Prevention and management of malaria during pregnancy: findings from a comparative qualitative study in Ghana, Kenya and Malawi

Malaria Journal

Research

Arantza Meñaca¹  Robert Pool²  Christopher Pell²  Linda Kalilani³  Lucinda Manda-Taylor³  Nana A Afrah⁴  Harry Tagbor⁴  Mary J Hamel⁵  Samuel Chatio⁶  Abraham Hodgson⁷  Florence Were⁸ 

[1] Centre de Recerca en Salut Internacional de Barcelona (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain;Departamento de Antropología Social, Universidad Complutense de Madrid, Madrid, Spain;Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands;Centre de Recerca en Salut Internacional de Barcelona (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain;College of Medicine, University of Malawi, Blantyre, Malawi;Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA;Navrongo Health Research Centre, Navrongo, Ghana;Research and Development Division, Ghana Health Service, Accra, Ghana;The Kenya Medical Research Institute (KEMRI) and Centers for Disease Control and Prevention (CDC), Research and Public Health Collaboration, Kisumu, Kenya;

关键词: Malaria;    Pregnancy;    IPTp;    Insecticide-treated bed nets;    ITNs;    Malaria case management;   

DOI  :  10.1186/1475-2875-12-427

 received in 2013-09-05, accepted in 2013-11-10,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundIn endemic regions of sub-Saharan Africa, malaria during pregnancy (MiP) is a major preventable cause of maternal and infant morbidity and mortality. Current recommended MiP prevention and control includes intermittent preventive treatment (IPTp), distribution of insecticide-treated bed nets (ITNs) and appropriate case management. This article explores the social and cultural context to the uptake of these interventions at four sites across Africa.MethodsA comparative qualitative study was conducted at four sites in three countries: Ghana, Malawi and Kenya. Individual and group interviews were conducted with pregnant women, their relatives, opinion leaders, other community members and health providers. Observations, which focused on behaviours linked to MiP prevention and treatment, were also undertaken at health facilities and in local communities.ResultsITNs were generally recognized as important for malaria prevention. However, their availability and use differed across the sites. In Malawi and Kenya, ITNs were sought-after items, but there were complaints about availability. In central Ghana, women saved ITNs until the birth of the child and they were used seasonally in northern Ghana. In Kenya and central Ghana, pregnant women did not associate IPTp with malaria, whereas, in Malawi and northern Ghana, IPTp was linked to malaria, but not always with prevention. Although IPTp adherence was common at all sites, whether delivered with directly observed treatment or not, a few women did not comply with IPTp often citing previous side effects. Although generally viewed as positive, experiences of malaria testing varied across the four sites: treatment was sometimes administered in spite of a negative diagnosis in Ghana (observed) and Malawi (reported). Despite generally following the advice of healthcare staff, particularly in Kenya, personal experience, and the availability and accessibility of medication – including anti-malarials – influenced MiP treatment.ConclusionAlthough ITNs were valued as malaria prevention, health messages could address issues that reduce their use during pregnancy in particular contexts. The impact of previous side effects on adherence to IPTp and anti-malarial treatment regimens during pregnancy also requires attention. Overtreatment of MiP highlights the need to monitor the implementation of MiP case management guidelines.

【 授权许可】

CC BY   
© Pell et al.; licensee BioMed Central Ltd. 2013