Intermittent screening and treatment versus intermittent preventive treatment of malaria in pregnancy: user acceptability
Identifieur interne : 000925 ( Main/Exploration ); précédent : 000924; suivant : 000926Intermittent screening and treatment versus intermittent preventive treatment of malaria in pregnancy: user acceptability
Auteurs : Lucy A. Smith [Royaume-Uni] ; Caroline Jones [Royaume-Uni] ; Rose O. Adjei [Ghana] ; Gifty D. Antwi [Ghana] ; Nana A. Afrah [Ghana] ; Brian Greenwood [Royaume-Uni] ; Daniel Chandramohan [Royaume-Uni] ; Harry Tagbor [Royaume-Uni, Ghana] ; Jayne Webster [Royaume-Uni]Source :
- Malaria Journal [ 1475-2875 ] ; 2010.
Abstract
Malaria in pregnancy is associated with increased risks of maternal and foetal complications. Currently, intermittent preventive treatment (IPT) of malaria during pregnancy with sulphadoxine-pyrimethamine (SP) is recommended by the WHO as part of a package of interventions also including insecticide-treated nets and effective case management. However, with increasing resistance to SP, the effectiveness of SP-IPT has been questioned. A randomized controlled trial (RCT) to investigate the relative efficacy of an alternative strategy of intermittent screening and treatment (IST), which involves a rapid diagnostic test for malaria at scheduled ANC visits and treatment of women only if positive, versus SP-IPT has been conducted in Ashanti region, Ghana. This paper reports on a complementary study investigating the acceptability of the different strategies to women enrolled in the trial.
Data were collected through twelve focus group discussions with women selected at random from the different arms of the RCT, exploring their experiences and perceptions about antenatal care and their involvement in the trial. Content analysis was used to identify relevant themes to structure the results.
Five main themes emerged from participants' experiences of ANC and the RCT that would influence their acceptability of malaria prevention strategies during pregnancy: health benefits; drugs received; tests received; other services received; and health worker attitude. Their own health and that of their baby were strong motivations for attending ANC, and reported favourably as an outcome of being in the RCT. Women were not always clear on the biomedical function of drugs or blood tests but generally accepted them due to strong trust in the health staff. Home visits by staff and free ITNs as part of the trial were appreciated. Politeness and patience of health staff was a very strong positive factor.
Overall, both intermittent screening and treatment and intermittent preventive treatment appeared equally acceptable to pregnant women as strategies for the control of malaria in pregnancy. The women were more concerned about quality of services received, in particular the polite and patient attitude of health staff, and positive health implications for themselves and their babies than about the nature of the intervention.
Url:
DOI: 10.1186/1475-2875-9-18
PubMed: 20074372
PubMed Central: 2817700
Affiliations:
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WC1E 7HT</wicri:noRegion></affiliation></author><author><name sortKey="Tagbor, Harry" sort="Tagbor, Harry" uniqKey="Tagbor H" first="Harry" last="Tagbor">Harry Tagbor</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London. WC1E 7HT, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London. WC1E 7HT</wicri:regionArea><wicri:noRegion>London. WC1E 7HT</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Private Mail Bag, University Post Office, Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Private Mail Bag, University Post Office, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Webster, Jayne" sort="Webster, Jayne" uniqKey="Webster J" first="Jayne" last="Webster">Jayne Webster</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London. WC1E 7HT, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London. WC1E 7HT</wicri:regionArea><wicri:noRegion>London. 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Smith</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London. WC1E 7HT, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London. WC1E 7HT</wicri:regionArea><wicri:noRegion>London. WC1E 7HT</wicri:noRegion></affiliation></author><author><name sortKey="Jones, Caroline" sort="Jones, Caroline" uniqKey="Jones C" first="Caroline" last="Jones">Caroline Jones</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London. WC1E 7HT, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London. WC1E 7HT</wicri:regionArea><wicri:noRegion>London. WC1E 7HT</wicri:noRegion></affiliation></author><author><name sortKey="Adjei, Rose O" sort="Adjei, Rose O" uniqKey="Adjei R" first="Rose O" last="Adjei">Rose O. Adjei</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Private Mail Bag, University Post Office, Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Private Mail Bag, University Post Office, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Antwi, Gifty D" sort="Antwi, Gifty D" uniqKey="Antwi G" first="Gifty D" last="Antwi">Gifty D. Antwi</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Private Mail Bag, University Post Office, Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Private Mail Bag, University Post Office, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Afrah, Nana A" sort="Afrah, Nana A" uniqKey="Afrah N" first="Nana A" last="Afrah">Nana A. Afrah</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Private Mail Bag, University Post Office, Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Private Mail Bag, University Post Office, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Greenwood, Brian" sort="Greenwood, Brian" uniqKey="Greenwood B" first="Brian" last="Greenwood">Brian Greenwood</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London. WC1E 7HT, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London. WC1E 7HT</wicri:regionArea><wicri:noRegion>London. WC1E 7HT</wicri:noRegion></affiliation></author><author><name sortKey="Chandramohan, Daniel" sort="Chandramohan, Daniel" uniqKey="Chandramohan D" first="Daniel" last="Chandramohan">Daniel Chandramohan</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London. WC1E 7HT, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London. WC1E 7HT</wicri:regionArea><wicri:noRegion>London. WC1E 7HT</wicri:noRegion></affiliation></author><author><name sortKey="Tagbor, Harry" sort="Tagbor, Harry" uniqKey="Tagbor H" first="Harry" last="Tagbor">Harry Tagbor</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London. WC1E 7HT, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London. WC1E 7HT</wicri:regionArea><wicri:noRegion>London. WC1E 7HT</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Private Mail Bag, University Post Office, Kumasi, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Private Mail Bag, University Post Office, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Webster, Jayne" sort="Webster, Jayne" uniqKey="Webster J" first="Jayne" last="Webster">Jayne Webster</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London. WC1E 7HT, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London. WC1E 7HT</wicri:regionArea><wicri:noRegion>London. WC1E 7HT</wicri:noRegion></affiliation></author></analytic><series><title level="j">Malaria Journal</title><idno type="eISSN">1475-2875</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Malaria in pregnancy is associated with increased risks of maternal and foetal complications. Currently, intermittent preventive treatment (IPT) of malaria during pregnancy with sulphadoxine-pyrimethamine (SP) is recommended by the WHO as part of a package of interventions also including insecticide-treated nets and effective case management. However, with increasing resistance to SP, the effectiveness of SP-IPT has been questioned. A randomized controlled trial (RCT) to investigate the relative efficacy of an alternative strategy of intermittent screening and treatment (IST), which involves a rapid diagnostic test for malaria at scheduled ANC visits and treatment of women only if positive, versus SP-IPT has been conducted in Ashanti region, Ghana. This paper reports on a complementary study investigating the acceptability of the different strategies to women enrolled in the trial.</p></sec><sec><title>Methods</title><p>Data were collected through twelve focus group discussions with women selected at random from the different arms of the RCT, exploring their experiences and perceptions about antenatal care and their involvement in the trial. Content analysis was used to identify relevant themes to structure the results.