Primary caregivers, healthcare workers, teachers and community leaders' perceptions and experiences of their involvement, practice and challenges of disclosure of HIV status to children living with HIV in Malawi: A qualitative study

Background: The World Health Organisation has recommended that healthcare workers, teachers and community leaders work with parents to support children living with HIV. The aim of this study was to assess the perceptions and experiences of primary caregivers and other care providers such as healthcare workers, teachers, and community leaders regarding their involvement, practice and challenges of HIV disclosure to children aged between 6 and 12 years living with HIV in Malawi. Methods: Twelve focus group discussions and 19 one-on-one interviews involving a total of 106 participants were conducted in all three administrative regions of Malawi. The interviews and focus group discussions explored perceptions and experiences regarding involvement, practice and challenges of disclosure of HIV status to children. Data were analysed using thematic analysis. Results: Primary caregivers, healthcare workers, teachers, and community leaders all reported that the disclosure of HIV status to children was not well coordinated because each of the groups of participants was working in isolation instead of working as a team. A "working together" model emerged from the data analysis where participants expressed the need for them to work as a team in order to promote safe and effective HIV status disclosure through talking about HIV, sharing responsibility and open communication. Participants reported that by working together, the team members would ensure that the prevalence of HIV disclosure to young children increases and that there would be a reduction in any negative impact of disclosure. Conclusion: Global resources are required to better support children living with HIV and their families. Healthcare workers and teachers would benefit greatly from training in working together with families living with HIV and, specifically, training in the disclosure process. Resources, in the form of books and other educational materials, would help them explain HIV and its effective management to children and families

Side to Side Probe Position improves Accuracy of Pulse Oximeter Readings in the Presence of Nail Polish.

Background: Pulse oximetry is an invaluable monitor within and outside the operating theatre. Its accuracy may be affected by nail polish. With the probe in the standard top to bottom position, previous results have been inconsistent. This study investigated the accuracy of peripheral oxygen saturation (SpO2) readings with the probe in the side to side position in the presence of nail polish. Materials and Methods: Seventy healthy female volunteers had their fingers numbered from left to right (left little finger = 1 & right little finger = 10). Alternate fingers were painted with red, blue, purple, brown and black nail colours (experimental). The corresponding finger on the other hand served as control. SpO2 readings were obtained in the top to bottom and side to side probe positions.Results: In the top to bottom position, SpO2 values were recorded for all fingers painted red (100%). The mean SpO2 for all experimental fingers differed significantly from their corresponding controls (p=0.028 for red and p<0.001 for others). No oximetry readings were observed with Purple, Blue, Brown and Black nail polishes in 4.3%, 32.9%, 40% and 61.4% of volunteers respectively. In the side to side position, no missing values were observed and no significant difference was obtained between the experimental fingers and controls (p>0.05). Conclusion: Placing the probe in the side to side position obviated inaccuracies obtained in the presence of nail polish. This position may be adopted in emergent surgeries when time may not be available to remove the nail polish. Keywords: pulse oximeter, nail polish, probe position