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Perceptions of Malaria in Pregnancy and Acceptability of Preventive Interventions among Mozambican Pregnant Women: Implications for Effectiveness of Malaria Control in Pregnancy  [PDF]
Helena Boene, Raquel González, Anifa Valá, Maria Rupérez, César Velasco, Sónia Machevo, Charfudin Sacoor, Esperan?a Sevene, Eusébio Macete, Clara Menéndez, Khátia Munguambe
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0086038
Abstract: Background Intermittent Preventive Treatment (IPTp) and insecticide treated nets (ITNs) are recommended malaria in pregnancy preventive interventions in sub-Saharan Africa. Despite their cost-effectiveness and seemingly straight-forward delivery mechanism, their uptake remains low. We aimed at describing perceptions of pregnant women regarding malaria and the recommended prevention interventions to understand barriers to uptake and help to improve their effectiveness. Methods and findings We used mixed methods to collect data among 85 pregnant women from a rural area of Southern Mozambique. Information was obtained through observations, in-depth interviews, and focused ethnographic exercises (Free-listing and Pairwise comparisons). Thematic analysis was performed on qualitative data. Data from focused ethnographic exercises were summarized into frequency distribution tables and matrices. Malaria was not viewed as a threat to pregnancy. Participants were not fully aware of malaria- associated adverse maternal and birth outcomes. ITNs were the most preferred and used malaria preventive intervention, while IPTp fell between second and third. Indoor Residual Spraying (IRS) was the least preferred intervention. Conclusions Low awareness of the risks and adverse consequences of malaria in pregnancy did not seem to affect acceptability or uptake to the different malaria preventive interventions in the same manner. Perceived convenience, the delivery approach, and type of provider were the key factors. Pregnant women, through antenatal care (ANC) services, can be the vehicles of ITN distribution in the communities to maximise overall ITN coverage. There is a need to improve knowledge about neonatal health and malaria to improve uptake of interventions delivered through channels other than the health facility.
Quality of Life, Wishes, and Needs in Women with Gestational Diabetes: Italian DAWN Pregnancy Study  [PDF]
A. Lapolla,G. Di Cianni,A. Di Benedetto,I. Franzetti,A. Napoli,L. Sciacca,E. Torlone,L. Tonutti,E. Vitacolonna,D. Mannino
International Journal of Endocrinology , 2012, DOI: 10.1155/2012/784726
Abstract: The DAWN (Diabetes Attitudes, Wishes and Needs) study is a survey promoted by the International Diabetes Federation to recognize the perceptions and attitudes of people suffering from diabetes mellitus. In this context, we evaluated the quality of life of Italian and immigrant women with gestational diabetes mellitus (GDM). Information was gathered using a structured questionnaire for patients’ self-compilation. In a 3-month period, a 51-item questionnaire was submitted to 198 Italians and 88 immigrants (from 27 different foreign nationalities). Italian women were older and had higher education than the immigrants. 60% of the Italians and 38% of the immigrants had a family history of diabetes mellitus. In both groups, the diagnosis of GDM caused anxiety; one-third of women feared their child could contract diabetes at delivery and/or have congenital malformations. Some women had trouble in following treatment regimens: the major concern being dietary advice and blood glucose testing. Most women were satisfied (34%) or highly satisfied (60%) with the quality of care, although the degree of cooperation between diabetes specialists and gynaecologists was considered sometimes unsatisfactory. In order to optimize maternal and foetal outcomes, educational projects and improved communication between patients and the healthcare provider team are recommended. 1. Introduction The DAWN study (Diabetes Attitudes, Wishes and Needs) is a survey promoted by the International Diabetes Federation, with the aim of recognizing the feelings and attitudes of patients suffering from diabetes mellitus and the healthcare professionals responsible for patient management and care. Up to now the results of the DAWN study have shown that about half of the people with diabetes have a lower quality of life. The most important factors predicting discomfort or worse quality of life among diabetic patients are the country of residence and, subsequently, the type of healthcare system adopted there (i.e., the presence or absence of a specialized team dedicated to the care and assistance for diabetic patients and their chronic complications) [1, 2]. Inside the Italian DAWN study framework, the Italian DAWN Study Group on Pregnancy performed this survey to evaluate the wishes and needs of Italian and immigrant women affected by GDM. 2. Materials and Methods 2.1. Study Design The research was conducted in 10 Italian centres specialized in the care of pregnant women with diabetes. Each centre supplied 20 questionnaires submitted to pregnant women with GDM by nurses who had previously been
Antenatal care in The Gambia: Missed opportunity for information, education and communication
Samuel E Anya, Abba Hydara, Lamin ES Jaiteh
BMC Pregnancy and Childbirth , 2008, DOI: 10.1186/1471-2393-8-9
