P-136 Providing palliative care to the world’s poorest: a service review of a community palliative care programme in mulanje mission hospital, malawi

Abstract

Background Despite a huge need for palliative care in Sub-Saharan Africa it is estimated that only 5% of those requiring palliative care in Sub-Saharan Africa receive it. 1 One hospital providing an outpatient palliative care service since is Mulanje Mission Hospital (MMH) in southern Malawi. The clinic currently services 462 patients between 3 nurses, with appointments offered 2–3 times per year. Due to geographical challenges one home visit can take up to 5 hours to complete. As part of Swindon Academy’s External Student Selected Component program a field trip to MMH was undertaken in 2016. Approval from the senior board of MMH this service evaluation aimed to analyse the population demographic and look for any patterns of mortality. Methods 100 outpatient palliative care records were examined from a 2 year sample to determine the last point of contact with the patient and the number of years they spent in the programme, with Chi-squared tests used to assess significance. Results Of the 100 patients 45 died within one year of first contact. 32% of these deaths were due to Kaposi Sarcoma (KS), despite KS making up 57% of the primary diagnosis. Conversely 53% of deaths within one year were due to other non-KS cancers, most commonly cervical. It was statistically significant that a patient was more likely to be alive with KS than with other type of cancer (p=0.0000162). Conclusions To correctly prioritise the needs of palliative care patients in low resource settings there needs to be identification of patients who are most likely to require intensive input. Anticipating the need for end of life care may allow increased clinic reviews and ultimately better symptom management to be prioritised. Reference 1. Harding, R Powell, RA Downing, J Connor, et al . Generating an African palliative care evidence base: the context, need, challenges, and strategies. J Pain Symptom Manage 2008;36(3):304–9.