The rising number of people living with HIV/AIDS (PLWHA) worldwide has made health care professionals and policy makers search for accessible health care that will meet the needs of people who are suffering from the disease and enhance their quality of life (QoL). This study investigated met and unmet palliative care needs of PLWHA in selected areas in Rwanda. The study sample included 306 participants: PLWHA, health care professionals and coordinators of HIV/AIDS units. Quantitative and qualitative methodologies were used. The data were analysed separately and then triangulated. In the findings, over 50% of PLWHA had symptoms related to HIV/AIDS most of the time, with the most common symptom being pain. Participation in activities of daily living was significantly associated with the health status of PLWHA (p<0.001). The most common perceived palliative care needs of PLWHA were medical needs, psychosocial needs and the need for financial assistance (77%); home-based care (47%); nutritional support (44%); and pain relief and management of other symptoms (43%). Most PLWHA indicated these palliative care needs were unmet, in particular the need for pain relief, symptom management, financial assistance and nutritional support. Over 50% of health care professionals reported they were not trained in palliative care. They indicated that inadequate policy and resources were the main obstacles to the provision of optimal palliative care. Addressing unmet palliative care needs would enhance the QoL of PLWHA. In addition, developing policy related to the provision of palliative care and building the capacity of health care providers is essential for the provision of adequate palliative care services in Rwanda.

Clubfoot is a congenital structural impairment that, if untreated or inadequately treated, leads to deformity. Effective management is dependent on the compliance of parents to the treatment for clubfoot. A cross-sectional descriptive survey using a questionnaire identified the barriers parents encounter in bringing their children for treatment during the plaster-casting stage of managing clubfoot at the Talipes Clinics at Mbarara Regional Hospital and Mulago Hospital in Uganda. A total of 167 parents participated in the study. Ninety percent of the parents had attended weekly clinics with 67% indicating that they did not know about clubfoot and its treatment. The study found a significant association between compliance and transport costs (P = 0.014); distance travelled (P = 0.005); and family support (P = 0.028). Other barriers highlighted include the need to improve the communication skills between clinicians offering treatment to children with clubfoot and their parents. Informed parents could assist with compliance to treatment.

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PurposeThis paper examines the role of two higher education institutions in the Western Cape, South Africa, and how their initiatives and collaboration brought about a particular Health Promoting Schools (HPS) program in a resource poor setting. The aim of this paper is to reflect on the importance of the role that external systemic actors and stakeholders can play in the process of designing and implementing HPS programs in resource poor settings. Design/methodology/approachIn this paper a complex systems approach is employed to describe two different participatory methods of engagement with HPS by higher education institutions. On the one hand, engagement took place in terms of a formal and funded project, directed at the organizational level of the school, with capacity building as its aim. On the other hand, engagement was initiated informally (as part of a service learning project) via collaboration with the formal project, directed at the individual level of learners in the school. FindingsIn recognizing the complex nature of planning and implementing HPS programs, the paper demonstrates that HPS approaches could benefit from engaging with resources outside the ambit of institutional health and educational policies and structures. Originality/valueBy acknowledging the systemic nature of implementing HPS strategies, novel collaborations emerge as a result. The paper highlights the important role that external stakeholders such as higher education institutions play in creating and sustaining tailor-made HPS programs for schools based in resource poor settings.