An ethnographic study of how health system, socio-cultural and individual factors influence uptake of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine in a Ghanaian context

PLoS One. 2021 Oct 7;16(10):e0257666. doi: 10.1371/journal.pone.0257666. eCollection 2021.

Abstract

Background: Intermittent preventive treatment of malaria among pregnant women with sulfadoxine-pyrimethamine (IPTp-SP), is one of the three recommended interventions for the prevention of malaria in pregnancy (MiP) in sub-Sahara Africa. The World Health Organisation recommended in 2012 that SP be given at each scheduled ANC visit except during the first trimester and can be given a dose every month until the time of delivery, to ensure that a high proportion of women receive at least three doses of SP during pregnancy. Despite implementation of this policy, Ghana did not attain the target of 100% access to IPTp-SP by 2015. Additionally, negative outcomes of malaria infection in pregnancy are still recurring. This ethnographic study explored how health system, individual and socio-cultural factors influence IPTp-SP uptake in two Ghanaian regions.

Methods: The study design was ethnographic, employing non-participant observation, case studies and in depth interviews in 8 health facilities and 8 communities, from April 2018 to March 2019, in two Ghanaian regions. Recommended ethical procedures were observed.

Results: Health system factors such as organization of antenatal care (ANC) services and strategies employed by health workers to administer SP contributed to initial uptake. Women's trust in the health care system contributed to continued uptake. Inadequate information provided to women accessing ANC, stock-outs and fees charged for ANC services reduced access to IPTp-SP. Socio-cultural factor such as encouragement from social networks influenced utilization of ANC services and IPTp-SP uptake. Individual factors such as refusing to take SP, skipping ANC appointments and initiating ANC attendance late affected uptake.

Conclusion: Health system, socio-cultural and individual factors influence uptake of optimum doses of IPTp-SP. Consequently, interventions that aim at addressing IPTp-SP uptake should focus on regular and sufficient supply of SP to health facilities, effective implementation of free ANC, provision of appropriate and adequate information to women and community outreach programmes to encourage early and regular ANC visits.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anthropology, Cultural
  • Antimalarials / adverse effects
  • Antimalarials / therapeutic use*
  • Community Health Planning
  • Drug Combinations
  • Female
  • Ghana / epidemiology
  • Humans
  • Malaria / drug therapy
  • Malaria / epidemiology
  • Malaria / parasitology
  • Malaria / prevention & control*
  • Pregnancy
  • Pregnancy Complications, Parasitic / drug therapy
  • Pregnancy Complications, Parasitic / epidemiology
  • Pregnancy Complications, Parasitic / prevention & control*
  • Pregnancy Trimester, First
  • Pregnant Women / ethnology
  • Prenatal Care
  • Preventive Health Services
  • Pyrimethamine / adverse effects
  • Pyrimethamine / therapeutic use*
  • Sulfadoxine / adverse effects
  • Sulfadoxine / therapeutic use*
  • Young Adult

Substances

  • Antimalarials
  • Drug Combinations
  • fanasil, pyrimethamine drug combination
  • Sulfadoxine
  • Pyrimethamine

Grants and funding

This work was supported through the DELTAS Africa Initiative [MARCAD Grant Number: DEL-15-010]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [WT: 107741/A/15/Z] and the UK government. Disclaimer.