Mukhula Victoria, Sibale Daisy, Tarmahomed Lubna, Dzamalala Charles, Msyamboza Kelias, Chasimpha Steady
College of Medicine, University of Malawi, Blantyre, Malawi.
Malawi Cancer Registry, Queen Elizabeth Hospital, Blantyre, Malawi.
Malawi Med J. 2017 Jun;29(2):130-135. doi: 10.4314/mmj.v29i2.10.
This paper describes cancer burden and compares characteristics of cancer patients enrolled at 2 palliative care facilities of contrasting resources and geographical locations in Malawi. It also assesses the extent of differences in service delivery and the impact these might have on outcomes.
Data on all cancer patients registered between October 2010 and October 2015 at Tiyanjane Clinic (at Queen Elizabeth Central Hospital, Blantyre) and Mzuzu Central Hospital (MCH) palliative care clinics were extracted and analysed. Key informant in-depth interviews were carried out at both sites. Thematic analysis was used for qualitative data and Excel 2010 and Stata 12 were used for analysis of quantitative data.
Quantitative: There were 1362 and 633 cancer patients at Tiyanjane and MCH, respectively. Overall, females predominated over males (55.8% vs 42.8%); however, Tiyanjane had more males (52.2% vs 45.8%), which was contrary to Mzuzu (77.4% females vs 22.6% males). The 35- to 54-year age group was predominant at both Tiyanjane (43.1%) and Mzuzu (40.1%).Overall, the most common cancers were Kaposi's sarcoma (26.9%), cervical cancer (26.8%), oesophageal cancer (14.2%), hepatocellular carcinoma (4.9%), and bladder cancer (3.0%). Histologically confirmed diagnoses accounted for 13% of cases at Tiyanjane, whereas all patients from MCH were diagnosed clinically. Qualitative: Palliative care services were free of charge at both facilities, and owing to the expansion of services to district hospitals, the workload at central hospitals had been reduced. Between the 2 sites, there were differences in follow-up procedures, drug availabilities, as well as human resource capacity, with Mzuzu palliative care facility facing more extensive challenges.
The characteristics of patients seen at each site varied according to services available. Quality of care was assessed as superior at Tiyanjane, demonstrating the importance of multiple stakeholder involvement in the delivery of palliative care services.
本文描述了马拉维两家资源和地理位置不同的姑息治疗机构收治的癌症患者的癌症负担并比较了其特征。本文还评估了服务提供方面的差异程度以及这些差异可能对治疗结果产生的影响。
提取并分析了2010年10月至2015年10月期间在蒂扬贾内诊所（位于布兰太尔的伊丽莎白女王中央医院）和姆祖祖中心医院姑息治疗诊所登记的所有癌症患者的数据。在这两个地点都进行了关键信息人深入访谈。定性数据采用主题分析法，定量数据采用Excel 2010和Stata 12进行分析。
定量：蒂扬贾内诊所有1362名癌症患者，姆祖祖中心医院有633名癌症患者。总体而言，女性患者多于男性患者（55.8%对42.8%）；然而，蒂扬贾内诊所男性患者更多（52.2%对45.8%），这与姆祖祖中心医院相反（女性患者占77.4%，男性患者占22.6%）。35至54岁年龄组在蒂扬贾内诊所（43.1%）和姆祖祖中心医院（40.1%）均占主导地位。总体而言，最常见的癌症是卡波西肉瘤（26.9%）、宫颈癌（26.8%）、食管癌（14.2%）、肝细胞癌（4.9%）和膀胱癌（3.0%）。在蒂扬贾内诊所，经组织学确诊的病例占13%，而姆祖祖中心医院的所有患者均为临床诊断。定性：两家机构的姑息治疗服务均免费，由于服务扩展到地区医院，中心医院的工作量有所减少。两个地点在随访程序、药品供应以及人力资源能力方面存在差异，姆祖祖姑息治疗机构面临的挑战更为广泛。
每个地点的患者特征因可用服务而异。蒂扬贾内诊所的护理质量被评估为更高，这表明多个利益相关者参与提供姑息治疗服务的重要性。
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