Pool Robert, Mushi Adiel, Schellenberg Joanna Armstrong, Mrisho Mwifadhi, Alonso Pedro, Montgomery Catherine, Tanner Marcel, Mshinda Hassan, Schellenberg David
London School of Hygiene and Tropical Medicine, London, UK.
Malar J. 2008 Oct 21;7:213. doi: 10.1186/1475-2875-7-213.
Intermittent preventive treatment of malaria in infants (IPTi) reduces the incidence of clinical malaria. However, before making decisions about implementation, it is essential to ensure that IPTi is acceptable, that it does not adversely affect attitudes to immunization or existing health seeking behaviour. This paper reports on the reception of IPTi during the first implementation study of IPTi in southern Tanzania.
Data were collected through in-depth interviews, focus group discussions and participant observation carried out by a central team of social scientists and a network of key informants/interviewers who resided permanently in the study sites.
IPTi was generally acceptable. This was related to routinization of immunization and resonance with traditional practices. Promoting "health" was considered more important than preventing specific diseases. Many women thought that immunization was obligatory and that health staff might be unwilling to assist in the future if they were non-adherent. Weighing and socialising were important reasons for clinic attendance. Non-adherence was due largely to practical, social and structural factors, many of which could be overcome. Reasons for non-adherence were sometimes interlinked. Health staff and "road to child health" cards were the main source of information on the intervention, rather than the specially designed posters. Women did not generally discuss child health matters outside the clinic, and information about the intervention percolated slowly through the community. Although there were some rumours about sulphadoxine pyrimethamine (SP), it was generally acceptable as a drug for IPTi, although mothers did not like the way tablets were administered. There is no evidence that IPTi had a negative effect on attitudes or adherence to the expanded programme on immunisation (EPI) or treatment seeking or existing malaria prevention.
In order to improve adherence to both EPI and IPTi local priorities should be taken into account. For example, local women are often more interested in weighing than in immunization, and they view vaccination and IPTi as vaguely "healthy" rather preventing specific diseases. There should be more emphasis on these factors and more critical consideration by policy makers of how much local knowledge and understanding is minimally necessary in order to make interventions successful.
婴儿疟疾间歇性预防治疗（IPTi）可降低临床疟疾发病率。然而，在做出实施决策之前，必须确保IPTi是可接受的，且不会对免疫接种态度或现有的就医行为产生不利影响。本文报告了在坦桑尼亚南部首次进行的IPTi实施研究期间IPTi的接受情况。
数据通过深入访谈、焦点小组讨论以及由一组社会科学家核心团队和长期居住在研究地点的关键信息提供者/访谈者网络进行的参与观察收集。
IPTi总体上是可接受的。这与免疫接种的常规化以及与传统做法的共鸣有关。促进“健康”被认为比预防特定疾病更重要。许多妇女认为免疫接种是必须的，并且如果不依从，医护人员未来可能不愿意提供帮助。称重和社交是前往诊所就诊的重要原因。不依从主要是由于实际、社会和结构因素，其中许多因素是可以克服的。不依从的原因有时相互关联。医护人员和“儿童健康之路”卡片是关于该干预措施的主要信息来源，而非专门设计的海报。妇女通常不在诊所以外讨论儿童健康问题，关于该干预措施的信息在社区中传播缓慢。尽管有一些关于磺胺多辛 - 乙胺嘧啶（SP）的谣言，但它作为IPTi用药总体上是可接受的，尽管母亲们不喜欢片剂的给药方式。没有证据表明IPTi对免疫扩大计划（EPI）的态度或依从性、就医行为或现有的疟疾预防有负面影响。
为了提高对EPI和IPTi的依从性，应考虑当地的优先事项。例如，当地妇女通常对称重比对免疫接种更感兴趣，并且她们将疫苗接种和IPTi视为大致“有益健康”而非预防特定疾病。应更加重视这些因素，政策制定者应更审慎地考虑为使干预措施成功最少需要多少当地知识和理解。
