{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T17:26:12Z","timestamp":1788888372915,"version":"build-2803163510"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T00:00:00Z","timestamp":1667174400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Sweden International Development Agency","award":["1455"],"award-info":[{"award-number":["1455"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nIn low and middle-income countries (LMICs), severe pneumonia with hypoxemia is the leading cause of child deaths, even with the provision of WHO-recommended antibiotic therapy, oxygen therapy and other supportive care. Previous studies found positive outcomes from the use of bubble continuous positive airway pressure (bCPAP) for treating these children compared to the standard oxygen therapy. Due to lack of data on the perceptions and experiences of hospital health care workers and caregivers of children on the feasibility and acceptability of bCPAP in treating children with severe pneumonia and hypoxemia in real-life settings, we examined these issues in tertiary and general hospitals in Ethiopia.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nAs part of a three-stages clinical trial, this qualitative study was conducted in two tertiary (stage I) and two general (stage II) hospitals from September 2019 to July 2020. During stages I and II, we have consecutively enrolled children with severe pneumonia and hypoxemia and put them on bCPAP to examine its feasibility and acceptability by clinicians and parents. A total of 89 children were enrolled (49 from two tertiary and 40 from two general hospitals). Then qualitative data were collected through 75 repeated in-depth interviews by social-science experts with purposively selected 30 hospital health workers and 15 parents of 12 children who received bCPAP oxygen therapy in the hospitals. Interview data were supplemented by 6 observations in the hospitals. Data were analyzed using a thematic approach.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nIdentified structural and functional challenges for the introduction of bCPAP in treating childhood severe pneumonia and hypoxemia in the study hospitals include: inadequate number of pulse oximeters; unavailability of nasal prongs with age-specific size; inadequate and non-functioning oxygen flow meters, concentrator, and cylinders; disruption in power-supply; and inadequate number of staff. The opportunities in introducing bCPAP oxygen therapy included the availability of a dedicated corner for the study patients situated in front of nurse\u2019s station, required medicines and satisfactory level of clinicians\u2019 knowledge and skills for treating severe pneumonia patients. Additionally, the identified operational challenges were occasional lack of bubbling in the water-filled plastic bottle, lack of stand for holding the water-filled plastic bottle, and delayed shifting of oxygen source from an oxygen concentrator to a cylinder, particularly during electricity disruption. Participants (clinicians and parents) expressed their satisfaction as bCPAP oxygen therapy was found to be simple to handle, children had ease of breathing and recovered fast without major ill effects.<\/jats:p>\n<\/jats:sec>\n\nConclusion<\/jats:title>\nOur study identified some important structural, functional, and operational challenges that need to be addressed before implementation of bCPAP oxygen therapy especially in frontline general hospitals with limited resources. In spite of these observed challenges, the clinicians and caregivers were highly satisfied with the overall performance of bCPAP oxygen therapy.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0275952","type":"journal-article","created":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T17:42:50Z","timestamp":1667238170000},"page":"e0275952","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Perception and experience of clinicians and caregivers in treating childhood severe pneumonia and hypoxemia using bubble continuous positive airway pressure in Ethiopian tertiary and general hospitals"],"prefix":"10.1371","volume":"17","author":[{"given":"Meseret","family":"Gebre","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Fakhar","family":"Uddin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor","family":"Duke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kassa","family":"Haile","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2514-920X","authenticated-orcid":true,"given":"Md. Tanveer","family":"Faruk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1236-1044","authenticated-orcid":true,"given":"Mehnaz","family":"Kamal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Farhad","family":"Kabir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abebe","family":"Genetu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahel Argaw","family":"Kebede","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asrat","family":"Demtse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abate Yeshidinber","family":"Weldetsadik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abayneh Girma","family":"Demisse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bitseat W.","family":"Haile","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alemseged","family":"Abdissa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teferi","family":"Elfu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biruk","family":"Tesfaye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taye