Palliative care needs in Malawi: Care received by people living with HIV

Mkwinda, Esmie; Lekalakala-Mokgele, Eucebious

doi:10.4102/curationis.v39i1.1664

Cited by 12 publications

(23 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…72 Community home-based care services, as recommended by WHO and the Joint United Nations Programme on HIV or AIDS (UNAIDS) to reduce the burden of HIV care on the healthcare system, have been introduced. 73 More generally, the Ministry of Health has developed comprehensive palliative care guidance, and specialist palliative care is available in selected hospitals. [74][75][76] There are efforts to integrate palliative care into public health systems, but it is estimated that only onethird of those who need palliative care in Malawi are able to access such services.…”

Section: Palliative Carementioning

confidence: 99%

Cervical cancer screening – The challenges of complete pathways of care in low-income countries: Focus on Malawi

Cubie

Campbell

2020

Womens Health (Lond Engl)

View full text Add to dashboard Cite

Cervical cancer is the fourth most common cancer among women globally, with approximately 580,000 new diagnoses in 2018. Approximately, 90% of deaths from this disease occur in low- and middle-income countries, especially in areas of high HIV prevalence, and largely due to limited prevention and screening opportunities and scarce treatment options. In this overview, we describe the opportunities and challenges faced in many low- and middle-income countries in delivery of cervical cancer detection, treatment and complete pathways of care. In particular, drawing on our experience and that of colleagues, we describe cervical screening and pathways of care provision in Malawi, as a case study of a low-resource country with high incidence and mortality rates of cervical cancer. Screening methods such as cytology – although widely used in high-income countries – have limited relevance in many low-resource settings. The World Health Organization recommends screening using human papillomavirus testing wherever possible; however, although human papillomavirus primary testing is more sensitive and detects precancers and cancers earlier than cytology, there are currently costs, infrastructure considerations and specificity issues that limit its use in low- and middle-income countries. The World Health Organization accepts the alternative screening approach of visual inspection with acetic acid as part of ‘screen and treat’ programmes as a simple and inexpensive test that can be undertaken by trained health workers and hence give wider screening coverage; however, subjectivity and variability in interpretation of findings between providers raise issues of false positives and overtreatment. Cryotherapy using either nitrous oxide or carbon dioxide is an established treatment for precancerous lesions within ‘screen and treat’ programmes; more recently, thermal ablation has been recognized as suitable to low-resource settings due to lightweight equipment, short treatment times, and hand-held battery-operated and solar-powered models. For larger lesions and cancers, complete clinical pathways (including loop excision, surgery, radiotherapy, chemotherapy and palliative care) are required for optimal care of women. However, provision of each of these components of cancer control is often limited due to limited infrastructure and lack of trained personnel. Hence, global initiatives to reduce cervical mortality need to adopt a holistic approach to health systems strengthening.

show abstract

Section: Palliative Carementioning

confidence: 99%

Cervical cancer screening – The challenges of complete pathways of care in low-income countries: Focus on Malawi

Cubie

Campbell

2020

Womens Health (Lond Engl)

View full text Add to dashboard Cite

show abstract

“…This is because poor awareness and knowledge of PC among patients and their families can mean that they fail to engage in decision-making during their care or refuse to use this specialized service (Lakew et al, 2015;Opoku, 2014). However, patients and families are perceived to want health information (Mkwinda & Lekalakala-Mokgele, 2016;Nwankwo et al, 2013). Therefore, given the limited education and information provision available and the perceived desire for information from patients and families, the study reported in this article explored the factors affecting the provision of education and information in PC and its impact on care delivery and utilization of PC in a Nigerian hospital.…”

mentioning

confidence: 99%

An Ethnographic Study of Palliative and End-of-Life Care in a Nigerian Hospital: Impact of Education on Care Provision and Utilization

