"We have theoretical knowledge, but these are not things we do regularly": District hospital's healthcare workers' experiences and perceptions on gestational diabetes mellitus screening in Tanzania.

Screening for gestational diabetes mellitus (GDM) during antenatal care (ANC) is crucial for maternal and fetal health. It offers an opportunity for prevention, timely diagnosis, and treatment of cardiometabolic complications during pregnancy and over women's and babies' life course. We aimed to describe GDM screening service provision during ANC in two hospitals in Tanzania, focusing on gaps and opportunities for improving GDM screening services in hospitals. We employed a case-study design, with seven rounds of structured observation, two focus group discussions, and eight semi-structured in-depth interviews with healthcare workers (HCWs) from two primary healthcare level hospitals between January and April 2024. Observation notes, interviews, and discussions were audio recorded, transcribed, and analyzed using qualitative content analysis. We present our findings using three categories to describe the GDM screening services: 1) no GDM screening services were provided - screening for GDM was not conducted according to any existing national guidelines. 2) Reasons for unavailability of GDM screening services - there was inadequate support for GDM screening services at the hospitals: no continuous learning opportunities for HCWs on GDM screening, a shortage of screening supplies, and the hospitals did not prioritize GDM screening services. 3) Opportunities for improving GDM screening services - the inclusion of GDM in the structural and administrative agenda of the hospitals was deemed important to provide quality screening for GDM. There was a discrepancy between guidelines and actual GDM screening services at the hospitals studied. To provide GDM screening services per the available national guidelines, HCWs should be trained and supported with supplies for providing GDM screening services.