Prevention and treatment of malaria in pregnancy: what do pregnant women and health care workers in East India know and do about it?

Abstract

BackgroundLimited qualitative research has been performed in India to investigate views and behaviours of pregnant women regarding malaria despite the threat of malaria-related adverse maternal and neonatal outcomes. To address this gap, a comprehensive study on malaria prevention and treatment attitudes, knowledge and behaviour among pregnant women in India was conducted.MethodsPregnant women and healthcare workers (HCWs), encompassing clinic-based providers, traditional birth attendants, and auxiliary nurse-midwives were enrolled for in-depth interviews (IDIs) at 7 hospital sites and nearby communities in Jharkhand and Chhattisgarh States. Questions addressed health concerns and attitudes, knowledge and practices regarding malaria prevention and treatment; probing covered modern and traditional approaches. Data were analyzed using a thematic approach.ResultsA total of 83 pregnant women and 119 HCWs participated in 202 IDIs, 90 in Jharkhand and 112 in Chhattisgarh. A majority of Jharkhand respondents, but only one-fourth in Chhattisgarh, named malaria among top health issues for pregnant women. Just over half of pregnant women were willing to try new prevention methods (especially insecticide-treated bed nets), although cost-related barriers to such methods were stressed. Most respondents voiced concerns about malaria treatment during pregnancy, mainly citing potential harm to the baby. Most knew that mosquitoes transmitted malaria, but a substantial minority, including among HCWs, described incorrect transmission modes. Most knew a proven prevention method (usually bed nets or coils); a few knew other methods. A minority of pregnant women, but most HCWs, knew about malaria treatment, although some HCWs described unproven treatments. Most respondents described use of modern prevention methods in their communities, typically bed nets, although probing revealed irregular use. Half (especially in Jharkhand and particularly HCWs) described use of traditional prevention approaches such as burning leaves and rubbing oils on the body; traditional remedies for malaria treatment were common, and varied by site and population.ConclusionsUnderstanding of malaria varied as a concern for pregnant women, continued use of unproven malaria prevention and treatment strategies was evident in this population in India. These results highlight the need to educate both pregnant women and HCWs about effective malaria methods to protect pregnant women and their babies from malaria.

Averting Expenditure on Malaria: Effects on Labour Productivity of Maize Farmers in Bunkpurugu-Nakpanduri District of Ghana

“…This suggests that households with pregnant women are more likely to spend GH¢45.18 more than households without pregnant women. This con rms the ndings of Sabin et al [25] that most pregnant women are willing to try new methods of malaria prevention although cost related barriers to such methods were stressed. This is because pregnant women are more susceptible to malaria, and hence households need to employ all means to get rid of mosquitoes and as a result spend more to avert than households without pregnant women.…”

Malaria prevalence in symptomatic and asymptomatic pregnant women in a high malaria-burden state in India

“…The experience in Chhattisgarh suggested better feasibility of IST through CHWs as compared to formal providers. A study in Chhattisgarh and Jharkhand a decade ago had found that formal health workers did not perceive 'MiP' as an important problem and were poorly equipped to address it [43]. CHWs, when trained and equipped adequately, are known to enjoy trust of local communities and offer the important advantage of being close to community [44].…”

Evaluation of the implementation of single screening and treatment for the control of malaria in pregnancy in Eastern Indonesia: a systems effectiveness analysis

“…The adherence to the SSTp-DHP strategy may however indicate a general propensity to adhere to guidelines and, therefore, implementation of IPTp-DHP too, may be potentially successful. The qualitative study conducted alongside this evaluation explores further the perceptions of health workers on these strategies [ 14 ].…”

“…Observations and exit interviews of the ANC visit were conducted to assess compliance with national SST guidelines. The quantitative study was supplemented by in-depth interviews with health workers and focus group discussions with pregnant women accessing ANC to understand quantitative observations, these findings are reported elsewhere [ 14 ].…”