Focus group discussions on low-flow oxygen and bubble CPAP treatments among mothers of young children in Malawi: a CPAP IMPACT substudy

Kristen L Sessions, Laura Ruegsegger, Tisungane Mvalo, Davie Kondowe, Mercy Tsidya, Mina C Hosseinipour, Norman Lufesi, Michelle Eckerle, Andrew Gerald Smith, Eric D McCollum, Kristen L Sessions, Laura Ruegsegger, Tisungane Mvalo, Davie Kondowe, Mercy Tsidya, Mina C Hosseinipour, Norman Lufesi, Michelle Eckerle, Andrew Gerald Smith, Eric D McCollum

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.

Keywords: child; continuous positive airway pressure; developing countries; focus groups; hypoxia; respiratory tract diseases.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

References

    1. GBD 2015 LRI Collaborators Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the global burden of disease study 2015. Lancet Infect Dis 2017;17:1133–61. 10.1016/S1473-3099(17)30396-1
    1. Enarson PM, Gie RP, Mwansambo CC, et al. . Reducing deaths from severe pneumonia in children in Malawi by improving delivery of pneumonia case management. PLoS One 2014;9:e102955–e55. 10.1371/journal.pone.0102955
    1. Enarson P, La Vincente S, Gie R, et al. . Implementation of an oxygen concentrator system in district hospital paediatric wards throughout Malawi. Bull World Health Organ 2008;86:344–8. 10.2471/BLT.07.048017
    1. Nowadzky T, Pantoja A, Britton JR. Bubble continuous positive airway pressure, a potentially better practice, reduces the use of mechanical ventilation among very low birth weight infants with respiratory distress syndrome. Pediatrics 2009;123:1534–40. 10.1542/peds.2008-1279
    1. Diblasi RM. Nasal continuous positive airway pressure (CPAP) for the respiratory care of the newborn infant. Respir Care 2009;54:1209–35.
    1. Wilson PT, Morris MC, Biagas KV, et al. . A randomized clinical trial evaluating nasal continuous positive airway pressure for acute respiratory distress in a developing country. J Pediatr 2013;162:988–92. 10.1016/j.jpeds.2012.10.022
    1. Walk J, Dinga P, Banda C, et al. . Non-Invasive ventilation with bubble CPAP is feasible and improves respiratory physiology in hospitalised Malawian children with acute respiratory failure. Paediatr Int Child Health 2016;36:28–33. 10.1179/2046905514Y.0000000166
    1. Machen HE, Mwanza ZV, Brown JK, et al. . Outcomes of patients with respiratory distress treated with bubble CPAP on a pediatric ward in Malawi. J Trop Pediatr 2015;61:fmv052–27. 10.1093/tropej/fmv052
    1. Lum LCS, Abdel-Latif ME, de Bruyne JA, et al. . Noninvasive ventilation in a tertiary pediatric intensive care unit in a middle-income country. Pediatr Crit Care Med 2011;12:e7–13. 10.1097/PCC.0b013e3181d505f4
    1. Wilson PT, Benckert MM, Moresky RT, et al. . Development and implementation of a Training-of-Trainers program for continuous positive airway pressure in neonatal and pediatric patients in five low- and middle-income countries. J Trop Pediatr 2017;63:fmw096–64. 10.1093/tropej/fmw096
    1. Gondwe MJ, Gombachika B, Majamanda MD. Experiences of caregivers of infants who have been on bubble continuous positive airway pressure at Queen Elizabeth central Hospital, Malawi: a descriptive qualitative study. Malawi Medical Journal 2017;29:5–10. 10.4314/mmj.v29i1.2
    1. Peeler A, Fulbrook P, Kildea S. The experiences of parents and nurses of hospitalised infants requiring oxygen therapy for severe bronchiolitis: a phenomenological study. J Child Health Care 2015;19:216–28. 10.1177/1367493513503587
    1. Foster J, Bidewell J, Buckmaster A, et al. . Parental stress and satisfaction in the non-tertiary special care nursery. J Adv Nurs 2008;61:522–30. 10.1111/j.1365-2648.2007.04547.x
    1. Cervantes AC, Feeley N, Lariviere J. The experience of mothers whose very low-birth-weight infant requires the delivery of supplemental oxygen in the neonatal intensive care unit. Adv Neonatal Care 2011;11:54–61. 10.1097/ANC.0b013e318206d0d3
    1. McCollum ED, Mvalo T, Eckerle M, et al. . Bubble continuous positive airway pressure for children with high-risk conditions and severe pneumonia in Malawi: an open label, randomised, controlled trial. Lancet Respir Med 2019;7:964–74. 10.1016/S2213-2600(19)30243-7
    1. Ritchie J, Spencer L. Qualitative data analysis for applied policy research In: The qualitative researcher’s companion, 2002: 305–29.
    1. Patton MQ. Qualitative research: Wiley online library, 2005.
    1. Strauss A, Corbin JM. Basics of qualitative research: Grounded theory procedures and techniques. Sage Publications, Inc, 1990.
    1. World Health Organization Model list of essential medicines 21st list. Geneva: World Health Organization, 2019.
    1. Rojas-Reyes MX, Granados Rugeles C, Charry-Anzola LP. Oxygen therapy for lower respiratory tract infections in children between 3 months and 15 years of age. Cochrane Database Syst Rev 2014:CD005975. 10.1002/14651858.CD005975.pub3
    1. Haines A, Sanders D, Lehmann U, et al. . Achieving child survival goals: potential contribution of community health workers. Lancet 2007;369:2121–31. 10.1016/S0140-6736(07)60325-0
    1. Gilmore B, McAuliffe E. Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review. BMC Public Health 2013;13:847. 10.1186/1471-2458-13-847

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa