Hana Hamdi1, Oumar Ba2, Serigne Niang3, Christian Ntizimira4, Mouhadou Mbengue2, Aminata Sophie Coulbary5, Rokhaya Niang6, Matthew Parsons7, Joseph J Amon1, Diederik Lohman8. 1. Columbia University Mailman School of Public Health, New York, New York, USA. 2. Hopital General de Grand Yoff, Dakar, Senegal, Africa. 3. Ministry of Health and Social Action, Dakar, Senegal, Africa. 4. Harvard Medical School, Boston, Massachusetts, USA. 5. Centre Hopitalier de Pekine, Dakar, Senegal, Africa. 6. Dakar, Senegal, Africa. 7. Human Rights Watch, New York, New York, USA. 8. Human Rights Watch, New York, New York, USA. Electronic address: lohmand@hrw.org.
Abstract
CONTEXT: With prevalence of noncommunicable diseases and life expectancy rising in Senegal, the need for palliative care is likely growing. No national palliative care needs assessments have been carried out. OBJECTIVES: To assess the capacity and need for palliative care in Senegal. METHODS: A multicomponent assessment of availability and demand for palliative care was conducted in two tertiary and two regional hospitals in Senegal in 2015 with approval from Senegal's National Ethics Committee for Health Research. The assessment consisted of (1) an inpatient hospital census; (2, 3) surveys of inpatients and outpatients with life-limiting illness; (4) a knowledge, attitudes, and practices survey among health care workers; and (5) a facility survey to assess availability of palliative care medications. RESULTS: Nearly half (44.4%) of all inpatients (n = 167) had an active life-limiting illness. Among them, 56.6% reported moderate-to-severe pain in the past three days, 2.3% of whom received morphine, and 76.7% received weak or no pain medication. Inpatients also experienced moderate-to-severe dyspnea (42.1%), fatigue (66.5%), nausea (16.5%), and drowsiness (42.1%). About 39.2% of all outpatients (n = 395) reported moderate-to-severe pain, and 52.8% reported that the treatment they had received relieved their pain only partially or not at all. Two-thirds of all doctors reported feeling comfortable prescribing pain medicines; however, 83.0% rarely or never prescribed morphine. Two of four hospitals reported no use of morphine in 2014. CONCLUSION: There is significant need for palliative care in Senegal. Training of health care workers and ensuring availability of relevant medications should be prioritized.
CONTEXT: With prevalence of noncommunicable diseases and life expectancy rising in Senegal, the need for palliative care is likely growing. No national palliative care needs assessments have been carried out. OBJECTIVES: To assess the capacity and need for palliative care in Senegal. METHODS: A multicomponent assessment of availability and demand for palliative care was conducted in two tertiary and two regional hospitals in Senegal in 2015 with approval from Senegal's National Ethics Committee for Health Research. The assessment consisted of (1) an inpatient hospital census; (2, 3) surveys of inpatients and outpatients with life-limiting illness; (4) a knowledge, attitudes, and practices survey among health care workers; and (5) a facility survey to assess availability of palliative care medications. RESULTS: Nearly half (44.4%) of all inpatients (n = 167) had an active life-limiting illness. Among them, 56.6% reported moderate-to-severe pain in the past three days, 2.3% of whom received morphine, and 76.7% received weak or no pain medication. Inpatients also experienced moderate-to-severe dyspnea (42.1%), fatigue (66.5%), nausea (16.5%), and drowsiness (42.1%). About 39.2% of all outpatients (n = 395) reported moderate-to-severe pain, and 52.8% reported that the treatment they had received relieved their pain only partially or not at all. Two-thirds of all doctors reported feeling comfortable prescribing pain medicines; however, 83.0% rarely or never prescribed morphine. Two of four hospitals reported no use of morphine in 2014. CONCLUSION: There is significant need for palliative care in Senegal. Training of health care workers and ensuring availability of relevant medications should be prioritized.