Social and cultural factors affecting uptake of interventions for malaria in pregnancy in Africa
2011
Malaria during pregnancy is a major global health problem. This article presents the findings of a literature review of qualitative research on social and cultural factors associated with the use of malaria during pregnancy prevention in sub-Saharan Africa.
Malaria during pregnancy (MiP) is a major global health problem, particularly in sub-Saharan Africa. It can negatively affect maternal health and lead to poor birth outcomes. Interventions for MiP prevention recommended to be used in sub-Saharan Africa include intermittent preventive treatment (IPTp), insecticide-treated nets (ITN) and appropriate case management. These interventions have shown to have clinical efficacy (be effective under ideal conditions), however their effectiveness will be dependent on the attitudes and behaviours of pregnant women and their community that are influenced by social and cultural factors.This article, published in the journal PLoS ONE, presents the findings of a literature review of qualitative research on social and cultural factors associated with the use of MiP prevention in sub-Saharan Africa. Using what is known as a meta-ethnographic approach, whereby findings of qualitative research are synthesised and mapped together to see how they relate. A total of thirty-seven studies were identified. Fourteen of these studies focused on MiP, and the others focused on malaria treatment and prevention, use of antenatal care (ANC) services, anaemia during pregnancy or reproductive loss.Key findings from the review that link to MamaYe! focused countries include:Concepts of malaria:
- Several studies found that local categories of disease did not correspond to biomedical definitions of malaria and MiP. E.g. in Malawi the term used to describe malaria – malungo – was linked to a common and relatively harmless illness.
- Respondents from several countries saw pregnant women as vulnerable to malaria infection, but less so than children (e.g. Kenya, Ethiopia, Nigeria, Senegal, Uganda, and Zambia).
- There were differences in views of the seriousness of MiP. E.g. in southern Malawi and coastal Tanzania, MiP was not viewed seriously. Yet, in contrast, in north-eastern Tanzania, south-central Ethiopia, The Gambia and a different study in southern Malawi, it was viewed seriously.
- Even where MiP was viewed as serious, attitudes towards malaria prevention influenced uptake of interventions. E.g. in southern Ghana, malaria prevention was not viewed to be possible, which influenced uptake of preventive measures.
- Factors linked to low ITN usage included complaints about bednets being uncomfortable or not a suitable size, viewing ITN “chemicals” as harmful, affordability and availability.
- Many factors were identified as influencing the uptake of ANC e.g. obtaining an ITN was found to motivate some women in Tanzania and Ghana to access ANC. In contrast, a study in Malawi found that women who were rebuked by healthcare providers were discouraged from using ANC services.
- Fifteen studies in total identified structural factors affecting the delivery and uptake of MiP interventions, especially of those delivered through ANC services. E.g. in Tanzania, policy makers identified a number of factors that influenced the delivery and uptake of IPTp, such as late ANC attendance, lack of compliance with the IPTp guidelines by healthcare providers and lack of Sulfadoxine pyrimethine.
Pell, C., Straus, L., Andrew, E., Meñaca, A., & Pool, R. (2011). Social and cultural factors affecting uptake of interventions for malaria in pregnancy in Africa: a systematic review of the qualitative research. PloS ONE, 6(7), e22452.
