Nalwanga Damalie, Opoka Robert Opika, Ssemata Andrew Sentoogo, Kakooza Lawrence, Kiggwe Andrew, Musiime Victor, Kiguli Sarah
Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Makerere University Lung Institute, Kampala, Uganda.
BMC Health Serv Res. 2025 Jul 2;25(1):896. doi: 10.1186/s12913-025-13014-y.
Severe pneumonia remains the leading cause of morbidity and mortality among children worldwide. Severe pneumonia causes death during hospitalization, and survivors are prone to malnutrition after discharge from the hospital. The World Health Organization and United Nations International Children's Fund recommend 'continued' feeding following a severe pneumonia illness without specific recommendations on nutritional support. This recommendation could influence health workers' and caregivers' nutritional practices. This study aimed to explore the perspectives and practices of health workers and caregivers for mitigating malnutrition among children with severe pneumonia.
We conducted a cross-sectional qualitative study between June and November 2021 among health workers and caregivers of children hospitalized with severe pneumonia at Mulago National Referral Hospital in Kampala, Uganda. The data were collected via focus group discussions involving 17 caregivers and key informant interviews with 12 health workers and were analyzed via the content-thematic analysis approach. Both manual coding and Atlas Ti software were used to support the analysis.
Health workers and some caregivers were aware that severe pneumonia predisposes children to malnutrition to various degrees, citing reduced appetite, difficulty breathing, persistent vomiting, and increased metabolic demands as pathways. Caregivers increased breastfeeding and utilized nutrient-rich foods to prevent malnutrition, while health workers applied caregiver education and tailored pneumonia management strategies, including following available guidelines and working with nutritionists.
Severe pneumonia is recognized among health workers and some caregivers as a risk factor for malnutrition. However, mitigating strategies are not uniformly practiced by caregivers and could be enhanced by effective health education and sensitization. More specific guidelines could further reinforce the beneficial practices of health workers managing children with severe pneumonia who are not severely malnourished, and improve treatment outcomes.
重症肺炎仍然是全球儿童发病和死亡的主要原因。重症肺炎会导致患儿在住院期间死亡，幸存者出院后也容易出现营养不良。世界卫生组织和联合国儿童基金会建议在重症肺炎患病后“持续”喂养，但未对营养支持给出具体建议。这一建议可能会影响卫生工作者和照料者的营养实践。本研究旨在探讨卫生工作者和照料者对于减轻重症肺炎患儿营养不良状况的观点和做法。
2021年6月至11月，我们在乌干达坎帕拉穆拉戈国家转诊医院对患有重症肺炎住院儿童的卫生工作者和照料者开展了一项横断面定性研究。通过17名照料者参与的焦点小组讨论以及12名卫生工作者的关键 informant 访谈收集数据，并采用内容主题分析方法进行分析。同时使用手工编码和Atlas Ti软件辅助分析。
卫生工作者和部分照料者意识到重症肺炎会使儿童在不同程度上易患营养不良，指出食欲减退、呼吸困难、持续呕吐以及代谢需求增加是相关途径。照料者增加母乳喂养并使用营养丰富的食物来预防营养不良，而卫生工作者则开展照料者教育并制定针对性的肺炎管理策略，包括遵循现有指南以及与营养师合作。
卫生工作者和部分照料者认识到重症肺炎是营养不良的一个风险因素。然而，照料者并未统一实施减轻策略，有效的健康教育和宣传可加强这些策略。更具体的指南可进一步强化卫生工作者对非严重营养不良的重症肺炎患儿的有益做法，并改善治疗效果。
