“They Merely Prescribe and I Merely Swallow”: Perceptions of Antenatal Pharmaceuticals and Nutritional Supplements Among Pregnant Women in Bamako, Mali

• Published in: Maternal and child health journal 2020, Vol.24 (1), p.110-120
• Main Authors: Searle, Alexandra R., Hurley, Emily A., Doumbia, Seydou O., Winch, Peter J.
• Format: Article
• Language: English
• Subjects: Adult; Antimalarials - administration & dosage; Antimalarials - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; Beliefs, opinions and attitudes; Dietary supplements; Distribution; Drug Combinations; Drug dosages; Drugs; Female; Gynecology; Health aspects; Health Knowledge, Attitudes, Practice; HIV Infections - drug therapy; HIV Infections - prevention & control; Humans; Iron - administration & dosage; Iron - therapeutic use; Malaria; Malaria - prevention & control; Mali; Maternal & child health; Maternal and Child Health; Medicine; Medicine & Public Health; Patient outcomes; Pediatrics; Pharmaceuticals; Population Economics; Postnatal care; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Pregnancy Complications, Infectious - prevention & control; Pregnancy Complications, Parasitic - drug therapy; Pregnancy Complications, Parasitic - prevention & control; Pregnant women; Pregnant Women - psychology; Prenatal Care - methods; Prescriptions; Public Health; Pyrimethamine - administration & dosage; Pyrimethamine - therapeutic use; Qualitative Research; Quality of Health Care; Side effects; Sociology; Sulfadoxine - administration & dosage; Sulfadoxine - therapeutic use; Vector-borne diseases
• ISSN: 1092-7875; 1573-6628
• DOI: 10.1007/s10995-019-02808-2

Objectives New international guidelines for antenatal care (ANC) will likely result in an increase in nutritional supplements and preventative medications for pregnant women in low and middle-income countries. Our objective was to understand how pregnant women in Mali perceive and experience multi-drug regimens in ANC in order to reveal factors that may influence uptake and adherence. Methods We conducted 29 semi-structured interviews and three focus groups with 21 pregnant women in two urban ANC sites in Bamako, Mali. Interviews focused on perception of purpose of ANC pharmaceuticals (particularly iron supplements, sulfadoxine-pyrimethamine as intermittent prevention of malaria and antiretroviral therapy for HIV), beliefs regarding efficacy and risk, and understanding of dosage and regimen. Transcripts were inductively coded and analyzed using the ‘Framework’ method. Results Participant descriptions of medication purpose, understanding of dosing, and beliefs about risks and efficacy varied widely, revealing that many pregnant women lack complete information about their medications. While some were burdened by side effects or complex regimens, women generally held favorable attitudes toward ANC medications. Responses suggest major barriers to adherence lie in the health system, namely insufficient patient-provider communication and inconsistent prescribing practices. Conclusions for Practice National health programs looking to improve maternal and child health with ANC pharmaceuticals need to place greater attention on patient counseling and consistent implementation of administration guidelines. Communication that positions pharmaceuticals as beneficial to mother and child, while presenting understandable information about purpose, dosing and potential side effects can promote uptake of multi-drug regimens and ANC services in general.