Abstract:
Background: Rheumatic heart disease (RHD) remains a significant public health problem in
low- and middle-income countries. Beyond its clinical consequences, RHD adversely affects
the health-related quality of life (HRQoL) of affected children and adolescents, their families,
and healthcare systems. Addressing the HRQoL of children and adolescents with RHD will
contribute to strengthening patient-centered care and policy development. Objective: To
determine the health-related quality of life of children and adolescents with rheumatic
heart disease attending follow-up at the pediatric cardiology clinic of Moi Teaching and
Referral Hospital (MTRH), Kenya. Methods: This was a hospital-based cross-sectional
study conducted between January and July 2024. A total of 171 children and adolescents
aged 5–18 years were consecutively enrolled while attending follow-up at the pediatric
cardiology clinic of MTRH. The EuroQol EQ-5D-Y and EQ-5D-L questionnaires were used
to assess HRQoL across five domains: mobility, self-care, usual activities, pain/discomfort,
and anxiety/depression. Overall HRQoL was evaluated using the EQ visual analog scale
(EQ-VAS) and categorized as optimal (≥80%), suboptimal (70–79%), or poor (≤70%).
Results: Overall HRQoL was optimal in 70.8% (n = 121) of participants, suboptimal in 8.2%
(n = 14), and poor in 21.1% (n = 36). Impaired HRQoL was significantly associated with
poor self-care (95% CI: 0.066–0.853; p = 0.028), anxiety/depression (95% CI: 0.111–0.678;
p = 0.005), pain/discomfort (95% CI: 0.142–0.758; p = 0.009) and missing more than five
school days (95% CI: 0.109–0.584; p = 0.001). Caregiver characteristics (age, education
level, and income), surgical correction, RHD-related hospital admissions, comorbidities,
and Ross classification were not significantly associated with HRQoL. Conclusion: Health-
related quality of life among children and adolescents with RHD was most adversely
affected in the mental health and mobility domains. Routine assessment of HRQoL should
be incorporated into the clinical care of children and adolescents with RHD to reduce
disease-related morbidity and support holistic management.
