Tropical Health Matters

Cristina Enguita-Fernàndez and colleagues share findings on from a qualitative study on the acceptability of a community-based approach to IPTp delivery in 4 sub-Saharan countries in the UNITAID TiPTop project. Their poster is available at the vitrual 69^th Annual Meeting of American Society of Tropical Medicine and Hygiene.

Increasing uptake of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is key to improving maternal health indicators in malaria endemic countries, yet current coverage rates remain low. This qualitative study is part of a project evaluating the acceptability of a community-based approach to the delivery of IPTp (C-IPTp) through community health workers (CHWs) in 4 countries: the Democratic Republic of Congo (DRC), Madagascar, Mozambique and Nigeria.

Between March 2018 and February 2020 a total of 435 in-depth interviews and 181 focus group discussions were carried out in the four country sites with pregnant women, relatives, women of reproductive age, community leaders, CHWs, and health providers. These were combined with direct observations of both community and facility based IPTp delivery.

Grounded theory guided the study design and data collection, and data were analysed following a combination of content and thematic analysis to identify barriers to IPTp uptake. Although the novel C-IPTp intervention overcomes some access barriers (such as distance from health care providers, and travel costs), the study identified important barriers, some of which cut across delivery mechanisms and others that are specific to the C-IPTp approach.

Cross-cutting barriers consisted of perceived attributes of SP that explain treatment refusal. These consisted of sensorial characteristics, including the drug’s perceived foul smell, taste and large size; experiences with adverse drug effects, such as nausea and weakness; fears of adverse pregnancy outcomes, such as miscarriages or oversized babies leading to C-sections.

Attributes originated either in individual experiences of SP intake or were socially transmitted. Barriers specific to C-IPTp were centered around concerns over trust in CHWs as adequate providers of maternal healthcare and their competence in delivering IPTp. Despite sensitization activities, misinformation could still be determining these barriers. Ensuring an improved awareness of SP effects and its use, as well as a better understanding of the intervention should lead to enhanced C-IPTp adherence

Authors and Affiliations

Cristina Enguita-Fernàndez¹, Yara Alonso¹, Wade Lusengi², Alain Mayembe², Aimée M. Rasoamananjaranahary³, Estêvão Mucavele⁴, Ogonna Nwankwo⁵, Elaine Roman⁶, Franco Pagnoni¹, Clara Menéndez¹, Khátia Munguambe^{4 – 1}ISGlobal – Barcelona Institute for Global Health, Barcelona, Spain, ²Bureau d’Étude et de Gestion de l’Information Statistique, Kinshasa, Congo, Democratic Republic of the, ³Malagasy Associates for Numerical Information and Statistical Analysis, Antananarivo, Madagascar, ⁴Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique, ⁵University of Calabar, Calabar, Nigeria, ⁶Jhpiego, affiliate of Johns Hopkins University, Baltimore, MD, United States

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