Implementation Status of Low-Dose Aspirin and Calcium Supplementation to Prevent Preeclampsia in Burkina Faso, Ethiopia, Kenya, Nigeria and Pakistan

Abstract Purpose Hypertensive disorders of pregnancy are a leading cause of maternal death. Global guidance recommends use of low-dose aspirin and calcium supplementation for prevention of preeclampsia. Published literature showcasing the implementation of these guidelines in low- and middle-income countries (LMICs) is sparse. Description The objective of this practice note is to share our findings related to implementation of low-dose aspirin and calcium supplementation for the prevention of preeclampsia in Burkina Faso, Ethiopia, Kenya, Nigeria and Pakistan. The experiences from these five countries can illustrate important aspects about the nature and scope of scale of these two evidence-based interventions in LMICs. Assessment Between May 2023 and March 2024, we conducted policy review and key informant interviews ( n = 59) at global and country level. Implementation efforts for the two interventions show variations in the policy environment and clinical practices across countries. Progress toward scale of low-dose aspirin is hampered by variable clinical practices, low provider and community awareness, late antenatal care attendance, and under resourced health systems including weak supply chains. In the case of calcium supplementation, a complicated regimen and conditional global recommendations leaves countries without actionable plans aligning with optimal counseling models for improved adherence. Conclusion Effective implementation of low-dose aspirin and calcium supplementation for preeclampsia prevention will require strengthening antenatal care and provision of services at the primary health care level and enabling the policy environment where needed. Increased coordination around a package of interventions aimed at reducing preeclampsia will also be critical going forward. Practice recommendations on policy, demand, clinical implementation, and monitoring are summarized.