Browsing by Author "Luyirika, Emmanuel"

Now showing 1 - 6 of 6
  • Thumbnail Image
    Item
    An Analysis of Palliative Care Development in Africa: A Ranking based on Region-Specific Macro-Indicators
    (Journal of pain and symptom management, 2018) Rhee, John Y.; Garralda, Eduardo; Namisango, Eve; Luyirika, Emmanuel; Centeno, Carlos
    To date, there is no study comparing palliative care (PC) development among African countries.To analyze comparatively PC development in African countries based on region-specific indicators.Data were obtained from the African PC Association Atlas of PC in Africa, and a comparative analysis was conducted. Nineteen indicators were developed and defined through qualitative interviews with African PC experts and a two-round modified Delphi consensus process with international experts on global PC indicators. Indicators were grouped by the World Health Organization public health strategy for PC dimensions. These indicators were then sent as a survey to key informants in 52 of 54 African countries. Through an expert weighting process and ratings from the modified Delphi, weights were assigned to each indicator. Surveys were received from 89% (48 of 54) of African countries. The top three countries in overall PC development were, in order, Uganda, South Africa, and Kenya. Variability existed by dimension. The top three countries in specialized services were Uganda, South Africa, and Nigeria; in policies, it was Botswana followed by parity among Ethiopia, Rwanda, and Swaziland; in medicines, it was Swaziland, South Africa, then Malawi; and in education, it was equivalent between Uganda and Kenya, then Ghana and Zambia.Uganda, South Africa, and Kenya are the highest performing countries and were the only ones with composite scores greater than 0.5 (50%). However, not one country universally supersedes all others across all four PC dimensions. The breakdown of rankings by dimension highlights where even high-performing African countries can focus their efforts to further PC development.
  • Thumbnail Image
    Item
    Factors Affecting Palliative Care Development in Africa: In-Country Experts’ Perceptions in Seven Countries
    (Journal of Pain and Symptom Management, 2018) Rhee, John Y.; Garralda, Eduardo; Namisango, Eve; Luyirika, Emmanuel; de Lima, Liliana; Powell, Richard A.; Robinson, Carole A.; Centeno, Carlos
    Factors contributing to and impeding palliative care (PC) development in Africa can provide insights into current strategies for advancing PC.To identify key factors affecting PC development in African countries from in-country PC experts' perspectives.About 16 PC experts from seven African countries undertook semistructured interviews on PC development in their respective countries. An interpretive description approach was adopted, with data analyzed using constant comparison.Emerged themes included drivers, strengths, challenges, and aspirations for PC development in Africa. Drivers included advocates and pioneering organizations, HIV/AIDS, culture of caregiving, and the World Health Assembly PC resolution. Strengths included community health workers, the special role of nurses, diversity of services, and short training courses. Challenges included lack of PC education; lack of standardization in implementation; limited availability of and/or accessibility to morphine; poverty and disease burden; and lack of funding for PC. Aspirations included integration of PC, specialization in PC, nurse prescribing, and strong partnerships with Ministries of Health. Factors already highlighted in the literature were only briefly discussed.The key factors underpinning PC development in the seven countries contributed to the beginnings of PC in Africa, fueled by advocates who built on existing strengths to maximize opportunities. However, the current approach is at high risk in terms of its sustainability, and strategies for maximizing existing resources and growing infrastructure support are needed moving forward.
  • Thumbnail Image
    Item
    Palliative Care in Africa: a Scoping Review from 2005–16
    (The Lancet Oncology, 2017) Rhee, John Y.; Garralda, Eduardo; Torrado, Carlos; Blanco, Santiago; Namisango, Eve; Luyirika, Emmanuel; Powell, Richard A.; Centeno, Carlos
    Since the last comprehensive review on the development of national palliative care in Africa was undertaken 12 years ago, in 2005, we did a scoping review of peer-reviewed, published articles on palliative care development between 2005–16 for each African country. The scoping review was conducted by assessing the medical literature and including local expert recommendations of suggested articles. We did a basic quality assessment of the articles using the journals' impact factor, journal quartile, and the number of citations as suitable metrics for quality consideration. Articles published in English, Spanish, Portuguese, and French that mentioned at least one dimension of WHO's palliative care public health strategy (implementation of services, education, policies, or medicine availability) and vitality (activity by professionals or advocates) were included. Of the 518 articles found, 49 met the inclusion criteria. Information on 26 (48%) of 54 African countries was found. Most services were concentrated in Kenya, South Africa, and Uganda, and 14 (26%) countries showed an increase in services during this timeframe. Stand-alone palliative care policies exist in Malawi, Mozambique, Rwanda, Swaziland, Tanzania, and Zimbabwe. Postgraduate diplomas in palliative care are available in Kenya, South Africa, Uganda, and Tanzania. Restricted access to opioids, prescriber restriction laws, and a low prevalence of morphine use remain common barriers to adequate palliative care provision. Although information on palliative care is unevenly distributed, the available information showed an increased development of palliative care services in a subset of African countries. Despite this growth, however, there is still minimal to no identified palliative care development in most African countries.
