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Intermittent preventive treatment of malaria in children: a qualitative study of community perceptions and recommendations in Burkina Faso and Mali.

Pitt C, Diawara H, Ouédraogo DJ, Diarra S, Kaboré H, Kouéla K, Traoré A, Dicko A, Konaté AT, Chandramohan D, Diallo DA, Greenwood B, Conteh L - PLoS ONE (2012)

Bottom Line: There was no evidence that IPTc was perceived as a substitute for bed net usage, nor did it inhibit care seeking.The study identifies a number of key questions to consider in planning an IPTc distribution strategy.Single-dose formulations could increase the success of IPTc implementation, as could integration of IPTc within a package of activities, such as bed net distribution and free curative care, for which demand is already high.

View Article: PubMed Central - PubMed

Affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom. catherine.pitt@lshtm.ac.uk

ABSTRACT

Background: Intermittent preventive treatment of malaria in children (IPTc) is a highly efficacious method of malaria control where malaria transmission is highly seasonal. However, no studies published to date have examined community perceptions of IPTc.

Methods: A qualitative study was undertaken in parallel with a double-blind, placebo-controlled, randomized trial of IPTc conducted in Mali and Burkina Faso in 2008-2009 to assess community perceptions of and recommendations for IPTc. Caregivers and community health workers (CHWs) were purposively sampled. Seventy-two in-depth individual interviews and 23 focus group discussions were conducted.

Findings: Widespread perceptions of health benefits for children led to enthusiasm for the trial and for IPTc specifically. Trust in and respect for those providing the tablets and a sense of obligation to the community to participate in sanctioned activities favoured initial adoption. IPTc fits in well with existing understandings of childhood illness. Participants did not express concerns about the specific drugs used for IPTc or about providing tablets to children without symptoms of malaria. There was no evidence that IPTc was perceived as a substitute for bed net usage, nor did it inhibit care seeking. Participants recommended that distribution be "closer to the population", but expressed concern over caregivers' ability to administer tablets at home.

Conclusions: The trial context mediated perceptions of IPTc. Nonetheless, the results indicate that community perceptions of IPTc in the settings studied were largely favourable and that the delivery strategy rather than the tablets themselves presented the main areas of concern for caregivers and CHWs. The study identifies a number of key questions to consider in planning an IPTc distribution strategy. Single-dose formulations could increase the success of IPTc implementation, as could integration of IPTc within a package of activities, such as bed net distribution and free curative care, for which demand is already high.

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Related in: MedlinePlus

Questions to consider in planning an IPTc distribution strategy.
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pone-0032900-g003: Questions to consider in planning an IPTc distribution strategy.

Mentions: While Rogers finds that preventive innovations tend to diffuse slowly because their relative advantages are difficult to see [19], participants in this qualitative study quickly observed the absence of malaria in children participating in the trial. This perceived reduction in morbidity was not always attributed specifically to IPTc, but sometimes to the trial more broadly. However, it emerged as an important driver of participation, and adherence to IPTc was very high. Figure 2 summarizes the main barriers and facilitators to uptake of IPTc in this trial. Results from the two rural sites in Mali and four rural sites in Burkina Faso were strikingly similar; the most notable differences were between the six rural sites and the single, semi-urban site. Many of the themes that emerged echoed those identified in recent studies of the acceptability of IPTi in six African countries [20] and of the acceptability of IPTp and intermittent screening and treatment (IST) during antenatal visits in Ghana [20]. This study presents findings from francophone West Africa, which was not included in either study of IPTi or IPTp, broadening the scope of investigations into the acceptability of IPT. While the results of this study cannot be used to reach generalized conclusions about how IPTc should be delivered in all settings, Figure 3 highlights several aspects of IPTc implementation that are modifiable, of importance to community members, and likely to affect coverage.


Intermittent preventive treatment of malaria in children: a qualitative study of community perceptions and recommendations in Burkina Faso and Mali.

Pitt C, Diawara H, Ouédraogo DJ, Diarra S, Kaboré H, Kouéla K, Traoré A, Dicko A, Konaté AT, Chandramohan D, Diallo DA, Greenwood B, Conteh L - PLoS ONE (2012)

Questions to consider in planning an IPTc distribution strategy.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3295775&req=5

pone-0032900-g003: Questions to consider in planning an IPTc distribution strategy.
Mentions: While Rogers finds that preventive innovations tend to diffuse slowly because their relative advantages are difficult to see [19], participants in this qualitative study quickly observed the absence of malaria in children participating in the trial. This perceived reduction in morbidity was not always attributed specifically to IPTc, but sometimes to the trial more broadly. However, it emerged as an important driver of participation, and adherence to IPTc was very high. Figure 2 summarizes the main barriers and facilitators to uptake of IPTc in this trial. Results from the two rural sites in Mali and four rural sites in Burkina Faso were strikingly similar; the most notable differences were between the six rural sites and the single, semi-urban site. Many of the themes that emerged echoed those identified in recent studies of the acceptability of IPTi in six African countries [20] and of the acceptability of IPTp and intermittent screening and treatment (IST) during antenatal visits in Ghana [20]. This study presents findings from francophone West Africa, which was not included in either study of IPTi or IPTp, broadening the scope of investigations into the acceptability of IPT. While the results of this study cannot be used to reach generalized conclusions about how IPTc should be delivered in all settings, Figure 3 highlights several aspects of IPTc implementation that are modifiable, of importance to community members, and likely to affect coverage.

Bottom Line: There was no evidence that IPTc was perceived as a substitute for bed net usage, nor did it inhibit care seeking.The study identifies a number of key questions to consider in planning an IPTc distribution strategy.Single-dose formulations could increase the success of IPTc implementation, as could integration of IPTc within a package of activities, such as bed net distribution and free curative care, for which demand is already high.

View Article: PubMed Central - PubMed

Affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom. catherine.pitt@lshtm.ac.uk

ABSTRACT

Background: Intermittent preventive treatment of malaria in children (IPTc) is a highly efficacious method of malaria control where malaria transmission is highly seasonal. However, no studies published to date have examined community perceptions of IPTc.

Methods: A qualitative study was undertaken in parallel with a double-blind, placebo-controlled, randomized trial of IPTc conducted in Mali and Burkina Faso in 2008-2009 to assess community perceptions of and recommendations for IPTc. Caregivers and community health workers (CHWs) were purposively sampled. Seventy-two in-depth individual interviews and 23 focus group discussions were conducted.

Findings: Widespread perceptions of health benefits for children led to enthusiasm for the trial and for IPTc specifically. Trust in and respect for those providing the tablets and a sense of obligation to the community to participate in sanctioned activities favoured initial adoption. IPTc fits in well with existing understandings of childhood illness. Participants did not express concerns about the specific drugs used for IPTc or about providing tablets to children without symptoms of malaria. There was no evidence that IPTc was perceived as a substitute for bed net usage, nor did it inhibit care seeking. Participants recommended that distribution be "closer to the population", but expressed concern over caregivers' ability to administer tablets at home.

Conclusions: The trial context mediated perceptions of IPTc. Nonetheless, the results indicate that community perceptions of IPTc in the settings studied were largely favourable and that the delivery strategy rather than the tablets themselves presented the main areas of concern for caregivers and CHWs. The study identifies a number of key questions to consider in planning an IPTc distribution strategy. Single-dose formulations could increase the success of IPTc implementation, as could integration of IPTc within a package of activities, such as bed net distribution and free curative care, for which demand is already high.

Show MeSH
Related in: MedlinePlus