A Qualitative Assessment of Health Workers’ Knowledge, Perceptions, and Practices on Sudden Unexpected Infant Death in Central Uganda

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Abstract Introduction Health workers (HWs) have a central role in reducing the risk of Sudden Unexpected Infant Death (SUID) through caregiver education and safe-sleep counselling. Yet, awareness and application of evidence-based guidance are inconsistent in primary and maternal–child health settings in low- and middle-income countries (LMICs). This study explored the knowledge, perceptions, and practices of HWs regarding SUID in Uganda. Methods We conducted a qualitative study with 20 HWs (midwives, nurses, clinicians and medical officers) at three government facilities (two regional referral hospitals and one health centre III) in central Uganda (April–September 2024). Participants were purposively sampled. In-depth interviews were conducted in English or Luganda(a widely spoken local language), audio-recorded, and transcribed into English. Data were analysed thematically using a hybrid inductive–deductive approach supported by NVivo 14. Results HWs recognized sudden infant deaths but were largely unfamiliar with SUID as a clinical construct. Commonly perceived causes included accidental suffocation, overlay, unsafe sleep positioning and underlying illness, and cultural beliefs. Safe-sleep counselling was infrequent and non-standardized; many HWs recommended prone or side-lying positions to avoid perceived aspiration risk and favoured soft sleep surfaces. Mother infant bed-sharing was considered culturally normative and practical for warmth and monitoring despite acknowledged risks. HWs expressed a need for training and context-adapted guidelines. Conclusion Participants described gaps and inconsistencies regarding safe sleep and environmental risk factors for SUID. Developing national, context-appropriate safe sleep guidance, integrating pre-service and in-service training, and embedding consistent counselling in maternal–child health services could contribute to risk reduction and consequently prevent infant deaths.

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