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ORIGINAL ARTICLE
Year : 2013  |  Volume : 12  |  Issue : 3  |  Page : 171-173  

Problems with administration of international prostate symptom score in a developing community


Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria

Date of Web Publication5-Sep-2013

Correspondence Address:
Edwin Iduh Ogwuche
Department of Surgery, Benue State University Teaching Hospital, Makurdi, Benue State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1596-3519.117628

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   Abstract 

Background: The IPSS form has been found useful for assessing symptom severity, which assists in treatment choice and in monitoring patients on therapy. The form should be self-administered and requires some level of literacy. We assessed the problems associated with its administration in a developing community.
Materials and Methods: The IPSS form was administered to patients with benign prostatic hyperplasia at the Urology Clinic of the Jos University Teaching Hospital from November 2004 to October 2005. Those who did not understand the questions or who could not read English required explanations.
Result: There were a total of 70 patients who agreed to fill out the forms. Their ages ranged from 40 to 104 years with a mean of 63.6. The IPSS scores ranged from 3 to 35 with a mean of 18.3. About 56.7% of the patients had quality of life scores of ≥ 5. Only 2 (2.9%) patients were initially uncooperative in filling out the forms. Twenty-four (34.3%) did not understand English. Of the 46 (65.7%) that understood English, 28 (40.0%) could speak but could not read English, thus 52 (74.3%) could not read English. Ten (14.3%) patients thought the questions were either not comprehensive or clear enough.
Conclusion: Illiteracy is a major drawback with the administration of the IPSS form, with 74.3% of patients unable to read English. Attempts should be made to draft the forms in the main language(s) spoken or read in a particular locality so as to gain maximally from the benefits of the IPSS. Relevant bodies should improve on the education of the populace.

   Abstract in French 

Contexte: La forme de l'IPSS a jugé utile d'évaluer la gravité des symptômes, qui aide dans le choix du traitement et au suivi des patients sous traitement. Le formulaire doit être auto-administré et requiert un niveau d'alphabétisation. Nous avons évalué les problèmes liés à son administration dans une communauté en développement.
Méthodes et matériaux: La forme de l'IPSS a été administrée à des patients atteints d'hyperplasie bénigne de la prostate à la clinique d'urologie de l'hôpital universitaire de Jos University de novembre 2004 à octobre 2005. Ceux qui ne comprenaient pas les questions ou qui ne pouvait pas lire anglais exigé des explications.
Résultat: il y avait un total de 70 patients ayant accepté de remplir les formulaires. Leur âge varie de 40 à 104 ans avec une moyenne de 63,6. Les scores IPSS allant de 3 à 35 avec une moyenne de 18,3. Environ 56,7 % des patients avaient des scores de qualité de vie ≥ 5. Seulement 2 patients (2,9 %) ont été initialement peu coopératifs en remplissant les formulaires. Vingt-quatre (34,3 %) ne comprenait pas l'anglais. Du 46 (65,7 %) qui comprenait l'anglais, 28 (40,0 %) pouvait parler mais ne pouvait pas lire l'anglais, donc 52 (74,3 %) ne pouvait pas lire anglais. Dix patients (14,3 %) pensaient que les questions n'étaient pas complète ou suffisamment claire.
Conclusion: l'analphabétisme est un inconvénient majeur avec l'administration de la forme de l'IPSS, 74,3 % des patients incapables de lire l'anglais. Tentatives devraient être apportées au projet les formes dans la langue principale parlée ou lue dans une localité donnée afin de bénéficier au maximum des avantages de l'IPSS. Organes compétents devraient améliorer sur l'éducation de la population.
Mots clés: Administration, problèmes d'illettrisme, IPSS

Keywords: Administration, illiteracy, international prostate symptom score, problems


How to cite this article:
Ogwuche EI, Dakum NK, Amu CO, Dung ED, Udeh E, Ramyil VM. Problems with administration of international prostate symptom score in a developing community. Ann Afr Med 2013;12:171-3

How to cite this URL:
Ogwuche EI, Dakum NK, Amu CO, Dung ED, Udeh E, Ramyil VM. Problems with administration of international prostate symptom score in a developing community. Ann Afr Med [serial online] 2013 [cited 2019 Jul 19];12:171-3. Available from: http://www.annalsafrmed.org/text.asp?2013/12/3/171/117628


   Introduction Top


Benign prostate hyperplasia remains a common urological problem in males above 50 years of age. [1],[2] The severity of symptoms relating to obstruction from BPH has been shown not to correlate with the prostate size. [1],[3] This makes it imperative to devise objective ways of assessing the symptom severity with a view to categorizing patients into various treatment options as well as to monitor treatment. This desire gave rise to the development of the American Urological Association (AUA) score by Barry et al [4] in 1992. This was the early precursor of the current international prostate symptom score (IPSS), which was an adoption of the AUA score by the World Health Organization (WHO). This has been translated into several languages for ease of administration. There is, however, no local language translation in our center; more so we operate in a multilingual society, making it difficult to use one dialect.

The original version in the English language is hence still being used in our center. The IPSS assumes that the patient can read and understand the language, in which it is written, which is English in our setting. Our patients, most of who come from the rural hinterlands, unfortunately, may not be literate enough to read or comprehend the language. We set out to study the problems of administration of the IPSS in such a setting.


   Materials and Methods Top


This was a prospective study conducted at the urology outpatient of the Jos University Teaching Hospital, Jos, Nigeria. Ethical approval was obtained for the study from the hospital ethical committee. All consecutive patients with a clinical diagnosis of benign prostatic hyperplasia seen between 2004 and 2005 were enrolled for the study. IPPS questionnaire in English was self-administered with interpretation done as necessary. The patient's bio-data as well as ability to read and understand English were entered into a database. The outcome measures included ability to read, ability to understand, as well as the clarity of the questions from the perspective of the patient.


