{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T05:57:01Z","timestamp":1781675821178,"version":"3.54.5"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-001347"],"award-info":[{"award-number":["INV-001347"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Matern Child Health J"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Description<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Assessment<\/jats:title>\n                    <jats:p>\n                      Between May 2023 and March 2024, we conducted policy review and key informant interviews (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200959) 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10995-026-04270-3","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T22:37:11Z","timestamp":1780439831000},"page":"731-741","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation Status of Low-Dose Aspirin and Calcium Supplementation to Prevent Preeclampsia in Burkina Faso, Ethiopia, Kenya, Nigeria and Pakistan"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8961-0910","authenticated-orcid":false,"given":"Patricia S.","family":"Coffey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"Mansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nesibu","family":"Agonafir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gbenga","family":"Ishola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basilia Coefe","family":"Nitiema","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan E.","family":"Parker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soha","family":"Randhawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Shauri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharine D.","family":"Shelley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"4270_CR1","unstructured":"ATCO Lab. (n.d.). Ascard. ATCO. Retrieved June 13, 2024, from https:\/\/www.atcolab.com\/product\/acetylsalicylic-acid\/"},{"issue":"3","key":"4270_CR2","doi-asserted-by":"publisher","first-page":"3","DOI":"10.51253\/pafmj.v72i3.8600","volume":"72","author":"SM Baqai","year":"2022","unstructured":"Baqai, S. M., Rahim, R., Ala, H., Tarar, S. H., Waqar, F., Yasmeen, H., & Waheed, A. (2022). Society of Obstetricians and Gynaecologists Pakistan (SOGP) hypertensive disorders in pregnancy guidelines- 2022. Pakistan Armed Forces Medical Journal, 72(3), 3. https:\/\/doi.org\/10.51253\/pafmj.v72i3.8600","journal-title":"Pakistan Armed Forces Medical Journal"},{"key":"4270_CR3","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001059.pub6","author":"CA Cluver","year":"2025","unstructured":"Cluver, C. A., Rohwer, C., & Rohwer, A. C. (2025). Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database of Systematic Reviews. https:\/\/doi.org\/10.1002\/14651858.CD001059.pub6","journal-title":"Cochrane Database of Systematic Reviews"},{"issue":"4","key":"4270_CR4","doi-asserted-by":"publisher","first-page":"e016494","DOI":"10.1136\/bmjgh-2024-016494","volume":"10","author":"PS Coffey","year":"2025","unstructured":"Coffey, P. S., Parker, M. E., Shelley, K. D., Ebeling, E., Nguti, L., Knudson, S., Agonafir, N., Ahmed, S., Subramanian, S., Mansen, K., Khan, S., Engmann, C., & Shearer, J. C. (2025). Developing a framework for monitoring the stages towards achieving effective coverage and equity for maternal, newborn, child health and nutrition interventions. BMJ Global Health, 10(4), e016494. https:\/\/doi.org\/10.1136\/bmjgh-2024-016494","journal-title":"BMJ Global Health"},{"issue":"2","key":"4270_CR5","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1056\/NEJMoa2307212","volume":"390","author":"P Dwarkanath","year":"2024","unstructured":"Dwarkanath, P., Muhihi, A., Sudfeld, C. R., Wylie, B. J., Wang, M., Perumal, N., Thomas, T., Kinyogoli, S. M., Bakari, M., Fernandez, R., Raj, J.-M., Swai, N. O., Buggi, N., Shobha, R., Sando, M. M., Duggan, C. P., Masanja, H. M., Kurpad, A. V., Pembe, A. B., & Fawzi, W. W. (2024). Two randomized trials of low-dose calcium supplementation in pregnancy. New England Journal of Medicine, 390(2), 143\u2013153. https:\/\/doi.org\/10.1056\/NEJMoa2307212","journal-title":"New England Journal of Medicine"},{"key":"4270_CR6","unstructured":"Ekman, C. (2024). Concept Foundation and partners lead the largest ever trial study on use of aspirin to prevent pre-eclampsia, investigating optimal dosage and risks of blood loss. Concept Foundation. https:\/\/www.conceptfoundation.org\/concept-foundation\/concept-foundation-and-partners-lead-the-largest-ever-trial-study-on-use-of-aspirin-to-prevent-pre-eclampsia\/"},{"key":"4270_CR7","unstructured":"Ethiopian Food and Drug Administration (2023). Summary of Product Characteristics. http:\/\/www.fmhaca.gov.et\/wp-content\/uploads\/2023\/10\/Acetylsalicylic-Acid-enteric-coated-Tablets-BP-81-mg-Aspi-SSP-81SANSHENG-PHARMACEUTICAL-PLC.pdf"},{"key":"4270_CR8","unstructured":"Ethiopian