Abstract: A cross sectional survey of 457 pregnant women attending six urban and six rural antenatal clinics in the largest health division in The Gambia was undertaken. The women were interviewed using modified antenatal client exit interview and antenatal record review questionnaires from the WHO Safe Motherhood Needs Assessment kit. Differences between women attending urban and rural clinics were assessed using the Chi-square test. Relative risks with 95% confidence intervals are presented.Ninety percent of those interviewed had attended the antenatal clinic more than once and 52% four or more times. Most pregnant women (70.5%) said they spent 3 minutes or less with the antenatal care provider. About 35% recalled they were informed or educated on diet and nutrition, 30.4% on care of the baby, 23.6% on family planning, 22.8% on place of birth and 19.3% on what to do if there was a complication.About 25% of pregnant women said they were given information about the progress of their pregnancy after consultation and only 12.8% asked their provider any question. Awareness of danger signs was low. The proportions of women that recognised signs of danger were 28.9% for anaemia, 24.6% for hypertension, 14.8% for haemorrhage, 12.9% for fever and 5% for puerperal sepsis. Prolonged labour was not recognised as a danger sign. Women attending rural antenatal clinics were 1.6 times more likely to recognise signs of anaemia and hypertension as indicative of danger compared to women attending urban antenatal clinics.Information, education and communication during antenatal care in the largest health division are poor. Pregnant women are ill-equipped to make appropriate choices especially when they are in danger. This contributes to the persistence of high maternal mortality ratios in the country.Antenatal care provides an opportunity to inform and educate pregnant women on a variety of issues related to pregnancy, birth and parenthood. The aim of this exercise is to equip them to make app
Digging deeper: quality of patient-provider communication across Hispanic subgroups
Lorraine S Wallace, Jennifer E DeVoe, Edwin S Rogers, Joanne Protheroe, Gillian Rowlands, George E Fryer
BMC Health Services Research , 2009, DOI: 10.1186/1472-6963-9-240
Abstract: Cross-sectional analysis of the 2005 Medical Expenditure Panel Survey (MEPS). Participants included non-institutionalized Hispanics (n = 5197; US population estimate = 27,070,906), aged ≥18 years, reporting visiting a health care provider within the past 12 months. Six (n = 6) items were used to capture respondents' perceptions of their health care providers' communication behaviors.After controlling for socio-demographic covariates, compared to Other Hispanics (reference group), very few differences in perceptions of health care providers communication emerged across ethnic subgroups. Puerto Ricans were more likely to report that their health care provider "always" showed respect for what they had to say (OR = 2.16, 95% CI 1.16-4.03). Both Puerto Ricans (OR = 2.28, 95% CI 1.06-4.92) and Mexicans (OR = 1.88, 95% CI 1.02-3.46) were more likely to indicate that their health care provider "always" spent enough time with them as compared to Other Hispanics.We observed very few differences among Hispanics respondents in their perceived quality of interactions with health care providers as a function of their ethnic subgroup designation. While our findings somewhat contradict previous research, they do suggest that other underlying factors may influence the quality of perceived interactions with health care providers.Hispanic Americans now represent 15% of the total US population [1]. Over the past decade, studies have consistently documented a wide array of health-related disparities between Hispanics and non-Hispanic whites [2]. For instance, using data from the 2001 National Health Interview Survey, McGruder and colleagues [3] found that Hispanics were less aware of heart attack symptoms and the need to call for emergency help if someone near them had symptoms than were whites. In a population-based study of respondents residing in ten different states, Hispanics reported receipt of fewer routine preventive services (e.g., colorectal cancer screening and cholesterol te
Perceptions on the use of insecticide treated nets in parts of the Imo River Basin, Nigeria: Implications for preventing malaria in pregnancy
UM Chukwuocha, INS Dozie, COE Onwuliri, CN Ukaga, BEB Nwoke, BO Nwankwo, EA Nwoke, JC Nwaokoro, KS Nwoga, OG Udujih, CC Iwuala, ET Ohaji, OM Morakinyo, BC Adindu
African Journal of Reproductive Health , 2010,
Abstract: This study aimed at assessing perceptions on use of ITNs in parts of the Imo River Basin, Nigeria and its implications in preventing malaria in pregnancy. Data was collected using focus group discussions, key informant interviews and structured questionnaires. Results showed high awareness on the benefits of ITNs. Factors affecting use of ITNs included its high cost, perceptions of chemicals used to treat them as having dangerous effects on pregnancy, low utilization of antenatal care, husband’s lack of interest in malaria prevention and perceptions that adolescent girls are at low risk of getting malaria. The implications of these findings include demystifying the negative perceptions on the chemicals used for net treatment and subsidizing the cost of ITNs to increase access. These findings provide important lessons for malaria programmes that aim at increasing access to ITNs by pregnant women in developing countries (Afr J Reprod Health 2010; 14[1]:117-128).
