Sacred Birth, Clean Hands: Infection Prevention as Ritual and Practice among Traditional Birth Attendants in Mayuge District, East Central Uganda

Abstract

This study explored how Traditional Birth Attendants (TBAs) in rural Uganda implement infection prevention and control (IPC) through a blend of cultural traditions and hygiene practices. Using ethnographic methods, including interviews and observations, it found that TBAs view cleanliness as both a sacred obligation and a critical part of protecting maternal health. Despite facing limited training and resources, TBAs showed a strong commitment to infection prevention, positioning them as essential yet often under-recognized actors in maternal care.

Introduction: The study investigated IPC practices among TBAs in rural Uganda, situating them within a broader cultural and spiritual framework. It emphasized how TBAs integrate traditional knowledge with selected biomedical practices to ensure maternal safety. This intersection of ritual and hygiene highlights the TBAs' central role in rural maternal healthcare.

Objective: The main objective was to explore how TBAs interpret, adapt, and implement IPC practices by drawing from both cultural beliefs and biomedical hygiene principles in the context of rural Uganda.

Methods: A qualitative research approach was used, involving in-depth interviews and direct observations with 15 TBAs in Mayuge District. Data collection focused on everyday IPC practices such as waste disposal, hand hygiene, and use of protective materials. Thematic analysis helped identify recurring patterns and contextual challenges in IPC implementation.

Results: The findings revealed that TBAs practice IPC through a hybrid model that blends ritual and hygiene. Placenta disposal, symbolic use of gloves, and improvised handwashing with soap, herbs, or oil were common. Despite limited formal training, TBAs showed innovation and commitment to safe deliveries, although resource scarcity and misalignment with formal guidelines posed challenges.

Conclusion: The study highlighted the creative and spiritually informed IPC strategies of TBAs in rural Uganda, showing how they skillfully navigate material shortages and cultural expectations. These frontline caregivers operate with dedication and contextual intelligence, underscoring the need for culturally sensitive training and support to enhance maternal and newborn outcomes in under-resourced settings.

Keywords: Community Health; Cultural Beliefs; Ethnography; Hybrid Care Practices; Infection Prevention and Control; Maternal Health; Ritual Hygiene; Safe Delivery; Traditional Birth Attendants; Uganda.