Top

Published in:

Open Access 01-12-2016 | Research

Provider and user acceptability of intermittent screening and treatment for the control of malaria in pregnancy in Malawi

Authors: Deborah Almond, Mwayi Madanitsa, Victor Mwapasa, Linda Kalilani-Phiri, Jayne Webster, Feiko ter Kuile, Lucy Paintain

Published in: Malaria Journal | Issue 1/2016

Abstract

Background

Malaria in pregnancy is a major cause of adverse maternal and fetal outcomes. Intermittent preventive treatment with sulfadoxine–pyrimethamine (IPTp-SP) is one of the control strategies promoted by WHO. In response to mounting resistance to SP, intermittent screening and treatment (ISTp) has been proposed as an alternative. The objective of this study was to explore the acceptability of ISTp for health workers and pregnant women.

Methods

Semi-structured interviews of ten health workers and five focus group discussions of 38 women enrolled in an ongoing trial comparing IPTp-SP and ISTp with dihydroartemisinin–piperaquine (DP) were conducted at two antenatal clinics in rural Malawi. All transcripts were coded and themes were identified using a content analysis approach.

Results

Amongst health workers, there were contrasting opinions on the preference of blood sampling methods, and the influence of method on reliability of diagnosis. The perceived greater effectiveness of DP compared to SP was appreciated, however concerns of user compliance with the full dose of DP in non-trial settings were raised. Despite the discomfort of repeated finger pricks, pregnant women were generally accepting of ISTp, particularly the chance for regular blood tests to check for infections and the perceived greater effectiveness with fewer side effects of DP compared to SP.

Conclusion

In the trial context, pregnant women tended to prefer ISTp-DP over IPTp-SP. Health workers were also accepting of ISTp-DP as an alternative to IPTp-SP in light of increasing SP resistance. However, reliability of stock, adherence to malaria test results and user adherence to the full course of DP may present barriers to successful routine implementation. Effective communication with health workers and between health workers, pregnant women and their communities will be essential for the acceptability of focused antenatal care, including the best malaria control measures available.

Desai M, ter Kuile FO, Nosten F, McGready R, Asamoa K, Brabin B, et al. Epidemiology and burden of malaria in pregnancy. Lancet Infect Dis. 2007;7:93–104.CrossRefPubMed

Cornet M, Le Hesran JY, Fievet N, Cot M, Personne P, Gounoue R, et al. Prevalence of and risk factors for anemia in young children in southern Cameroon. Am J Trop Med Hyg. 1998;58:606–11.PubMed

van Eijk AM, Ayisi JG, ter Kuile FO, Misore AO, Otieno JA, Kolczak MS, et al. Malaria and human immunodeficiency virus infection as risk factors for anemia in infants in Kisumu, western Kenya. Am J Trop Med Hyg. 2002;67:44–53.PubMed

Reed SC, Wirima JJ, Steketee RW. Risk factors for anemia in young children in rural Malawi. Am J Trop Med Hyg. 1994;51:170–4.PubMed

Le Hesran JY, Cot M, Personne P, Fievet N, Dubois B, Beyeme M, et al. Maternal placental infection with Plasmodium falciparum and malaria morbidity during the first 2 years of life. Am J Epidemiol. 1997;146:826–31.CrossRefPubMed

Malhotra I, Dent A, Mungai P, Wamachi A, Ouma JH, Narum DL, et al. Can prenatal malaria exposure produce an immune tolerant phenotype? A prospective birth cohort study in Kenya. PLoS Med. 2009;6:e1000116.CrossRefPubMedPubMedCentral

Mutabingwa TK, Bolla MC, Li JL, Domingo GJ, Li X, Fried M, et al. Maternal malaria and gravidity interact to modify infant susceptibility to malaria. PLoS Med. 2005;2:e407.CrossRefPubMedPubMedCentral

Schwarz NG, Adegnika AA, Breitling LP, Gabor J, Agnandji ST, Newman RD, et al. Placental malaria increases malaria risk in the first 30 months of life. Clin Infect Dis. 2008;47:1017–25.CrossRefPubMed

O’Neil-Dunne I, Achur RN, Agbor-Enoh ST, Valiyaveettil M, Naik RS, Ockenhouse CF, et al. Gravidity-dependent production of antibodies that inhibit binding of Plasmodium falciparum-infected erythrocytes to placental chondroitin sulfate proteoglycan during pregnancy. Infect Immun. 2001;69:7487–92.CrossRefPubMedPubMedCentral

10.

