Perceptions of Malaria in Pregnancy and Acceptability of Preventive Interventions among Mozambican Pregnant Women: Implications for Effectiveness of Malaria Control in Pregnancy

Abstract

BackgroundIntermittent Preventive Treatment (IPTp) and insecticide treated nets (ITNs) are recommended malaria in pregnancy preventive interventions in sub-Saharan Africa. Despite their cost-effectiveness and seemingly straight-forward delivery mechanism, their uptake remains low. We aimed at describing perceptions of pregnant women regarding malaria and the recommended prevention interventions to understand barriers to uptake and help to improve their effectiveness.Methods and findingsWe used mixed methods to collect data among 85 pregnant women from a rural area of Southern Mozambique. Information was obtained through observations, in-depth interviews, and focused ethnographic exercises (Free-listing and Pairwise comparisons). Thematic analysis was performed on qualitative data. Data from focused ethnographic exercises were summarized into frequency distribution tables and matrices. Malaria was not viewed as a threat to pregnancy. Participants were not fully aware of malaria- associated adverse maternal and birth outcomes. ITNs were the most preferred and used malaria preventive intervention, while IPTp fell between second and third. Indoor Residual Spraying (IRS) was the least preferred intervention.ConclusionsLow awareness of the risks and adverse consequences of malaria in pregnancy did not seem to affect acceptability or uptake to the different malaria preventive interventions in the same manner. Perceived convenience, the delivery approach, and type of provider were the key factors. Pregnant women, through antenatal care (ANC) services, can be the vehicles of ITN distribution in the communities to maximise overall ITN coverage. There is a need to improve knowledge about neonatal health and malaria to improve uptake of interventions delivered through channels other than the health facility.

Assessing demand-side barriers to uptake of intermittent preventive treatment for malaria in pregnancy: a qualitative study in two regions of Uganda

“…For example, reluctance to reveal pregnancy early on has been reported in Mali [34] and a tendency to only seek help if sick has been described in Mozambique [41]. While this was not confirmed by any of the women interviewed in this study, it was noticeable that many women tended to talk about seeking care and treatment when they are experiencing symptoms of sickness rather than to prevent sickness.…”

Access to and use of preventive intermittent treatment for Malaria during pregnancy: a qualitative study in Chókwè district, Southern Mozambique

“…Quantitative data collection approaches have been widely used to explore factors affecting access and use of IPTp-SP. In this regard, several factors such as limited access to ANC services, health professionals attitudes and practices, low awareness of malaria consequences during pregnancy, low patient adherence, or community attitudes towards preventive interventions have been associated with low IPTp-SP coverage [7–10]. However, quantitative data collection often lacks inclusion of sociocultural data, such as individual and community’s sociocultural beliefs, that may be affecting pregnant women’s access and use of malaria control intervention [10–13].…”

Assessment of coverage of preventive treatment and insecticide-treated mosquito nets in pregnant women attending antenatal care services in 11 districts in Mozambique in 2011: the critical role of supply chain

“…Indeed, data on the determinants of low coverage of these interventions are limited in Mozambique, and the few studies conducted in the country focused their research on knowledge and acceptability of this intervention among pregnant women [23]. Moreover, current estimates on coverage in Mozambique are based mostly on data from household surveys alone.…”