A socioecological model of skilled birth attendant perspectives on gastroschisis in southwest Uganda.

BACKGROUND: Gastroschisis, a congenital abdominal wall defect, is increasingly reported in sub-Saharan Africa, yet survival remains poor in low-income and middle-income countries, such as Uganda. Barriers to care extend beyond clinical limitations, with societal stigma and cultural beliefs influencing health-seeking behavior. This study explores the sociocultural perspectives surrounding gastroschisis in southwest Uganda using a socioecological model. METHODS: A qualitative study was conducted with midwives and nurses from public and private facilities across 9 districts in Uganda. Participants underwent in-depth interviews, which were audio-recorded, transcribed, and analyzed using inductive semantic thematic analysis. RESULTS: Twenty-six midwives and nurses participated. Thematic analysis by level of the socio-ecological model revealed multiple factors that influence gastroschisis outcomes in Uganda. At the individual level, parental health literacy, financial constraints, and cultural beliefs were perceived to influence health-seeking behavior. Interpersonal family dynamics play a crucial role in decision-making, with blame and stigma often directed at mothers. Community perceptions, rooted in cultural and religious narratives that perpetuate stigma and misinformation, emerged as deterrents to seeking care. At the organizational level, poor referral systems, inadequate access to essential medical supplies, inadequate pediatric surgical capacity, and hidden financial costs within the health care system were identified as hindrances to gastroschisis management. CONCLUSION: Improving survival from gastroschisis in Uganda requires coordinated interventions across socioecological levels. Midwives are strategically positioned to influence early care. Strengthening health care infrastructure, reducing financial barriers, implementing early referral strategies, and delivering community education are critical to addressing stigma and improving outcomes.

Duke Scholars

Author Tamara Noel Fitzgerald Surgery, Pediatric General Surgery