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
Introduction Intermittent preventive treatment in pregnancy with sulphadoxine pyrimethamine (IPTp) is a key malaria prevention strategy in sub-Saharan African countries. We conducted an anthropological study as part of a project aiming to evaluate a community-based approach to the delivery of IPTp (...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-11-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/7/11/e010079.full |
| _version_ | 1797990143312789504 |
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| author | Khatia Munguambe Charfudin Sacoor Martin Meremikwu Elaine Roman Franco Pagnoni Clara Menendez Ogonna Nwankwo Yara Alonso Wade Lusengi Manu F Manun’Ebo Aimée M Rasoamananjaranahary Noroharifetra Madison Rivontsoa Estêvão Mucavele Neusa Torres Hope Okebalama Ugo James Agbor Cristina Enguita-Fernàndez |
| author_facet | Khatia Munguambe Charfudin Sacoor Martin Meremikwu Elaine Roman Franco Pagnoni Clara Menendez Ogonna Nwankwo Yara Alonso Wade Lusengi Manu F Manun’Ebo Aimée M Rasoamananjaranahary Noroharifetra Madison Rivontsoa Estêvão Mucavele Neusa Torres Hope Okebalama Ugo James Agbor Cristina Enguita-Fernàndez |
| author_sort | Khatia Munguambe |
| collection | DOAJ |
| description | Introduction Intermittent preventive treatment in pregnancy with sulphadoxine pyrimethamine (IPTp) is a key malaria prevention strategy in sub-Saharan African countries. We conducted an anthropological study as part of a project aiming to evaluate a community-based approach to the delivery of IPTp (C-IPTp) through community health workers (CHWs) in four countries (the Democratic Republic of Congo, Madagascar, Mozambique and Nigeria), to understand the social context in order to identify key factors that could influence C-IPTp acceptability.Methods A total of 796 in-depth interviews and 265 focus group discussions were undertaken between 2018 and 2021 in the four countries with pregnant women, women of reproductive age, traditional and facility-based healthcare providers, community leaders, and relatives of pregnant women. These were combined with direct observations (388) including both community-based and facility-based IPTp delivery. Grounded theory guided the overall study design and data collection, and data were analysed following a combination of content and thematic analysis.Results A series of key factors were found to influence acceptability, delivery and uptake of C-IPTp in project countries. Cross-cutting findings include the alignment of the strategy with existing social norms surrounding pregnancy and maternal health-seeking practices, the active involvement of influential and trusted actors in implementation activities, existing and sustained trust in CHWs, the influence of husbands and other relatives in pregnant women’s care-seeking decision-making, the working conditions of CHWs, pregnant women’s perceptions of SP for IPTp and persistent barriers to facility-based antenatal care access.Conclusions The findings provide evidence on the reported acceptability of C-IPTp among a wide range of actors, as well as the barriers and facilitators for delivery and uptake of the intervention. Overall, C-IPTp was accepted by the targeted communities, supporting the public health value of community-based interventions, although the barriers identified should be examined if large-scale implementation of the intervention is considered. |
| first_indexed | 2024-04-11T08:31:50Z |
| format | Article |
| id | doaj.art-04de7247fc1946feaed81b6a28bc8957 |
| institution | Directory Open Access Journal |
| issn | 2059-7908 |
| language | English |
| last_indexed | 2024-04-11T08:31:50Z |
| publishDate | 2022-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj.art-04de7247fc1946feaed81b6a28bc89572022-12-22T04:34:29ZengBMJ Publishing GroupBMJ Global Health2059-79082022-11-0171110.1136/bmjgh-2022-010079The social dimensions of community delivery of intermittent preventive treatment of malaria in pregnancy in Madagascar, Mozambique, Nigeria and the Democratic Republic of the CongoKhatia Munguambe0Charfudin Sacoor1Martin Meremikwu2Elaine Roman3Franco Pagnoni4Clara Menendez5Ogonna Nwankwo6Yara Alonso7Wade Lusengi8Manu F Manun’Ebo9Aimée M Rasoamananjaranahary10Noroharifetra Madison Rivontsoa11Estêvão Mucavele12Neusa Torres13Hope Okebalama14Ugo James Agbor15Cristina