Perinatal palliative care in sub-Saharan Africa: recommendations for practice, future research, and guideline development

Abstract

Worldwide, sub-Saharan Africa has the highest burden of global neonatal mortality (43%) and neonatal mortality rate (NMR): 27 deaths per 1,000 live births. The WHO recognizes palliative care (PC) as an integral, yet underutilized, component of perinatal care for pregnancies at risk of stillbirth or early neonatal death, and for neonates with severe prematurity, birth trauma or congenital anomalies. Despite bearing a disproportionate burden of neonatal mortality, many strategies to care for dying newborns and support their families employed in high-income countries (HICs) are not available in low-and-middle-income countries (LMICs). Many institutions and professional societies in LMICs lack guidelines or recommendations to standardize care, and existing guidelines may have limited adherence due to lack of space, equipment, supplies, trained professionals, and high patient load. In this narrative review, we compare perinatal/neonatal PC in HICs and LMICs in sub-Saharan Africa to identify key areas for future, research-informed, interventions that might be tailored to the local sociocultural contexts and propose actionable recommendations for these resource-deprived environments that may support clinical care and inform future professional guideline development.

Perinatal loss in Tanzania: Perspectives of maternal-child healthcare providers

“…This stigma leads to the normalization or societal expectation that women experience additional consequences at home or in their community following their loss. For this reason, there has been increased recognition of the importance of psychosocial support for families following perinatal loss [ 23 , 49 , 60 ]. This recognition comes alongside global calls to sensitize healthcare workers to parents who have had a stillbirth concurrent with efforts to increase the number of births attended by a skilled birth attendant [ 60 ].…”

“…Globally, the literature on perinatal loss has emphasized the need for better bereavement support in LMICs [48][49][50]. Parent-focused studies in HICs highlight the importance of healthcare providers recognizing the deceased newborn as member of the family and engaging in "memory making" [26,51,52].…”