Background We sought to understand barriers to high quality hospital based 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 following a half-day refresher course on pediatric ALRI case management. The underpinning research methodology of the FGDs was phenomenology, and they were analysed using thematic analysis.

Results We recruited 16 COs to participate in 3 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 at Mchinji District Hospital. 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.

What is already known on this topic ALRIs remain a leading cause of child mortality in Malawi, despite significant gains from the national child lung health program. Little is known about healthcare workers’ perspectives on hospital-based barriers to ALRI care.

What this study adds Clinical officers described their lived experience of barriers to ALRI care delivery, including limited confidence in ALRI management, dysfunctional team dynamics, and resource shortages. They also identified potential solutions such as refresher trainings, job aides, structured plans to manage power outages, and improved access to pulse oximetry.

How this study might affect research, practice, or policy We present healthcare worker-identified interventions that are perceived as acceptable and implementable. These lessons can serve as a starting point for both locally developed and national-level interventions and solutions.

The authors have declared no competing interest.

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This study was approved by the Malawian National Health Sciences Research Committee under Protocol # 18/07/2098 and the Institutional Review Board of Baylor College of Medicine (H-43312).

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