A qualitative assessment of the health systems factors influencing the prevention of malaria in pregnancy using intermittent preventive treatment and insecticide-treated nets in Ghana
Abstract Background Ghana has adopted and implemented intermittent preventive treatment using sulfadoxine-pyrimethamine (IPTp-SP) and insecticide-treated nets (ITNs) in an antenatal care (ANC) context to prevent malaria among pregnant women. However, the increased ANC attendance and its frequency fa...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-04-01
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| Series: | Malaria Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12936-022-04159-w |
| _version_ | 1811289224861712384 |
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| author | Virtue Fiawokome De-Gaulle Joseph Kamgno Verner N. Orish Agnes Kotoh Wilfred Mbacham Harry Tagbor Pascal Magnussen |
| author_facet | Virtue Fiawokome De-Gaulle Joseph Kamgno Verner N. Orish Agnes Kotoh Wilfred Mbacham Harry Tagbor Pascal Magnussen |
| author_sort | Virtue Fiawokome De-Gaulle |
| collection | DOAJ |
| description | Abstract Background Ghana has adopted and implemented intermittent preventive treatment using sulfadoxine-pyrimethamine (IPTp-SP) and insecticide-treated nets (ITNs) in an antenatal care (ANC) context to prevent malaria among pregnant women. However, the increased ANC attendance and its frequency facilitated by a free maternal health care policy in Ghana does not correspond with the uptake of IPTp-SP and ITN use among pregnant women. This study sought to elucidate the contextual health system factors influencing the delivery of IPTp-SP and ITN from a related quantitative study conducted in Ghana. Methods This is the qualitative section of a mixed-methods study design, where audio recorded key informant interviews (KIIs) were conducted with health workers from across health facilities, districts, regional and national health directorates. The KIIs elicited information on health worker knowledge, perceptions, and rationale for the delivery practices of IPTp-SP and ITN revealed in the quantitative findings. The interviews were transcribed and imported into NVivo for analysis. Using the World Health Organization (WHO) Health Systems Framework as the theoretical basis, thematic analysis was conducted under broad themes of the building blocks. Findings are presented in narrative quotes, with a mindmap used to summarize the various health system factors and their interrelated relationship influencing the delivery of IPTp-SP and ITN. Results Health system factors identified included health staff untrained on malaria delivery directives due to an ineffective trainer of trainer (ToT) system. Additionally, health worker confusion on when to commence SP (at quickening or ≥ 16 weeks) was found to result in delayed start of SP. Stock-outs in facilities due to procurement delays at the national level resulted in missed opportunities to deliver SP to eligible pregnant women at the ANC. Similarly, ITN stock outs led to eligible pregnant women not receiving one at ANC clinics. Conclusion Poor health worker knowledge on policy directives, a consequence of ineffective training strategy led to delayed delivery of IPTp-SP to eligible pregnant women. Supply chain management challenges related to stock of SP and ITN resulted in missed opportunities to deliver the interventions to pregnant women attending ANC. |
| first_indexed | 2024-04-13T03:51:08Z |
| format | Article |
| id | doaj.art-531e6f3d4fd84be4a97476a91332d4e8 |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-04-13T03:51:08Z |
| publishDate | 2022-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Malaria Journal |
| spelling | doaj.art-531e6f3d4fd84be4a97476a91332d4e82022-12-22T03:03:49ZengBMCMalaria Journal1475-28752022-04-0121111510.1186/s12936-022-04159-wA qualitative assessment of the health systems factors influencing the prevention of malaria in pregnancy using intermittent preventive treatment and insecticide-treated nets in GhanaVirtue Fiawokome De-Gaulle0Joseph Kamgno1Verner N. Orish2Agnes Kotoh3Wilfred Mbacham4Harry Tagbor5Pascal Magnussen6Faculty of Medicine and Biomedical Sciences, University of Yaoundé IFaculty of Medicine and Biomedical Sciences, University of Yaoundé ISchool of Medicine, University of Health and Allied ScienceSchool of Public Health, University of GhanaFaculty of Medicine and Biomedical Sciences, University of Yaoundé ISchool of