Acceptability of alcohol-based hand rub during neonatal care in rural Ugandan households: a qualitative study nested within the BabyGel trial.

TL;DR

A qualitative study found that alcohol-based hand rub combined with training was generally acceptable among mothers and households in rural Uganda for neonatal care, with perceived infection protection and convenience driving acceptance, though concerns about safety and spiritual beliefs sometimes limited use.

Key findings

• Participants appreciated the intervention's convenience and perceived protective effect against infection, with many reporting sustained hand hygiene improvements after the intervention period.
• Acceptability was supported by practical and health benefits but challenged by concerns regarding harmful effects, spiritual beliefs, and social tensions with visitors.
• The study was conducted during the COVID-19 pandemic, a period of heightened hygiene awareness, which may have enhanced acceptability compared to non-pandemic periods.
• Culturally adapted education and community engagement are recommended to improve acceptability and long-term sustainability of alcohol-based hand rub interventions in similar resource-limited settings.

Why this matters at the bedside

Identifies barriers and facilitators to implementing hygiene interventions in resource-limited neonatal care settings; findings inform design of sustainable infection prevention strategies in sub-Saharan Africa where water scarcity limits traditional handwashing.