Primary healthcare provider perspectives on hypertensive disorders of pregnancy in southwestern Uganda: a qualitative study

Abstract Background Hypertensive disorders of pregnancy (HDP), specifically preeclampsia and eclampsia, are leading causes of maternal and perinatal mortality in sub-Saharan Africa. In Uganda’s tiered health system, primary healthcare facilities (Health Center III and IV) serve as the frontline for early detection of HDP among women attending antenatal care (ANC). However, implementation gaps persist in these settings. This study explored the perspectives of healthcare providers (HCPs) on the practices, barriers, and facilitators regarding HDP screening, diagnosis, and management in Southwestern Uganda. Methods We conducted an exploratory qualitative study using in-depth interviews with 13 purposively sampled HCPs (midwives, nurses, and medical officers) across six primary health facilities in Mbarara City. Using a semi-structured interview guide, data were collected from January 2025 to March 2025. Data were analyzed using inductive thematic content analysis. Results Screening for HDP during ANC was primarily conducted using blood pressure measurement and urinalysis, but was frequently undermined by technical barriers such as non-functional blood pressure machines and supply constraints like stock-outs of urine dipsticks. No participants (0/13) reported the use of prophylactic aspirin for high-risk mothers. Key barriers included the absence of HDP-specific guidelines, heavy workloads, cultural and socioeconomic factors. Facilitators included routine health education sessions and the use of digital consultation via WhatsApp groups for real-time specialist support. To address these challenges, HCPs proposed potential measures such as facility-based mentorship for HCPs, the integration of mHealth decision-support tools, and redesigning ANC cards to make risk factors more visible. Conclusions Healthcare providers in southwestern Uganda showed strong awareness of HDP care but were constrained by unreliable equipment, supply shortages, and limited staffing. Strengthening supply chains, mentorship, and digital decision-support could enhance the capacity of primary care facilities to deliver timely HDP prevention, screening, and early diagnosis.