Quality of life of ostomates at a teaching and referral hospital in Kenya
Ostomy surgery is performed to maintain gastrointestinal function. However, there is a lack of knowledge and experience about ostomies among patients and clinicians in public hospitals in Kenya. The issue is compounded by the social isolation and stigma ostomates face in the wards and in the community after discharge. Although it is not easy to identify the exact number of ostomates in Kenya and other African countries, there is need to shift the focus from curing symptoms in ostomates to maximising patients’ quality of life (QoL) and integrating services for ostomates in mainstream public hospitals.
To understand the effects of ostomies on patients’ QoL, with a focus on nutrition, psychosocial aspects and challenges around sexuality after ostomy creation.
A descriptive study was undertaken using an interviewer-administered QoL questionnaire with 81 patients.
Most patients were male (54%); the largest age group was 35–44 years (24.7%). Colorectal carcinoma, intestinal obstruction and traumatic injuries were the main indications for ostomy. Ostomates resumed sexual activity, but did not find it fulfilling (P=0.002). Most reported feeling depressed, with suicidal attempts that negatively correlated with QoL. Ostomates adjusted their diets regardless of whether their level of QoL was poor, fair, good or excellent after ostomy creation (P=0.564).
Ostomates experience low QoL. Patients’ lives can be improved by focusing on providing individualised ostomy care services after discharge. Enhancing stoma therapy training for nurses and running ostomy clinics alongside mainstream services, as well as support for ostomates towards enrolment into the country’s National Hospital Insurance Fund, will also improve patients’ QoL.
The purpose of an ostomy is to correct developmental anomalies, for decompression and lavage of the intestinal tract, stool diversion with obstruction and exteriorisation of the elimination passage, and also on a temporary basis to treat and reduce patients’ pain and discomfort related to disease. However, the creation of an ostomy alters a patient’s elimination patterns and can affect an individual both physically and psychologically.
Patients undergo ostomy surgery (colostomies, ileostomies and urostomies) for both permanent and temporary maintenance of gastrointestinal/urinary function. However, in Kenya, there is a general lack of knowledge about or experience of ostomy surgery and the implications of living with an ostomy among both patients and clinicians, an issue that is often observed during a patient’s hospitalisation. This lack of knowledge is compounded by the social stigma associated with ostomy care in most Kenyan communities.
There is limited documentation on quality of life (QoL) of ostomates in Kenya and equally little information on how ostomies affect patients’ QoL, as well as the interventions undertaken in public hospitals to improve ostomates’ QoL.
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