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Compaoré A, Nikièma J, Kiemdé F, Tinto H, Salami O, Nkeramahame J, Olliaro P, Horgan P. What Influences Patients' Adherence to Healthcare Worker Prescription in Primary Healthcare Facilities in Burkina Faso? A Qualitative Account of Barriers and Facilitators. Clin Infect Dis 2023; 77:S171-S181. [PMID: 37490739 PMCID: PMC10368408 DOI: 10.1093/cid/ciad347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND This study explores the factors influencing patients and caregivers' adherence to prescription of healthcare workers (HCWs). METHODS The study was conducted in Temnaore and Pella, in the Nanoro health district in Burkina Faso. HCWs and community members were purposively recruited from 4 communities seeking care at the selected primary healthcare facilities for the clinical trial to attend in-depth interviews and focus group discussions on the factors influencing adherence to prescription. The Behaviour Change Wheel incorporating the Capability, Opportunity, and Motivation Behaviour approach was used. RESULTS Factors influencing the ability of patients to obtain the prescribed medicine include the availability of medicines and money and the perception of consequences for not getting the medicine. Regarding compliance with the intake of medicines, communication was considered a key factor whose effectiveness depends on the performance of HCWs and on the attention of patients. It is followed by other factors such as adequate management of patients, social influences, the patient's beliefs regarding treatment, and memory. CONCLUSIONS This research highlights factors influencing adherence to HCWs' prescription from the perspective of the community members and HCWs and therefore provides contextual enablers and barriers, which allows for the development of an intervention to support the clinical trial.
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Affiliation(s)
- Adélaïde Compaoré
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Jacqueline Nikièma
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Francois Kiemdé
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | | | | | - Piero Olliaro
- FIND, Geneva, Switzerland
- Evidence and Impact Oxford, Oxford, United Kingdom
| | - Philip Horgan
- FIND, Geneva, Switzerland
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute University of Oxford, Oxford, United Kingdom
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
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Olliaro P, Nkeramahame J, Salami O, Moore CE, Horgan P, Baiden R, Kukula V, Adjei A, Kapisi J, Hopkins H, Kaawa-Mafigiri D, Ekusai-Sebatta D, Rutebemberwa E, Kitutu FE, Tinto H, Kiemde F, Compaoré A, Valia D, Dittrich S. Advancing Access to Diagnostic Tools Essential for Universal Health Coverage and Antimicrobial Resistance Prevention: An Overview of Trials in Sub-Saharan Africa. Clin Infect Dis 2023; 77:S125-S133. [PMID: 37490744 PMCID: PMC10368407 DOI: 10.1093/cid/ciad326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Indexed: 07/27/2023] Open
Abstract
We introduce the Antimicrobial Resistance Diagnostic Use Accelerator program, and the articles in this Supplement, which cover the program in 3 sub-Saharan Africa countries.
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Affiliation(s)
- Piero Olliaro
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
- FIND, Geneva, Switzerland
| | | | | | - Catrin E Moore
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | - Philip Horgan
- FIND, Geneva, Switzerland
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- Evidence & Impact Oxford, Oxford, United Kingdom
| | | | - Vida Kukula
- Dodowa Health Research Centre, Dodowa, Ghana
| | | | - James Kapisi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Heidi Hopkins
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Elizeus Rutebemberwa
- Department of Health Policy and Planning, Makerere University School of Public Health, Kampala, Uganda
| | - Freddy Eric Kitutu
- Department of Pharmacy, Makerere University School of Health Sciences, Kampala, Uganda
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de La Santé, Nanoro, Burkina Faso
| | - François Kiemde
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de La Santé, Nanoro, Burkina Faso
| | - Adélaïde Compaoré
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de La Santé, Nanoro, Burkina Faso
| | - Daniel Valia
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de La Santé, Nanoro, Burkina Faso
| | - Sabine Dittrich
- FIND, Geneva, Switzerland
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Deggendorf Institute of Technology, European Campus Rottal Inn, Pfarrkirchen, Germany
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Compaoré A, Ekusai-Sebatta D, Kaawa-Mafigiri D, Kukula V, Odopey S, Kapisi J, Hopkins H, Kiemde F, Tinto H, Baiden R, Olliaro P, Nkeramahame J, Dittrich S, Horgan P. Viewpoint: Antimicrobial Resistance Diagnostics Use Accelerator: Qualitative Research on Adherence to Prescriptions. Clin Infect Dis 2023; 77:S206-S210. [PMID: 37490738 PMCID: PMC10368411 DOI: 10.1093/cid/ciad323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
In this Viewpoint, the authors explore the determinants of patients' prescription adherence behaviors as part of FIND's Advancing Access to Diagnostic Innovation essential for Universal Health Coverage and AMR Prevention (ADIP) trials (ClinicalTrials.gov identifier: NCT04081051). Research findings from Burkina Faso, Ghana, and Uganda show that basic knowledge and understanding of prescription instructions are essential for adherence and can be improved through better communication. However, there are a range of other factors that influence adherence, some of which can be influenced through tailored communication messages from healthcare workers. These messages may contribute to changes in adherence behavior but may require other reinforcing interventions to be effective. Finally, there are some drivers of nonadherence centered around costs and time pressure that require other forms of intervention.
