Abstract:
Background: Intermittent Preventive Treatment (IPTp) and insecticide treated nets (ITNs) are recommended malaria in
pregnancy preventive interventions in sub-Saharan Africa. Despite their cost-effectiveness and seemingly straight-forward
delivery mechanism, their uptake remains low. We aimed at describing perceptions of pregnant women regarding malaria
and the recommended prevention interventions to understand barriers to uptake and help to improve their effectiveness.
Methods and findings: We used mixed methods to collect data among 85 pregnant women from a rural area of Southern
Mozambique. Information was obtained through observations, in-depth interviews, and focused ethnographic exercises
(Free-listing and Pairwise comparisons). Thematic analysis was performed on qualitative data. Data from focused
ethnographic exercises were summarized into frequency distribution tables and matrices. Malaria was not viewed as a
threat to pregnancy. Participants were not fully aware of malaria- associated adverse maternal and birth outcomes. ITNs
were the most preferred and used malaria preventive intervention, while IPTp fell between second and third. Indoor
Residual Spraying (IRS) was the least preferred intervention.
Conclusions: Low awareness of the risks and adverse consequences of malaria in pregnancy did not seem to affect
acceptability or uptake to the different malaria preventive interventions in the same manner. Perceived convenience, the
delivery approach, and type of provider were the key factors. Pregnant women, through antenatal care (ANC) services, can
be the vehicles of ITN distribution in the communities to maximise overall ITN coverage. There is a need to improve
knowledge about neonatal health and malaria to improve uptake of interventions delivered through channels other than
the health facility.
