Elizabeth Namukwaya

Background: Place of death is a key population health indicator routinely recorded in death certificates. Monitoring place of death can help identify health inequalities. Studies using death certificates have examined place of death across countries, yet no synthesis exists. We aimed to identify cross-national commonalities and differences in place of death classifications, distributions and associated factors in multi-country comparative death certificate studies. Methods: We searched MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science and grey literature for death certificate studies comparing place of death across two or more countries. We extracted data on countries, years, causes of death, place of death and associated factors, assessed study quality using the Newcastle-Ottawa Scale and narratively synthesised findings. Results: We included 19 studies (68,433 − 100 million deaths; 1957–2021) examining place of death and associated factors across 72 countries (27 low- and middle-income). Despite heterogeneity, hospital/health institution (60 countries, 17 studies) and home (62 countries, 12 studies) were the most frequently analysed place of death categories. Hospital/health institution deaths ranged from 11% (Albania) to 87% (Taiwan) and home deaths ranged from 11% (Malta) to 83% (Uganda). Fewer studies examined deaths at long-term care facility/nursing home and palliative care/hospice facility. Age, sex/gender and cause of death were the most frequently examined factors. Oldest age was generally associated with death at home and long-term care facility/nursing home, while findings on sex/gender were inconsistent. Cancer was consistently associated with lower odds of death in long-term care facility/nursing home and markedly higher odds of death in palliative care/hospice facility (relative risk 2.5–32). Country differences persisted after adjustment for confounding factors, including individual characteristics and healthcare resource availability. Conclusion: Our findings show cross-country variation in place of death classifications, distribution, and associated factors. Persistent country differences suggest that broader health and care system and policy contexts may influence where people die, underscoring concerns about global health inequalities. An internationally harmonised place of death classification may help improve health monitoring and support future epidemiological research.

Objective: The aim of this scoping review is to identify the currently available mHealth interventions for palliative care and factors influencing their use in sub-Saharan Africa (SSA). Introduction: Although palliative care is essential for improving quality of life, its use in SSA remains low. mHealth (an interaction with a mobile device) interventions could enhance and promote palliative care in the region. Integration of mHealth into palliative care has been observed across Europe and the USA to support pain management and improve communication between health professionals and patients; however, there is little evidence on its use in low- and middle-income countries. Eligibility criteria: Eligible studies will involve key stakeholders in palliative care, such as patients with life-limiting illnesses (eg, cancer), health professionals, community volunteer workers, and community leaders. Studies reporting evidence on mHealth in the design, implementation, or evaluation of palliative care services in any country in SSA will be considered. Methods: The review will follow JBI methodology for scoping reviews and will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The following sources will be searched for published and unpublished literature: CINAHL (EBSCOhost), PubMed (Ovid), Embase (Ovid), the Cochrane Library, Google Scholar, Scopus, Web of Science, and ProQuest Dissertations and Theses Global. Study screening and selection will be conducted independently by 2 reviewers. Data will be extracted using a modified JBI data charting form, and will be presented in tabular format and narrative summary. Review registration: OSF https://osf.io/gbqcn/overview

Background: Whenever possible, a person should die where they feel it is the right place to be. There is substantial global variation in home death percentages but it is unclear whether these differences reflect preferences, and there are major limitations in how the place of death is classified and compared across countries. Objectives: EOLinPLACE is an international interdisciplinary research project funded by the European Research Council aiming to create a solid base for a ground-breaking international classification tool that will enable the mapping of preferred and actual places towards death. Design: Mixed-methods observational research. Methods and analysis: We combine classic methods of developing health classifications with a bottom-up participatory research approach, working with international organizations representing patients and informal carers [International Alliance of Patients’ Organizations (IAPO) and Eurocarers]. First, we will conduct an international comparative analysis of existing classification systems and routinely collected death certificate data on place of death. Secondly, we will conduct a mixed-methods study (ethnography followed by longitudinal quantitative study) in four countries (the Netherlands, Portugal, Uganda and the United States), to compare the preferences and experiences of patients with life-threatening conditions and their families. Thirdly, based on the generated evidence, we will build a contemporary classification of dying places; assess its content validity through focus groups with patients, carers and other stakeholders; and evaluate it in a psychometric study to examine construct validity, reliability, responsiveness, data quality and interpretability. Ethics: Approved by the ethics committee of the University of Coimbra, Faculty of Medicine (CE-068-2022) and committees in each of the participating countries. Discussion: The findings will provide a deeper understanding of the diversity in individual end-of-life pathways. They will enable key developments such as measurement of progress towards achievement of preferences when care can be planned. The project will open new directions in how to care for the dying. Trial registration: Research Registry UIN 9213.

