Discharge instructions given to women following delivery by cesarean section in Sub-Saharan Africa: A scoping review

Abstract

Objective A scoping review of discharge instructions for women undergoing cesarean section (c-section) in sub-Saharan Africa (SSA). Method Studies were identified from PubMed, Globus Index Medicus, NiPAD, EMBASE, and EBSCO databases. Eligible papers included research based in a SSA country, published in English or French, and containing information on discharge instructions addressing general postnatal care, wound care, planning of future births, or postpartum depression targeted for women delivering by c-section. For analysis, we used the PRISMA guidelines for scoping reviews followed by a narrative synthesis. We assessed quality of evidence using the GRADE system. Results We identified 78 eligible studies; 5 papers directly studied discharge protocols and 73 included information on discharge instructions in the context of a different study objective. 37 studies addressed wound care, with recommendations to return to a health facility for dressing changes and wound checks between 3 days to 6 weeks. 16 studies recommended antibiotic use at discharge, with 5 specifying a particular antibiotic. 19 studies provided recommendations around contraception and family planning, with 6 highlighting intrauterine device placement immediately after birth or 6-weeks postpartum and 6 studies discussing the importance of counselling services. Only 5 studies provided recommendations for the evaluation and management of postpartum depression in c-section patients; these studies screened for depression at 4–8 weeks postpartum and highlighted connections between c-section delivery and the loss of self-esteem as well as connections between emergency c-section delivery and psychiatric morbidity. Conclusion Few studies in SSA directly examine discharge protocols and instructions for women following c-section. Those available demonstrate wide variation in recommendations. Research is needed to develop structured evidence-based instructions with clear timelines for women. These instructions should account for financial burden, access to resources, and education of patients and communities.

Safe recovery after cesarean in rural Africa: Technical consensus guidelines for post‐discharge care

“…Across several studies, women delivering via cesarean in Rwanda reported a lack of instructions or conflicting instructions at the time of discharge 8–10 . A scoping review found that very few studies based in SSA comment on cesarean recovery activities or postoperative care pathways after hospital discharge, and even fewer studies provide concrete recommendations 11 . Here, we outline recommendations for discharge instructions to be provided to women who have given birth by cesarean in SSA to optimize their recovery.…”

“… 8 , 9 , 10 A scoping review found that very few studies based in SSA comment on cesarean recovery activities or postoperative care pathways after hospital discharge, and even fewer studies provide concrete recommendations. 11 Here, we outline recommendations for discharge instructions to be provided to women who have given birth by cesarean in SSA to optimize their recovery. These recommendations were developed through expert consensus with a focus on rural Rwanda and discussions on how these instructions could be generalized to other SSA contexts.…”

Exploring Perceptions of Cesarean Sections among Postpartum Women in Nigeria: A Qualitative Study

“…In five countries (the Dominican Republic, Brazil, Cyprus, Egypt, and Turkey), caesarean sections surpass vaginal deliveries [9,12]. Conversely, in the least Women 2024, 4 developed countries, merely about 8% of women undergo caesarean section, with a meager 5% in sub-Saharan Africa, illustrating a disconcerting lack of access to this lifesaving procedure [9,13]. The World Health Organization recommended a CS range of 10-15% for countries [14].…”

Protocol for designing and testing the effectiveness of a post caesarean section home care guide in preventing surgical site infection in Central Tanzania

“…Studies report a complete lack of or less information regarding home care after CS compared to home care after vaginaly delivery [ 23 , 24 ]. The limited available information about home care after CS highly varies among different sources across the region [ 25 ]. Post-discharge instruction, especially for post-CS mothers has been a neglected aspect of post-CS care for a long time [ 21 ].…”