We used a combination of a systematic review and documentary analysis. We searched biomedical databases with supplementary hand searches in July, 2003. We searched MEDLINE (1966–2003), CINAHL (1982–2003), AMED (1985–2003), CancerLit (1975–2003), PsychInfo (1974–2003), EMBASE (1980–2003), Science Citation Index (1981–2003) and Social Sciences Citation Index (1981–2003). Search terms were the union of “hospice”, “terminal care”, “terminally ill”, “palliat*”, “hospice*”, “dying”, “end of
ReviewPalliative care in sub-Saharan Africa
Section snippets
Background
In 2003, there were an estimated 26·6 million people in sub-Saharan Africa living with HIV, 3·2 million new infections, and 2·3 million AIDS-related deaths.1 Additionally, WHO estimates that there were 0·5 million deaths per year from cancer in Africa,2 and that by 2020, 70% of new cancer cases will be in the developing world.3 Cancer rates in Africa are expected to grow by 400% over the next 50 years.4 Palliative care has gained broad support as an important part of disease management,5 and
Results
We identified 26 palliative care service organisations, which were described in 38 reports. Research, monitoring, and evaluation findings from 15 studies were reported by eight organisations. A further 169 relevant publications and reports were included. The full review and extraction tables with reference lists are available to download free of charge.15
Cultural dimensions
A good death in Africa varies culturally and historically;16 for example, bearing bad news could be seen as the cause of a terminal illness, or as incompatible with the clinician's responsibility to cure.17, 18 Traditions dictate appropriate models and places of care: sick people might be removed from villages to avoid risk to the community, or returned from hospital to the community to avoid the dangers of crowded wards and toxic drugs from developed countries.19 Therefore, the development of
Place of care
A lesson from the foundation of hospice at Selian Hospital in Arusha, Tanzania, a small service attached to existing cancer services, has resonance for all countries: “opportunities accompany the problems. Hospice care doesn't have to fit any particular model”.23 All countries need palliative care that meets cultural, spiritual, and economic needs of its people,44 but it may be offered in forms not recognised as a traditional hospice model.
Resource constraints direct the site of care, with 80%
Conclusions
Limitations in identifying factors associated with success, were (1) the shortage of research activity, (2) the paucity of written experience, and (3) the potential bias in reports written mainly for funders. The risk with the last issue is that, understandably, services may present themselves favourably, and challenges and even failures might not be fully shared. We could not make assumptions on any service, and our review relies entirely on the existing published work. We hope that
Search strategy and selection criteria
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