one of the most
common and widespread neurological disorders which affect over 65 million people [4].

The International League against Epilepsy (ILAE) classifies seizures according to either the
clinical presentation or the underlying pathology. There are three major types of seizure
including focal seizures, generalized seizures and unclassified seizures [5].

The cause of epilepsy is completely unknown. However, some evidences suggested that heredity
play an important role in many causes of epilepsy, but it can also result from brain injuries
caused by blows to the head, stroke, infections, high fever or tumors [6]. Many people in Africa
also believe that epilepsy is contagious and that can be spread by urine, saliva, flatus, or feces
excreted at all times or during a convulsion because of these unwilling to help or to touch the
person who has fallen during a seizure [1, 4].

Epilepsy can affect the Quality of Life (QOL) due to the need for regular medications, their side
effects and also due to prejudices and social conventions that still surround it [7].

Epilepsy has a great influence on the three levels of quality of life (physical, mental and social
health), which is exercised directly - by affecting the physical and mental health, and indirectly -
by introducing limitations and decreasing the opportunities for taking part in quality of life
improving activities. The social functioning has a significant role in obtaining a good QOL[8, 9].

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World Health Organization (WHO) defined quality of life as individuals’' perceptions of their
position in life in the context of the culture and value systems in which they live and in relation
to their goals, expectations, standards and concerns’’ [10].

1.2 Statement of the Problem

Epilepsy is among the most common serious neurological conditions, yet its epidemiology is not
completely known. This is due mainly to methodological problems and to the failure to consider
epilepsy’s heterogeneous nature. The incidence of epilepsy in developed countries is usually
quoted as being between 40 and 70 per 100,000 persons per year, and it is usually higher in
young children and in older people. The incidence in resource-poor countries is usually much
higher than in developed countries, often above 120/100,000/year. Poor sanitation, inadequate
health delivery systems, and higher risk of brain infections and infestations may contribute to
this, although methodological issues may also contribute. [11]

Most large-scale studies in resource-poor countries report prevalence rates for active epilepsy of
between 6 and 10 per 1000; many of these studies also report higher rates in rural areas. Lifetime
prevalence rates are much higher than rates for active epilepsy; this is even the case in resource
poor countries, where there is a huge treatment gap and, indeed, anti-epileptic drugs (AEDs) may
not be available [12].

Epilepsy accounts for 0.6%, of the global burden of disease, a time-based measure that combines
years of life lost due to premature mortality and time lived in less than full health. Epilepsy has
significant economic implications in terms of health care needs, premature death and lost work
productivity. An Indian study conducted in 1998 calculated that the cost per patient of epilepsy
treatment was as high as 88.2% of the country’s per capita Gross National Product (GNP), and
epilepsy-related costs, which included medical costs, travel, and lost work time, exceeded $2.6
billion/year [13].

As some researcher report that, quality of life can be affected in that, people with epilepsy report
significant, negative psychosocial consequences of the disorder including decreased social and
leisure opportunities, low self esteem and feeling of shame and guilt compared with individuals
without epilepsy [14].

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There is a paucity data on health related quality of life of epilepsy in Ethiopia. Hence, this study
would attempt to assess health related quality of life by taking psychiatric co-morbidity and self
management practice as a factor. In addition, seizure control would also be assessed as it could
determine the quality of life.

1.3. Significance of the study

Epilepsy is the commonest neurological disorder which affects the individuals’ quality of life on
the world. It is a higher risk of lifelong neurologic complication and leads to death.

This research is useful for identifying factors affecting quality of life among epileptic adult
patients. In addition to this, it is useful to know status of epilepsy self management practice and
believe with regards to individual epileptic patients.

There are various strategies suggested for improving health related quality of life of patient’s.
Therefore, strategies for improvement of poor quality of life depends on underling factors
affecting quality of life and so the research is aimed to identify the common factors associated
with poor quality of life and to give recommendation for health professional and concerned
bodies, those giving care for patients in Ethiopia, specifically in Wollega University Referral
Hospital.

Finally yet importantly, since there is no research done on this topic in the area, it can be used as
initial point or reference for who those are interested to perform similar studies on this area. The
findings could be used to uncover the practices rendered at the hospital, improve the service.

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2. Literature review
2.1 Prevalence and Burden of Epilepsy
Epilepsy is an important public health problem representing 0.6% of the global burden of disease
that particularly impacts the people living in the lowest income countries where epilepsy
incidence may be 10 fold more than in the developed world [15].

One epidemiological survey conducted in Brazil revealed that the life time prevalence of
epilepsy was 9.2/1,000 people and the estimated prevalence of active epilepsy was 5.4/1,000
people [16]. Incidence as well as prevalence of epilepsy is generally lower in developed regions
in comparison to developing region [17].

A cross-sectional study from rural southern India done on a total of 117 persons with epilepsy
were on record in the 20 villages studied with a prevalence of 5.1 per 1000 population[18].

However, prevalence rates have been estimated to vary from 49 to 215 per 100,000 people
among regions of Africa [19]. In a cross-sectional study using a survey questionnaire of rural and
urban dwelling population in Kampala, Uganda and surrounding countryside, identified an
overall epilepsy prevalence of 13.3% [20]. Similarly a cross-sectional survey of individuals
residing in the middle part of Ghana show that, 10.1 per 1000 individuals residing in West
African region had active convulsive epilepsy [21].

