# Impact of Atopic Dermatitis on the Quality of Life of Children in Ethiopia: A Multicenter Prospective Cohort Study

## TL;DR

This study shows that combining standard treatments with education helps improve the quality of life for children with atopic dermatitis in Ethiopia.

## Contribution

The study identifies specific predictors of quality of life in children with atopic dermatitis in a low-resource setting.

## Key findings

- Standard treatments with educational interventions reduce disease severity and improve quality of life in children with AD after six months.
- Baseline disease severity, change in severity, age at onset, and family size are independent predictors of quality of life.
- Quality of life significantly improved across all domains after six months of follow-up.

## Abstract

What are the main findings?
Standard treatments combined with educational interventions effectively reduce disease severity and quality of life impairments in children with AD after six months of follow-up.The severity of AD (according to SCORAD score), changes in SCORAD scores, age at disease onset, and the number of children in the family were independent predictors of quality of life.

Standard treatments combined with educational interventions effectively reduce disease severity and quality of life impairments in children with AD after six months of follow-up.

The severity of AD (according to SCORAD score), changes in SCORAD scores, age at disease onset, and the number of children in the family were independent predictors of quality of life.

What are the implications of the main findings?
Identified predictors of quality of life can guide more personalized management for children with AD.Integrated clinical and psychosocial care approaches for pediatric AD are crucial in resource-limited settings.

Identified predictors of quality of life can guide more personalized management for children with AD.

Integrated clinical and psychosocial care approaches for pediatric AD are crucial in resource-limited settings.

Background: Atopic dermatitis (AD) is a chronic, pruritic and relapsing inflammatory skin disorder affecting children’s quality of life (QoL). Despite rising global prevalence, data on its impact on QoL in low-resource settings remain limited. This study aimed to assess the impact of AD and associated factors on the QoL of children and assesses the effect of educational intervention in Ethiopia. Methods: A prospective cohort study was conducted among 461 AD children and their caregivers across four randomly selected hospitals dermatology clinics in Ethiopia from October 2022 to March 2024. Assessments included AD Severity using Scoring Atopic Dermatitis (SCORAD), Infants’ Dermatitis Quality of Life Index (IDLQI) for children aged 0–4, and Children’s Dermatology Life Quality Index (CDLQI) for children aged 5 to 16. Participants received educational guidance from trained nurses during follow-up beyond routine AD treatment. Trained personnel collected clinical and sociodemographic data. AD severity and QoL were reassessed after 6 months. Descriptive, univariate, and linear regression analyses identified factors influencing QoL, with associations reported as odds ratios (95% CI) and significance set at p < 0.05. Results: Of 461 children, 424 (92%) completed follow-up. Most were under five (67%) with a median age of 3 years; 72.2% had AD onset before age two. Most caregivers were female (68.9%). After six months, clinical signs of AD, including dryness, erythema, excoriation, and lichenification, improved notably. Mild AD increased by 33.5%, while moderate and severe cases decreased by 17.5% and 16%, respectively. QoL significantly improved across all domains (p = 0.001). Baseline disease severity (β = 0.11), change in severity (ΔSCORAD) (β = 0.043), number of dependents (β = −0.71), and age at disease onset (β = 0.005) as significant predictors of QoL. Conclusions: AD significantly impairs QoL in Ethiopian children, with greater severity causing more disruption. Routine treatments with educational interventions significantly improve disease severity and QoL. Integrated clinical and psychosocial care approaches for pediatric AD are crucial in resource-limited settings.