1.1 BACKGROUND OF THE STUDY
There is an increasing interest in measuring Quality of Life (QOL) in everyday clinical practice. In addition to mortality and morbidity as key indicators for performance, Quality of Life has been recognized as an important factor for evaluating the quality and outcome of healthcare for patients with chronic illness (Macduff, 2015).
World Health Organization (WHO) has defined Quality of Life as an "individual's perception 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". Quality of life(QOL) is an important parameter that needs to be considered when evaluating the experience and outcome of patients receiving healthcare, since complete cure for Chronic kidney Disease is often impossible(National Kidney Foundation's Kidney Disease Outcomes Quality Initiative: NKF-K/DOQI, 2010).
Chronic Kidney Disease (CKD) is now regarded as a global public health epidemic. According to Global Burden of Disease (GBD)(2013), CKD now ranks as the 13th leading cause of death, 15th cause of year lived with disability and 20th leading cause of disability-adjusted life year(DALYs). The incidence and prevalence of CKD is thought to be on the increase globally. In Nigeria, the incidence has shown to be a range between 1.6% and 12.4%. However, these studies are hospital based and failed to include many patients who lack hospital care (Odubanjo, Oluwasola, Kadris, 2011). According to Nigerian Vanguard Newspaper (March 7th, 2015), 36.8million Nigerians (23% of the population) are suffering from various stages of kidney disease. This figure means that one in seven Nigerians is suffering from some forms of renal disorder.
CKD draws heavily on patient's daily functioning. The disease treatment and associated demands have a great impact on psychological, emotional and physical well-being. It also interferes with patient's spiritual function. Patients who are being prepared for renal replacement therapy often experience difficulties in participating in various domains of life, such as paid work which may impede their feelings of autonomy. Renal replacement therapy options that are available to perform some of the functions of the kidneys in a patient with CKD are haemodialysis, peritoneal dialysis and renal transplant. These different treatment options have different levels of negative impact on physical, psychological, economic and social health on the Quality of Life of patients with CKD. Haemodialysis is commoner in Nigeria and it is associated with frequency of hospitalization, affordability, burden and the effect of the treatment modalities and with several others. They are very expensive and no established support group for patients having renal replacement therapy in order to enhance their quality of life.
Nowadays, the goal of patient care support is not only to extend life but also to relieve suffering, or enhance QOL. QOL focuses more on the ability to live a fulfilled life. It is important because long-term management such as renal replacement therapy often results in a loss of freedom, financial income, and dependence on caregivers, living on dialysis, negative effect on marital status, thus QOL should be measured and monitored for better understanding of patient's outcome.
Considering the importance of QOL in these patients, the present study is aimed to assess QOL among patients with CKD.
1.2 STATEMENT OF THE STUDY
Considerable progress has been made in the treatment and nursing intervention of CKD. However, quality of life continues to be a significant problem. A study conducted in Greece by Malindretos in 2012, found out that CKD has detrimental effect on quality of life of patients with CKD and Valan in 2017 also stated that quality of life of patients with CKD was poor in a study carried out in India. Patients with CKD were sometimes readmitted after few weeks of discharge without any specific reasons known to the health practitioners, despite the knowledge and expertise of healthcare providers few patients end up dying even after being treated.
The researcher therefore, was curious to find out what might be responsible for their predicament despite adequate treatment and management. Few patients and relatives complained of high cost of management, decreased income due to illness, broken families and changes in social roles as few of consequences they were facing. Therefore, this study was undertaken to assess the quality of life among patients with CKD.