Barriers and Facilitators to Malaria Prevention among Pregnant Women in Guinea: A Qualitative Study
Abstract:
Malaria during pregnancy poses serious health risks in sub-Saharan
Africa. Despite efforts in Guinea, gaps persist in the adoption of preventive
measures such as insecticide-treated nets (ITNs) and intermittent preventive
treatment (IPT). This qualitative study explores the lived experiences,
perceptions, and contextual factors that influence malaria prevention behaviors
among pregnant women in Guinea. We conducted semi-structured interviews with
200 participants across four regions, including pregnant women attending
antenatal care (ANC), health care providers (midwives and nurses), and
policymakers or program managers involved in maternal health and malaria
control programs. Participants were purposively selected to reflect regional
diversity, with sample sizes proportional to annual pregnancy estimates.
Thematic analysis was applied to identify barriers and facilitators related to
knowledge, health systems, sociocultural dynamics, and enabling factors. Four
major themes emerged: (1) knowledge and perceptions of malaria prevention, (2)
health system barriers, (3) sociocultural influences, and (4) facilitators and
enablers. While most women were aware of malaria risks, misconceptions about
IPTp and limited knowledge about timing and dosage were common. Health system
challenges included frequent SP stock-outs, provider workload, and inconsistent
ANC counseling. Sociocultural norms, such as male decision-making and
traditional beliefs, further limited access. Facilitators included trust in
healthcare providers, community sensitization programs, and positive
experiences with ANC services. Addressing malaria in pregnancy in Guinea
requires a multifaceted approach that goes beyond increasing access. Tailored
interventions that improve health system readiness, enhance community
education, and engage men in maternal health are essential for improving IPTp
and ITN uptake.
References:
[1]. Badu, K., Agyei-Baffour, P., &
Acheampong, E, 2021, Knowledge, attitude, and practices on malaria prevention
among pregnant women and caregivers of children under five in Ghana. Malaria Research and Treatment,
2021, 1–8. https://doi.org/10.1155/2021/6677632
[2]. Braun, V., & Clarke, V., 2006. Using
thematic analysis in psychology. Qualitative
Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
[3]. Creswell, J. W., & Poth, C. N., 2018, Qualitative inquiry and research
design: Choosing among five approaches (4th ed.). Sage Publications.
[4]. Diala, C. C., Pennas, T.,
Choi, M., & Rogers, S., 2013, Barriers to uptake of malaria prevention and treatment during pregnancy
in sub-Saharan Africa: A review. Malaria
Journal, 12, 426. https://doi.org/10.1186/1475-2875-12-426
[5]. DHS Guinea. 2018, Guinea Demographic and Health
Survey. National Institute of Statistics and ICF.
[6]. Desai, M., Gutman, J., Taylor, S. M.,
Wiegand, R. E., Khairallah, C., Kayentao, K., ... & Ter Kuile, F. O., 2018,
Impact of IPTp with sulfadoxine–pyrimethamine on maternal and newborn outcomes. The Lancet Infectious Diseases, 18(5),
546–558. https://doi.org/10.1016/S1473-3099(18)30064-4
[7]. Glaser, B. G., &
Strauss, A. L. 1967. The discovery of grounded theory:
Strategies for qualitative research. Aldine.
[8]. Hill, J., Dellicour, S., Bruce, J., Ouma,
P., Kioko, U., & Webster, J., 2013, Factors affecting delivery, access, and
use of malaria interventions in pregnancy in Africa: A systematic review. PLOS Medicine, 10(7),
e1001488. https://doi.org/10.1371/journal.pmed.1001488
[9]. Hill, J., Hoyt, J., van Eijk, A. M.,
D'Mello-Guyett, L., Ter Kuile, F. O., Steketee, R., & Webster, J., 2021,
Updated evidence on barriers to IPTp delivery in sub-Saharan Africa. PLOS Medicine, 18(10),
e1003862. https://doi.org/10.1371/journal.pmed.1003862
[10]. Hodgins, S., & D’Agostino, A., 2014,
The quality–coverage gap in antenatal care: Toward better measurement of
effective coverage. Global
Health: Science and Practice, 2(2), 173–181. https://doi.org/10.9745/GHSP-D-13-00176
[11]. Koenker, H., Kilian, A., & Harvey, S.
