title: Intermittent screening and treatment versus intermittent preventive treatment of malaria in pregnancy: user acceptability.
abstract: BACKGROUND
  Malaria in pregnancy is associated with increased risks of maternal and foetal complications. Currently, intermittent preventive treatment (IPT) of malaria during pregnancy with sulphadoxine-pyrimethamine (SP) is recommended by the WHO as part of a package of interventions also including insecticide-treated nets and effective case management. However, with increasing resistance to SP, the effectiveness of SP-IPT has been questioned. A randomized controlled trial (RCT) to investigate the relative efficacy of an alternative strategy of intermittent screening and treatment (IST), which involves a rapid diagnostic test for malaria at scheduled ANC visits and treatment of women only if positive, versus SP-IPT has been conducted in Ashanti region, Ghana. This paper reports on a complementary study investigating the acceptability of the different strategies to women enrolled in the trial.
  
  
  METHODS
  Data were collected through twelve focus group discussions with women selected at random from the different arms of the RCT, exploring their experiences and perceptions about antenatal care and their involvement in the trial. Content analysis was used to identify relevant themes to structure the results.
  
  
  RESULTS
  Five main themes emerged from participants' experiences of ANC and the RCT that would influence their acceptability of malaria prevention strategies during pregnancy: health benefits; drugs received; tests received; other services received; and health worker attitude. Their own health and that of their baby were strong motivations for attending ANC, and reported favourably as an outcome of being in the RCT. Women were not always clear on the biomedical function of drugs or blood tests but generally accepted them due to strong trust in the health staff. Home visits by staff and free ITNs as part of the trial were appreciated. Politeness and patience of health staff was a very strong positive factor.
  
  
  CONCLUSIONS
  Overall, both intermittent screening and treatment and intermittent preventive treatment appeared equally acceptable to pregnant women as strategies for the control of malaria in pregnancy. The women were more concerned about quality of services received, in particular the polite and patient attitude of health staff, and positive health implications for themselves and their babies than about the nature of the intervention.
authors.affiliation: Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK. Lucy.Smith@lshtm.ac.uk
authors.forename: Lucy A
authors.initials: LA
authors.lastname: Smith
authors.forename: Caroline
authors.initials: C
authors.lastname: Jones
authors.forename: Rose O
authors.initials: RO
authors.lastname: Adjei
authors.forename: Gifty D
authors.initials: GD
authors.lastname: Antwi
authors.forename: Nana A
authors.initials: NA
authors.lastname: Afrah
authors.forename: Brian
authors.initials: B
authors.lastname: Greenwood
authors.forename: Daniel
authors.initials: D
authors.lastname: Chandramohan
authors.forename: Harry
authors.initials: H
authors.lastname: Tagbor
authors.forename: Jayne
authors.initials: J
authors.lastname: Webster
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage* / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods*; D005260:Female; D017144:Focus Groups; D005869:Ghana; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000517:prevention & control; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000962:Antimalarials