Slutsker L, Marston BJ. HIV and malaria: interactions and implications. Curr Opin Infect Dis. 2007;20:3–10.CrossRefPubMed

11.

Anders K, Marchant T, Chambo P, Mapunda P, Reyburn H. Timing of intermittent preventive treatment for malaria during pregnancy and the implications of current policy on early uptake in north-east Tanzania. Malar J. 2008;7:79.CrossRefPubMedPubMedCentral

12.

Mubyazi GM, Magnussen P, Goodman C, Bygbjerg IC, Kitua AY, Olsen OE, et al. Implementing intermittent preventive treatment for malaria in pregnancy: review of prospects, achievements, challenges and agenda for research. Open Trop Med J. 2008;1:92–100.CrossRefPubMedPubMedCentral

13.

Mbonye AK, Magnussen P. Symptom-based diagnosis of malaria and its implication on antimalarial drug use in pregnancy in Central Uganda: results from a community trial. Int J Adolesc Med Health. 2010;22:257–62.PubMed

14.

WHO. A strategic framework for malaria prevention and control during pregnancy in the African Region. Geneva: World Health Organization; 2004.

15.

WHO. Policy brief for the implementation of intermittent preventive treatment of malaria in pregnancy using sulfadoxine–pyrimethamine (IPTp-SP). Geneva: World Health Organization; 2014.

16.

Peters PJ, Thigpen MC, Parise ME, Newman RD. Safety and toxicity of sulfadoxine/pyrimethamine: implications for malaria prevention in pregnancy using intermittent preventive treatment. Drug Saf. 2007;30:481–501.CrossRefPubMed

17.

Bardaji A, Bassat Q, Alonso PL, Menendez C. Intermittent preventive treatment of malaria in pregnant women and infants: making best use of the available evidence. Expert Opin Pharmacother. 2012;13:1719–36.CrossRefPubMed

18.

ter Kuile FO, van Eijk AM, Filler SJ. Effect of sulfadoxine–pyrimethamine resistance on the efficacy of intermittent preventive therapy for malaria control during pregnancy: a systematic review. JAMA. 2007;297:2603–16.CrossRefPubMed

19.

Feng G, Simpson JA, Chaluluka E, Molyneux ME, Rogerson SJ. Decreasing burden of malaria in pregnancy in Malawian women and its relationship to use of intermittent preventive therapy or bed nets. PLoS ONE. 2010;5:e12012.CrossRefPubMedPubMedCentral

20.

Nkhoma S, Molyneux M, Ward S. Molecular surveillance for drug-resistant Plasmodium falciparum malaria in Malawi. Acta Trop. 2007;102:138–42.CrossRefPubMed

21.

Villar BJ. WHO antenatal care randomized trial; manual for the implementation of the new model. Geneva: World Health Organization; 2003.

22.

Madanitsa M, Kalilani L, Mwapasa V, van Eijk AM, Khairallah C, Ali D, et al. Scheduled intermittent screening with rapid diagnostic tests and treatment with dihydroartemisinin–piperaquine versus intermittent preventive therapy with sulfadoxine–pyrimethamine for malaria in pregnancy in Malawi: an open-label randomized controlled trial. PLoS Med. 2016;13:e1002124.CrossRefPubMedPubMedCentral

23.