</p></sec><sec><title>Results</title><p>Five main themes emerged from participants' experiences of ANC and the RCT that would influence their acceptability of malaria prevention strategies during pregnancy: health benefits; drugs received; tests received; other services received; and health worker attitude. Their own health and that of their baby were strong motivations for attending ANC, and reported favourably as an outcome of being in the RCT. Women were not always clear on the biomedical function of drugs or blood tests but generally accepted them due to strong trust in the health staff. Home visits by staff and free ITNs as part of the trial were appreciated. Politeness and patience of health staff was a very strong positive factor.</p></sec><sec><title>Conclusions</title><p>Overall, both intermittent screening and treatment and intermittent preventive treatment appeared equally acceptable to pregnant women as strategies for the control of malaria in pregnancy. The women were more concerned about quality of services received, in particular the polite and patient attitude of health staff, and positive health implications for themselves and their babies than about the nature of the intervention.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Brabin, Bj" uniqKey="Brabin B">BJ Brabin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Menendez, C" uniqKey="Menendez C">C Menendez</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Goodman, Ca" uniqKey="Goodman C">CA Goodman</name></author><author><name sortKey="Coleman, Pg" uniqKey="Coleman P">PG Coleman</name></author><author><name sortKey="Mills, Aj" uniqKey="Mills A">AJ Mills</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Newman, Rd" uniqKey="Newman R">RD Newman</name></author><author><name sortKey="Parise, 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Ali</name></author><author><name sortKey="Rotllant, G" uniqKey="Rotllant G">G Rotllant</name></author><author><name sortKey="Abass, Ak" uniqKey="Abass A">AK Abass</name></author><author><name sortKey="Omari, Rs" uniqKey="Omari R">RS Omari</name></author><author><name sortKey="Al Mafazy, Aw" uniqKey="Al Mafazy A">AW Al-mafazy</name></author><author><name sortKey="Bjorkman, A" uniqKey="Bjorkman A">A Bjorkman</name></author><author><name sortKey="Kallander, K" uniqKey="Kallander K">K Kallander</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Oyakhirome, S" uniqKey="Oyakhirome S">S Oyakhirome</name></author><author><name sortKey="Potschke, M" uniqKey="Potschke M">M Potschke</name></author><author><name sortKey="Schwarz, Ng" uniqKey="Schwarz N">NG Schwarz</name></author><author><name sortKey="Dornemann, J" uniqKey="Dornemann J">J Dornemann</name></author><author><name sortKey="Laengin, M" uniqKey="Laengin M">M Laengin</name></author><author><name sortKey="Salazar, Co" uniqKey="Salazar C">CO Salazar</name></author><author><name sortKey="Lell, B" uniqKey="Lell B">B Lell</name></author><author><name sortKey="Kun, Jf" uniqKey="Kun J">JF Kun</name></author><author><name sortKey="Kremsner, Pg" uniqKey="Kremsner P">PG Kremsner</name></author><author><name sortKey="Grobusch, Mp" uniqKey="Grobusch M">MP Grobusch</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Ghana</li><li>Royaume-Uni</li></country></list><tree><country name="Royaume-Uni"><noRegion><name sortKey="Smith, Lucy A" sort="Smith, Lucy A" uniqKey="Smith L" first="Lucy A" last="Smith">Lucy A. Smith</name></noRegion><name sortKey="Chandramohan, Daniel" sort="Chandramohan, Daniel" uniqKey="Chandramohan D" first="Daniel" last="Chandramohan">Daniel Chandramohan</name><name sortKey="Greenwood, Brian" sort="Greenwood, Brian" uniqKey="Greenwood B" first="Brian" last="Greenwood">Brian Greenwood</name><name sortKey="Jones, Caroline" sort="Jones, Caroline" uniqKey="Jones C" first="Caroline" last="Jones">Caroline Jones</name><name sortKey="Tagbor, Harry" sort="Tagbor, Harry" uniqKey="Tagbor H" first="Harry" last="Tagbor">Harry Tagbor</name><name sortKey="Webster, Jayne" sort="Webster, Jayne" uniqKey="Webster J" first="Jayne" last="Webster">Jayne Webster</name></country><country name="Ghana"><noRegion><name sortKey="Adjei, Rose O" sort="Adjei, Rose O" uniqKey="Adjei R" first="Rose O" last="Adjei">Rose O. Adjei</name></noRegion><name sortKey="Afrah, Nana A" sort="Afrah, Nana A" uniqKey="Afrah N" first="Nana A" last="Afrah">Nana A. Afrah</name><name sortKey="Antwi, Gifty D" sort="Antwi, Gifty D" uniqKey="Antwi G" first="Gifty D" last="Antwi">Gifty D. Antwi</name><name sortKey="Tagbor, Harry" sort="Tagbor, Harry" uniqKey="Tagbor H" first="Harry" last="Tagbor">Harry Tagbor</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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