{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:43:52Z","timestamp":1790729032801,"version":"4.1.0"},"reference-count":58,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2014,10,14]],"date-time":"2014-10-14T00:00:00Z","timestamp":1413244800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"DOI":"10.1371\/journal.pone.0110457","type":"journal-article","created":{"date-parts":[[2014,10,14]],"date-time":"2014-10-14T14:11:52Z","timestamp":1413295912000},"page":"e110457","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":60,"title":["Assessing and Responding to Palliative Care Needs in Rural Sub-Saharan Africa: Results from a Model Intervention and Situation Analysis in Malawi"],"prefix":"10.1371","volume":"9","author":[{"given":"Michael E.","family":"Herce","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shekinah N.","family":"Elmore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noel","family":"Kalanga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James W.","family":"Keck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily B.","family":"Wroe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atupere","family":"Phiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alishya","family":"Mayfield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Chingoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason A.","family":"Beste","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Listern","family":"Tengatenga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junior","family":"Bazile","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric L.","family":"Krakauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Rigodon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2014,10,14]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1971","DOI":"10.1016\/S0140-6736(05)66666-4","article-title":"Palliative care in sub-Saharan Africa","volume":"365(9475)","author":"R Harding","year":"2005","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1056\/NEJMoa1000678","article-title":"Early palliative care for patients with metastatic non-small-cell lung cancer","volume":"363(8)","author":"JS Temel","year":"2010","journal-title":"NEJM"},{"key":"ref3","unstructured":"Eramova I, Matic S, Munz M (2007) HIV\/AIDS treatment and care: clinical protocols for the WHO European Region. Available: http:\/\/www.euro.who.int\/__data\/assets\/pdf_file\/0004\/78106\/E90840.pdf<\/ext-link>. Accessed 2013 Dec 13."},{"key":"ref4","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/S1473-3099(12)70085-3","article-title":"Integration of palliative care throughout HIV disease","volume":"12","author":"V Simms","year":"2012","journal-title":"Lancet Infect Dis"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1093\/cid\/ciq180","article-title":"Quality HIV care to the end of life","volume":"52(4)","author":"R Harding","year":"2011","journal-title":"Clinical Infectious Diseases"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.jpainsymman.2007.02.016","article-title":"The public health strategy for palliative care","volume":"33","author":"J Stjernsw\u00e4rd","year":"2007","journal-title":"J Pain Symptom Manage"},{"key":"ref7","unstructured":"World Health Organization (2011) Global status report on noncommunicable diseases 2010. Geneva: World Health Organization. Available: http:\/\/whqlibdoc.who.int\/publications\/2011\/9789240686458_eng.pdf<\/ext-link>. Accessed 2014 Jan 22."},{"key":"ref8","unstructured":"Human Rights Watch (9 September 2010). Needless Pain: Government Failure to Provide Palliative Care for Children in Kenya. Human Rights Watch. Available: http:\/\/www.hrw.org\/reports\/2010\/09\/09\/needless-pain-0<\/ext-link>. Accessed 2014 Jun 26."},{"key":"ref9","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1056\/NEJMp1113622","article-title":"Painful inequalities\u2013Palliative care in developing countries","volume":"366(3)","author":"D Lamas","year":"2012","journal-title":"N Engl J Med"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1136\/bmjspcare-2011-000057","article-title":"Palliative care in Africa since 2005: good progress, but much further to go","volume":"1(2)","author":"L Grant","year":"2011","journal-title":"BMJ Supportive & Palliative Care"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/1744-8603-6-5","article-title":"Tackling Africa's chronic disease burden: from the local to the global","volume":"6","author":"A de-Graft Aikins","year":"2010","journal-title":"Globalization and Health"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Kanavos P (2006) The rising burden of cancer in the developing world. Ann Oncol (Suppl 8): viii15\u2013viii23.","DOI":"10.1093\/annonc\/mdl983"},{"key":"ref13","unstructured":"Government of Malawi Ministry of Health (2011). National Palliative Care Guidelines. Lilongwe: Ministry of Health. 