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

Intermittent preventive treatment in pregnancy with is a key malaria prevention strategy. We conducted an anthropological study to understand the social context of a community based approach to delivering sulphadoxine pyrimethamine (C-IPTp) through community health workers (CHWs) in four countries (the DRC, Madagascar, Mozambique and Nigeria) to identify key factors influencing the intervention’s acceptability. In-depth interviews, focus group discussions and direct observations were undertaken between 2018 and 2021. 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.