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• Tools Validation and Assessment of Health-Related
  Quality of Life with Chronic Obstructive
  Pulmonary Disease at three selected tertiary Care
  Hospitals in Addis Ababa, Ethiopia
• By Shimelis Engida(Bsc)
• advisor Oumer Sada (assistance professor)
• Co advisor Girma Tekle(associated professor)
• March 15, 2023
• Addis Abeba, Ethiopia

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Presentation Outline

• Introduction
• Statement of the problem
• Significance of the study
• Objectives
• Method
• Other supplementary docx
• References

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Introduction
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• COPD is airway (bronchitis, bronchiolitis) and/or
  alveolar (emphysema) abnormalities result in
  resistance and frequently progressive airflow
  obstruction. it is characterized by chronic
  respiratory symptoms (dyspnoea, cough, sputum,
  sputum production). (GOLD , 2023)
• According to different systemic review done in
  USA (R.J. Halbert et al.,2015) and China (Zhu et
  al., 2018) The prevalence of COPD is increase
  and one of non-communicable diseases public
  health problem

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• WHO predicts copd became the 3rd leading cause
  of deaths in 2030 (World Health
  Organization(WHO), 2019 ).
• Nearly 90 of COPD deaths occur in low- and
  middle-income countries(WHO,2019 ).
• among noncommunicable diseases in Ethiopia,
  chronic obstructive pulmonary disease accounts
  for 2.7-4.3 of cases and causes 3 of death
  Patients with COPD showed a significantly reduced
  health-related quality of life(awokola, B.L et
  al,2022)

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Cont.
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• COPD and its associated symptoms impair the
  functional capacity of individuals to perform
  normal activities of daily living, thus affecting
  their quality of life(Marin JM.et.al.2011)
• (HRQoL) is a subjective and multidimensional
  measure of physical and psychosocial factors in
  the context of everyday quality life.(Pati S et
  al., 2018)
• Many disease-specific HRQL instruments with
  proven validity and reliability are now available
  to assess HRQL in patients with COPD

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Cont..

• Health measures available for specific diseases,
  such as the St. George's (SGRQ) and COPD Clinical
  Questionnaire (CCQ), are reliable, valid, and
  widely used in clinical research or clinical
  practice
• There is a new assessment tool called chronic
  obstructive pulmonary disease assessment test
  (CAT) which widely used and recommended by GOLD
  Guideline in clinical practices(Gupta N et
  al.,2014)
• such disease-specific instrument designed to
  measure the impact of COPD on overall health and
  perceived well-being among COPD patients and this
  has been validated and translated into various
  languages

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Statement of Problem
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• COPD is a neglected disease in LMIC countries.it
  is even unknown in public perception and opinion
  Health Planning COPD management programs are
  underdeveloped( Finney LJ et al., 2013)
• In spite of COPD treatment and its management is
  mainly focused on lung function assessments.
  There is increasing evidence that conventional
  lung function measures alone do not correlate
  with COPD symptoms.(Troosters et al., 2013)

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Conti..

• Study conducted in India(Ibrahim S.et al., 2021,
  Barani S et al., 2022) and Nepal (Adhikari TB et
  al., 2022) HRQOL of life reduced
• A growing number of questionnaires or measurement
  tools are now available to assess psychosocial
  characteristics and various health outcomes that
  can be used in research, clinical practice and
  population health assessment. (Dekker J, et al.,
  2007)

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Cont..

• many tools have been developed, many have not yet
  been properly validated
• carefully choose which tools are appropriate and
  accurate to ensure the quality of their
  results.(Souza et al.,2017)
• among those assessment tools there is no any
  validated, reliable and responsive tools in
  Ethiopia. it is critical to explore the
  applicability of easily accessible and
  cost-effective tools like CAT in low-resource
  countries like Ethiopia.

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Cont..

• Despite the establishment of the validity and
  reliability of the tool in different countries,
• there are no previous studies that have
  investigated the applicability of the CAT tool
  among COPD patients in Ethiopia. Therefore, this
  study will carried out to validate
• CAT instrument in the context of the Ethiopia
  healthcare setting. and used to assess health
  related quality of life.

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Significance of the Study
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• Assessment of health-related quality of life is
  important for A COPD patient according to
  different literature suggests HRQOL assessment is
  important for COPD patients
• that listed frontal and most of its symptoms
  affect QOL of COPD patient.
• To measure the HRQOL it needs validated tools
  which adaption according the situation of country
  

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Cont..

• request exacerbations, multiple comorbidities,
  and smoking were associated with a lower HRQoL.
  train more physical activities and a better
  6-minute walk were associated with better
  HRQoL.(Fazekas-Pongor . V et al.,2021)
• researcher and these also important for health
  care workers to monitor patients disease
  response to the treatment as well as guideline
  developer and policymakers(Guyatt GH et al.,1993)

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Cont..

