Icahn School of Medicine at Mount Sinai, New York, NY, USA; ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain.
IdiSNA (Institute of Health Research of Navarra), Pamplona, Spain; ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain.
Lancet Oncol. 2017 Sep;18(9):e522-e531. doi: 10.1016/S1470-2045(17)30420-5.
Since the last comprehensive review on the development of national palliative care in Africa was undertaken 12 years ago, in 2005, we did a scoping review of peer-reviewed, published articles on palliative care development between 2005-16 for each African country. The scoping review was conducted by assessing the medical literature and including local expert recommendations of suggested articles. We did a basic quality assessment of the articles using the journals' impact factor, journal quartile, and the number of citations as suitable metrics for quality consideration. Articles published in English, Spanish, Portuguese, and French that mentioned at least one dimension of WHO's palliative care public health strategy (implementation of services, education, policies, or medicine availability) and vitality (activity by professionals or advocates) were included. Of the 518 articles found, 49 met the inclusion criteria. Information on 26 (48%) of 54 African countries was found. Most services were concentrated in Kenya, South Africa, and Uganda, and 14 (26%) countries showed an increase in services during this timeframe. Stand-alone palliative care policies exist in Malawi, Mozambique, Rwanda, Swaziland, Tanzania, and Zimbabwe. Postgraduate diplomas in palliative care are available in Kenya, South Africa, Uganda, and Tanzania. Restricted access to opioids, prescriber restriction laws, and a low prevalence of morphine use remain common barriers to adequate palliative care provision. Although information on palliative care is unevenly distributed, the available information showed an increased development of palliative care services in a subset of African countries. Despite this growth, however, there is still minimal to no identified palliative care development in most African countries.
自 12 年前,即 2005 年对非洲国家的整体姑息治疗发展进行全面审查以来,我们对 2005 年至 2016 年期间每个非洲国家发表的姑息治疗发展同行评议的已出版文章进行了范围界定审查。范围界定审查通过评估医学文献和纳入关于建议文章的当地专家建议进行。我们使用期刊影响因子、期刊四分位数和引用次数作为合适的质量考虑因素对文章进行了基本质量评估。纳入了发表在英语、西班牙语、葡萄牙语和法语的文章,这些文章至少提到了世界卫生组织姑息治疗公共卫生战略(服务实施、教育、政策或药物供应)和活力(专业人员或倡导者的活动)的一个方面。在 518 篇文章中,有 49 篇符合纳入标准。发现了 54 个非洲国家中的 26 个(48%)的信息。大多数服务集中在肯尼亚、南非和乌干达,14 个(26%)国家在此期间服务有所增加。马拉维、莫桑比克、卢旺达、斯威士兰、坦桑尼亚和津巴布韦都有独立的姑息治疗政策。肯尼亚、南非、乌干达和坦桑尼亚都有姑息治疗研究生文凭。阿片类药物的获取受限、处方限制法律以及吗啡使用率低仍然是充分提供姑息治疗的常见障碍。尽管姑息治疗信息分布不均,但现有信息显示,在一些非洲国家中,姑息治疗服务得到了更多的发展。然而,尽管有所增长,但在大多数非洲国家,仍然几乎没有或没有确定的姑息治疗发展。