Prevalence, practices, and maternal perceptions of traditional uvulectomy among sudanese children and adolescents: A community-based cross-sectional study.

Abstract

Traditional uvulectomy (TU) is the removal of the uvula, either partially or totally, by the traditional healer. It is prevalent in sub-Saharan Africa, driven by cultural beliefs and perceived therapeutic benefits, despite the risks of complications such as bleeding, infections, and death, and limited data exist. Our study aimed to assess the prevalence and practice of traditional uvulectomy among Sudanese children and adolescents, along with maternal perceptions, and identify associated risk factors. A descriptive community-based cross-sectional study was conducted between January and April 2025 across more than ten states on mothers of children and adolescents (≤18 years). Data were collected via face-to-face interviews using a validated structured questionnaire to assess the socio-demographics, TU perception regarding TU, practice pattern, and reported complications. A convenience sampling technique was used. Statistical analyses were performed using R software, with p < 0.05 considered statistically significant. A total of 1,135 mothers of children and adolescents (≤18 years) were interviewed face-to-face. The overall prevalence of TU was 15%, with higher rates among children <6 years (16%) and adolescents aged 12-18 years (17%). Maternal belief in TU varied significantly by child age (p < 0.001). Commonly cited reasons included breastfeeding difficulties (18%), cultural tradition (16%), and failure to thrive (13%). Mothers (45%) and grandmothers (41%) were the primary decision-makers, while traditional healers performed 55% of procedures, frequently using unsterilized instruments. Reported complications included fever (35%), feeding difficulties (21%), and bleeding (13%). TU practice was significantly associated with younger maternal age, lower educational attainment, higher parity, and strong adherence to tribal traditions (all p < 0.001). Traditional uvulectomy remains prevalent in Sudan due to deeply rooted cultural beliefs, intergenerational influence, and gaps in healthcare access. Targeted, culturally sensitive interventions engaging tribal leaders, grandmothers, and traditional healers, alongside improved health education and service accessibility, are essential to reduce associated child health risks.