Synthesis of Qualitative Evidence on Malaria in Pregnancy, 2005–2022: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Type
2.2. PICo (Population or Problem, Interest and Context) Question
2.3. Search Protocol and Study Selection
2.3.1. Data Source and Searches
2.3.2. Eligibility Criteria
2.4. Data Extraction, Quality Assessment and Reproducibility
2.5. Data Analysis
3. Results
3.1. Description of Included Studies and Methodological Quality
3.2. Antenatal Care
3.2.1. Positive Perceptions
3.2.2. Experiences That Prevent the Use of ANC
3.3. Malaria in Pregnancy
3.3.1. Knowledge Attitudes (Perceptions) and Practices
3.3.2. Determinants of Prevention and Management
3.4. Insecticide Treated Net
3.5. Intermittent Preventive Treatment in Pregnancy with Sulfadoxine-Pyrimethamine
3.5.1. Knowledge Attitudes and Practices
3.5.2. Determinants of Acceptability
3.6. Detection and Treatment of Cases
3.7. Utility of Investigations in MiP
4. Discussion
4.1. Main Findings
4.2. Saturated Qualitative Evidence
4.3. New Qualitative Evidence of This Meta-Synthesis
4.4. Limitations and Strengths
5. Conclusions
Funding
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Author—Country | Year * | Main Topic | Population | SRQR Score |
---|---|---|---|---|
Mubyazi—TZA [32] | 2005 (2004) | Knowledge attitudes and practices (KAP) on malaria, emphasis on IPTp | Health managers, health services personnel in clinics, antenatal (ANC) service providers, pregnant women | 67 a1 |
Mbonye—UGA [33] | 2006 (2002–2003) | Perceptions and barriers in the use of ITN | Adolescent (10–19 years), young (20–29 years) and adult (30–49 years) women, opinion leaders, local officials, teachers, pharmacy owners, midwives and pregnant women | 50 ab |
Mbonye—UGA [34] | 2006 (2002–2003) | Perceptions about SP-IPTp | Adolescent (10–19 years), young (20–29 years) and adult (30–49 years) women, opinion leaders, local officials, elderly midwives, retired teachers, pharmacy owners, midwives and pregnant women | 50 ab2 |
Mbonye—UGA [35] | 2006 (2002–2003) | Perceptions about MIP. Signs of pregnancy and malaria that lead to the search for treatment | Opinion leaders (local council officials, elderly midwives, retired teachers, pharmacy owners), midwives, and pregnant and non-pregnant women and men | 42 ab2 |
Ahorlu—GHA [36] | 2007 (2002–2004) | Importance of culture and behavior in malaria transmission, prevention and control | Men and women | 67 a3 |
Launiala—MWI [37] | 2007 (2002) | Factors affecting compliance with the SP-IPTp Scheme | Pregnant women | 92 ac3 |
Mubyazi—TZA [38] | 2008 (2006–2007) | Perspectives, achievements, challenges and opportunities to implement SP-IPTp | Officials at the national level | 75 b1 |
Brabin—GMB [39] | 2009 (2007) | SP-IPTp awareness | Young and older married women, adolescents, midwives and men | 67 a |
Chukwuocha—NGA [40] | 2010 (No data) | Perceptions about ITN to prevent MiP | Adolescents, young women and men, opinion leaders, local government officials, elderly midwives, retired leaders, pharmacy owners, midwives, pregnant and non-pregnant women. | 25 ab |
Mubyazi—TZA [41] | 2010 (2005–2006) | Perceptions and attitudes about barriers and costs of SP-IPTp and other ANC services | Pregnant women and mothers of young children | 67 abc1 |
Smith—GHA [42] | 2010 (2009) | Acceptability, experiences and perceptions of ANC and clinical trial participation | Women enrolled in a clinical trial | 50 ab2 |
Onoka—NGA [43] | 2012 (2010) | Provider Factors Affecting SP-IPTp Delivery | Public and private ANC | 42 b |
Diala—NGA [44] | 2013 (2012) | Perceptions about SP-IPTp and barriers to adherence | Pregnant women who attend ANC and others who do not attend, with their husbands | 58 a1 |
Menaca—GHA/KEN/MWI [45] | 2013 (2009–2011) | Local understanding of MiP | Pregnant women, relatives, opinion leaders, health providers and community members | 75 ac |
Pell—GHA/KEN/MWI [46] | 2013 (2009–2011) | Sociocultural factors related to the prevention and management of MiP | Pregnant women, relatives, opinion leaders, health providers, community members | 75 ac |
Webster—MLI [47] | 2013 (No data) | Factors that explain ineffectiveness of SP-IPTp and ITN | HWs at the national, regional, district and health facility levels | 58 b |
Dræbela—SDN [48] | 2014 (2008) | Perceptions and practices of prevention and treatment of MiP | Pregnant women | 33 b |
Pell—GHA [49] | 2014 (2010) | Acceptability of screening and intermittent treatment artemether-lumefantrine compared to SP-IPTp | Pregnant women and staff of the clinical trial | 50 ac2 |
