Table 2 Summary of studies included in the synthesis

Aberese‑Ako et al. [17]

To understand health system, socio‑cultural, economic and environmental

dynamics in utilization of LLINs among pregnant women in two Ghanaian regions

Pregnant women

Health care providers, opinion leaders

LLINs

Ghana

Ethnography using observations, informal conversations and IDIs

QSR Nvivo was used to support data coding. Data were triangulated and analysed thematically

Health systems, Individual, Socio-cultural and Environmental

Aberese-Ako et al. [57]

This ethnographic study explored how health care managers dealt with existing MiP policy implementation challenges and the consequences on IPTp‑SP uptake and access to maternal health care

Health managers, health providers, pregnant women, National Health Insurance Authority officials

IPTp-SP

Ghana

Ethnography using non‑participant observations, conversations, in‑depth interviews and case studies in eight health facilities and 12 communities for 12 months in two administrative regions in Ghana. Grounded theory analysis and data coded with support of QSR Nvivo

Health system,

Individual

Aberese-Ako et al. [58]

Ethnographic

study explored how health system, individual and socio-cultural factors influence

IPTp-SP uptake in two Ghanaian regions

Pregnant women, health providers, opinion leaders

IPTp-SP

Ghana

case studies

and in-depth interviews in 8 health facilities and 8 communities in two Ghanaian regions

Health system,

Individual, Socio-cultural

Arnaldo et al. [64]

Explored factors limiting access to and use of IPTp-SP rural Mozambique

46 Pregnant women

4 Health workers

IPTp-SP

Mozambique

Semi-structured interviews with

pregnant women, and health workers in a rural area of southern Mozambique

Data were transcribed, manually coded, and thematic analysis was done

Health system, Individual

Boene et al. [65]

To describe pregnant women’s perceptions of malaria, barriers to effective interventions and recommendations on effective interventions to prevent malaria infections

85 pregnant women

IPTp-SP,

LLINs

Mozambique

Mixed methods: observations, IDIs and focused ethnographic exercises

(Free-listing and Pairwise comparisons)

Thematic analysis. Data from focused

ethnographic exercises were summarized into frequency distribution tables and matrices

Individual

Chukwuocha et al. [27]

To assess perceptions on the use of LLINs and its implications in preventing malaria in pregnancy

Pregnant women, adolescent girls, non-pregnant women and men between 20 and 50 years old

Opinion leaders, local government officials,

elderly midwives, retired women leaders, drug

shop owners, traditional birth attendants

LLINs

Nigeria

FGDs, IDIs

key informant interviews and structured questionnaires

No method of data analysis mentioned nor described in the main text

Individual,

Socio-cultural

Diala et al. [61]

Examined social, cultural, and economic factors that serve as barriers to malaria treatment for pregnant women and possible factors to IPTp2 uptake in two Nigerian states

Women who had ever accessed ANC and MiP care, husbands or partners of women and health workers providing ANC and care for malaria in pregnancy

IPTp-SP

Nigeria

In-depth interviews, focus group discussions

Health system,

Socio-cultural,

Individual

Diala et al. [24]

Perspectives of pregnant women and ANC providers on real and perceived barriers to IPTp-SP adherence

Community-based and facility-based maternal health care providers, women of reproductive age and their husbands

IPTp-SP

Nigeria

Socio-ecological model, cross-sectional study, focus group discussions and in-depth interviews

Used Atlas ti software for analysis, coded using a framework and thematic analysis

Individual, Socio-cultural, Environmental

Doku et al. [25]

Pregnant women, health workers and health managers

To investigate factors contributing to high

dropout rate between IPT1 and IPT3 in the Tamale Metropolis of Ghana

IPTp-SP

Ghana

Survey, short ethnographic techniques

employing IDIs and non-participant observation Ethnographic techniques and content analysis

Health system,

Individual

Hill et al. [54]

Explored the delivery, access and use of interventions to control malaria in pregnancy

Non-pregnant women aged 15–49 years, pregnant women, mothers of children aged < 1 year and adolescent men

LLINs, IPTp-SP

Testing and treating malaria in pregnancy

Kenya,

Mali

Focus group discussions

Content analysis

Health system, Socio-cultural, Individual

Hurley et al. [68]

To identify factors contributing to low uptake of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP)

Pregnant women

IPTp-SP

Mali

Secondary data analysis on Mali’s2012–2013 Demographic and Health Survey (DHS)

IDIs, FGDs and ANC observations in six rural sites

Descriptive coding supported by ATLAS.ti

Health system,

Individual

Klein et al. [59]

Explored perceptions and experiences of IPTp-SP cost in Mali and its impact on uptake

Pregnant women, husbands, mothers-in-law and health workers

IPTp-SP

Mali

IDIs, FGDs, ANC observations and record reviews at health centres

Topical coding supported by ATLAS.ti (version 7)

Health system

Socio-cultural

Manu et al. [55]

Explored factors associated with LLIN use among pregnant women in the middle belt f Ghana

Women who had delivered six months prior to the study

LLINs

Ghana

Used IDIs and FGDs Thematic analysis of major themes put into a matrix for interpretation

Health system

Individual

Socio-cultural

Mubyazi [49]

