Tropical Medicine & International Health
March 2012  Volume 17, Issue 3  Pages 263–403
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-3156/currentissue

Malaria
Acceptability of coupling Intermittent Preventive Treatment in infants with the Expanded Programme on Immunization in three francophone countries in Africa
Alexandra de Sousa, Leon P. Rabarijaona, Jean L. Ndiaye, Doudou Sow, Mouhamed Ndyiae, Jacques Hassan, Nilda Lambo, Paul Adovohekpe, Flavia Guidetti, Judith Recht and Alphonse Affo
Article first published online: 29 NOV 2011 | DOI: 10.1111/j.1365-3156.2011.02915.x

Abstract
Objective  Intermittent preventive treatment in infants (IPTi) is a malaria control strategy currently recommended by WHO for implementation at scale in Africa, consisting of administration of sulphadoxine-pyrimethamine (SP) coupled with routine immunizations offered to children under 1 year. In this study, we analysed IPTi acceptability by communities and health staff.

Methods  Direct observation, in-depth interviews (IDIs) and focus group discussions (FGDs) were conducted in Benin, Madagascar and Senegal during IPTi pilot implementation. Villages were stratified by immunization coverage. Data were transcribed and analysed using NVivo7 software.

Results  Communities’ knowledge of malaria aetiology and diagnosis was good, although generally villagers did not seek treatment at health centres as their first choice. Perceptions and attitudes towards IPTi were very positive among communities and health workers. A misconception that SP was an antipyretic that prevents post-vaccinal fever contributed to IPTi’s acceptability. No refusals or negative rumours related to IPTi coupling with immunizations were identified, and IPTi did not negatively influence attitudes towards other malaria control strategies. Healthcare decisions about children, normatively made by the father, are starting to shift to educated and financially independent mothers.

Discussion  Intermittent preventive treatment in infants is well accepted by providers and communities, showing a synergic acceptability when coupled with routine immunizations. However, a misconception that SP alleviates fever should be addressed when scaling up implementation.