FHI360, C-Change Project, Global Health Population and Nutrition Division, 1825 Connecticut Avenue, Washington DC, NW 20009, USA.
Malar J. 2013 Sep 23;12:342. doi: 10.1186/1475-2875-12-342.
Malaria during pregnancy is dangerous to both mother and foetus. Intermittent preventive treatment of malaria in pregnancy (IPTp) is a strategy where pregnant women in malaria-endemic countries receive full doses of sulphadoxine-pyrimethamine (SP), whether or not they have malaria. The Nigerian government adopted IPTp as a national strategy in 2005; however, major gaps affecting perception, uptake, adherence, and scale-up remain.
A cross-sectional study was conducted in peri-urban and rural communities in Nasarawa and Cross River States in Nigeria. Study instruments were based on the socio-ecological model and its multiple levels of influences, taking into account individual, community, societal, and environmental contexts of behaviour and social change. Women of reproductive age, their front-line care providers, and (in Nasarawa only) their spouses participated in focus group discussions and in-depth individual interviews. Facility sampling was purposive to include tertiary, secondary and primary health facilities.
The study found that systems-based challenges (stockouts; lack of provider knowledge of IPTp protocols) coupled with individual women's beliefs and lack of understanding of IPT contribute to low uptake and adherence. Many pregnant women are reluctant to seek care for an illness they do not have. Those with malaria often prefer to self-medicate through drug shops or herbs, though those who seek clinic-based treatment trust their providers and willingly accept medicine prescribed.
Failing to deliver complete IPTp to women attending antenatal care is a missed opportunity. While many obstacles are structural, programmes can target women, their communities and the health environment with specific interventions to increase IPTp uptake and adherence.
孕期疟疾对母亲和胎儿都有危险。孕妇在疟疾流行地区接受磺胺多辛-乙胺嘧啶（SP）全剂量间歇性预防治疗（IPTp）是一种策略，无论是否患有疟疾，孕妇都接受该治疗。尼日利亚政府于 2005 年将 IPTp 作为国家战略采用；然而，影响认识、接受、坚持和扩大规模的主要差距仍然存在。
在尼日利亚纳萨拉瓦州和克罗斯河州的城市周边和农村社区进行了一项横断面研究。研究工具基于社会生态模型及其多个层面的影响，考虑到行为和社会变革的个人、社区、社会和环境背景。育龄妇女、她们的一线护理提供者，以及（仅在纳萨拉瓦州）她们的配偶参加了焦点小组讨论和深入的个人访谈。设施抽样是有目的的，包括三级、二级和一级保健设施。
研究发现，基于系统的挑战（库存短缺；提供者对 IPTp 方案缺乏了解）加上妇女个人的信念和对 IPT 的缺乏理解，导致接受度和坚持率低。许多孕妇不愿意为她们没有的疾病寻求护理。那些患有疟疾的人往往更愿意通过药店或草药进行自我治疗，尽管那些寻求诊所治疗的人信任他们的提供者，并愿意接受开的药。
未能向接受产前护理的妇女提供完整的 IPTp 是一个错失的机会。虽然许多障碍是结构性的，但方案可以针对妇女、她们的社区和卫生环境采取具体干预措施，以提高 IPTp 的接受率和坚持率。
