Abstract
BackgroundLiberia is a West African country that needs substantial investment to strengthen its National Malaria Control Programme (NMCP), which was disrupted during the 2014–2016 Ebola epidemic. As elsewhere, Liberian pregnant women are especially vulnerable to malaria. Understanding prevention and treatment-seeking behaviours among the population is crucial to strategize context-specific and women-centred actions, including locally-led malaria research, to improve women’s demand, access and use of NMCP strategies against malaria in pregnancy.MethodsIn 2016, after the Ebola crisis, a qualitative inquiry was conducted in Monrovia to explore populations’ insights on the aetiology, prevention and therapeutics of malaria, as well as the community and health workers’ perceptions on the utility of malaria research for pregnant women. In-depth interviews and focus group discussions were conducted among pregnant women, traditional community representatives and hospital staff (n = 38), using a feminist interpretation of grounded theory.ResultsThe narratives indicate that some Liberians believed in elements other than mosquito bites as causes of malaria; many had a low malaria risk perception and disliked current effective prevention methods, such as insecticide-treated nets; and some would resort to traditional medicine and spiritual care to cure malaria. Access to clinic-based malaria care for pregnant women was reportedly hindered by lack of financial means, by unofficial user fees requested by healthcare workers, and by male partners’ preference for traditional medicine. The participants suggested that malaria research in Liberia could help to design evidence-based education to change current malaria prevention, diagnostic and treatment-seeking attitudes, and to develop more acceptable prevention technologies.ConclusionPoverty, insufficient education on malaria, corruption, and poor trust in healthcare establishment are structural factors that may play a greater role than local traditional beliefs in deterring Liberians from seeking, accessing and using government-endorsed malaria control strategies. To increase access to and uptake of preventive and biomedical care by pregnant women, future malaria research must be informed by people’s expressed needs and constructed meanings and values on health, ill health and healthcare.
Highlights
Liberia is a West African country that needs substantial investment to strengthen its National Malaria Control Programme (NMCP), which was disrupted during the 2014–2016 Ebola epidemic
According to the last 2016 Malaria Indicator Survey (MIS), prevalence of Plasmodium falciparum infection among 6–59 months-old children in Liberia was as high as 45% [11]
Seventeen women, 11 leaders, and 10 staff consented to participate in 26 in-depth interview (IDI) and in three focus group discussion (FGD) (Table 1)
Summary
Liberia is a West African country that needs substantial investment to strengthen its National Malaria Control Programme (NMCP), which was disrupted during the 2014–2016 Ebola epidemic. In spite of a reduction in malariaattributable morbidity and mortality among this vulnerable group [1], current global malaria control efforts are threatened by the spread of multi-drug resistant parasites [2, 3], pyrethroid-resistant mosquitoes [3, 4], interruption of free healthcare in some endemic settings [5], and cultural beliefs and gendered norms that deter women from accessing biomedical care against malaria disease [6,7,8,9]. In West Africa, is a country that needs investment to strengthen its national malaria control program (NMCP). It is estimated that the disruption of routine healthcare provision might have led to increases of up to 62% in the rate of malaria-attributable mortality [14]
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