Psychosocial, behavioural and health system barriers to delivery and uptake of intermittent preventive treatment of malaria in pregnancy in Tanzania – viewpoints of service providers in Mkuranga and Mufindi districtsReport as inadecuate




Psychosocial, behavioural and health system barriers to delivery and uptake of intermittent preventive treatment of malaria in pregnancy in Tanzania – viewpoints of service providers in Mkuranga and Mufindi districts - Download this document for free, or read online. Document in PDF available to download.

BMC Health Services Research

, 14:15

Health systems and services in low and middle income settings

Abstract

BackgroundIntermittent preventive treatment of malaria in pregnancy IPTp using sulphurdoxine-pyrimethamine SP is one of key malaria control strategies in Africa. Yet, IPTp coverage rates across Africa are still low due to several demand and supply constraints. Many countries implement the IPTp-SP strategy at antenatal care ANC clinics. This paper reports from a study on the knowledge and experience of health workers HWs at ANC clinics regarding psychosocial, behavioural and health system barriers to IPTp-SP delivery and uptake in Tanzania.

MethodsData were collected through questionnaire-based interviews with 78 HWs at 28 ANC clinics supplemented with informal discussions with current and recent ANC users in Mkuranga and Mufindi districts. Qualitative data were analysed using a qualitative content analysis approach. Quantitative data derived from interviews with HWs were analysed using non-parametric statistical analysis.

ResultsThe majority of interviewed HWs were aware of the IPTp-SP strategy’s existence and of the recommended one month spacing of administration of SP doses. Some HWs were unsure of that it is not recommended to administer IPTp-SP and ferrous-folic acid concurrently. Others were administering three doses of SP per client following instruction from a non-governmental agency while believing that this was in conflict with national guidelines. About half of HWs did not find it appropriate for the government to recommend private ANC providers to provide IPTp-SP free of charge since doing so forces private providers to recover the costs elsewhere. HWs noted that pregnant women often register at clinics late and some do not comply with the regularity of appointments for revisits, hence miss IPTp and other ANC services. HWs also noted some amplified rumours among clients regarding health risks and treatment failures of SP used during pregnancy, and together with clients’ disappointment with waiting times and the sharing of cups at ANC clinics for SP, limit the uptake of IPTp-doses.

ConclusionHWs still question SP’s treatment advantages and are confused about policy ambiguity on the recommended number of IPTp-SP doses and other IPTp-SP related guidelines. IPTp-SP uptake is further constrained by pregnant women’s perceived health risks of taking SP and of poor service quality.

AbbreviationsANCAntenatal care

fANCFocused antenatal care

IPTpIntermittent preventive treatment during pregnancy

HFsHealth facilities

HWsHealth care workers

MoHMinistry of health

MoHSWMinistry of health and social welfare

PMIUS Presidential malaria initiative

SPSulphadoxine-pyrimethamine

UNICEFUnited Nations Children’s Fund

URTUnited Republic of Tanzania

WHOWorld Health Organization.

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Author: Godfrey M Mubyazi - Paul Bloch

Source: https://link.springer.com/



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