Andrew—PNG [50] | 2015 (2010–2011) | KAP on MiP and its prevention | Pregnant women, HWs, community members, relatives (husbands, parents, siblings) | 83 ac |
Hill—KEN/MLI [51] | 2015 (2009–2010) | Operational, socioeconomic and cultural barriers to access and use IPTp, ITN and case management | Men, adolescents, not pregnant and pregnant | 58 ab |
Onyeneho—NGA [52] | 2015 (No data) | Perceptions and attitudes about MiP prevention | Mothers and husbands of women who gave birth within 6 months, HWs and women who gave birth within 6 months | 75 a1 |
Yoder—MWI [53] | 2015 (2013) | Experiences in the provision of ANC and SP-IPTp services | ANC suppliers | 67 |
Hill—KEN [54] | 2016 (2013–2014) | Acceptability of intermittent screening and treatment with dihydroartemisinin-piperaquine | Pregnant women and HWs | 83 a2 |
Jaiteh—GMB [55] | 2016 (2014) | Perceptions of MiP and its influence on adherence to treatment | Community nurses, husbands, mothers-in-law, women of reproductive age, community HWs, midwives | 83 ac23 |
Klein—MLI [56] | 2016 (2013–2014) | Perceptions, barriers and experiences of the cost of SP-IPTp | Pregnant women, HWs and people from the community | 75 ac |
Rassi—UGA [57] | 2016 (2013–2014) | Barriers in the demand for SP-IPTp (access, affordability and acceptability) | District health officials, HWs, pregnant women and opinion leaders | 83 b1 |
Rassi—UGA [58] | 2016 (2013–2014) | Barriers in the supply of SP-IPTp | District health officials, HWs | 83 b |
Manu—GHA [59] | 2017 (2010) | Factors associated with ITN use | Pregnant women | 67 abc1 |
Quist—GHA [60] | 2017 (2015) | KAP on the use of ITN | Pregnant women | 58 b |
Hill—IDN [61] | 2018 (2015) | Acceptability and perceptions of the feasibility of a single screening and treatment strategy | ANC providers (midwives, physicians, laboratory personnel, pharmacists and pharmacy managers), heads of health establishments and staff of the District Health Office. | 50 b2 |
Hoyt—IDN [62] | 2018 (2015–2016) | Acceptability of “one-off screen and treat” strategy compared to SP-IPTp, and intermittent screen-and-treat | ANC providers (midwives, physicians, laboratory personnel, pharmacists, pharmacy manager), heads of health establishments and staff of the District Health Office, and pregnant women | 58 ab2 |
Martínez—LBR [63] | 2018 (2016–2017) | Barriers to participate in research on MiP | Hospital staff, representatives of traditional communities and pregnant women | 92 a4 |
Sabin—IND [64] | 2018 (2007–2008) | KAP on prevention and treatment of MiP | Pregnant women and HWs | 75 |
Tarr—LBR [65] | 2018 (2016–2017) | Knowledge about etiology, prevention and therapeutics of MiP. Perceptions of the usefulness of MiP research | Pregnant women, community leaders and hospital staff | 75 a4 |
Aberese—GHA [66] | 2019 (2018–2019) | Health system, sociocultural, economic, environmental, and individual factors influencing ITN ownership and use | HWs, pregnant women and community members | 83 bc3 |
Arnaldo—MOZ [67] | 2019 (2015) | Factors that limit the access and use of IPTp-SP in a rural area | Pregnant women and nurses | 67 b |
Aberese—GHA [68] | 2020 (2018–2019) | Challenges for the implementation of MiP policies, consequences in the adoption of SP-IPTp and access to maternal health care | HWs, pregnant women and community members | 92 b3 |
Enguita—NGA/MOZ/COD/MDG [69] | 2020 | Factors influencing the acceptability of SP-IPTp | Pregnant women, community leaders, relatives, HWs, formal and informal health providers | 92 a4 |
Palmer—GHA [70] | 2020 (2015) | Facilitators, barriers and use of tests at the point-of-care for MiP | Staff and pregnant women | 67 a |
Aberese—GHA [71] | 2021 (2018–2019) | Health system, sociocultural and individual factors influencing the adoption of SP-IPTp | HWs, pregnant women and community members | 92 bc3 |
Burke—BFA [72] | 2021 (2017–2018) | Perceptions about two SP-IPTp delivery modalities | Community HWs and clinical facilities | 58 |
Faye—NGA/MOZ/COD [73] | 2021 (2018) | Perception and acceptability of SP-IPTp, new SP packaging and communication tools for its use | Health care providers, community HWs, and pregnant women | 75 ac5 |
Hoyt—KEN [74] | 2021 (2015) | Perceptions about intermittent preventive treatment, screening and treatment with dihydroartemisinin-piperaquine | Pregnant women and HWs | 58 ab |
Muhammad—NGA [75] | 2021 | Barriers to the use of SP-IPTp | Malaria experts, program coordinators, community HWs and pregnant women | 83 ab |
Nyaaba—NGA [76] | 2021 (2019) | Factors associated with low acceptance of SP-IPTp and ITN | Public health care providers, midwives, community leaders, caregivers, relatives, pregnant women | 83 4 |
