Mapping policy and practice gaps in preeclampsia care in Ethiopia: A scoping review

Abstract

Objectives Maternal mortality remains a major public health challenge in Ethiopia, with hypertensive disorders of pregnancy, particularly preeclampsia and eclampsia, contributing substantially to maternal and perinatal deaths. This study aimed to map maternal health policies and available evidence in Ethiopia, focusing on community-level approaches to preeclampsia prevention, early detection, and referral, and to identify gaps between policy provisions and implementation. Study design Scoping review. Methods A scoping review was conducted using the Arksey and O'Malley framework, as refined by Levac et al. Peer-reviewed and grey literature published from 2010 onwards were systematically retrieved from major databases and institutional repositories. Data were extracted and synthesized thematically across key domains, including policy frameworks, implementation strategies, referral systems, community engagement, and monitoring and evaluation. The characteristics and relevance of the included documents were described narratively in accordance with PRISMA-ScR guidance. Results Thirty-seven documents were included, comprising national policies, strategies, guidelines, operational plans, and empirical studies. Ethiopia has a comprehensive maternal health policy framework; however, explicit operational guidance for community-level preeclampsia interventions remains limited. Policies predominantly emphasize facility-based antenatal care and referral systems, with insufficient operational guidance for community health workers regarding early detection, risk identification, and follow-up. Additional gaps identified included limited provider knowledge and practice, shortages of essential screening equipment, low antenatal care utilization, poor community awareness of preeclampsia and its danger signs, and weak integration of monitoring and feedback systems for community-based interventions. Conclusion Despite a strong policy foundation, a persistent gap exists between policy intentions and the operational implementation of preeclampsia prevention and management in Ethiopia. Strengthening health system readiness, provider capacity, community engagement strategies, and monitoring systems may improve early detection, timely referral, and maternal outcomes.