In a large community-based epidemiological study, the prevalence of epilepsy in Ethiopia was

reported as 5.2/1000 population [22]. The incidence was 64/100,000 population as reported in a
community-based study conducted in Mescal and Marko districts of rural central Ethiopia [23]

2.2 Psychiatric co-morbidity

Cross sectional study conducted in Brazil showed that using hospital anxiety and depression
scale (HADS) 24.4% subjects as having depression and 39.4% with an anxiety disorder. Being
inactive (retired, unemployed or never had a job), fewer years of schooling and age above 41
years old were associated with depression. The female gender, fewer schooling years and being
in the low economic group were associated with anxiety [24]. A case control study conducted in
USA showed that the prevalence of anxiety among PWE was using generalized anxiety disorder-
7(GAD-7) was 26.2% [25]. A population-based cross sectional study conducted in Canadian

4
show that people living with epilepsy having depression and anxiety were 17.4% and 22.8%
respectively. [26]

A hospital based study from southern India showed that psychiatric co morbid conditions was
highly prevalence and epileptic patients with co morbidity disorders were associated with poor
QOL [27].

A case control study conducted by using HADs in Iran showed that 9.5% epilepsy patients had
depression and 24.5% had anxiety [28]. A cross sectional study conducted in Nigeria showed
that the prevalence of anxiety and depressive symptoms were 20.2% and 15.4% respectively
among PWE [29].

A cross sectional study conducted in Ethiopia using HADS instrument showed that the
prevalence of anxiety symptoms among epileptic patient was found to be 33.5 % whereas
prevalence of depression was 32.8 % and monthly family income, frequency of seizure and side
effects of AEDs were significantly associated with both depression and anxiety. However, being
divorced/ widowed was significantly associated with anxiety whereas perceived stigma, types of
AEDs, and unable to read and write were associated with depression [30].

Institutional Based Cross- Sectional Study conducted in Nekemte showed that the prevalence of
depression among people with epilepsy was 43% and the prevalence of anxiety was 47.8 % [31].

2.3 Treatment Modality and Treatment Outcome

Different literatures found monotherapy was the preferred treatment modality ranging from 55 to
96 %. The highest frequency of monotherapy found in developed countries. Such as 96% in UK ,
77% in Saudi Arabia, 78% in Pakistan, but lower in India (62%) and Singapore (63%). However,
the lowest rate of monotherapy treatment modality was found in Jimma, Ethiopia (55%) and
Amanuel Specialized Mental Hospital, Ethiopia (62%) [32-38].

A cross-sectional comparative study undertaken at Kenyatta National Hospital, Adult neurology

clinic shows, 360 had seizures for more than 2 years and out of whom 180 were selected. The
prevalence of poorly controlled epilepsy was found to be 40%. The poor drug adherence is a
major factor, which was associated with poor control of epilepsy due to financial reasons [39].

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A cross-sectional study was conducted among epileptic patients on follow-up at Amanuel
Specialized Mental Hospital From a total of 397 patients 61% were males. About 70% patients
were adherent to their treatment and only 38.6% of the patients were seizure free for at least two
years [40].

Retrospective cross-sectional study conducted in Jimma University specialized hospital (JUSH)

show that one hundred and sixty-five (56.7%) patients were seizure free during follow-up
periods and 125 (43.3%) patients were not, of which 121 (73.3%) [41].

2.4 Quality of life and factor affecting QOL among PLWE

A case-control study was carried out in Basrah, Iraq state that, the epileptic patients rather poor
QOL explained by the disease’s chronicity (the mean duration of patient’s illness in the study
was 10.6 years). As a result 78% of patients have poor QOL regarding with long duration of
illness [42].

A cross sectional study conducted in India showed that the mean total QOL was 51.49 by the
using WHOQOL-BREF [43]. In similar way the study conducted in the same country by the
different investigator show that the mean QOL was 63.05[44]. According to some study Seizure
frequency was described as one of the most relevant determinants of poor QOL [45].

A few studies have assessed co morbid psychiatric disorders among epileptic patients. It has
been shown that co morbidity moods, especially depression and anxiety, can have adverse effects
on QOL in patients with epilepsy. [46]

Study conducted in Bulgaria state that different socio demographic factor could affect the quality
of life of epileptic patients [47].

An institution based cross -sectional study conducted at Amanuel Mental Specialized Hospital
show that, lower educational level and psychiatric co-morbidity were significantly associated
with poor quality of life when compared with their counterpart [48]. An institutional based cross-
sectional study conducted in South Ethiopia at Dilla University on total 317 respondents show
that (53.1%) of study participants had low quality of life in area of physical domain and 46.8%
had role impairment of physical problem while 45.6% and 36.7% of the studied participants

6
experienced low quality of life due to role impairment of emotional problem and pain
experience, respectively [49].

Conceptual Framework

 Co morbidity condition • Treatment outcome

- Psychiatric (depression, anxiety) -AED side effect
- Other co morbidity -poor drug adherance

QOL among
epileptic
patients
• Patient demography

• Disease condition
- Seizure frequency - Age
- Seizure freedom - Marital status
- Duration of illness - Family income

Figure 1. The conceptual framework encompasses factor affecting QOL among PLWE.

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3. Objectives of the study
3.1 General Objective
To assess health related quality of life and its determinant among ambulatory epileptic adult
patients at WURH.

3.2 Specific Objectives

• To assess health related quality of life of:

• Physical health

• Psychological health

• Social health and

• Environmental health among adults living with epilepsy on follows up at

Wollega University Referral Hospital.

• To determine the associated factors that affect quality of life of adults living with
epilepsy on follow up at Wollega University Referral Hospital.

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4. Methodology
4.1 Study area
The study was conducted at Wollega University Referral Hospital which is found in Nekemte
town, Oromia regional State. Nekemte town located at 328 km away from the capital city of
Ethiopia, Addis Ababa with estimated population of 76,774 inhabitants. There are different
wards and departments in WURH; these include medical ward, surgical ward, obstetrics and
gynecology ward, pediatric ward, medical emergency room, outpatient department (OPD),
psychiatry clinic, ART clinics, pharmacy and laboratory.

