Clinicians' experience with quinine-based treatment of malaria in the first trimester of pregnancy in Ghana: a phenomenological study.

Background: In pregnancy, treating malaria with quinine and reducing its adverse effects on pregnant women has posed a significant challenge to clinicians in malaria-endemic areas such as Ghana for over 2-decades. Clinicians' experiences, therefore, play a significant role in clinicians' choices of drugs to safeguard pregnant women. Thus, this study aims to explore clinicians' experiences with quinine-based treatment (QBT) of malaria in early pregnancy in the Tamale Metropolis of Ghana.

Methods: An exploratory qualitative approach, using a phenomenological design, was employed to allow for an in-depth exploration of the experiences of clinicians with QBT during first trimester pregnancy. The data were collected in-between June to July 2023, through key informant interviews with obstetricians/gynaecologists and in-depth interviews with other cadre of healthcare professionals, with a purposive sample of 26 participants, selected across the 2 largest healthcare facilities (Tamale Central Hospital and Tamale Teaching Hospital) in the Tamale Metropolis. The data were audio-recorded, transcribed and manually analysed using thematic analysis.

Results: The study revealed that clinicians have negative experiences, beliefs, and attitudes towards quinine-based treatment of malaria in pregnancy. Clinicians' experiences include deleterious side effects of quinine, professional norms, and institutional bottlenecks. Participants also encounter challenges related to clinicians and patient concordance, such as patients' beliefs, adherence to review schedules, fears of medico-legal issues, and myths about quinine which affect treatment choices. Participants' attitudes towards malaria treatment include "watchful waiting" and the tension to treat promptly amidst concerns about potential treatment risks. The novel findings of this study were "watchful waiting" and the treatment of uncomplicated malaria in early pregnancy with intravenous artesunate.

Conclusions: Clinicians' experiences with quinine-based treatment of malaria in pregnancy affect their attitude towards malaria treatment in pregnancy. Most clinicians with experiences of the side effects of quinine and patient negative beliefs about quinine, desist from prescribing it. It is important for the Ministry of Health and the Ghana Health Service to provide feedback systems that allow clinicians to communicate experiences on malaria treatment to policy makers to enable policy review on malaria treatment during pregnancy, particularly in first trimesters.