A. 2018, ITN use among pregnant women: Behavioral insights. Global Health: Science and
Practice, 6(3), 486–499. https://doi.org/10.9745/GHSP-D-18-00168
[12]. Kruk, M. E., Gage, A. D.,
Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S., ... & Pate, M., 2018, High-quality health
systems in the Sustainable Development Goals era: Time for a revolution. The Lancet Global Health, 6(11),
e1196–e1252. https://doi.org/10.1016/S2214-109X(18)30386-3
[13]. Mubyazi, G. M., Magnussen, P., Byskov, J.,
& Bloch, P., 2020, Women's experiences accessing malaria prevention in
pregnancy: A study from Tanzania. Malaria
Journal, 19, 1–10. https://doi.org/10.1186/s12936-020-03435-9
[14]. Ouma, P. O., Maina, J., Thuranira, P. N.,
Macharia, P. M., Alegana, V. A., English, M., & Snow, R. W., 2020, Access
to emergency hospital care in sub-Saharan Africa in 2015: A spatial analysis. The Lancet Global Health, 6(3),
e342–e350. https://doi.org/10.1016/S2214-109X(17)30488-6
[15]. Patton, M. Q., 2002, Qualitative research and
evaluation methods (3rd
ed.). Sage Publications.
[16]. Pell, C., Meñaca, A., Were, F., Afrah, N.
A., Chatio, S., Manda-Taylor, L., ... & Pool, R., 2013, Factors affecting
ANC attendance and malaria prevention in pregnancy: Insights from qualitative
research. PLOS ONE, 8(6),
e53747. https://doi.org/10.1371/journal.pone.0053747
[17]. Roll Back Malaria Partnership. 2015, Malaria in pregnancy strategic
framework 2015–2020. https://www.rollbackmalaria.org/
[18]. Simkhada, B., van Teijlingen, E. R.,
Porter, M., & Simkhada, P., 2008, Factors affecting utilization of ANC in
developing countries: Systematic review. Journal
of Advanced Nursing, 61(3), 244–260. https://doi.org/10.1111/j.1365-2648.2007.04532.x
[19]. Stake, R. E., 1995, The art of case study research.
Sage Publications.
[20]. Tong, A., Sainsbury, P., & Craig, J.,
2007, Consolidated criteria for reporting qualitative research (COREQ): A
32-item checklist. International
Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042
[21]. UNICEF. 2022, Guinea: Maternal and newborn
health profile. https://data.unicef.org
[22]. USAID. 2020, President’s Malaria Initiative:
Guinea malaria operational plan FY 2021. https://www.pmi.gov/
[23]. WHO. 2016, Recommendations on antenatal care
for a positive pregnancy experience. World Health Organization. https://www.who.int/publications/i/item/9789241549912
[24]. WHO. 2022, World malaria report 2022. https://www.who.int/publications/i/item/9789240064898
[25]. WHO. 2021, Malaria in pregnancy: Briefing
note. https://www.who.int/publications/m/item/malaria-in-pregnancy
[26]. Yaya, S., Uthman, O. A., Amouzou, A., &
Bishwajit, G., 2018, Inequalities in maternal healthcare utilization in
sub-Saharan Africa. International
Journal for Equity in Health, 17, 147. https://doi.org/10.1186/s12939-018-0862-2
[27]. Zachariah, R., Harries, A. D., Srinath, S., Ram, S., & Kapur, A., 2012, Language, culture, and communication in public health programs. Tropical Medicine & International Health, 17(11), 1357–1359. https://doi.org/10.1111/j.1365-3156.2012.03065.x
