Abstract
BackgroundTo prevent malaria infection during pregnancy in endemic areas in Africa, the World Health Organization recommends the administration of intermittent preventive treatment in pregnancy (IPTp) as part of the focused antenatal care package. However, IPTp uptake in most countries remains low despite generally high antenatal care coverage and increased efforts by governments to address known bottlenecks such as drug stock-outs. The study explored factors that continue to impede uptake of IPTp among women who attend antenatal care. This paper focuses on demand-side barriers with regard to accessibility, affordability and acceptability.MethodsThe research was conducted in 2013/2014 and involved 46 in-depth interviews with four types of respondents: (i) seven district health officials; (ii) 15 health workers; (iii) 19 women who attended antenatal care; (iv) five opinion leaders. Interviews were conducted in Eastern and West Nile regions of Uganda. Data was analysed by thematic analysis.ResultsDistrict health officials and health workers cited a range of barriers relating to knowledge and attitudes among pregnant women, including lack of awareness of pregnancy-related health risks, a tendency to initiate antenatal care late, reluctance to take medication and concerns about side effects of IPTp. However, women and opinion leaders expressed very positive views of antenatal care and IPTp. They also reported that the burden of travel and cost associated with antenatal care attendance was challenging, but did not keep them from accessing a service they perceived as beneficial. The role of trust in health workers’ expertise was highlighted by all respondents and it was reported that women will typically accept IPTp if encouraged by a health worker.ConclusionsGiven the positive views of antenatal care and IPTp, high antenatal care coverage and reported low refusal rates for IPTp, supply-side issues are likely to account for the majority of missed opportunities for the provision of IPTp when women attend antenatal care. However, to increase uptake of IPTp on the demand side, health workers should be encouraged to reassure eligible women that IPTp is safe.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1589-7) contains supplementary material, which is available to authorized users.
Highlights
To prevent malaria infection during pregnancy in endemic areas in Africa, the World Health Organization recommends the administration of intermittent preventive treatment in pregnancy (IPTp) as part of the focused antenatal care package
This study explored thoughts and opinions of key stakeholders to better understand how stakeholders’ perceptions may affect uptake of IPTp, for those women who attend antenatal care (ANC), albeit not necessarily following the recommended four-visit schedule
Demand-side barriers to IPTp uptake will be discussed under the themes of accessibility, affordability and acceptability
Summary
To prevent malaria infection during pregnancy in endemic areas in Africa, the World Health Organization recommends the administration of intermittent preventive treatment in pregnancy (IPTp) as part of the focused antenatal care package. The study explored factors that continue to impede uptake of IPTp among women who attend antenatal care. Intermittent preventive treatment in pregnancy (IPTp), which involves repeated administration of curative doses of a safe and effective anti-malarial to pregnant women, without testing the recipient’s infection status. Pregnant women typically receive IPTp as part of the focused antenatal care (ANC) package, which specifies that pregnant women should have at least four assessments at specified intervals by or under the supervision of a skilled attendant [4].
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