title: Assessment of palliative care services in western Kenya.
abstract: BACKGROUND
  The need for palliative care services is rapidly increasing due to the rising number of patients with non-communicable diseases. The objective of this study was to assess the current availability and barriers to palliative care and healthcare worker knowledge and perceptions on palliative pain control in western Kenya.
  
  
  METHODS
  An evidence-based 40-question assessment tool was conducted between October 2015 and February 2016 in Siaya County, western Kenya. All level 4 and 5 facilities (e.g., regional and district hospitals) were assessed, as well as a selection of lower-level facilities chosen via convenience sampling, stratified by facility level (e.g., dispensaries, health centers, and health clinics).
  
  
  RESULTS
  A key informant at each of 22 facilities was surveyed and included 1 medical officer (5%), 12 clinical officers (55%), and 9 nurses (41%). Key themes included training and education, awareness of palliative care and hospice, services provided, and pain control. All 22 providers had heard of palliative care and 4 (18%) had received formal training. Fourteen (64%) providers knew that morphine was on the World Health Organization (WHO) essential medication list, 8 (36%) had previously prescribed opioids, and 5 (23%) had prescribed them for palliation. Provider concerns for opioid use included its addictive properties (59%), appropriate dosing (9%), cost (5%), side effects (9%), and availability (5%).
  
  
  CONCLUSIONS
  Palliative care and hospice services were identified by providers as important components in the management of chronic illnesses in western Kenya. Further provider education as well as increased access to pain medications including opioids is necessary to improve the care of patients in western Kenya.
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; HarvardT.H. Chan School of Public Health, Boston, MA, USA; Sagam Community Hospital, Luanda, Kenya. Hijabz@gmail.com.
authors.forename: Hijab
authors.initials: H
authors.lastname: Zubairi
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Sagam Community Hospital, Luanda, Kenya.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Tulshian
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Sagam Community Hospital, Luanda, Kenya.
authors.forename: Sarah
authors.initials: S
authors.lastname: Villegas
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Sagam Community Hospital, Luanda, Kenya; Harvard Medical School, Boston, MA, USA.
authors.forename: Brett D
authors.initials: BD
authors.lastname: Nelson
authors.affiliation: Sagam Community Hospital, Luanda, Kenya.
authors.forename: Kennedy
authors.initials: K
authors.lastname: Ouma
authors.affiliation: Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; HarvardT.H. Chan School of Public Health, Boston, MA, USA; Sagam Community Hospital, Luanda, Kenya; Harvard Medical School, Boston, MA, USA.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Burke
mesh_terms: D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D010166:Palliative Care; D011795:Surveys and Questionnaires
keywords: Developing countries; Kenya; end of life care; hospice; morphine; palliative care; sub-Saharan Africa