Tagbor H, Bruce J, Agbo M, Greenwood B, Chandramohan D. Intermittent screening and treatment versus intermittent preventive treatment of malaria in pregnancy: a randomised controlled non-inferiority trial. PLoS ONE. 2010;5:e14425.CrossRefPubMedPubMedCentral

24.

National Malaria Control Programme (NMCP) and ICF International. Malawi malaria indicator survey (MIS). Rockville: NMCP and ICF International; 2014. p. 2014.

25.

Kalilani-Phiri L, Thesing PC, Nyirenda OM, Mawindo P, Madanitsa M, Membe G, et al. Timing of malaria infection during pregnancy has characteristic maternal, infant and placental outcomes. PLoS ONE. 2013;8:e74643.CrossRefPubMedPubMedCentral

26.

Bernard HR. Analysis of qualitative data. Research methods in anthropology: qualitative and quantitative approaches. Walnut Creek: AltaMira Press; 2006. p. 360–92.

27.

Smith LA, Jones C, Adjei RO, Antwi GD, Afrah NA, Greenwood B, et al. Intermittent screening and treatment versus intermittent preventive treatment of malaria in pregnancy: user acceptability. Malar J. 2010;9:18.CrossRefPubMedPubMedCentral

28.

Hill J, Hoyt J, Achieng F, Ouma P, L’Lanziva A, Kariuki S, et al. User and provider acceptability of intermittent screening and treatment and intermittent preventive treatment with dihydroartemisinin–piperaquine to prevent malaria in pregnancy in Western Kenya. PLoS ONE. 2016;11:e0150259.CrossRefPubMedPubMedCentral

29.

Pell C, Menaca A, Afrah NA, Manda-Taylor L, Chatio S, Were F, et al. Prevention and management of malaria during pregnancy: findings from a comparative qualitative study in Ghana, Kenya and Malawi. Malar J. 2013;12:427.CrossRefPubMedPubMedCentral

30.

Pell C, Menaca A, Chatio S, Hodgson A, Tagbor H, Pool R. The acceptability of intermittent screening and treatment versus intermittent preventive treatment during pregnancy: results from a qualitative study in Northern Ghana. Malar J. 2014;13:432.CrossRefPubMedPubMedCentral

31.

Barat L, Chipipa J, Kolczak M, Sukwa T. Does the availability of blood slide microscopy for malaria at health centers improve the management of persons with fever in Zambia? Am J Trop Med Hyg. 1999;60:1024–30.PubMed

32.

Reyburn H, Mbatia R, Drakeley C, Carneiro I, Mwakasungula E, Mwerinde O, et al. Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study. BMJ. 2004;329:1212.CrossRefPubMedPubMedCentral

33.

Asiimwe C, Kyabayinze DJ, Kyalisiima Z, Nabakooza J, Bajabaite M, Counihan H, et al. Early experiences on the feasibility, acceptability, and use of malaria rapid diagnostic tests at peripheral health centres in Uganda-insights into some barriers and facilitators. Implement Sci. 2012;7:5.CrossRefPubMedPubMedCentral

34.

Chandler CI, Mangham L, Njei AN, Achonduh O, Mbacham WF, Wiseman V. As a clinician, you are not managing lab results, you are managing the patient: how the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests. Soc Sci Med. 2012;74:1528–35.CrossRefPubMed

35.

Hill J, D’Mello-Guyett L, Hoyt J, van Eijk AM, ter Kuile FO, Webster J. Women’s access and provider practices for the case management of malaria during pregnancy: a systematic review and meta-analysis. PLoS Med. 2014;11:e1001688.CrossRefPubMedPubMedCentral

36.

Menaca A, Pell C, Manda-Taylor L, Chatio S, Afrah NA, Were F, et al. Local illness concepts and their relevance for the prevention and control of malaria during pregnancy in Ghana, Kenya and Malawi: findings from a comparative qualitative study. Malar J. 2013;12:257.CrossRefPubMedPubMedCentral

37.

