1 | Page 1 Access to and use of preventive intermittent treatment for 2 Malaria during pregnancy: a qualitative study in Chókwè 3 district, Southern Mozambique 4 Paulo Arnaldo 1,2,4* , Isabel Cambe 3 , Amílcar Magasso 3 , Sérgio Chicumbe 3 , Eduard Rovira- 5 Vallbona 2 , Anna Rosanas-Urgell 2 , Sónia M. Enosse 1 6 1 Plataforma de Parasitologia Molecular, Instituto Nacional de Saúde, Maputo, Mozambique. 7 2 Department of Biomedical Sciences, Institute of Tropical Medicine, Belgium. 8 3 Unidade de Sistemas de Saúde, Instituto Nacional de Saúde, Maputo, Mozambique 9 4 Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium. 10 * Email: pauloarnaldo554@hotmail.com (PA) 11 Abstract 12 Background: Malaria remains a significant health problem in Mozambique, particularly to 13 pregnant women and children less than five years old. Intermittent preventive treatment is 14 recommended for malaria prevention in pregnancy (IPTp). Despite the widespread use and 15 cost-effectiveness of this intervention, the coverage remains low. In this study, we aimed to 16 explore the factors limiting the access and use of IPTp-SP in Chókwè district. 17 Methods and findings: We used qualitative research methods through semi-structured 18 interviews to collect data from 46 pregnant women and four health care staff from Chókwè, a 19 rural area of southern Mozambique. Data were transcribed, manually coded and analysed 20 using content and thematic method. Participants were not aware of pregnancy-related risks of 21 malaria infection or the benefit of malaria prevention in pregnancy. Late and infrequently 22 antenatal care (ANC) attendance, concerns about the long waiting time at ANC consultations, . CC-BY 4.0 International license not certified by peer review) is the author/funder. It is made available under a The copyright holder for this preprint (which was this version posted August 28, 2018. . https://doi.org/10.1101/402727 doi: bioRxiv preprint