et al. 2020

View full text Add to dashboard Cite

Most clinicians receive little or no palliative care (PC) education. Similarly, patients and their families receive little or no information on PC. Our study explored education in PC, while examining for its impacts on service delivery and utilization from the perspective of health care professionals (HCPs), patients, and their families. An ethnographic approach was utilized to gather data from 41 participants. Spradley’s ethnographic analytical framework guided data analysis. Two themes identified were inadequate HCPs’ knowledge base and impact of service-users’ inadequate health education. The findings show that most HCPs had no formal education in PC, attributed to the lack of PC residency programs and the absence of educational institutions that provide such education. Patients and families also conveyed poor understandings of their illness and palliation, rooted in the HCP culture of partial disclosure of information about their diagnosis, care, and prognosis. Findings suggest a cultural shift that supports PC education for professionals is required to promote realist medical approach in the care for patients with life-limiting illnesses.

show abstract

“…All identified articles defined CoC for HIV/AIDS patients as a follow-up to provide continuous life-long care [56–64]. Four empirical studies investigated CoC for HIV/AIDS patients from the patient perspective, and compared HIV service delivery models in different countries.…”

Section: Resultsmentioning

confidence: 99%

“…Four empirical studies investigated CoC for HIV/AIDS patients from the patient perspective, and compared HIV service delivery models in different countries. These empirical studies mentioned other components of CoC, for example, healthcare access, linkages across levels and services, and quality of care [56–58, 60], in addition to recording systems and documentation transitions [57, 58].…”

Section: Resultsmentioning

confidence: 99%

How have researchers defined and used the concept of ‘continuity of care’ for chronic conditions in the context of resource-constrained settings? A scoping review of existing literature and a proposed conceptual framework

Meiqari

Aloudat

Essink

et al. 2019

Health Res Policy Sys

View full text Add to dashboard Cite

Background Within the context of the growing burden of non-communicable diseases (NCDs) globally, there is limited evidence on how researchers have explored the response to chronic health needs in the context of health policy and systems in low- and middle-income countries. Continuity of care (CoC) is one concept that represents several elements of a long-term model of care. This scoping review aims to map and describe the state of knowledge regarding how researchers in resource-constrained settings have defined and used the concept of CoC for chronic conditions in primary healthcare. Methods This scoping review adopted the modified framework for interpretive scoping literature reviews. A systematic literature search in PubMed was performed, followed by a study selection process and data extraction, analysis and synthesis. Extracted data regarding the context of using CoC and the definition of CoC were analysed inductively to identify similar patterns; based on this, articles were divided into groups. MaxQDA was then used to re-code each article with themes according to the CoC definition to perform a cross-case synthesis under each identified group. Results A total of 55 peer-reviewed articles, comprising reviews or commentaries and qualitative or quantitative studies, were included. The number of articles has increased over the years. Five groups were identified as those (1) reflecting a change across stages or systems of care, (2) mentioning continuity or lack of continuity without a detailed definition, (3) researching CoC in HIV/AIDS programmes and its scaling up to support management of NCDs, (4) researching CoC in NCD management, and (5) measuring CoC with validated questionnaires. Conclusion Research or policy documents need to provide an explicit definition of CoC when this terminology is used. A framework for CoC is suggested, acknowledging three components for CoC (i.e. longitudinal care, the nature of the patient–provider relationship and coordinated care) while considering relevant contextual factors, particularly access and quality. Electronic supplementary material The online version of this article (10.1186/s12961-019-0426-1) contains supplementary material, which is available to authorized users.

show abstract

Palliative care needs in Malawi: Care received by people living with HIV

Cited by 12 publications

References 36 publications

Cervical cancer screening – The challenges of complete pathways of care in low-income countries: Focus on Malawi

Cervical cancer screening – The challenges of complete pathways of care in low-income countries: Focus on Malawi

An Ethnographic Study of Palliative and End-of-Life Care in a Nigerian Hospital: Impact of Education on Care Provision and Utilization

How have researchers defined and used the concept of ‘continuity of care’ for chronic conditions in the context of resource-constrained settings? A scoping review of existing literature and a proposed conceptual framework

Contact Info

Product

Resources

About