29 p."},{"key":"ref14","unstructured":"Ministry of Health, Department of Planning (2004). A joint programme of work for a health sector wide approach (SWAp), 2004\u20132010. Lilongwe: Government of the Republic of Malawi. Available: http:\/\/gametlibrary.worldbank.org\/FILES\/466_Health%20Sector%20SWAp%20Malawi.pdf<\/ext-link>. Accessed 2013 Oct 20."},{"key":"ref15","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1472-684X-10-12","article-title":"Hospital based palliative care in sub-Saharan Africa; a six month review from Malawi","volume":"10","author":"JB Tapfield","year":"2011","journal-title":"BMC Palliative Care"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/1472-684X-10-8","article-title":"Palliative care in rural Uganda, Kenya and Malawi: three rapid evaluation field studies","volume":"10","author":"L Grant","year":"2011","journal-title":"BMC Palliative Care"},{"key":"ref17","first-page":"118","article-title":"Palliative care in Salima district","volume":"20(4)","author":"T Finch","year":"2008","journal-title":"Malawi Medical Journal"},{"key":"ref18","unstructured":"World Bank (2013). Rural population databank. Washington, D.C.: World Bank. Available: http:\/\/data.worldbank.org\/indicator\/SP.RUR.TOTL<\/ext-link>."},{"key":"ref19","unstructured":"United Nations Joint Programme on HIV and AIDS (UNAIDS) (2013). Global Report: UNAIDS report on the global AIDS epidemic 2013. Geneva: Joint United Nations Programme on HIV\/AIDS. Available: http:\/\/www.unaids.org\/en\/media\/unaids\/contentassets\/documents\/epidemiology\/2013\/gr2013\/UNAIDS_Global_Report_2013_en.pdf<\/ext-link>. Accessed 2013 Nov 20."},{"key":"ref20","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1186\/1756-0500-5-149","article-title":"Burden of cancer in Malawi; common types, incidence and trends: National population-based cancer registry. available care","volume":"5","author":"KP Msyamboza","year":"2012","journal-title":"BMC Research Notes"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.jpainsymman.2007.11.015","article-title":"Just palliative care: responding responsibly to the suffering of the poor","volume":"36(5)","author":"EL Krakauer","year":"2008","journal-title":"J Pain Symptom Manage"},{"key":"ref22","unstructured":"Bruera E, De Lima L, Wenk R, Farr W (2004) In: Palliative care in developing countries: principles and practice. Houston: IAHPC Press. 9, 23\u201337."},{"key":"ref23","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1136\/bmj.326.7385.368","article-title":"Dying from cancer in developed and developing countries: lessons from two qualitative interview studies of patients and their carers","volume":"326(7385)","author":"SA Murray","year":"2003","journal-title":"BMJ"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Wright M, Clark M (2006) Hospice and palliative care in Africa: a review of development and challenges. Oxford: Oxford University Press. 528 p.","DOI":"10.1093\/acprof:oso\/9780199206803.001.0001"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/1472-684X-12-35","article-title":"\u2018My dreams are shuttered down and it hurts lots\u2019\u2013a qualitative study of palliative care needs and their management by HIV outpatient services in Kenya and Uganda","volume":"12","author":"L Selman","year":"2013","journal-title":"BMC Palliat Care"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1089\/jpm.2009.0259","article-title":"Symptom burden in HIV-infected adults at time of HIV diagnosis in rural Uganda","volume":"13(4)","author":"K Wakeham","year":"2010","journal-title":"J Palliat Med"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"334","DOI":"10.3109\/15360288.2012.734897","article-title":"\u201cWhat is killing me most\u201d: Chronic pain and the need for palliative care in the Eastern Cape, South Africa","volume":"26(2)","author":"AM Dekker","year":"2012","journal-title":"J Pain Palliat Care Pharmacother"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.jpainsymman.2008.04.008","article-title":"Generating an