Quality of life, Knowledge and Access to Treatment in Times of Economic crisis in Lebanon

Abstract

Background Multiple sclerosis (MS) is a degenerative disease of the central nervous system that can lead to lifelong disabilities, and thus, significantly impacts patient's quality of life. There is lack of studies to assess public knowledge about the disease in Lebanon, including quality of life (QOL) and accessibility to MS therapies during the economic crisis.

Objectives The aim of this study was to assess the QOL among a cohort of Lebanese MS patients, evaluate their knowledge about the disease and identify barriers to treatment during the economic recession.

Methods A cross-sectional, survey-based study was conducted between June and September 2022 in Lebanon on patients with a confirmed MS diagnosis as per the 2017 McDonald criteria. A structured questionnaire was used to obtain (1) sociodemographic and medical information, (2) quality of life assessment using the MS International QOL (MusiQOL), (3) knowledge about the disease using a validated MS knowledge questionnaire (MSKQ-25), and (4) information related to obstacles in accessing MS therapies. The questionnaire was administered via a telephone call.

Results A total of 350 MS patients were included in the study. Most participants (92.3%) were diagnosed with relapsing-remitting MS and were females (65.1%) with a mean age of 39.45 ±11.43 years. The mean MusiQol global index was 69.25 ±11.53. In the multivariate analysis, younger age, higher level of education, being employed, being married, living outside Beirut, and having no physical disability were significantly associated with higher MusiQol global index scores. 61.7% (n=216) of Lebanese MS patients had no access to MS treatment due to the economic crisis. Moreover, discontinuing the treatment due to its unavailability in the Lebanese market and being non-insured were significant predictors of lower MusiQol scores (p<0.05). As for knowledge about the disease, the mean MSKQ-25 score was 15.11 ± 3.997. There was a significant positive correlation between education level, employment, receiving care at a specialized MS center and residency in Beirut and the knowledge level (p<0.05).

Conclusion Our study shows that the economic recession in Lebanon has negatively impacted the QOL of MS patients and the access to treatment. Interventions that affect sociodemographic and clinical factors may be help improving QOL and knowledge in MS patients as those can have a direct impact on their physical, mental and behavioral conditions.