Perceptions of malaria in pregnancy and acceptability of preventive interventions among Mozambican pregnant women: implications for effectiveness of malaria control in pregnancy.
BACKGROUND
Intermittent Preventive Treatment (IPTp) and insecticide treated nets (ITNs) are recommended malaria in pregnancy preventive interventions in sub-Saharan Africa. Despite their cost-effectiveness and seemingly straight-forward delivery mechanism, their uptake remains low. We aimed at describing perceptions of pregnant women regarding malaria and the recommended prevention interventions to understand barriers to uptake and help to improve their effectiveness.


RESULTS
We used mixed methods to collect data among 85 pregnant women from a rural area of Southern Mozambique. Information was obtained through observations, in-depth interviews, and focused ethnographic exercises (Free-listing and Pairwise comparisons). Thematic analysis was performed on qualitative data. Data from focused ethnographic exercises were summarized into frequency distribution tables and matrices. Malaria was not viewed as a threat to pregnancy. Participants were not fully aware of malaria- associated adverse maternal and birth outcomes. ITNs were the most preferred and used malaria preventive intervention, while IPTp fell between second and third. Indoor Residual Spraying (IRS) was the least preferred intervention.


CONCLUSIONS
Low awareness of the risks and adverse consequences of malaria in pregnancy did not seem to affect acceptability or uptake to the different malaria preventive interventions in the same manner. Perceived convenience, the delivery approach, and type of provider were the key factors. Pregnant women, through antenatal care (ANC) services, can be the vehicles of ITN distribution in the communities to maximise overall ITN coverage. There is a need to improve knowledge about neonatal health and malaria to improve uptake of interventions delivered through channels other than the health facility.
Centro de Investigação em Saúde da Manhiça, Manhiça, Mozambique.
Helena
H
Boene
Centro de Investigação em Saúde da Manhiça, Manhiça, Mozambique ; Barcelona Centre for International Health Research, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.
Raquel
R
González
Centro de Investigação em Saúde da Manhiça, Manhiça, Mozambique.
Anifa
A
Valá
Centro de Investigação em Saúde da Manhiça, Manhiça, Mozambique ; Barcelona Centre for International Health Research, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.
Maria
M
Rupérez
Barcelona Centre for International Health Research, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.
César
C
Velasco
Centro de Investigação em Saúde da Manhiça, Manhiça, Mozambique ; Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Mozambique.
Sónia
S
Machevo
Centro de Investigação em Saúde da Manhiça, Manhiça, Mozambique.
Charfudin
C
Sacoor
Centro de Investigação em Saúde da Manhiça, Manhiça, Mozambique ; Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Mozambique.
Esperança
E
Sevene
Centro de Investigação em Saúde da Manhiça, Manhiça, Mozambique ; Direcção Nacional de Saúde Pública, Ministério da Saúde, Maputo, Mozambique.
Eusébio
E
Macete
Centro de Investigação em Saúde da Manhiça, Manhiça, Mozambique ; Barcelona Centre for International Health Research, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.
Clara
C
Menéndez
Centro de Investigação em Saúde da Manhiça, Manhiça, Mozambique ; Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Mozambique.
Khátia
K
Munguambe
D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D044383:Black People / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006801:Humans; D057148:Insecticide-Treated Bednets; D007407:Interviews as Topic / Q000379:methods; D008288:Malaria / Q000517:prevention & control*; D009032:Mosquito Control / Q000379:methods*; D009073:Mozambique; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D010465:Perception; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D011295:Prenatal Care / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D055815:Young Adult
D000962:Antimalarials