Systematic Review of Mixed Studies on Malaria in Pregnancy: Individual, Cultural and Socioeconomic Determinants of Its Treatment and Prevention
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Type
2.2. Data Source and Searches
2.3. Eligibility Criteria
2.4. Study Selection and Data Extraction
2.5. Quality Assessment and Reproducibility
2.6. Data Analysis
3. Results
3.1. Study Population
3.2. Methodological Quality and Main Topics
3.3. WHO Strategies
3.3.1. SP-IPTp: Intermittent Preventive Treatment in Pregnancy with Sulfadoxine–Pyrimethamine
3.3.2. Insecticide-Treated Mosquito Net (ITN)
3.3.3. Policy of Screening Test and Treatment
3.4. Knowledge, Perceptions and Behaviors Related to the Prevention and Treatment of MiP
3.5. Antenatal Care and other Structural (Sociocultural) Determinants of MiP
4. Discussion
4.1. Populations, Methodological Quality and Mail Topics of Systematized Studies
- The advantages of systematic reviews, such as achieve greater possibilities of the extrapolation of the results, increase the statistical power and precision, group the published evidence of this topic, and identify and relate the central categories of qualitative evidence, among others [49].
- The concentration of evidence in Africa shows that MiP research is incipient in other continents, as has been documented by a previous review [50].
- Despite the relevance of mixed methods, they are marginal in malaria research, other researchers have reported that this area has been hegemonically positivist [15], which should warn about the dimensions and determinants that are not cognizable by quantitative components, and derive recommendations that will only achieve partial control of MiP.
4.2. SP-IPTp
4.3. ITN
4.4. Policies or Actions of the Health System related to Antenatal Care
4.5. Knowledge, Perceptions and Behaviors related to the Prevention, Treatment and Consequences of MiP
4.6. Antenatal Care and other Structural Determinants of MiP
4.7. Limitations
4.8. Strengths
4.9. Contribution to Public Health Policies
5. Conclusions
Funding
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Author | Year a | Country | Population | |
---|---|---|---|---|
Quantitative Component | Qualitative Component | |||
Miaffo [28] | 2004 (2003) | Burkina Faso | 225 pregnant women attended in ANC (four near the village and four more than 5 km away) | Two FGD with pregnant women of ANC, two with husbands of ANC users, and two with pregnant women who do not use ANC. IDI to four health workers, seven traditional birth attendants, and 29 women community leaders |
Launiala [29] | 2006 (2002) | Malawi | 189 pregnant women and 48 health workers | IDI to 34 women in reproductive age, four traditional advisors, two midwives, one traditional healer and two men |
Mbonye [30] | 2007 (2003–2005) | Uganda | 1321 women who received SP-IPTp | IDI to 108 women. 60 IDI with human resources personnel, health workers and opinion leaders |
Grietens [31] | 2010 (2003–2006) | Burkina Faso | 721 pregnant women from hospitals that promote SP-IPTp. 793 without SP-IPTp and 726 promoting chloroquine | IDI to 48 health workers and 35 key informants from the community. four FGD with 12 community health promoters, nine FGD with 32 pregnant women and family members |
Smith [32] | 2011 (2009) | Ghana | 134 ANC Providers | IDI to 14 midwives and nurses |
Tutu [33] | 2011 (2006–2007) | Ghana | 306 pregnant women with SP-IPTp | IDI to 17 health workers and four FGD with pregnant women (without “n”) |
Mutagonda [34] | 2012 (2010–2011) | Tanzania | 470 pregnant women of ANC | FGD with 46 pregnant women |
Onoka [35] | 2012 (2010) | Nigeria | 1307 women who gave birth up to one year before the study, 146 women attending ANC | Four FGD each one with 8–10 women |
Borges [36] | 2013 (2007–2008) | Brazil | 250 medical records of pregnant women | IDI to 51 health workers |
Boene [37] | 2014 (2010) | Mozambique | 85 pregnant women | IDI to 85 pregnant women and 30 observations in ANC |
Mubyazi [38] | 2014 (2003–2007) | Tanzania | Number of doses of SP-IPTp delivered in 3 years | IDI to program user (without “n”) |
