Prevalence and factors associated with poor quality of life among adolescents with epilepsy attending the paediatric neurology and paediatric psychiatry clinics in Mulago national referral hospital

Abstract

Background: Epilepsy is a major cause of disability among adolescents in low- and middle-income countries, with impacts extending beyond seizure control to physical, psychological, and social well-being. Despite this, evidence on the burden and determinants of poor quality of life (QoL) among adolescents with epilepsy in Uganda remains limited. Aim: To determine the prevalence of poor quality of life and its associated factors among adolescents with epilepsy attending Mulago National Referral Hospital. Methods: A hospital-based cross-sectional study was conducted among 383 adolescents aged 10–19 years attending the Paediatric Neurology and Psychiatry Clinics at Mulago National Referral Hospital. QoL was assessed using the QOLIE-AD-48, with poor QoL defined as a score <60. Data on psychological and clinical factors were collected using validated tools. Modified Poisson regression with robust standard errors was used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Results: The prevalence of poor QoL was 83.3%. Adolescents aged 15–19 years were less likely to have poor QoL compared to those aged 10–14 years (aPR = 0.84, 95% CI: 0.73–0.97). Higher educational attainment was associated with increased prevalence of poor QoL, including primary (aPR = 1.59, 95% CI: 1.14–2.21), secondary (aPR = 1.90, 95% CI: 1.39–2.59), and tertiary education (aPR = 1.95, 95% CI: 1.42–2.67), compared to no formal education. Adolescents uncertain of their family history of epilepsy had lower prevalence of poor QoL (aPR = 0.87, 95% CI: 0.76–0.99), while normal self-esteem was protective (aPR = 0.84, 95% CI: 0.75–0.94). Other clinical and psychological factors were not independently associated with QoL after adjustment. Conclusion: Poor quality of life among adolescents with epilepsy in this setting is alarmingly high. The pattern of associations suggests that QoL in this population is less driven by traditional clinical markers and more shaped by developmental and psychosocial context, particularly self-perception and lived experience within educational environments. This reframes epilepsy care in adolescents as a multidimensional challenge, requiring integrated models that address not only disease control but also identity, resilience, and social functioning.