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Social and cultural factors affecting uptake of interventions for malaria in pregnancy in Africa: a systematic review of the qualitative research.

Pell C, Straus L, Andrew EV, Meñaca A, Pool R - PLoS ONE (2011)

Bottom Line: Besides their clinical efficacy, the effectiveness of these interventions depends on the attitudes and behaviours of pregnant women and the wider community, which are shaped by social and cultural factors.Understandings of ANC, health worker-client interactions, household decision-making, gender relations, cost and distance to health facilities affect pregnant women's access to MiP interventions and lack of healthcare infrastructure limits provision of interventions.Further qualitative research is however required: many studies were principally descriptive and an in-depth comparative approach is recommended.

View Article: PubMed Central - PubMed

Affiliation: Centre de Recerca en Salut Internacional de Barcelona, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain. Christopher.pell@gmail.com

ABSTRACT

Background: Malaria during pregnancy (MiP) results in adverse birth outcomes and poor maternal health. MiP-related morbidity and mortality is most pronounced in sub-Saharan Africa, where recommended MiP interventions include intermittent preventive treatment, insecticide-treated bednets and appropriate case management. Besides their clinical efficacy, the effectiveness of these interventions depends on the attitudes and behaviours of pregnant women and the wider community, which are shaped by social and cultural factors. Although these factors have been studied largely using quantitative methods, qualitative research also offers important insights. This article provides a comprehensive overview of qualitative research on social and cultural factors relevant to uptake of MiP interventions in sub-Saharan Africa.

Methods and findings: A systematic search strategy was employed: literature searches were undertaken in several databases (OVID SP, IS Web of Knowledge, MiP Consortium library). MiP-related original research, on social/cultural factors relevant to MiP interventions, in Africa, with findings derived from qualitative methods was included. Non-English language articles were excluded. A meta-ethnographic approach was taken to analysing and synthesizing findings. Thirty-seven studies were identified. Fourteen concentrated on MiP. Others focused on malaria treatment and prevention, antenatal care (ANC), anaemia during pregnancy or reproductive loss. Themes identified included concepts of malaria and risk in pregnancy, attitudes towards interventions, structural factors affecting delivery and uptake, and perceptions of ANC.

Conclusions: Although malaria risk is associated with pregnancy, women's vulnerability is often considered less disease-specific and MiP interpreted in locally defined categories. Furthermore, local discourses and health workers' ideas and comments influence concerns about MiP interventions. Understandings of ANC, health worker-client interactions, household decision-making, gender relations, cost and distance to health facilities affect pregnant women's access to MiP interventions and lack of healthcare infrastructure limits provision of interventions. Further qualitative research is however required: many studies were principally descriptive and an in-depth comparative approach is recommended.

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Related in: MedlinePlus

Summary of the article inclusion/exclusion process.
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pone-0022452-g001: Summary of the article inclusion/exclusion process.

Mentions: Citations and abstracts were downloaded into Endnote X2 and duplicates identified and deleted. All titles and abstracts were read and the following inclusion criteria were applied: original research; relating to MiP; about social or cultural factors relevant to the uptake of MiP interventions; conducted in an African site; employed qualitative methods and findings were derived from qualitative methods; and English language. Methods considered to be qualitative were interviews, focus group discussions, observations (including participant observation), ethnography and participatory methods (including free-listing, mapping and identification exercises). Access to the full text of the remaining articles was sought and the articles read and the inclusion criteria applied again. The full text of nine articles could not be accessed. Details of these articles can be found in Appendix S2. (See Figure 1 for a review of the article inclusion/exclusion process).


Social and cultural factors affecting uptake of interventions for malaria in pregnancy in Africa: a systematic review of the qualitative research.

Pell C, Straus L, Andrew EV, Meñaca A, Pool R - PLoS ONE (2011)

Summary of the article inclusion/exclusion process.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3140529&req=5

pone-0022452-g001: Summary of the article inclusion/exclusion process.
Mentions: Citations and abstracts were downloaded into Endnote X2 and duplicates identified and deleted. All titles and abstracts were read and the following inclusion criteria were applied: original research; relating to MiP; about social or cultural factors relevant to the uptake of MiP interventions; conducted in an African site; employed qualitative methods and findings were derived from qualitative methods; and English language. Methods considered to be qualitative were interviews, focus group discussions, observations (including participant observation), ethnography and participatory methods (including free-listing, mapping and identification exercises). Access to the full text of the remaining articles was sought and the articles read and the inclusion criteria applied again. The full text of nine articles could not be accessed. Details of these articles can be found in Appendix S2. (See Figure 1 for a review of the article inclusion/exclusion process).

Bottom Line: Besides their clinical efficacy, the effectiveness of these interventions depends on the attitudes and behaviours of pregnant women and the wider community, which are shaped by social and cultural factors.Understandings of ANC, health worker-client interactions, household decision-making, gender relations, cost and distance to health facilities affect pregnant women's access to MiP interventions and lack of healthcare infrastructure limits provision of interventions.Further qualitative research is however required: many studies were principally descriptive and an in-depth comparative approach is recommended.

View Article: PubMed Central - PubMed

Affiliation: Centre de Recerca en Salut Internacional de Barcelona, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain. Christopher.pell@gmail.com

ABSTRACT

Background: Malaria during pregnancy (MiP) results in adverse birth outcomes and poor maternal health. MiP-related morbidity and mortality is most pronounced in sub-Saharan Africa, where recommended MiP interventions include intermittent preventive treatment, insecticide-treated bednets and appropriate case management. Besides their clinical efficacy, the effectiveness of these interventions depends on the attitudes and behaviours of pregnant women and the wider community, which are shaped by social and cultural factors. Although these factors have been studied largely using quantitative methods, qualitative research also offers important insights. This article provides a comprehensive overview of qualitative research on social and cultural factors relevant to uptake of MiP interventions in sub-Saharan Africa.

Methods and findings: A systematic search strategy was employed: literature searches were undertaken in several databases (OVID SP, IS Web of Knowledge, MiP Consortium library). MiP-related original research, on social/cultural factors relevant to MiP interventions, in Africa, with findings derived from qualitative methods was included. Non-English language articles were excluded. A meta-ethnographic approach was taken to analysing and synthesizing findings. Thirty-seven studies were identified. Fourteen concentrated on MiP. Others focused on malaria treatment and prevention, antenatal care (ANC), anaemia during pregnancy or reproductive loss. Themes identified included concepts of malaria and risk in pregnancy, attitudes towards interventions, structural factors affecting delivery and uptake, and perceptions of ANC.

Conclusions: Although malaria risk is associated with pregnancy, women's vulnerability is often considered less disease-specific and MiP interpreted in locally defined categories. Furthermore, local discourses and health workers' ideas and comments influence concerns about MiP interventions. Understandings of ANC, health worker-client interactions, household decision-making, gender relations, cost and distance to health facilities affect pregnant women's access to MiP interventions and lack of healthcare infrastructure limits provision of interventions. Further qualitative research is however required: many studies were principally descriptive and an in-depth comparative approach is recommended.

Show MeSH
Related in: MedlinePlus