PURPOSE: AIDS-related mortality declined markedly since the introduction of antiretroviral therapy (ART); however, cancer mortality in Africa was higher than its incidence in 2020. People living with HIV (PLWHIV) are at an increased risk of malignancy and death from malignancy compared with the general population. In Uganda, AIDS-defining malignancies (ADMs), including cervical cancer, Kaposi sarcoma, and non-Hodgkin lymphoma, are among the commonest malignancies. Virologic nonsuppression has been identified as an important predictor of mortality among PLWHIV diagnosed with cancer. This study aimed to determine the prevalence and to identify factors associated with virologic nonsuppression among PLWHIV newly diagnosed with cancer. METHODS: This was a cross-sectional study that was carried out between December 2018 and April 2019 at the Uganda Cancer Institute. PLWHIV who had been on ART for at least 6 months and were newly diagnosed with cancer were enrolled. RESULTS: A total of 167 participants were enrolled. Cervical cancer was the commonest ADM (n = 45; 50.6%) of all ADMs, while esophageal and breast cancers were the commonest non-ADMs, accounting for 17.5% (n = 14) each of all non-ADMs. The prevalence of virologic nonsuppression was 15%. Having Kaposi sarcoma (odds ratio [OR], 8.15; P = .003), being poorly adherent to ART (OR, 4.1; P = .045), and being on second-line ART (OR, 5.68; P = .011) were associated with virologic nonsuppression. CONCLUSION: The prevalence of virologic nonsuppression is high among patients with HIV newly diagnosed with cancer. These findings emphasize the need for strengthening of adherence strategies, optimizing ART regimens, and prioritization of viral load testing among PLWHIV with newly diagnosed malignancy.

Introduction Palliative care is a clinically and cost‐effective component of cancer services in sub-Saharan Africa (SSA). Despite the significant need for palliative cancer care in SSA, coverage remains inadequate. The exploration of digital health approaches could support increases in the quality and reach of palliative cancer care services in SSA. However, there is currently a lack of any theoretical underpinning or data to understand stakeholder drivers for digital health components in this context. This project addresses this gap through engaging with key stakeholders to determine data and information needs that could be supported through digital health interventions. Methods and analysis This is a multicountry, cross-sectional, qualitative study conducted in Nigeria, Uganda and Zimbabwe. In-depth interviews will be conducted in patients with advanced cancer (n=20), caregivers (n=15), health professionals (n=20) and policy-makers (n=10) in each of the three participating countries. Data from a total of 195 interviews will transcribed verbatim and translated into English before being imported into NVivo software for deductive framework analysis. The analysis will seek to understand the acceptability and define mechanisms of patient-level data capture and usage via digital technologies. Ethics and dissemination Ethics approvals have been obtained from the Institutional Review Boards of University of Leeds (Ref: MREC 18–032), Research Council of Zimbabwe (Ref: 03507), Medical Research Council of Zimbabwe (Ref: MRCZ/A/2421), Uganda Cancer Institute (Ref: 19–2018), Uganda National Council of Science and Technology (Ref: HS325ES) and College of Medicine University of Lagos (Ref: HREC/15/04/2015). The project seeks to determine optimal mechanisms for the design and development of subsequent digital health interventions to support development, access to, and delivery of palliative cancer care in SSA. Dissemination of these findings will occur through newsletters and press releases, conference presentations, peer-reviewed journals and social media. Trial registration number ISRCTN15727711

While early involvement and integration of palliative care with oncology can positively impact quality of life and survival of patients with advanced cancer, there is a dearth of information regarding this integration in sub-Saharan Africa. We sought to describe the rate and factors predicting specialist palliative referrals among cancer patients in Uganda. We examined the rate of referrals of cancer patients to palliative specialists via a chart review, while also surveying and interviewing doctors at the Uganda Cancer Institute (UCI) about their approaches to palliative care. All adult patients at the UCI who died in a 20-month interval from 2014 to 2015. All UCI doctors were approached for the survey and 25 (96%) participated. Seven of these doctors were also individually interviewed. Number of referrals to palliative specialists and qualitative responses to questions about end-of-life care management. Sixty-six (11.1%) of 595 patients were referred to palliative care specialists. Patients with worse ECOG performance statuses were more likely to be referred to palliative specialists (odds ratio 2.23, p = 0.03); no other factors were predictive of a referral. Median number of days lived after referral was 5 days (interquartile range 2-13). Doctors explained the low referral rate and short life expectancy after referral by limited palliative resources and a reticence to have end-of-life management conversations with patients due to cultural taboos. Despite recognized benefits of palliative collaboration, doctors at the UCI seldom refer patients to palliative care specialists due to limited staffing, cultural barriers, and difficult interservice communication.