Guideline adherence to aspirin prophylaxis use for preeclampsia among healthcare providers in Northwest Ethiopia: an explanatory sequential mixed-methods study

Abstract

BACKGROUND

Preeclampsia is a significant cause of illness and mortality among mothers and newborns, especially in countries with limited resources. Preeclampsia is less common when low-dose aspirin (LDA) is used early in high-risk pregnancies.

OBJECTIVE

The purpose of this study was to evaluate aspirin prophylaxis guideline adherence among Northwest Ethiopian healthcare providers (HCPs).

STUDY DESIGN

A sequential mixed-methods explanatory research was carried out in three tertiary hospitals between March and May of 2025. Using a standardized questionnaire based on WHO, ACOG, and NICE standards, quantitative data was gathered from 304 HCPs who were chosen at random. Logistic regression was used to examine adherence-related characteristics. Qualitative perspectives were investigated through in-depth interviews with providers who were specifically chosen.

RESULTS

Among 304 participants (mean age 29.8 ± 4.7 years; 56.6% male), nurses (38.2%) and midwives (32.6%) predominated. Only 41.4% had adequate knowledge, 54.3% held a positive attitude, and 34.9% exhibited good adherence to guidelines. Poor knowledge (AOR = 3.42), negative/uncertain attitude (AOR = 2.67), and <5 years of experience (AOR = 1.89) were independently associated with poor adherence. Qualitative findings identified four themes: knowledge gaps, safety concerns, system-level barriers (absence of national guideline, drug stock-outs, high workload), and limited experience/mentorship.

CONCLUSION

Adherence to aspirin prophylaxis guidelines is not optimal. To improve maternal outcomes, specific training, mentorship, supportive supervision, and the creation of national guidelines must address knowledge gaps, attitudes, clinical experience, and systemic barriers.