Background: The prevalence of use of traditional medicines by patients receiving palliative care is poorly documented. In 2002, the World Health Organisation estimated about 4 billion people (80% of the world’s population) used traditional medicines for some aspect of primary healthcare, with 90% of users living in low and middle income countries. Studies in Africa have shown that patients on palliative care are more likely to use traditional medicines especially after the diagnosis of cancer. This study describes the prevalence of and reasons for TM use amongst PC patients and also explores the common herbs used by this population. Methodology: A mixed method descriptive cross sectional study design was used including the following: questionnaire administered to patients attending palliative care clinic and focus group discussions with palliative care patients. Results: 60.4% of palliative care patients (n = 96; males = 53%) reported use of traditional herbal medicines. The majority of survey participants had the diagnosis of cancer (94%; n = 90) and HIV (89%; n = 85). Traditional herbal medicine use was common in participants who had the following symptoms: diarrhoea 83%, anorexia 63%, pain 61% etc. Traditional medicine use was not associated with age, gender, education, occupation, distance from hospital, diagnosis or symptom. 62% of the participants who used herbal medicines did not know the herbs they were taking. Kigelia Africana, Moringa oleifera, Cyphostema sp, and Strychnos innocua were the common herbs used. Cultural practices, limitations of conventional health system and credibility of traditional healers were the main reasons for using traditional herbal medicines. Conclusion: Use of traditional herbal medicines is high among patients receiving palliative care at Mulanje Mission hospital mainly for symptom management and cancer. Further research is needed to investigate effectiveness of identified herbs and also assess their potential herb-drug interactions. Ongoing work including liaison with traditional healers would assist to formulate effective local palliative care management programs that are sensitive to traditional medicine practices.

Introduction-The WHA resolution in 2014 to strengthen PC as a continuum of health care service delivery mandated member states to incorporate PC into their NHS using the PHS. An assessment of a health system will only be complete when the four elements of the PHS that (entrenches palliative care) are assessed alongside preventative, curative and rehabilitative care. Aim-To assess the current status of integration of PC into the PHC centers in Alexandra community in Johannesburg, South Africa. Objectives - 1) to identify the existing policies including budgets available in the clinics relating to PC, 2) to identify the availability of PC essential medicines in the PHC and 3) to survey the HCPs training in PC. Methodology- Each objective has different targets. Objective number 1) has clinic managers as its targets. Objective 2), HCPs and people involved in procuring and prescribing essential medications and objective 3), all the HCPS. Data was collected using structured questionnaires administered by the researcher and analyzed using statistical tables. Results-The clinic mangers are not aware of NPFSPC, there is no provincial policy, budget or any existing policy on PC in any of the clinics. The essential medicines are available in the clinics, only recent graduates has undergraduate trainings in PC, no HCP has any post graduate training in PC at any level (Certificate, Diploma or Masters) as recommended by the WHA resolution to member countries. Skills in PC is close to zero in the PHCs. Conclusion-The study confirm the findings in previous literature and highlights the needs for PC policies and continuous training in PC for HCPs, essential medicines for PC are in the clinics contrary to findings in other LMIC.

Includes abstract.~Includes bibliographical references. / Managing patients whose disease has become unresponsive to anticancer treatment confronts oncologists with major stressors which may range from the management of distressing physical symptoms to complex psychosocial issues. These sets of circumstances prompted the undertaking of this study: An evaluation of the current practices followed by oncologists in private practice in Cape Town, South Africa, in the management of patients with advanced cancer which no longer responds to anticancer treatment and the identification of the needs associated with such management. A descriptive qualitative study was selected for data collection. Cross-sectional, in-depth semi structured face to face interviews were conducted with fifteen radio-oncologists working in five satellite units of a private oncology company in Cape Town. The interviews were conducted with the aid of a topic guide. The process of coding was employed to organise and manage the collected data. The following six themes which had a bearing on the main topic were distilled from the data: Oncologists' experiences pertaining to the management of patients with advanced disease; the difficult discussion necessary when a patient's disease became incurable and when it had to be decided whether anticancer treatment should be stopped; the decision to stop anticancer treatment; advance directives; oncologists’ burnout and the palliative care team approach. A description of challenging aspects associated with the management of terminally ill cancer patients is given. Identified needs include training of staff in palliative care; guidance for oncologists regarding the discussion of and the decision to stop anticancer treatment; implementation of advance directives; the development and employment of a multidisciplinary approach to provide palliative care; and support for oncologists facing burnout. Recommendations were made pertaining to appropriate training in the field of palliative care; the development of guidelines to aid oncologists in the discussion of and decision to stop anticancer treatment and the implementation of advance directives; the provision of palliative care through employment of a multidisciplinary approach led by a palliative care physician; and external support which should be provided by the oncologists' company to prevent and treat burnout.

