Evidence map›Paper›PMID 39806485›Full record

ArticleMalaria journal2025

Acceptability of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine plus dihydroartemisinin-piperaquine in Papua New Guinea: a qualitative study.

Elvin Lufele, Sophie Pascoe, Alice Mengi, Alma Auwun, Nalisa Neuendorf, John W Bolnga, Moses Laman, Stephen J Rogerson, Kamala Thriemer, Holger W Unger

Abstract read
In one paragraph

Article in Malaria journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Elvin LufeleGlobal and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia. elvin.lufele@menzies.edu.au.
Sophie PascoeWellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
Alice MengiVector-Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea.
Alma AuwunVector-Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea.
Nalisa NeuendorfPopulation Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea.
John W BolngaVector-Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea.
Moses LamanVector-Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea.
Stephen J RogersonDepartment of Infectious Diseases, University of Melbourne, The Doherty Institute, Melbourne, VIC, Australia.
Kamala ThriemerGlobal and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
Holger W UngerGlobal and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.

Funding

Clinical Trials and Cohort Studies grant from the National Health and Medical Research Council of Australia GNT2000780
6 · The paper itself

Abstract

backgroundIn moderate-to-high malaria transmission regions, the World Health Organization recommends intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) alongside insecticide-treated bed nets to reduce the adverse consequences of pregnancy-associated malaria. Due to high-grade Plasmodium falciparum resistance to SP, novel treatment regimens need to be evaluated for IPTp, but these increase pill burden and treatment days. The present qualitative study assessed the acceptability of IPTp-SP plus dihydroartemisinin-piperaquine (DP) in Papua New Guinea, where IPTp-SP was implemented in 2009.

methodsIndividual in-depth interviews (IDIs) and focus group discussions were conducted at health facilities where a clinical trial evaluated IPTp-SP plus DP (three-day regimen) versus IPTp-SP plus DP-placebo. IDIs were conducted with: (1) trial participants at different stages of engagement with ANC and IPTp, e.g. first antenatal clinic visit, subsequent antenatal clinic visits and postpartum; (2) local health workers (nurses, community health workers, midwives, health extension officers, doctors); and (3) representatives of district, provincial and national health authorities involved in programming ANC and IPTp. Focus group discussions comprised pregnant women only, including those engaged in the clinical trial and those receiving routine ANC outside of the trial. All interviews were audio recorded and transcribed. Transcripts were analysed using inductive and deductive thematic analysis applying a framework assessing: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy.

resultsWomen expressed positive feelings and attitudes towards SP plus DP/DP-placebo; reported limited side effects; and found the size, number, colour, and taste of study medicines acceptable. Health workers and policymakers were concerned that, compared to SP alone, additional tablets, frequency (three-day regimen), and tablet size might be barriers to acceptability for users outside a non-trial setting. There was a high perceived effectiveness of SP plus DP; most women reported that they did not get malaria or felt sick during pregnancy. Broader healthcare benefits received through trial participation and the involvement of health workers, relatives and community members in the clinical trial enabled antenatal clinic attendance and perceived acceptability of this IPTp regimen.

conclusionsIn the trial context, IPTp-SP plus DP was acceptable to both users and providers. Healthcare providers were concerned about the realities of acceptability and adherence to SP plus DP outside a clinical trial setting.

Indexed as

AntimalarialsArtemisininsChemopreventionMalariaMalaria, FalciparumPatient Acceptance of Health CarePregnancy Complications, ParasiticPyrimethamineQuinolinesSulfadoxineAdolescentAdultDrug CombinationsFemaleHumansInterviews as TopicAntimalarialsArtemisininsartenimolDrug Combinationsfanasil, pyrimethamine drug combinationpiperaquinePiperazinesPyrimethamineQuinolinesSulfadoxineAcceptabilityDihydroartemisinin-piperaquineIntermittent preventive treatment in pregnancyMalariaPapua New GuineaPregnancyQualitative

Identifiers

PMID39806485
PMCPMC11731547

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.