Systematic Review of Mixed Studies on Malaria in Pregnancy: Individual, Cultural and Socioeconomic Determinants of Its Treatment and Prevention

Abstract

Malaria in pregnancy (MiP) is a global public health problem; its research is predominantly quantitative. The objective was to analyze the individual, cultural and socioeconomic determinants of the treatment and prevention of MiP with a systematic review of mixed studies (search had no date restriction). Reproducibility and evaluation of the methodological quality were guaranteed. 21 studies were included (20 from Africa). The quantitative component included 7816 pregnant women and 483 health workers. The qualitative component included 800 subjects (pregnant women, health workers, family members and community leaders). The main topics were the use and acceptability of WHO strategies to prevent MiP, individual determinants related with knowledge, perceptions, attitudes and behaviors on MiP, and cultural and socioeconomic barriers for its treatment and prevention. The main determinants of MiP were long distance to the clinic, lack of economic resources, low-coverage antenatal care, few health workers in the communities, drug shortages, cultural rules that prevent women’s participation in health issues, and misconceptions about MiP. MiP has determinants related to economic conditions, the structure and functioning of the health system, symbolic and cultural aspects, as well as knowledge, beliefs, perceptions and behavior of pregnant women, which prevent optimal access and use of preventive strategies. This study evidences the importance of intersectional, intersectoral, and interdisciplinary work to prevent MiP.

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.…”

“…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.…”

Meeting the challenges and strategies regarding malaria elimination: qualitative evaluation of perceptions from a local population in Colombia

“…Other studies carried out in Colombia using qualitative analysis allow malaria to be approached as a problem from the perspective of the social determinants of health, grouped as structural determinants (the origin of malaria, its relation to life and work conditions, and the importance of home and family) and individual determinants (traditional knowledge about paludism, the importance of knowledge secularization about malaria and the perception of different communities about the risk of infection and death from malaria) (Cardona-Arias et al, 2019;Cardona-Arias et al, 2020;Cardona-Arias, 2022). Here, our work aimed to use qualitative analysis to understand the perceptions of the residents about: malaria risk areas, their own problems, the solutions proposed by themselves and how those solutions are related to the strategies proposed in the official programs from health institutions.…”

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

“…In this review, 48 qualitative studies were included with 2600 pregnant women, 1300 HWs, and 2200 relatives and community members; the most frequent topics were the meanings, perceptions and behaviors on MiP, SP-IPTp, ITN and case management, which is similar to a systematic review on mixed studies about MiP [80].…”

“…In the first group, this and other reviews recognized MiP as a risk event but pregnant women do not perceive their vulnerability to this disease. Local interpretations overlap the symptoms and consequences of MiP with other febrile syndromes or are assumed as conditions inherent to pregnancy, and there is preference for the diagnosis and treatment over prevention [20,21,80]. Attitudes and behaviors related to MiP interventions are associated with attitudes and interactions with HWs, the organization of health services, and experiences of poor health care [20,21,23].…”