A survey of Ugandan skilled birth attendants regarding beliefs and management of gastroschisis

Abstract

Introduction: Gastroschisis mortality is disproportionately high in Africa due in part to delayed presentation and limited surgical capacity. Skilled birth attendants (SBAs) are often the first to encounter these babies and can be an important part of their stabilisation. We assessed baseline Ugandan SBA knowledge of gastroschisis and interest in a training course. Methods: Southwestern Ugandan SBAs were surveyed regarding practice patterns, common beliefs and training course interest. Data were analysed with descriptive statistics. Results: We recruited 121 participants (70 midwives, 51 nurses). Most had a certificate or diploma (n=117, 97%) and 85% had more than 3 years of experience (n=103). Eighty- seven (72%) SBAs had cared for babies with gastroschisis. Most reported that communities stigmatised families (n=67, 55%), saw the child as cursed (n=74, 61%), blamed the mother (n=69, 57%) and advised parents to kill (n=30, 24%) or abandon the child (n=55, 45%). Barriers to families seeking care included healthcare mistrust (n=3, 2%), hopelessness (n=37, 31%), lack of knowledge (n=51, 42%), transportation difficulties (n=54, 45%) and fear of impoverishment (n=84, 69%). Most SBAs were unsure of the cause of gastroschisis and only 6% (n=8) recognised fetal vascular interruption as the cause. While 57% (n=69) prioritised intestinal coverage, only 7% (n=9) and 5% (n=6) would place a nasogastric tube or fast the baby. Three midwives encouraged immediate breastfeeding. Antibiotics (n=22, 18%) and fluid resuscitation (n=19, 16%) were sometimes recommended. Most participants (n=119, 98%) desired a course on gastroschisis management, but 41% (n=50) reported time constraints as a barrier. Conclusions: Southwestern Ugandan SBAs encounter gastroschisis babies, have limited training in its management and desire a training course. Engaging SBAs into a task- sharing role on delivery is a promising next step. Additional studies will be needed to determine if this can improve gastroschisis survival by reducing delays in care and improving community awareness.