Mubyazi [39] | 2014 (2006) | Tanzania | 78 health workers of ANC | FGD with administrators, nurses, midwives and auxiliaries (without “n”) |
Mubyazi [40] | 2015 (2006) | Tanzania | 820 ANC clients, health workers and mothers | FGD with pregnant women and health worker (without “n”) |
Hurley [41] | 2016 (2012–2013) | Mali | Mali Sociodemographic and Health Survey 2012–2013, Maternal Health Database | IDI to 15 pregnant women, four midwives, three pharmacists, four doctors, one community leader, two community volunteers, one mayor, one NGO member and six district health officers. FGD with eight young women, three teachers, five community volunteers, five husbands, two community leaders, two pregnant women and one health group leader. 29 observations in ANC |
Taremwa [42] | 2017 (2015) | Uganda | 369 mothers of children under 5 years of age, and pregnant women | IDI to 15 key subject (local council leaders, district health inspector, religious leaders, health workers and members of village health teams) |
Rassi [43] | 2018 (2015) | Uganda | 90 health workers | Four FGD (without “n”) with health workers. Three IDI to district health officers |
Doumbia [44] | 2021 (2018) | Mali | 200 pregnant women | IDI to gynecologists (without “n”) |
Dun-Dery [45] | 2021 (2018–2019) | Ghana | 697 pregnant women. 74 nurses and midwives | Three FGD with pregnant women (without “n”) |
Kitojo [46] | 2021 (2018) | Tanzania | 143 pregnant women | Interview with 16 health workers (mostly nurses) of ANC |
Yirsaw [47] | 2021 (2020) | Ethiopia | 724 pregnant women | FGD and IDI to 37 people who work on women’s health issues |
Favero [48] | 2022 (2017) | Madagascar | 31 health providers | FGD and IDI with five community health workers, 102 caregivers and 90 pregnant women |
Author | Quantitative Result | Qualitative Result |
---|---|---|
Miaffo [28] | At least one visit to ANC 71%, at least three visits 28%. Use of chloroquine 65% and ITN 17% | Importance of MiP and chloroquine prophylaxis are recognized. Barriers to MiP prevention: distance from the health center, lack of economic resources and ignorance |
Launiala [29] | Limited knowledge without differentiating malaria from other causes of fever, only 6% thought that malaria is common in pregnancy. Main effects of MiP: abortion (28%), maternal death (12%), anemia (11%), weakness (7%), and premature delivery (6%) | There is no term for MiP, they used a local term malungo that refers to diseases that cause fever. Most of the women did not perceive malungo as a serious illness, they considered anemia, sexually transmitted diseases or cholera more important |
Mbonye [30] | The community approach increased access and compliance of SP-IPTp compared to the health-unit approach. Community approach increased pregnant women with two doses (67.5% of compared to 39.9% in health units) and threefold ITN use | Factors influencing acceptability and use of SP-IPTp: trust in community health personnel, home visits, support from spouses, education about the dangers of MiP and the benefits of SP-IPTp |
Grietens [31] | 58.5% with MiP by P. falciparum, higher risk of infection in the younger; 51% completed the recommendation of ≥3 ANC | Low-use of SP-IPTp because health education is not aimed at adolescents, pregnancies are socially hidden, internal regulations of authority limit participation of teenagers, and in the rainy season domestic work increases |
Smith [32] | 88.1% of providers were aware of all elements of the SP-IPTp policy, compared to 20.1% and 41.8% who were aware of the malaria treatment policy in the first or second/third trimester, respectively. Workshop attendance was a predictor of knowledge on MiP | There is a preference for prevention over cure, increased workload is a barrier to policies implementation. Health of pregnant women is a strong motivation for ANC providers. It is necessary improve the knowledge and practices of ANC staff |
Tutu [33] | SP-IPTp decreased malaria, anemia and maternal morbidity, with few adverse effects. ITN use 56.5%, 24% use traditional medicine for febrile symptoms | Health workers with low knowledge on SP-IPTp, pregnant women consume drugs without knowing what they are prescribed for. Vendors do not recognize adverse effects of SP-IPTp |
