title: Fear of birth defects is a major barrier to soil-transmitted helminth treatment (STH) for pregnant women in the Philippines.
abstract: The World Health Organization recommends anthelminthic treatment for pregnant women after the first trimester in soil-transmitted helminth (STH) endemic regions to prevent adverse maternal-fetal consequences. Although studies have shown the high prevalence of infection in the Philippines, no research has evaluated deworming practices. We hypothesized that pregnant women are not receiving deworming treatment and we aimed to identify barriers to World Health Organization guideline implementation. We conducted key informant interviews with local Department of Health (DOH) administrators, focus group discussions with nurses, midwives, and health care workers, and knowledge, attitudes, and practices surveys with women of reproductive age to elicit perspectives about deworming during pregnancy. Key informant interviews revealed that healthcare workers were not deworming pregnant women due to inadequate drug supply, infrastructure and personnel as well as fear of teratogenicity. Focus group discussions showed that healthcare workers similarly had not implemented guidelines due to infrastructure challenges and concerns for fetal malformations. The majority of local women believed that STH treatment causes side effects (74.8%) as well as maternal harm (67.3%) and fetal harm (77.9%). Women who were willing to take anthelminthics while pregnant had significantly greater knowledge as demonstrated by higher Treatment Scores (mean rank 146.92 versus 103.1, z = -4.40, p<0.001) and higher Birth Defect Scores (mean rank 128.09 versus 108.65, z = -2.43, p = 0.015). This study concludes that World Health Organization guidelines are not being implemented in the Philippines. Infrastructure, specific protocols, and education for providers and patients regarding anthelminthic treatment are necessary for the successful prevention of STH morbidity and mortality among pregnant women.
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Insetta
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Soriano
authors.affiliation: National Institutes of Health and College of Public Health, University of the Philippines Manila, Manila, Philippines.
authors.forename: Francis Isidore G
authors.initials: FI
authors.lastname: Totañes
authors.affiliation: Division of Infectious Diseases, University of Pittsburgh School Medicine, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Bernard J C
authors.initials: BJ
authors.lastname: Macatangay
authors.affiliation: National Institutes of Health and College of Public Health, University of the Philippines Manila, Manila, Philippines.
authors.forename: Vicente Y
authors.initials: VY
authors.lastname: Belizario
mesh_terms: D000328:Adult; D000871:Anthelmintics / Q000009:adverse effects* / Q000627:therapeutic use; D000013:Congenital Abnormalities / Q000523:psychology*; D005239:Fear; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006373:Helminthiasis / Q000150:complications* / Q000188:drug therapy / Q000635:transmission; D006801:Humans; D010679:Philippines; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy*; D012987:Soil / Q000469:parasitology*; D055815:Young Adult
chemical_list: D000871:Anthelmintics; D012987:Soil