Prevalence and predictors of surgical-site infection after caesarean section at a rural district hospital in Rwanda

Nkurunziza, Theoneste; Kateera, Frederick; Sonderman, Kristin; Gruendl, Magdalena; Nihiwacu, Edison; Ramadhan, Bahati; Cherian, Teena; Nahimana, Evrard; Ntakiyiruta, Georges; Habiyakare, Caste; Ngamije, Patient; Matousek, Alexi; Gaju, Erick; Riviello, Robert; Hedt‐Gauthier, Bethany

doi:10.1002/bjs.11060

Cited by 48 publications

(48 citation statements)

References 28 publications

(34 reference statements)

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“…This study is a secondary analysis of baseline data collected as part of a larger prospective cohort study assessing the use of mHealth technology to identify and refer surgical site infections in Rwanda. 19,20 Our analyses included all adult women (18 y old) who delivered at KDH via c-section between April 1 through September 30, 2017 and resided in Kirehe District (including women residing in Mahama Refugee Camp within the district). In addition to data available through the larger study, we extracted neonatal outcome data from patients' medical files.…”

Section: Study Design and Populationmentioning

confidence: 99%

Perioperative Management and Outcomes After Cesarean Section—A Cross-Sectional Study From Rural Rwanda

Mazimpaka

Uwitonze

Cherian

et al. 2020

Journal of Surgical Research

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Background: Cesarean sections (c-sections), the most common surgical procedures performed worldwide, are essential in reducing maternal and neonatal deaths. There is a paucity of research studies on c-section care and outcomes in rural African settings. The objective of this study was to describe demographic characteristics, clinical management, and maternal and neonatal outcomes among women receiving c-sections at Kirehe District Hospital (KDH) in rural Rwanda. Methods: This retrospective cohort study included all women aged 18 y residing in KDH catchment area who delivered by c-section at KDH between April 1 and September 30, 2017. Demographic and clinical characteristics of these women and their newborns were collected using patient interviews and medical chart extraction. Descriptive analyses were performed, and frequency and percentages are reported. Results: Of the 621 women included in the study, 45.7% (n ¼ 284) were aged 25-34 y; 42.2% (n ¼ 262) were married; 67.5% (n ¼ 419) had primary education; and 75.7% (n ¼ 470) were farmers by occupation. Burundian refugees living in the nearby Mahama Refugee Camp comprised 13.7% (n ¼ 85) of the study population. The most common indication for csection was having undergone a c-section previously (31.9%, n ¼ 198), followed by acute fetal distress (30.8%, n ¼ 191). Among those with previous c-section as the sole indication for surgery, 85.4% presented as either urgent or emergent cases. Postoperatively, 67.7%

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Section: Study Design and Populationmentioning

confidence: 99%

Perioperative Management and Outcomes After Cesarean Section—A Cross-Sectional Study From Rural Rwanda

Mazimpaka

Uwitonze

Cherian

et al. 2020

Journal of Surgical Research

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“…A similar nding was reported in the Netherlands, a high-income country 11 . The higher rate of maternal deaths after CS as compared to vaginal delivery may be attributed to postpartum haemorrhage, complications of anaesthesia and postoperative sepsis 12,13 . However, all of these studies are cross sectional and unable to conclude the observed associations were causal.…”

Section: Introductionmentioning

confidence: 99%

Association between maternal mortality and caesarean section in Ethiopia: A national cross-sectional study

Bali

Chojenta

Taddele

et al. 2020

Preprint

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Background Several studies concluded that there is a reduction of maternal deaths with improved access to caesarean section, while other studies showed the existence of a direct association between the two variables. In Ethiopia, literature about the association between maternal mortality and caesarean section is scarce. This study was aimed to assess the association between maternal mortality ratios and caesarean section rates in hospitals in Ethiopia. Methods Analysis was done of a national maternal health dataset of 293 hospitals that accessed from the Ethiopian Public Health Institute. Hospital specific characteristics, maternal mortality ratios and caesarean section rates were described. Pearson’s correlation coefficient was used to determine the direction of association between maternal mortality ratios and caesarean section rate, taking regions into consideration. Presence of a linear association between these variables was declared statistically significant at p-value < 0.05. Results The overall maternal mortality ratio in Ethiopian hospitals was 149 (95% CI: 136–162) per 100,000 live births. There was significant regional variation in maternal mortality ratios, ranging from 74 (95% CI: 51–104) per 100,000 live births in Tigray region to 548 (95% CI: 251-1,037) in Afar region. The average annual caesarean section rate in hospitals was 20.3% (95% CI: 20.2–20.5). The highest caesarean section rate of 38.5% (95% CI: 38.1–38.9) was observed in Addis Ababa, while the lowest rate of 5.7% (95% CI: 5.2–6.2) occurred in Somali region. At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates. Similarly, unlike in other regions, there were inverse associations between maternal mortality ratios and caesarean section rates in Addis Ababa, Afar Oromia and Somali, although associations were not statistically significant. Conclusions At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates in hospitals, although there were regional variations. Additional studies with a stronger design should be conducted to assess the association between population-based maternal mortality ratios and caesarean section rates.

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“…SSI is the commonest postoperative complication in abdominal surgery. Initiatives to reduce it should be prioritized worldwide, but the need is greatest in LMICs, where up to one‐quarter of patients develop an SSI after gastrointestinal surgery.…”

Section: Discussionmentioning

confidence: 99%

Delphi prioritization and development of global surgery guidelines for the prevention of surgical-site infection

Adenekan¹,

Cotton²,

Davies³

et al. 2020

British Journal of Surgery

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Background Most clinical guidelines are developed by high‐income country institutions with little consideration given to either the evidence base for interventions in low‐ and middle‐income countries (LMICs), or the specific challenges LMIC health systems may face in implementing recommendations. The aim of this study was to prioritize topics for future global surgery guidelines and then to develop a guideline for the top ranked topic. Methods A Delphi exercise identified and prioritized topics for guideline development. Once the top priority topic had been identified, relevant existing guidelines were identified and their recommendations were extracted. Recommendations were shortlisted if they were supported by at least two separate guidelines. Following two voting rounds, the final recommendations were agreed by an international guideline panel. The final recommendations were stratified by the guideline panel as essential (baseline measures that should be implemented as a priority) or desirable (some hospitals may lack these resources at present, in which case they should plan for future implementation). Results Prevention of surgical‐site infection (SSI) after abdominal surgery was identified as the highest priority topic for guideline development. The international guideline panel reached consensus on nine essential clinical recommendations for prevention of SSI. These included recommendations concerning preoperative body wash, use of prophylactic antibiotics, decontamination of scrub teams' hands, use of antiseptic solutions for surgical site preparation and perioperative supplemental oxygenation. In addition, three desirable clinical recommendations and four recommendations for future research were agreed. Conclusion This process led to the development of a global surgery guideline for the prevention of SSI that is both clinically relevant and implementable in LMICs.

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Prevalence and predictors of surgical-site infection after caesarean section at a rural district hospital in Rwanda

Cited by 48 publications

References 28 publications

Perioperative Management and Outcomes After Cesarean Section—A Cross-Sectional Study From Rural Rwanda

Perioperative Management and Outcomes After Cesarean Section—A Cross-Sectional Study From Rural Rwanda

Association between maternal mortality and caesarean section in Ethiopia: A national cross-sectional study

Delphi prioritization and development of global surgery guidelines for the prevention of surgical-site infection

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