Main Article Content
quality of life, global dermatology, burden, disability, DLQI, low- and middle-income countries
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.
2. Seth D, Cheldize K, Brown D, Freeman EF. Global Burden of Skin Disease: Inequities and Innovations. Curr Dermatol Rep. 2017;6(3):204-10.
3. Rosenbaum BE, Klein R, Hagan PG, Seadey MY, Quarcoo NL, Hoffmann R, et al. Dermatology in Ghana: a retrospective review of skin disease at the Korle Bu Teaching Hospital Dermatology Clinic. Pan Afr Med J. 2017;26:125.
4. Central Intelligence Agency. Ghana. In: The World Factbook. Washington, DC:
Central Intelligence Agency; 2015. Accessed June 10, 2020 from
5. Truong A, Cobb NM, Hawkes JE, Adjase ET, Goldgar DE, Powell DL, et al. Continuing Dermatology Education for Rural Physician Assistants in Ghana: An Assessment of Needs and Effectiveness. J Physician Assist Educ. 2018;29(1):19-24.
6. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19(3):210-6.
7. Ali F. Quality of life questionnaires. Accessed in October 2019 [Available from: https://www.cardiff.ac.uk/medicine/resources/quality-of-life-questionnaires].
8. Abdel-Hafez K, Mahran AM, Hofny ER, Mohammed KA, Darweesh AM, Aal AA. The impact of acne vulgaris on the quality of life and psychologic status in patients from upper Egypt. Int J Dermatol. 2009;48(3):280-5.
9. Henok L, Davey G. Validation of the Dermatology Life Quality Index among patients with podoconiosis in southern Ethiopia. Br J Dermatol. 2008;159(4):903-6.
10. Khoudri I, Lamchahab FZ, Ismaili N, Senouci K, Hassam B, Abouqal R. Measuring quality of life in patients with psoriasis using the Arabic version for Morocco of the Dermatology Life Quality Index. Int J Dermatol. 2013;52(7):795-802.
11. Kiprono S, Chaula B, Makwaya C, Naafs B, Masenga J. Quality of life of patients with vitiligo attending the Regional Dermatology Training Center in Northern Tanzania. Int J Dermatol. 2013;52(2):191-4.
12. Klis S, Ranchor A, Phillips RO, Abass KM, Tuah W, Loth S, et al. Good quality of life in former Buruli ulcer patients with small lesions: long-term follow-up of the BUROLICO trial. PLoS Negl Trop Dis. 2014;8(7):e2964.
13. Wiese S, Elson L, Feldmeier H. Tungiasis-related life quality impairment in children living in rural Kenya. PLoS Negl Trop Dis. 2018;12(1):e0005939.
14. Jobanputra R, Bachmann M. The effect of skin diseases on quality of life in patients from different social and ethnic groups in Cape Town, South Africa. Int J Dermatol. 2000;39(11):826-31.
15. Lim HW, Collins SAB, Resneck JS, Jr., Bolognia JL, Hodge JA, Rohrer TA, et al. The burden of skin disease in the United States. J Am Acad Dermatol. 2017;76(5):958-72 e2.
16. World Health Organization. 19th WHO Model List of Essential Medicines. Updated June 2019. Available from: https://www.who.int/medicines/publications/essentialmedicines/en/