Enguita-Fernàndez16Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Maputo, MozambiqueCentro de Investigação em Saúde de Manhiça (CISM), Manhiça, Maputo, MozambiqueCross River Health and Demographic Surveillance System, University of Calabar, Calabar, Cross River State, NigeriaJHPIEGO, a Johns Hopkins University affiliate, Baltimore, Maryland, USAISGlobal Hospital Clínic - Universitat de Barcelona, Barcelona, SpainISGlobal Hospital Clínic - Universitat de Barcelona, Barcelona, SpainDepartment of Community Medicine, University of Calabar, Calabar, Cross River State, NigeriaISGlobal Hospital Clínic - Universitat de Barcelona, Barcelona, SpainBureau d’Étude et de Gestion de l’Information Statistique (BEGIS), Kinshasa, CongoBureau d’Étude et de Gestion de l’Information Statistique (BEGIS), Kinshasa, CongoMalagasy Associates for Numerical Information and Statistical Analysis (MANISA), Antananarivo, MadagascarMalagasy Associates for Numerical Information and Statistical Analysis (MANISA), Antananarivo, MadagascarCentro de Investigação em Saúde de Manhiça (CISM), Manhiça, Maputo, MozambiqueCentro de Investigação em Saúde de Manhiça (CISM), Manhiça, Maputo, MozambiqueCross River Health and Demographic Surveillance System, University of Calabar, Calabar, Cross River State, NigeriaCross River Health and Demographic Surveillance System, University of Calabar, Calabar, Cross River State, NigeriaISGlobal Hospital Clínic - Universitat de Barcelona, Barcelona, SpainIntroduction Intermittent preventive treatment in pregnancy with sulphadoxine pyrimethamine (IPTp) is a key malaria prevention strategy in sub-Saharan African countries. We conducted an anthropological study as part of a project aiming to evaluate a community-based approach to the delivery of IPTp (C-IPTp) through community health workers (CHWs) in four countries (the Democratic Republic of Congo, Madagascar, Mozambique and Nigeria), to understand the social context in order to identify key factors that could influence C-IPTp acceptability.Methods A total of 796 in-depth interviews and 265 focus group discussions were undertaken between 2018 and 2021 in the four countries with pregnant women, women of reproductive age, traditional and facility-based healthcare providers, community leaders, and relatives of pregnant women. These were combined with direct observations (388) including both community-based and facility-based IPTp delivery. Grounded theory guided the overall study design and data collection, and data were analysed following a combination of content and thematic analysis.Results A series of key factors were found to influence acceptability, delivery and uptake of C-IPTp in project countries. Cross-cutting findings include the alignment of the strategy with existing social norms surrounding pregnancy and maternal health-seeking practices, the active involvement of influential and trusted actors in implementation activities, existing and sustained trust in CHWs, the influence of husbands and other relatives in pregnant women’s care-seeking decision-making, the working conditions of CHWs, pregnant women’s perceptions of SP for IPTp and persistent barriers to facility-based antenatal care access.Conclusions The findings provide evidence on the reported acceptability of C-IPTp among a wide range of actors, as well as the barriers and facilitators for delivery and uptake of the intervention. Overall, C-IPTp was accepted by the targeted communities, supporting the public health value of community-based interventions, although the barriers identified should be examined if large-scale implementation of the intervention is considered.https://gh.bmj.com/content/7/11/e010079.full |
| spellingShingle | Khatia Munguambe Charfudin Sacoor Martin Meremikwu Elaine Roman Franco Pagnoni Clara Menendez Ogonna Nwankwo Yara Alonso Wade Lusengi Manu F Manun’Ebo Aimée M Rasoamananjaranahary Noroharifetra Madison Rivontsoa Estêvão Mucavele Neusa Torres Hope Okebalama Ugo James Agbor Cristina Enguita-Fernàndez 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 BMJ Global Health |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | social dimensions of community delivery of intermittent preventive treatment of malaria in pregnancy in madagascar mozambique nigeria and the democratic republic of the congo |
| url | https://gh.bmj.com/content/7/11/e010079.full |
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