Table 3.
Experiences and perceptions on the feasibility of ISTp-DP vs. IPTp-SP among healthcare providers and pregnant women
| Feasibility framework | Themes | Pregnant women | Healthcare providers |
|---|---|---|---|
| Sub-themes | Sub-themes | ||
| Acceptability | ISTp vs. IPTp | Women want to know if they have an illness and either receive prevention or treatment; happy to be tested, gives peace of mind; testing can be painful; women not always told what the test is for |
ISTp: better to test before treating for malaria; reduce unnecessary medication in pregnancy; good to identify asymptomatic cases; prefer not to rely on RDTs; women may not want repeated testing; complaints of testing at every visita IPTp: good because focused on prevention; concerns about resistance to SP; women accepted IPTp once benefits were explaineda IPT/IST: Women are accepting of tests and treatments offered at ANCa |
| DP and SP | Women are not always sure about taking drugs during pregnancy; complaints about side effects nausea, dizziness, headaches (both SP and DP but more frequent with SP); women happy with DP, it cured malaria; not happy to take SP on empty stomach | n/a | |
| RDTs vs. microscopy | n/a | RDTs: fast, convenient and easy to use; good alternative to microscopy when no laboratory technician or electricity; not always accurate; they do not detect all species of malaria; some confusion that finger prick was for HIV testinga; RDTs more accepted because of HIV testinga | |
|
Demand (pregnant women) Implementation/integration (Healthcare providers) |
ISTp delivery at ANC | Women are motivated to return to ANC to be tested for malaria | “One-stop-shop” is good for women, reduces wait times, continuity of care; better follow up for women receiving treatment; better to dispense anti-malarials at ANC; only pharmacy should dispense drugs; need adequate staffing to carry out screening at ANC |
| Demand | DP vs. SP | Women are motivated to attend ANC to receive drugs, treatments |
DP: effective drug as women don’t return with malaria; has shorter dosing regimen than quinine; expensive for women to buy if out of stock at health facility; should only be used for treatment, don’t want to build resistance to it SP: has been good in reducing the burden of MiP; concerns about resistance; good for prevention because can be given in one dose by DOT |
| Practicality | Sustainability of RDTs and DP | n/a | Stock outs for both RDTs and DP; women may not afford DP if they need to buy from private providers; limited as facilities can only order from KEMSA |
| Adaptation/expansion | ISTp delivery at ANC | n/a | Have high workloads already, RDTs in ANC may add to that; RDTs at ANC save time as we don’t need to wait from women to return from the laboratory; reduced workload for laboratory staff; happy for ANC providers to administer RDTs if properly trained |
ISTp intermittent screening and treatment, IPTp intermittent preventive treatment, DP dihydroartemisinin–piperaquine, SP sulfadoxine–pyrimethamine, RDT rapid diagnostic test, ANC antenatal care, KEMSA Kenya Medical Supplies Authority
aHealth care provider perceptions of pregnant women