A cross-sectional survey of knowledge and perceptions related to prevention and treatment of malaria in pregnancy among health care providers at health facilities in Tanzania

A cross-sectional survey was conducted among 131 health-care providers in rural Tanzania to examine the knowledge and availability of malaria preventive and curative treatment for pregnant women recommended by the World Health Organization and contained in Tanzanian national guidelines. Perceptions of harm attributable to malaria infection and, separately, to malaria treatment were recorded, as well as malariaspecific training received in the last three years. Thirty-nine percent of providers correctly stated that malaria during the first trimester should be prevented by sleeping under insecticide treated nets only. In contrast, 80% of providers correctly reported that malaria is to be prevented using insecticide treated nets and intermittent preventive treatment of malaria with sulfadoxine-pyrimethamine during the second and third trimesters. Knowledge of appropriate first-trimester case management was correctly reported by 50% of providers, increasing to 60% when providers were asked to describe curative care for pregnant women in their second and third trimesters. Approximately 30% of the providers stated having received malaria training in the last three years. Untreated malaria infection was viewed as extremely harmful by over 93% of providers to pregnant women and their unborn babies in any trimester. Malaria treatment was considered harmful to pregnant women in the first trimester and unborn babies in the second and third trimesters by 44% and 45% of providers, respectively. Only 48%, 44% and 69% of providers reported having sulfadoxine-pyrimethamine, quinine, and artemisinincombination treatment available at the health facility, respectively, for preventive and curative care. These results suggest that the scale up of interventions to reduce the burden of malaria in pregnancy will, in part, require substantial improvements in supply chain management as well as pre-service training and in-service retraining of health-care providers in appropriate preventive and curative care with an emphasis on the safety of treatments by trimester.