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Affiliation(s)
- Adélaïde Compaoré
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | | | - David Kaawa-Mafigiri
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala, Uganda
| | - Vida Kukula
- Social Science Department, Dodowa Health Research Centre, Ghana
| | - Selase Odopey
- Social Science Department, Dodowa Health Research Centre, Ghana
| | | | - Heidi Hopkins
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - François Kiemde
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Rita Baiden
- Social Science Department, Dodowa Health Research Centre, Ghana
| | - Piero Olliaro
- Department of Medical Affairs, FIND, Geneva, Switzerland
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, and
| | | | - Sabine Dittrich
- Department of Medical Affairs, FIND, Geneva, Switzerland
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
- Deggendorf Institute of Technology, European Campus Rottal Inn, Pfarrkirchen, Germany
| | - Philip Horgan
- Department of Medical Affairs, FIND, Geneva, Switzerland
- Nuffield Department of Medicine, Big Data Institute, University of Oxford
- Department of Medicine, Evidence & Impact - Oxford, United Kingdom
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Watson D, Chatio S, Barker M, Boua PR, Compaoré A, Dalaba M, Erzse A, Godfrey K, Hofman K, Kehoe S, McGrath N, Mukoma G, Nonterah EA, Norris SA, Sorgho H, Ward KA, Hardy-Johnson P. Men’s motivations, barriers to and aspirations for their families’ health in the first 1000 days in sub-Saharan Africa: a secondary qualitative analysis. BMJ Nutr Prev Health 2023. [PMID: 37484540 PMCID: PMC10359544 DOI: 10.1136/bmjnph-2022-000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
IntroductionThe first 1000 days of life are a critical period of growth and development that have lasting implications for health, cognitive, educational and economic outcomes. In sub-Saharan Africa, gender and social norms are such that many men have little engagement with maternal and child health and nutrition during pregnancy and early childhood. This study explores how men perceive their role in three sites in sub-Saharan Africa.MethodsSecondary qualitative analysis of 10 focus group discussions with 76 men in Burkina Faso, Ghana and South Africa. Data were thematically analysed to explore men’s perceptions of maternal and child health and nutrition.ResultsMen considered themselves ‘providers’ and 'advisors' within their families, particularly of finances, food and medicines. They also indicated that this advice was out of care and concern for their families’ health. There were similarities in how the men perceive their role. Differences between men living in rural and urban settings included health priorities, the advice and the manner in which it was provided. Across all settings, men wanted to be more involved with maternal and child health and nutrition. Challenges to doing so included stigma and proscribed social gender roles.ConclusionMen want a greater engagement in improving maternal and child health and nutrition but felt that their ability to do so was limited by culture-specified gender roles, which are more focused on providing for and advising their families. Involving both men and women in intervention development alongside policymakers, health professionals and researchers is needed to improve maternal and child health and nutrition.