Pharmaceuticals Manufacturing (2016). Products. Ethiopian Pharmaceuticals Manufacturing Sh. Co. http:\/\/www.epharmsc.com\/products-2\/"},{"key":"4270_CR9","unstructured":"FAO\/WHO GIFT. (n.d.). Global Individual Food Consumption Data Tool. Food and Agricultural Organization of the United Nations. Retrieved June 13 (2024). from https:\/\/www.fao.org\/gift-individual-food-consumption\/data\/en"},{"key":"4270_CR10","unstructured":"FIGO (2019). FIGO releases new guidelines to combat Pre-Eclampsia. FIGO: The Global Voice for Women\u2019s Health. https:\/\/www.figo.org\/figo-releases-new-guidelines-combat-pre-eclampsia"},{"key":"4270_CR11","unstructured":"Highnoon (2022). Loprin. Highnoon. https:\/\/highnoon-labs.com\/hi_products\/loprin\/"},{"issue":"1","key":"4270_CR12","doi-asserted-by":"publisher","first-page":"e2400074","DOI":"10.9745\/GHSP-D-24-00074","volume":"12","author":"S Hodgins","year":"2024","unstructured":"Hodgins, S., & Mathai, M. (2024). Low-dose antenatal calcium supplementation: An intervention ready for prime time. Global Health, Science and Practice, 12(1), e2400074. https:\/\/doi.org\/10.9745\/GHSP-D-24-00074","journal-title":"Global Health, Science and Practice"},{"issue":"10","key":"4270_CR13","doi-asserted-by":"publisher","first-page":"CD001059","DOI":"10.1002\/14651858.CD001059.pub5","volume":"2018","author":"GJ Hofmeyr","year":"2018","unstructured":"Hofmeyr, G. J., Lawrie, T. A., Atallah, \u00c1. N., & Torloni, M. R. (2018). Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database of Systematic Reviews, 2018(10), CD001059. https:\/\/doi.org\/10.1002\/14651858.CD001059.pub5","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"4270_CR14","unstructured":"Institute for Health Metrics and Evaluation (IHME) (2025). GBD Results. https:\/\/vizhub.healthdata.org\/gbd-results\/"},{"key":"4270_CR15","unstructured":"JUHEL (2022). Analgesics. JUHEL. https:\/\/juhelnigeria.com\/analgesics\/"},{"key":"4270_CR16","unstructured":"Noriega, A., Sharma, G., Gomez, P., Somji, A., Blockett, A., & Stalls, S. (2022). National Programs for the Prevention and Management of Postpartum Hemorrhage and Hypertensive Disorders of Pregnancy: A Global Survey. USAID MOMENTUM. https:\/\/usaidmomentum.org\/resource\/national-programs-for-the-prevention-and-management-of-postpartum-hemorrhage-and-hypertensive-disorders-of-pregnancy-a-global-survey\/"},{"key":"4270_CR17","unstructured":"PATH (2024). Explore the dashboard tool. Tracking the Journey to Scale for Lifesaving Maternal, Newborn, and Child Health and Nutrition Interventions. https:\/\/www.path.org\/who-we-are\/programs\/primary-health-care\/tracking-the-journey-to-scale\/#an-asset-tracker"},{"key":"4270_CR18","unstructured":"Revvity (2024). RONIA\u2122 Platform. Revvity. https:\/\/www.revvity.com\/category\/pigf-testing-research"},{"key":"4270_CR32","doi-asserted-by":"publisher","unstructured":"Robbins, T., Hanlon, C., Kelly, A. H., Gidiri, M. F., Musiyiwa, M., Silverio, S. A., Shennan, A. H., & Sandall, J. (2021). Pills and prayers: a comparative qualitative study of community conceptualisations of pre-eclampsia and pluralistic care in Ethiopia, Haiti and Zimbabwe. BMC Pregnancy and Childbirth, 21(1), 716. https:\/\/doi.org\/10.1186\/s12884-021-04186-6","DOI":"10.1186\/s12884-021-04186-6"},{"issue":"7","key":"4270_CR19","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1056\/NEJMoa1704559","volume":"377","author":"DL Rolnik","year":"2017","unstructured":"Rolnik, D. L., Wright, D., Poon, L. C., O\u2019Gorman, N., Syngelaki, A., de Paco Matallana, C., Akolekar, R., Cicero, S., Janga, D., Singh, M., Molina, F. S., Persico, N., Jani, J. C., Plasencia, W., Papaioannou, G., Tenenbaum-Gavish, K., Meiri, H., Gizurarson, S., Maclagan, K., & Nicolaides, K. H. (2017). Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. New England Journal of Medicine, 377(7), 613\u2013622. https:\/\/doi.org\/10.1056\/NEJMoa1704559","journal-title":"New England Journal of Medicine"},{"issue":"6","key":"4270_CR20","doi-asserted-by":"publisher","first-page":"e323","DOI":"10.1016\/S2214-109X(14)70227-X","volume":"2","author":"L Say","year":"2014","unstructured":"Say, L., Chou, D., Gemmill, A., Tun\u00e7alp, \u00d6., Moller, A. B., Daniels, J., G\u00fclmezoglu, A. M., Temmerman, M., & Alkema, L. (2014). Global causes of maternal death: A WHO systematic analysis. The Lancet Global Health, 2(6), e323\u2013333. https:\/\/doi.org\/10.1016\/S2214-109X(14)70227-X","journal-title":"The Lancet Global Health"},{"issue":"9","key":"4270_CR21","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1007\/s11906-020-01082-w","volume":"22","author":"RG Sinkey","year":"2020","unstructured":"Sinkey, R. G., Battarbee, A. N., Bello, N. A., Ives, C. W., Oparil, S., & Tita, A. T. N. (2020). Prevention, diagnosis, and management