• Justin M Amery, Caroline J Rose, Jennie Holmes, Jerry Nguyen, and Charles Byarugaba.
• Hospice Africa Uganda, Kampala, Uganda. justin@amery.org
• J Palliat Med. 2009 Nov 1;12(11):1015-21.

AimTo evaluate a children's palliative care service designed specifically for a resource-poor sub-Saharan African setting.MethodologyThe study used mixed quantitative and qualitative methodology: quantitative retrospective, comparative survey and cross-sectional, noninterventional interview survey.ResultsEvaluation showed increases in referrals, proportion of children on program, morphine and chemotherapy prescriptions, and improved compliance for a cost of $100 per child. The most valued service strengths were free drugs, food, play, learning, and staff attitude. Weaknesses included insufficiency of strengths listed above, as well as poor hospital staff attitude, lack of school fees and poor treatment compliance rates. Suggestions included more of the strengths as well as more accessible service locations.DiscussionThe study suggests affordable, nurse-led, volunteer-supported children's palliative care services are both achievable and effective in sub-Saharan African. The study suggests that palliative care units should provide a specialized service focused on children. Such a service would clearly identify children in need of children's palliative care and should provide medication for symptom control; food and basic needs support; play and learning facilities; child protection; and systems for patient education, communication and follow up. Staff lack confidence and/or competence and this is a significant barrier to children's palliative care that should be addressed in Africa.

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