Perceptions and drivers of healthcare provider and drug dispenser practices for the treatment of malaria in pregnancy in the context of multiple first-line therapies in western Kenya: a qualitative study

Malaria Journal

Research

Eleanor Ochodo¹  Caroline B. Osoro¹  Feiko O. ter Kuile²  Jenny Hill²  Stephanie Dellicour²  Taryn Young³  Julie R. Gutman⁴ 

[1] Centre for Global Health Research, Kenya Medical Research Institute, P.O. Box 1578, 40100, Kisumu, Kenya;Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, 8000, Cape Town, South Africa;Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, Liverpool, Liverpool, UK;Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, 8000, Cape Town, South Africa;Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, 30333, Atlanta, GA, USA;

关键词: Anti-malarials;    Artemisinin-based combination therapies;    Malaria;    Pregnancy;    Healthcare providers;    Knowledge;    Behaviour;    Health practices;    Kenya;   

DOI  :  10.1186/s12936-023-04698-w

 received in 2023-04-28, accepted in 2023-09-01,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundEmergence of Plasmodium falciparum resistance to artemether-lumefantrine in Africa prompted the pilot introduction of multiple first-line therapies (MFT) against malaria in Kenya, potentially exposing women-of-childbearing-age (WOCBAs) to anti-malarials with unknown safety profiles in the first trimester. This qualitative study explored knowledge and perceptions among healthcare providers providing malaria treatment to WOCBAs and pregnant women.MethodsIn-depth interviews were conducted with purposively selected public and private health facility (HF) and drug outlet (DO) providers within and outside the pilot-MFT area. County health managers were interviewed about their knowledge of the national treatment guidelines. Transcripts were coded by content analysis using the World Health Organization health system building blocks (leadership/governance, financing, health workforce, health information systems, access to medicines, and service delivery).ResultsThirty providers (HF:21, DO:9) and three health managers were interviewed. Eighteen providers were from HFs in the pilot-MFT area; the remaining three and all nine DOs were outside the pilot-MFT area. The analysis revealed that providers had not been trained in malaria case management in the previous twelve months. DO providers were unfamiliar with national treatment guidelines in pregnancy and reported having no pregnancy tests. Health managers were unable to supervise DOs due to resource limitations. Providers from HFs and DOs noted poor sensitivity of malaria rapid diagnostic tests (RDTs) and hesitancy among patients who associated malaria-RDTs with HIV testing. Almost all providers reported anti-malarial stock-outs, with quinine most affected. Patient preference was a major factor in prescribing anti-malarials. Providers in HFs and DOs reported preferentially using artemether-lumefantrine in the first trimester due to the side effects and unavailability of quinine.ConclusionKnowledge of malaria case management in drug outlets and health facilities remains poor. Improved regulation of DO providers is warranted. Optimizing treatment of malaria in pregnancy requires training, availability of malaria commodities, and pregnancy tests.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023