African palliative care evidence base: the context, need, challenges, and strategies","volume":"36(3)","author":"R Harding","year":"2008","journal-title":"J Pain Symptom Manage"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Powell RA, Harding R, Namisango E, Katabira E, Gwyther L, et al<\/etal>.. (2013) Palliative care research in Africa: Consensus building for a prioritized agenda. J Pain Symptom Manage. doi:10.1016\/j.jpainsymman.2013.03.022.","DOI":"10.1016\/j.jpainsymman.2013.03.022"},{"key":"ref30","first-page":"15","article-title":"Rapid evaluation methods (REM) of health services performance: methodological observations","volume":"71(1)","author":"M Anker","year":"1993","journal-title":"Bull World Health Organ"},{"key":"ref31","unstructured":"Annett H, Rifkin SB (1995). Guidelines for rapid participatory appraisals to assess community health needs: A focus on health improvements for low-income urban and rural areas. Geneva: World Health Organization. 60 p."},{"key":"ref32","first-page":"94","article-title":"Epidemiological and statistical methods for rapid health assessment introduction","volume":"44","author":"M Anker","year":"1991","journal-title":"World Health Statistics Quarterly"},{"key":"ref33","unstructured":"Neno District Executive Committee (2013) Neno District Socioeconomic Profile: 2013. Neno, Malawi: Ministry of Local Government and Rural Development. 86 p."},{"key":"ref34","unstructured":"World Bank (2007) Malawi poverty and vulnerability assessment: Investing in our future. Washington, D.C.: World Bank. 304 p."},{"key":"ref35","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1136\/bmj.308.6930.698","article-title":"Listening to local voices: adapting rapid appraisal to assess health and social needs in general practice","volume":"308","author":"SA Murray","year":"1994","journal-title":"BMJ"},{"key":"ref36","unstructured":"Wolfe BA, Mamlin BW, Biondich PG, Fraser HSF, Jazayeri D, et al<\/etal>.. (2006) The OpenMRS system: Collaborating toward an open source EMR for developing countries. AMIA Annual Symposium Proceedings 1146."},{"key":"ref37","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.jpainsymman.2006.10.008","article-title":"Development of the APCA African Palliative Outcome Scale","volume":"33(2)","author":"RA Powell","year":"2007","journal-title":"Journal of Pain and Symptom Management"},{"key":"ref38","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1016\/j.jpainsymman.2012.04.007","article-title":"How to analyze palliative care outcomes data for patients in sub-Saharan Africa: An international, multicenter, factor analytic examination of the APCA African POS","volume":"45(4)","author":"R Harding","year":"2013","journal-title":"J Pain Symptom Manage"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/1477-7525-8-10","article-title":"Validation of a core outcome measure for palliative care in Africa: the APCA African Palliative Outcome Scale","volume":"8","author":"R Harding","year":"2010","journal-title":"Health and Quality of Life Outcomes"},{"key":"ref40","unstructured":"African Palliative Care Association (2010) Beating pain: A pocket guide for pain management in Africa. Kampala: African Palliative Care Association. 99 p. Available: http:\/\/apps.who.int\/medicinedocs\/documents\/s19114en\/s19114en.pdf<\/ext-link>. Accessed 2014 Jun 28."},{"key":"ref41","unstructured":"Government of Malawi Ministry of Health (2011) Introduction to palliative care: Health Care Workers\u2019 Service Providers Manual. Lilongwe: Ministry of Health. 136 p. Available: http:\/\/palliativecareassociationofmalawi.org\/media\/data\/palliative_care_service_providers_manual_for_health_care_workers.pdf<\/ext-link>. Accessed 2014 Jun 26."},{"key":"ref42","unstructured":"Government of Malawi Ministry of Health (2009) Palliative Care Training Manual for Home Based Care Volunteers in Malawi. Lilongwe: Ministry of Health. 56 p."},{"key":"ref43","unstructured":"Government of Malawi Ministry of Health (2011) Malawi Guidelines for the Clinical Management of HIV in Children and Adults. Lilongwe: Ministry of Health. 79 p."