Annals of African Medicine
Home About AAM Editorial board Ahead of print Current Issue Archives Instructions Subscribe Contact us Search Login 


 
Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 21  |  Issue : 3  |  Page : 269-273  

Misconception on oxygen administration among patients and their caregivers in Ado Ekiti, Nigeria


1 Department of Medicine, Ekiti State University/Ekiti State Teaching Hospital, Ado-Ekiti, Nigeria
2 Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
3 Department of Biochemistry, Landmark University, Omu-Aran, Nigeria

Date of Submission26-Mar-2021
Date of Decision13-Dec-2021
Date of Acceptance08-Jan-2022
Date of Web Publication26-Sep-2022

Correspondence Address:
Adekunle Olatayo Adeoti
Department of Medicine, Ekiti State University/Ekiti State University Teaching Hospital, Ado-Ekiti
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aam.aam_63_21

Rights and Permissions
   Abstract 


Introduction: Appropriate oxygen administration is a life-saving therapy; however, patients and their caregivers could decline such therapy for several reasons. Poor perceptions may delay consent to oxygen therapy. There is a lack of data on the perception of oxygen use among patients and caregivers in our setting. Hence, this study was aimed at evaluating the perception of patients and their caregivers toward emergency oxygen use in a tertiary hospital in Nigeria. Materials and Methods: This survey was a descriptive cross-sectional study conducted between December 2017 and May 2018 at a tertiary hospital in southwestern Nigeria. We administered a structured questionnaire to 334 eligible patients and their 539 caregivers while on admission. Results: A significant proportion of the patients compared to their caregivers have had oxygen therapy in the past 40.6% versus. 6.9% P < 0.0001. The majority of the participants (patients vs. caregivers 84.7% vs. 81.1% P = 0.511) believed oxygen therapy to be beneficial and safe for use (patients vs. caregivers 79.4% vs. 78.6%; P = 0.8949). However, 21.1% of patients and 19.5% of caregivers believed it is solely for terminally ill patients. More than 50% of patients and caregivers thought oxygen can cause adverse effects and fire outbreaks. Most of the respondents considered oxygen therapy as expensive (patients vs. caregivers; 78.2% vs. 87.2%; P = 0.0176) which was regarded as a possible barrier to treatment (patients vs. caregivers 81.9% vs. 85.0% P = 0.3893). <1% of both patients and their caregivers have had any form of training in basic life support. Conclusion: The misconceptions about oxygen use require urgent attention by raising community awareness and knowledge toward improving the acceptability of this life-saving intervention.

   Abstract in French 

Résumé
Introduction : L'administration appropriée d'oxygène est une thérapie salvatrice ; cependant, les patients et leurs soignants pourraient refuser une telle thérapie pour plusieurs raisons. De mauvaises perceptions peuvent retarder le consentement à l'oxygénothérapie. Il y a un manque de données sur la perception de l'utilisation d'oxygène chez les patients et soignants dans notre milieu. Ainsi, cette étude visait à évaluer la perception des patients et de leurs soignants face à l'urgence. utilisation d'oxygène dans un hôpital tertiaire au Nigeria. Matériels et méthodes : Cette enquête était une étude transversale descriptive menée entre décembre 2017 et mai 2018 dans un hôpital tertiaire du sud-ouest du Nigéria. Nous avons administré un questionnaire structuré à 334 patients éligibles et leurs 539 soignants lors de leur admission. Résultats : Une proportion significative des patients par rapport à leurs soignants ont reçu de l'oxygène thérapie dans le passé 40,6% versus. 6,9 % P < 0,0001. La majorité des participants (patients vs soignants 84,7% vs 81,1% P = 0,511) croyaient que l'oxygénothérapie était bénéfique et sans danger (patients vs soignants 79,4 % vs 78,6 % ; P = 0,8949). Cependant, 21,1 % des patients et 19,5 % des soignants pensaient que c'était uniquement pour les patients en phase terminale. Plus de 50 % des patients et des soignants pensaient que l'oxygène pouvait causer les effets néfastes et les départs de feu. La plupart des répondants considéraient l'oxygénothérapie comme coûteuse (patients vs soignants ; 78,2 % vs 87,2 % ; P = 0,0176) qui était considéré comme un obstacle possible au traitement (patients vs soignants 81,9 % vs 85,0 % P = 0,3893). <1 % des deux patients et leurs soignants ont suivi une formation de base en maintien de la vie. Conclusion : Les idées fausses sur l'utilisation de l'oxygène nécessitent une attention en augmentant la sensibilisation et les connaissances de la communauté en vue d'améliorer l'acceptabilité de cette intervention qui sauve des vies.
Mots-clés : Aidants, conception erronée, Nigérian, oxygénothérapie, patients, perception

