Participatory research for the development of information, education and communication tools to promote intermittent preventive treatment of malaria in pregnancy in the Democratic Republic of the Congo, Nigeria and Mozambique

Abstract

Background To improve the coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) in Africa, Medicines for Malaria Venture (MMV) developed, tested and validated a new packaging of sulfadoxine–pyrimethamine (SP), as well as specific communications tools designed to improve knowledge of IPTp and the motivation of women to adhere to it, particularly if it is distributed by community health workers (CHW). Methods This article describes and analyses the results of an empirical research carried out in the Democratic Republic of the Congo (DRC), Nigeria and Mozambique, to evaluate the perception and social acceptability of SP for healthcare providers, CHW and pregnant women, and to assess the ability of the new SP packaging and the communications tools to change their perception of SP and improve their attitudes towards IPTp. Results The results indicate that SP’s new individual packaging was perceived by pregnant women and healthcare providers as a “hygienic” and “safe”, with a specific identity. The graphics used in IPTp communications tools were modified according to the respondents’ feedback to make them more culturally and socially sensitive, and then validated. However, although the new blister packaging and IPTp communications tools generated greater confidence and motivation, SP side effects as well as preconceived ideas, particularly regarding its efficacy, remain a challenge that must be addressed to improve IPTp acceptance and compliance by healthcare providers and pregnant women. Conclusion This participatory approach to social research based on ongoing feedback to the graphic designer provided more empirical evidence to improve and adapt the textual and visual content of communication tools (SP blister packaging, leaflet, user guide) to local contexts and user preferences. Tested and validated in different socio-cultural and socio-political contexts, these tools provide a good basis for the promotion of IPTp in Africa.

The social dimensions of community delivery of intermittent preventive treatment of malaria in pregnancy in Madagascar, Mozambique, Nigeria and the Democratic Republic of the Congo

“…This finding contrasts with findings from research conducted in the same study settings indicating that healthcare providers doubt the effectiveness of SP in preventing MiP. 36 This hesitancy was not captured among any of the health providers targeted by our study.…”

“…The unquestioned efficacy of SP as a prophylactic drug against malaria is a clear opportunity for its administration, regardless of the delivery mechanism. This finding contrasts with findings from research conducted in the same study settings indicating that healthcare providers doubt the effectiveness of SP in preventing MiP 36. This hesitancy was not captured among any of the health providers targeted by our study.…”

“…This contrasts with other studies that strongly associate IPTp-SP acceptance to the adequacy or completeness of pregnant women’s knowledge of the treatment. 36 38 …”

It Is Time to Strengthen the Malaria Control Policy of the Democratic Republic of Congo and Include Schools and School-Age Children in Malaria Control Measures

“…However, SP resistance has spread globally, probably due to SP overuse, and in part because of improper self-medication [ 118 ]. SP self-medication is still widely used for treatment of uncomplicated malaria [ 119 , 120 , 121 , 122 ], and addressing its misuse and overuse will help to delay the increase in resistance. There is a need to continuously sensitize and educate women on the benefits of malaria prevention, including IPTp during pregnancy; and to educate community members, including community healthcare and private health professionals, about the guideline of malaria case management and malaria prevention [ 119 , 123 , 124 , 125 , 126 , 127 ].…”

“…SP self-medication is still widely used for treatment of uncomplicated malaria [ 119 , 120 , 121 , 122 ], and addressing its misuse and overuse will help to delay the increase in resistance. There is a need to continuously sensitize and educate women on the benefits of malaria prevention, including IPTp during pregnancy; and to educate community members, including community healthcare and private health professionals, about the guideline of malaria case management and malaria prevention [ 119 , 123 , 124 , 125 , 126 , 127 ]. To minimize the risk of SP resistance, SP may be used in combination with other non-artemisinin derivatives used as first-line treatment to protect ACT resistance [ 32 , 114 , 115 , 116 , 128 , 129 ].…”