Tolera","family":"Balcha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muluye","family":"Shemeles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahmeed","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Clemens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9958-3071","authenticated-orcid":true,"given":"Mohammod Jobayer","family":"Chisti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,10,31]]},"reference":[{"key":"pone.0275952.ref001","article-title":"Levels and trends in child mortality: report 2019","author":"United Nations Children\u2019s Fund","year":"2019","journal-title":"Estimates developed by the UN Inter-agency Group for child mortality estimation"},{"key":"pone.0275952.ref002","doi-asserted-by":"crossref","first-page":"1606783","DOI":"10.1155\/2020\/1606783","article-title":"Magnitude and Predictors of Pneumonia among Under-Five Children in Ethiopia: A Systematic Review and Meta-Analysis","volume":"2020","author":"YM Alamneh","year":"2020","journal-title":"J Environ Public Health"},{"key":"pone.0275952.ref003","volume-title":"Pocket book for hospital care of children: guidelines for the management of common illness with limited resources","author":"WHO","year":"2013"},{"issue":"1","key":"pone.0275952.ref004","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1111\/j.1365-3156.2011.02890.x","article-title":"Clinical predictors and outcome of hypoxaemia among under\u2010five diarrhoeal children with or without pneumonia in an urban hospital, Dhaka, Bangladesh","volume":"17","author":"MJ Chisti","year":"2012","journal-title":"Trop Med Int Health"},{"issue":"4","key":"pone.0275952.ref005","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S1473-3099(09)70071-4","article-title":"The prevalence of hypoxaemia among ill children in developing countries: a systematic review","volume":"9","author":"R Subhi","year":"2009","journal-title":"Lancet Infect Dis"},{"issue":"3","key":"pone.0275952.ref006","doi-asserted-by":"crossref","first-page":"e348","DOI":"10.1016\/S2214-109X(21)00586-6","article-title":"Prevalence of hypoxaemia among children with pneumonia in low and middle-income countries: a systematic review and meta-analysis","volume":"10","author":"AE Rahman","year":"2022","journal-title":"The Lancet Global Health"},{"issue":"9966","key":"pone.0275952.ref007","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/S0140-6736(14)61698-6","article-title":"Global, regional, and national causes of child mortality in 2000\u201313, with projections to inform post-2015 priorities: an updated systematic analysis","volume":"385","author":"L Liu","year":"2015","journal-title":"Lancet"},{"issue":"10010","key":"pone.0275952.ref008","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1016\/S0140-6736(15)00120-8","article-title":"Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation","volume":"386","author":"D You","year":"2015","journal-title":"Lancet"},{"issue":"5","key":"pone.0275952.ref009","doi-asserted-by":"crossref","first-page":"349","DOI":"10.2471\/BLT.07.048512","article-title":"Challenges to improving case management of childhood pneumonia at health facilities in resource-limited settings","volume":"86","author":"SM Graham","year":"2008","journal-title":"Bull World Health Organ"},{"issue":"7","key":"pone.0275952.ref010","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1111\/apa.13836","article-title":"Hypoxaemia and septic shock were independent risk factors for mechanical ventilation in Bangladeshi children hospitalised for diarrhoea","volume":"106","author":"MJ Chisti","year":"2017","journal-title":"Acta paediatrica"},{"issue":"6","key":"pone.0275952.ref011","doi-asserted-by":"crossref","first-page":"976","DOI":"10.3346\/jkms.2016.31.6.976","article-title":"Management of Ventilatory Insufficiency in Neuromuscular Patients Using Mechanical Ventilator Supported by the Korean Government","volume":"31","author":"SW Kang","year":"2016","journal-title":"J Korean Med Sci"},{"issue":"1","key":"pone.0275952.ref012","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1179\/2046905513Y.0000000102","article-title":"CPAP: a guide for clinicians in developing countries","volume":"34","author":"T. Duke","year":"2014","journal-title":"Paediatr Int Child Health"},{"issue":"9998","key":"pone.0275952.ref013","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1016\/S0140-6736(15)60249-5","article-title":"Bubble continuous positive airway pressure for children with severe pneumonia and hypoxaemia in Bangladesh: an open, randomised controlled trial","volume":"386","author":"MJ Chisti","year":"2015","journal-title":"Lancet"},{"key":"pone.0275952.ref014","doi-asserted-by":"crossref","first-page":"71","DOI":"10.3329\/bccj.v2i2.24085","article-title":"The Use of Bubble CPAP and Humidified High Flow Nasal Cannula Oxygen Therapy in Children with Severe Pneumonia and Hypoxemia: A Systematic Review of the Evidence","volume":"2","author":"MJ Chisti","year":"2014","journal-title":"Bangladesh Crit Care J"},{"issue":"6","key":"pone.0275952.ref015","doi-asserted-by":"crossref","first-page":"F495","DOI":"10.1136\/archdischild-2013-305519","article-title":"Efficacy and safety of bubble CPAP in neonatal care in low- and middle-income countries: a systematic review","volume":"99","author":"S