Intermittent screening and treatment versus intermittent preventive treatment of malaria in pregnancy: user acceptability

Abstract

BackgroundMalaria in pregnancy is associated with increased risks of maternal and foetal complications. Currently, intermittent preventive treatment (IPT) of malaria during pregnancy with sulphadoxine-pyrimethamine (SP) is recommended by the WHO as part of a package of interventions also including insecticide-treated nets and effective case management. However, with increasing resistance to SP, the effectiveness of SP-IPT has been questioned. A randomized controlled trial (RCT) to investigate the relative efficacy of an alternative strategy of intermittent screening and treatment (IST), which involves a rapid diagnostic test for malaria at scheduled ANC visits and treatment of women only if positive, versus SP-IPT has been conducted in Ashanti region, Ghana. This paper reports on a complementary study investigating the acceptability of the different strategies to women enrolled in the trial.MethodsData were collected through twelve focus group discussions with women selected at random from the different arms of the RCT, exploring their experiences and perceptions about antenatal care and their involvement in the trial. Content analysis was used to identify relevant themes to structure the results.ResultsFive main themes emerged from participants' experiences of ANC and the RCT that would influence their acceptability of malaria prevention strategies during pregnancy: health benefits; drugs received; tests received; other services received; and health worker attitude. Their own health and that of their baby were strong motivations for attending ANC, and reported favourably as an outcome of being in the RCT. Women were not always clear on the biomedical function of drugs or blood tests but generally accepted them due to strong trust in the health staff. Home visits by staff and free ITNs as part of the trial were appreciated. Politeness and patience of health staff was a very strong positive factor.ConclusionsOverall, both intermittent screening and treatment and intermittent preventive treatment appeared equally acceptable to pregnant women as strategies for the control of malaria in pregnancy. The women were more concerned about quality of services received, in particular the polite and patient attitude of health staff, and positive health implications for themselves and their babies than about the nature of the intervention.

Provider and user acceptability of intermittent screening and treatment for the control of malaria in pregnancy in Malawi

“…Many pregnant women agreed with the idea of being tested for an infection before receiving treatment citing the discomfort of side effects of unnecessary drugs. This is in line with findings of other studies exploring the acceptability of ISTp in Ghana and Kenya [27, 28, 30]. The importance of clear communication in relation to what the tests are for, and their results was emphasized by both pregnant women and health workers.…”

“…As seen elsewhere [27–30], this study found that pregnant women do not attend ANC solely for malaria screening; they want the progress of their babies’ development to be monitored to increase the chance that the baby will be born healthy and without complications. Furthermore, the study findings strongly suggest that the likelihood of pregnant women complying with repeat visits is related to the quality of services and care that they received.…”

“…As such, it was not possible to design the composition of the FGDs with respect to trial arm and experience of the different interventions as has been done in previous studies [27, 28]. This means that the women involved in the qualitative study may not be fully representative of the trial population as a whole.…”

Assessing demand-side barriers to uptake of intermittent preventive treatment for malaria in pregnancy: a qualitative study in two regions of Uganda

“…However, it appears that most women can be persuaded to accept medication if the benefits are pointed out by a qualified health care provider. This confirms that women’s trust in health workers’ judgement plays a crucial role in ensuring high IPTp uptake, which has been highlighted by a number of previous studies [28–30]. …”

Intermittent Preventive Treatment of Malaria in Children: A Qualitative Study of Community Perceptions and Recommendations in Burkina Faso and Mali

“…The initial refusals and withdrawals in Mali, though small in number, were concentrated in an area of greater socio-economic diversity with more educated residents, and seemed to reflect a degree of scepticism regarding the trial, which could also affect willingness to try a new intervention. This motivation to comply with sanctioned health activities also emerged in the studies of IPTi [20] and in the comparison of IPTp with IST [27]. A growing literature around the ethics of trial participation has explored the important role of social relations in trials [22], [28], [29] and found that “interactions and relationships between researchers and community members, and within the community, play a critical role in participants' perceptions of a study” [28].…”