4.2 Study period

The study was carried out from March 05 /2020 – June 27/ 2020 G.C.

4.3 Study designs

Hospital based cross-sectional study was employed to assess the health related QOL and its
determinants among adult epileptic patients.

4.4 Population

4.4.1 Source of population

The primary source population for this study was all persons living with epilepsy and attending
Wollega University Referral Hospital.

4.4.2 Study population

The study population was persons living with epilepsy who are 18 years and above who had
agreed to take part in the study and have been on medication for not less than 6 months at
WURH during study period.

4.5 Inclusion and Exclusion criteria

4.5.1 Inclusion Criteria

• Epileptic patients whose age was equal and greater than 18 years.

• Epileptic patients having at least 6 months follow up at the clinic.

• Willingness to participate in the study

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4.5.2 Exclusion criteria
• Those patients who were mentally unstable or critically ill.

4.6. Sample size determination

Sample size was determined using a single population proportion formula. Due to absence of
data in Nekemte area; proportion of population living with epilepsy and who had poor QOL was
assumed 50%,withlevel of significance (α) equals to 0.05 and marginal error of 5%.

n = z (α/2)2 p q

d2

Where n= the desirable sample size

Z (α/2) =the critical value at 95% level of significance (1.96)

p=proportion of patients with epilepsy =0.5

d=acceptable marginal error=0.05

q=1-p=0.5

d=0.05

n= (1.96)2x (0.5) x (0.5) n= 384

(0.05)2

Since the number of population is less than 10,000, it should be adjusted. Therefore the corrected
sample size was;

Where, nf =desired sample size

n = sample from infinite population
N =population size 175 (total number of epileptic patients who follow up at the clinic).
nf= n/(1+n/N) =384/(1+384/175)
nf = 121
By adding 5% contingency, (121*0.05) + 121= 127

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A total of 127 study populations were involved.

4.7. Sampling procedures

Consecutive sampling technique was used to select the study subjects.Wollega University
Referral Hospital psychiatric unit has one clinics visit every work days for patients with epilepsy
and total number of epileptic patients who follow up at the clinic were 175. Being it is small in
number of study population continuously all eligible patient visiting the clinic during the data
collection period were interviewed using structured data collection questionnaire until desired
sample size was achieved.

4.8. Data Collection procedure and Tools

Data was collected by using a structured questionnaire regarding socio-demographic
characteristics and clinical factors of epilepsy. Concerning quality of life and self-management
practice, World Health Organization Quality of Life questionnaire (WHO QOL BREF) scale and
epilepsy self management protocol evaluation form were used respectively and face to face
interview and revised their medical record data were employed to obtain the data.

WHOQOL-BREF contains 26 items and a sound, cross-culturally valid assessment of QOL,

consisting of four domains: physical health (7 items), psychological health (6 items), social
relationships (3 items), and environmental health (8 items); it also contains the first two
questions on general perception of life and health. Each individual item of the WHOQOL-BREF
is scored from 1(very dissatisfied/very poor) to 5 (very satisfied/very good). According to
instruction manual, raw scores for the domains of WHOQOL-BREF were calculated and were
transformed on the scale ranging from 0 to 100, where 100 the highest and 0 the lowest QOL.
The mean score of each domain and the total score were also calculated since quality of life
measures in studies are often presented as means.

Therefore, categorization was done using the mean scores of WHOQOL-BREF. Subjects were
categorized as having GOOD QOL in WHOQOL-BREF, those scores greater than or equal to
mean (M). While subjects with values less than the mean (M), were categorized as having POOR
QOL [49].

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4.9. Study variables

4.9.1 Dependent variable

• Quality of Life

4.9.2 Independent variables

• Age

• Sex

• Educational status

• Income

• Adherence to epileptic self management practice

4.10. Standard & Operational Definition

Epilepsy: Epilepsy is characterized by a tendency to recurrent seizures and it is defined by two
or more un-provoked seizures generally within 2 years [4].

Good quality of life: Subjects those scores greater than or equal to mean in WHOQOL-BREF
were categorized as having GOOD QOL [49].

Health Related Quality of Life: It is often referred to as the impact of disease and treatment on
QOL

Poor quality of life: Subjects those scores less than the mean in WHOQOL-BREF, were
categorized as having POOR QOL [49].

Quality of Life: The World Health Organization defines QOL as an individual’s “perception of
their position in life in the context of the culture and value system in which they live and in
relation to their goals, expectations, standards and concerns” [4].

Seizures-Seizures is a neurologic event in which there is a temporary change in behavior

resulting from a sudden, abnormal burst of electrical activity in the brain. [4].

Unclassified seizure: The diagnosis was documented as epilepsy.

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Uncontrolled seizure: If the patient is not seizure free for at least two year provided that the
patient is on AEDs [5].

4.11. Data Quality Assurance

All questionnaires were translated into the local language afan Oromo and then translated back
into English by different person to ensure validity of translation and Pre-testing of the
questionnaire was done on 5% of total sample size at WURH before two days prior to data
collection.

4.12. Data Processing and Analysis

The coded Data was checked, cleaned and then exported into SPSS window version 20.0 for
analysis. Logistic regression was performed to assess the association between binary outcomes
and different explanatory variables. Bivariate analysis was first conducted for each potentially
explanatory risk factor. Then for variables with p-value of <0.25 with binary logistic regression
was entered into backward multi-step logistic regression and p-value of < 0.05 was taken as
independent predictors.

