CHAPTER II

REVIEW OF LITERATURE

Health care is facing drastic changes. Relevant literature refers to those that are sources important in proving in depth knowledge needed to make changes in practice or to strengthen the present study in order to lay down the foundation which helps to reveal the prevailing situation of the similar studies in different areas.

A cross-sectional survey was conducted in three hospitals in Thailand during June to November 2006. Peds Quality of Life 4.0 Scale (Thai version) was used to assess Health Related Quality Of Life in 315 thalassemia patients between age group of 5 and 18 years. Related clinical characteristics of the patients were collected through medical record review. The mean (SD) of the total summary score was 76.67 (11.40), while the means for the Physical Health Summary score and Psychosocial Health Summary score were 78.24 (14.77) and 75.54 (12.76) respectively. The school functioning scored the lowest, with a mean of 67.89 (SD = 15.92). The following factors significantly affected the Health related Quality of life of the patients: age; onset of anemia and also age at first transfusion; pre-transfusion hemoglobin (Hb) level; receiving blood transfusion during the previous three months and severity of the disease. It was found iron chelation therapy had a significant effect on Health Related Quality of life in the school functioning subscale negatively. In contrast, serum feritin level, frequency of blood transfusions per year, and gender were not significantly related to HRQOL among these patients. Multivariate analysis were used to confirme these findings. (Montarat, 2010)

A cross sectional study was conducted for 142 beta thalassemia children of three years or more receiving regular blood transfusions at a transfusion centre in western India from 1st April to 30th June 2009.Out of 142 children 68% had poor physical domain, 30 children had poor quality of life in psychological domain, 20 children have poor environment domain and 28 had social domain. (Neeraj, 2010)

A cross-sectional study was conducted for 112 transfusion dependent thalassemia patients at two hospitals in Kuala Lumpur, Malaysia, in 2005. Quality of life scores were measured by using the translated Short Form-36 questionnaires. The diseases related to iron overload complications were obtained from the medical records. The data regarding the use of desferoxamine was found through interviews and validated by drug records. Quality adjusted life years were formulated from residual life years and quality of life scores. QALYs were higher in 54(48 percent) and 58 (52 percent) patients on optimum desferrioxamine(9.04,2.46) than patients on sub-optimum desferrioxamine (5.12, SD 2.51). There was an association between the level of serum ferritin, iron overload complications and total family income. The use of optimum desferrioxamine reduces iron overload complications and also provides a better quality of life (Dahlui M, 2009)

A comparative study was conducted in Japan for 28 children with thalassemia and 34 healthy children to find out the adverse emotional effects on child and family to investigate psychiatric state and behavioral problems in children with thalassemia. This study showed psychiatric illness found more in thalassemic children when compared to healthy children. Anxiety disorders were found in 30%,depression disorder in 15%.attention problems and social problems. Peer relations and educational success were also compared with control group. Thalassemia children had increased risk of psycho pathology (Burcu , 2008)

A cross sectional descriptive study was done in Mofid children’s hospital,California for 121 children with thalassemia who were on regular blood transfusions. This study was conducted with eq-5d. In this study the mobility, self care, usual activities , pain and discomfort were assessed. About 60% children had problems with their usual activities. About 12% suffered with pain, 15% with mobility and about 11% suffered with self care activities(Bibi Shahin,2008) .

A cross sectional study was done for 80 patients between the age group between 5 to 17 children. This study was conducted in Tehran university. This study was done with the help of Short Form 36 scale .They concluded that more than 50% of children had poor quality of life.(Afshin,2008)

An assessment was done in Colombo for 147 thalassemia patients which included adolescents between 16 to 18 years inorder to assess self image ,quality of life and ways of coping. Three interviews were conducted with psychological test, 36 health survey questionnaire, Machover’s test and symptom check list with 90 revised items. Psychological aspects, psychiatric disorders were assessed and found that more than 70% children were affected with psycho social problems.(Messina,2008)

A assessment was conducted in Persia for Iranian patients with thalassemia major using Short Form Health Survey 36 scale by a standard forward backward translation procedure, the English language version of the questionnaire was translated into Persian. Two hundred patients with thalassemia major following up at the Thalassemia Center, Dastgheib Hospital, Shiraz, Iran, were enrolled in this study. The mean age of 200 subjects enrolled in the study was 19.81+/-4.07 years. Most of the patients were in lower range of normal for both mental and physical summary status. The study showed that about 62% of the patients had poor quality of life and about 30% had average quality and remaining only 80% had good quality of life (Jafari H, Lahsarizadeh S, 2008)

Structured interviews were carried out with fifty samples in Chandigarh in Nehru hospital with each of the subjects using a schedule which has quality related questions of psychological life aspects in affected adolescents. Adverse impact of thalassemia was perceived in the domains of education (70%) and sports (72%). This study has shown that there was tremendous psychosocial burden in adolescents (Khurana, 2008)

A descriptive study was conducted in Western India showed that thalassemia minor is not life threatening on its own, can affect the quality of life because of the effect of anemia, this study also revealed that thalassemia minor often exists with other diseases such as asthma (Yaish,2008)

A prospective assessment study was done in middle eastern countries for 28 thalassemia children in the age group 5 to 18 years to know whether the quality of life can be improved by hematopoietic stem cell transplantation. This study was concluded by using child self and parent proxy reports. The Peds QOL 4.0 generic core scales were administered to patients and their parents one month before and 3,6,18 months this study. Results revealed that improved quality of life found in children after Hematopoietic stem cell transplantation. (Caocci G,et al.,2007)

A cohort study was conducted in England for adolescent age group from 16 to 17 years to find out emotional problems for 4524 participants. This study extended for 20 years using a 12 item general health questionnaire reported depression and anxiety seen in thalassemia children (Stephan, 2007)

A cross sectional study done in a thalassemia blood transfusion organization outpatient clinic for 200 beta thalassemia patients to determine the association of physical and mental health with the help of short form 36 survey in nTehran,Iran. Findings revealed that somatic comorbidities and physical health are positively associated.(Azita,2007)

A case control study was conducted in China for sixty children of 5 to 15 years. They performed semi structured interview and gave questionnaire of pediatric symptom checklist and childhood psychopathology measurement schedule. This was used to assess psychosocial morbidity. Children with thalassemia had significantly higher social morbidity. (Saini, 2007)

A cross sectional study was conducted for 292 adolescents between 14 to 18 years of age in Heijibeji for their anxiety and depression symptoms with health related quality of life and sleep quality in patients with beta thalassemia. Mental and physical scores were predicted by symptoms of depression, somatic co morbidities. About 80 children had problems of somatic illness and thirty participants had depression. (Onur, 2006)

A comparative s