An investigation of the beliefs, attitudes and practice of health care workers towards the use of oral morphine in the palliative care management of HIV/AIDS and cancer patients in the Southern Region of Malawi
Master Thesis
2008
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University of Cape Town
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[Background] Palliative care has been highlighted as an urgent need for patients with both HIV/AIDS and cancer in sub-Saharan Africa. Morphine is considered by the WHO as the drug of choice for severe pain in cancer. Pain is common in people with HIV/AIDS, though it is frequently unrecognised or poorly treated. Health workers fears about morphine have been reported to be a barrier to patients' accessing necessary pain medication in studies from Africa as well as other parts of the world. [ Methods ] Semi-structured interviews were conducted with a total of fifteen nurses, clinicians, health service managers and pharmacy staff at five sites in the Southern Region of Malawi between November 2007 and February 2008. Study sites were randomly selected from groupings representing the different hospital institutions which exist in the region (district and central government institutions and mission hospitals). Interviews were conducted in either English or Chichewa. After translation, interview data was intensively reviewed by the researcher and emerging themes were identified. [ Results ] Three main themes were identified during the interviews. Firstly the availability of oral morphine, secondly concerns about opiate misuse and thirdly the need 6 for education and training amongst health workers and community members. Respondents understood that morphine was a strong pain killer, which they thought was useful and should be more widely available for patients with both HIV/AIDS and cancer related problems, though reported stock outs at their institutions were common. Oral morphine was available at only two of the institutions visited at the time of the interviews. A third of respondents were unable to supply information on correct practises for storage and reporting of morphine. Concerns were expressed about making oral morphine available to patients at home. Fears about addiction (either amongst patients or health workers) directly affected their prescribing practise, as respondents reported that they may either prescribe lower doses or only prescribe morphine late in the course of the illness to try to reduce the risk of addiction. [ Conclusions and recommendations ] Many of the health workers requested improved availability of oral morphine to treat patients with HIV/AIDS and cancer with severe pain. However other beliefs, attitudes and practises of health workers in the Southern Region of Malawi present major barriers to timely access to oral morphine for patients in need. Further education, training and hands on experience are required for health care workers (including pharmacy staff). Advocacy should be intensified at national and international level towards the development of appropriate policies and supply chains to improve the availability of morphine for medical purposes.
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Bates, J. 2008. An investigation of the beliefs, attitudes and practice of health care workers towards the use of oral morphine in the palliative care management of HIV/AIDS and cancer patients in the Southern Region of Malawi. University of Cape Town.