title: Provision of palliative care for life-limiting disease in a low income country national hospital setting: how much is needed?
abstract: OBJECTIVE
  This study aimed to measure the magnitude of palliative care needs among hospital inpatients. Objectives were to: (1) determine the point prevalence of inpatients with active life-limiting disease and (2) describe multidimensional need for palliative care among these patients.
  
  
  METHODS
  The study was a hospital inpatient census in Uganda. Patient notes were surveyed and those patients identified as having an active life-limiting disease were interviewed. Multidimensional palliative care need was assessed using the African Palliative Care Association (APCA) African Palliative Outcome Scale (POS).
  
  
  RESULTS
  122/267 (46%) patient notes were found to indicate an active life-limiting disease. Diagnoses were; HIV/AIDS (74/122, 61%), cancer (22/122, 18%), heart failure (11/122, 9%), renal failure (11/122, 9%), liver failure (3/122, 2%) and chronic obstructive pulmonary disease (1/122, 1%). A total of 78/122 patients consented to be interviewed. Most patients reported multidimensional need in the three most negative of six categories for any APCA African POS question (75/78, 96%). Social problems included an inability to work (72/78, 92%), having unaffordable medical expenses (39/78, 50%) and limited access to food (11/78, 14%). Of those with a faith (76/78), more than a third (29/78, 38%) expressed the need for increased faith support.
  
  
  CONCLUSIONS
  The prevalence of active life-limiting disease reported here (46%) is greater than in comparable European studies (5-23%).This reflects the sub-Saharan increased disease prevalence, presentation at a later stage and limited access to curative therapies. There is need for symptom control, food, financial assistance and spiritual support. Service development should be tailored to meet these needs.
authors.affiliation: St. Christopher's Hospice, London, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Lewington
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Namukwaya
authors.forename: Julie
authors.initials: J
authors.lastname: Limoges
authors.forename: Mhoira
authors.initials: M
authors.lastname: Leng
authors.forename: Richard
authors.initials: R
authors.lastname: Harding
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003906:Developing Countries / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000191:economics / Q000706:statistics & numerical data; D010166:Palliative Care / Q000191:economics / Q000706:statistics & numerical data*; D015995:Prevalence; D012067:Religion; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult