Bridging the know-do gap: a cross-sectional assessment of hypertension management amongst primary healthcare workers in Northwestern Nigeria

Abstract Background Hypertension is a leading cause of cardiovascular mortality in Nigeria, with a high burden in the Northwest. Effective management at the primary healthcare (PHC) level is critical, yet data on healthcare workers’ capacity in this security-challenged region are limited. Objectives To assess the knowledge and practice of hypertension management amongst PHC workers in Gusau, Zamfara State, and identify associated factors. Methods A cross-sectional study was conducted amongst 320 healthcare workers using a pretested questionnaire. Knowledge and self-reported practice were assessed and categorised as ‘good/adequate’ (score ≥ 75%) or ‘poor/inadequate.’ Data were analysed with SPSS using chi-square tests and multivariable logistic regression (p < 0.05). Results Respondents’ mean age was 34.6 ± 7.8 years; 62.8% were male, and 48.4% were Community Health Extension Workers. Overall, 61.9% had good knowledge, but gaps existed in identifying diagnostic thresholds (56.3%) and complications (59.7%). Only 54.7% demonstrated adequate practice, with low follow-up scheduling (48.1%), guideline use (51.6%), and referral (46.9%). Prior training (AOR = 2.6; 95% CI: 1.6–4.3) and > 10 years’ experience (AOR = 1.8; 95% CI: 1.1–3.0) predicted good knowledge. Good knowledge (AOR = 2.1; 95% CI: 1.3–3.5) and on-site guideline availability (AOR = 1.9; 95% CI: 1.2–3.1) predicted adequate practice. Conclusion A significant know-do gap exists in hypertension management. Recurrent in-service training for all PHC cadres—particularly Community Health Extension Workers (CHEWs) and Community Health Officers (CHOs), who constitute the majority of the workforce—alongside accessible point-of-care guidelines, strengthened chronic care systems, and supportive supervision are urgently needed to improve hypertension care in this region.