Access and Use of Interventions to Prevent and Treat Malaria among Pregnant Women in Kenya and Mali: A Qualitative Study

Abstract

BackgroundCoverage of malaria in pregnancy interventions in sub-Saharan Africa is suboptimal. We undertook a systematic examination of the operational, socio-economic and cultural constraints to pregnant women’s access to intermittent preventive treatment (IPTp), long-lasting insecticide-treated nets (LLINs) and case management in Kenya and Mali to provide empirical evidence for strategies to improve coverage.MethodsFocus group discussions (FGDs) were held as part of a programme of research to explore the delivery, access and use of interventions to control malaria in pregnancy. FGDs were held with four sub-groups: non-pregnant women of child bearing age (aged 15–49 years), pregnant women or mothers of children aged <1 year, adolescent women, and men. Content analysis was used to develop themes and sub-themes from the data.ResultsWomen and men’s perceptions of the benefits of antenatal care were generally positive; motivation among women consisted of maintaining a healthy pregnancy, disease prevention in mother and foetus, checking the position of the baby in preparation for delivery, and ensuring admission to a facility in case of complications. Barriers to accessing care related to the quality of the health provider-client interaction, perceived health provider skills and malpractice, drug availability, and cost of services. Pregnant women perceived themselves and their babies at particular risk from malaria, and valued diagnosis and treatment from a health professional, but cost of treatment at health facilities drove women to use herbal remedies or drugs bought from shops. Women lacked information on the safety, efficacy and side effects of antimalarial use in pregnancy.ConclusionWomen in these settings appreciated the benefits of antenatal care and yet health services in both countries are losing women to follow-up due to factors that can be improved with greater political will. Antenatal services need to be patient-centred, free-of-charge or highly affordable and accountable to the women they serve.

Malaria Intermittent Preventive Treatment in Nigeria: A Qualitative study to explore barriers and facilitators

“…In fact, when responding to questions about willingness to take IPTp if given, most of them agree to take SP to protect themselves and their unborn from malaria. This disagree with the ndings reported from Kenya and Mali in which some women fear taking IPTp (26).…”

Evaluation of Malaria Screening during Pregnancy with Rapid Diagnostic Tests Performed by Community Health Workers in Burkina Faso

“…4 Reasons for low coverage are a lack of coordination and leadership, financial constraints, unmotivated and unsupported health staff, perceived risk of the medication, logistic challenges, and ANC attendance among others. [5][6][7] Adolescents and primigravidae, who have among pregnant women the highest risk of malaria, are even less likely to receive sufficient doses of IPTp-SP, mainly due to low ANC attendance.…”

Achieving development goals for HIV, tuberculosis and malaria in sub-Saharan Africa through integrated antenatal care: barriers and challenges

“…To achieve effective integration of HIV, TB and malaria interventions into ANC services, implementation must be accompanied by improved physical and technical infrastructure; services provided at different locations (e.g. consulting rooms and laboratories in different facilities) or those not provided on the same day pose a significant challenge to integrated HIV services (reviewed in [11, 26, 43]) and have impacted on the integration of malaria treatment into ANC [44, 45]. While IPTp is given presumptively in ANC, thus removing the need for testing, women are often required to purchase the drug elsewhere or are not directly observed taking therapy having been given the drug to take home, both of which have been identified as a significant barrier to IPTp coverage [45–47].…”

“…consulting rooms and laboratories in different facilities) or those not provided on the same day pose a significant challenge to integrated HIV services (reviewed in [11, 26, 43]) and have impacted on the integration of malaria treatment into ANC [44, 45]. While IPTp is given presumptively in ANC, thus removing the need for testing, women are often required to purchase the drug elsewhere or are not directly observed taking therapy having been given the drug to take home, both of which have been identified as a significant barrier to IPTp coverage [45–47]. Effective procurement and distribution systems are also important determinants of success for integrated services, with inadequate and irregular supplies of essential drugs and interventions, in both the public and private healthcare sector, representing a major barrier in the uptake of both integrated HIV and malaria services [18, 39, 40].…”