   Results Top


A total of 70 patients filled the forms. Their ages ranged from 40 to 104 years with a mean of 63.

The IPPS score ranged from 3 - 35 with a mean of 18. Six (9%) of the patients had mild symptoms while 25 (36%) and 39 (55%) had moderate and severe symptoms, respectively [Figure 1]. Quality of life score was 35 in 56.7% of the patients [Figure 2].
Figure 1: Distribution of IPSS scores in 70 patients at Jos University Teaching Hospital

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Figure 2: Quality of life scores in 70 patients at Jos University Teaching Hospital

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Only 2 (2.9%) patients were initially uncooperative in filling the form.

Twenty-four (34.3%) patients did not understand English while 28 (40.0%) could speak but could not read English; thus, 52 (74.3%) could not read English. Only about a quarter (25.7%) could speak and understand English [Table 1]. Ten (14.3%) patients thought the questions were either not comprehensive or clear enough.
Table 1: Showing ability of patients to speak or understand English

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   Discussion Top


The age distribution of our patients correspond to established data in literature for presentation of LUTS from BPH. [1],[2] The distribution of the IPSS scores indicates that majority of patients (55%) present with severe symptoms while 36% presented with moderate symptoms.

The findings of the severe symptoms in our patients is in keeping with studies by Sarma et al.[5] who noted that black patients were more likely to present with severe symptoms. The implication of this is that this class of patients is more likely to present with complications relating to prostatic enlargement. [6]

The major drawback to the administration of the IPSS in our environment is illiteracy. Van der walt et al. compared a new visual prostate symptom score (VPSS) versus IPSS in men in cape town and found no significant difference between the VPSS and the IPSS. Hence, the need to advocate this method of assessment in areas of limited education. [7]

The IPSS has been translated in various languages [8] for ease of administration though the question of cultural and linguistic validation has been raised by several authors. [9],[10],[11]

Physician administration will help overcome the patient's inability to read, but this would mean additional work burden on the few physicians available. An abbreviated model items with a view to saving time when administered by a physician has been developed in turkey by Cam K. et al. [12]

We conclude that illiteracy is the major drawback to the administration of the IPSS in our environment. Attempts should be made to draft the forms in the major languages spoken in our community. This will enable patients and practitioners to take advantage of the benefits of the IPSS. The visual IPSS as advocated by Van der walt et al. in South Africa will also be of benefit.

 
   References Top

1.Yeboah EO. The prostate gland. In: Badoe EA, Archampong EQ, Da RochaAfodu JI, editors. Principles and practice of surgery including pathology in the tropics. 3 rd ed. Ghana: Ghana Publishing Corporation; 2000. p. 850-67.  Back to cited text no. 1
    
2.Barry MJ. Epidemiology of and Natural history of BPH. Urol Clin North Am 1990;17:495-7.   Back to cited text no. 2
[PUBMED]    
3.Chute CG. Non relationship of urinary symptoms, prostate volume and uroflow in a population based sample of men. J Urol 1993;149:356-7.  Back to cited text no. 3
    
4.Barry MJ, Fowler FJ Jr, O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK. The American urological Association symptom index for BPH. The measurement committee of the AUA. J Urol 1992;148:1553-8.  Back to cited text no. 4
    
5.Sarma AV, Wei JT, Jacobson DJ, Dunn RL, Roberts RO, Girman CJ, et al. Comparison of lower urinary tract symptom severity and associated bother between community-dwelling black and white men: The Olmsted County Study of Urinary Symptoms and Health Status and the Flint Men's Health Study. Urology 2003;61;1086-91.  Back to cited text no. 5
    
6.Dos Reis RB, Rodrigues Neto AA, Reis LO, Machado RD, Kaplan S. Correlation between the presence of inguinal hernia and the intensity of lower urinary tract symptoms. Acta Cir Bras 2011;26(Suppl 2):125-8.  Back to cited text no. 6
    
7.Vand der walt CL, Heyns CF, Edlin RS, Van Vuuren SP. Prospective comparison of a new visual prostate symptom score versus the international prostate symptom score in men with lower urinary tract symptoms. Urology 2011;78:17-20.  Back to cited text no. 7
    
8.Russo F, Di Pasquale B, Romano G, Vicentini C, Manieri C, Tubaro A, et al. International prostate symptom score: Comparison of doctor and patient. Arch Ital Urol Androl 1998; 70(3 Suppl):15-24.  Back to cited text no. 8
    
9.Boyle P. Cultural and linguistic validation of questionnaires for use in international studies: The nine-item BPH-specific quality-of-life scale. Eur Urol 1997;32 (Suppl 2):50-2.  Back to cited text no. 9
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10.Quek KF, Chua CB, Razack AH, Low WY, Loh CS. Construction of the Mandarin version of the International Prostate Symptom Score inventory in assessing lower urinary tract symptoms in a Malaysian population. Int J Urol 2005;12:39-45.  Back to cited text no. 10
[PUBMED]    
11.Homma Y, Tsukamoto T, Yasuda K, Ozono S, Yoshida M, Shinji M. Linguistic validation of Japanese version of International Prostate Symptom Score and BPH impact index. Nihon Hinyokika Gakkai Zasshi 2002;93:669-80.   Back to cited text no. 11
[PUBMED]    
12.Cam K, Senel F, Akman Y, Erol A. The efficacy of an abbreviated model of the International Prostate Symptom Score in evaluating benign prostatic hyperplasia. BJU Int 2003;91:186-9.  Back to cited text no. 12
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]


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