**6. Conclusion**

The findings of this study support the impression that chronic medical conditions are associated with reduced quality of life, which, together with a number of sociodemographic and clinical factors, in turn affect life expectancy. The results support the call that the management of patients with these medical conditions should necessarily include attention to the mental health status of the sufferers.

Chronic medical and mental diseases account for multiple burdens for patients, including the necessity to deal with pain, suffering, reduced quality of life, premature mortality, financial costs, and familial emotional trauma [12, 30, 32, 72, 73]. The risk factors for mental health problems among patients suffering from chronic medical illnesses are complex [72, 73, 113]. Usually, the more serious the somatic disease and symptoms are, the more probable it will be to be accompanied by mood and/or anxiety symptoms of variable severity [72, 73]; conditions arising after the somatic disease are diagnosed. In other words, even if those with dual diagnoses were excluded from the study, it clearly understood that most chronic medical conditions tend to be associated with some emotional disturbance. Failure to manage such mental health problems increases the patients' probability of suffering

In chronic medical conditions, functionality may be severely impaired due to chronic psychogenic and somatic pain, frequent hospital admissions, and dependency from medical and nursing personnel. These are all markers of poor quality of life and well-being. It is important to mention that most of the mortalities in chronic medical conditions may not be due to the direct complication of the disease, rather a cumulative outcome of social and psychological dissatisfaction of the condition. Sufferers maintain the feeling that they have come to the end of the road and seek the easiest escape rooting out of the problem which is suicide [114–117]. In addition, research has pointed out a relationship between sustained emotional disturbance especially depression and reduced immunity. This may be worse among chronically ill patients, and this makes them more vulnerable to recurrent infections or reinfections. Good quality of life and well-being are a measure of satisfaction in major areas of life including mood stability and affording basic nutrition which will

Most chronic illnesses particularly HIV, cancer, and tuberculosis in sub-Saharan Africa are classic examples of diseases with both medical and social dimensions, characterized by its close relation to poor socioeconomic conditions [27–31]. For instance, in tuberculosis, a higher risk of acquiring active disease occurs with alcoholism, smoking [48, 49], intravenous drug abuse [48, 49, 58, 74], diabetes mellitus, HIV infection, overcrowding, and other factors. The abovementioned risk factors are very prevalent among populations with reduced quality of life and well-being and increase risk of having HIV and progression from latent TB to

From the study, mortality was the highest among tuberculosis and cancer patients, followed by patients with diabetes mellitus. Schizophrenia had the lowest mortality after 5 years. There was no mortality among the control within the period. Correspondingly, mortally was the highest among the groups with the lowest quality of life. Quality of life is an indicator of total well-being and optimal health; therefore, if it is low, then it is an indication that the individual may not be enjoying good health. The finding among the diabetes group is in line with the earlier report that reduced life expectancy at age 15 by 1.3 years for men and 2.0 years for women in Canada [47] and a BMI of 40–45 kg/m<sup>2</sup> were associated with a 10-year reduction of life expectancy at age 35 compared to a BMI of 22.5–25 kg/m<sup>2</sup> [118]. Causes of mortality may be due to organ damage, complication of medication, systemic damage, or hemodynamic changes. Actual or direct causes of the deaths could not be ascertained as many of the deaths did not occur in the hospital. Mortality from tuberculosis and cancer tends to be high with a low rate of survival. Mortality in severe chronic mental illness is recognized to be raised, and underlying causes may be multiple. However, the death rate was lowest among schizophrenics in this study. This may be due to the fact the schizophrenics were predominantly young

from complications, even lethal.

*Aging - Life Span and Life Expectancy*

sustain immunity.

active TB [77].

**72**