4.13. Ethical Consideration

Ethical clearance was obtained from the Institutional Review Ethics Committee of the Pharmacy
Department, Institute of Health Science, Wollega University as well as permission was received
from clinical director of WURH. Written informed consent was obtained from the study
participants. To ensure confidentiality, names or identifying information were not indicated on
the questionnaires.

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5. Results
5.1. Socio-Demographic Characteristics of the Respondents
Of the total 127 study participants enrolled, 121 were interviewed with 95.3 response rate. From
total 127 enrolled 6 of them were not participate in the study. Because from 6 of them 2
participants were severely mental ill to give their consent and 4 participants were unwilling to
give their consent during data collection. From 121 interviewed participants, 67(55.4%) were
males. Seventy two(59.5%) of the respondents lie in the age group between 18-35 years whereas
the median age were 32 years ranging from 18-69 years. Majority of them were married 58
(47.9%), Orthodox 51(42.1%), Oromo ethnicity109 (90.1%), Farmer 39 (32.2%), urban
residence 62 (51.2%), primary (1-8) education 57 (47.1%)) and earn <500 ETB monthly 66
(54.5%) (Table1).

Table 1. Distribution of participants by socio-demographic characteristics at Wollega university referral

hospital nakamte (2021)(n= 121)

Variable Frequency Percentage

(%)
Sex Male 67 55.4
Female 54 44.6
Age 18-35 72 59.5
36-55 36 29.8
>55 13 10.7
Ethnicity Oromo 109 90.1
Amhara 9 7.4
Others* 3 2.5
Religion Muslim 26 21.5
Orthodox 51 42.1
Protestant 36 29.8
Wakefata 8 6.6
Marital status Married 58 47.9
Single 50 41.3
Divorced 7 5.8
Widowed 6 5.0
Occupation Governmental employed 13 10.7

Farmer 39 32.2
Student 34 28.1
Businessman/women 13 10.7
Daily labor 10 8.3
Others 12 9.9
Residence Urban 62 51.2
Rural 59 48.8
Educational status Not educated 23 19.0

14
 Primary 57 47.1
Secondary 14 11.6
College and University(tertiary) 27 22.3
Monthly income <500 66 54.5
500-1500 23 19.0
(ETB)
1500-2500 9 7.4
>2500 23 19.0
ETB-Ethiopian birr

5.2. Clinical Characteristics of the Respondents

All of the study participants know the disease they have. Regarding duration of the illness among
study subjects (45.5%) had duration above three years, followed by (38.8%) up to three years.
Concerning times of experienced with symptoms/days most of the respondents (88.4%) had
experienced once per days before they start taking AED. From the study participants, 33
respondents have co morbid condition. From those 11 of them have psychiatric and 22 of them
have non psychiatric co morbidity. In regards to poly pharmacy 13.2% of the respondents takes
poly pharmacy. In similar manner the respondents who’s their seizure was not controlled were
21.5% of the study participants. In terms of seizure types (52.9%) of the participants were
unclassified seizure followed by (44.6%) of the participants were generalized tonic-clonic
seizure (GTCS) (Table2).

Table 2. Distribution of participants by clinical characteristics at WURH, Nekemte, 2021(n= 121)

Variable Name Frequency Percent

Who Knows the disease All 121 100.0
they have
Duration of illness 1 years 3 2.5
2 years 16 13.2
3 years 47 38.8
Above 3 years 55 45.5
Times of experienced Once a day 107 88.4
Twice a day 9 7.4
with symptoms/days
More than two 5 4.1
before starting AED
days

15
 Poly Pharmacy Yes 16 13.2
No 105 86.8
Types of Seizures Simple partial 1 0.8
seizure
Absence seizure 2 1.7
GTCS 54 44.6
Unclassified 64 52.9
Seizure free Yes 95 78.5
No 26 21.5
Seizure burden Controlled 35 28.9
Uncontrolled 86 71.1

Regarding co-morbidity, out of the total respondents 27.3% had co morbid condition. Out of
them 9.1% and 18.2 % had psychiatric co morbid and non-psychiatric co morbid conditions
respectively (figure 1).

Figure 2. Frequency of co morbid conditions (psychiatric and non-psychiatric) and non co

morbid condition among epileptic patients attending at WURH, 2021

80.00%

70.00%

60.00%

50.00%
non psychiatric
40.00%
Psychiatric
30.00%

20.00%

10.00%

0.00%
Comorbidity non comorbidity

16
5.3. WHOQOL-BREF (0-100) Characteristics of Respondents
The mean (SD) total score on the WHOQOL-BREF scale in this study was 56.4±
12.4. Out of the total 121 study participants, 24.4% had poor quality of life. The WHOQOL
BREF covers four different domains of quality of life, physical, psychological, social and
environmental. In this study the individual those score poor QOL in each domain were as follow.
Physical domain (24%), psychological domain (14%), social domain (24.8%) and environmental
domain (34.7%) (Table3).

Table 3. Distribution of four domains of WHO QOL- BREF among epileptic patients at WURH,
Nekemte Ethiopia, 2021 (n= 121).

Variables Mean ± SD Poor QOL frequency (%) Good QOL

frequency (%)
Physical (58.2 ±13.904) 29(24) 92(76)
domain(D1)
Psychological (63.42 ±13.898) 17(14) 104(86)
domain(D2)
Social domain(D3) (51.90 ±11.185) 30(24.8) 91(75.2)
Environmental (51.97 ±10.791) 42(34.7) 79(65.3)
domain(D4)
Overall QOL 56.4 ±12.4 30(24.4) 91(75.6)

5.4. Factor associated with quality of life

On bivariate analysis the factors that fulfilled the minimum requirement (p-value< 0.25) in this
study were entered in to multivariate logistic regression for further analysis in order to control

17
confounding effects. The factors that fulfill the minimum requirement were age, sex, marital
status, place of residency, monthly income, co morbid condition, poly pharmacy and seizure
burdens for all domains (Table 4).