Medicine, University of Health and Allied ScienceFaculty of Health and Medical Sciences, University of CopenhagenAbstract Background Ghana has adopted and implemented intermittent preventive treatment using sulfadoxine-pyrimethamine (IPTp-SP) and insecticide-treated nets (ITNs) in an antenatal care (ANC) context to prevent malaria among pregnant women. However, the increased ANC attendance and its frequency facilitated by a free maternal health care policy in Ghana does not correspond with the uptake of IPTp-SP and ITN use among pregnant women. This study sought to elucidate the contextual health system factors influencing the delivery of IPTp-SP and ITN from a related quantitative study conducted in Ghana. Methods This is the qualitative section of a mixed-methods study design, where audio recorded key informant interviews (KIIs) were conducted with health workers from across health facilities, districts, regional and national health directorates. The KIIs elicited information on health worker knowledge, perceptions, and rationale for the delivery practices of IPTp-SP and ITN revealed in the quantitative findings. The interviews were transcribed and imported into NVivo for analysis. Using the World Health Organization (WHO) Health Systems Framework as the theoretical basis, thematic analysis was conducted under broad themes of the building blocks. Findings are presented in narrative quotes, with a mindmap used to summarize the various health system factors and their interrelated relationship influencing the delivery of IPTp-SP and ITN. Results Health system factors identified included health staff untrained on malaria delivery directives due to an ineffective trainer of trainer (ToT) system. Additionally, health worker confusion on when to commence SP (at quickening or ≥ 16 weeks) was found to result in delayed start of SP. Stock-outs in facilities due to procurement delays at the national level resulted in missed opportunities to deliver SP to eligible pregnant women at the ANC. Similarly, ITN stock outs led to eligible pregnant women not receiving one at ANC clinics. Conclusion Poor health worker knowledge on policy directives, a consequence of ineffective training strategy led to delayed delivery of IPTp-SP to eligible pregnant women. Supply chain management challenges related to stock of SP and ITN resulted in missed opportunities to deliver the interventions to pregnant women attending ANC.https://doi.org/10.1186/s12936-022-04159-wMalariaHealth systemIntermittent preventive treatmentSulfadoxine-pyrimethamineInsecticide-treated netsPregnancy |
| spellingShingle | Virtue Fiawokome De-Gaulle Joseph Kamgno Verner N. Orish Agnes Kotoh Wilfred Mbacham Harry Tagbor Pascal Magnussen A qualitative assessment of the health systems factors influencing the prevention of malaria in pregnancy using intermittent preventive treatment and insecticide-treated nets in Ghana Malaria Journal Malaria Health system Intermittent preventive treatment Sulfadoxine-pyrimethamine Insecticide-treated nets Pregnancy |
| title | A qualitative assessment of the health systems factors influencing the prevention of malaria in pregnancy using intermittent preventive treatment and insecticide-treated nets in Ghana |
| title_full | A qualitative assessment of the health systems factors influencing the prevention of malaria in pregnancy using intermittent preventive treatment and insecticide-treated nets in Ghana |
| title_fullStr | A qualitative assessment of the health systems factors influencing the prevention of malaria in pregnancy using intermittent preventive treatment and insecticide-treated nets in Ghana |
| title_full_unstemmed | A qualitative assessment of the health systems factors influencing the prevention of malaria in pregnancy using intermittent preventive treatment and insecticide-treated nets in Ghana |
| title_short | A qualitative assessment of the health systems factors influencing the prevention of malaria in pregnancy using intermittent preventive treatment and insecticide-treated nets in Ghana |
| title_sort | qualitative assessment of the health systems factors influencing the prevention of malaria in pregnancy using intermittent preventive treatment and insecticide treated nets in ghana |
| topic | Malaria Health system Intermittent preventive treatment Sulfadoxine-pyrimethamine Insecticide-treated nets Pregnancy |
| url | https://doi.org/10.1186/s12936-022-04159-w |
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