Williams JE, Cairns M, Njie F, Laryea Quaye S, Awine T, Oduro A, et al. The performance of a rapid diagnostic test in detecting malaria infection in pregnant women and the impact of missed infections. Clin Infect Dis. 2016;62:837–44.CrossRefPubMed

38.

Cottrell G, Moussiliou A, Luty AJ, Cot M, Fievet N, Massougbodji A, et al. Submicroscopic Plasmodium falciparum infections are associated with maternal anemia, premature births, and low birth weight. Clin Infect Dis. 2015;60:1481–8.PubMed

39.

Mbacham WF, Mangham-Jefferies L, Cundill B, Achonduh OA, Chandler CIR, Ambebila JN, et al. Basic or enhanced clinician training to improve adherence to malaria treatment guidelines: a cluster-randomised trial in two areas of Cameroon. Lancet Glob Health. 2014;2:e346–58.CrossRefPubMed

40.

Mannava P, Durrant K, Fisher J, Chersich M, Luchters S. Attitudes and behaviours of maternal health care providers in interactions with clients: a systematic review. Glob Health. 2015;11:36.CrossRef

41.

Smith Paintain L, Antwi GD, Jones C, Amoako E, Adjei RO, Afrah NA, et al. Intermittent screening and treatment versus intermittent preventive treatment of malaria in pregnancy: provider knowledge and acceptability. PLoS ONE. 2011;6:e24035.CrossRefPubMedPubMedCentral

42.

Mace KE, Mwandama D, Jafali J, Luka M, Filler SJ, Sande J, et al. Adherence to treatment with artemether–lumefantrine for uncomplicated malaria in rural Malawi. Clin Infect Dis. 2011;53:772–9.CrossRefPubMed

43.

Bell DJ, Wootton D, Mukaka M, Montgomery J, Kayange N, Chimpeni P, et al. Measurement of adherence, drug concentrations and the effectiveness of artemether–lumefantrine, chlorproguanil–dapsone or sulphadoxine–pyrimethamine in the treatment of uncomplicated malaria in Malawi. Malar J. 2009;8:204.CrossRefPubMedPubMedCentral

44.

Kabanywanyi AM, Lengeler C, Kasim P, King’eng’ena S, Schlienger R, Mulure N, et al. Adherence to and acceptability of artemether–lumefantrine as first-line anti-malarial treatment: evidence from a rural community in Tanzania. Malar J. 2010;9:48.CrossRefPubMedPubMedCentral

45.

Jaiteh F, Dierickx S, Gryseels C, O’Neill S, D’Alessandro U, Scott S, et al. ‘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. Malar J. 2016;15:1–7.CrossRef

Title: Provider and user acceptability of intermittent screening and treatment for the control of malaria in pregnancy in Malawi
Authors: Deborah Almond
Mwayi Madanitsa
Victor Mwapasa
Linda Kalilani-Phiri
Jayne Webster
Feiko ter Kuile
Lucy Paintain
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: Malaria Journal / Issue 1/2016
Electronic ISSN: 1475-2875
DOI: https://doi.org/10.1186/s12936-016-1627-5

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Provider and user acceptability of intermittent screening and treatment for the control of malaria in pregnancy in Malawi

Abstract

Background

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2016

Concurrent malaria and arbovirus infections in Kedougou, southeastern Senegal

Feasibility, acceptability and impact of integrating malaria rapid diagnostic tests and pre-referral rectal artesunate into the integrated community case management programme. A pilot study in Mchinji district, Malawi

Prevalence of G6PD deficiency and Plasmodium falciparum parasites in asymptomatic school children living in southern Ghana

A national health facility survey of malaria infection among febrile patients in Kenya, 2014

Prevalence of crt and mdr-1 mutations in Plasmodium falciparum isolates from Grande Comore island after withdrawal of chloroquine

Susceptibility of Anopheles gambiae to insecticides used for malaria vector control in Rwanda

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page