IPTp2 coverage in Malawi. Other possible explanations for relatively low coverage of IPTp2 are related to the process of providing SP within ANC clinics: the actions and understandings of nurses and midwives, or the knowledge and actions of women attending ANC services.

Ashwood-Smith and colleagues conducted a study of the provision of sulphadixine-pyrimethamine (SP) in pregnancy in Blantyre District of Malawi in 2001 \[[@CR11]\]. The study found that the majority of the medical staff did not understand government guidelines clearly and were confused by the instructions to give the first dose during the second trimester and the second in the third trimester. Similarly, a study by Launiala and colleagues examined factors that affected compliance with IPTp guidelines by conducting focus groups and individual interviews among Yao women in Machingait made them dizzy. However, they explained that they would take the time necessary to convince women to take SP while in the ANC clinic rather than take at home. Several nurses stated that they encourage the women to return home quickly after taking SP so they can eat and drink as soon as possible.

The experience of nurses in providing SP to pregnant women taught them about the reasons women offered for initially refusing to take SP, and ways they could persuade women to accept the three white pills despite their bitter taste. Nurses recognized that women were not accustomed to taking drugs without food, and that some were afraid of possible side effects, mainly dizziness and nausea. Several nurses confessed that they too had trouble swallowing the