Knowledge of Hypertensive Disorders of Pregnancy and Associated Factors Among Antenatal-Care Attendees in Mbarara City, Southwestern Uganda: A Cross-Sectional Study

Abstract

Background: Hypertensive disorders of pregnancy (HDP) are important contributors to maternal and perinatal morbidity and mortality in sub-Saharan Africa. Women’s knowledge of warning signs, risk factors, diagnosis, and prevention may support earlier care-seeking and timely diagnosis, yet data from primary-level antenatal-care settings in Uganda remain limited. We assessed knowledge of HDP and associated factors among antenatal-care attendees in Mbarara City, southwestern Uganda. Methods: We conducted a cross-sectional study among pregnant women attending their third or later antenatal-care visit at six public health facilities in Mbarara City between January and March 2025. Participants were recruited by consecutive sampling. Knowledge was assessed using 41 scored knowledge items covering awareness, disease manifestations, risk factors, diagnosis, management, prevention, complications, and blood-pressure monitoring. Scores were expressed as percentages of correct responses; adequate knowledge was defined as ≥60%. Multivariable modified Poisson regression was used to estimate adjusted prevalence ratios. Results: Among 426 antenatal-care attendees, 271 had adequate knowledge, giving a prevalence of 63.6% (95% CI: 58.8–68.2). Knowledge was highest for timing or frequency of blood-pressure checks (86.2%) and complications (76.1%), but lower for diagnosis (51.4%), timing of occurrence (53.3%), treatment and management (53.4%), and risk factors (56.8%). Adequate knowledge was more prevalent among women with secondary education (aPR=1.34; 95% CI: 1.10–1.64) or tertiary education (aPR=1.36; 95% CI: 1.04– 1.78), compared with primary education or less; women with five or more pregnancies compared with primigravidas (aPR=1.77; 95% CI: 1.27–2.48); and women with family history of preeclampsia compared with those without (aPR=1.26; 95% CI: 1.06–1.50). Conclusions: Approximately two-thirds of antenatal-care attendees had adequate knowledge of HDP, but important gaps remained in diagnosis, timing of occurrence, treatment and management, and risk-factor recognition. Health education during antenatal care should prioritize practical messages for women with lower educational attainment, primigravidas or limited pregnancy experience, and women without a family history of preeclampsia.