Adherence to National Standard Treatment Guidelines in the Management of Hypertension and Associated Factors Among Healthcare Providers at Public District Hospitals in Dar es Salaam, Tanzania

Abstract

Abstract Background Hypertension affects 15–25% of adults in Tanzania, with less than 30% of treated patients achieving adequate blood pressure control, leading to complications like stroke, heart failure, and renal disease. The National Standard Treatment Guidelines (NSTGs), 6th edition (2021), guide management, but healthcare provider adherence in district hospitals is unclear. Materials and Methods A mixed-methods cross-sectional study was conducted at five public district hospitals in Dar Es Salaam, Tanzania. Quantitative data from 397 patient files assessed healthcare provider adherence in pharmacological treatment, complication monitoring, and comorbidity screening, categorized as complete, partial, or non-adherent. Modified Poisson regression was used to identify patient and provider factors. Qualitative data from 11 in-depth interviews were thematically analyzed for barriers, and facilitators to this adherence Results Only 26.2% of patients received management with complete adherence to NSTGs, 27.7% showed partial adherence, and 46.1% were non-adherent. Higher healthcare provider adherence was associated with follow-up visits (aPR = 5.81; 95% CI: 3.12–10.81), Grade 1 hypertension (aPR = 3.87; 95% CI: 1.95–7.65), Grade 2 hypertension (aPR = 5.06; 95% CI: 2.64–9.71), presence of comorbidities (aPR = 2.35; 95% CI: 1.31–4.22), specialist providers (aPR = 7.00; 95% CI: 3.08–15.92), and provider experience of 5–10 years (aPR = 3.25; 95% CI: 1.52–6.97) and > 10 years (aPR = 3.91; 95% CI: 1.88–8.14). Barriers included outdated guidelines, absence of comorbidity-specific protocols, limited user input, weak monitoring, drug shortages, inadequate diagnostics, staffing gaps, and inadequate training, while facilitators included peer collaboration, mentorship, accessible guidelines, and continuing medical education. Conclusion Low healthcare provider adherence to NSTGs contributes to poor hypertension control. Interventions like updated and inclusive guidelines, enhanced training, improved resource availability, and peer support are critical to improve adherence and patient outcomes.