Women's Access and Provider Practices for the Case Management of Malaria during Pregnancy: A Systematic Review and Meta-Analysis  [PDF]
Jenny Hill ,Lauren D'Mello-Guyett,Jenna Hoyt,Anna M. van Eijk,Feiko O. ter Kuile,Jayne Webster
PLOS Medicine , 2014, DOI: 10.1371/journal.pmed.1001688
Abstract: Background WHO recommends prompt diagnosis and quinine plus clindamycin for treatment of uncomplicated malaria in the first trimester and artemisinin-based combination therapies in subsequent trimesters. We undertook a systematic review of women's access to and healthcare provider adherence to WHO case management policy for malaria in pregnant women. Methods and Findings We searched the Malaria in Pregnancy Library, the Global Health Database, and the International Network for the Rational Use of Drugs Bibliography from 1 January 2006 to 3 April 2014, without language restriction. Data were appraised for quality and content. Frequencies of women's and healthcare providers' practices were explored using narrative synthesis and random effect meta-analysis. Barriers to women's access and providers' adherence to policy were explored by content analysis using NVivo. Determinants of women's access and providers' case management practices were extracted and compared across studies. We did not perform a meta-ethnography. Thirty-seven studies were included, conducted in Africa (30), Asia (4), Yemen (1), and Brazil (2). One- to three-quarters of women reported malaria episodes during pregnancy, of whom treatment was sought by >85%. Barriers to access among women included poor knowledge of drug safety, prohibitive costs, and self-treatment practices, used by 5%–40% of women. Determinants of women's treatment-seeking behaviour were education and previous experience of miscarriage and antenatal care. Healthcare provider reliance on clinical diagnosis and poor adherence to treatment policy, especially in first versus other trimesters (28%, 95% CI 14%–47%, versus 72%, 95% CI 39%–91%, p = 0.02), was consistently reported. Prescribing practices were driven by concerns over side effects and drug safety, patient preference, drug availability, and cost. Determinants of provider practices were access to training and facility type (public versus private). Findings were limited by the availability, quality, scope, and methodological inconsistencies of the included studies. Conclusions A systematic assessment of the extent of substandard case management practices of malaria in pregnancy is required, as well as quality improvement interventions that reach all providers administering antimalarial drugs in the community. Pregnant women need access to information on which anti-malarial drugs are safe to use at different stages of pregnancy. Please see later in the article for the Editors' Summary
Perceptions of rural teenagers on teenage pregnancy
M S Richter,G T Mlambo
Health SA Gesondheid , 2005, DOI: 10.4102/hsag.v10i2.195
Abstract: It is important to seek an understanding of teenagers’ perceptions regarding teenage pregnancy. Opsomming Die doel van hierdie studie was om die persepsies van tieners in die Bosbokrand-distrik in die Limpopo Provinsie, Suid-Afrika, te ondersoek en te beskryf. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.