Mutagonda [34] | 54.3% of pregnant women were unaware of SP-IPTp; 9.1%reported having had MiP. The antimalarials used by pregnant women were quinine 42.9%, SP 23.8%, artemether-lumefantrine 21.4%, and sulfamethoxyprazinepyrimethamine 2.4%. 98.3% perceived artemether–lumefantrine as an unsafe drug during pregnancy. | The study did not develop qualitative categories, some testimonies are taken to support quantitative findings |
Onoka [35] | SP-IPTp coverage for the first and second doses was 13.7% and 7.3%, respectively. Among the women who could have received SP-IPTp only 14% were offered the first dose of those 99% took the drug | Pregnant women use drugs recommended by medical personnel because they believe they should be safe. ANC attendance and perceptions of side effects do not explain the low coverage of SP-IPTp |
Borges [36] | Only 6.8% had malaria tests. For P. falciparum only 44.8% received the recommended first-line therapy; 10.2% with treatments that are not part of the national guidelines | Knowledge on MiP is suboptimal. Health workers perceive pregnant women as cooperative patients, and MiP as an event that requires specialized medical care |
Boene [37] | 74% associated MiP with the mosquito; 65% consider pregnant women as the highest risk group; 58% do not self-perceive at risk of malaria; 75% sleep in ITN | Participants are unaware of adverse outcomes of MiP. Most describe consequences of malaria for maternal health, few name consequences for the fetus and newborn. Medications provided in ANC serve to prevent diseases, but they do not differentiate their uses for specific problems. |
Mubyazi [38] | It shows the number and coverage of 1st and 2nd doses of SP-IPTp in three years. It compares SP-IPTp coverage estimation methods | A reporting system is proposed to improve shortcomings. Lacks reporting standardization, handling of lost data, and variations in the reporting system affect the coverage estimation methods |
Mubyazi [39] | Knowledges on SP-IPTp: the guide recommends at least two doses (83%), is part of ANC (88%), is prevention and not treatment (55%). Barriers: fear of being seen in pregnancy (54%), long distance to the clinic (78%), carelessness and negligence of pregnant women (69%), ignorance of health risks (28%), cost (user fees, ITN voucher redemption, and transportation) (31%), domestic or community occupations (45%) | Health workers did not consider appropriate that private ANC clinics provide SP-IPTp free, because they recover costs elsewhere. Pregnant women often register late at clinics, and some do not keep appointments regularly, miss out on SP-IPTp and others ANC services. Rumors about the health risks and failures of SP, coupled with client disappointment with waiting times, limit acceptance of the SP-IPTp |
Mubyazi [40] | Seeking of ANC was influenced by motivation for safe pregnancy and childbirth, and not necessarily by SP-IPTp. The main barriers for ANC are sociocultural values that stigmatize and discriminate to the pregnant women, hostile attitudes of health service providers, shortage of medicines, fees in health facilities, and pregnant women’s unawareness about ANC services. | The study does not develop qualitative categories, some testimonies are taken to support quantitative findings |
Hurley [41] | SP-IPTp coverage is misleading due to their reliance on a variable (“IPTp source”) that is missing 62% of the data. In the survey of pregnant women, 56.2% take at least one dose of SP-IPTp; 5.2% chloroquine, and 1.9% another medication to prevent MiP. Most of the women who did not receive SP-IPTp were women who did not attend ANC | Many health centers do not administer SP-IPTp by directly observed therapy, neither at monthly intervals, nor free of charge. Women generally reported that SP-IPTp was available and tolerable, but were often unable to identify its name or purpose, which could affect the accuracy of responses in household surveys |
