The role of healthcare workers and caregivers in monitoring critically ill children: a qualitative study in Zomba, Malawi

Abstract

Background Critically ill children require close monitoring to facilitate timely interventions throughout their hospitalization. In low- and middle-income countries, a high disease burden yet scarce paediatric critical care resources complicate effective monitoring. This study describes the monitoring practices for critically ill children and examines factors affecting monitoring in a paediatric high-dependency unit in Malawi. Methods An exploratory qualitative study based on 21 in-depth interviews with healthcare workers (n = 12) working in the high dependency unit and caregivers of critically ill children (n = 9), and structured observation of monitoring. Interviews were transcribed and translated for thematic content analysis. Results The ward layout, power outages, lack of human resources and limited familiarity with the available monitoring devices, affected monitoring of critically ill children admitted to the high dependency unit. Monitoring was mostly performed intermittently, through clinical observations. Healthcare workers prioritized the sickest children for more frequent monitoring using the available devices. Caregivers, who were present throughout admission, were involved informally in flagging possible deterioration to healthcare staff. Conclusion Opportunities to improve monitoring of critically ill children in high dependency unit include ongoing training of healthcare workers to effectively allocate and employ the available devices, and/or supporting caregivers to play more formal role in escalation.