Hospital based palliative care in sub-Saharan Africa; a six month review from Malawi

A retrospective review of case notes for all in-patients seen by Tiyanjane Clinic over a six month period (April-Sept 2009) was undertaken.A total of 177 patients were seen, for whom 137 case notes were available (77%). 58% of patients were male, 42% female. The average age of patients was 39.1 years (range 15-92 years). 54% of patients were HIV positive, with 34% on ARV drugs at the time of care. 42% of patients had HIV related diagnoses, including AIDS defining malignancies, 48% had (non AIDS related) cancers and 9% had other palliative diagnoses. The mean age of patients with HIV related diagnoses was 34 years, for cancer patients it was 48 years. Pain was the most commonly reported symptom (74%), with 56% of patients requiring oral morphine. The mean daily dose of morphine was 30 mg/day (range 9-100 mg). 65% of patients were discharged home, 26% of patients died during admission.The palliative care population in this setting is relatively young, especially among patients with HIV related diagnoses. HIV and cancer are the main diagnostic groups. Pain is the most commonly reported symptom, with oral morphine frequently required. Health workers require access to and knowledge of oral morphine in order to provide appropriate assistance to patients under their care.Palliative care improves the quality of life for patients and families who face life-threatening illnesses, from diagnosis through to end of life and bereavement [1]. In the developing world the majority of cancer patients present at an advanced stage of disease making palliative care an essential part of management [2]. Palliative care has also been shown to play a critical role in the management of other chronic conditions, including HIV and AIDS, even in places where anti-retroviral drugs (ARVs) are available [3,4]. Despite recognition from the World Health Organisation (WHO) of the importance of providing palliative care, studies show that the service provision in Africa remains patchy and inconsistent