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Current state of palliative and end-of-life care in home versus inpatient facilities and urban versus rural settings in Africa

Published online by Cambridge University Press:  23 January 2013

Jessica Jang  and
Mark Lazenby
Jessica Jang
Affiliation:
School of Nursing, Yale University, New Haven, Connecticut
Mark Lazenby*
Affiliation:
Council on Middle East Studies, Yale University, New Haven, Connecticut
*
Address correspondence and reprint requests to: Mark Lazenby, Yale University, Council on Middle East Studies, 100 Church Street South, New Haven, CT 06536, USA. E-mail: [email protected]
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Abstract

Objective:

Because palliative care in sub-Saharan Africa may not fit the style of delivery of palliative care in the global north, exploring the evidence can serve to reduce existing barriers and help streamline national policies that determine the optimal setting to implement formal palliative and end-of-life services.

Method:

A search was conducted in Ovid MEDLINE®, PubMed, and Google Scholar databases using the search terms nursing care, terminal care, end of life care, palliative care, dying, death, hospice, opioids, morphine, Africa, sub-Saharan Africa, caregivers, and place of death. Eighty-seven relevant articles were found using the search terms. Of these, 22 matched inclusion criteria and were reviewed.

Results:

Opioid availability and distribution is best accessed at the inpatient level, and hence, pain and end-of-life symptoms are best managed at the inpatient level. Despite the great need, nurses’ lack of prescription power in the home-based setting is a shortcoming. Home deaths have not been adequately studied, but research suggests that palliative care generally causes economic strain, psychosocial distress on family members, and increased risk of transmission of communicable disease. Hospice is understudied but shows favorable outcomes.

Significance of results:

Funding and research need to focus on development of inpatient palliative and hospice care units in urban areas. In rural areas, the priority should be a home-based care model that involves nurses who are privileged to prescribe opioids and adjunctive medication therapies.

Keywords

palliative careend-of-life careAfricahomeurbanrural
Type
Review Article
Information
Palliative & Supportive Care , Volume 11 , Issue 5 , October 2013 , pp. 425 - 442
Copyright
Copyright © Cambridge University Press 2013 

