Health worker perspectives on the screening and management of hypertensive disorders and diabetes in pregnancy in Uganda: a cross-sectional survey

Abstract

Hypertensive disorders of pregnancy (HDP) and diabetes in pregnancy (DIP) are leading contributors to maternal and perinatal morbidity and mortality in sub-Saharan Africa, yet effective management depends on health workers having the knowledge, attitudes, and practices to screen, diagnose, and treat these conditions. Evidence on these provider-level factors remains limited in Uganda. We conducted a descriptive cross-sectional survey among health workers in Uganda (November–December 2025), disseminating a structured questionnaire on HDP and DIP knowledge, attitudes, practices, prescribing, and task shifting via WhatsApp-based Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH) networks and professional association platforms, hosted on REDCap. We analysed data in STATA 17 using descriptive statistics and comparisons across health worker groups. Of the 690 eligible health workers, 577 completed the survey (83.5%). Midwives comprised the largest group (341, 59.1%) and most worked in public facilities (425, 73.7%). Knowledge and protocol integration were substantially stronger for HDP than DIP: CPD attendance was 70.9% for HDP versus 36.4% for DIP, self-reported protocol familiarity was 90.1% versus 38.6%, and routine BP screening was near-universal (538, 93.2%) while only 122 (21.1%) always screened for diabetes in pregnancy. Correct oral glucose tolerance test (OGTT) thresholds were identified by only 186 (32.2%). Attitudes reflected strong support for patient involvement in treatment decisions and consistent treatment targets, with moderate confidence in guideline-based adjustments (279, 48.4%). Prescribing prioritised affordability (438, 75.9%) and reliable drug supply (473, 82.0%). Task shifting was widely accepted for basic functions including BP measurement (538, 93.2%) and lifestyle counselling (514, 89.1%), but less so for algorithm-based prescribing (170, 29.5%). Cadre differences were consistent across domains: for HDP, correct identification of severe preeclampsia features and use of advanced diagnostics were significantly lower among midwives than specialist cadres ( p < 0.001); for DIP, gaps were most pronounced among midwives, with the lowest DIP CPD attendance (105, 30.8%) and OGTT endorsement (186, 54.5%) of all cadres ( p < 0.001). Advanced diagnostic use and OGTT endorsement also increased progressively with facility level ( p < 0.001). Health workers in Uganda demonstrate substantially stronger knowledge, attitudes, and practices for HDP than for DIP, with consistent cadre-related differences. Under-recognition of DIP likely contributes to missed opportunities for timely intervention. Targeted CPD on DIP, wider protocol dissemination, and system-level support for diabetes screening are urgently needed. Leveraging existing RMNCAH networks offers a practical pathway for integrating DIP into routine antenatal care.