A Social-Ecological Model of Skilled Birth Attendant Perspectives on Gastroschisis in Southwest Uganda

Abstract

Background: Gastroschisis, a congenital abdominal wall defect, is increasingly common in sub-Saharan Africa, yet survival rates remain low in low- and middle-income countries (LMICs) like Uganda. The barriers to care extend beyond medical limitations, with societal stigma and cultural beliefs significantly influencing health-seeking behavior. This study explores the sociocultural perspectives surrounding gastroschisis and their impact in southwest Uganda, using a socio-ecological model.Methods: A qualitative study was conducted with midwives and nurses—the frontline maternal and neonatal healthcare providers in Uganda. Participants were recruited from public and private health facilities across nine districts. Dyadic interviews were conducted, audio-recorded, transcribed, and analyzed thematically using NVivo 14. Ethical approvals were obtained from relevant institutional review boards.Results: Twenty-six midwives and nurses participated. Socio-ecological analysis revealed multifaceted factors influencing gastroschisis outcomes in Uganda. At the individual level, parental health literacy, financial constraints, and cultural beliefs were identified 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, perpetuate stigma and misinformation are powerful deterrents to seeking care. And at the organizational level, poor referral systems, inadequate access to essential medical supplies, and inadequate pediatric surgical capacity, and hidden financial costs within the healthcare system significantly hinder gastroschisis management.Conclusion: Addressing gastroschisis-related mortality in Uganda requires a multifaceted approach, including improving healthcare infrastructure, reducing financial barriers, integrating midwives into early intervention strategies, and community-level education to combat stigma. Strengthening referral systems and increasing access to essential resources, such as low-cost silos, could significantly improve survival outcomes.