Hill Jenny, Kayentao Kassoum, Achieng Florence, Diarra Samba, Dellicour Stephanie, Diawara Sory I, Hamel Mary J, Ouma Peter, Desai Meghna, Doumbo Ogobara K, ter Kuile Feiko O, Webster Jayne
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
Malaria Research and Training Centre, University of Sciences, Techniques and Technologies of Bamako, Mali.
PLoS One. 2015 Mar 23;10(3):e0119848. doi: 10.1371/journal.pone.0119848. eCollection 2015.
Coverage of malaria in pregnancy interventions in sub-Saharan Africa is suboptimal. We undertook a systematic examination of the operational, socio-economic and cultural constraints to pregnant women's access to intermittent preventive treatment (IPTp), long-lasting insecticide-treated nets (LLINs) and case management in Kenya and Mali to provide empirical evidence for strategies to improve coverage.
Focus group discussions (FGDs) were held as part of a programme of research to explore the delivery, access and use of interventions to control malaria in pregnancy. FGDs were held with four sub-groups: non-pregnant women of child bearing age (aged 15-49 years), pregnant women or mothers of children aged <1 year, adolescent women, and men. Content analysis was used to develop themes and sub-themes from the data.
Women and men's perceptions of the benefits of antenatal care were generally positive; motivation among women consisted of maintaining a healthy pregnancy, disease prevention in mother and foetus, checking the position of the baby in preparation for delivery, and ensuring admission to a facility in case of complications. Barriers to accessing care related to the quality of the health provider-client interaction, perceived health provider skills and malpractice, drug availability, and cost of services. Pregnant women perceived themselves and their babies at particular risk from malaria, and valued diagnosis and treatment from a health professional, but cost of treatment at health facilities drove women to use herbal remedies or drugs bought from shops. Women lacked information on the safety, efficacy and side effects of antimalarial use in pregnancy.
Women in these settings appreciated the benefits of antenatal care and yet health services in both countries are losing women to follow-up due to factors that can be improved with greater political will. Antenatal services need to be patient-centred, free-of-charge or highly affordable and accountable to the women they serve.
撒哈拉以南非洲地区孕期疟疾干预措施的覆盖情况并不理想。我们对肯尼亚和马里孕妇获得间歇性预防治疗（IPTp）、长效驱虫蚊帐（LLINs）及病例管理方面的操作、社会经济和文化限制因素进行了系统审查，以提供改善覆盖率策略的实证依据。
作为一项探索孕期疟疾控制干预措施的提供、获取和使用情况的研究项目的一部分，我们组织了焦点小组讨论（FGDs）。FGDs面向四个子群体开展：育龄非孕妇（15 - 49岁）、孕妇或1岁以下儿童的母亲、青春期女性和男性。采用内容分析法从数据中提炼主题和子主题。
女性和男性对产前护理益处的认知总体上是积极的；女性的动机包括维持孕期健康、预防母婴疾病、检查胎儿位置以准备分娩，以及确保在出现并发症时能入院治疗。获得护理的障碍涉及医疗服务提供者与患者互动的质量、感知到的医疗服务提供者技能和不当行为、药品供应以及服务成本。孕妇认为自己和胎儿特别容易感染疟疾，重视从医疗专业人员处获得诊断和治疗，但医疗机构的治疗费用促使女性使用草药疗法或从商店购买的药物。女性缺乏关于孕期使用抗疟药物的安全性、疗效和副作用的信息。
这些地区的女性认识到产前护理的益处，但由于一些可以通过更大政治意愿加以改善的因素，两国的医疗服务都在失去对女性的随访。产前服务需要以患者为中心，免费或费用极低，并对其所服务的女性负责。