Table 4. Bivariate analysis of variables associated with quality of life among epileptic patients at
WURH, Nekemte Ethiopia, 2021 (n= 121).
Variable p. value < Exp(B) 95% C.I.for EXP(B)
Lower Upper
0.25
Binary logistic regression for domain I

Age 36-55 0.144 11.136 0.439 282.802

>55 0.503 4.373 0.058 327.376
Sex Female 0.138 0.225 0.031 1.616
Marital Single 0.288 5.472 0.239 125.472
Divorced 0.055 47.793 0.923 2475.735
status
Widowed 0.053 24.046 0.965 599.392
Place of Rural
0.195 8.610
residence 0.787 1.297
Monthly 500-1500 0.177 0.236 0.029 1.917
1500-2500 0.225 0.117 0.004 3.736
income
>2500 0.997 0.000 0.000 .
Co morbidity 0.019 15.800 1.570 159.016
Poly pharmacy 0.445 0.271 0.009 7.772
Binary logistic regression for domain II
Age 36-55 0.054 23.590 0.945 588.930
>55 0.115 40.331 0.408 3987.482
Sex Female 0.215 0.310 0.049 1.973
Marital Single 0.056 22.482 0.918 550.426
Divorced 0.193 16.914 0.238 1200.153
status
Widowed 0.880 1.288 0.048 34.601
Place of Rural
0.436 2.577 0.237 27.984
residence
Co
0.175 4.315 0.522 35.695
morbidity

0.407 0.299 0.017 5.183

Poly pharmacy
Binary logistic regression for domain III

Age 36-55 0.118 8.850 0.573 136.619

>55 0.023 42.140 1.694 1048.382
Sex Female 0.631 1.415 0.343 5.833
Marital status Single 0.005 64.268 3.505 1178.312
Divorced 0.024 50.491 1.676 1521.242
Widowed 0.451 2.863 0.186 44.137
Place of residence Rural 0.135 3.708 0.665 20.672
Monthly income 500-1500 0.767 1.297 0.233 7.224
1500-2500 0.998 0.000 0.000 .

18
 >2500 0.849 0.723 0.026 20.178
Co morbidity 0.351 2.395 0.382 15.035
Poly pharmacy 0.158 0.141 0.009 2.141
Seizure burden uncontrolled 0.052 6.040 0.983 37.129
Binary logistic regression for domain IV

Age 36-55 0.538 1.813 0.273 12.025

>55 0.452 0.396 0.035 4.432
Sex Female 0.929 0.943 0.262 3.393
Marital status Single 0.113 4.378 0.704 27.236
Divorced 0.027 32.949 1.483 732.094
Widowed 0.597 1.900 0.176 20.518
Place of Rural
0.010 8.030 1.632 39.517
residence
Monthly income 500-1500 0.256 0.413 0.090 1.900
1500-2500 0.985 0.976 0.084 11.307
>2500 0.897 1.174 0.104 13.236
Co morbidity 0.368 2.155 0.406 11.440
Poly pharmacy 0.591 0.547 0.061 4.935
Seizure burden Uncontrolled 0.229 2.473 0.566 10.802

The results of backward stepwise multivariate analysis showed that quality of life of each
domain was significantly associated as follows: quality of life of physical health significantly
associated with marital status and co morbidity. For psychological health, poor QOL was
significantly associated with co morbid condition. Similarly, quality of life social and
environmental health were significantly associated with (age, marital status, poly pharmacy&
seizure burden) and (marital status, place of residence & seizure burden) respectively (Table5).

Physical health

It was found that marital status was significantly associated with poor QOL of physicalhealth.
Being widowed was 44 times (AOR=43.89,95%CI: 3.815-505.019, P value= 0.002) and
respondents who their marital was divorced were 11 times (AOR=11.09, 95%CI: 1.379- 89.308,
P value =0.024) more likely to have poor quality of life as compared to respondents who have
married. But being single was not significantly associated with poor QOL of physical health.

Co morbidity was another factor associated with quality of life of physical health. Those who
had co morbidity were thirteen times more likely to have poor quality of life as compared to
patients with no co morbidity (AOR=13.34, 95%CI: 4.337-41.023, P value= 0.001).

19
 Psychological health

In regards toPsychological health co morbidity was the factors that associated with poor QOL.
The respondents who had co morbidity were 9 times (AOR=9.48, 95%CI: 3.010- 29.894, P
value=0.001) more likely to have poor quality of life as compared to respondents who haven’t co
morbidity. Although, another factors like age, Sex, Marital status, Place of residence, Level of
education, Monthly income, Poly pharmacy and Seizure burden were entered into logistic
regression multivariate, they were not significantly associated with poor QOL of psychological
health because they not fulfill the criteria to be significant with their P value above 0.05.

Social health

It was found that age, marital status, poly pharmacy and seizure burden were significantly
associated with poor quality of life of social health. Those whose ages were above 55 years were
fifteen times more likely to have poor QOL as compared to respondents whose ages lies in the
range of 18-35 years (AOR=14.94, 95%CI: 1.605-138.994,P value= 0.018). The respondents
whose their ages lies between 36-55 were not significantly associated with QOL of social health
(P value= 0.143). Marital status was the other factors that associated with poor QOL. Being
single and divorced were 14 and 13 times (AOR=14.32, 95%CI: 1.885- 108.814, P value=0.01)
and (AOR=12.95, 95%CI: 1.315- 127.712, P value=0.028) more likely to have poor quality of
life as compared to respondents who married respectively. But being widowed were not
significantly associated with poor QOL of social health (P value=0.312).

