Mixed study on barriers of access to prevention, diagnosis and treatment of gestational malaria in pregnant women at risk from an endemic region of Colombia.

Background: Gestational malaria (GM) is a serious public health problem, control of GM requires guarantee universal access to prevention, diagnosis and treatment. In Colombia, no studies have been conducted on barriers to healthcare access for pregnant women exposed to GM. The objective of this study was to analyse the barriers to healthcare access for women at risk of GM in an endemic region of Colombia.

Methods: A mixed QUAN-QUAL study with 400 pregnant women; from this group, 28 were selected for the QUAL component, to which an interview with eight health workers was added. The barriers investigated were sociocultural, economic, institutional response capacity, knowledge of the actors, previous experiences and health financing. In the QUAN component, the frequency of the barriers and their associated factors were identified. In the QUAL component, a hermeneutic analysis was conducted to enhance the explanatory depth of the barriers, through open (description), axial (conceptual ordering) and selective (theorization) categorization.

Results: The most frequent barriers included delays in care from a physician (93%) or specialist (89%), and procedures with a Health-Promoting Entity (HPE) (84%); the least frequent barriers were the delivery of drugs (23%) and quality of care (23%). All pregnant women reported at least one barrier, 50% reported between 7 and 11 barriers, with the highest number of barriers among housewives, multigravida and poor pregnant women. The QUAL component included the intersection of GM with sociocultural and economic barriers, financial limitations of public health programmes, failure to fulfill responsibilities by health professionals, and a lack of knowledge regarding health rights among pregnant women.

Conclusion: Multiple access barriers were identified; the most affected subgroups were identified, and some sociocultural and economic explanations for this problem were explored in depth. It is important to expand the health action of GM control, and to improve the care of pregnant women and their quality of life.