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Cardona-Arias JA. Synthesis of Qualitative Evidence on Malaria in Pregnancy, 2005-2022: A Systematic Review. Trop Med Infect Dis 2023; 8:tropicalmed8040235. [PMID: 37104360 PMCID: PMC10145031 DOI: 10.3390/tropicalmed8040235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023] Open
Abstract
Qualitative research on malaria in pregnancy (MiP) is incipient, therefore its contextual, experiential and symbolic associated factors are unknown. This study systematizes the qualitative research on MiP, describes knowledge, perceptions and behaviors about MiP, and compiles individual, socioeconomic, cultural and health system determinants of MiP through a meta-synthesis in 10 databases. A total of 48 studies were included with 2600 pregnant women, 1300 healthcare workers, and 2200 relatives or community members. Extensive knowledge was demonstrated on ITN and case management, but it was lacking on SP-IPTp, risks and consequences of MiP. Attitudes were negative towards ANC and MiP prevention. There were high trustfulness scores and preference for traditional medicine and distrust in the safety of drugs. The main determinants of the Health System were rationing, copayments, delay in payment to clinics, high out-of-pocket expenses, shortage, low workforce and work overload, shortcomings in care quality, low knowledges of healthcare workers on MiP and negative attitude in care. The socioeconomic and cultural determinants were poverty and low educational level of pregnant women, distance to the hospital, patriarchal-sexist gender roles, and predominance of local conceptions on maternal-fetal-neonatal health. The meta-synthesis demonstrates the difficulty to detect MiP determinants and the importance of performed qualitative research before implementing MiP strategies to understand the multidimensionality of the disease.
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Affiliation(s)
- Jaiberth Antonio Cardona-Arias
- Research Group Salud y Comunidad-César Uribe Piedrahita, School of Microbiology, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellin 050010, Colombia
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Aberese-Ako M, Doegah P, Acquah E, Magnussen P, Ansah E, Ampofo G, Agyei DD, Klu D, Mottey E, Balen J, Doumbo S, Mbacham W, Gaye O, Gyapong M, Owusu-Agyei S, Tagbor H. Motivators and demotivators to accessing malaria in pregnancy interventions in sub-Saharan Africa: a meta-ethnographic review. Malar J 2022; 21:170. [PMID: 35659232 PMCID: PMC9166609 DOI: 10.1186/s12936-022-04205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Despite the introduction of efficacious interventions for malaria control, sub-Saharan Africa continues to bear the highest burden of malaria and its associated effects on vulnerable populations, such as pregnant women and children. This meta-ethnographic review contributes to literature on malaria in pregnancy interventions in sub-Saharan Africa by offering insights into the multiple factors that motivate or demotivate women from accessing MiP interventions. Methods A meta-ethnographic approach was used for the synthesis. Original qualitative research articles published from 2010 to November 2021 in English in sub-Saharan Africa were searched for. Articles focusing on WHO’s recommended interventions such as intermittent preventive treatment with sulfadoxine-pyrimethamine, long-lasting insecticidal nets and testing and treatment of Malaria in Pregnancy (MiP) were included. Selected articles were uploaded into Nvivo 11 for thematic coding and synthesis. Results Twenty-seven original qualitative research articles were included in the analysis. Main factors motivating uptake of MiP interventions were: (1) well organized ANC, positive attitudes of health workers and availability of MiP services; (2) Women’s knowledge of the effects of malaria in pregnancy, previous experience of accessing responsive ANC; (3) financial resources and encouragement from partners, relatives and friends and (4) favourable weather condition and nearness to a health facility. Factors that demotivated women from using MiP services were: (1) stock-outs, ANC charges and health providers failure to provide women with ample education on the need for MiP care; (2) perception of not being at risk and the culture of self-medication; (3) fear of being bewitched if pregnancy was noticed early, women’s lack of decision-making power and dependence on traditional remedies and (4) warm weather, long distances to health facilities and the style of construction of houses making it difficult to hang LLINs. Conclusions Health system gaps need to be strengthened in order to ensure that MiP interventions become accessible to women. Additionally, health managers need to involve communities in planning, designing and implementing malaria interventions for pregnant women. It is important that the health system engage extensively with communities to facilitate pregnant women and communities understanding of MiP interventions and the need to support pregnant women to access them.