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Tahita MC, Sondo P, Kabore B, Ilboudo H, Rouamba T, Sanou H, Ouédraogo K, Compaoré A, Lompo P, Ouedraogo F, Sawadogo S, Derra K, Sawadogo YE, Somé AM, Nana M, Sorgho H, Traore-Coulibaly M, Bassat Q, Tinto H. Impact and operational feasibility of adding malaria infection screening using an ultrasensitive RDT for placental and fetal outcomes in an area of high IPTP-SP coverage in Burkina Faso: the ASSER MALARIA pilot study protocol. Pilot Feasibility Stud 2022; 8:221. [PMID: 36183100 PMCID: PMC9526310 DOI: 10.1186/s40814-022-01181-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Malaria infection during pregnancy (MIP) is not only deleterious to the woman, but it also puts her fetus at increased risk of adverse outcomes, such as preterm delivery, low birth weight, and intrauterine growth retardation. Additionally, all-cause mortality during the first year of life in babies born to women with malaria during pregnancy is also increased. Many interventions such as IPTp-SP and long-lasting insecticidal nets have proven to be efficient at reducing malaria in pregnancy burden but adherence to recommended policies remains poor. In sub-Saharan Africa, malaria in pregnancy is often asymptomatic and many malaria infections may be missed due to the inadequate performance of the current rapid diagnostic test to detect low-level parasitemias. Therefore, additional strategies such as intermittent screening with ultrasensitive rapid diagnostic tests and treatment with an effective artemisinin-based combination therapy in addition to IPTp-SP could reduce placental malaria, peripheral malaria infection at delivery, and low birth weight. Methods This pilot 2-group randomized open trial with a nested qualitative social behavioral will be carried out in Nanoro district in which 340 pregnant women will be recruited. Pregnant women will be randomized into two groups and followed on a monthly basis until delivery. In the intervention group, monthly screening using ultrasensitive rapid diagnostic tests and treatment of those found to be infected with dihydroartemisinin-piperaquine will be performed. In addition, a reminder will be sent to increase the uptake of IPTp-SP doses per woman. During scheduled and unscheduled visits, malaria infection, hemoglobin level, and other clinical outcomes will be assessed and compared by the group. The primary feasibility outcome will evaluate the study site's capacity to enroll participants and the women’s perception and acceptability of the intervention. The primary clinical outcome will be the prevalence of placental malaria at delivery. Discussion The present protocol aims to evaluate the feasibility on a large-scale and also to demonstrate the impact and the operational feasibility of additional screening with ultrasensitive rapid diagnostic tests and treatment with DHA-PQ on placental malaria, low birth weight, and peripheral malaria infection at delivery in a high-burden setting in Burkina Faso. Trial registration ClinicalTrials.gov, ID: NCT04147546 (14 October 2019).
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Affiliation(s)
- Marc Christian Tahita
- , Clinical Research Unit of Nanoro (CRUN)/Institut de Recherche en Sciences de la Santé (IRSS-DRCO), Nanoro, Burkina Faso.
| | - Paul Sondo
- , Clinical Research Unit of Nanoro (CRUN)/Institut de Recherche en Sciences de la Santé (IRSS-DRCO), Nanoro, Burkina Faso
| | - Berenger Kabore
- , Clinical Research Unit of Nanoro (CRUN)/Institut de Recherche en Sciences de la Santé (IRSS-DRCO), Nanoro, Burkina Faso
| | - Hamidou Ilboudo
- , Clinical Research Unit of Nanoro (CRUN)/Institut de Recherche en Sciences de la Santé (IRSS-DRCO), Nanoro, Burkina Faso
| | - Toussaint Rouamba
- , Clinical Research Unit of Nanoro (CRUN)/Institut de Recherche en Sciences de la Santé (IRSS-DRCO), Nanoro, Burkina Faso
| | - Hyacinthe Sanou
- , Clinical Research Unit of Nanoro (CRUN)/Institut de Recherche en Sciences de la Santé (IRSS-DRCO), Nanoro, Burkina Faso
| | - Kadija Ouédraogo
- , Clinical Research Unit of Nanoro (CRUN)/Institut de Recherche en Sciences de la Santé (IRSS-DRCO), Nanoro, Burkina Faso
| | - Adélaïde Compaoré
- , Clinical Research Unit of Nanoro (CRUN)/Institut de Recherche en Sciences de la Santé (IRSS-DRCO), Nanoro, Burkina Faso
| | - Palpouguini Lompo
- , Clinical Research Unit of Nanoro (CRUN)/Institut de Recherche en Sciences de la Santé (IRSS-DRCO), Nanoro, Burkina Faso
| | - Florence Ouedraogo
- , Clinical Research Unit of Nanoro (CRUN)/Institut de Recherche en Sciences de la Santé (IRSS-DRCO), Nanoro, Burkina Faso
| | - Seydou Sawadogo
- , Clinical Research Unit of Nanoro (CRUN)/Institut de Recherche en Sciences de la Santé (IRSS-DRCO), Nanoro, Burkina Faso
| | - Karim Derra
- , Clinical Research Unit of Nanoro (CRUN)/Institut de Recherche en Sciences de la Santé (IRSS-DRCO), Nanoro, Burkina Faso
| | | | - Athanase M Somé
- , Clinical Research Unit of Nanoro (CRUN)/Institut de Recherche en Sciences de la Santé (IRSS-DRCO), Nanoro, Burkina Faso
| | - Macaire Nana
- Sanitary Health District of Nanoro, Ministry of Health, Nanoro, Burkina Faso
| | - Hermann Sorgho
- , Clinical Research Unit of Nanoro (CRUN)/Institut de Recherche en Sciences de la Santé (IRSS-DRCO), Nanoro, Burkina Faso
| | - Maminata Traore-Coulibaly
- , Clinical Research Unit of Nanoro (CRUN)/Institut de Recherche en Sciences de la Santé (IRSS-DRCO), Nanoro, Burkina Faso
| | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Halidou Tinto
- , Clinical Research Unit of Nanoro (CRUN)/Institut de Recherche en Sciences de la Santé (IRSS-DRCO), Nanoro, Burkina Faso
