“A child with severe pneumonia cannot feed, causing malnutrition”: Health workers’ and caregivers’ perceptions about nutrition among children with pneumonia in Uganda

Background: Severe pneumonia remains the leading cause of morbidity and mortality among children worldwide. It is a catabolic illness, which predisposes children to severe malnutrition. Severe pneumonia deaths during hospitalization and following discharge are largely associated with malnutrition. 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 could influence health workers’ and caregivers’ nutritional practices. This study aimed to explore the understanding, attitudes and nutritional practices of health workers and caretakers among children with severe pneumonia. Methods: We conducted a cross-sectional qualitative study between June and November 2021 among health workers and caregivers of children hospitalized with severe pneumonia in Mulago National Referral Hospital in Kampala, Uganda. Data was collected using focus-groups involving caregivers and key informant interviews for health workers and analyzed using the content-thematic analysis approach. Both manual coding and Atlas Ti software were used to support analysis. Results: Health workers and some caregivers were aware that severe pneumonia predisposes to malnutrition to various degrees, citing that reduced appetite, difficulty in breathing and persistent vomiting lead to malnutrition. They noted that the increased risk for malnutrition called for a balanced diet and more frequent breastfeeding. Suppressed immunity in malnourished children was mentioned as a pathway to fatal severe pneumonia. Some caregivers confessed to a lack of knowledge about a possible relationship between the two conditions, which affected their nutritional practices. Conclusion: Severe pneumonia is recognized among health workers and some caregivers as a risk factor for malnutrition. However, mitigating strategies are not generally practiced by caregivers, and could be enhanced by effective health education and sensitization. Specifying feeding guidelines for children with severe pneumonia could further improve attitudes and practices of health workers and caregivers and reduce preventable pneumonia deaths.