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Quality of life among patients receiving palliative care in South Africa and Uganda: a multi-centred study

Lucy E Selman1*, Irene J Higginson1, Godfrey Agupio2, Natalya Dinat3, Julia Downing4, Liz Gwyther5, Thandi Mashao6, Keletso Mmoledi3, Tony Moll7, Lydia Mpanga Sebuyira8, Barbara Ikin9 and Richard Harding1

Author Affiliations

1 King's College London, Dept. Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London SE5 9PJ, UK

2 Hospice Africa Uganda, PO Box 7757, Makindye, Kampala, Uganda

3 The Division of Palliative Care, Department of Internal Medicine, University of the Witwatersrand, Theatre Road, The Chris Hani Baragwanath Hospital, Soweto, South Africa

4 Formerly of the African Palliative Care Association, PO Box 72518, Plot 850, Dr Gibbons Road, Kampala, Uganda

5 Hospice Palliative Care Association of South Africa, PO Box 38785, Howard Place, 7450 Suite 11a, Lonsdale Building, Lonsdale Way, Pinelands, 7430, Cape Town, South Africa

6 Palliative Medicine Unit, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa

7 Church of Scotland Hospital, P/Bag X502, Tugela Ferry 3010, KwaZulu Natal, South Africa

8 Infectious Diseases Institute, Faculty of Medicine, Makerere University, PO Box 22418, Kampala, Uganda

9 Msunduzi Hospice, Head Office, PO Box 22023, Mayors Walk 3208, Pietermaritzburg, KwaZulu Natal, South Africa

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Health and Quality of Life Outcomes 2011, 9:21  doi:10.1186/1477-7525-9-21

Published: 8 April 2011



Quality of life (QOL) is a core outcome of palliative care, yet in African settings there is a lack of evidence on patients' levels of QOL. We aimed to describe QOL among patients with incurable, progressive disease receiving palliative care in South Africa and Uganda, to compare QOL in cancer and HIV, to determine how domains of QOL correlate with overall QOL, and compare levels of QOL in this population with those in other studies using the same tool.


A cross-sectional survey was conducted using the Missoula Vitas Quality of Life Index (MVQOLI), a 26-item QOL questionnaire with five subscales (Function, Symptom, Interpersonal, Well being, Transcendent) covering physical, social, psychological and spiritual domains and one global QOL item. One item in each subscale assesses the subjective importance of the domain on a score from 1 (least important) to 5 (most important), used to weight the contribution of the subscale towards the Total QOL score. The tool was translated into 6 languages and administered to consecutively recruited patients at four facilities in South Africa and one in Uganda.


285 patients were recruited, with a mean age of 40.1; 197 (69.1%) were female. Patients' primary diagnoses were HIV (80.7%), cancer (17.9%) and other conditions (1.4%). The mean global QOL score was 2.81 (possible range 0 (worst) to 5 (best)); mean Total score 17.32 (possible range 0 to 30). Patients scored most poorly on Function (mean 0.21), followed by Well being (2.59), Symptoms (5.38), Transcendent (5.50), Interpersonal (9.53) (possible range for subscale scores -30 to 30). Most important to patients were: close relationships (mean 4.13), feeling at peace (4.12), sense of meaning in life (4.10), being active (3.84), physical comfort (2.58). Cancer patients were predominantly recruited at three of the sites; hence comparison with HIV-infected patients was restricted to these sites. HIV+ patients (n = 115) scored significantly worse than cancer patients (n = 50) on Well being (Z = -2.778, p = 0.005), Transcendence (Z = -2.693, p = 0.007) and Total QOL (Z = -2.564, p = 0.01). Global QOL score was most weakly correlated with Total QOL (r = 0.37) and the Transcendent subscale was most highly correlated (r = 0.77) (both p < 0.001). Patients receiving palliative care in South Africa and Uganda exhibited significantly poorer QOL compared to similar populations in the USA.


Feeling at peace and having a sense of meaning in life were more important to patients than being active or physical comfort, and spiritual wellbeing correlated most highly with overall QOL. It is therefore vital to identify and meet the psychological and spiritual care needs of patients, as well as to assess and treat pain and other symptoms. Our finding that patients scored most poorly on the Function domain warrants further research.