Date of Award

2-5-2026

Thesis Type

PhD

Document Type

Thesis

Divisions

Faculty of Medicine

Department

Department of Social and Preventive Medicine

Institution

Universiti Malaya

Abstract

Introduction: As the world transitions into the endemic phase of COVID-19, a new challenge emerges: the long-term burden of illness among survivors. Health-related quality of life (HRQoL) outcomes remains poorly understood in low- and middle-income countries, where postpandemic policy decisions lack localized evidence. This study aimed to map the trajectory of HRQoL recovery in a large cohort of Malaysian COVID-19 survivors and identify key sociodemographic and clinical predictors—critical inputs for value-based post-COVID care and pandemic preparedness. Materials and methods: This study was conducted in two phases from January 2022 to December 2023 in Selangor, Malaysia. Phase I involved the validation of the COVID-19 Quality-of-Life (CO-19-QoL) survey using internationally recognized guidelines for questionnaire translation and cultural adaptation. Face, content, and construct validity were assessed, and test-retest reliability was evaluated in a pilot sample of 30 participants. Phase II was a mixed retrospective and prospective cohort study involving 2,000 recovered COVID-19 patients who met the inclusion criteria of confirmed diagnosis via RT-PCR and aged 18 years and above. Generic health-related QoL was assessed using the five-level EQ-5D (EQ-5D-5L), and disease-specific QoL was assessed using the CO-19-QoL at baseline (during infection), 3-months, and 6-months post-discharge. HRQoL was analysed using General Linear Model (GLM) univariate analysis to determine associations between predictors and outcomes, and repeated measures ANOVA to assess changes across time points Results: Content validity was excellent (Kappa > 0.8), indicating that the items are relevant to COVID-19 symptoms and translation was accurate. Internal consistency coefficient (Cronbach’s alpha) of the CO-19_QoL was 0.919. Test-retest reliability showed excellent reliability (ICC = 0.896, p < 0.001). Construct validity revealed a single domain consisting of 15 items reliable and a valid instrument to measure the QoL of COVID-19 patients. A total of 2,000 participants (mean age 47.54 years; 58.6% males) were included in the cohort study. EQ-5D utility scores improved from 0.33 += 0.19 (baseline) to 0.54 += 0.20 (6 months; p< 0.001), and EQ-VAS scores rose from 45.50 to 86.38. CO-19-QoL scores declined from 19.49 to 1.89, indicating reduced symptom burden. However, recovery was uneven. Poorer HRQoL trajectories were significantly associated with older age (≥60), comorbidities, lower education, private sector employment, overweight BMI, smoking, and severe COVID-19 (Category 4). Socioeconomic disparities were evident; low-income patients (B40) experienced the slowest recovery (p< 0.001). Conclusion: This study is the first to report that COVID-19 negatively affects both generic and disease-specific quality of life of patients in Malaysia, not only during acute phase but also approximately three months and six months after the first symptoms related to COVID-19 appeared. While overall HRQoL improved, vulnerable groups faced persistent deficits, highlighting the need for targeted post-COVID rehabilitation and equity-driven policies. EQ-5D-derived utility values lay the groundwork for cost-utility analyses and health technology assessments in Malaysia. These findings provide critical evidence for post-pandemic planning and reinforce the importance of integrating HRQoL into future emergency preparedness frameworks.

Initial

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Additional Information

Thesis (PhD) – Faculty of Medicine, Universiti Malaya, 2026.

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