Includes bibliographical references (leaves 60-64). / Although national guidelines in South Africa recommend starting antiretroviral therapy (ART) mainly to outpatients with WHO stage four disease and/or CD4 count of 200 cells/uL, immediate ART initiation after opportunistic infection (OI) treatment in the inpatient wards at several international sites has been shown to reduce the adverse outcomes of AIDS progression and death. Current South African policies of discharging patients after hospital admission for management of OIs for follow up and initiation of ART at ARV clinics result in poor patient outcomes as described by reports from South Africa. In contrast, this study demonstrates the feasibility and effectiveness, under routine programme conditions, of a rapid, supervised inpatient ART initiation. Further research is needed to reduce the high rate of early mortality among patients with advanced HIV disease.

Includes bibliographical references (leaves 34-39). / Since 1948, when the World Health Organization (WHO) defined health as being not only the absence of disease and infinity but also the presence of physical, mental, and social well-being (Constitution of the World Health Organization, 1952), quality of life issues became more apparent. The aim of the research undertaken was to establish whether the hospital palliative care team (HPCT) at the Johannesburg General Hospital was making a difference to referred hospital patients' quality of life. The HPCT was started at the Johannesburg General Hospital in 2001. The team functions as an advisory body on pain and symptom control. Palliative Care is an approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. The method used was the FACT G questionnaire, which was completed by the patient group initially, and thereafter HPCT intervention. The questionnaire is used to measure quality of life (QOL). The study is a descriptive cohort design. The first 24 patients completed the informed consent prior to completing the questionnaire. The pre QOL questionnaire served as the baseline QOL scores prior to HPCT intervention. The initial QOL scores were then compared to the post QOL scores after HPCT intervention. Seven subjects were excluded from the research as six patients were discharged from hospital early due to a bed shortage and one patient died. The seven patients' results from the pre FACT G questionnaire were discarded and all subsequent calculations did not include their results. The increase in the total percentage scores (45.53 to 63.35) was statistically significant (p< 0.001) using the paired t-test. Thus the results show a significant difference between pre and post assessment QOL scores. The research demonstrates significant improvements in patients' quality of life (p<0.001) after HPCT intervention. It is hoped that future research would continue to show the value of HPCT and their effect of benefiting patients' quality of life.

Includes bibliographical references (leaves 70-75). / This study set out to document quality of life in the industrialized setting of HIV infected South African gold minders who are on highly-active anti-retroviral therapy, by administering the MOS SF-36, and to determine which categorical variables impact on QOL in this study cohort. It also intended to promote routine quality of life measurements, as an index of programme performance, and to strengthen the case for widened access to anti-retroviral treatment. A cross sectional survey of 202 outpatients was carried out at the central clinic at the health service hospital owned by Anglogold in the Northwest Province. Scores of eight scales of the MOS SF-36 measuring different aspects of quality of life were calculated. Demographic and laboratory data were collected from a separate case report form and the clinic database, as part of the categorical variables. Results showed that more than 59% of all respondents achieved scores of 100 for all subscale domains, and that the only categorical variables that showed statistically significant impact was age, with QOL scores on the physical function domains decreasing with age. This decrease in function was thought to be more attributable to age, than HIV status, stage or progression. The sample population was noted to have a high level of health care, and exhibited both the well-worker and survival cohort effect, as a result of a stringent pre-employment selection, on-going occupational fitness assessments and medical boarding in the case of sub-standard fitness.

