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OBJECTIVES: The study aimed to explore the determinants of quality of life (QoL) among Omani family caregivers (FCGs) of adult patients with cancer pain. METHODS: A descriptive cross-sectional design, measures of caregiver reaction, knowledge about cancer pain, self-efficacy for cancer pain and other symptom management, QoL, and patient functional status were used to collect data from 165 FCGs and patients. Descriptive, correlation, and regression analyses were performed. RESULTS: Most patients had intermittent (83%) and severe (50.9%) cancer pain. The FCGs had low QoL (58.44 ± 17.95), and this mostly impacted support and positive adaptation (55.2%). Low QoL was associated with low self-rated health, low confidence in the ability to control the patient's pain, low self-efficacy, high perceived distress due to patient pain, and a high impact of caregiving on physical health. The level of caregiver distress due to the patient's pain (p < 0.01), patient's functional status (p < 0.01), and perceived impact of caregiving on health (p < 0.05) were significant predictors of overall QoL. CONCLUSION: Omani FCGs of patients with cancer pain suffer a negative impact on their QoL, and this is related to the patient's level of pain and functional status, caregiver's health, and self-efficacy in cancer pain and symptom management. The FCGs' QoL may be enhanced by augmenting their skills and self-efficacy in cancer pain and symptom management and by health promotion programs.

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BACKGROUND: Family caregivers (FCGs) contribute significantly to the management of pain and other symptoms experienced by their family member with cancer and may not receive preparation to meet the changing patient needs. OBJECTIVE: The aim of this study was to identify the predictors of FCG self-efficacy (SE) for pain and related symptom management of adult family members with cancer. METHODS: Data were collected from 165 Omani FCGs. The questionnaire comprised the caregiver cancer pain and related symptom management SE scale, the Katz index, Caregiver Reaction Assessment, and Family Pain Questionnaire. Electronic medical records provided data on patients' cancer diagnosis, pain, and symptoms. Predictors of SE were examined using linear regression analysis. RESULTS: Most FCGs were female (58.2%) and children of the patient (53.9%). Most patients were on chemotherapy or palliative care (82.4%) and had at least stage 3 cancer (58.8%). Family caregivers reported average SE. The predictors of SE were as follows: patients' functional status (ß = 40.90, P = .001), patients' pain intensity (ß = -15.10, P = .036), FCGs' confidence in controlling the patients' pain (ß = 28.80, P = .000), FCGs' self-rated health (ß = -25.90, P = .038), and interaction of FCGs' knowledge level with patients' pain intensity (ß = -1.31, P = .008), caregiving hours (ß = -0.10, P = .025), and impact of caregiving on FCGs' physical health (ß = 1.29, P = .031). CONCLUSION: Family caregivers' health status, knowledge, caregiving demands, patient functional status, and pain intensity have a significant effect on caregivers' symptom management. IMPLICATIONS FOR PRACTICE: A deliberate model of care that includes supportive interventions to enhance the abilities of FCGs with symptom management is needed in Oman.

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BACKGROUND: Family caregivers (FCGs) of adult cancer patients (ACPs) are typically involved in the entire trajectory of cancer disease, from diagnosis to survivorship or end of life. In developing countries, FCGs are more intensely involved in the process of providing care to the hospitalized ACPs because of lack of adequate cancer care resources. Active performance of tasks to meet the needs of ACPs in the hospital setting is likely to elicit significant caregiver burden. OBJECTIVE: The aim of this study was to explore the tasks performed and the caregiver burden experienced by FCGs of hospitalized ACPs in a sub-Saharan country. METHODS: A cross-sectional descriptive design was used to collect data from 168 FCGs of ACPs. The Caregiver Burden Scale was used to measure burden. RESULTS: The most common cancer diagnosis in male and female ACPs was Kaposi's sarcoma (32.1%) and breast cancer (37.9%), respectively. The tasks regularly performed by most FCGs for the ACPs were providing emotional support (79.8%), feeding (68.5%), transporting to other appointments (62.5%), preparing meals (55%), and giving medications (46.4%). Most FCGs (75%) were experiencing severe or very severe general caregiver burden. The dimensions of caregiver burden that were most severely impacted were general strain (70.6%), disappointment (85.8%), and isolation (72%). Predictors of caregiver burden are reported. CONCLUSION: Family caregivers of hospitalized ACPs experience severe caregiver burden. The main forms of burden experienced were general strain, disappointment, and isolation. IMPLICATIONS FOR PRACTICE: Cancer care services in developing countries should be strengthened with services that address FCGs' emotional needs and human resources to curtail the strain imposed on FCGs.