• the difficulty in accessing copyright-free HRQL
  assessment tools having freely available but also
  valid and reliable tools in Amharic version.
• which is the official language in Ethiopia would
  have great importance to assess health-related
  quality of life in the Ethiopian context.
• there is no study on the HRQoL and factors
  affecting It among patients with COPD.

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Objective
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• General objective
• to validate the Amharic version of the COPD
  assessment test (CAT) tools
• assessment of the health-related quality of life
  in COPD
• Specific Objective
• To assess the validity of the CAT -Amharic
  version among COPD patients
• To assess health-related quality of life in COPD
  by using CAT- Amharic version
• To assess factors affecting health related
  quality of life

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Method

• Study Setting
• The study will be conducted at the adult chest
  clinics of
• TASHis the biggest tertiary care and teaching
  hospital in the country with many outpatient
  services On average, around 59 patients are
  expected to attend care at the clinic per day.
  Over four months of the study period around 80
  patients will have a follow-up

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Method

• St. Peters Specialized Hospital, has chest
  clinic with about patients follow-up over four
  months
• SPHMMC, third largest tertiary teaching and
  referral hospital with chest clinic that serves
  for about patients per day for two days per
  week. Over the study period of four months the
  hospital will have patients on follow-up

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Method

• Study design and study period
• A hospital based cross-sectional study design
  will be carried out
• The study will be conducted from January 1 to
  October 2023
• Source and study population
• All patients who attended the adult chest clinics
  of TASH, St. Peter Specialized Hospital and
  SPHMMC.
• All COPD patients who have a follow up during the
  study period and who fulfilled the inclusion
  criteria

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Method

• Inclusion and Exclusion Criteria
• Inclusion Criteria
• All patients (age gt18 years) with a diagnosis of
  COPD A patient on follows up Out Patient
  Department
• Patients who were taking COPD medication for at
  least 6 months before enrolment.

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Method

• Exclusion Criteria
• Patients who are critically ill during the period
  of data collection
• patient with newly diagnosed
• patient is not willing to participate
• Patient with under 18 years

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Study Variables
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• Dependant variable
• health-related quality of life
• Validity and reliability
• Independent Variables
• Sociodemographic characteristics of the
  participant
• Medical characteristics like family history of
  COPD, current COPD treatment
• the presence of comorbid disease, presence or
  absence of poly-pharmacy, and disease duration.
• Factors affecting HRQOL

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Method

• Sample size determination
• Calculated by using single population proportion
  formula considering 16.2 proportion of COPD
  patient from previous study 95 confidence level,
  5 margin of error(van Gemert, F. et al., 2015)
• n (Z a /2) 2 p (1-p)
• (d)2
• n (1.96) 2 0.162(1-0.162 209
• (0.05)2
• 5 contingency, final sample size is 220 COPD
  patients

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Method

• Sampling technique
• A systematic random sampling technique will be
  used
• The sample size (n) will be proportionally
  allocated to each hospital depending on the
  number of patients on follow-up (N) care in each
  hospital during the study period from
• N500/four months TASH (N120, n30), SPSH
  (N200, n50) and SPHMMC (N150, n35).
• Sampling interval (Kth) will be determined by
  total number of source population, K N/n3

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Method

• Data collection procedures and instruments
• The data collection tool will have two parts
• Questionnaire and data abstraction format
  prepared by reviewing different various
  literatures for important variables to extract
  all necessary information
• Socio-demographic data will be obtained by
  interviewing
• Trained Pharmacists will involve in data
  collection

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Method

• Data quality assurance
• Training will be given for data collectors
  focusing on the purpose of the study, how to fill
  the questionnaire
• The data collection tool will be validated
• During data collection supervision will be
  carried out daily to ensure the completeness of
  the collected data

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Method

• Data interpretation and data analysis
• A chronic obstructive pulmonary assessment test
  is charged Descriptive statistics were used to
  describe sociodemographic and clinical variables.
  Frequencies and percentages were used to express
  categorical variables.
• Normality of continuous variables was tested
  using the Shapiro Wilk test and presented as mean
  standard deviation for normal data and median
  with interquartile range (IQR) for non-normal
  data.

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Method
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• In addition, the reliability and validity of the
  CAT Am tool were examined. All statistical tests
  were analysed using SPSS version 26.
• Results were considered statistically significant
  if they had P-values less than 0.05.

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Ethical consideration
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• Letter of ethical clearance will be obtained from
  Ethical Review Committee
• Patient data will be accessed upon the approval
  of the clinical director of each hospitals
• Each participant will be requested for informed
  consent
• Clear description of the study objective will be
  given before starting the data collection process
• Patient confidentiality will be ensured

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Dissemination of the Result
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• The final result of the study will be submitted
  to School of Pharmacy College of Health Science,
  Addis Ababa University
• The final manuscript will be sent for publication

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Supplementary document references

• Study timelinetimel.docx
• Budget plan6.docx budget plan.docx
• References References.docx
• Appendixes Appendix I.docx

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• 
  
• Thank
  you