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Abstract
Objective To determine the acceptability of bubble continuous positive airway pressure (bCPAP) and low-flow oxygen among mothers of children who had received either therapy.
Setting A district hospital in Salima, Malawi.
Participants We conducted eight focus group discussions (FGDs) with a total of 54 participants. Eligible participants were mothers of children 1 to 59 months of age with severe pneumonia and a comorbidity (HIV-infection, HIV-exposure, malnutrition or hypoxaemia) who, with informed consent, had been enrolled in a randomised clinical trial, CPAP IMPACT (Improving Mortality for Pneumonia in African Children Trial), comparing low-flow oxygen and bCPAP treatments (ClinicalTrials.gov, NCT02484183).
Primary and secondary outcome measures FGDs assessed mothers’ attitudes and feelings towards oxygen and bCPAP before and after therapy along with general community perceptions of respiratory therapies. Data was analysed using inductive thematic analysis to assess themes and subthemes of the transcripts.
Results Community perceptions of oxygen and bCPAP were widely negative. Mothers recounted that they are told that ‘oxygen kills babies’. They are often fearful of allowing their child to receive oxygen therapy and will delay treatment or seek alternative therapies. Mothers report limiting oxygen and bCPAP by intermittently removing the nasal cannulas or mask. After oxygen or bCPAP treatment, regardless of patient outcome, mothers were supportive of the treatment their child received and would recommend it to other mothers.
Conclusion There are significant community misconceptions around oxygen and bCPAP causing mothers to be fearful of either treatment. In order for low-flow oxygen treatment and bCPAP implementation to be effective, widespread community education is necessary.
- focus groups
- developing countries
- respiratory tract diseases
- child
- continuous positive airway pressure
- hypoxia
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Footnotes
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Contributors KS, LR, TM and EM participated in study design, data collection and statistical analysis and were major contributors to manuscript writing. MT participated in focus group discussion (FGD) guide preparation, conducted the FGDs, completed translation and transcription and contributed to analysis and manuscript preparation. DK contributed to data collection and design and implementation of CPAP IMPACT. MCH, NL, AGS, ME and EM contributed to study design and implementation of CPAP IMPACT. EM was the principle investigator. All authors contributed to manuscript preparation and approved the final manuscript.
Funding KS received funding for this work through a Doris Duke Charitable Foundation grant (2016177) supporting the Doris Duke International Clinical Research Fellows programme at the University of North Carolina Chapel Hill. The Bill & Melinda Gates Foundation (OPP1123419), International AIDS Society (141022) and Health Empowering Humanity provided funding for CPAP IMPACT.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval This study was approved by both the National Health Research Science Committee of Malawi (1325) and the Institutional Review Board of John Hopkins University (IRB00199008).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. De-identified transcripts of focus group discussions are available on request from corresponding authors.