Keywords: Caregivers, misconception, Nigerian, oxygen therapy, patients, perception


How to cite this article:
Adeoti AO, Desalu OO, Elebiyo T, Aremu OA. Misconception on oxygen administration among patients and their caregivers in Ado Ekiti, Nigeria. Ann Afr Med 2022;21:269-73

How to cite this URL:
Adeoti AO, Desalu OO, Elebiyo T, Aremu OA. Misconception on oxygen administration among patients and their caregivers in Ado Ekiti, Nigeria. Ann Afr Med [serial online] 2022 [cited 2023 Feb 6];21:269-73. Available from: https://www.annalsafrmed.org/text.asp?2022/21/3/269/356830




   Introduction Top


Oxygen therapy is widely used in the hospital- and home-based care for cardiorespiratory diseases. Several biochemical processes within the body depend solely on oxygen utilization, of which its deficiency can result in cellular dysfunction and death.[1],[2] However, the appropriate oxygen prescription is vital to patients' survival, and if given otherwise, it could be harmful and can result in death.[3] This seemly elementary but essential therapy is required and often administered in health facilities in the management of the critically ill patients.[4],[5],[6]

Despite the available recommendations and guidelines on oxygen use, there are misconceptions in most low- and middle-income countries (LMICs) such as an indicator of disease severity, palliative care, deteriorating clinical condition, poor outcome, and imminent death.[6],[7],[8] This misconception is not limited to the populace, as health-care professionals (HCPs) often regarded oxygen therapy as the remedy to almost every severe medical condition.[9]

The perception of patients and their caregivers on oxygen therapy varies across the different regions; hence, it is important to ascertain the existence of such beliefs in our environment so that appropriate awareness programs could be given the required attention. Although patients' autonomy is well recognized in treatment, caregivers who provide the necessary socioeconomic support, especially in communal and low-income settings, could also influence patients' decision-making.[10],[11],[12] We, therefore, hypothesized that there are misconceptions about oxygen therapy among Nigerian patients and their caregivers. This study was aimed at assessing the perceptions of patients and their caregivers toward oxygen use in a tertiary facility in southwestern Nigeria.


   Materials and Methods Top


Study design

This survey was a descriptive cross-sectional study conducted between December 2017 and May 2018 in Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.

Sample size

The calculation of the sample size was done using the raosoft formula, where the confidence interval of 95%, margin of error of 5%, and the response distribution of 50% were imputed into the software.[13] The estimated sample size of 302 was increased to 334 to increase power of the study and consider for attrition. The sample size for the caregiver of 604 was based on the presumed ratio 1:2 of patients and their main caregivers.

Survey instrument

We administered a structured questionnaire to eligible patients and their caregivers at the point of discharge from the medical and surgical wards. The questionnaire was developed from previous observational studies and systematic reviews on how respiratory patients perceived oxygen therapy[7],[8],[14] and reviewed by three medical specialists familiar with oxygen therapy. This instrument was then pretested among hospitalized patients and their caregivers for clarity and better understanding of content to ensure that the ambiguous questions were removed.

Setting and sampling

All consenting patients admitted within the study period over the age of 18 years and who could communicate were recruited. A systematic random sampling technique was employed in selecting the patients and their caregivers. Two caregivers of each consenting patient were randomly selected and if only one was available, he/she was recruited for the study. However, patients who were unwilling to complete the questionnaire administered by the trained research assistants or those who were unfit due to medical status were excluded from the study.

Data collection

Two trained research assistants helped the patients to complete the questionnaire. The patients and their selected caregivers were informed that the responses were anonymous. There were, however, codes and numbering for data entry. The questions items were related to perception of patients' and their caregivers on oxygen administration, safety and cost of oxygen as well as their socioeconomic status.

Statistical analysis

Data cleaning was done following the entry of the administered questionnaire. The analysis was done using the statistical analysis using the statistical packages for the social science (SPSS) version 22 (SPSS IBM Inc., Chicago, III., USA) and Graphpad Prism Version 7 (Graphpad Software, San Diego, California). The continuous variables were presented as means and standard deviations, and the categorical variables were expressed in proportions and compared using Chi-square. P < 0.05 was considered statistically significant.

Ethical considerations

Ethical approval was obtained from the Institutional Ethical Committee of the Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.


