Integrating malaria control with immunization and antenatal care could dramatically increase frontline access, given annually 110 million families access immunization, and more access antenatal care. Review of experiences in low-income settings show that while often beneficial, integration efforts sometimes fail, and immunization may not always be the optimal platform. Additionally, while common strategic rationales for integrated services relate to greater efficiency and boosting coverage, the demand-side perspective is often omitted.
We nested research within a prospective observational cohort study tracking 700 pregnant women in rural Papua New Guinea from first antenatal visit until six months after childbirth. We conducted in-depth interviews on feasibility, acceptability and preferences regarding additional services added to antenatal or immunization care. We also measured mothers’ and infants’ co-morbidity including clinical data and results of point-of-care tests (POCT). Longitudinal follow-up allowed us to track how clinical patterns and preferences evolved. We checked our measures against a cross-sectional survey of providers and clinics; and extracted experiences integrating malaria interventions with immunization from a recent global systematic review.
A high prevalence of co-morbidity included under-nutrition, STIs, malaria and other infections. Malaria interventions were inconsistently reported at antenatal and immunization visits. Mothers had clear preferences for what should be integrated with antenatal and immunization care, which were were not always aligned with national and global recommendations. Malaria was not always ranked highly in relation to other services. A sub-set (10%) found integration not acceptable, the reasons provided have clear implications for service planning. Many women provided recommendations to overcome barriers to access. Preference patterns changed significantly as women progressed through the life course.
Previously unexamined clients’ needs and preferences illuminate new options for planners of integrated services. Understanding the nature of co-morbidity, co-existing health needs within families, and families’ preferences are essential to front-line service planning.