Perceptions of hospital feeding practices among mothers of infants with severe pneumonia in Malawi: A qualitative descriptive study

Objective To determine caregiver knowledge of, attitudes towards, and perceptions of feeding practices for infants admitted to a tertiary referral hospital with severe pneumonia, and to identify community feelings about nasogastric tube feeding in Malawi. Setting The paediatric ward of a government tertiary referral hospital in Lilongwe, Malawi. Methods From March through April 2023, we conducted in-depth interviews with 14 mothers of infants 0-12 months of age hospitalised with severe pneumonia who had been enrolled in an observational study evaluating feeding and swallowing in breastfed infants. In-depth interviews assessed mothers' attitudes towards hospital feeding practices including nasogastric tube feeding, along with community perceptions of nasogastric tubes. Data were analysed using a thematic analysis approach to assess themes and subthemes of transcripts. Results Mothers understood that children with pneumonia are at risk of â € choking' during oral feeding; however, they had substantial worries about both withholding breastfeeding and providing nasogastric feeds to their infants through a nasogastric tube. Community perceptions of nasogastric tubes were widely negative and included beliefs that nasogastric tubes cause children to â € choke' and die and that medical providers want to harm children. Mothers held strong beliefs about the benefits of breastfeeding. Conclusion There are alarming misconceptions in the community around nasogastric tubes and the intentions of medical providers. This leads to maternal concerns about this hospital feeding practice, poor adherence to medical recommendations, and mistrust in the broader healthcare system. To improve hospital outcomes of children with severe pneumonia, caregiver and community education is needed.