  • Thumbnail Image
    Item
    Progress Update: Palliative Care Development Between 2017 and 2020 in Five African Countries
    (Journal of Pain and Symptom Management, 2022) Luyirika, Emmanuel; Ali, Zipporah; Atieno, Mackuline; Mahenge, Anna; Muinga, Esther; Musyoki, David; Mwesiga, Mark Donald; Namisango, Eve; Opio, Geoffrey; Ruzima, Aimable; Zalwango, Joyce; Aluso, Aggrey
    This article provides a progress update on the development of palliative care in five countries in Africa—Kenya, Rwanda, South Africa, Tanzania, and Uganda—between 2017 and 2021, and explores the role of palliative care advocates and the Open Society Foundations in this process.To provide a progress update on the development of palliative care in Kenya, Rwanda, South Africa, Tanzania, and Uganda between 2017 and 2021 and to examine the impact of twenty years of Open Society Foundations support for palliative care in the region on the integration of palliative care into publicly funded health systems.In the mid-2000s, palliative care pioneers in these five countries, supported by Open Society Foundations, began to train health care providers and engage policy makers to ensure that people with life-limiting illnesses and their families had access to appropriate services and essential medicines. In the late 2010s, it embraced an approach that mixed strategic communications and advocacy for inclusion of palliative care into universal health coverage with technical assistance.By the mid-2010s, a vibrant palliative care community existed that worked closely with governments to develop palliative care policies, train providers, and ensure access to morphine. By 2021, Kenya and Rwanda had made significant progress scaling up palliative care services as part of the public health care system, and Uganda's government had instructed public hospitals to start providing these services. In South Africa and Tanzania, governments had yet to commit to publicly funded palliative care services.The experiences in these countries suggest that mixing advocacy, communications, and technical assistance can lead to substantial progress for patient access although full inclusion in universal health coverage remained uncertain in all but Rwanda.
  • Thumbnail Image
    Item
    The quality of death and dying of patients with advanced cancer in hospice care in Uganda and Kenya
    (Cambridge University Press, 2023-11) Goombs, Mary; Mah, Kenneth; Namisango, Eve; Luyirika, Emmanuel; Mwangi-Powell, Faith; Gikaara, Nancy; Chalklin, Lesley; Rydall, Anne; Zimmermann, Camilla; Hales, Sarah; Wolofsky, Kayla; Tilly, Alyssa; Powell, Richard A; Rodin, Gary
    Abstract Objectives. Minimal information is available about the quality of dying and death in Uganda and Kenya, which are African leaders in palliative care. We investigated the quality of dying and death in patients with advanced cancer who had received hospice care in Uganda or Kenya. Methods. Observational study with bereaved caregivers of decedents (Uganda: n = 202; Kenya: n = 127) with advanced cancer who had received care from participating hospices in Uganda or Kenya. Participants completed the Quality of Dying and Death questionnaire and a measure of family satisfaction with cancer care (FAMCARE). Results. Quality of Dying and Death Preparation and Connectedness subscales were most frequently rated as good to almost perfect for patients in both countries (45.5% to 81.9%), while Symptom Control and Transcendence subscales were most frequently rated as intermediate (42.6% to 60.4%). However, 35.4% to 67.7% of caregivers rated overall quality of dying and overall quality of death as terrible to poor. Ugandan caregivers reported lower Preparation, Connectedness, and Transcendence (p < .001). Controlling for covariates, overall quality of dying was associated with better Symptom Control in both countries (p < .001) and Transcendence in Uganda (p = .010); overall quality of death, with greater Transcendence in Uganda (p = .004); and family satisfaction with care, with better Preparation in Uganda (p = .004). Significance of results. Findings indicate strengths in spiritual and social domains of the quality of dying and death in patients who received hospice care in Uganda and Kenya, but better symptom control is needed to improve this outcome in these countries.
  • Thumbnail Image
    Item
    Women, economic hardship and the path of survival: HIV/AIDS risk behavior among women receiving HIV/AIDS treatment in Uganda
    (Psychological and Socio-medical Aspects of AIDS/HIV, 2014) MacLachlan, Ellen; Neema, Stella; Luyirika, Emmanuel; Ssali, Francis; Juncker, Margrethe; Rwabukwali, Charles; Harvey, Marie; Duncan, Terry
    The results are presented from a 2005 survey of 377 women in four HIV/AIDS treatment programs in Uganda. The aim of the study was to explore women’s economic hardships and the association with four sexual risk behaviors: whether a woman was sexually active in the last 12 months, whether a condom was used during the last sex act, whether she reported having had a sexual partner in the last six months who she suspected had multiple partners and report of forced, coercive or survival sex in the last six months. Few women were sexually active (34%), likely due to the high proportion of widows (49%). Married women were likely to report forced, coercive or survival sex (35%). Eighty-four percent of women reported condom used at last sex act. Forced, coercive or survival sex was associated with number of meals missed per week (AOR 1.125, 95% CI 1.11, 1.587, pB0.05). Sex with a partner in the last six months who a woman suspected had multiple partners was also associated with number of missed meals per week (AOR 2.080, 95% CI 1.084, 3.992). Currently women in Ugandan antiretroviral therapy programs are not likely to be sexually active, except for married women. Many women need to find food and other support, which may put them at risk of forced, coercive or survival sex due to dependency on men.