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A Qualitative Health Systems Effectiveness Analysis of the Prevention of Malaria in Pregnancy with Intermittent Preventive Treatment and Insecticide Treated Nets in Mali

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  • Jayne Webster
  • Kassoum Kayentao
  • Samba Diarra
  • Sory I Diawara
  • Alhassane Ag Haiballa
  • Ogobara K Doumbo
  • Jenny Hill

Abstract

Introduction: Delivery of intermittent preventive treatment with sulphadoxine-pyrimethamine to pregnant women (IPTp-SP) through antenatal clinic (ANC) in Mali is low, and whilst ANC delivery of insecticide treated nets (ITNs) is higher, coverage is still below national and international targets. The aim of this study was to explain quantitative data from a related study which identified ineffective processes in the delivery of these interventions in one district in Mali. Methods: In-depth interviews were conducted with health workers at the national, regional, district and health facility levels on their perceptions of reasons for the ineffective processes identified in the quantitative study, and their reported practices. Themes were coded for each ineffective process, and within these a health systems lens was used. Content analysis was used for emergent themes within this framework. MindMaps were used to display the findings. Results: Intervention specific factors for the ineffective delivery of IPTp-SP included misunderstanding of the upper limit of the gestational age at which SP could be given and side effects of SP. Incorrect practices had been recommended in training and supervision of health workers. Pregnant women who were ill on attendance at ANC were not consistently managed across health facilities. The most common reason for not offering women an ITN on their first ANC visit was if they were from outside the health facility catchment area. Broader health systems issues influencing the effectiveness of delivery of each of these interventions were also identified. Conclusion: In this setting, intervention-specific factors resulted in the ineffective delivery of IPTp-SP. These relate to complex policy guidelines, lack of guidance on how to implement the guidelines, and the institutionalising of practices that undermine the national guidelines. Interventions may be implemented and show real gains in the shorter-term whilst waiting for broader health systems issues to be addressed.

Suggested Citation

  • Jayne Webster & Kassoum Kayentao & Samba Diarra & Sory I Diawara & Alhassane Ag Haiballa & Ogobara K Doumbo & Jenny Hill, 2013. "A Qualitative Health Systems Effectiveness Analysis of the Prevention of Malaria in Pregnancy with Intermittent Preventive Treatment and Insecticide Treated Nets in Mali," PLOS ONE, Public Library of Science, vol. 8(7), pages 1-12, July.
    • Handle: RePEc:plo:pone00:0065437
    DOI: 10.1371/journal.pone.0065437
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    References listed on IDEAS

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    1. Abdisalan M Noor & Abdinasir A Amin & Willis S Akhwale & Robert W Snow, 2007. "Increasing Coverage and Decreasing Inequity in Insecticide-Treated Bed Net Use among Rural Kenyan Children," PLOS Medicine, Public Library of Science, vol. 4(8), pages 1-8, August.
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    Cited by:

    1. Juliet Iwelunmor & Jacob Plange-Rhule & Collins O Airhihenbuwa & Chizoba Ezepue & Olugbenga Ogedegbe, 2015. "A Narrative Synthesis of the Health Systems Factors Influencing Optimal Hypertension Control in Sub-Saharan Africa," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-17, July.
    2. Diawara Sory Ibrahim & Kayentao Kassoum & Konaté Drissa & Diarra Souleymane Sekou & Oumou Coulibaly & Diakité Mahamadou & Doumbia Seydou & Tounkara Moctar, 2020. "Coverage of Malaria Interventions During Antenatal Care in Mali," Biomedical Journal of Scientific & Technical Research, Biomedical Research Network+, LLC, vol. 30(2), pages 23319-23324, September.

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