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Malaria Journal
Published in: Malaria Journal 1/2020

Open Access 01-12-2020 | Malaria | Research

Managing intermittent preventive treatment of malaria in pregnancy challenges: an ethnographic study of two Ghanaian administrative regions

Authors: Matilda Aberese-Ako, Pascal Magnussen, Margaret Gyapong, Gifty D. Ampofo, Harry Tagbor

Published in: Malaria Journal | Issue 1/2020

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Abstract

Background

Malaria in pregnancy (MiP) is an important public health problem across sub-Saharan Africa. The package of measures for its control in Ghana in the last 20 years include regular use of long-lasting insecticide-treated bed nets (LLINs), directly-observed administration (DOT) of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) and prompt and effective case management of MiP. Unfortunately, Ghana like other sub-Saharan African countries did not achieve the reset Abuja targets of 100% of pregnant women having access to IPTp and 100% using LLINs by 2015.

Methods

This ethnographic study explored how healthcare managers dealt with existing MiP policy implementation challenges and the consequences on IPTp-SP uptake and access to maternal healthcare. The study collected date using non-participant observations, conversations, in-depth interviews and case studies in eight health facilities and 12 communities for 12 months in two Administrative regions in Ghana.

Results

Healthcare managers addressed frequent stock-outs of malaria programme drugs and supplies from the National Malaria Control Programme and delayed reimbursement from the NHIS, by instituting co-payment, rationing and prescribing drugs for women to buy from private pharmacies. This ensured that facilities had funds to pay creditors, purchase drugs and supplies for health service delivery. However, it affected their ability to enforce DOT and to monitor adherence to treatment. Women who could afford maternal healthcare and MiP services and those who had previously benefitted from such services were happy to access uninterrupted services. Women who could not maternal healthcare services resorted to visiting other sources of health care, delaying ANC and skipping scheduled ANC visits. Consequently, some clients did not receive the recommended 5 + doses of SP, others did not obtain LLINs early and some did not obtain treatment for MiP. Healthcare providers felt frustrated whenever they could not provide comprehensive care to women who could not afford comprehensive maternal and MiP care.

Conclusion

For Ghana to achieve her goal of controlling MiP, the Ministry of Health and other supporting institutions need to ensure prompt reimbursement of funds, regular supply of programme drugs and medical supplies to public, faith-based and private health facilities.
Appendix
Available only for authorised users
Footnotes
1
In the year 2000, African leaders met in Abuja under the Roll Back malaria Partnership and set targets of 60% of pregnant women having access to anti-malarial chemoprophylaxis or intermittent preventive treatment (IPTp) and 80% of women using insecticide-treated nets by 2005. More ambitious targets were reset to 100% of women utilizing both interventions by 2015 [13].
 
2
Conversation is defined as: ‘An informal conversational interview. An unplanned and unanticipated interaction between an interviewer and a respondent that occurs naturally during the course of fieldwork observation. It is the most open-ended form of interviewing [103].
 
3
MA initially trained the RAs on immersing themselves in health facilities and study communities, conducting transect walks and non-participant observation and taking field notes, Other activities were conducting in depth interviews and conversations. The research assistants participated in two other training sessions during the data collection phase.
 
4
An urban and a rural district were selected in each region in order to reflect diverse cultural experiences. The initial plan was to select a rural and an urban district in each region, however upon our visit to the Ashanti region, we realized that one of the districts had recently been divided into two, so we went ahead to work in the two districts.
 
5
While written consent is recommended for study participants, verbal consent can be used in situations where time is of the essence [104]. In this study women who were attending ANC were invited to participate in conversations and in depth interviews. Those who had ample time for an interview were given time to reflect and to consent. They were followed to their homes at a later date for interviews. However, RAs conversed with women who were willing to participate in the study, but did not have enough time to participant in IDIs. Such study participants granted oral consent to participate in the study.
 
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Metadata
Title
Managing intermittent preventive treatment of malaria in pregnancy challenges: an ethnographic study of two Ghanaian administrative regions
Authors
Matilda Aberese-Ako
Pascal Magnussen
Margaret Gyapong
Gifty D. Ampofo
Harry Tagbor
Publication date
01-12-2020
Publisher
BioMed Central
Keywords
Malaria
Care
Published in
Malaria Journal / Issue 1/2020
Electronic ISSN: 1475-2875
DOI
https://doi.org/10.1186/s12936-020-03422-2

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