Intermittent Screening and Treatment versus Intermittent Preventive Treatment of Malaria in Pregnancy: Provider Knowledge and Acceptability  [PDF]
Lucy Smith Paintain, Gifty D. Antwi, Caroline Jones, Esther Amoako, Rose O. Adjei, Nana A. Afrah, Brian Greenwood, Daniel Chandramohan, Harry Tagbor, Jayne Webster
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0024035
Abstract: Malaria in pregnancy (MiP) is associated with increased risks of maternal and foetal complications. The WHO recommends a package of interventions including intermittent preventive treatment (IPT) with sulphadoxine-pyrimethamine (SP), insecticide-treated nets and effective case management. However, with increasing SP resistance, the effectiveness of SP-IPT has been questioned. Intermittent screening and treatment (IST) has recently been shown in Ghana to be as efficacious as SP-IPT. This study investigates two important requirements for effective delivery of IST and SP-IPT: antenatal care (ANC) provider knowledge, and acceptance of the different strategies. Structured interviews with 134 ANC providers at 67 public health facilities in Ashanti Region, Ghana collected information on knowledge of the risks and preventative and curative interventions against MiP. Composite indicators of knowledge of SP-IPT, and case management of MiP were developed. Log binomial regression of predictors of provider knowledge was explored. Qualitative data were collected through in-depth interviews with fourteen ANC providers with some knowledge of IST to gain an indication of the factors influencing acceptance of the IST approach. 88.1% of providers knew all elements of the SP-IPT policy, compared to 20.1% and 41.8% who knew the treatment policy for malaria in the first or second/third trimesters, respectively. Workshop attendance was a univariate predictor of each knowledge indicator. Qualitative findings suggest preference for prevention over cure, and increased workload may be barriers to IST implementation. However, a change in strategy in the face of SP resistance is likely to be supported; health of pregnant women is a strong motivation for ANC provider practice. If IST was to be introduced as part of routine ANC activities, attention would need to be given to improving the knowledge and practices of ANC staff in relation to appropriate treatment of MiP. Health worker support for any MiP intervention delivered through ANC clinics is critical.
Perceptions of teenage pregnancy among South African adolescents
Kelvin Mwaba
Health SA Gesondheid , 2000, DOI: 10.4102/hsag.v5i3.35
Abstract: Teenage pregnancy has been viewed as a social problem that has implications for the development and empowerment of women in South Africa. This study sought to determine the attitudes, perceptions and beliefs of a group of South African adolescents regarding teenage pregnancy. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.
Attitudes, perceptions and understanding amongst teenagers regarding teenage pregnancy, sexuality and contraception in Taung
T Kanku, R Mash
South African Family Practice , 2010,
Abstract: Background: South African teenage pregnancy rates remain high by international comparison and, in the rural town of Taung, the rate of 13% is twice the national average of 6.5%. Teenage pregnancy is a risk factor for disruption of education, future unemployment, sexually transmitted infections, HIV, preterm birth and poor mental health. The aim of this study was to understand the attitudes and perceptions of teenagers in Taung regarding teenage pregnancy and to explore their understanding of sexuality and contraception. This study intended to contribute to a deeper understanding by exploring teenagers’ own perceptions on the matter, to identify factors that, in their view, may influence the risk of pregnancy and suggest possible interventions. No previous studies from the Taung area have been identified. Methods: The qualitative study entailed 13 in-depth interviews with pregnant teenagers and three focus groups: one with 10 women aged 19 to 25 years who had a baby as a teenager, one with 14 teenage girls aged 16 to 19 years who had never been pregnant, and one with 11 males aged 18 to 23 years. Qualitative data was analysed through the framework method. Results: Factors influencing teenage pregnancy were found to be broad and complex: 1) Socioeconomic factors included poverty, the controversial influence of the child support grant, transgenerational sex and financial support from an older partner to secure income for the teenage girl or her family. 2) Substance abuse, particularly alcohol, in either the teenager or her parents was found to have a critical influence. A lack of alternative entertainment and social infrastructure made shebeens (local bars) a normal part of teenage social life. 3) Peer pressure from boyfriends and the broader social network. 4) Other factors included the right to motherhood before becoming HIV positive, poor sexual negotiation skills, the need to prove one’s fertility, sexual coercion and low self-esteem. Understanding of contraceptives and reproductive health was poor, condoms were the contraceptive method most known by teenagers and their understanding of the menstrual cycle was inaccurate. Most teenagers perceived falling pregnant as a negative event with consequences such as unemployment, loss of a boyfriend, blame from friends and family members, feeling guilty, difficulty at school, complications during pregnancy or delivery, risk of HIV, secondary infertility if an abortion is done and not being prepared for motherhood. A number of teenagers, however, perceived some benefits and saw that it could be a positive event depending on the circumstances. Conclusions: The study identified a number of factors that may influence the teenage pregnancy rate. These factors may influence teenagers’ behavioural intentions through altering their perceptions of the personal and social consequences of falling pregnant and their self-efficacy in relation to sexual behaviour. Environmental factors may also facilitate or prevent
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