Community response to intermittent preventive treatment delivered to infants (IPTi) through the EPI system in Manhiça, Mozambique.
OBJECTIVE
To describe attitudes to the expanded programme on immunization (EPI) and intermittent preventive treatment in infants (IPTi), and perceptions of the relationship between them. In particular, whether the introduction of IPTi negatively affects community attitudes to, or use of, EPI; or, conversely, whether and if so how, the concurrent delivery of IPTi and immunization influences perceptions of IPTi.


METHODS
Anthropological study carried out in the context of a trial of IPTi with sulphadoxine-pyrimethamine delivered alongside routine EPI vaccinations. We used open in-depth interviews, semi-structured interviews and participant observation, conducted in both community and clinic settings.


RESULTS
IPTi was generally acceptable, in spite of initial resistance. Perceived negative aspects of IPTi did not affect perceptions of EPI, and IPTi was not misinterpreted as immunization against malaria, leading to a reduction of other preventive measures or delay in treatment seeking. Initial resistance was related more to the trial than to IPTi per se, but both rejection and acceptance were embedded in a complex constellation of local and wider contextual factors.


CONCLUSIONS
IPTi delivered together with EPI was generally accepted after initial rejection. The factors that led to this rejection were largely local and trial related, but they did resonate with much wider cultural themes (rumours about research and health interventions, gender inequality and health-related decision making). The prior acceptance and routine administration of EPI played a key role in the acceptance of IPTi in this community. However, more studies, in different social and cultural settings and using different drugs and regimens, are needed before generalizations can be made. Although trial settings are different from actual implementation, it is necessary to study acceptability before implementation in order to anticipate problems and design information campaigns to ensure maximum community acceptance.
Pool
Robert
R
London School of Hygiene and Tropical Medicine, London, UK, and Center for International Health, Hospital Clinic, IDIBAPS, Barcelona, Spain. robert.pool@lshtm.ac.uk
Munguambe
Khatia
K
Macete
Eusebio
E
Aide
Pedro
P
Juma
Geraldina
G
Alonso
Pedro
P
Menendez
Clara
C
D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology; D002648:Child; D003695:Delivery of Health Care / Q000379:methods / Q000458:organization & administration; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006403:Hematologic Tests / Q000523:psychology; D006801:Humans; D007114:Immunization / Q000523:psychology; D017589:Immunization Programs / Q000458:organization & administration*; D017780:Malaria Vaccines / Q000627:therapeutic use; D016778:Malaria, Falciparum / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D009073:Mozambique / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000523:psychology
D017780:Malaria Vaccines