Post-cesarean section surgical site infection and associated factors in East Gojjam zone primary hospitals, Amhara region, North West Ethiopia, 2020

Abstract

Purpose Maternal surgical site infection after cesarean delivery is a clinical problem which contributes to significant morbidity and mortality. In Ethiopia admissions following cesarean section due to surgical site infection have been routine activities of health care institutions but there is limited scientific evidence on both the magnitude of the problem and factors associated with it making prevention mechanisms less effective. Therefore, this study aimed to assess magnitude and risk factors of post-cesarean section surgical site infection at primary hospitals of East Gojjam Zone, Northwest Ethiopia. Methods Institution-based cross sectional study with retrospective chart review was conducted from September 10–30 /2020 at 3 randomly selected primary hospitals of east Gojjam zone. The data were entered in Epi data version 3.1 and exported to Statistical Package for Social Science Software version 26. Post-cesarean section surgical site infection was measured based on disease classification and definition of the term by Center for Disease Control and Prevention. After checking for presence of multicollinarity, presence and degree of association of factors with outcome variable were computed through logistic regression analysis. Factors with P value ≤ 0.2 in bi-variable logistic regression analysis were included in the multivariable logistic regression analysis and those variables with P-value of <0.05 in multivariable analysis were considered statistically significant. Result From 622 medical records of women who underwent cesarean section, 77 (12.4%) of them developed surgical site infection. Rural residence [(AOR = 2.30, 95%CI: (1.29, 4.09)], duration of labor greater than 24hrs [(AOR = 3.48, 95%CI: (1.49, 8.09)], rupture of membrane>12hrs[(AOR = 4.61,95%CI:(2.34,9.09)], hypertension[(AOR = 3.14,95%CI:(1.29,7.59)] and preoperative Hematocrit ≤30%[(AOR = 3.22,95%CI:(1.25,8.31)] were factors significantly associated with post-cesarean section surgical site infections. Conclusion Magnitude of post-cesarean section surgical site infection was a significant problem in primary hospitals. Minimizing prolonged labor; minimize early rupture of membrane, properly managing patients with comorbidities like hypertension, strengthen prophylaxis and treatment for anemia during antenatal care and raising awareness for rural residents can reduce the problem. Zonal police makers should give emphasis to reduce its burden.

Post-Caesarean Wound Infections: Incidence, Bacterial Profiles, Antimicrobial Susceptibility Patterns and Associated Factors in Public Hospitals, Southern Ethiopia

“…A literature scan indicated that a previous study done in Egypt reported the association of parity with SSIs [24]. The results of this study are contradictory to the outcome of a couple of studies done in other cities of Ethiopia, which reported that parity is not associated with SSIs [14,37].…”

“…A scan of the literature indicated that in Ethiopia, only limited data exist which describe the epidemiology of PSWI, the causative organisms, or the incidence of antimicrobial drug resistance, and often, there is no information linked to the post-discharge surveillance programs. Furthermore, risk factors linked to PSWI, too, showed wider variations in several Ethiopian studies [13][14][15][16][17]. In addition, the incidence of infections may vary, depending on the surgeon, hospital, surgical procedures applied, and patient.…”

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

“…Worldwide, SSIs contribute to mortality and morbidity among patients following surgeries, whereby, globally, one-third of operated patients' deaths are SSIs-related [14]. SSIs following caesarian section (CS) remain one of the signi cant threats to public health with an imperative exerted impacts on human and economic resources, health facilities, and patients as well as antibiotic resistance and, thus compromising the global surgery success [11][12][13].…”

“…Even though World Health Organization (WHO) recommends an optimal CS rate of 5 to 15%, this rate has been increasing in both developed and developing countries, with an increasing worldwide rate ranging from 6 to 27.2% [13,20], and its signi cant decrease has yet to be anticipated by experts in two decades [9,21]. Nonetheless, the delivery by CS increases up to 20 times the likelihood of developing infections than spontaneous delivery [22,23].…”

“…Risk factors for SSI post-CS Surgical site infections post-obstetrical surgeries are commonly associated with obesity/overweight and smoking [24], complicated deliveries/ prolonged labour/operation duration, rupture of membranes as well as younger aged mothers [1,4,6,25], effective use of antibiotics, pre-operative optimization, medical management of pregnancy-related conditions and other comorbidities, peri-operative behaviors, surgical techniques, septic operations, emergency procedures, [12,13,26]. Poor nutrition, coexisting infections, and comorbid factors like retroviral diseases, diabetes, and exposure to irradiation effects [4].…”