   Results Top


Sociodemographic features

A total of 334 patients and 539 caregivers were recruited for this study. The demographic features of the respondents, as presented in [Table 1], showed that the gender distribution (male-to-female ratio) of the patients and caregivers was 1:1 and 1:2, respectively. The mean age of the patients and their caregivers was 45.8 ± 1.0 years and 41.3 ± 0.5 years, respectively. There were fewer respondents above the age 75 years as the percentages of the patients versus caregivers were 19.2% versus. 0.6%, respectively. About half of the patients (48.5%) and caregivers (43.7%) were self-employed, while the minority was retired. The majority of the respondents, i.e., patients versus caregivers (76.5% vs. 79.9%) were married and above half of the patients versus caregivers (52.8% vs. 64.1%) were graduates. <1% of both patients (0.62%) and their caregivers (0.56%) had any form of training in basic life support (BLS).
Table 1: Sociodemographics of respondents

Click here to view


Perception of oxygen use

[Table 2] shows that a minority of the respondents have had oxygen therapy in the past (patients vs. caregivers, 40.6% vs. 6.9% P < 0.0001). However, the majority would accept the administration of oxygen, if the need arises (Patients vs Caregivers, 84.68% vs 81.41%). Also, the respondents admitted that oxygen administration is beneficial to patients when administered (Patients vs Caregivers, 85.85% vs 88.48%). Furthermore, there was the misconception among the patients and caregivers (21.14% vs. 19.48%) that oxygen administration is only for terminally ill patients.
Table 2: Perception of patients and their caregivers toward the use of oxygen

Click here to view


Perception on safety

A majority of the patients and caregivers considered oxygen to be safe for administration (79.38% vs. 78.61% P = 0.8949), while on the contrary, a small proportion of both the patients and caregivers admitted that oxygen use could be poisonous. Slightly above half of the patients and caregivers reported that fire outbreaks could result from oxygen use and likewise have adverse effects when administered.

Perception on cost of oxygen

A major proportion of patients and caregivers (patients vs. caregivers, 78.19% vs. 87.20%) felt that oxygen was too expensive and a barrier to its procurement and administration.


   Discussion Top


The main finding of the study is that significant proportion of the participants believed oxygen therapy to be beneficial and safe for use, but a minority regarded its administration solely for terminally ill patients. More than half of patients and caregivers believed that oxygen could cause adverse effects and fire outbreaks. Most of the respondents considered oxygen therapy as expensive which they regarded such as a possible barrier to its use.

In this study, the majority of the participants were middle-aged, educated individuals who were mainly unpaid female caregivers. In previous studies, most caregivers were females which could be due to their presumed domestic skills.[14],[15] The caregivers were mostly relatives of the patients which is understandable as most Nigerians live a communal life, even when they can afford to hire a caregiver.

In this study, a greater proportion of patients than the caregivers reported to have had previous oxygen administration. This finding could be due to oxygen often being the preliminary therapy in most hospitalized patients for which several studies have identified its erroneous administration among health-care practitioners.[16] The participants' perception was, however, fixated on oxygen administration being mainly for the terminally ill patients, deteriorating medical conditions, and prescription to revive dying patients. In a similar study in Malawi, oxygen therapy was believed to be associated with deteriorating health and eventual death of individuals who received the treatment.[7] Furthermore, terminally ill patients were reported to have had oxygen therapy as one of the conventional and palliative care toward life preservation.[17] This misconception could be due to previous experiences of patients or their relatives in which hospitalized individuals with severe medical conditions which necessitate oxygen administration resulted in mortality.

Most of the respondents perceived oxygen therapy as safe, but a significant proportion believed oxygen could be poisonous, if not properly administered and could result in fire outbreaks. This perception of oxygen as being safe in the hands of trained medical practitioners could be due to their belief in the HCPs prescribing it. However, the required attention while administrating oxygen could be responsible for the response on possible fire hazards. In a systematic review on patients' perception about oxygen, Kelly and Maden reported patients' divergent views and uncertainty regarding oxygen benefits which was regarded as highly inflammable when weighing the benefits against the risk of administration.[8]

In our study, the majority of the respondents indicated that oxygen was expensive and the high cost of oxygen as a likely impediment to its administration when required. In Nigeria, most patients do “out-of-pocket” payments for healthcare as <4% of the population have insurance schemes to lessen the cost burden in admitted patients and allow sustainable cost recovery.[18] This “user-pay” policy of health-care system is expensive and contributes to delayed presentation, early discharge, and high patient debt burden.[18],[19]

Individual proficiency in BLS is essential for every potential caregiver for prompt and effective prehospital care of patients. This is particularly lacking as a negligible percentage of participants, both patients and caregivers, had undergone any form of emergency training which could have equally exposed them to the right perspective on oxygen therapy.[20]

The study has some limitations: the survey instrument was not validated, and this may have some effect on the external validity of the result. The result may not be generalized to other situation like the use of domiciliary oxygen because the study setting and participant were different. Notwithstanding these limitations, our study has a large sample size which would improve the precision of the data which would add to existing body of knowledge on oxygen use in LMICs.


