Anthropological studies on malaria in pregnancy

Project Coordinator:         Prof Robert Pool (IS Global, Spain)

Principal Investigators:   Dr Arantza Meñaca, Dr Christopher Pell, Erin V. W. Andrew (IS Global, Spain)

Site PIs:

Dr Harry Tagbor Nana A. Boateng (KNUST, Kumasi, Ghana), Dr Abraham Hodgson, Samuel Chatio (NHRC, Navrongo Ghana), Dr Peter Ouma, Florence Achieng (KEMRI-CDC, Kisumu, Kenya), Suparat Phuanukoonnon, Alma Auwun, Angeline Angwin (IMR, PNG)

---

Objective

Anthropological studies were carried out to ensure that interventions, as well being efficacious, safe and affordable, are also socially and culturally acceptable, are widely adhered to in the longer-term, and do not negatively affect attitudes and adherence to existing public health measures.

Study design

The anthropological studies were conducted in each of the treatment and prevention trial sites. The study design was flexible, with ethnographic fieldwork based on participant observation as well as more formal data collection activities including free-listing and pile sorting, in-depth interviews, focus group discussions and case studies. Field data collection was preceded by a systematic review of all relevant literature.

Results and Conclusions

Local malaria concepts

Local malaria-related concepts and explanations overlapped with biomedical concepts and explanations which varied and impacted on prevention and treatment seeking activities among respondents. The symptoms of malaria and pregnancy often overlapped and were differentiated by severity. Malaria was generally viewed as serious for pregnant women with miscarriage being the most widely understood outcome of illness. Links to anaemia and low birth weight were also understood but not as widely.

MiP Interventions

LLINs were seen as important to malaria prevention, but their availability and use differed across sites, in some areas they were sought and in others saved until the birth of the child or used seasonally.

IPTp

In some areas IPTp was not linked with malaria while it was in others, although not always with malaria prevention. Adherence was common, regardless of delivery, although some women did not comply citing previous side effects.

Treatment

While generally participants followed the advice of healthcare staff, personal experience and the availability and accessibility of medication influenced treatment. Testing was perceived as positive.

Antenatal care

General ideas about pregnancy care motivated women to attend ANC, however women’s timing of ANC initiation was influenced by a number of factors such as pregnancy uncertainties, response to those uncertainties, perceived cost as well as ideas about the compulsory nature of follow ups.

Overall the project found that locally held perceptions to malaria and MiP, along with their associated behaviours are complex and diverse. While variation exist between countries and regions there are striking similarities.