Publication Date

2024

"Better understanding of the various psycho-social factors associated with behaviors can inform tailored interventions."

This brief, published by Breakthrough ACTION, summarises data trends related to the prevention of malaria in pregnancy emerging from Malaria Behavior Surveys in six countries: Benin, Cameroon, Côte d'Ivoire, the Democratic Republic of the Congo, Malawi, and Sierra Leone. It also includes evidence-based recommendations for using social and behaviour change (SBC) to increase the uptake of intermittent preventive treatment during pregnancy (IPTp) and antenatal care (ANC) based on these data trends.

As explained in this brief, "In 2022, 36% of pregnant women in the WHO [World Health Organization] African Region were infected with malaria. Pregnant women have a higher risk of infection than non-pregnant women, particularly during the first and second trimesters of pregnancy. Malaria in pregnancy contributes to preterm birth and low birth weight, increasing the risk of morbidity, including cognitive and social developmental delays and mortality. The WHO recommends that pregnant women have at least eight antenatal care contacts with a health provider and take at least three doses of intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) beginning in the second trimester. Attendance at ANC in the first trimester of pregnancy is associated with a greater likelihood of receiving IPTp3, reducing the risk of malaria in pregnancy and associated adverse outcomes."

The United States President's Malaria Initiative (PMI) is partnering with Breakthrough ACTION and national malaria control programmes to implement the Malaria Behavior Survey, a theory-based household survey designed to assess factors associated with malaria-related behaviours with the goal of informing tailored SBC interventions. At the time of publishing this summary, surveys had been conducted in 11 countries with two more in progress. Survey results related to a variety of behaviours from all countries can be found on the Malaria Behavior Survey website. This report is a synthesis of the results related to the prevention of malaria in pregnancy fielded between 2018 and 2021 in six countries.

Based on the results of the survey, the brief outlines three trends together with a list of SBC recommendations related to that trend.

The first trend identified is that the intention to attend prenatal care in the first trimester is associated with several psychosocial factors, including whether women felt confident in their ability to make it to health facilities for prenatal appointments, had correct knowledge about malaria in pregnancy, had favourable attitudes towards IPTp, perceived malaria in pregnancy as severe, talked to others about malaria, and perceived that attending prenatal care the recommended number of times was the social norm.

The recommendations include, for example: celebrating women in the community who do attend early prenatal care using testimonials where they explain the barriers they faced and how they overcame them. These testimonials can also discuss the benefits women feel this behaviour brought them and their pregnancy.

The second trend involves the barriers to attending prenatal care in the first trimester, which were primarily related to a lack of knowledge that prenatal visits are preventative care (for example, women reported that they felt fine so didn't see a reason to see a health provider in the first trimester) and access (women reported inadequate finances, lack of money for transport, lack of time, and a long distance to the facility). Not knowing one's pregnancy status can also, in part, reflect a lack of access to pregnancy testing and counselling.

The list of recommendations on how to assist with perceived and real barriers to prenatal care includes, for example, encouraging communities to organise group transportation for those who live a long distance away from a health facility and changing the perception that it is important to go for prenatal care visits early in pregnancy even if a pregnant woman is feeling well.

The third trend highlights the importance of spousal support and shared decision-making in early prenatal care attendance. Male engagement and shared decision-making are critical for securing the needed family resources to seek early medical services.

SBC recommendations for addressing these issues include encouraging male community role models to voice their intention to share decision-making or to support their partner to make her own decisions about prenatal care attendance. Programmes can encourage couples to discuss the importance of attending prenatal care appointments, provide conversation prompts to spark the discussion, and plan ahead for prenatal care.