The Impact of Skin Disease on Quality of Life in Rural Communities of Ghana

Background: Skin disease is the fourth-leading cause of non-fatal disability worldwide. Granular data are limited on the skin disease burden in underserved populations. Objectives: To describe the skin disease burden among adults in rural Ghana. Methods: In this observational study, 230 adults in rural Ghana were surveyed using the Dermatology Life Quality Index (DLQI). For those reporting a skin problem in the previous week (n=117) and who had skin examination performed by a dermatology resident and/or local dermatologist (n=98), prevalences and univariate comparisons were calculated. Results: 51% (117/230) of participants reported a skin problem in the previous week with 36% (42/117) reporting at least a moderate impact on quality of life (QoL). Factors associated with a higher QoL impact included female gender (p=0.01) and living further from the city center (p=0.02). The most common dermatologic diagnoses for those with skin examination performed included acne, bacterial infection, and pruritus. QoL was most impacted (highest average DLQI scores) for those with scabies. Diagnoses were categorized by the level of treatment or medical expertise that would be required had the participant presented to a clinic. 80% (78/98) of diagnoses rendered were potentially manageable with counseling or topical medication. Limitations: The studied cohort was obtained via convenience sampling. The DLQI has not yet been validated in this population. Conclusions: Much of the QoL impact from skin disease among adults in rural Ghana resulted from diagnoses that are manageable with counseling and topical medication. Better access to basic health care and more dermatologic education among community health providers would address much of the skin disease burden in these communities. Future studies should examine best practices for addressing unmet dermatologic needs of this and other comparable populations in underserved communities.