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

Christopher Pell12*, Arantza Meñaca23, Nana A Afrah4, Lucinda Manda-Taylor5, Samuel Chatio6, Florence Were7, Abraham Hodgson8, Mary J Hamel9, Linda Kalilani5, Harry Tagbor4 and Robert Pool12

Author Affiliations

1 Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands

2 Centre de Recerca en Salut Internacional de Barcelona (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain

3 Departamento de Antropología Social, Universidad Complutense de Madrid, Madrid, Spain

4 Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

5 College of Medicine, University of Malawi, Blantyre, Malawi

6 Navrongo Health Research Centre, Navrongo, Ghana

7 The Kenya Medical Research Institute (KEMRI) and Centers for Disease Control and Prevention (CDC) Research and Public Health Collaboration, Kisumu, Kenya

8 Research and Development Division, Ghana Health Service, Accra, Ghana

9 Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA

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Malaria Journal 2013, 12:427  doi:10.1186/1475-2875-12-427

Published: 20 November 2013

Abstract

Background

In 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.

Methods

A 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.

Results

ITNs 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.

Conclusion

Although 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.

Keywords:
Malaria; Pregnancy; IPTp; Insecticide-treated bed nets; ITNs; Malaria case management