Malaria chemoprophylaxis to pregnant women provided by community health workers in Saradidi, Kenya. I. Reasons for non-acceptance

Abstract

Chloroquine prophylaxis for malaria was available free of charge to pregnant women in Saradidi, Kenya. The drug was supplied by village health helpers (VHH's). However, only 29.1% of 357 pregnant women seen in antenatal clinics from 1983 to 1984 were on chemoprophylaxis. One hundred and seven pregnant women not using antimalarial chemoprophylaxis from 22 villages were interviewed in June 1984 to determine the reasons. Age (mean 26.9 years), parity (mean 4.5 children), occupation (96.3% subsistence farmers and housewives) and education (median five to seven years) of the 107 respondents were similar to other women in the area. Previous pregnancies had occurred in 92 women; for 15 this was the first pregnancy. The last pregnancy had resulted in a live birth for 81 (88.0%), a stillbirth for nine (9.8%) and a miscarriage for two (2.2%); 21 (22.8%) of the 92 had experienced a miscarriage or stillbirth at some time (15 once, five twice and one woman four times). Malaria was the most frequent mentioned (28.6% of 21 women) cause of the last stillbirth or abortion. The major reason for not taking chemoprophylaxis was lack of awareness that the service was available (53.3% of 107 women). Other reasons were fear of chloroquine-induced itching (10.3%), the VHH had no drug (8.4%), the VHH had not advised her to take drug (8.4%), the woman was ‘not sick’ (7.5%), the woman was ‘lazy’ (6.5%), she had not been advised by clinic so was afraid to mix medicines (3.7%) and chloroquine was ‘bad for pregnancy’ (1.9%). The results suggest that the Saradidi programme has not been effective in providing malaria chemoprophylaxis to pregnant women even though malaria is perceived as an important cause of abortions and stillbirths. Most pregnant women interviewed were not taking chloroquine for logistical or organizational reasons. The responses elicited suggest problems in training and communication. Asking VHH's to give malaria chemoprophylaxis to pregnant women in addition to their other responsibilities was too difficult for many of the VHH's. Providing chemoprophylaxis in antenatal clinics may be more effective.