Osarfo—GHA [77] | 2021 (2012) | Experiences and perceptions about participation in a clinical trial | Pregnant women and husbands | 42 2 |
De Gaukke—GHA [78] | 2022 (2019) | Contextual factors of the health system that influence the delivery of SP-IPTp and ITN | HWs and administrative staff | 83 a |
Taremwa—UGA [79] | 2022 (2020) | Factors that influence the prevention of MiP and the impact of COVID-19 | Pregnant women, midwives, village health teams, local leaders, and healthcare providers | 75 |
Category | Subcategories | Properties |
---|---|---|
Antenatal Care | ||
Positive perceptions | Health benefits | (i) health control and prevention, (ii) diagnostic tests, (iv) drugs and vitamins |
Type of care | (i) courtesy–patience, (ii) trust, (iii) home visits, (iv) free of charge | |
Experiences that prevent use | Costs | (i) transportation to clinic, (ii) wasting time, (iii) user fees and unofficial payments |
Negative perception | (i) due to gender roles and rurality, (ii) by low social support, (iii) negative attitude of the HW, (iv) refusal to take medicine or attend appointments | |
Malaria in Pregnancy | ||
Knowledge attitudes and practices | Local understanding and knowledge of the disease | (i) overlapping of local and biomedical concepts, (ii) multiple causes of abortion, anemia and low birth weight, (iii) low knowledge on etiology, preventive methods with proven efficacy, and treatment of MiP |
Attitudes (perceptions) and practices (behaviors) | (i) positive attitude to seek treatment in symptomatic cases, (ii) low perception of MiP risk, (iii) regular perception of preventive methods, (iv) mistrust due to drug effects, (v) high trust in and use of traditional medicine | |
Determinants of prevention | Sociocultural determinants | (i) local worldviews and trust in traditional medicine, (ii) low education, poverty and economic dependence |
Determinants of the health system | (i) shortages and rationing, (ii) delay in payments and reimbursement to hospitals, (iii) out-of-pocket health expenses | |
Insecticide Treated Net | ||
Knowledge attitudes and barriers of its acceptability | Knowledge and attitudes | (i) High knowledge on benefits, (ii) negative attitudes towards its use, (iii) preference for traditional mosquito management |
Sociocultural barriers | (i) erroneous beliefs, (vii) family and gender roles | |
Health system barriers | (i) ITN cost, (ii) shortages, (iii) governance, financing and human resource problems, (iv) low knowledge and negative attitude of HW | |
Intermittent Preventive Treatment in Pregnancy with Sulfadoxine-pyrimethamine | ||
Knowledge attitudes and practices | Knowledge and attitudes | (i) low knowledge in pregnant women, (ii) HWs with high knowledge about effectiveness but moderate knowledge about implementation, (iii) positive perception of effectiveness in pregnant women and HWs, (iv) pregnant women distrust of effects on maternal–fetal health (negative attitudes about their safety) |
Practices | (i) low adherence, (ii) preference of HWs for observed treatment | |
Determinants of acceptability | Individual determinants | (i) late admission to ANC, (ii) low understanding of the intervention, (iii) refusal to take SP or resistance to pharmacological measures for prevention |
Healthcare system | (i) quality of health care, (ii) information of HW, (iii) work overload, (iv) shortages, (iv) costs and out-of-pocket expenses | |
Case Detection and Management | ||
Acceptability | Attitudes | (i) negative attitudes about the diagnosis and the efficacy of the treatment, (i) negative attitudes about the adverse effects of the treatment |
Barriers | (i) distrust of HW in rapid tests and safety of some drugs, (ii) adherence problems, (iii) distance to clinic, (iv) low availability of tests and drugs |
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Cardona-Arias, J.A. Synthesis of Qualitative Evidence on Malaria in Pregnancy, 2005–2022: A Systematic Review. Trop. Med. Infect. Dis. 2023, 8, 235. https://doi.org/10.3390/tropicalmed8040235
Cardona-Arias JA. Synthesis of Qualitative Evidence on Malaria in Pregnancy, 2005–2022: A Systematic Review. Tropical Medicine and Infectious Disease. 2023; 8(4):235. https://doi.org/10.3390/tropicalmed8040235
Chicago/Turabian StyleCardona-Arias, Jaiberth Antonio. 2023. "Synthesis of Qualitative Evidence on Malaria in Pregnancy, 2005–2022: A Systematic Review" Tropical Medicine and Infectious Disease 8, no. 4: 235. https://doi.org/10.3390/tropicalmed8040235