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'Some anti-malarials are too strong for your body, they will harm you.' : socio-cultural factors influencing pregnant women's adherence to anti-malarial treatment in rural Gambia

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Abstract
Background: Despite declining prevalence of malaria in The Gambia, non-adherence to anti-malarial treatment still remains a challenge to control efforts. There is limited evidence on the socio-cultural factors that influence adherence to anti-malarial treatment in pregnancy. This study explored perceptions of malaria in pregnancy and their influence on adherence to anti-malarial treatment in a rural area of The Gambia. Methods: An exploratory ethnographic study was conducted ancillary to a cluster-randomized trial on scheduled screening and treatment of malaria in pregnancy at village level in the Upper River Region of The Gambia from June to August 2014. Qualitative data were collected through interviewing and participant observation. Analysis was concurrent to data collection and carried out using NVivo 10. Results: Although women had good bio-medical knowledge of malaria in pregnancy, adherence to anti-malarial treatment was generally perceived to be low. Pregnant women were perceived to discontinue the provided antimalarial treatment after one or 2 days mainly due to non-recognition of symptoms, perceived ineffectiveness of the anti-malarial treatment, the perceived risks of medication and advice received from mothers-in-law. Conclusion: Improving women's knowledge of malaria in pregnancy is not sufficient to assure adherence to antimalarial treatment. Addressing structural barriers such as unclear health workers' messages about medication dosage, illness recognition, side effects of the medication and the integration of relatives, especially the mothers-in-law, in community-based programmes are additionally required.
Keywords
PLASMODIUM-VIVAX, Adherence, Anti-malarials, Pregnancy, Rural Gambia

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MLA
Jaiteh, Fatou, et al. “’Some Anti-Malarials Are Too Strong for Your Body, They Will Harm You.’ : Socio-Cultural Factors Influencing Pregnant Women’s Adherence to Anti-Malarial Treatment in Rural Gambia.” MALARIA JOURNAL, vol. 15, 2016, doi:10.1186/s12936-016-1255-0.
APA
Jaiteh, F., Dierickx, S., Gryseels, C., O’Neill, S., D’Alessandro, U., Scott, S., … Peeters Grietens, K. (2016). ’Some anti-malarials are too strong for your body, they will harm you.’ : socio-cultural factors influencing pregnant women’s adherence to anti-malarial treatment in rural Gambia. MALARIA JOURNAL, 15. https://doi.org/10.1186/s12936-016-1255-0
Chicago author-date
Jaiteh, Fatou, Susan Dierickx, Charlotte Gryseels, Sarah O’Neill, Umberto D’Alessandro, Susana Scott, Julie Balen, and Koen Peeters Grietens. 2016. “’Some Anti-Malarials Are Too Strong for Your Body, They Will Harm You.’ : Socio-Cultural Factors Influencing Pregnant Women’s Adherence to Anti-Malarial Treatment in Rural Gambia.” MALARIA JOURNAL 15. https://doi.org/10.1186/s12936-016-1255-0.
Chicago author-date (all authors)
Jaiteh, Fatou, Susan Dierickx, Charlotte Gryseels, Sarah O’Neill, Umberto D’Alessandro, Susana Scott, Julie Balen, and Koen Peeters Grietens. 2016. “’Some Anti-Malarials Are Too Strong for Your Body, They Will Harm You.’ : Socio-Cultural Factors Influencing Pregnant Women’s Adherence to Anti-Malarial Treatment in Rural Gambia.” MALARIA JOURNAL 15. doi:10.1186/s12936-016-1255-0.
Vancouver
1.
Jaiteh F, Dierickx S, Gryseels C, O’Neill S, D’Alessandro U, Scott S, et al. ’Some anti-malarials are too strong for your body, they will harm you.’ : socio-cultural factors influencing pregnant women’s adherence to anti-malarial treatment in rural Gambia. MALARIA JOURNAL. 2016;15.
IEEE
[1]
F. Jaiteh et al., “’Some anti-malarials are too strong for your body, they will harm you.’ : socio-cultural factors influencing pregnant women’s adherence to anti-malarial treatment in rural Gambia,” MALARIA JOURNAL, vol. 15, 2016.
@article{8569441,
  abstract     = {{Background: Despite declining prevalence of malaria in The Gambia, non-adherence to anti-malarial treatment still remains a challenge to control efforts. There is limited evidence on the socio-cultural factors that influence adherence to anti-malarial treatment in pregnancy. This study explored perceptions of malaria in pregnancy and their influence on adherence to anti-malarial treatment in a rural area of The Gambia. 
Methods: An exploratory ethnographic study was conducted ancillary to a cluster-randomized trial on scheduled screening and treatment of malaria in pregnancy at village level in the Upper River Region of The Gambia from June to August 2014. Qualitative data were collected through interviewing and participant observation. Analysis was concurrent to data collection and carried out using NVivo 10. 
Results: Although women had good bio-medical knowledge of malaria in pregnancy, adherence to anti-malarial treatment was generally perceived to be low. Pregnant women were perceived to discontinue the provided antimalarial treatment after one or 2 days mainly due to non-recognition of symptoms, perceived ineffectiveness of the anti-malarial treatment, the perceived risks of medication and advice received from mothers-in-law. 
Conclusion: Improving women's knowledge of malaria in pregnancy is not sufficient to assure adherence to antimalarial treatment. Addressing structural barriers such as unclear health workers' messages about medication dosage, illness recognition, side effects of the medication and the integration of relatives, especially the mothers-in-law, in community-based programmes are additionally required.}},
  articleno    = {{195}},
  author       = {{Jaiteh, Fatou and Dierickx, Susan and Gryseels, Charlotte and O'Neill, Sarah and D'Alessandro, Umberto and Scott, Susana and Balen, Julie and Peeters Grietens, Koen}},
  issn         = {{1475-2875}},
  journal      = {{MALARIA JOURNAL}},
  keywords     = {{PLASMODIUM-VIVAX,Adherence,Anti-malarials,Pregnancy,Rural Gambia}},
  language     = {{eng}},
  pages        = {{7}},
  title        = {{'Some anti-malarials are too strong for your body, they will harm you.' : socio-cultural factors influencing pregnant women's adherence to anti-malarial treatment in rural Gambia}},
  url          = {{http://doi.org/10.1186/s12936-016-1255-0}},
  volume       = {{15}},
  year         = {{2016}},
}

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