Health care worker–reported barriers and potential facilitators of acute lower respiratory infection care deliver for children at Mchinji District Hospital in Malawi

Objectives: We sought to understand barriers to high-quality hospital-based child acute lower respiratory infection (ALRI) care at Mchinji District Hospital in Malawi. Methods: In 2020, we conducted focus group discussions (FGDs) with clinical officers (COs) who provided direct clinical care after a half-day refresher course on pediatric ALRI case management. The underpinning research methodology of the FGDs was phenomenology, and they were analyzed using inductive and deductive thematic analysis. Results: We recruited 16 COs to participate in three FGDs. Five themes emerged: lack of confidence in ALRI diagnosis and management, high clinical burden with understaffing, dysfunctional team dynamics, limited physical resources, and the recognition of the importance of vital sign measurements despite barriers to practice. Conclusions: COs shared several barriers and potential interventions to improve child ALRI care delivery. Some solutions were locally implementable, with minimal to modest cost, such as a program for continuing education, standard operating procedures during electricity outages, and posting of job aides. However, many of their suggestions require investments and commitment from the Malawian Ministry of Health to increase staffing capacity and improve the physical infrastructure and are, therefore, of undetermined feasibility. Future research should examine the impact of hospital layout and infrastructure, continuing education programs, and informal vital sign assistants on clinical care delivery.