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Affiliation(s)
| | - Phidelia Doegah
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Evelyn Acquah
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Pascal Magnussen
- Faculty of Health and Medical Sciences, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Evelyn Ansah
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Gifty Ampofo
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | | | - Desmond Klu
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Elsie Mottey
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Julie Balen
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Safiatou Doumbo
- University of Sciences, Techniques and Technologies of Bamako, Malaria Research and Training Center, Bamako, Mali
| | - Wilfred Mbacham
- The Fobang Institutes for Innovations in Science and Technologies & The Biotechnology Center, The Centre for Health Innovations and Translational Research, University of Yaounde I, Yaounde, Cameroon
| | - Ouma Gaye
- Faculty of Medicine, University Cheikh Anta Diop Dakar, Dakar, Senegal
| | - Margaret Gyapong
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Seth Owusu-Agyei
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Harry Tagbor
- University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Aberese-Ako M, Magnussen P, Ampofo GD, Gyapong M, Ansah E, Tagbor H. An ethnographic study of how health system, socio-cultural and individual factors influence uptake of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine in a Ghanaian context. PLoS One 2021; 16:e0257666. [PMID: 34618812 PMCID: PMC8496863 DOI: 10.1371/journal.pone.0257666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background Intermittent preventive treatment of malaria among pregnant women with sulfadoxine-pyrimethamine (IPTp-SP), is one of the three recommended interventions for the prevention of malaria in pregnancy (MiP) in sub-Sahara Africa. The World Health Organisation recommended in 2012 that SP be given at each scheduled ANC visit except during the first trimester and can be given a dose every month until the time of delivery, to ensure that a high proportion of women receive at least three doses of SP during pregnancy. Despite implementation of this policy, Ghana did not attain the target of 100% access to IPTp-SP by 2015. Additionally, negative outcomes of malaria infection in pregnancy are still recurring. This ethnographic study explored how health system, individual and socio-cultural factors influence IPTp-SP uptake in two Ghanaian regions. Methods The study design was ethnographic, employing non-participant observation, case studies and in depth interviews in 8 health facilities and 8 communities, from April 2018 to March 2019, in two Ghanaian regions. Recommended ethical procedures were observed. Results Health system factors such as organization of antenatal care (ANC) services and strategies employed by health workers to administer SP contributed to initial uptake. Women’s trust in the health care system contributed to continued uptake. Inadequate information provided to women accessing ANC, stock-outs and fees charged for ANC services reduced access to IPTp-SP. Socio-cultural factor such as encouragement from social networks influenced utilization of ANC services and IPTp-SP uptake. Individual factors such as refusing to take SP, skipping ANC appointments and initiating ANC attendance late affected uptake. Conclusion Health system, socio-cultural and individual factors influence uptake of optimum doses of IPTp-SP. Consequently, interventions that aim at addressing IPTp-SP uptake should focus on regular and sufficient supply of SP to health facilities, effective implementation of free ANC, provision of appropriate and adequate information to women and community outreach programmes to encourage early and regular ANC visits.
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Affiliation(s)
- Matilda Aberese-Ako
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
- * E-mail: ,
| | - Pascal Magnussen
- Faculty of Health and Medical Sciences, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Gifty D. Ampofo
- School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Evelyn Ansah
- Institute of Health Research, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Harry Tagbor
- School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
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Looman L, Pell C. End-user perspectives on preventive antimalarials: A review of qualitative research. Glob Public Health 2021; 17:753-767. [PMID: 33617406 DOI: 10.1080/17441692.2021.1888388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Antimalarials have been administered widely to prevent clinical malaria and researchers have explored how end-users' perspectives influence uptake and adherence. Drawing on a systematic search, this review aims to synthesise qualitative research on end-user perceptions of antimalarials for disease prevention. Searches were undertaken in PubMed and ISI Web of Knowledge. After applying exclusion criteria, identified sources underwent thematic analysis. Identified sources were published between 2000 and 2020 and drew on studies undertaken across Africa, Asia, Europe, Oceania and America. The sources revealed end-user concerns about the potential benefits and harms of preventive treatment that are entwined with broader understandings of the disease, the intervention, its implementation, accompanying information, and how it is embedded in wider healthcare and social relationships. The implications for antimalarials as preventive therapy encompass the need to build trust, including interpersonal trust, engage diverse stakeholders and to address broader health and wellbeing concerns during implementation.
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Affiliation(s)
- Lisanne Looman
- Department of Global Health Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Christopher Pell
- Department of Global Health Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands.,Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands
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