Taremwa [42] | 98.1% considered ITNs as a key strategy for malaria prevention. ITN possession was 84.0%, of which 66.1% used them systematically; 39% did not have a positive attitude towards ITNs. | The qualitative categories were: knowledge about malaria (caused by mosquito bites), attitude towards the use of ITN (agreeing that use ITN use helps to prevent malaria), not making effective use of ITN despite know its benefits |
Rassi [43] | Intervention improve knowledge of SP-IPTp and coverage of three doses of SP-IPTp | Intervention is a feasible, acceptable and cost-effective. The text messages served as reminders for those who had attended the classroom training and helped spread information to those who did not |
Doumbia [44] | After a visit to the gynecologist increased the level of knowledge and preventive actions; 83% of participants were unaware of malaria before use of the checklist vs. 15% after. Supervised SP-IPTp coverage increased from 0 to 59% after the introduction of the checklist | The intervention was effective and easy to adopt. Gynecologists recommend the use of this checklist during routine practice and generalize it to others health providers |
Dun-Dery [45] | 26.4% took the third dose of SP-IPTp. SP-IPTp uptake was associated with the number of maternal contacts in ANC and the gestational age | The main challenges to uptake of SP-IPTp were missed ANC contacts, knowledge gaps among pregnant women about the importance of SP-IPTp, drug stock-outs, provider neglect/absenteeism, adverse drug reactions, and change of residence |
Kitojo [46] | 97% had a favorable perception of the screening; 95% satisfied with the service; 99% would recommend continuing with the ministry’s strategy; 76% experienced pain and 16% anxiety in taking a blood sample for diagnosis | Service providers consider the screening and treatment policy favorable; the main challenge is that nurses cannot prescribe antimalarials. Health workers had a good understanding of the policy. The policy is not a burden because the malaria test is integrated into the routine laboratory tests of ANC |
Yirsaw [47] | The prevalence of ITN use was 56.5%, associated with an iron roof in the house, rural residence, ≥ 2 rooms in the house and a high perception of barriers; 27.9% with low knowledge about MiP and ITN; 51.5% with low perception of susceptibility to malaria; 96.1% consider that ITN prevents malaria and 39.5% did not sleep under ITN | The most common individual-level barriers were related to misconceptions about ITN (increase heat and create bed bugs). Barriers at the institutional level: insufficient access, lack of timely immersion of ITNs in insecticides, lack of proportional allocation to family size, and lack of priority of vulnerable groups. Socio-cultural barriers: using ITNs for purposes other than malaria prevention, lack of adequate places to sleep, and erroneous cultural beliefs |
Favero [48] | It presents costs associated with malaria case management, by type of healthcare provider | Care-seeking for fever is delayed until the ill person does not respond to home treatment or symptoms become severe. Care-seeking determinants for MiP included cost, travel time, distance, and perceived quality of care at clinics. Providers felt that the lack of basic products and workloads hampered their ability to provide MiP care services. Health community staff were not generally consulted for malaria care |
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Cardona-Arias, J.A. Systematic Review of Mixed Studies on Malaria in Pregnancy: Individual, Cultural and Socioeconomic Determinants of Its Treatment and Prevention. Trop. Med. Infect. Dis. 2022, 7, 423. https://doi.org/10.3390/tropicalmed7120423
Cardona-Arias JA. Systematic Review of Mixed Studies on Malaria in Pregnancy: Individual, Cultural and Socioeconomic Determinants of Its Treatment and Prevention. Tropical Medicine and Infectious Disease. 2022; 7(12):423. https://doi.org/10.3390/tropicalmed7120423
Chicago/Turabian StyleCardona-Arias, Jaiberth Antonio. 2022. "Systematic Review of Mixed Studies on Malaria in Pregnancy: Individual, Cultural and Socioeconomic Determinants of Its Treatment and Prevention" Tropical Medicine and Infectious Disease 7, no. 12: 423. https://doi.org/10.3390/tropicalmed7120423