Restrictive government policies leave Kenyan children dying in pain

BMJ 2010; 341 doi: (Published 09 September 2010) Cite this as: BMJ 2010;341:c4864
  1. Peter Moszynski
  1. 1London

    Kenyan children in acute and chronic pain suffer needlessly because of government policies that restrict access to inexpensive pain treatments, a lack of investment in palliative care services, and inadequately trained health workers, says a new report by Human Rights Watch.

    The report found that most Kenyan children with diseases such as cancer or HIV and AIDS are unable to get palliative care or drugs for pain. Kenya’s few palliative care services provide counselling and support to families of chronically ill patients, as well as pain treatment, but lack programmes for children.

    Healthcare workers lack training in pain treatment and palliative care, and even when strong drugs for pain are available the workers are often reluctant to give them to children, says the report.

    One doctor treating children with cancer in Nairobi told researchers, “People have no problems with relieving pain in adults with morphine, but when it comes to children there is always some reservation. Putting a child on morphine is always a big issue.”

    A nurse from Bondo district hospital said, “We have no pethidine, no DF118 [dihydrocodeine], and no morphine. We have children here with advanced HIV; some are in severe pain. The pain management for children with advanced HIV is not enough.”

    Juliane Kippenberg, senior researcher in children’s rights at Human Rights Watch, said, “Kenyan children with cancer or AIDS are living, and dying, in horrible agony. Pain medicines are cheap, safe, and effective, and the government should make sure that children who need them get them.”

    The Kenyan government has taken a step in the right direction by establishing a few palliative care units in hospitals in recent years, she said, but added, “Much more needs to be done to stop sick children from suffering needlessly.”

    The report notes that the World Health Organization considers oral morphine an essential drug for treating chronic pain, as does Kenya’s own drug policy. A daily dose can cost as little as a few cents. Yet the Kenyan government does not purchase oral morphine for public health facilities as it does other essential drugs. As a result it is available in just seven of the country’s approximately 250 public hospitals.

    People with HIV can experience severe pain whether or not they receive antiretroviral drugs, and inexpensive pain treatments can improve adherence to HIV treatment, the report maintains. It says that current antinarcotics legislation in Kenya “is perceived by many healthcare workers as a prohibition on morphine” and has contributed to undertreatment of pain with opioids.

    More than 1.5 million Kenyans have HIV or AIDS, including about 150 000 children, and 100 000 Kenyans die from AIDS each year, the report says. Although 250 000 people in Kenya are taking antiretrovirals, the report estimates that all the morphine in the country is enough to treat only 1500 patients with terminal cancer or AIDS.

    “The Kenyan government and donors should be working to improve pain treatment for everyone,” said Ms Kippenberg. “And they should make sure that the youngest and most vulnerable sufferers, sick children, are not left out.”


    Cite this as: BMJ 2010;341:c4864


    • Needless Pain: Government Failure to Provide Palliative Care for Children in Kenya is at

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