Gyebuni Prosper, Salifu Yula, Lasong Joseph
Department of Population and Reproductive Health, School of Public Health, University for Development Studies, Tamale, Ghana.
Directorate of University Health Service, University Hospital, University for Development Studies, Tamale, Ghana.
Malar J. 2025 Jun 5;24(1):178. doi: 10.1186/s12936-025-05342-5.
In pregnancy, treating malaria with quinine and reducing its adverse effects on pregnant women has posed a significant challenge to clinicians in malaria-endemic areas such as Ghana for over 2-decades. Clinicians' experiences, therefore, play a significant role in clinicians' choices of drugs to safeguard pregnant women. Thus, this study aims to explore clinicians' experiences with quinine-based treatment (QBT) of malaria in early pregnancy in the Tamale Metropolis of Ghana.
An exploratory qualitative approach, using a phenomenological design, was employed to allow for an in-depth exploration of the experiences of clinicians with QBT during first trimester pregnancy. The data were collected in-between June to July 2023, through key informant interviews with obstetricians/gynaecologists and in-depth interviews with other cadre of healthcare professionals, with a purposive sample of 26 participants, selected across the 2 largest healthcare facilities (Tamale Central Hospital and Tamale Teaching Hospital) in the Tamale Metropolis. The data were audio-recorded, transcribed and manually analysed using thematic analysis.
The study revealed that clinicians have negative experiences, beliefs, and attitudes towards quinine-based treatment of malaria in pregnancy. Clinicians' experiences include deleterious side effects of quinine, professional norms, and institutional bottlenecks. Participants also encounter challenges related to clinicians and patient concordance, such as patients' beliefs, adherence to review schedules, fears of medico-legal issues, and myths about quinine which affect treatment choices. Participants' attitudes towards malaria treatment include "watchful waiting" and the tension to treat promptly amidst concerns about potential treatment risks. The novel findings of this study were "watchful waiting" and the treatment of uncomplicated malaria in early pregnancy with intravenous artesunate.
Clinicians' experiences with quinine-based treatment of malaria in pregnancy affect their attitude towards malaria treatment in pregnancy. Most clinicians with experiences of the side effects of quinine and patient negative beliefs about quinine, desist from prescribing it. It is important for the Ministry of Health and the Ghana Health Service to provide feedback systems that allow clinicians to communicate experiences on malaria treatment to policy makers to enable policy review on malaria treatment during pregnancy, particularly in first trimesters.
二十多年来，在加纳等疟疾流行地区，使用奎宁治疗疟疾并减少其对孕妇的不良影响一直是临床医生面临的重大挑战。因此，临床医生的经验在其选择保护孕妇的药物方面起着重要作用。因此，本研究旨在探索加纳塔马利市临床医生在妊娠早期使用基于奎宁的治疗方法（QBT）治疗疟疾的经验。
采用探索性定性研究方法，运用现象学设计，以便深入探究临床医生在孕早期使用QBT的经验。2023年6月至7月期间，通过对产科医生/妇科医生进行关键信息访谈以及对其他医护人员进行深入访谈收集数据，从塔马利市2家最大的医疗机构（塔马利中心医院和塔马利教学医院）中选取了26名有目的的参与者作为样本。数据进行了录音、转录，并使用主题分析法进行人工分析。
研究表明，临床医生对妊娠期间基于奎宁的疟疾治疗有负面的经验、信念和态度。临床医生的经验包括奎宁的有害副作用、专业规范和机构瓶颈。参与者还遇到与临床医生和患者一致性相关的挑战，如患者的信念、遵守复诊计划、对医疗法律问题的担忧以及影响治疗选择的关于奎宁的误解。参与者对疟疾治疗的态度包括“观察等待”以及在担心潜在治疗风险的情况下急于及时治疗的紧张情绪。本研究的新发现是“观察等待”以及在孕早期使用静脉注射青蒿琥酯治疗非复杂性疟疾。
临床医生在妊娠期间使用基于奎宁的疟疾治疗的经验影响他们对妊娠疟疾治疗的态度。大多数有奎宁副作用经验以及患者对奎宁有负面信念的临床医生不再开这种药。对卫生部和加纳卫生服务局来说，提供反馈系统很重要，该系统能让临床医生与政策制定者交流疟疾治疗经验，以便对妊娠期间尤其是孕早期的疟疾治疗政策进行审查。
