Synthesis of Qualitative Evidence on Malaria in Pregnancy, 2005–2022: A Systematic Review

Abstract

Qualitative research on malaria in pregnancy (MiP) is incipient, therefore its contextual, experiential and symbolic associated factors are unknown. This study systematizes the qualitative research on MiP, describes knowledge, perceptions and behaviors about MiP, and compiles individual, socioeconomic, cultural and health system determinants of MiP through a meta-synthesis in 10 databases. A total of 48 studies were included with 2600 pregnant women, 1300 healthcare workers, and 2200 relatives or community members. Extensive knowledge was demonstrated on ITN and case management, but it was lacking on SP-IPTp, risks and consequences of MiP. Attitudes were negative towards ANC and MiP prevention. There were high trustfulness scores and preference for traditional medicine and distrust in the safety of drugs. The main determinants of the Health System were rationing, copayments, delay in payment to clinics, high out-of-pocket expenses, shortage, low workforce and work overload, shortcomings in care quality, low knowledges of healthcare workers on MiP and negative attitude in care. The socioeconomic and cultural determinants were poverty and low educational level of pregnant women, distance to the hospital, patriarchal–sexist gender roles, and predominance of local conceptions on maternal–fetal–neonatal health. The meta-synthesis demonstrates the difficulty to detect MiP determinants and the importance of performed qualitative research before implementing MiP strategies to understand the multidimensionality of the disease.

Social determination of malaria in pregnancy in Colombia: a critical ethnographic study

“…This situation has also been described in the qualitative component of mixed studies on MiP, and a systematic review of QHR in MiP that reported lacking knowledge about MiP and its consequences, lacking perception of the risk of becoming infected, and poor knowledge about prevention [ 6 , 7 ]. This demonstrates multiple challenges for health education, information and communication programmes, since the individual cognitive dimension in this population is determined by social, cultural and economic processes, which are excluded in this type of health strategy, despite having a greater explanatory power on individual behaviour.…”

“…Singular level findings were determined by the economic, geographic, cultural and health system barriers to access malaria control programmes, in interaction with a lacking perception of the risk of becoming ill and dying for this disease. These events have been recurrent in the QHR on MiP, and in other countries they have been used to explain less effectiveness of control strategies (such as intermittent preventive treatment, use of nets, detection and treatment of cases) [ 7 , 25 ]. These barriers coexist and would explain the high frequency of asymptomatic MiP, which increases the risk of severe malaria, placental malaria, congenital malaria, anaemia, and low birth weight, among other outcomes [ 29 – 31 ].…”

“…Although explicit categories on the gender approach did not emerge in this research, it is necessary that further studies investigate power relations according to gender, the degrees of autonomy of pregnant women in decision-making related to their health, and other issues related to the gender approach, given that previous QHR have indicated its importance for understanding some sociocultural determinants of MiP [ 7 , 25 ].…”

“…For critical health theory, social relations within capitalism are important to explain health outcomes; the dialectic relations of singular, particular, and general levels are the core of the methodological design, and the centrality of the subject reveals the importance of transcending the disease dimension of the biomedicine-positivist approach toward subjective and intersubjective domains (illness and sickness dimensions of medical anthropology) [ 1 – 3 ]. Despite the importance of critical public health approaches, they have not been applied in scientific publications on the social determinants of malaria [ 4 ]; in malaria in pregnancy (MiP) the investigative hegemony has been the biomedical-positivist model, with a marginal investigation of PSDH in some qualitative studies [ 5 – 7 ].…”

“…Despite the advances in QHR, critical approaches are scarce, and phenomenological-hermeneutic studies predominate [ 1 ]. Regarding MiP there are no studies about PSDH and most QHR focus on content (frequency of concepts or words to infer meanings) or thematic (focused in pre-established categories) analysis about acceptability barriers of insecticide-treated bed nets, intermittent preventive treatment or case management [ 6 , 7 ]. There is no social study of MiP in Colombia or America, that allows an initial identification of their PSDH.…”