Acceptability of coupling Intermittent Preventive Treatment in infants with the Expanded Programme on Immunization in three francophone countries in Africa

Abstract

Abstractobjective Intermittent preventive treatment in infants (IPTi) is a malaria control strategy currently recommended by WHO for implementation at scale in Africa, consisting of administration of sulphadoxine-pyrimethamine (SP) coupled with routine immunizations offered to children under 1 year.In this study, we analysed IPTi acceptability by communities and health staff.methods Direct observation, in-depth interviews (IDIs) and focus group discussions (FGDs) were conducted in Benin, Madagascar and Senegal during IPTi pilot implementation. Villages were stratified by immunization coverage. Data were transcribed and analysed using NVivo7 software.results Communities' knowledge of malaria aetiology and diagnosis was good, although generally villagers did not seek treatment at health centres as their first choice. Perceptions and attitudes towards IPTi were very positive among communities and health workers. A misconception that SP was an antipyretic that prevents post-vaccinal fever contributed to IPTi's acceptability. No refusals or negative rumours related to IPTi coupling with immunizations were identified, and IPTi did not negatively influence attitudes towards other malaria control strategies. Healthcare decisions about children, normatively made by the father, are starting to shift to educated and financially independent mothers.discussion Intermittent preventive treatment in infants is well accepted by providers and communities, showing a synergic acceptability when coupled with routine immunizations. However, a misconception that SP alleviates fever should be addressed when scaling up implementation.

Increase in EPI vaccines coverage after implementation of intermittent preventive treatment of malaria in infant with Sulfadoxine -pyrimethamine in the district of Kolokani, Mali: Results from a cluster randomized control trial

“…Mothers' knowledge of immunization or other interventions is known to be positively correlated with full immunization rates [ 23 , 24 , 26 ] and it is possible that the adhesion of the community through information and sensitization was responsible for this increase in EPI vaccines coverage compared to baseline levels for all the vaccines and for the fact that this increase was more marked in the intervention zone compared to the non intervention zone. Acceptability surveys conducted in Mali (our unpublished data) and other countries in sub-saharan Africa [ 15 ] have found that mothers like IPTi and come more to health centers because i) they are concern with malaria; ii) they think it is an anti-pyretic (and post-vaccinal fever is one of the major bottlenecks of EPI coverage) and iii) it is free. Even in the context of maternal illiteracy, educating mothers about the vaccines and vaccine-preventable diseases was reported to be highly effective in increasing the immunization coverage [ 27 ].…”

“…Even though the efficacy, the absence of interaction with EPI vaccines and safety of IPTi are well established, there are still concerns that addition of IPTi will result in an increase in the work burden and will disrupt the routines EPI services especially in Africa where the target EPI vaccines coverage remains to be met. However IPTi may also increase the adherence of the community to EPI services and improve EPI coverage, once the benefit of the strategy is perceived [ 14 , 15 ].…”

Voodoo, Vaccines, and Bed Nets

“…This allows us to control for a father's ATR-adherence. If mother-specific factors rather than household-level factors drive our ATR estimate, we should find that ATR adherence of the mother has a larger effect on our outcome variables than ATR adherence of the father, because women in Benin have the primary responsibility when it comes to children's healthcare decisions (de Sousa et al, 2011;ONE, 2011b;Rashed et al, 1999).…”

“…Aujoulat et al (2003), for instance, argue that cultural beliefs in southern Benin affect the demand for treatment of Buruli ulcer, a skin infection 12 which can lead to disfigurement and disability. Magico-religious beliefs in Benin are also said to affect malaria prevention and treatment (Rashed et al, 1999;de Sousa et al, 2011), and have been blamed for a low demand for vaccines, because some traditional healers have advised against their use (ONE, 2011a(ONE, , 2011bSoumonni, 2012). 16 Magico-religious beliefs do not always go against conventional medical prescriptions.…”

“…Conventional medicine and its products, being solely focused on the physical world, may not easily take root in such a belief system. Numerous qualitative studies have indeed argued that African traditional beliefs affect the demand for healthcare, and that conventional health programs should take these beliefs into account to improve their effectiveness (Aikins et al, 1994;Comoro et al, 2003;de Sousa et al, 2011;Kale, 1995;Maslove et al, 2009;Muela et al, 1998). These arguments were further underlined in research on HIV/AIDS prevention and treatment (Awusabo-Asare and Anarfi, 1997; Kalichman and Simbayi, 2004;Thomas, 2007;Van Dyk, 2001), and also 9 the recent Ebola outbreak in West-Africa gave way to a similar discussion.…”