Magnitude and factors associated with surgical site infections post caesarian sections in an urban district hospital, Kigali-Rwanda

Abstract

Background One-third to two-thirds of patients operated in low-and-middle-income countries acquire surgical site infection (SSI), which is eight times higher compared to high-resource countries. Identifying the incidence and risk factors contributing to surgical site infection post caesarean section (post-CS) is a step ahead for reducing and preventing the problem. Nevertheless, the distribution of SSI post-CS in Kigali, where CS delivery is high compared to the other parts of Rwanda, needs to be investigated. This study assessed SSI incidence and risk factors among caesarean deliveries at Muhima Hospital, Kigali. Methods A hospital-based retrospective chart review was conducted among 373 women who gave birth by cesarean delivery systematically selected from the theatre room and medical records from August 2019 to August 2022. SPSS Version 27 was used for all analyses. Descriptive statistics were used to determine SSI post-CS, and bivariate chi-square and binary logistic regression analyses were used to identify factors associated with SSI post-CS. A p-value less than 0.05 was considered statistically significant. Results The mean (standard deviation) age of the 373 mothers was 30.36 (6.06) years. The incidence of SSI post-CS was 11.3% (95% CI 7.80–14.18). Maternal age ≥ 35 years (AOR = 5.12, 95% CI (1.10-23.95), p = 0.038) was the only independent risk factor for SSI post-CS. Five independent protective factors for SSI post-CS were urban residence (AOR = 0.01, 95% CI (0.003–0.08) p < 0.001), Ubudehe (Income) category 2, (AOR = 0.06, 95%CI (0.01–0.33) p = 0.001), procedure duration less than 45 minutes (AOR = 0.05, 95% CI (0.008–0.34), p = 0.002), pre-operative random glycaemia ≥ 70 mg/dl (AOR = 0.08, 95%CI (0.01–0.69, p = 0.020), pre-operative hematocrit ≥ 33% (AOR = 0.09, 95% CI (0.01–0.59), p = 0.013). Conclusion This study found an incidence of SSIs post-CS at Muhima District Hospital at 11.39%. Maternal age was the only independent risk factor for SSI post-CS in this study. Protective factors for SSI post-CS were the urban residence, Ubudehe (income) category, procedure duration, pre-operative random glycaemia, and pre-operative hematocrit. Maternal health care providers, workers, and policymakers must prioritize SSI prevention for older mothers.