Martin","year":"2014","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"3","key":"pone.0275952.ref016","doi-asserted-by":"crossref","first-page":"F168","DOI":"10.1136\/fn.88.3.F168","article-title":"Nasal CPAP for neonates: what do we know in 2003?","volume":"88","author":"AGD Paoli","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"pone.0275952.ref017","first-page":"649","author":"M Chisti","year":"2018","journal-title":"Outcome of post trial implementation of bubble cpap in treating childhood severe pneumonia and hypoxemia in bangladesh"},{"issue":"2","key":"pone.0275952.ref018","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1177\/1367493513503587","article-title":"The experiences of parents and nurses of hospitalised infants requiring oxygen therapy for severe bronchiolitis: a phenomenological study","volume":"19","author":"A Peeler","year":"2015","journal-title":"J Child Health CareJun"},{"issue":"1","key":"pone.0275952.ref019","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1097\/ANC.0b013e318206d0d3","article-title":"The experience of mothers whose very low-birth-weight infant requires the delivery of supplemental oxygen in the neonatal intensive care unit","volume":"11","author":"AC Cervantes","year":"2011","journal-title":"Adv Neonatal Care"},{"issue":"5","key":"pone.0275952.ref020","doi-asserted-by":"crossref","first-page":"e1441","DOI":"10.1542\/peds.2008-0565","article-title":"Communicating with children and families: from everyday interactions to skill in conveying distressing information","volume":"121","author":"AAPCB Levetown M","year":"2008","journal-title":"Pediatrics"},{"issue":"6","key":"pone.0275952.ref021","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1097\/01.NAJ.0000398544.82777.3c","article-title":"Building the nursing workforce in Malawi","volume":"111","author":"ES Schell","year":"2011","journal-title":"Am J Nurs"},{"issue":"12","key":"pone.0275952.ref022","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.1016\/j.ijnurstu.2008.06.008","article-title":"Family involvement in the care of a hospitalised child: A questionnaire survey of Mozambican family caregivers","volume":"45","author":"M S\u00f6derb\u00e4ck","year":"2008","journal-title":"Int J Nurs Stud"},{"issue":"2","key":"pone.0275952.ref023","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.pec.2010.07.015","article-title":"A qualitative study of caregivers\u2019 expectations and communication desires during medical consultation for sick children in Uganda","volume":"84","author":"S Kiguli","year":"2011","journal-title":"Patient Educ Couns"},{"issue":"1","key":"pone.0275952.ref024","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1186\/s12913-019-4672-2","article-title":"Health system readiness to support facilities for care of preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment","volume":"19","author":"AK Usman","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"pone.0275952.ref025","volume-title":"National human resource for health strategic plan for Ethiopia 2016\u20132025","author":"Federal Ministry of Health (FMOH) FDRoE","year":"2016"},{"issue":"3","key":"pone.0275952.ref026","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1080\/08854726.2014.925660","article-title":"Overview of qualitative research","volume":"20","author":"DH Grossoehme","year":"2014","journal-title":"J Health Care Chaplain"},{"issue":"1","key":"pone.0275952.ref027","doi-asserted-by":"crossref","first-page":"10","DOI":"10.4314\/mmj.v29i1.2","article-title":"Experiences of caregivers of infants who have been on bubble continuous positive airway pressure at Queen Elizabeth Central Hospital, Malawi: A descriptive qualitative study","volume":"29","author":"MJ Gondwe","year":"2017","journal-title":"Malawi Med J"},{"key":"pone.0275952.ref028","article-title":"An Introduction to Qualitative Research","author":"B Hancock","year":"2007","journal-title":"The NIHR RDS EM \/ YH"},{"issue":"8","key":"pone.0275952.ref029","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1038\/sj.bdj.2008.292","article-title":"Analysing and presenting qualitative data","volume":"204","author":"P Burnard","year":"2008","journal-title":"Br Dent J"},{"key":"pone.0275952.ref030","article-title":"Emic Approach to Qualitative Research","author":"Jennifer A. Scarduzio","year":"2017","journal-title":"Wiley Online Library"},{"issue":"1\u20133","key":"pone.0275952.ref031","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.pec.2007.08.014","article-title":"Effective nurse parent communication: a study of parents\u2019 perceptions in the NICU environment","volume":"69","author":"L Jones","year":"2007","journal-title":"Patient Educ Couns"},{"issue":"1","key":"pone.0275952.ref032","doi-asserted-by":"crossref","first-page":"33","DOI":"10.4103\/0974-2077.41159","article-title":"Informed consent: an ethical obligation or legal compulsion?","volume":"1","author":"KHS Rao","year":"2008","journal-title":"J Cutan Aesthet Surg"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0275952","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T17:43:24Z","timestamp":1667238204000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0275952"}},"subtitle":[],"editor":[{"given":"Shane","family":"Patman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,10,31]]},"references-count":32,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0275952","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,31]]}}}