Palliative care in Malawi: a scoping review

Natalie Palumbo; Alyssa Tilly; Eve Namisango; Christian Ntizimira; Lameck Thambo; Maria Chikasema; Gary Rodin

doi:10.1186/s12904-023-01264-8

Palliative care in Malawi: a scoping review

BMC Palliat Care. 2023 Oct 4;22(1):146. doi: 10.1186/s12904-023-01264-8.

Authors

Natalie Palumbo¹, Alyssa Tilly², Eve Namisango^{3

4}, Christian Ntizimira⁵, Lameck Thambo⁶, Maria Chikasema⁷, Gary Rodin^{8

9

10}

Affiliations

¹ Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, Canada.
² Division of General Medicine and Clinical Epidemiology and Palliative Care Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³ African Palliative Care Association, Kampala, Uganda.
⁴ Cicely Saunders Institute, King's College London, London, UK.
⁵ African Center for Research on End of Life Care, Kigali, Rwanda.
⁶ Palliative Care Association of Malawi, Lilongwe, Malawi.
⁷ UNC Project-Malawi, Lilongwe, Malawi.
⁸ Department of Supportive Care, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada. Gary.Rodin@uhn.ca.
⁹ Princess Margaret Hospital, University Health Network, Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), University of Toronto, Toronto, ON, Canada. Gary.Rodin@uhn.ca.
¹⁰ Department of Psychiatry, University of Toronto, Toronto, ON, Canada. Gary.Rodin@uhn.ca.

Abstract

Background: Universal access to palliative care remains a distant goal in many low resource settings, despite the growing evidence of its benefits. The unmet need for palliative care is evident in Africa, but great strides in palliative care development have occurred in several African countries. Located in sub-Saharan Africa, Malawi has been regarded as an exemplar of progress in this area that is achievable in a low resource region. This scoping review examined the literature on the development and state of palliative care in Malawi according to the pillars of health care policy, medicine availability, education, implementation, research activity, and vitality of professionals and advocates.

Methods: A scoping review was conducted of the MEDLINE, Embase, Global Health, CINAHL, Web of Science and PsycINFO databases, as well as grey literature sources. Articles were included if they explored any aspect of palliative care in Malawi.

Results: 114 articles were identified that met the inclusion criteria. This literature shows that Malawi has implemented diverse strategies across all pillars to develop palliative care. These strategies include creating a national stand-alone palliative care policy; integrating palliative care into the curricula of healthcare professionals and developing training for diverse service providers; establishing systems for the procurement and distribution of opioids; implementing diverse models of palliative care service delivery; and launching a national palliative care association. Malawi has also generated local evidence to inform palliative care, but several research gaps were identified.

Conclusions: Malawi has made considerable progress in palliative care development, although initiatives are needed to improve medicine availability, access in rural areas, and socioeconomic support for patients and their families living with advanced disease. Culturally sensitive research is needed regarding the quality of palliative care and the impact of therapeutic interventions.

Keywords: Malawi; Palliative care development; Public health.

Publication types

Review

MeSH terms

Curriculum
Health Personnel / education
Hospice and Palliative Care Nursing*
Humans
Malawi
Palliative Care*