title: Community response to intermittent preventive treatment of malaria in infants (IPTi) delivered through the expanded programme of immunization in five African settings.
abstract: BACKGROUND
  IPTi delivered through EPI has been shown to reduce the incidence of clinical malaria by 20-59%. However, new health interventions can only be effective if they are also socially and culturally acceptable. It is also crucial to ensure that attitudes to IPTi do not negatively influence attitudes to and uptake of immunization, or that people do not misunderstand IPTi as immunization against malaria and neglect other preventive measures or delay treatment seeking.
  
  
  METHODS
  These issues were studied in five African countries in the context of clinical trials and implementation studies of IPTi. Mixed methods were used, including structured questionnaires (1,296), semi-structured interviews (168), in-depth interviews (748) and focus group discussions (95) with mothers, fathers, health workers, community members, opinion leaders, and traditional healers. Participant observation was also carried out in the clinics.
  
  
  RESULTS
  IPTi was widely acceptable because it resonated with existing traditional preventive practices and a general concern about infant health and good motherhood. It also fit neatly within already widely accepted routine vaccination. Acceptance and adherence were further facilitated by the hierarchical relationship between health staff and mothers and by the fact that clinic attendance had a social function for women beyond acquiring health care. Type of drug and regimen were important, with newer drugs being seen as more effective, but potentially also more dangerous. Single dose infant formulations delivered in the clinic seem to be the most likely to be both acceptable and adhered to. There was little evidence that IPTi per se had a negative impact on attitudes to EPI or that it had any affect on EPI adherence. There was also little evidence of IPTi having a negative impact on health seeking for infants with febrile illness or existing preventive practices.
  
  
  CONCLUSIONS
  IPTi is generally acceptable across a wide range of settings in Africa and involving different drugs and regimens, though there is a strong preference for a single dose infant formulation. IPTi does not appear to have any negative effect on attitudes to EPI, and it is not interpreted as immunization against malaria.
authors: Centre for International Health Research (CRESIB), University of Barcelona, Spain. marjolein.gysels@cresib.cat
authors: Marjolein
authors: M
authors: Gysels
authors: Christopher
authors: C
authors: Pell
authors: Don P
authors: DP
authors: Mathanga
authors: Philip
authors: P
authors: Adongo
authors: Frank
authors: F
authors: Odhiambo
authors: Roly
authors: R
authors: Gosling
authors: Patricia
authors: P
authors: Akweongo
authors: Rose
authors: R
authors: Mwangi
authors: George
authors: G
authors: Okello
authors: Peter
authors: P
authors: Mangesho
authors: Lawrence
authors: L
authors: Slutsker
authors: Peter G
authors: PG
authors: Kremsner
authors: Martin P
authors: MP
authors: Grobusch
authors: Mary J
authors: MJ
authors: Hamel
authors: Robert D
authors: RD
authors: Newman
authors: Robert
authors: R
authors: Pool
mesh_terms: D000349:Africa; D000962:Antimalarials / Q000008:administration & dosage* / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000517:prevention & control*; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011795:Surveys and Questionnaires
chemical_list: D000962:Antimalarials