Article Text

Attitudes towards oxygen: exploring barriers to acceptance of oxygen therapy in Malawi
  1. J Langton1,
  2. A Stevenson2,
  3. C Edwards3,
  4. N Kennedy1,
  5. C Bandawe4
  1. 1Department of Paediatrics, Queen Elizabeth Central Hospital, College of Medicine, Blantyre, Malawi
  2. 2Department of Medicine, Queen Elizabeth Central Hospital, College of Medicine, Blantyre, Malawi
  3. 3Paediatrics, Trinity Hospital, Muona, Malawi
  4. 4Mental Health, College of Medicine, Blantyre, Malawi


Aims Malawian clinicians recognise that oxygen therapy is important for sick patients. Availability has recently increased through introduction of oxygen concentrators to hospitals. Many patients and parents of sick children are unwilling to accept oxygen. We aimed to evaluate reasons for this.

Study objectives

  1. Document understanding of oxygen usage;

  2. Explore barriers to acceptance of oxygen therapy

Methods A prospective qualitative exploratory study using framework analysis of data. Nine focus groups were held involving patient guardians, urban and rural communities, using a Chichewa speaking facilitator. In depth interviews were undertaken with fifteen staff from paediatrics and medicine at a central hospital. Written consent was obtained. Focus groups and interviews were audio-recorded then transcribed.

Results Data analysis revealed common themes:

Focus groups Malawians understand oxygen is used for breathing problems, illness and low oxygen levels. They do not understand how oxygen works. It is accepted because of medical advice “you will obey whatever the doctor says regardless of its consequences”. People fear oxygen and associate it with death “we believe that once the patient goes for the machine, he is going to die right away”. Beliefs stem from personal and family experiences “for those afraid of the machine it's because they previously lost a child”. Some believe doctors seek to harm. People are keen to know more about oxygen recommending community based strategies and information provision through radio and hospitals.

Interviews Staff had experienced patients or parents of sick children refusing oxygen. Sick patients receive oxygen before they die leading to belief that oxygen contributes to death. Communities discuss medical treatments so even those with no experience of oxygen may become wary. They lack understanding about oxygen therapy.

Conclusion There is a strong belief that oxygen kills. Whilst it remains a relatively scarce commodity in Malawi, it will only be given to the sickest, therefore this misconception will prevail. Patients and guardians recognise they have a lack of understanding about oxygen and are keen to learn more. Education aimed at community level may improve acceptance of oxygen therapy in Malawi.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.