Assessing and responding to palliative care needs in rural sub-Saharan Africa: results from a model intervention and situation analysis in Malawi

Palliative care is rarely accessible in rural sub-Saharan Africa. Partners In Health and the Malawi government established the Neno Palliative Care Program (NPCP) to provide palliative care in rural Neno district. We conducted a situation analysis to evaluate early NPCP outcomes and better understan...

Full description

Saved in:
Bibliographic Details
Published in:PloS one 2014-10, Vol.9 (10), p.e110457-e110457
Main Authors: Herce, Michael E, Elmore, Shekinah N, Kalanga, Noel, Keck, James W, Wroe, Emily B, Phiri, Atupere, Mayfield, Alishya, Chingoli, Felix, Beste, Jason A, Tengatenga, Listern, Bazile, Junior, Krakauer, Eric L, Rigodon, Jonas
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adult
Africa South of the Sahara
Aged
AIDS
Antiretroviral agents
Antiretroviral therapy
Cancer
Caregivers
Chronic illnesses
Computer and Information Sciences
Earth Sciences
Female
Geography
Global health
Health care
Health Knowledge, Attitudes, Practice
Health Services Needs and Demand
HIV
Hospice care
Hospitals
Human immunodeficiency virus
Humans
Illnesses
Infectious diseases
Kaposis sarcoma
Malawi - epidemiology
Male
Medical diagnosis
Medical personnel
Medical treatment
Medicine
Medicine and health sciences
Middle Aged
Morphine
Neoplasms - diagnosis
Neoplasms - epidemiology
Neoplasms - therapy
Occupational health
Pain
Pain Management
Pain Measurement
Palliation
Palliative Care
Patients
People and Places
Physicians
Prevalence
Program Evaluation
Qualitative Research
Research and Analysis Methods
Rural areas
Rural Health Services
Rural Population
Socioeconomics
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Palliative care is rarely accessible in rural sub-Saharan Africa. Partners In Health and the Malawi government established the Neno Palliative Care Program (NPCP) to provide palliative care in rural Neno district. We conducted a situation analysis to evaluate early NPCP outcomes and better understand palliative care needs, knowledge, and preferences. Employing rapid evaluation methodology, we collected data from 3 sources: 1) chart review of all adult patients from the NPCP's first 9 months; 2) structured interviews with patients and caregivers; 3) semi-structured interviews with key stakeholders. The NPCP enrolled 63 patients in its first 9 months. Frequent diagnoses were cancer (n = 50, 79%) and HIV/AIDS (n = 37 of 61, 61%). Nearly all (n = 31, 84%) patients with HIV/AIDS were on antiretroviral therapy. Providers registered 112 patient encounters, including 22 (20%) home visits. Most (n = 43, 68%) patients had documented pain at baseline, of whom 23 (53%) were treated with morphine. A majority (n = 35, 56%) had ≥1 follow-up encounter. Mean African Palliative Outcome Scale pain score decreased non-significantly between baseline and follow-up (3.0 vs. 2.7, p = 0.5) for patients with baseline pain and complete pain assessment documentation. Providers referred 48 (76%) patients for psychosocial services, including community health worker support, socioeconomic assistance, or both. We interviewed 36 patients referred to the NPCP after the chart review period. Most had cancer (n = 19, 53%) or HIV/AIDS (n = 10, 28%). Patients frequently reported needing income (n = 24, 67%) or food (n = 22, 61%). Stakeholders cited a need to make integrated palliative care widely available. We identified a high prevalence of pain and psychosocial needs among patients with serious chronic illnesses in rural Malawi. Early NPCP results suggest that comprehensive palliative care can be provided in rural Africa by integrating disease-modifying treatment and palliative care, linking hospital, clinic, and home-based services, and providing psychosocial support that includes socioeconomic assistance.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0110457