Includes abstract. / Includes bibliographical references. / The purpose of the study was to evaluate the impact of the IPCF in improving identification of HIV positive children. Contrary to other two traditional approaches for HIV testing, Voluntary Counselling and Testing (VCT) and Provider Initiated Counselling and Testing (PICT), the IPCF approach initiates the process of HIV testing for children by identifying children while at the community through utilization of community social networks whereas, VCT and PICT interventions initiate the process of HIV testing for children who have already presented at health facilities for either an HIV test or other health needs.

Introduction: Children suffering from cardiac disease present with an increasing burden of symptoms throughout the trajectory of their disease. There is little research describing symptom burden among children with cardiac disease in resource-limited settings in general and looking particularly from the patients' perspective. Social, spiritual and psychological symptom burden and challenges are rarely examined in literature. This study was designed to explore the symptom burden of children with cardiac disease by engaging the children in a discussion about their illness with reference to their social (family and school), physical, spiritual and psychological lives. This was done with the understanding that palliative care improves quality of life through alleviation of distressing symptoms. AIM: To determine symptom burden and palliative care needs of paediatric cardiology outpatients from the perspective of the patient. OBJECTIVES: 1. To describe the common physical symptoms of the children coming to cardiology clinic 2. To describe the psychosocial burden of paediatric cardiology patients in outpatient clinic 3. To describe the spiritual symptoms burden of paediatric cardiology patients in outpatient clinic Methods: This was a cross-sectional descriptive study, using qualitative methodology with semi-structured interviews. The study had twelve participants (aged between 8 years and 18 years) and was conducted at Queen Elizabeth Central Hospital (QECH)'s Paediatric Cardiac Clinic. Findings: Pain was a common physical symptom in all the participants. Only 2 participants received analgesia aimed at treating the pain. Other common physical symptoms were breathlessness, fatigue, vomiting and insomnia. Schooling challenges were common with 7 of the participants either repeating a class or starting school at an older age. Availability of a loving and caring family provided an enabling environment. Schools which had been informed of the cardiac condition of the participants were found to be helpful in supporting the children. Faith and religion were found to be important to most of the participants in coping with the disease. Conclusion: Children with cardiac disease have physical, social, psychological and spiritual challenges and symptoms. To alleviate the burden of symptoms, health workers must pay attention and aim to treat all possible reported symptoms and provide support to families. Living with a chronic cardiac condition affects the whole being of a child including relationships, schooling, family and faith.

Includes bibliographical references (leaves 72-75). / The main study purpose was to inform a proposed model of palliative care in Soweto, the N'doro model, to identify an acceptable approach for a palliative care service in Soweto, and find out which issues were of concern to the people who would be potentially receiving these services. The aim is to understand meaning of death and dying and the burden of living with HIV/AIDS.

Includes abstract. / Includes bibliographical references (leaves 68-77). / This study aimed to evaluate the perception and needs for Home Based Palliative Care (HBPC) among patients suffering from life-threatening conditions presenting at the Federal Medical Centre Abeo-Ogun State, Nigeria. Needs assessment for this specialized care were investigated among cancer and HIV/AIDS patients receiving treatment in this health institution. Questionnaires were administered to the patients and statistical analysis of the collected data evaluated.

[Background] Palliative care has been highlighted as an urgent need for patients with both HIV/AIDS and cancer in sub-Saharan Africa. Morphine is considered by the WHO as the drug of choice for severe pain in cancer. Pain is common in people with HIV/AIDS, though it is frequently unrecognised or poorly treated. Health workers fears about morphine have been reported to be a barrier to patients' accessing necessary pain medication in studies from Africa as well as other parts of the world. [ Methods ] Semi-structured interviews were conducted with a total of fifteen nurses, clinicians, health service managers and pharmacy staff at five sites in the Southern Region of Malawi between November 2007 and February 2008. Study sites were randomly selected from groupings representing the different hospital institutions which exist in the region (district and central government institutions and mission hospitals). Interviews were conducted in either English or Chichewa. After translation, interview data was intensively reviewed by the researcher and emerging themes were identified. [ Results ] Three main themes were identified during the interviews. Firstly the availability of oral morphine, secondly concerns about opiate misuse and thirdly the need 6 for education and training amongst health workers and community members. Respondents understood that morphine was a strong pain killer, which they thought was useful and should be more widely available for patients with both HIV/AIDS and cancer related problems, though reported stock outs at their institutions were common. Oral morphine was available at only two of the institutions visited at the time of the interviews. A third of respondents were unable to supply information on correct practises for storage and reporting of morphine. Concerns were expressed about making oral morphine available to patients at home. Fears about addiction (either amongst patients or health workers) directly affected their prescribing practise, as respondents reported that they may either prescribe lower doses or only prescribe morphine late in the course of the illness to try to reduce the risk of addiction. [ Conclusions and recommendations ] Many of the health workers requested improved availability of oral morphine to treat patients with HIV/AIDS and cancer with severe pain. However other beliefs, attitudes and practises of health workers in the Southern Region of Malawi present major barriers to timely access to oral morphine for patients in need. Further education, training and hands on experience are required for health care workers (including pharmacy staff). Advocacy should be intensified at national and international level towards the development of appropriate policies and supply chains to improve the availability of morphine for medical purposes.