Assessed knowledge, perceptions of antenatal care (ANC) services and actually delivered services and reasons for seeking ANC including intermittent presumptive treatment during pregnancy (IPTp-SP) against malaria

Pregnant women

IPTp-SP

Tanzania

Quantitative and qualitative

techniques were employed, involving interviews with ANC clients, informal

communications with health care workers, FGDs with mothers of young children, and intertemporal observations

Health system

Individual

Socio-cultural

Mubyazi and Bloch [9]

Described the experience and perceptions of pregnant women about costs and cost barriers to accessing

ANC services with emphasis on IPTp-SP in rural Tanzania

Pregnant women and mothers with infants

LLINs

IPTp-SP

Tanzania

FGDs and IDIs

Manually coded using qualitative content analysis

Health system

Environment

Individual

Mutagonda et al. [48]

To assess the knowledge and awareness of pregnant women regarding the use of IPTp-SP and artemether-lumefantrine (ALu) for treatment MiP

Pregnant women

IPTp-SP

Testing and treating MiP

Tanzania

Mixed method

FGDs conducted with 46 pregnant women

Qualitative data analysis not reported in the paper

Health system

Individual

Nyaaba et al. [3]

Explored factors influencing poor uptake of IPTp-SP and use of ITNs in lower socioeconomic communities in Nigeria

Traditional

birth attendants,

faith-based birth attendants, health care providers

IPTp-SP

LLINs

Nigeria

Semi-structured interviews with key stakeholders and focus group discussions with multi- and first-time pregnant women

Thematic approach was used in data analysis with the initial coding framework generated in QRS Nvivo

Health system

Socio-cultural,

Onoka et al. [62]

Examined the influence of demand side factors on IPTp-SP coverage

Women 15–49 years, who had delivered live babies during the previous year

IPTp-SP

Nigeria

FGDs

Content analysis was used to generate common themes

Socio-cultural

Individual

Onoka et al. [63]

Heads of maternal health

units of 28 public and six private health facilities

offering antenatal care (ANC) services in two districts

in south-east Nigeria

A checklist was used to check the availability of SP and water, review of facility staff registers to ascertain the number of health providers

Explored provider factors affecting the delivery of IPTp-SP

IPTp-SP

Nigeria

IDIs and information from checklist coded thematically. No software mentioned

Health system

Individual

Onyeneho et al. [60]

Identified perceptions and attitudes towards sleeping under LLINs and uptake of recommended doses of IPTp-SP

Health workers and mothers who delivered within 6 months preceding the study, grandmothers and fathers of children born within 6 months preceding the study

LLINs

IPTp-SP

Nigeria

A cross-sectional study in three local government areas. IDIs and FGDs

Thematic coding and Atlas.ti software was used in managing the data

Health system

Individual

Pell et al. [53]

Provided insight into the social and cultural context

to the uptake of interventions for malaria prevention and control in four sites within three countries

Pregnant women with pregnant women, their relatives, opinion leaders, other community members and health providers

LLINs

IPTp-SP

Ghana, Kenya, Malawi

IDIs and group interviews. Observations at health facilities and in local communities

Atlas.ti was used to support coding

Health system

Socio-cultural

Individual

Environmental

Quist and Adomah Afari [56]

Explore how socio-cultural beliefs and practices influence knowledge, attitude and perception of LLIN use in the control of malaria amongst pregnant women attending antenatal clinic

Pregnant women

LLINs

Ghana

Interviews and documentary review

NVivo, framework analysis was applied to classify emerging themes and the findings interpreted using the health belief model

Individual

Rassi et al. [50]

Assessed demand side barriers to accessibility, affordability and acceptability of IPTp-SP intervention

District health officials, health workers, women who attended antenatal care and

opinion leaders

IPTp-SP

Uganda

IDIs,

Thematic analysis

Individual

Socio-cultural

Environmental

Rassi et al. [51]

This study assessed supply-side barriers (health service provider), which impede IPTp-SP uptake in Uganda especially among women who attend ANC

District health officials, health workers, women attending antenatal care and

opinion leaders

IPTp-SP

Uganda

Document and record review in four health centres

IDIs

Used QSR NVivo to support thematic data coding and analysis

Health system

Taremwa et al. [52]

Explored knowledge, attitude, and behaviour towards the use of LLINs as a nightly malaria prevention strategy for pregnant women and children

Pregnant women and caregivers of children under five years old. Local council leaders, district health

inspectors, religious leaders, health workers and members

of village health teams (VHTs)

LLINs

Uganda

Mixed methods

Qualitative aspect involved conducting key informant interviews

Thematic content analysis. Manually analysed

Socio-cultural

Individual

Webster et al. [66]

To explain quantitative data from a related study

which identified ineffective processes in the delivery of IPTp-SP and LLINS in one district in Mali

Health workers at the national, regional, district and health facility levels

IPTp-SP

Mali

In-depth interviews with health workers at the national, regional, district and health facility levels

Thematic coding using content analysis

Health system

Yoder et al. [47]

Examined the experiences of nurses and midwives in providing antenatal care (ANC) services

Health care providers

IPTp-SP

Malawi

Interviews with a semi-structured interview guide

Content analysis

Health system