},{"key":"ref44","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1472-684X-10-1","article-title":"Mapping hospice patients' perceptions and verbal communication of end-of-life needs: an exploratory mixed methods inquiry","volume":"10","author":"BL Arnold","year":"2011","journal-title":"BMC palliative care"},{"key":"ref45","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.jpainsymman.2005.09.002","article-title":"Caregiving at the end of life: Perceptions of health care quality and quality of life among patients and caregivers","volume":"31(5)","author":"DA Fleming","year":"2006","journal-title":"Journal of pain and symptom management"},{"key":"ref46","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19(6)","author":"A Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"key":"ref47","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1016\/j.jpainsymman.2007.02.004","article-title":"Vietnam: integrating palliative care into HIV\/AIDS and cancer care","volume":"33(5)","author":"EL Krakauer","year":"2007","journal-title":"J Pain and Symptom Manage"},{"key":"ref48","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.jpainsymman.2010.04.009","article-title":"Vietnam\u2019s palliative care initiative: successes and challenges in the first five years","volume":"40(1)","author":"EL Krakauer","year":"2010","journal-title":"J Pain Symptom Manage"},{"key":"ref49","first-page":"129","article-title":"Management of HIV associated Kaposi's sarcoma in Malawi","volume":"20(4)","author":"Y Mlombe","year":"2008","journal-title":"Malawi Med J"},{"key":"ref50","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1089\/jpm.2008.0228","article-title":"Rural palliative care: a comprehensive review","volume":"12(3)","author":"CA Robinson","year":"2009","journal-title":"J Palliat Med"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.jpainsymman.2010.04.005","article-title":"The Zimbabwe rural palliative care initiative: PCI-Z","volume":"40(1)","author":"PG Di Sorbo","year":"2010","journal-title":"J Pain Symptom Manage"},{"key":"ref52","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.jpainsymman.2010.04.002","article-title":"Scaling up palliative care services in rural Tanzania","volume":"40(1)","author":"E Nanney","year":"2010","journal-title":"J Pain Symptom Manage"},{"key":"ref53","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jpainsymman.2011.08.008","article-title":"Prevalence, burden, and correlates of physical and psychological symptoms among HIV palliative care patients in Sub-Saharan Africa: An international multicenter study","volume":"44(1)","author":"R Harding","year":"2012","journal-title":"J Pain Symptom Manage"},{"key":"ref54","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jana.2005.03.005","article-title":"The symptom experience of people living with HIV\/AIDS in Southern Africa","volume":"16(3)","author":"LN Makoae","year":"2005","journal-title":"J Assoc Nurses AIDS Care"},{"key":"ref55","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1186\/1472-6963-8-271","article-title":"The symptom experience of people living with HIV and AIDS in the Eastern Cape, South Africa","volume":"8","author":"K Peltzer","year":"2008","journal-title":"BMC Health Serv Res"},{"key":"ref56","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/j.jpainsymman.2007.02.014","article-title":"Uganda: Delivering analgesia in rural Africa: Opioid availability and nurse prescribing","volume":"33(5)","author":"J Jagwe","year":"2007","journal-title":"J Pain Symptom Manage"},{"key":"ref57","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1177\/082585970301900303","article-title":"A good death in rural Kenya? Listening to Meru patients and their families talk about care needs at the end of life","volume":"19(3)","author":"E Grant","year":"2003","journal-title":"J Palliat Care"},{"key":"ref58","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1023\/A:1018709314503","article-title":"Assessing community attitude towards home-based care for people with AIDS (PWAs) in Kenya","volume":"24","author":"JM Olenja","year":"1999","journal-title":"J Community Health"}],"container-title":["PLoS ONE"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/dx.plos.org\/10.1371\/journal.pone.0110457","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,8,16]],"date-time":"2019-08-16T01:34:40Z","timestamp":1565919280000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0110457"}},"subtitle":[],"editor":[{"given":"Sam","family":"Eldabe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2014,10,14]]},"references-count":58,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2014,10,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0110457","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,10,14]]}}}