Presenting symptoms and signs in children referred for palliative care in Malawi

Abstract

A study of 95 children referred for palliative care was carried out at Queen Elizabeth Central Hospital in southern Malawi, to determine the prevalence of different symptoms and signs. Seventy-seven percent of the children had HIV, 17% had cancer and 6% had a variety of other diagnoses. The commonest symptoms spontaneously presented by patients and carers were pain (27%) cough (22%) and diarrhoea (18%). Pain was significantly more common among children with cancer than those with HIV/AIDS. Cough, diarrhoea and mouth sores were significantly more common in those with HIV/AIDS. Many symptoms were not volunteered initially, but were revealed on direct questioning. This uncovered that 84% had a history of weight loss, 56% had fever and 51% had mouth sores. The commonest physical signs were wasting (76%), lymphadenopathy (40%) and oral candida (40%). Forty-seven percent of children with HIV had either lost their mother or had a mother who was sick. The wide range of physical symptoms and frequency of sickness or death in the children's mothers demonstrates the need for palliative care to be holistic, addressing the manifold physical, emotional and social problems associated with chronic and terminal illness.

Prevalence, profile and predictors of malnutrition in children with congenital heart defects: a case-control observational study

“…Growth is considered to be the best global indicator of children's well-being, and growth impairment has both short- and long-term consequences 26–39. Progressive decline in nutritional status is linked with active and poorly controlled disease, and deteriorating cardiac function, morbidity and mortality 4–6…”

Children's palliative care in low- and middle-income countries

“…Umodzi (http://palliativecaresupportmw.org/index.php/2013-05-14-08-49-44/paediatric-care) is a CPC programme based at Queen Elizabeth Central Hospital in Blantyre, Malawi 9 28 35 36. It is part of the Palliative Care Support Trust (http://www.palliativecaresupportmw.org), a charitable organisation supporting, promoting and developing palliative care services to patients and families in Blantyre district and the surrounding communities.…”

“…These include a study on presenting symptoms in children referred for palliative care in Malawi,28 the needs of HIV-exposed and infected children in Uganda34 and lessons learnt through the development of beacon centres in Tanzania, Uganda and South Africa 48. A recent study to identify the need for CPC, assessing provision and its gaps in three countries—Kenya, South Africa and Zimbabwe—is part of a wider study to estimate global need for CPC 18 20.…”

Reporting of pediatric palliative care: A systematic review and quantitative analysis of research publications in palliative care journals

“…Individually, AJHPC had 16 articles,[20–35] BMCPC had 0 article, COSPC had 0 article, IJPC had 3 articles,[36–38] IJPN had 12 articles,[39–50] JHPN had 1 article,[51] JPC had 11 articles,[52–62] JPM had 35 articles,[63–97] JPPCP had 1 article,[98] JSWELPC had 5 articles,[99–103] PM had 9 articles,[104–112] and PSC had 4 articles[113–116] on “pediatric palliative care.” Also refer to Table 1 for respective reporting rates for journals and Figure 3 for the comparison of number of “pediatric” articles and “nonpediatric” articles between the journals.…”