of hypertensive disorders of pregnancy: A comparison of international guidelines. Current Hypertension Reports, 22(9), 66. https:\/\/doi.org\/10.1007\/s11906-020-01082-w","journal-title":"Current Hypertension Reports"},{"key":"4270_CR22","unstructured":"The Fetal Medicine Foundation. (version 1.0.19). Risk for preeclampsia: Risk Assessment. The Fetal Medicine Foundation. Retrieved June 13 (2024). https:\/\/fetalmedicine.org\/research\/assess\/preeclampsia\/first-trimester"},{"issue":"5","key":"4270_CR23","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1080\/13561820.2018.1470499","volume":"32","author":"S Vinayak","year":"2018","unstructured":"Vinayak, S., & Brownie, S. (2018). Collaborative task-sharing to enhance the point-of-care ultrasound (POCUS) access among expectant women in Kenya: The role of midwife sonographers. Journal of Interprofessional Care, 32(5), 641\u2013644. https:\/\/doi.org\/10.1080\/13561820.2018.1470499","journal-title":"Journal of Interprofessional Care"},{"issue":"1","key":"4270_CR24","doi-asserted-by":"publisher","first-page":"922","DOI":"10.1186\/s12909-023-04886-x","volume":"23","author":"J Wachira","year":"2023","unstructured":"Wachira, J., Matheka, D. M., Masheti, S. A., Githemo, G. K., Shah, S., Haldeman, M. S., Ramos, M., & Bergman, K. (2023). A training program for obstetrics point-of-care ultrasound to 514 rural healthcare providers in Kenya. BMC Medical Education, 23(1), 922. https:\/\/doi.org\/10.1186\/s12909-023-04886-x","journal-title":"BMC Medical Education"},{"key":"4270_CR26","unstructured":"World Health Organization (2011). WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. WHO. https:\/\/www.who.int\/publications\/i\/item\/9789241548335"},{"key":"4270_CR27","unstructured":"World Health Organization (2018). WHO recommendation: Calcium supplementation during pregnancy for prevention of pre-eclampsia and its complications. WHO. https:\/\/www.who.int\/publications\/i\/item\/9789241550451"},{"key":"4270_CR28","unstructured":"World Health Organization (2021). WHO recommendations on antiplatelet agents for the prevention of pre-eclampsia. WHO. https:\/\/www.who.int\/publications\/i\/item\/9789240037540"},{"key":"4270_CR29","unstructured":"World Health Organization (2023a). Trends in maternal mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population Division. WHO. https:\/\/www.who.int\/publications\/i\/item\/9789240068759"},{"key":"4270_CR30","unstructured":"World Health Organization (2023b). A roadmap to combat postpartum haemorrhage between 2023 and 2030. WHO. https:\/\/www.who.int\/publications\/i\/item\/9789240081802"},{"key":"4270_CR31","unstructured":"World Health Organization (2024). Maternal mortality. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/maternal-mortality"},{"key":"4270_CR25","unstructured":"World Health Organization. (2026). Global pre-eclampsia summit. Retrieved April 18 (2026). https:\/\/www.who.int\/news-room\/events\/detail\/2026\/05\/05\/default-calendar\/global-pre-eclampsia-summit"}],"container-title":["Maternal and Child Health Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10995-026-04270-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10995-026-04270-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10995-026-04270-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T05:36:19Z","timestamp":1781674579000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10995-026-04270-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":32,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["4270"],"URL":"https:\/\/doi.org\/10.1007\/s10995-026-04270-3","relation":{},"ISSN":["1092-7875","1573-6628"],"issn-type":[{"value":"1092-7875","type":"print"},{"value":"1573-6628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"26 July 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Nothing to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This assessment (Sponsor Protocol Number RES-00534) underwent ethics review and was granted an exemption by WCG IRB in April 2023 and the protocol was also approved (Ref. Number ERC\/S20\/P-026) by the Applied Economics Research Centre (AERC) Committee on Ethics IRB in Pakistan in May 2023 and the Maseno University Ethics Review Committee in Kenya in August 2023 (included within an existing umbrella protocol Ref. Number 1628333 [IRBNet]). For the other three countries, local IRB review was not required and instead we obtained a letter of approval from the Ministry of Health to conduct all data collection activities.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"Verbal consent was obtained from all key informants prior to interview.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}},{"value":"Consent was obtained from study participants to publish summary findings.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication"}}]}}