Similarly, poly pharmacy and seizure burden were the factors those significantly associated with
poor QOL of social health. A clients who takes five and more than five medication were 10 times
more likely to have poor QOL as compared to who takes less than five medication (AOR=10.17,
95%CI: 2.319- 44.569, P value=0.002). Concerning to seizure burden, respondents who’s their
seizure were uncontrolled i.e. they are not seizure free for more than 2 years despite taking AED
were five times more likely to have poor QOL as compared to who were seizure free for more
than two years(AOR=5.35, 95%CI: 1.105- 25.950, P value=0.037).

But sex of respondents, monthly income, level of education and co morbidityhad no statistically
significant association with QOL of social health on multivariate logistic regression.

20
 Environmental health

In environmental health,it was found that marital status, place of residency and seizure burden
were significantly associated with poor QOL. Being divorced were 49 times (AOR=49.47,
95%CI: 3.390-721.888, P value=0.004), more likely to have poor quality of life of environmental
health as compared to respondents who were married. But being single and widowed was not
significantly associated with poor QOL of environmental health as their P value 0.081 and 0.532
respectively. In regards to residency, being rural was 15 times more likely to have poor QOL of
environmental health as compared to being urban (AOR=15.20, 95%CI: 4.951- 46.661, P
value=0.001). And also, respondents who’s their seizure were uncontrolled were four times more
likely to have poor QOL as compared to respondents who’s their seizure were controlled i.e.
those who were free from seizure for more than two years (AOR=3.94, 95%CI: 1.147- 13.492, P
value=0.029).

On the other hand, sex and age of respondents, monthly income, level of education and co
morbidityhad no statistically significant association with QOL of environmental health on
multivariate logistic regression.

21
Table 5. Backward Multivariate logistic regression analysis of variables associated with quality
of life among epileptic patients at WURH, Nekemte Ethiopia, 2021 (n= 121).
Variable p. value < Exp(B) 95% C.I.for EXP(B)
Lower Upper
0.05
Backward Multivariate logistic regression of Domain I
Marital status Single 0.940 1.046 0.319 3.432
Divorced 0.024 11.098 1.379 89.308
Widowed 0.002 43.895 3.815 505.019
Co morbidity 0.001 13.339 4.337 41.023
Backward Multivariate logistic regression of Domain II

Co morbidity 0.001 9.486 3.010 29.894

Backward Multivariate logistic regression of Domain III
Ages >55 years 0.018 14.938 1.605 138.994
Marital status Single 0.010 14.323 1.885 108.814
Divorced 0.028 12.957 1.315 127.712
Widowed 0.312 2.924 0.365 23.445
Poly pharmacy 0.002 10.167 2.319 44.569
Seizure burden Uncontrolled 0.037 5.354 1.105 25.950
Backward Multivariate logistic regression of Domain IV
Marital Single 0.081 2.558 0.891 7.341
Divorced 0.004 49.473 3.390 721.888
status
Widowed 0.532 1.898 0.255 14.147
Place of Rural
0.001 15.200 4.951 46.664
residence
Seizure Uncontrolled
0.029 3.935 1.147 13.492
burden

6. Discussion
The aim of this study was to assess health-related quality of life andits associated factors among
ambulatory epileptic adult patients at Wollega University Referral Hospital, Nekemte Ethiopia.
Overall, about 24.4% of the respondents have found to be poor quality of life. Effect of epilepsy
on the QoL of the patients is enormous. Both socio-demographic and clinical factors were

22
associated with poor QOL of each corresponding domains. Among the goal of therapy for
patients with epilepsy; one is improving QOL, therefore, the Ethiopian ministry of health, oromia
regional health bureau, East Wollega Health Bureau as well as health care providers in WURH
should strive to improve QOL of PLWE.

The mean total QOL scores in this study were 56.4±12.4 which was higher than other similar
study conducted in Tamil Nadu (51.49) [43]. The score was lower than the study done in India
(63.05) [44]. The possible reasons for the differences might be due to study conducted in India;
the percentage of co morbidity (13%) was less relative to this study (27%) which decreases their
mean QOL score as compared to less percentage of co morbid condition. But the score was
almost similar with the study conducted in Ethiopia (56.36) [48].

The pattern of domain scores in this study showed a higher mean score in the psychological
domain followed by the physical domain. The least score was seen in the social domain. It is
congruent with the study done in the India which scores higher in psychological domain [44].
Similar studies conducted on epileptic subjects using WHO-QOL BREF questionnaire differed
from this study finding by showing higher scores in social domain [43, 48]

In this study various socio-demographic and clinical characteristics were compared for the QOL
of domain scores. It was found that people who had uncontrolled seizure, poly pharmacy, co
morbidity and ages above 55 years were significantly associated with poor QOL.

The study showed that there are significant associations between poor physical health’s related
QOL and marital status. Respondents who were being divorced and widowed had a higher
proportion of poor physical quality of life compared with being married. Previous research has
also revealed that poor QOL was associated with, being separated/widowed [18]. However the
study conducted in Bulgaria shows that, there is no significant association between poor QOL
and marital status [47]. The possible reasons for the differences might be; this cross-sectional
study was conducted using WHOQOL-BREF, but that of the Bulgaria was conducted using
Quality of Life Inventory for Epilepsy (QOLIE-89 P>0.05).

In the present study co morbid condition were prominent predictors for poor QOL of physical
health in epilepsy patients. Previous studies have also reported that the presence of co morbidity
may affect the physical health of the patients with epilepsy [25, 28, 29].

