Perspectives from clinicians from different levels of care in Maputo, Mozambique: qualitative study of the barriers to and facilitators of paediatric injury care in resource-poor hospital settings

Abstract

Objectives Providing care for injured children is challenging in resource-poor settings. While checklists can assess local capacities and guide the setting of priorities for improvement, key insights can be gained from consultation with locally practising clinicians. This study aimed to highlight barriers to and facilitators of the delivery of paediatric injury care experienced by clinicians from hospitals at different levels of care in Maputo, Mozambique. Design We conducted semistructured individual qualitative interviews with clinical staff at four hospitals. Data were analysed using inductive content analysis. Setting The study was conducted in four hospitals, each representing a specific level of care in Maputo, Mozambique. Participants We recruited clinicians (doctors, nurses and technicians) involved in paediatric injury care to be interviewed on-site (we target around 10 clinicians per hospital). Results From the 40 interviews conducted, four categories of barriers emerged: (1) prehospital care constraints, (2) shortage of child-appropriate resources, (3) inappropriate infrastructure for paediatric emergency care and (4) limited qualified staff available. By contrast, one category of facilitators stood out, namely that of cross-boundaries support and mentorship, between professionals and institutions. Conclusion From clinicians' perspective, barriers to paediatric injury care are often similar across hospitals and professional groups, and they include the prehospital setting. Resource and infrastructure challenges were emphasized, as expected, and clinicians expressed a clear desire for knowledge and competence sharing.