Abstract

Background The community plays key roles in protecting pregnant women in rural areas from malaria. This study assessed malaria experiences, knowledge, perceived roles in malaria prevention in pregnancy, and acceptability of community-directed distribution of intermittent preventive therapy (IPTp) for malaria in pregnancy in rural Southeast Nigeria. Methods This study presents part of the baseline findings of a before-and-after study. Data was collected from 817 community members in Ebonyi State using interviewer-administered questionnaires and focus group discussions (FGDs). Data were analyzed using SPSS version 20 and thematic analysis. Results The majority of the respondents were females (73.8%) with a mean age of 36.08 ± 15.4. Most respondents (65.2%) had Insecticide-Treated Net (ITN) and fever in the past year (67.1%). Malaria (88.6%) was identified as the major health condition in the community. Majority (74.1%) knew infected mosquito bites as the cause of malaria while 61.1% and 71.5% were definitely sure that pregnant women and children were at risk for malaria. Sleeping under ITN (54.3%), clean environment (39.7%), and herbal medications (26.8%) were the main ways of malaria prevention cited. Only 18.4% of the participants rated their knowledge of IPTp as adequate, and only 9.3% knew the common drug names used for IPTp. The major perceived roles in malaria prevention in pregnancy were referral of pregnant women to the health facility, encouragement of household ITN use, and sustaining malaria-related projects. The majority of the participants (60.6%) strongly agreed that community-directed distribution of IPTp-SP will improve the prevention of malaria in pregnancy. Most (77.2%) considered community-directed distribution of IPTp acceptable, and 74.4% of the pregnant respondents preferred community to facility administration of IPTp. Conclusions Malaria was recognized as a prevalent disease, but there was inadequate knowledge of malaria prevention in pregnancy notably intermittent preventive therapy. There was positive perception of roles in malaria prevention in pregnancy and high acceptability of community-directed distribution of IPTp. Community-level malaria control programs should utilize a whole-of–community approach to optimally engage and educate the community on malaria prevention in pregnancy as well as explore community distribution approach for IPTp.

Highlights

  • According to the World Malaria Report 2021, the World Health Organization (WHO) African Region continues to bear the global malaria burden, accounting for about 95% of the 241 million malaria cases worldwide and 96% of the 627000 deaths from malaria in 2020 [1]

  • Most of the respondents had long-lasting Insecticide-Treated Net (ITN) (65.2%) and were definitely sure of ever having had fever in the past one year (67.1%), and over four-fifths had fever diagnosed as malaria (81.4%)

  • Windows with nets Netted doors and windows Ordinary mosquito nets Long-lasting ITN None Source of ITN (n = 533) Health facility Personal purchase Friend/family member Medical outreach Others Ever had fever in the past one year Definitely yes Probably yes Unsure Probably no Definitely no Was this fever diagnosed as malaria (n = 591) Yes No Unsure Where and how was the malaria diagnosed (n = 481) Health facility using microscopy Chemist using symptoms Health facility using RDT Health facility using history Chemist using RDT By family/friends Self-diagnosed using usual symptoms How was the fever treated (n = 591) Use of antimalarial from a chemist Drugs mixed form chemist Use of antimalarial from a health facility Antibiotics Paracetamol Herbal drugs/concoctions No treatment

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Summary

Introduction

According to the World Malaria Report 2021 (page xv), the World Health Organization (WHO) African Region continues to bear the global malaria burden, accounting for about 95% of the 241 million malaria cases worldwide and 96% of the 627000 deaths from malaria in 2020 [1]. The disease overstretches the nation’s struggling health system with grave socio-economic consequences for both household and national levels This is manifested in reduced gross domestic product, productivity, and high out-of-pocket expenditures on treatment and prevention expenditures [4]. This study assessed malaria experiences, knowledge, perceived roles in malaria prevention in pregnancy, and acceptability of community-directed distribution of intermittent preventive therapy (IPTp) for malaria in pregnancy in rural Southeast Nigeria. 18.4% of the participants rated their knowledge of IPTp as adequate, and only 9.3% knew the common drug names used for IPTp. The major perceived roles in malaria prevention in pregnancy were referral of pregnant women to the health facility, encouragement of household ITN use, and sustaining malaria-related projects. The majority of the participants (60.6%) strongly agreed that community-directed distribution of IPTp-SP will improve the prevention of malaria in pregnancy.

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