Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.
Malar J. 2010 Jan 14;9:18. doi: 10.1186/1475-2875-9-18.
Malaria in pregnancy is associated with increased risks of maternal and foetal complications. Currently, intermittent preventive treatment (IPT) of malaria during pregnancy with sulphadoxine-pyrimethamine (SP) is recommended by the WHO as part of a package of interventions also including insecticide-treated nets and effective case management. However, with increasing resistance to SP, the effectiveness of SP-IPT has been questioned. A randomized controlled trial (RCT) to investigate the relative efficacy of an alternative strategy of intermittent screening and treatment (IST), which involves a rapid diagnostic test for malaria at scheduled ANC visits and treatment of women only if positive, versus SP-IPT has been conducted in Ashanti region, Ghana. This paper reports on a complementary study investigating the acceptability of the different strategies to women enrolled in the trial.
Data were collected through twelve focus group discussions with women selected at random from the different arms of the RCT, exploring their experiences and perceptions about antenatal care and their involvement in the trial. Content analysis was used to identify relevant themes to structure the results.
Five main themes emerged from participants' experiences of ANC and the RCT that would influence their acceptability of malaria prevention strategies during pregnancy: health benefits; drugs received; tests received; other services received; and health worker attitude. Their own health and that of their baby were strong motivations for attending ANC, and reported favourably as an outcome of being in the RCT. Women were not always clear on the biomedical function of drugs or blood tests but generally accepted them due to strong trust in the health staff. Home visits by staff and free ITNs as part of the trial were appreciated. Politeness and patience of health staff was a very strong positive factor.
Overall, both intermittent screening and treatment and intermittent preventive treatment appeared equally acceptable to pregnant women as strategies for the control of malaria in pregnancy. The women were more concerned about quality of services received, in particular the polite and patient attitude of health staff, and positive health implications for themselves and their babies than about the nature of the intervention.
妊娠疟疾会增加母婴并发症的风险。目前，世卫组织建议在妊娠期间采用磺胺多辛-乙胺嘧啶（SP）间歇性预防治疗（IPT），作为包括驱虫蚊帐和有效病例管理在内的干预措施包的一部分。然而，随着对 SP 的耐药性增加，SP-IPT 的有效性受到了质疑。一项在加纳阿散蒂地区开展的、针对替代策略（即间歇性筛查和治疗策略，简称 IST）的相对疗效的随机对照试验（RCT）已经完成，该策略涉及在定期 ANC 就诊时使用快速诊断检测疟疾，并仅在检测结果为阳性时对妇女进行治疗，而不是采用 SP-IPT。本文报告了一项补充研究，该研究调查了不同策略对参加试验的妇女的可接受性。
通过对从 RCT 的不同组随机选择的妇女进行的 12 次焦点小组讨论收集数据，探讨了她们对产前保健的经验和看法，以及对参与试验的看法。采用内容分析法确定相关主题以构建结果。
从参与者的 ANC 经历和 RCT 中得出了五个主要主题，这些主题将影响她们对妊娠期间疟疾预防策略的可接受性：健康效益；接受的药物；接受的检查；接受的其他服务；以及卫生工作者的态度。自身和婴儿的健康是参加 ANC 的主要动机，并被认为是参加 RCT 的一个积极结果。妇女对药物或血液检查的生物医学功能并不总是清楚，但由于对卫生人员的强烈信任，她们通常会接受。工作人员的家访和作为试验一部分的免费 ITN 受到赞赏。工作人员的礼貌和耐心是一个非常积极的因素。
总的来说，间歇性筛查和治疗以及间歇性预防治疗作为妊娠期间疟疾控制策略，对孕妇来说同样可以接受。与干预措施的性质相比，妇女更关心所接受的服务质量，特别是卫生人员的礼貌和耐心态度，以及对自己和婴儿的积极健康影响。
