Preeclampsia (PE) is a multisystem disorder of pregnancy classically characterized by hypertension with significant proteinuria [1], [2]. Globally, it results in over 500,000 fetal and neonatal deaths and more than 38,000 maternal deaths each year [3], [4]. In Malawi, 10.1 % of maternal deaths were due to hypertensive disorders of pregnancy in 2016 [5]. Furthermore, among ten other low and middle income countries, Malawi was reported to have a 4.1 % rate of eclampsia in 2016 and half of these eclampsia cases occurred in women <20 years of age [6]. Furthermore, preeclampsia is reported to be the most common cause of acute kidney injury (AKI), and the fourth for caesarean section in Malawi [7], [8]. Despite to the above figures, data on knowledge of recent preeclampsia preventive interventions is unknown.

According to the World Health Organization (WHO), the risk of preeclampsia and preterm delivery can be minimized with interventions such as oral calcium supplementation (of at least 1.5–2 g) in a population with low dietary calcium intake as seen in low income setting [9], and/or low dose aspirin (LDA) (75 mg) taken at bedtime starting before 20 weeks of gestation [10]. However, other clinical guidelines suggest other dosage and timings for LDA [11], [12].

Although preferred strategies to prevent preeclampsia may vary within and between regions, reported evidence suggest that supplementing at least 1 g calcium daily to women with poor dietary calcium intake is associated with 55 % (13 trials, 15,730 women; RR 0.45 95 CI O.41–0.83) reduction in the risk of preeclampsia if taken before the 16th week gestation [16]. Also, recent studies have shown that taking LDA in women at risk has a greater chance of reducing the incidence of preterm preeclampsia [17]. However, in Malawi, effort has been put into treating women with preeclampsia/eclampsia and its complications [13], [14] but not in determining the role of prevention strategies.

Currently, Malawi guidelines recommend calcium supplements (1.5–2 g) after 20 weeks gestation but uptake is unknown [15]. Not only that, Malawian antenatal care (ANC) guidelines have not included LDA for this purpose [15]. This makes clinical decision making for HCW and KPI difficult in terms of adherence to international and local guidelines (on calcium and LDA) for prevention of preeclampsia. Furthermore, health care services should be made accessible, affordable, available and acceptable by clients by all means, but, this hasn’t been the case for pregnant women in Malawi [18], [19]. Delays in receiving care are a significant problem that have contributed to maternal mortality [20] as evidenced by the high Maternal Mortality Ratio (MMR) of 439 maternal deaths per 100,000 live births with preeclampsia being a major contributor to the MMR [21].

For Malawian health care worker (HCW) and key policy informants (KPI), the barriers to providing early interventions such as calcium and LDA to high-risk pregnant mothers as a preventive measure for preeclampsia/eclampsia in Malawian hospitals is unknown.

Therefore, this study aimed to assess HCW and KPI barriers to providing early pregnancy intervention (e.g. calcium and LDA) to prevent preeclampsia/eclampsia in high-risk pregnant women, at Queen Elizabeth Central Hospital (QECH), Blantyre, and in Lilongwe, Malawi.