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References

REFERENCES

Alsirafy, S.A. (2010). Regulations governing morphine prescription in Egypt: An urgent need for modification. Journal of Pain & Symptom Management, 39, 4–6.Google Scholar
Alsirafy, S.A., Med, D.P., Mesidy, S.M., et al. (2010). Where do Egyptian palliative care patients with cancer die? American Journal of Hospice and Palliative Medicine, 27, 313–315.Google Scholar
Bates, J., Gwyther, L. & Dinat, N. (2008). Morphine: Friend or foe? Malawi Medical Journal, 20, 112–114.Google Scholar
Beck, S. (1998). A systematic evaluation of opioid availability and use in Republic of South Africa. Journal of Pharmaceutical Care in Pain & Symptom Control, 6, 5–22.Google Scholar
Beck, S. & Falkson, G. (2001). Prevalence and management of cancer pain in South Africa. Pain, 95, 75–84.Google Scholar
Bryceson, D. (1996). Deagrarianization and rural employment in sub–Saharan Africa: A sectoral perspective. World Development, 24, 97–111.CrossRefGoogle Scholar
Chimwaza, A.F. & Watkins, S.C. (2004). Giving care to people with symptoms of AIDS in rural sub-Saharan Africa. AIDS Care, 16, 795–807.Google Scholar
Clark, D., Wright, M., Hunt, J., et al. (2007). Hospice and palliative care development in Africa: A multi-method review of services and experiences. Journal of Pain & Symptom Management, 33, 698–710.Google Scholar
Collinson, M., Tollman, S. & Kahn, K. (2007). Migration, settlement change, and health in post-apartheid South Africa: Triangulating health demographic surveillance with national census data. Scandinavian Journal of Public Health, 35, 77–84.CrossRefGoogle Scholar
Donnelly, M., McCall, PJ., Lengeler, C., et al. (2005). Malaria and urbanization in sub-Saharan Africa. Malaria Journal, 4, 1–5.Google Scholar
Harding, R., Powell, R., Downing, J., et al. (2008). Generating an African palliative care evidence base: The context, need, challenges, and strategies. Journal of Pain and Symptom Managment, 36, 304–309.Google Scholar
Harding, R., Powell, R., Kiyange, F., et al. (2010). Provision of pain and symptom relieving drugs for HIV/AIDS in sub-Saharan Africa. Journal of Pain and Symptom Management, 40, 405–415.Google Scholar
Hongoro, C. & Dinat, N. (2011). A cost analysis of a hospital based palliative care outreach program: Implications for expanding public sector palliative care in South Africa. Journal of Pain and Symptom Management, 1, 1–9.Google Scholar
Kamuhabwa, A. & Ezekiel, D. (2009). Rational use and effectiveness of morphine in the palliative care of cancer patients at the Ocean Road Institute in Dar es Salaam, Tanzania. Tanzania Journal of Health Research, 11, 170–174.Google Scholar
Kang'the, S.M. (2009). Challenges impacting on the quality of care to persons living with HIV/AIDS and other terminal illnesses with reference to Kanye community home-based care programme. SAHARA Journal of Social Aspects of HIV/AIDS related Research Alliance, 6, 24–32.Google Scholar
Kruger, F. (1998). Taking advantage of rural assets as a coping strategy for the urban poor: The case of rural–urban interrelations in Botswana. Environment and Urbanization, 10, 119–134.Google Scholar
Lazenby, M., Ma, T., Moffat, H., Funk, M., Knobf, T., McCorkle, R. (2010). Influences on places of death in Botswana. Palliative and Supportive Care, 8, 177–185.Google Scholar
Lerberghe, W., Bethune, X. & Brouwere, V. (1997). Hospitals in sub-Saharan Africa: Why we need more of what does not work as it is. Tropical Medicine and International Health, 2, 799–808.Google Scholar
Lindsey, E., Hirschfeld, M., Tlou, S., et al. (2003). Home-based in Botswana: Experiences of older women and young girls. Health Care for Women International, 24, 486–501.Google Scholar
Logie, D.E. & Harding, R. (2005). An evaluation of a morphine public health programme for cancer and AIDS pain relief in sub-Saharan Africa. BMC Public Health, 5, 82.CrossRefGoogle ScholarPubMed
Manicom, C. (2011). Where do our patients die? A review of the place of death of cancer patients in Cape Town, South Africa. Palliative and Supportive Care, 9, 31–41.CrossRefGoogle Scholar
Ndaba–Mbata, R.D. & Seloilwe, E.S. (2000). Home-based care of the terminally ill in Botswana: Knowledge and Perceptions. International Council of Nurses, International Nursing Review, 47, 218–223.CrossRefGoogle ScholarPubMed
Orner, P. (2006). Psychosocial impacts on caregivers of people living with AIDS. AIDS Care, 28, 236–240.Google Scholar
Rampanjato, M., Florence, M., Patrick, N., et al. (2007). Factors Influencing pain management by nurses in emergency departments in Central Africa. Emergency Medical Journal, 24, 475–477.CrossRefGoogle ScholarPubMed
Ramsay, S. (2003). Leading the way in African home-based palliative care. Free oral morphine has allowed expansion of model home-based palliative care in Uganda. Lancet, 362, 1812–1813.CrossRefGoogle ScholarPubMed
Sardiwalla, N., VandenBerg, H. & Esterhuyse, K G F. (2007). The role of stressors and coping strategies in the burnout experienced by hospice workers. Cancer Nursing, 30, 488–497.Google Scholar
Schietinger, H., Almedal, C., Marianne, B.N., et al. (1993). Teaching Rwandan families to care for people with AIDS at home. Hospice Journal – Physical, Psychosocial, & Pastoral Care of the Dying, 9, 33–53.Google Scholar
Sepulveda, C., Habiyambere, V., Amanda, J., et al. (2003). Quality care at the end of life in Africa. BMJ, 327, 209–213.Google Scholar
Uys, R. & Social, D. (2003). Aspects of the care of people with HIV/AIDS in South Africa. Public Health Nursing, 20 (4), 271–280.Google Scholar
Whittaker, S., Prinsloo, F. & Wicht, C. (1991a). Frail aged persons residing in South African homes for the aged who require hospitalisation. Part I. Urban areas. South African Medical Journal, 79, 39–44.Google Scholar
Whittaker, S., Prinsloo, F. & Wicht, C. (1991b). Frail aged persons residing in South African homes for the aged who require hospitalisation. Part II. Rural areas. South African Medical Journal,, 79, 44–47.Google Scholar
World Health Organization. (2004). A community health approach to palliative care for HIV/AIDS and cancer patients in sub-Saharan Africa. Geneva: World Health Organization. http://www.who.int/cancer/publications/en/#palliativeGoogle Scholar