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Watson D, Kehoe SH, Erzse A, Compaoré A, Debpuur C, Nonterah EA, Sorgho H, Norris SA, Hofman KJ, Lawrence W, Newell ML, Godfrey KM, Ward KA, Barker M. Community perspectives on maternal and child health during nutrition and economic transition in sub-Saharan Africa. Public Health Nutr 2021; 24:3710-3718. [PMID: 32928324 PMCID: PMC10195324 DOI: 10.1017/s1368980020003018] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 07/03/2020] [Accepted: 07/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To explore community perceptions on maternal and child nutrition issues in Sub-Saharan Africa. DESIGN Thirty focus groups with men and women from three communities facilitated by local researchers. SETTING One urban (Soweto, South Africa) and two rural settings (Navrongo, Ghana and Nanoro, Burkina Faso) at different stages of economic transition. PARTICIPANTS Two hundred thirty-seven men and women aged 18-55 years, mostly subsistence farmers in Navrongo and Nanoro and low income in Soweto. RESULTS Differences in community concerns about maternal and child health and nutrition reflected the transitional stage of the country. Community priorities revolved around poor nutrition and hunger caused by poverty, lack of economic opportunity and traditional gender roles. Men and women felt they had limited control over food and other resources. Women wanted men to take more responsibility for domestic chores, including food provision, while men wanted more involvement in their families but felt unable to provide for them. Solutions suggested focusing on ways of increasing control over economic production, family life and domestic food supplies. Rural communities sought agricultural support, while the urban community wanted regulation of the food environment. CONCLUSIONS To be acceptable and effective, interventions to improve maternal and child nutrition need to take account of communities' perceptions of their needs and address wider determinants of nutritional status and differences in access to food reflecting the stage of the country's economic transition. Findings suggest that education and knowledge are necessary but not sufficient to support improvements in women's and children's nutritional status.
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Affiliation(s)
- Daniella Watson
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, SouthamptonSO16 5YA, UK
| | - Sarah H Kehoe
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Agnes Erzse
- SAMRC Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
| | - Adélaïde Compaoré
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Cornelius Debpuur
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | | | - Hermann Sorgho
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Shane A Norris
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, SouthamptonSO16 5YA, UK
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen J Hofman
- SAMRC Centre for Health Economics and Decision Science, PRICELESS, University of Witwatersrand School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
| | - Wendy Lawrence
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Marie-Louise Newell
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, SouthamptonSO16 5YA, UK
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Kate A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Compaoré A, Dierickx S, Jaiteh F, Nahum A, Bohissou TFE, Tinto H, Scott S, D'Alessandro U, Schallig H, Grietens KP. Fear and rumours regarding placental biopsies in a malaria-in-pregnancy trial in Benin. Malar J 2018; 17:425. [PMID: 30442132 PMCID: PMC6238265 DOI: 10.1186/s12936-018-2578-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/09/2018] [Indexed: 05/30/2023] Open
Abstract
Background A multi-country, community-based trial on scheduled screening and treatment for malaria in pregnancy was conducted in Benin, The Gambia and Burkina Faso. Despite standardized procedures and outcomes, the study became subject to rumours and accusations of placenta being sold for mystical and financial gain by trial staff, leading to drop-out rates of 30% and the consequent halting of placental biopsy sampling in Benin. This paper explores the role of socio-cultural beliefs related to placenta and identified additional factors contributing these rumours. Methods A qualitative comparative emergent-theory design was used to assess social factors related to trial implementation and uptake in the three countries. Data from participant observation, informal conversations, group discussions and interviews were triangulated and analysed with NVivo Qualitative Analysis software. Results Despite similar sociocultural beliefs about the sacred nature of the placenta in all three study countries, these beliefs did not affect participation rates in Burkina Faso and The Gambia and placenta-related rumours only emerged in Benin. Therefore, the presence of beliefs is not a sufficient condition to have generated placenta-selling fears. The rumours in Benin reflected the confluence of placenta-related beliefs and factors related to the implementation of the trial (including a catalysing adverse event and miscommunication during the informed consent procedure). Furthermore, distinct socio-political factors contributed to the emergence of rumours, including the historical distrust in governmental organizations and the tense relationship between some of the actors involved in the trial. Conclusion Transdisciplinary social science research designs should accompany the implementation of the trial. The integration of multiple stakeholders’ knowledge and involvement is required to define and solve upcoming barriers.
