Pediatric palliative care in a tertiary level hospital in Bangladesh

Abstract

Objectives: The study was carried out to explore the demographic profile of the pediatric patients with advanced stage disease and to observe treatment modalities needed for symptom management. Methods: A retrospective observational study was conducted in the Palliative Care Unit, of Dhaka Medical College Hospital, Bangladesh. Patients admitted to this unit from May 2014 to March 2016 were included in this study. Data were collected from hospital register book and bed head tickets by utilizing a structured check list. Epi-info and SPSS were utilized for data entry and analysis respectively. Pain was assessed by Faces pain scale-revised for > 3 years and FLACC scale for those who were unable to self report. Results: A total of 40 patients were admitted to the Palliative Care Unit and 60.0% of them were boys. Majority of the patients (87.5%) came from rural areas which was statistically significant (p=0.002). Forty percent were from the age group of 1 to 5 years. Patients were suffering from Abdominal solid tumor (25.0%), Non-Hodgkin’s Lymphoma (15.0%), Acute lymphoblastic Leukemia (12.0%), Sarcoma (10.0%), Acute Myeloid Leukemia (8.0%), Retinoblastoma and Intracranial space occupying lesions (5.0% each), Hodgkin’s Disease (3.0%) and Aplastic Anemia (17.0%). They were admitted with multiple symptoms including pain (70.0%), bleeding (37.5%), respiratory distress (25.0%), fever (20.0%), infection (20.0%), headache (17.5%), vomiting (12.5%), ascitis, convulsion, bladder and bowel incontinence (7.5% each). Half of the patients were treated with palliative chemotherapy. Pain was treated with morphine by injection. Percentage of hospital death was 22.5%. Conclusions: Majority of the patients came from rural areas and almost half of the patients’ age was within 1 to 5 years. Abdominal solid tumors were most common in this sudy. Prevailing symptom was pain. Most of the patients received palliative chemotherapy and morphine by injection. Over one fifth of the patients died during treatment.