TY - JOUR T1 - The social dimensions of community delivery of intermittent preventive treatment of malaria in pregnancy in Madagascar, Mozambique, Nigeria and the Democratic Republic of the Congo JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2022-010079 VL - 7 IS - 11 SP - e010079 AU - Yara Alonso AU - Wade Lusengi AU - Manu F Manun’Ebo AU - Aimée M Rasoamananjaranahary AU - Noroharifetra Madison Rivontsoa AU - Estêvão Mucavele AU - Neusa Torres AU - Charfudin Sacoor AU - Hope Okebalama AU - Ugo James Agbor AU - Ogonna Nwankwo AU - Martin Meremikwu AU - Elaine Roman AU - Franco Pagnoni AU - Clara Menéndez AU - Khátia Munguambe AU - Cristina Enguita-Fernàndez Y1 - 2022/11/01 UR - http://gh.bmj.com/content/7/11/e010079.abstract N2 - Introduction Intermittent preventive treatment in pregnancy with sulphadoxine pyrimethamine (IPTp) is a key malaria prevention strategy in sub-Saharan African countries. We conducted an anthropological study as part of a project aiming to evaluate a community-based approach to the delivery of IPTp (C-IPTp) through community health workers (CHWs) in four countries (the Democratic Republic of Congo, Madagascar, Mozambique and Nigeria), to understand the social context in order to identify key factors that could influence C-IPTp acceptability.Methods A total of 796 in-depth interviews and 265 focus group discussions were undertaken between 2018 and 2021 in the four countries with pregnant women, women of reproductive age, traditional and facility-based healthcare providers, community leaders, and relatives of pregnant women. These were combined with direct observations (388) including both community-based and facility-based IPTp delivery. Grounded theory guided the overall study design and data collection, and data were analysed following a combination of content and thematic analysis.Results A series of key factors were found to influence acceptability, delivery and uptake of C-IPTp in project countries. Cross-cutting findings include the alignment of the strategy with existing social norms surrounding pregnancy and maternal health-seeking practices, the active involvement of influential and trusted actors in implementation activities, existing and sustained trust in CHWs, the influence of husbands and other relatives in pregnant women’s care-seeking decision-making, the working conditions of CHWs, pregnant women’s perceptions of SP for IPTp and persistent barriers to facility-based antenatal care access.Conclusions The findings provide evidence on the reported acceptability of C-IPTp among a wide range of actors, as well as the barriers and facilitators for delivery and uptake of the intervention. Overall, C-IPTp was accepted by the targeted communities, supporting the public health value of community-based interventions, although the barriers identified should be examined if large-scale implementation of the intervention is considered.Data are available on reasonable request. The anonymised data that support the findings of this study are available from the corresponding author, YA, on reasonable request. ER -