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

Abstract

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.

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

“…From this research it appears that, in analogy with general concerns over taking medication in pregnancy, women can generally be persuaded to accept IPTp when recommended by a health worker. This has also been reported from a study conducted in Ghana, Kenya and Malawi [33]. …”

“…It was evident, however, that many women and opinion leaders did not distinguish clearly between taking medication to prevent malaria and taking medication to treat symptomatic malaria, a challenge which has also been reported from Malawi and Ghana [33]. …”

Effect of a Nurse-Led Health Talk on Malaria Prevention Behaviors among Primigravida Women Attending University of Jos Health Centre, Plateau State

“…This is an indication that they had some knowledge about how malaria could be prevented, although, the preventive behaviors may have not been well articulated. This finding is consistent with Pell et al 14 where it was indicated that ITNs were generally recognized as important for malaria prevention among people while low level of awareness was responsible for low intake of IPT. The non-use of ITNs by some pregnant women may arise from their lack of awareness, and prohibitive cost.…”

Women's Access and Provider Practices for the Case Management of Malaria during Pregnancy: A Systematic Review and Meta-Analysis

“…Poor knowledge of and adherence to national treatment policy guidelines among healthcare providers was a consistent finding across countries in east [42],[51] and west Africa [21],[30],[37],[38],[40],[43],[44],[46],[47], Asia [16],[17], the Middle East [18], and Latin America [20], and knowledge was particularly poor among private providers [35],[39]. In Ghana, healthcare providers asserted that pregnant women were exceptions to the policy of testing prior to treatment, and provided treatment even when a malaria test was negative.…”