Community Malaria Knowledge, Experiences, Perceived Roles, and Acceptability of Community-Directed Distribution of Intermittent Preventive Therapy for Pregnancy in Rural Southeast Nigeria

Abstract

Background. The community plays key roles in protecting pregnant women in rural areas from malaria. This study assessed malaria experiences, knowledge, perceived roles in malaria prevention in pregnancy, and acceptability of community-directed distribution of intermittent preventive therapy (IPTp) for malaria in pregnancy in rural Southeast Nigeria. Methods. This study presents part of the baseline findings of a before-and-after study. Data was collected from 817 community members in Ebonyi State using interviewer-administered questionnaires and focus group discussions (FGDs). Data were analyzed using SPSS version 20 and thematic analysis. Results. The majority of the respondents were females (73.8%) with a mean age of 36.08 ± 15.4 . Most respondents (65.2%) had Insecticide-Treated Net (ITN) and fever in the past year (67.1%). Malaria (88.6%) was identified as the major health condition in the community. Majority (74.1%) knew infected mosquito bites as the cause of malaria while 61.1% and 71.5% were definitely sure that pregnant women and children were at risk for malaria. Sleeping under ITN (54.3%), clean environment (39.7%), and herbal medications (26.8%) were the main ways of malaria prevention cited. Only 18.4% of the participants rated their knowledge of IPTp as adequate, and only 9.3% knew the common drug names used for IPTp. The major perceived roles in malaria prevention in pregnancy were referral of pregnant women to the health facility, encouragement of household ITN use, and sustaining malaria-related projects. The majority of the participants (60.6%) strongly agreed that community-directed distribution of IPTp-SP will improve the prevention of malaria in pregnancy. Most (77.2%) considered community-directed distribution of IPTp acceptable, and 74.4% of the pregnant respondents preferred community to facility administration of IPTp. Conclusions. Malaria was recognized as a prevalent disease, but there was inadequate knowledge of malaria prevention in pregnancy notably intermittent preventive therapy. There was positive perception of roles in malaria prevention in pregnancy and high acceptability of community-directed distribution of IPTp. Community-level malaria control programs should utilize a whole-of–community approach to optimally engage and educate the community on malaria prevention in pregnancy as well as explore community distribution approach for IPTp.

The social dimensions of community delivery of intermittent preventive treatment of malaria in pregnancy in Madagascar, Mozambique, Nigeria and the Democratic Republic of the Congo

“…The fact that lay persons’ confidence in the treatment’s efficacy can go hand in hand with a limited or non-specific understanding of its purpose has been described in a recent mixed-methods study on C-IPTp conducted in Nigeria. 20 Both qualitative and quantitative results of that study reported low levels of awareness of IPTp among lay persons (including pregnant women) while a majority agreed that C-IPTp would improve the prevention of MiP. Similarly, a study on the acceptability of preventive interventions in Mozambique found that few pregnant women could distinguish the drugs provided to them during ANC (which included IPTp-SP) or point at the health problems targeted by each, 37 yet all accepted taking them.…”

“…Substantial qualitative research literature has been generated on the role of CHWs in the promotion and delivery of maternal and child health services, 18 19 including recent work that addresses the anticipated acceptability of the community distribution of IPTp. 20 However, to our knowledge, this is the first longitudinal qualitative study that has focused specifically on the reported acceptability of the delivery of IPTp-SP via CHWs and studied it from the perspective of pregnant women, CHWs and the communities they serve.…”

“…Specifically, the study sought to understand the social context where the project was being implemented in order to identify the factors that influence C-IPTp acceptability among pregnant women and the network of actors involved in the intervention, including the barriers and opportunities for its delivery and uptake. Substantial qualitative research literature has been generated on the role of CHWs in the promotion and delivery of maternal and child health services,18 19 including recent work that addresses the anticipated acceptability of the community distribution of IPTp 20. However, to our knowledge, this is the first longitudinal qualitative study that has focused specifically on the reported acceptability of the delivery of IPTp-SP via CHWs and studied it from the perspective of pregnant women, CHWs and the communities they serve.…”

Knowledge, Attitude, and Practice of pregnant women toward Intermittent preventive treatment during pregnancy in selected medical centers in banadir region, Mogadishu Somalia.; A Cross-Sectional Study.

“…Moreover, some of the respondents misbelieve malaria spread. A good example is an older male who believes that eating uncooked food can cause malariainfected (11).…”

The Curious Case of CAR (Cordillera Administrative Region): Healthcare Workers are Key to Improving Maternal Health Outcomes

“…18 "Fostering relationships of trust between CHWs, community members, and the personnel at facilities in the health system is vital in improving service delivery and uptake of services." 18,19 Bain et al similarly suggest community-based health planning and services (CHPS) "to facilitate supervised and emergency skill delivery at the community level" to improve skilled birth attendance. 17,20 Culturally, people of the Cordilleras believed in home deliveries and traditional healers.…”