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Affiliation(s)
- Adélaïde Compaoré
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso.
| | - Susan Dierickx
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Centre of Expertise on Gender, Diversity and Intersectionality (RHEA), Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.,Centre for Research on Culture and Gender, Ghent University, Rozier 44, 9000, Ghent, Belgium
| | - Fatou Jaiteh
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands.,Medical Research Council Unit The Gambia at London, School of Tropical Medicine and Hygiene, Fajara, The Gambia
| | - Alain Nahum
- Centre de Recherches Entomologiques de Cotonou, Cotonou, Benin
| | | | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Susana Scott
- Medical Research Council Unit The Gambia at London, School of Tropical Medicine and Hygiene, Fajara, The Gambia.,London School of Tropical Medicine and Hygiene, London, UK
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at London, School of Tropical Medicine and Hygiene, Fajara, The Gambia
| | - Henk Schallig
- Department of Medical Microbiology-Parasitology Unit, Academic Medical Centre, Amsterdam, 1105, AZ, The Netherlands
| | - Koen Peeters Grietens
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands.,Partners for Applied Social Sciences (PASS) International, Tessenderlo, Belgium.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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8
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Compaoré A, Gies S, Brabin B, Tinto H, Brabin L. Community approval required for periconceptional adolescent adherence to weekly iron and/or folic acid supplementation: a qualitative study in rural Burkina Faso. Reprod Health 2018. [PMID: 29540225 PMCID: PMC5852966 DOI: 10.1186/s12978-018-0490-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Iron deficiency remains a prevalent adolescent health problem in low income countries. Iron supplementation is recommended but improvement of iron status requires good adherence. Objectives We explored factors affecting adolescent adherence to weekly iron and/or folic acid supplements in a setting of low secondary school attendance. Methods Taped in-depth interviews were conducted with participants in a randomised, controlled, periconceptional iron supplementation trial for young nulliparous women living in a rural, malaria endemic region of Burkina Faso. Participants with good, medium or poor adherence were selected. Interviews were transcribed and analysed thematically. Results Thirty-nine interviews were conducted. The community initially thought supplements were contraceptives. The potential benefits of giving iron supplementation to unmarried “girls” ahead of pregnancy were not recognised. Trial participation, which required parental consent, remained high but was not openly admitted because iron supplements were thought to be contraceptives. Unmarried non-school attenders, being mobile, were often sent to provide domestic labour in varied locations. This interrupted adherence - as did movement of school girls during vacations and at marriage. Field workers tracked participants and trial provision of free treatment encouraged adherence. Most interviewees did not identify health benefits from taking supplements. Conclusions For success, communities must be convinced of the value of an adolescent intervention. During this safety trial, benefits not routinely available in iron supplementation programmes were important to this low income community, ensuring adolescent participation. Nevertheless, adolescents were obliged to fulfil cultural duties and roles that interfered with regular adherence to the iron supplementation regime. Trial Registration Trial Registration at clinicaltrials.gov: NCT01210040. Electronic supplementary material The online version of this article (10.1186/s12978-018-0490-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adélaïde Compaoré
- Clinical Research Unit Nanoro, Institut de Recherche en Sciences de la, Santé, Direction Régionale du Centre-Ouest, Nanoro, Burkina Faso
| | - Sabine Gies
- Department of Biomedical Sciences, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium.,Present address: Medical Mission Institute, Würzburg, Germany
| | - Bernard Brabin
- Liverpool School of Tropical Medicine and Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom; Global Child Health Group, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Halidou Tinto
- Clinical Research Unit Nanoro, Institut de Recherche en Sciences de la, Santé, Direction Régionale du Centre-Ouest, Nanoro, Burkina Faso
| | - Loretta Brabin
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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