Predictors for Persistent Perioperative Symptoms after a Cesarean Section at a Hospital in Rural Rwanda

Mukantwari, Joselyne; Gatete, Jean de Dieu; Miranda, Elizabeth; Niyigena, Anne; Kateera, Fredrick; Riviello, Robert; Hedt‐Gauthier, Bethany

doi:10.1016/j.jamcollsurg.2020.08.068

Cited by 2 publications

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“…This association could be explained in the context of poor health outcomes previously reported among poor postpartum women. Poverty has been associated with poor postpartum nutritional status [ 49 , 50 ], incidence of SSI [ 22 , 51 ] and poor post-natal care [ 52 ]. A study in Ethiopia reported that irrespective of mode of delivery, women with low income were almost half as likely to seek postpartum care [ 53 ], and a study in Iran found that rural women who did not receive enhanced postpartum follow-up reported poor functional status at six weeks postpartum [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

Functional recovery after cesarean delivery: a prospective cohort study in rural Rwanda

Niyigena,

Gato,

Alayande

et al. 2023

BMC Pregnancy Childbirth

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Introduction Women who deliver via cesarean section (c-section) experience short- and long-term disability that may affect their physical health and their ability to function normally. While clinical complications are assessed, postpartum functional outcomes are not well understood from a patient’s perspective or well-characterized by previous studies. In Rwanda, 11% of rural women deliver via c-section. This study explores the functional recovery of rural Rwandan women after c-section and assesses factors that predict poor functionality at postoperative day (POD) 30. Methods Data were collected prospectively on POD 3, 11, and 30 from women delivering at Kirehe District Hospital between October 2019 and March 2020. Functionality was measured by self-reported overall health, energy level, mobility, self-care ability, and ability to perform usual activities; and each domain was rated on a 4-point likert scale, lower scores reflecting higher level of difficulties. Using the four functionality domains, we computed composite mean scores with a maximum score of 4.0 and we defined poor functionality as composite score of ≤ 2.0. We assessed functionality with descriptive statistics and logistic regression. Results Of 617 patients, 54.0%, 25.9%, and 26.8% reported poor functional status at POD3, POD11, and POD30, respectively. At POD30, the most self-reported poor functionality dimensions were poor or very poor overall health (48.1%), and inability to perform usual activities (15.6%). In the adjusted model, women whose surgery lasted 30–45 min had higher odds of poor functionality (aOR = 1.85, p = 0.01), as did women who experienced intraoperative complications (aOR = 4.12, 95% CI (1.09, 25.57), p = 0.037). High income patients had incrementally lower significant odds of poor physical functionality (aOR = 0.62 for every US$1 increase in monthly income, 95% CI (0.40, 0.96) p = 0.04). Conclusion We found a high proportion of poor physical functionality 30 days post-c-section in this Rwandan cohort. Surgery lasting > 30 min and intra-operative complications were associated with poor functionality, whereas a reported higher income status was associated with lower odds of poor functionality. Functional status assessments, monitoring and support should be included in post-partum care for women who delivered via c-section. Effective risk mitigating intervention should be implemented to recover functionality after c-section, particularly among low-income women and those undergoing longer surgical procedures or those with intraoperative complications.

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Section: Discussionmentioning

confidence: 99%

Functional recovery after cesarean delivery: a prospective cohort study in rural Rwanda

Niyigena,

Gato,

Alayande

et al. 2023

BMC Pregnancy Childbirth

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“…This association could be explained in the context of poor health outcomes previously reported among poor postpartum women. Poverty has been associated with poor postpartum nutritional status [37,38], incidence of SSIs [17,39], and poor post-natal care [40]. A study in Ethiopia reported that irrespective of mode of delivery, women with low income were almost half as likely to seek postpartum care [41], and a study in Iran found that rural women who did not received enhanced postpartum follow-up reported poor functional status at six weeks postpartum [41].…”

Section: Discussionmentioning

confidence: 99%

Functional recovery after cesarean delivery: a prospective cohort study in rural Rwanda

Niyigena¹,

Gato²,

Alayande³

et al. 2021

Preprint

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Background Women who deliver via cesarean section (c-section) experience short- and long-term complications that may affect their physical health and their ability to function normally. While physical health outcomes are routinely assessed and monitored, postpartum functional outcomes are not well understood from a patient’s perspective or characterized by clinicians. In Rwanda, 11% of rural women deliver via c-section. This study explores the functional recovery of rural Rwandan women after c-section and assesses factors that predict poor functionality at postoperative day (POD) 30. Methods Data were collected prospectively on POD 3, 11, and 30 from women delivering at Kirehe District Hospital between October 2019 and March 2020. Functionality was measured by self-reported overall health, energy level, mobility, self-care ability, and ability to perform usual activities. We computed composite mean scores with a maximum score of 4.0 and scores ≤ 2.0 reflected poor functionality. We assessed functionality with descriptive statistics and logistic regression. Results Of 617 patients, 54.0%, 25.9%, and 26.8% reported poor functional status at POD3, POD11, and POD30, respectively. At POD30, the most self-reported poor functionality dimensions were poor or very poor overall health (48.1%), and inability to perform usual activities (15.6%). In the adjusted model, women whose surgery lasted 30–45 minutes had higher odds of poor functionality (aOR = 1.85, p = 0.01), as did women who experienced intraoperative complications (aOR = 4.12, p = 0.037). High income patients had incrementally lower significant odds of poor functionality (aOR = 0.62 for every US$100 increase in monthly income, p = 0.04). Conclusion We found a high proportion of poor functionality 30 days post-c-section and while surgery lasting > 30 minutes and experiencing intra-operative complications was associated with poor functionality, a reported higher income status was associated with lower odds of poor functionality. Functional status assessments, monitoring and support should be included in post-partum care for women who delivered via c-section. Effective risk mitigating intervention should be implemented to recover functionality after c-section, particularly among low-income women and those undergoing longer surgical procedures or those with intraoperative complications.

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Predictors for Persistent Perioperative Symptoms after a Cesarean Section at a Hospital in Rural Rwanda

Cited by 2 publications

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Functional recovery after cesarean delivery: a prospective cohort study in rural Rwanda

Functional recovery after cesarean delivery: a prospective cohort study in rural Rwanda

Functional recovery after cesarean delivery: a prospective cohort study in rural Rwanda

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