title: Access and use of interventions to prevent and treat malaria among pregnant women in Kenya and Mali: a qualitative study.
abstract: BACKGROUND
  Coverage of malaria in pregnancy interventions in sub-Saharan Africa is suboptimal. We undertook a systematic examination of the operational, socio-economic and cultural constraints to pregnant women's access to intermittent preventive treatment (IPTp), long-lasting insecticide-treated nets (LLINs) and case management in Kenya and Mali to provide empirical evidence for strategies to improve coverage.
  
  
  METHODS
  Focus group discussions (FGDs) were held as part of a programme of research to explore the delivery, access and use of interventions to control malaria in pregnancy. FGDs were held with four sub-groups: non-pregnant women of child bearing age (aged 15-49 years), pregnant women or mothers of children aged <1 year, adolescent women, and men. Content analysis was used to develop themes and sub-themes from the data.
  
  
  RESULTS
  Women and men's perceptions of the benefits of antenatal care were generally positive; motivation among women consisted of maintaining a healthy pregnancy, disease prevention in mother and foetus, checking the position of the baby in preparation for delivery, and ensuring admission to a facility in case of complications. Barriers to accessing care related to the quality of the health provider-client interaction, perceived health provider skills and malpractice, drug availability, and cost of services. Pregnant women perceived themselves and their babies at particular risk from malaria, and valued diagnosis and treatment from a health professional, but cost of treatment at health facilities drove women to use herbal remedies or drugs bought from shops. Women lacked information on the safety, efficacy and side effects of antimalarial use in pregnancy.
  
  
  CONCLUSIONS
  Women in these settings appreciated the benefits of antenatal care and yet health services in both countries are losing women to follow-up due to factors that can be improved with greater political will. Antenatal services need to be patient-centred, free-of-charge or highly affordable and accountable to the women they serve.
authors: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors: Jenny
authors: J
authors: Hill
authors: Malaria Research and Training Centre, University of Sciences, Techniques and Technologies of Bamako, Mali.
authors: Kassoum
authors: K
authors: Kayentao
authors: Kenya Medical Research Institute/Center for Global Health Research, Kisumu, Kenya.
authors: Florence
authors: F
authors: Achieng
authors: Malaria Research and Training Centre, University of Sciences, Techniques and Technologies of Bamako, Mali.
authors: Samba
authors: S
authors: Diarra
authors: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors: Stephanie
authors: S
authors: Dellicour
authors: Malaria Research and Training Centre, University of Sciences, Techniques and Technologies of Bamako, Mali.
authors: Sory I
authors: SI
authors: Diawara
authors: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America and Kenya.
authors: Mary J
authors: MJ
authors: Hamel
authors: Kenya Medical Research Institute/Center for Global Health Research, Kisumu, Kenya.
authors: Peter
authors: P
authors: Ouma
authors: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America and Kenya.
authors: Meghna
authors: M
authors: Desai
authors: Malaria Research and Training Centre, University of Sciences, Techniques and Technologies of Bamako, Mali.
authors: Ogobara K
authors: OK
authors: Doumbo
authors: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors: Feiko O
authors: FO
authors: ter Kuile
authors: Disease Control Department, London School of Tropical Medicine and Hygiene, London, United Kingdom.
authors: Jayne
authors: J
authors: Webster
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D019090:Case Management; D003695:Delivery of Health Care; D018479:Early Intervention, Educational; D005260:Female; D017144:Focus Groups; D006801:Humans; D007159:Immunologic Tests; D007223:Infant; D007231:Infant, Newborn; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D007630:Kenya; D008288:Malaria / Q000469:parasitology / Q000517:prevention & control*; D008297:Male; D008302:Mali; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010963:Plasmodium falciparum / Q000302:isolation & purification; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011315:Preventive Medicine / Q000379:methods*; D036301:Qualitative Research; D055815:Young Adult
chemical_list: D000962:Antimalarials