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Fear of oxygen therapy for children in Malawi
  1. Anna Clare Stevenson1,
  2. Christopher Edwards2,
  3. Josephine Langton3,
  4. Collins Zamawe4,
  5. Neil Kennedy5
  1. 1Department of Acute Medicine, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  2. 2Royal Hospital for Sick Children, Glasgow, UK
  3. 3Leicester Royal Infirmary, Leicester, UK
  4. 4Blantyre International University, Blantyre, Malawi
  5. 5Department of Paediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
  1. Correspondence to Dr Anna Clare Stevenson, Department of Acute Medicine, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK; stevensonac{at}


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.

  • Respiratory
  • Tropical Paediatrics
  • Qualitative research
  • Patient perspective

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