23
In regards to psychological quality of life, the study showed significant associations between co
morbidity and psychological quality of life. A hospital based study from southern India showed
that psychiatric co morbid conditions in patients with seizure disorders were associated with poor
QOL in epileptic patients [27]. A few studies have assessed co morbid condition among epileptic
patients. It has been shown that co morbid moods, especially depression and anxiety, can have
adverse effects on psychological QOL in patients with epilepsy [28]. A cross-sectional study
conducted at Amanuel mental specialized Hospital in Ethiopia showed that, epileptic patient with
psychiatric co-morbidity has poor QOL when compared with the patient without co morbidity
[48]. The current study also found similar results with the QOL being poorer among epileptic
patients with co morbidity.

Concerning the social related quality of life, the study revealed that poor social QOL was
associated with socio demographic and clinical factors. Among socio demographic factors that
significantly associated to poor QOL being unmarried and ages above 55 years. This finding was
consistent with many previous studies [18, 29].

In regards to clinical factors seizure burden and poly pharmacy were most likely associated with
poor QOL of social health in this study. Patients whose seizure was not controlled were score
poor QOL related to social health. This finding is congruent with many previous studies [29, 39,
41, 45]. In similar manner epileptic patients who take multiple drugs were significantly
associated with poor QOL of this domain because it might be suggested that, prescription of
multiple drugs can result in multiple adverse side effects and have a negative effect on QOL.
Different literatures [32, 33, 48] also suggested that poly therapy receiving patients had lower
mean QOL score as compared to their counterpart.

In the case of environmental health, the poor QOL was strongly associated with being rural,
unmarried and uncontrolled seizure. There were more separated from their spouse respondents
with low environmental quality of life compared with married respondents. This finding is
similar with the study conducted in India, which state that poor QOL of environmental health
was strongly associated with being separated/unmarried [18]. In terms of seizure burden the
current study shows that respondents whose seizure was not controlled had poor QOL of
environmental health. The previous study also revealed that frequent seizure and uncontrolled
seizure were positively associated with poor QOL [29, 39, 41, 45].

24
7. Limitation of the study
• From the enrolled study participants, some patients were unwillingness to give their
consent.

• Some data of patient’s record were ineligible which affect quality of collected data.

• Some patients might not remember the exact times of their seizure free period.

• Finally, the questionnaire was only administered to patients of a single hospital,

which might not represent the general population of epileptic patients and have
a limit in broader applications of these findings.

25
8. Conclusion
This study sought to investigate the quality of physical, psychological social and environmental
health and its associated factors of persons living with epilepsy attending Wollega University
Referral Hospital.

24.4% of the study participants were score poor quality of life in this study. Ages >55 years,
being female, divorce and widowed in marital status, co morbidity, poly pharmacy, and
uncontrolled seizure were significantly associated with poor quality of life.

26
27
9. Recommendation
From the study the following recommendations are suggested:

• East Wollega Health Bureau should work on the improvement of the QOL for PLWE

• Health professional staffs in WURH should manage patients with epilepsy to become
seizure free period and early recognition of co morbid condition like psychiatric and
non-psychiatric in people with epilepsy should be of great concern for health care
providers to achieve a good QOL of epileptic patients.

• Epileptic patients should be counseled to live with his/her spouse since according to this
study being separated from their spouse has negative effect on the QOL.

• Further studies are needed to evaluate the effect of other associated factors that
contribute for poor QOL in epilepsy, and to assess its impact on quality of life.

28
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11. Annexes
11.1. Information sheet

Greeting

Hello. My name is Abdi Edosa student at Wollega University, Institute of health Science,
pharmacy department. I collect data of the study on Epilepsy, conducting for partial fulfillment
of bachelor degree in pharmacy. I would very much appreciate your participation in this study.
The information you provide will help me to contribute to improvement of quality health service
for diabetes patients. The interview takes between 20-25 minutes to complete. As part of the
study I would first like to ask you socio demographic and self care behaviors and I would like to
access your medical record to abstract co morbid condition. Whatever information you provide
will be kept strictly confidential, and will not be shared with anyone other than members of our
research team. Participation in this survey is voluntary, and if I should come to any question you
don't want to answer, just let me know and I will go on to the next question; or you can stop the
interview at any time. However, I hope you will participate in the survey since your views are
important. At this time, do you want to ask me anything about the survey? May I begin the
interview now?

Signature of interviewer: -------------------- Date: ----------/--------/--------

1. RESPONDENT AGREES TO BE INTERVIEWED- interview

2. RESPONDENT DOES NOT AGREE TO BE INTERVIEWED–end

For more information and questions here is the contact address of investigator. Abdi Edosa
+251917663984

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11.2. Consent form

Dear Sir /Madam Good morning/afternoon;

My name is________________. I am a data collector for the study entitled as assessment of

health related quality of life and its determinant among adults with epilepsy who are admitted to
Wollega University Referral Hospital. Thus this interview is prepared for this purpose to get
appropriate information on the topic. The information that will be obtained using this interview
will be used only for research purpose and also confidentiality is assured. Therefore, I am
politely request your cooperation to participate in this interview. You do have the right not to
respond at all or to withdraw in the meantime, but your input has great value for the success of
the objectives of the research.

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11.3. English version of questionnaire
Part I.Socio demographic characteristic of the study participants.
1. Card number______________________
2. Age _______Years
3. Sex a) Male [ ] b) Female [ ]

4. Ethnicity a) Oromo [ ] b) Amhara [ ] c) Tigre [ ]

d) Gurage [ ] e) Somali[ ] f) Others, specify-----------------------------------

5. Religion a) Muslim [ ] b) Orthodox [ ] c) Protestant [ ] d) Others [ ]

specify---------------------------------

6. Marital status (a) Married [ ] (b) Single [ ] (c) Divorced [ ] (d) Widowed [ ]

7. Occupation (a) government employee [ ] (b) farmer [ ] (c) Student [ ]

(d) Businessman/woman [ ] (e) daily labor [ ] (f) others specify ………………….

8. Place of residence (a) urban [ ] (b) rural [ ]

9. Level of education (a) Not educated [ ] (b) Primary(1-8) [ ] (C) Secondary (8-12) [ ]
(d) Colleges and university [ ]

10. How much is your monthly income? (a)<500 [ ] (b) 500-1000 [ ] (c) 1000-
2000 [ ] (d) >2000 [ ]

Part II : disease condition

a) Do you know the disease you have? YES NO

b) Have you had this disease before? YES NO

c) For how long do you have stayed with this disease? 1 year 2 years 3 years above

d) How many time do you experienced with this symptoms /day. Once a day Twice a day

more than two

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Part III. WHOQOL-BREF

Please keep in mind your standards, hopes, pleasures and concerns. I ask that you think about
your life in the last four weeks (The overall quality of life and general health facet).

Very poor Poor Neither Good Very

poor nor good
good

1 How would you rate 1 2 3 4 5

your quality of life?
Very Dissatisfied Neither Satisfied Very
dissatisfied satisfied satisfied
nor
dissatisfied
2 How satisfied are 1 2 3 4 5
you with your health?
The following questions ask about how much you have experienced certain things in the last two
weeks.

Not at A little A Very An

all moderate much extreme
amount amount
3 To what extent do you feel that 1 2 3 4 5
physical pain prevents you from
doing what you need to do?
4 How much do you need any 1 2 3 4 5
medical treatment to function in
your daily life?
5 How much do you enjoy life? 1 2 3 4 5
6 To what extent do you feel your 1 2 3 4 5
life to be meaningful?
Not at A little A Very Extremely
all moderate much
amount
7 How well are you able to 1 2 3 4 5

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 concentrate?
8 How safe do you feel in your 1 2 3 4 5
daily life?
9 How healthy is your physical 1 2 3 4 5
environment?

The following questions ask about how completely you experience or were able to do certain
things in the last two weeks.

Not at A little Moderately Mostly Completely

all
10 Do you have enough energy 1 2 3 4 5
for everyday life?
11 Are you able to accept your 1 2 3 4 5
bodily appearance?
12 Have you enough money to 1 2 3 4 5
meet your needs?
13 How available to you is the 1 2 3 4 5
information that you need in
your day-to-day life?
14 To what extent do you have 1 2 3 4 5
the opportunity for leisure
activities?

Very Poor Neither Good Very

poor poor nor good
good
15 How well are you able to 1 2 3 4 5
get around?
The following questions ask you tosay how good or satisfied you have felt about various aspects
of your life over the last two weeks.

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 Very Dissatisfied Neither Satisfied Very
dissatisfie satisfied satisfied
d nor
dissatisfied
16 How satisfied are 1 2 3 4 5
you with your
sleep?
17 How satisfied are 1 2 3 4 5
you with your
ability to perform
your daily living
activities?
18 How satisfied are 1 2 3 4 5
you with your
capacity for work?
19 How satisfied are 1 2 3 4 5
you with yourself?
20 How satisfied are 1 2 3 4 5
you with your
personal
relationships?
21 How satisfied are 1 2 3 4 5
you with your sex
life?
22 How satisfied are 1 2 3 4 5
you with the
support you get
from your friends?
23 How satisfied are 1 2 3 4 5
you with the
conditions of your
living place?
24 How satisfied are 1 2 3 4 5
you with your

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 access to health
services?
25 How satisfied are you 1 2 3 4 5
with your transport?
The following question refers to how often you have felt or experienced certain things in the last
two weeks.

Never Seldom Quite Very Always

often often
26 How often do you have 1 2 3 4 5
negative feelings such as blue
mood, despair, anxiety,
depression?

Part IV Epilepsy Self Management (Practitioner)

Evaluation Form for Epilepsy Self Management Protocol (Practitioner) Please circle one:
Physician Nurse PractitionerNurse

Please answer the following with an X in the yes or no box:

Yes No
Were the Self management patient packets easy to find?
Usability of educational information
Information was easy to understand
Is the information timely and applicable to epilepsy
Patients
Comments

Epilepsy Self Management Protocol Evaluation Form (Patients)

1. Please Answer the Following by marking an X in the yes or no box below

Yes No
Did you receive information about seizure medications and possible side
effects?
Did you receive information describing the type of seizures you have?

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 Did you receive information about safety issues related to seizures, such
as no driving until seizure free for 6 months?
Was the information you were given by the nurses easy to read and
understand?
2. Please Evaluate the Following by marking an X in the yes or no box below

Yes No
Did you visit the Epilepsy web sites?
Did you find the web site information useful?
Was the educational information you received about your seizure type,
medication, safety issue helpful?
Would you recommend the Epilepsy Self Management Education
Session be given to all patients?
Part V: Assessment of co morbid condition from the patient’s medical records
1. Is there any co morbid condition? A. yes B. no
2. If yes what types of co morbid are there?
A. psychiatric co morbidity B. other condition specify………
3. Is there poly pharmacy? a) Yes b) no
4. Types of seizure ……………
VII. Tools for Assessing Seizure control
1. Are you seizure free? A. Yes B. No
2. If the above question is yes, for how long you are free from seizure ?
A. > 2 years B. 1-2 years C. 6 months to 1 year D. < 06 months

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