title: 'Some anti-malarials are too strong for your body, they will harm you.' Socio-cultural factors influencing pregnant women's adherence to anti-malarial treatment in rural Gambia.
abstract: BACKGROUND
  Despite declining prevalence of malaria in The Gambia, non-adherence to anti-malarial treatment still remains a challenge to control efforts. There is limited evidence on the socio-cultural factors that influence adherence to anti-malarial treatment in pregnancy. This study explored perceptions of malaria in pregnancy and their influence on adherence to anti-malarial treatment in a rural area of The Gambia.
  
  
  METHODS
  An exploratory ethnographic study was conducted ancillary to a cluster-randomized trial on scheduled screening and treatment of malaria in pregnancy at village level in the Upper River Region of The Gambia from June to August 2014. Qualitative data were collected through interviewing and participant observation. Analysis was concurrent to data collection and carried out using NVivo 10.
  
  
  RESULTS
  Although women had good bio-medical knowledge of malaria in pregnancy, adherence to anti-malarial treatment was generally perceived to be low. Pregnant women were perceived to discontinue the provided anti-malarial treatment after one or 2 days mainly due to non-recognition of symptoms, perceived ineffectiveness of the anti-malarial treatment, the perceived risks of medication and advice received from mothers-in-law.
  
  
  CONCLUSIONS
  Improving women's knowledge of malaria in pregnancy is not sufficient to assure adherence to anti-malarial treatment. Addressing structural barriers such as unclear health workers' messages about medication dosage, illness recognition, side effects of the medication and the integration of relatives, especially the mothers-in-law, in community-based programmes are additionally required.
authors.affiliation: Department of Geography, The University of Sheffield, Sheffield, UK. fjaiteh@mrc.gm.|Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. fjaiteh@mrc.gm.|Medical Research Council Unit, Fajara, The Gambia. fjaiteh@mrc.gm.
authors.forename: Fatou
authors.initials: F
authors.lastname: Jaiteh
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.|Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands.
authors.forename: Susan
authors.initials: S
authors.lastname: Dierickx
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.|Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Gryseels
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Sarah
authors.initials: S
authors.lastname: O'Neill
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.|Medical Research Council Unit, Fajara, The Gambia.|London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia.|London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Susana
authors.initials: S
authors.lastname: Scott
authors.affiliation: School of Health and Related Research, The University of Sheffield, Sheffield, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Balen
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.|School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.|Partners for Applied Social Sciences (PASS) International, Tessenderlo, Belgium.
authors.forename: Koen Peeters
authors.initials: KP
authors.lastname: Grietens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000962:Antimalarials / Q000008:administration & dosage*; D005260:Female; D005714:Gambia; D006801:Humans; D007407:Interviews as Topic; D008288:Malaria / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D012424:Rural Population; D055815:Young Adult
chemical_list: D000962:Antimalarials
keywords: Adherence; Anti-malarials; Pregnancy; Rural Gambia