Treatment-seeking and uptake of malaria prevention strategies among pregnant women and caregivers of children under-five years during COVID-19 pandemic in rural communities in South West Uganda: a qualitative study

Abstract

Background Despite efforts to avert the negative effects of malaria, there remain barriers to the uptake of prevention measures, and these have hindered its eradication. This study explored the factors that influence uptake of malaria prevention strategies among pregnant women and children under-five years and the impact of COVID-19 in a malaria endemic rural district in Uganda. Methods This was a qualitative case study that used focus group discussions, in-depth interviews, and key informant interviews involving pregnant women, caregivers of children under-five years, traditional birth attendants, village health teams, local leaders, and healthcare providers to explore malaria prevention uptake among pregnant women and children under-five years. The interviews were audio-recorded, transcribed and data were analyzed using thematic content approach. Results Seventy-two participants were enrolled in the Focus Group Discussions, 12 in the in-depth interviews, and 2 as key informants. Pregnant women and caregivers of children under-five years were able to recognize causes of malaria, transmission, and symptoms. All participants viewed malaria prevention as a high priority, and the use of insecticide-treated mosquito bed nets (ITNs) was upheld. Participants' own experiences indicated adverse effects of malaria to both pregnant women and children under-five. Home medication and the use of local herbs were a common practice. Some participants didn’t use any of the malaria prevention methods due to deliberate refusal, perceived negative effects of the ITNs, and family disparity. The Corona Virus Disease-2019 (COVID-19) control measures did not abate the risk of malaria infection but these were deleterious to healthcare access and the focus of malaria prevention. Conclusions Although pregnant women and caregivers of children under-five years recognized symptoms of malaria infection, healthcare-seeking was not apt as some respondents used alternative approaches and delayed seeking formal healthcare. It is imperative to focus on the promotion of malaria prevention strategies and address drawbacks associated with misconceptions about these interventions, and promotion of health-seeking behaviors. As COVID-19 exacerbated the effect of malaria prevention uptake and healthcare seeking, it’s critical to recommit and integrate COVID-19 prevention measures in normative living and restrict future barriers to healthcare access.

Community-level impacts of the coronavirus pandemic on malaria prevention and health-seeking behaviours in rural Benin: A mixed methods study

“…Prior to the pandemic, there was a dichotomy of people avoiding and going to health centres when they were sick. Consistent with other studies, the pandemic exacerbated the dichotomy of people going to and avoiding health centres [36,38,40]. Namely, fear of exposure to COVID-19 at the hospitals and financial barriers associated with health centres (i.e., cost of care, reduced PLOS GLOBAL PUBLIC HEALTH income) led some people to avoid health centres because of the pandemic, while fear of COVID-19 and its overlapping symptoms with malaria lead some people to go to the health centre more often than before the pandemic.…”

Effects of the COVID-19 pandemic on general health and malaria control in Ghana: a qualitative study with mothers and health care professionals

“…Also, education on non-COVID-19 diseases was reduced [ 31 ]. A qualitative study by Taremwa et al [ 32 ] in Uganda generated similar findings, emphasising the negative effects of the pandemic on malaria by a reduced access to health care and disrupted prevention activities. The pandemic compromised health care through financial challenges, fear as well as difficulties in the clinical handling of COVID-19 alongside malaria and the associated increase in socio-economic inequities as supported by a qualitative study with focus on malaria mass testing, treatment and tracing in a rural community in the Eastern Region of Ghana.…”

Impact of the COVID-19 pandemic on malaria cases in health facilities in northern Ghana: a retrospective analysis of routine surveillance data

“…As another consequence of the COVID-19 pandemic, the provision of rapid diagnostic tests for malaria was fragile, which may have led to under-diagnosis of cases [ 42 ]. The main explanation for the lower number of malaria cases seen in health facilities was limited access to health facilities – public transportations were unavailable or unaffordable, and health facilities were closed or only provided reduced services [ 43 , 44 ]. This is supported by findings from a study from Rwanda which showed that health facility visits for malaria decreased while community health services for malaria increased [ 43 ].…”