Fear of oxygen therapy for children in Malawi.
BACKGROUND
Although pneumonia is a common cause of death in children in Malawi, healthcare staff frequently encounter patients or carers who refuse oxygen therapy. This qualitative study documents factors that influence acceptance or refusal of oxygen therapy for children in Malawi.


METHODS
Nine group interviews involving 86 participants were held in community and hospital settings in rural and urban Malawi. Eleven in-depth interviews of healthcare staff providing oxygen were held in a central hospital. Thematic analysis of transcripts of the audio recordings was carried out to identify recurring themes.


RESULTS
Similar ideas were identified in the group interviews and in-depth staff interviews. Past experiences of oxygen use (direct and indirect, positive and negative) had a strong influence on views of oxygen. A recurrent theme was fear of oxygen, often due to a perceived association between death and recent oxygen use. Fears were intensified by a lack of familiarity with equipment used to deliver oxygen, distrust of medical staff and concerns about cost of oxygen.


CONCLUSIONS
This study identifies reasons for refusal of oxygen therapy for children in a low-income country. Findings from the study suggest that training of healthcare staff to address fears of parents, and information, education and communication (IEC) approaches that improve public understanding of oxygen and provide positive examples of its use are likely to be helpful in improving uptake of oxygen therapy in Malawi.
Department of Acute Medicine, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Anna Clare
AC
Stevenson
Royal Hospital for Sick Children, Glasgow, UK.
Christopher
C
Edwards
Leicester Royal Infirmary, Leicester, UK.
Josephine
J
Langton
Blantyre International University, Blantyre, Malawi.
Collins
C
Zamawe
Department of Paediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.
Neil
N
Kennedy
D000293:Adolescent; D000328:Adult; D000368:Aged; D005239:Fear / Q000523:psychology*; D005260:Female; D006266:Health Education; D006801:Humans; D008295:Malawi; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000523:psychology*; D016312:Treatment Refusal; D055815:Young Adult
Patient perspective; Qualitative research; Respiratory; Tropical Paediatrics