ABSTRACT
The widespread problem of low and non-compliance to antimalarial chemoprophylaxis during pregnancy demands that attention be focused on alternative approaches to programming, product acceptability and demand for preventive services. This study describes the testing of three interventions to determine their effect on use of chloroquine (currently the most widely used drug for chemoprophylaxis) during pregnancy. The strategies evolved from community-based formative research undertaken to learn about the local concept of malaria and issues surrounding malaria prevention and treatment during pregnancy. The resulting interventions were tested in four clinics, and included a change in the health education message given during antenatal sessions, distribution of a sugar-coated chloroquine tablet, and an intervention combining the two strategies. The results showed a 45% increase in chloroquine use when the health education message was changed, and a 64% increase when the product was changed. High use levels were maintained with the combined intervention; an additive effect was seen. The study shows that improving the product was the most important factor in increasing the use of the program, and that changing the health education message can also make an impact on use.
Subject(s)
Chloroquine/therapeutic use , Malaria/prevention & control , Patient Compliance , Pregnancy Complications, Parasitic/prevention & control , Chemistry, Pharmaceutical , Chloroquine/administration & dosage , Chloroquine/chemistry , Chloroquine/urine , Effect Modifier, Epidemiologic , Female , Follow-Up Studies , Health Education , Humans , Pregnancy , Randomized Controlled Trials as Topic , Sweetening Agents/pharmacologyABSTRACT
Compliance to malaria chemoprophylaxis among pregnant women in Malawi has historically been low. Three separate interventions, based upon an ethnographic study of malaria beliefs among pregnant women in Malawi, were introduced to increase compliance to the malaria chemoprophylaxis program provided by the Ministry of Health. Each intervention consisted of a health education message and an antimalarial drug. A cost-effectiveness analysis of the interventions was conducted to compare the interventions as alternative strategies to increase compliance among pregnant women.
Subject(s)
Malaria/prevention & control , Patient Compliance , Pregnancy Complications, Parasitic/prevention & control , Anthropology, Cultural , Antimalarials/therapeutic use , Chloroquine/analogs & derivatives , Chloroquine/therapeutic use , Cost-Benefit Analysis , Female , Health Education , Humans , Malawi , Pregnancy , Preventive Health Services/economics , Process Assessment, Health CareABSTRACT
Experts acknowledge that communication projects would benefit from the use of open-ended interviews, focus groups, surveys, trials of behaviors, observation, and other research techniques to identify community and individual knowledge, beliefs, preferences, actual behavior, as well as a host of sociodemographic and economic characteristics necessary for planning and implementation. Communication planners often rely exclusively on survey research for program planning, claiming ease of administration and reliability of results. Reliance on this single research method often results in less appropriate interventions than could be developed with multiple research methods. This article reports the use of multiple methods to examine the cultural and behavioral factors which influence the use of antimalarial chemoprophylaxis during pregnancy in Malawi, Central Africa. This article will demonstrate how quantitative techniques such as cross sectional interviews and chemical tests as well as qualitative ethnographic information were used in the study; demonstrate how diverse results from multiple research techniques may be integrated; discuss general sources of bias in this research; and show how the use of multiple research methods may be incorporated in formative research for health communication programs.