<p>Factors Affecting and Strategies to Improve Risk Screening and Prevention of Pre-Eclampsia: A Multi-Country, Mixed-Methods Formative Study</p>
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Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality. Early pregnancy pre-eclampsia screening can identify high-risk women to initiate low-dose preventive aspirin, yet implementation of these interventions is limited in sub-Saharan Africa. This multi-country, mixed-methods study explored implementation barriers and enablers to pre-eclampsia risk screening, preventive aspirin, and AI-ultrasound gestational age assessment in Ghana, Kenya, and South Africa. We conducted surveys, qualitative interviews, and focus group discussions with women, health workers, and stakeholders. We identified two critical gaps. Without appropriate training and counselling, “risk screening” may be misunderstood as pre-eclampsia detection, rather than estimating future risk early in pregnancy to inform prevention. Busy antenatal workflows, weak information and referral systems, poor aspirin availability, limited prescribing authority, concerns about aspirin safety, low trust in new technologies, and challenges communicating high-risk status might constrain implementation of preventive action. Risk screening should be embedded in antenatal care pathways that support aspirin initiation, adherence, counselling, follow-up and referral.