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BACKGROUND: Despite being a key component to be addressed during postnatal period, sexuality has long been a subject of secrecy and taboo in Africa. Resumption of sexual intercourse after giving birth has been shown to reduce extramarital affairs and consequently reduce risk of sexually transmitted infections like HIV/AIDS. Consequences of early resumption of sexual intercourse include unwanted pregnancy, genital trauma and puerperal infection. The objective of the study was to assess prevalence and factors associated with early resumption of sexual intercourse among postnatal mothers attending postnatal clinic at a National referral Hospital in Uganda. METHODOLOGY: A cross-sectional study that employed an interviewer-administered questionnaire was conducted among 374 women who delivered six months prior to conducting the study. The independent variables included socio-demographic characteristics of the participant, socio-demographic characteristics of the spouse, perceived cultural norms, medical history, mode of delivery, and postpartum complications. The dependent variable was timing of resumption of sexual intercourse after childbirth (before or after six weeks postpartum). Data were analysed using SPSS version 16.0. RESULTS: The study showed that 105 participants (21.6%) had resumed sexual intercourse before 6 weeks after childbirth. The participants' education level, occupation, and parity; education level of the spouse, age of baby and use of family planning were the factors associated with early resumption of sexual intercourse after child birth (before six weeks postpartum) (p < 0.05). CONCLUSION: Many women resumed sexual intercourse after six weeks. Women with high income, low parity, who ever-used contraception or had a spouse with high education level were more likely to have early resumption of sexual intercourse.

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BACKGROUND: Mulago National Referral Hospital (MNRH), Uganda's primary tertiary and teaching hospital, and Makerere University College of Health Sciences (MakCHS) have a close collaborative relationship. MakCHS students complete clinical rotations at MNRH, and MakCHS faculty partner with Mulago staff in clinical care and research. In 2009, as part of a strategic planning process, MakCHS undertook a qualitative study to examine care and service provision at MNRH, identify challenges, gaps, and solutions, and explore how MakCHS could contribute to improving care and service delivery at MNRH. METHODS: Key informant interviews (n=23) and focus group discussions (n=7) were conducted with nurses, doctors, administrators, clinical officers and other key stakeholders. Interviews and focus groups were tape recorded and transcribed verbatim, and findings were analyzed through collaborative thematic analysis. RESULTS: Challenges to care and service delivery at MNRH included resource constraints (staff, space, equipment, and supplies), staff inadequacies (knowledge, motivation, and professionalism), overcrowding, a poorly functioning referral system, limited quality assurance, and a cumbersome procurement system. There were also insufficiencies in the teaching of professionalism and communication skills to students, and patient care challenges that included lack of access to specialized services, risk of infections, and inappropriate medications.Suggestions for how MakCHS could contribute to addressing these challenges included strengthening referral systems and peripheral health center capacity, and establishing quality assurance mechanisms. The College could also strengthen the teaching of professionalism, communication and leadership skills to students, and monitor student training and develop courses that contribute to continuous professional development. Additionally, the College could provide in-service education for providers on professionalism, communication skills, strategies that promote evidence-based practice and managerial leadership skills. CONCLUSIONS: Although there are numerous barriers to delivery of quality health services at MNRH, many barriers could be addressed by strengthening the relationship between the Hospital and MakCHS. Strategic partnerships and creative use of existing resources, both human and financial, could improve the quality of care and service delivery at MNRH. Improving services and providing more skills training could better prepare MakCHS graduates for leadership roles in other health care facilities, ultimately improving health outcomes throughout Uganda.