Quality Of Life

Quality of life is one of the important indicators to measure overall population health or health status of the people living in any location. As the end expected outcome of any medical intervention, nursing intervention or any public health program is to improve the quality of life, health professionals at least once think about measuring Quality of life among their population of interest in their professional life.

What is quality of life?

Quality of life is a multidimensional concept and it involves subjective evaluations of various aspects of life. Human life has complicated structure physically and socially, as human can’t exist alone. They have body, which is further controlled by the mind, their mind is further affected their social, physical surrounding, system and significant others. Thus, quality of life is very difficult to measure. However, experts have developed definitions and tools to measure the quality of life of people.

WHO defines quality of life as “individuals’ 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.”

Why do we use quality of life?

1. Comparison of people in different geographical region: people in different geographical area can be compared with this indicator. It will be easy to understand the reasons for the differences in Quality of life in those geographical region. Why do Swiss have better quality of life than Chinese or other countries?
2. Impact of any program or intervention or Policy: Quality of life indicator is the ultimate outcome of any interventions. The aim of smoking control and prevention program could be to reduce the number of people, who smoke, its effect could be seen as the change in quality of life in the targeted population. The improvement in relationship, self-esteem, improvement in physical health, improvement in environment, reduction in expenditure increases the quality of life of the people through the smoking prevention policies and programs. Depending on assessment of the quality of life, the policy, programs or interventions could be designed and modified so that they increase the quality of life of targeted population.
3. Health needs: Need of the population could be evaluated with this indicator. Lower quality of life indicates lack of good health or failings in other parameters and ultimately the shortcomings in the existing programs, and inadequate interventions to improve the quality of life.
4. Effect of chronic illness, short term or long term illness: We can also estimate impact of certain disease conditions on quality of life and to measure the ways to improve quality of life of the people living with such disease conditions.

Tools to measure the quality of life

• CDC HRQOL-4: Centre for disease control and prevention (CDC) uses 4 items questionnaire CDC HRQOL-4.
• CDC HRQOL-14 “Healthy days measure”: This is constructed by adding 10 more items in CDC HRQOL-4 tool.
• WHOQOL-100: This tool is developed by world health organization and it is elaborate. This includes 100 questionnaires from different aspects of life, that can affect the quality of life of a person.
• WHOQOL-BREF: It is abbreviated form of WHOQOL-100 and consists of 26 items only.

There are some tools such as SF 36, SF 12, which can be used to measure Health status of any population. They also used as quality of life indicators sometimes by some authors.

Difference between CDC Health related quality of life (HRQOL) and WHOQOL scale

The definition of health includes mental, physical, social and spiritual domains of life and HRQOL should measure all aspects of those domains. HRQOL tends to measure the quality of life that are directly related to health status of the people. HRQOL tool used by CDC contains items/ questions related to subjective perception of overall general health status, mental health, physical health and activity limitations. WHOQOL is more elaborate and includes health, psychology, level of independence, social relations, environment, spirituality/ religion/personal beliefs. WHOQOL-BREF is usually used in small scale studies. Authors need permission to use WHOQOL tools and required to abide by user agreement and researchers need approval if any modifications of the tool is required. WHOQOL have been adapted for certain diseases, for example, WHOQOL-HIV is constructed especially to assess quality of life of people with HIV.

- by Pramila Rai

Nutritional status of children and Anthropometric measurement!!

Background

Nutrition is key to life. “In fact people are pack of nutrients and they need all the nutrition since the formation of embryo to become a mature human. They need nutrition to keep on restoring depleted nutrition throughout the life.” This makes maternal, childhood, adult nutrition equally important throughout the life course of human.

How does Nutrition affect the Health?

If you don’t get adequate and essential nutrients, physical and mental growth will be delayed through various mechanisms, causes many diseases and even leads to death. The foremost mechanism is direct nutritional deficiency diseases such as deficiency of Vitamin A causes night blindness; imbalance of protein and carbohydrate results in PEM malnutrition, obesity; Iodine deficiency causes mental retardation, goiter. There are number of disease conditions that are directly related to the nutrition deficiencies. Such diseases are also responsible for other chronic disease such as cardiovascular diseases, diabetes.

Figure: Factors affecting Nutrition and its impact on health

Lack of nutrition also reduces immunity thereby making our body susceptible to many opportunistic infectious microorganisms. As for example, in a healthy people, tuberculosis could be in dormant phase but once the immunity or defense system of our body is disturbed, TB pathogen can become active and manifest TB disease. Viral infections are especially immunity relative and immunocompromised people suffer bouts of seasonal influenza or diarrheal diseases compared to people with strong immunity.

Anthropometric measures to measure the nutritional status of children

Anthropometry is the study of measurement of body parts. Nutritional status can be measured by various indicators such as mid arm circumference, BMI, height for age, weight for height, weight for age etc. However, the last three aforementioned indicators are used frequently.
Height for age: children should have comparable height for their age just like other children in their age group. If their height is below two standard deviations of that age group, then it is considered less height for age showing inadequate nutritional status. Having short gesture for age is also known as stunting. stunting is usually taken as sign of long term, chronic nutritional deprivation
Weight for height : Having short gesture or height for weight is also known as wasting. wasted children have short gesture for weight.If their weight for height is below two standard deviations of that age group, then it is considered less weight for height showing inadequate nutritional status. Low weight for height is an indicator of acute undernutrition
Weight for age : Similarly, this is one of the commonest and easiest way to measure the nutritional status of the children. children should have comparable weight for their age just like other children in their age group. If their weight is below two standard deviations of that age group, then it is considered low weight for age showing inadequate nutritional status. This combines information about linear growth retardation and weight for height

Indicators in NDHS Nepal Demographic and Health Survey 2016

According to NDHS 2016, 36 % of the children are stunted or have short gesture for that age group, 10% of the children are wasted or have lower weight for height and 27% under five children are underweight or have weight low for their age. These show Progress from the early years.

What are the reasons of Nutritional deficiency in Nepal?

I would like to describe the causes of nutritional deficiencies based on socio-ecological model.

• Policy: Certainly, Nepal is a developing country and significant fraction of people live under the poverty and very far from the light of development and education. The policy helps to shape the investment in different section of the programmes and population.
  
• Society, organization and culture: The culture, tradition and some taboos prevalent in the society, and organization equally affects the nutritional level of the population. Certain tradition like early weaning of female child, taboos prohibiting some foods during pregnancies, gender discrepancy in nutrition etc affect the nutrition of the children.
  
• Family level factors: socioeconomic status of the family, trade off of investment in other things vs nutrition also affects the family's importance in nutrition. This also depends upon the over all understanding of importance of nutrition.
  
• Individual level factors: Education of parents, other family members, occupation, knowledge about the nutrients, balanced diet and preparation, handling of the foods also affect the nutrition of the children
  
• International support: International support has tremendous influence over the policy and programmes and current programs like SUAAHARA project is funded by USAID. Many UNITED NATIONS organization have focussed in improving child nutrition in Nepal and all over the world affected by malnutrition.

By Pramila Rai