   Conclusion Top


There are obvious misconceptions about oxygen therapy that requires urgent attention by increased community awareness to improve its acceptability as a live-saving intervention among the patients and their caregivers. Furthermore, enactment of policy to subsidize oxygen supply to be affordable would reduce the financial burden and improve its acceptability.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Shankar PS. Oxygen therapy. Q Med Rev 1980;31:1-20.  Back to cited text no. 1
    
2.
Singh CP, Singh N, Singh J, Brar GK, Singh G. Oxygen therapy. J Indian Acad Clin Med 2001;2:178-85.  Back to cited text no. 2
    
3.
Perkins JF. Historical development of respiratory physiology. In: Fenn WO, Rahn H, editors. Handbook of Physiology. 1st ed. Bethesda: American Physiological Society; 1964. p. 1-62.  Back to cited text no. 3
    
4.
Duke T. The Clinical Use of Oxygen in Hospitals with Limited Resources: Guidelines for Health-Care Workers, Hospital Engineers and Managers. Australia: World Health Organisation; 2011.  Back to cited text no. 4
    
5.
Stevenson AC, Edwards C, Langton J, Zamawe C, Kennedy N. Fear of oxygen therapy for children in Malawi. Arch Dis Child 2015;100:288-91.  Back to cited text no. 5
    
6.
Duke T, Graham SM, Cherian MN, Ginsburg AS, English M, Howie S, et al. Oxygen is an essential medicine: A call for international action. Int J Tuberc Lung Dis 2010;14:1362-8.  Back to cited text no. 6
    
7.
Langton J, Stevenson A, Edwards C, Kennedy N, Bandawe C. Attitudes towards oxygen: Exploring barriers to acceptance of oxygen therapy in Malawi. Arch Dis Child 2012;A46 97 Suppl 1:A1-86.  Back to cited text no. 7
    
8.
Kelly CA, Maden M. How do respiratory patients perceive oxygen therapy? A critical interpretative synthesis of the literature. Chron Respir Dis 2014;11:209-28.  Back to cited text no. 8
    
9.
Burls A, Emparanza JI, Quinn T, Cabello JB. Oxygen use in acute myocardial infarction: An online survey of health professionals' practice and beliefs. Emerg Med J 2010;27:283-6.  Back to cited text no. 9
    
10.
Venetis MK, Greene K, Checton MG, Magsamen-Conrad K. Decision making in cancer-related topic avoidance. J Health Commun 2015;20:306-13.  Back to cited text no. 10
    
11.
NASEM. In: Schulz R, Eden J, editors. Families Caring for an Ageing America. Washington, DC: The National Academies Press; 2016.  Back to cited text no. 11
    
12.
Weber KM, Solomon DH, Meyer BJ. A qualitative study of breast cancer treatment decisions: Evidence for five decision-making styles. Health Commun 2013;28:408-21.  Back to cited text no. 12
    
13.
Sample Size Calculator; 2004. Available from: http://www.raosoft.com/samplesize.html. [Last accessed on 2020 Sep 20].  Back to cited text no. 13
    
14.
Caporaso N, Lanzoni M, Castaldi S. The characteristics of caregivers attending adult and paediatric patients in a Milan hospital. Ann Ig 2016;28:133-44.  Back to cited text no. 14
    
15.
Okoye UO. Family care-giving for ageing parents in Nigeria: Gender differences, cultural imperatives and the role of education. Int J Educ Ageing 2012;2:139-54.  Back to cited text no. 15
    
16.
Cousins JL, Wark PA, McDonald VM. Acute oxygen therapy: A review of prescribing and delivery practices. Int J Chron Obstruct Pulmon Dis 2016;11:1067-75.  Back to cited text no. 16
    
17.
Campos-Calderón C, Montoya-Juárez R, Hueso-Montoro C, Hernández-López E, Ojeda-Virto F, García-Caro MP. Interventions and decision-making at the end of life: The effect of establishing the terminal illness situation. BMC Palliat Care 2016;15:91.  Back to cited text no. 17
    
18.
Mokuolu OA, Ajayi OA. Use of an oxygen concentrator in a Nigerian neonatal unit: Economic implications and reliability. Ann Trop Paediatr 2002;22:209-12.  Back to cited text no. 18
    
19.
Gray AZ. Report from the Lao Oxygen Pilot Project Review Workshop, 6-7. Parkville: Centre for International Child Health, University of Melbourne; 2013.  Back to cited text no. 19
    
20.
Handley AJ. Basic life support. Br J Anaesth 1997;79:151-8.  Back to cited text no. 20
    



 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed612    
    Printed36    
    Emailed0    
    PDF Downloaded5    
    Comments [Add]    

Recommend this journal