Includes bibliographical references. / This research aimed to explore the perceived needs of support required by paediatric staff caring for children with LL and LTIs in the Paediatric Department in DNH and set out the following objectives: 1) To identify the need for educational support; 2) To explore the emotional impact on Health Care Professionals HCPs caring for children with LL and LTI; 3) To identify the kind of support required for staff in order to offer the best possible care to these paediatric patients and their families.

Includes bibliographical references (leaves 48-52). / The study aimed to explore the causes of death, the costs involved in these deaths as well as the places where these deaths occurred. As all patients had access to ART once registered with the disease management company, AfA, most patients would have received ART, once the criteria for starting treatment were met.

Includes bibliographical references / Background: WHO has been advocating for provision of palliative care for all who need it according to needs and context. Though significant advances have been achieved in providing palliative care for adults in Sub Saharan Africa, very little progress has been made in providing paediatric palliative care. Coverage of paediatric palliative care services have remained low and there is lack of evidence on child specific palliative care needs and tools for assessing these needs. This study tested applicability of some tools for assessing palliative needs in children in the Zambian context and reports palliative care needs of children and their families attending the University Teaching Hospital (UTH) in Lusaka, Zambia Methodology: This was a mixed study with quantitative and qualitative components. The quantitative component assessed and applied 2 new research tools for assessing palliative care needs in children attending University teaching hospital in Lusaka, Zambia. The tools assessed included the Needs Evaluations questionnaire (NEQ) and the paedsQL4 questionnaire. Cronbach's alpha was used to determine reliability while factor analysis was used to identify relevant factors. Focus group discussions were conducted with selected group of parents/legal guardians of children. In-depth interviews were conducted with key informants. All participants were purposely selected to take part in the study and were informed about the voluntary nature of the study. Results: The NEQ and the paedsQL4 questionnaires were both found to be reliable for assessing palliative care needs for children in the Zambian context (Cronbach's alpha >0.8). Generally there were very high need gaps across all hospital wards with 15/23 items having need gap of >50%. Overall the largest need gap was in the information domain. The HIV ward had least need gap with only 8/23 items having a need gap of > 50%. Results from the paedsQL4 showed that there were significant mean differences across the three categories of patients in all domains of functioning with oncology patients performing worst. In physical functioning domain, the items showed that 6/7 items had significant mean differences (p<0.05).Confirmatory factors analysis showed that 2 items were loading highly on the physical functioning factor. These were running and participating in sports (0.896).In the emotional functioning domain, 2 items loaded highly on factor analysis, feeling sad (0.842 and angry (0.666).In the social functioning domain, highest loading were in 2 items, both related to making friends. In the school domain missing school to go to hospital loaded highly on factor analysis (0.842) followed by difficulty paying attention in class (0.716) Qualitative results supported findings from quantitative data. Several needs were highlighted by the parents/guardians and health workers. The major family needs focused on economic/financial and bereavement support. Most families were referred to the UTH from very far off places without any form of support. In line with quantitative findings, there was high demand for information for families which health workers did not adequately provide. One major barrier identified to provision of palliative care was poor coordination of services with most patients missing out on services which were already available. While social workers were available, poor funding negatively affected this service. There were very few trained health workers in palliative care. Pain management remained poor with many clinicians still not comfortable to prescribe stronger analgesia such as morphine for severe pain. Conclusion: This study applied two quantitative tools for assessing palliative care needs in Children. The results showed that the tools were fairly reliable and applicable in the Zambian context. The findings indicate huge needs gap for child palliative care services in Zambia. The major family needs were economic and bereavement support. There was high demand for information for families which health workers did not adequately provide. Pain control remained sub-optimal especially for children with cancer. One major barrier identified to provision of palliative care was poor coordination of services.

Includes bibliographical references. / Sedation in the context of terminal care has been a hotly debated topic for many years. There are two main reasons for this. Firstly, the wide variation in its reported use leads to doubts about the appropriateness of the care available in areas with a high percentage of sedation, and secondly, there is the suspicion that terminal sedation is actually a euphemism for euthanasia. Ventafridda's report in 1990 that 52% of moribund patients required sleep-inducing sedation to control physical suffering, stimulated a lot of discussion in palliative care circles with many physicians being surprised at the apparent high percentage of patients needing terminal sedation. This was followed by the publication of studies from various centres throughout the world in an effort to determine current international practice.