Includes bibliographical references. / The purpose of the thesis is to determine the incidence of late radiation proctitis in patients treated with radical radiotherapy in Pretoria Academic Hospital during a peroid when hypofractionated radiotherapy and external boosts were being utilised for the treatment of advances carcinoma of the cervix. Possible contributing factors were also examined in an attempt to identify areas where possible changes to our treatment policies would ensure effective palliation without severe late radiation proctitis.

Includes bibliographical references / BACKGROUND: The number of patients with cancer and other life-limiting diseases continues to increase. The WHO estimate that by 2050 there will be 24 million new cancer cases diagnosed annually. Seventeen (17) from the 24 million cancer cases in 2050 will come from developing countries. The vast majority of patients in the Third World Countries do not have access to modern diagnostic and therapy facilities and for them palliation is all they can hope for. Palliative care is a basic human right when curative care is no longer appropriate. The World Health Assembly (WHA) stated that each health care practitioner and health system has an ethical duty to relieve the pain and suffering of patients. This is only possible if the health care professionals are effectively trained to provide holistic, end-of-life care. The World Health Organisation (WHO) challenged training institutions to ensure that palliative care is compulsory and given high recognition. The 67th WHA (resolution A67.19) published a document in 2014 with nine recommendations to ensure effective palliative care delivery. There should be emphasis on palliative care teaching to all levels of health care workers and palliative training should be implemented as part of the curricula to all health care workers. PURPOSE: To conduct a needs assessment for palliative care training in undergraduate students at the University of Stellenbosch. METHODS: Two validated assessment scales were distributed via a questionnaire to all the fifth year medical students: * The Self-efficacy in palliative care scale (SEPC) assesses the confidence/anxiety the student experience in performing certain tasks. * The Thanatophobia scale assesses the student's attitudes towards caring for dying patients. The results of the above two scales provided a valid measure of the impact of the current undergraduate palliative curriculum at the University of Stellenbosch. RESULTS: A total of 135 from 179 students responded to the questionnaire (response rate of 75.4%) A minority (21%) of the students felt that their training and skills in palliative care was sufficient. Only 28% of students feel comfortable to discuss death with a patient. 52.7% of students felt anxious about their communication skills. Certain topics were highlighted as challenges: Discussing death with the patient and family, answering questions on pain and suffering and "How long will I live?", as well as the knowledge and management of symptoms in palliative patients. In 2013, the University of Stellenbosch dedicated six hours to the palliative care curriculum. Since 2014, palliative care training has been removed from the curriculum. The study indicated that communication and patient management skills were experienced as challenging by students and this correlated with the curriculum that focused only 15% respectively on these two concepts. CONCLUSION: According to the literature, a lack of palliative care training can result in poor symptom control and inevitably a decrease in quality of care for the patients. The need for palliative care is increasing. To address the palliative care needs of the population, health care professionals should be effectively trained in palliative care. This study highlights the need for a dedicated undergraduate palliative care curriculum that should focus more on communication and patient management's skills to empower the next generation of medical practitioners to care for dying patients with confidence and a positive attitude.

