Barriers to early pregnancy intervention to prevent preeclampsia/eclampsia especially: the use of calcium and low dose aspirin in Blantyre, Malawi

Abstract

Calcium and aspirin for prevention of preeclampsia is widely implemented and highly recommended. However, despite evidence of proven safety and efficacy, in low resource settings such as Malawi, the barriers to its use as well as efficacy of calcium and aspirin remained a subject needing further research. This thesis examined barriers to early pregnancy intervention, and efficacy of calcium and low dose of aspirin in preventing preeclampsia and eclampsia in high-risk pregnant women, in Blantyre, Malawi. The study further assessed the knowledge of patients, health workers (HCW) and key policy informants and towards reeclampsia/eclampsia at QECH and assessed knowledge and perception of HCW and key policy informants of the use of calcium and low dose of aspirin as a preventive measure of preeclampsia/eclampsia. Lastly, the study also examined factors that influenced implementation of calcium and aspirin for prevention of preeclampsia in Blantyre, Malawi. This was a mixed methods study design using a qualitative approach (pre-and post-trial). The implementation component was conducted through a double-blind cluster randomised controlled clinical trial (RCT) in 266 women, across 4 health care and 1 tertiary referral hospital. In this RCT, aspirin was compared to a placebo, and all women were given calcium supplements from 12 to 34 weeks of gestation. In keeping with the current data, this thesis demonstrates that calcium and aspirin were not well known among patients and some HCWs and key policy informants as a preventive intervention for preeclampsia prior to the trial. The RCT demonstrated an overall low rate of preeclampsia even though there was no significant different between aspirin and placebo group in terms of primary and secondary maternal and neonatal outcomes. This study also shows that lack of knowledge, calcium unavailability, misconceptions, pill burden, lack of local evidence, poor adherence, side effects, lack of support and unavailability of guidelines are the barriers to the use. Most importantly, findings from this study show that a clinical trial was possible in Blantyre, Malawi, and that calcium and aspirin use is a welcomed intervention in Malawi as many participants had positive experiences.

Date of Thesis submission	2026
Original language	English
Awarding Institution	Western Sydney University
Supervisor	Annemarie Hennessy (Supervisor), Angela Makris (Supervisor), Luis A. Gadama (Supervisor) & Renuka Shanmugalingam (Supervisor)