title: Local illness concepts and their relevance for the prevention and control of malaria during pregnancy in Ghana, Kenya and Malawi: findings from a comparative qualitative study.
abstract: BACKGROUND
  In sub-Saharan Africa, the burden of morbidity and mortality linked to malaria during pregnancy (MiP) is significant and compounded by its unclear symptoms and links with other health problems during pregnancy. Mindful of the biomedical and social complexity of MiP, this article explores and compares local understandings of MiP and their links with other pregnancy-related health problems.
  
  
  METHODS
  A comparative qualitative study was undertaken at four sites in three countries: Ghana, Malawi and Kenya. Individual and group interviews were conducted with pregnant women, their relatives, opinion leaders, other community members and health providers. MiP-related behaviours were also observed at health facilities and in local communities.
  
  
  RESULTS
  Across the four sites, local malaria concepts overlapped with biomedically defined malaria. In terms of symptoms, at-risk groups, outcomes and aetiology of malaria during pregnancy, this overlap was however both site-specific and partial. Moreover, the local malaria concepts were not monolithic and their descriptions varied amongst respondents. The symptoms of pregnancy and malaria also overlapped but, for respondents, symptom severity was the distinguishing factor. Malaria was generally, though not universally, perceived as serious for pregnant women. Miscarriage was the most widely known outcome, and links with anaemia, low birth weight and congenital malaria were mentioned. Nonetheless, amongst many potential causes of miscarriage, malaria was not recognized as the most important, but rather interacted with other pregnancy-related problems.
  
  
  CONCLUSIONS
  Given the overlap of common pregnancy problems with the symptoms of malaria, and the limited association of malaria with its main outcomes, a comprehensive antenatal care programme is the most appropriate strategy for the provision of health education, prevention and treatment for MiP. Variations in locally shared understandings of MiP must however be taken into account when designing and promoting MiP intervention strategies.
authors.affiliation: Centre de Recerca en Salut Internacional de Barcelona CRESIB, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Arantza
authors.initials: A
authors.lastname: Menaca
authors.forename: Christopher
authors.initials: C
authors.lastname: Pell
authors.forename: Lucinda
authors.initials: L
authors.lastname: Manda-Taylor
authors.forename: Samuel
authors.initials: S
authors.lastname: Chatio
authors.forename: Nana A
authors.initials: NA
authors.lastname: Afrah
authors.forename: Florence
authors.initials: F
authors.lastname: Were
authors.forename: Abraham
authors.initials: A
authors.lastname: Hodgson
authors.forename: Peter
authors.initials: P
authors.lastname: Ouma
authors.forename: Linda
authors.initials: L
authors.lastname: Kalilani
authors.forename: Harry
authors.initials: H
authors.lastname: Tagbor
authors.forename: Robert
authors.initials: R
authors.lastname: Pool
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D003140:Communicable Disease Control / Q000379:methods*; D005260:Female; D005869:Ghana / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology / Q000401:mortality / Q000473:pathology* / Q000517:prevention & control*; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000401:mortality / Q000473:pathology* / Q000517:prevention & control*; D055815:Young Adult