Background: Breast and gynaecological cancers are the leading causes of cancer morbidity and mortality among women in developing countries. Advanced stage diseases with limited availability for treatment imply significant symptom burden; the relief of which poses a challenge for the health care providers. Aim: This study was conducted to measure symptom burden and relief among breast and gynaecological cancer patients accessing care in a tertiary health institution in Nigeria. Objectives : 1)To determine the prevalence of symptoms among breast cancer and gynaecological cancer patients accessing care in UITH, Ilorin; 2) To determine the most distressing symptoms experienced by breast and gynaecological cancer patients accessing care in UITH, Ilorin and 3) To assess symptom relief in the two studied groups. Methods: Both inpatients and outpatients with breast and gynaecologic cancers accessing care during the study period were recruited. All patients completed an interviewer administered MSAS-SF which assesses a 7-day prevalence and distress/frequency of 32 physical/psychological symptoms. Symptom relief was assessed 7 days later. Demographics, cancer stages, treatments received and palliative care referrals were obtained from the case notes. Karnofsky Performance Status Scale was used to assess functional status. Results: Fifty breast and 49 gynaecological cancer patients were studied. Eighty percent of breast cancer and 91.9% of gynaecological cancer patients had advanced cancer. The overall mean number of symptoms was 5.8 ± 4.5 for breast cancer while gynaecological cancers had 8.1 ± 4.6. The top 5 symptoms in breast cancer patients were pain (62%), worrying (44%), feeling sad (42%), weight loss (40%) and difficulty sleeping (38%). Gynaecological cancers had weight loss (67.3%), pain (65.3%), worrying (53.1%), feeling sad (51.0%) and lack of energy (46.9%) as the top 5. The most distressing symptoms were cancer-site specific such as fungating breast masses in breast cancer patients and vaginal bleeding/discharges in gynaecological cancer patients. Both groups similarly had pain and "don't look like myself" as most distressing too. Symptoms reliefs were poor and comparable between the two groups and palliative care referrals were also generally low but worse among breast cancer patients. Gynaecological cancer patients had higher Global Distress Index (GDI= 0.88 Vs 0.48), were more physically distressed (MSAS-PHYS= 0.67 Vs 0.40) and had a poorer KPS (77 ± 17.41 Vs 85 ± 16.91) compared to breast cancer patients. Conclusions: This study shows higher symptom burden in gynaecological cancer patients, a comparably poor symptom relief in both groups and poorer palliative care referrals among breast cancer than the gynaecologic cancer patients. Gynaecological cancer patients had higher symptom prevalence and higher symptom distress scores and lower performance status compared to the breast cancer patients.

Background: The palliative and supportive care needs of children with cancer and their families are unique and require special attention. Children and their families in Africa facing lifethreatening/ life-limiting diseases have unique needs and have the right to achieve effective and evidence-based care. Development of appropriate services sensitive to the needs of families and based on observed evidence has become more and more recognized. As an introduction to develop and improve supportive and palliative care services for children with cancer, families were questioned regarding their experiences and suggestions for improvements. Methods: Sixteen family members of children with cancer and treated at Universitas Academic Hospital, Bloemfontein, South Africa, were questioned regarding their children's standard oncology and supportive/palliative care. Their responses were studied and repeating themes were identified. Results: A number of areas of need were identified: erratic psychosocial support, minimal financial support, poor parental access to basic needs and food provision, preventable errors in procedures and lack of sibling support. Staff were also not always sufficiently equipped to attend to palliative care patients. Conclusions: Supportive and palliative care for children with cancer needs to be improved. Family members are a valuable resource and the interviews identified a number of themes, valuable to consider in the expansion of a supportive/palliative care service. The intension of the study was to create the awareness that by making small and affordable changes, the quality of care that children and families receive can be improved.

Introduction: The Palliative Care needs of patients with Drug-Resistant Tuberculosis (DR-TB) are under-researched, yet pertinent in the management and control of DR-TB. Most literature reviewed focused on treatment schedules, outcomes, transmission, drug adherence, drug side effects and further drug-resistance. Aim: The aim was to determine the palliative care needs of patients infected with DR-TB living in the Southern sub-district of Cape Town. The Objectives The objectives were to determine the quality of life and symptom burden of DR-TB patients and to assess for correlation between these variables and palliative care needs. Methodology: In this cross-sectional study, twenty-eight participants were posed a culturally sensitive questionnaire designed by the researcher, that comprised: demographic questions, Likert-type questions for the African Palliative Care Association – Palliative Outcome Score (APCA-POS) tool, Eastern Co-operative Oncology Group (ECOG) score, a symptom checklist and open patient dignity questions. Quantitative and qualitative data of the respondents’ quality of life, functional status and burden of symptoms in the preceding week were ascertained. Pre-determined numerical scores in the Likert-type questions were deemed indicative of palliative care need. Results: Quantitative and qualitative analysis of the data showed that each participant had a palliative care need: be it either (or a combination of) unmet clinical, psychological, social and/or spiritual needs - despite being at differing stages of the DR-TB disease trajectory. These needs required contextualizing within the respondents’ communities where socio-economic issues were prevalent. Predominant physical complaints were tiredness (79%), joint pain (64%), confusion (61%) and shortness of breath (51%). Respondents’ also experienced a loss of autonomy, poor self-value and financial insecurity. Fifty percent of patients interviewed required urgent further management and referral to the local clinic. Conclusion: Despite the small cohort of patients and possible recruitment bias, this research concurred that a palliative care approach be adopted from the point of DR-TB diagnosis and throughout the treatment period – regardless of treatment outcome; and that DR-TB patients had significant unmet palliative care needs that affected their quality of life, functional status and dignity, regardless of whether pain was present.