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

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.