Pregnant women’s acceptability of intermittent preventive treatment with dihydroartemisinin-piperaquine from user and provider’s perspectives: qualitative findings from the pilot implementation in Papua, Indonesia

Intermittent preventive treatment with dihyroartemisinin-piperaquine (IPTp-DP) was found to be safe and more cost-effective than the current policy of single screening and treatment for the prevention of malaria in pregnancy in Papua, Indonesia. However, acceptability of the strategy under routine conditions has yet to be explored. This qualitative study explored pregnant women’s acceptability of IPTp-DP in the context of a Ministry of Health pilot programme. In-depth interviews with 94 pregnant women, 103 healthcare providers/managers and 13 husbands were conducted at two time points in ten health centres as part of a wider mixed method evaluation of implementation feasibility. Data were coded using Sekhon’s Acceptability constructs. Thematic framework analysis was used to explore women’s acceptability of IPTp-DP over time and identify potential drivers of change, which were then triangulated with data from healthcare providers/managers and husbands. Women perceived malaria in pregnancy to be a serious issue and valued the opportunity to prevent malaria with IPTp-DP. They had initial concerns about the safety of taking DP in pregnancy without a diagnostic test. Concerns about safety and side effects were allayed with information and reassurance from healthcare providers. Changes in women’s acceptability of IPTp-DP were mainly driven by improved communication about the intervention from providers and enhanced engagement with family members/husbands through quality improvement activities. Health information about the benefits and safety of IPTp-DP for preventing malaria in pregnancy, together with support from spouses, were important drivers of women's acceptability of, and adherence to, IPTp-DP in this setting.