Abstract
BackgroundFollowing delivery by caesarean section, surgical site infection is the most common infectious complication. Despite a large number of caesarean sections performed at Debre Markos Referral Hospital, there was no study documenting the incidence of surgical site infection after caesarean section. Therefore, this study aimed to estimate the incidence of surgical site infection following caesarean section at Debre-Markos Referral Hospital in Amhara region, North-west Ethiopia.MethodsA prospective cohort study was conducted among 520 pregnant women who had a caesarean section between March 28, 2019 and August 31, 2019. Preoperative, intraoperative, and postoperative data were collected using a standardized questionnaire. Data was entered using EpiData™ Entry Version 4.1 software and analyzed using R Version 3.6.1 software. A descriptive analysis was conducted using tables, interquartile ranges and median. The time to development of surgical site infection was estimated using Kaplan-Meier method. The Cox regression model for bivariable and multivariable analyses was done. Adjusted Hazard Ratio (AHR) with 95% Confidence Interval (CI) was reported to show the strength of association.ResultThe mean age of the study cohort was 27.4 ± 4.8 years. The overall cumulative incidence of surgical site infection was 25.4% with an incidence of 11.7 (95% CI:9.8,13.9) per 1000 person/days. Not able to read and write (AHR = 1.30,95% CI:1.19,2.11), no antenatal care (AHR = 2.16, 95%CI:1.05,4.53), previous history of CS (AHR = 1.21, 95% CI:1.11,2.31), HIV positive (AHR = 1.39, 95% CI:1.21,2.57), emergency procedure (AHR = 1.13, 95% CI:1.11,2.43), vertical type of incision (AHR = 2.60, 95% CI:1.05,6.44), rupture of membrane (AHR = 1.50, 95% CI:1.31,1.64), multiple vaginal examination (AHR = 1.88, 95% CI: 1.71, 3.20) were significant predictors of surgical site infection in this study.ConclusionThis study concluded that the incidence of surgical site infection following caesarean section was relatively high compared to previous studies. Not able to read and write, have no ante natal care, previous history of caesarean section, HIV, emergency surgery, vertical type of incision, rupture of membranes before caesarean section, and multiple vaginal examinations were significant predictors of surgical site infection in this study. Therefore, intervention programs should focus on and address the identified factors to minimize and prevent the infection rate after caesarean section.
Highlights
Following delivery by caesarean section, surgical site infection is the most common infectious complication
Not able to read and write (AHR = 1.30,95% Confidence Interval (CI):1.19,2.11), no antenatal care (AHR = 2.16, 95%CI:1.05,4.53), previous history of Caesarean section (CS) (AHR = 1.21, 95% CI:1.11,2.31), Human Immune Deficiency Virus (HIV) positive (AHR = 1.39, 95% CI:1.21,2.57), emergency procedure (AHR = 1.13, 95% CI:1.11,2.43), vertical type of incision (AHR = 2.60, 95% CI:1.05,6.44), rupture of membrane (AHR = 1.50, 95% CI:1.31,1.64), multiple vaginal examination (AHR = 1.88, 95% CI: 1.71, 3.20) were significant predictors of surgical site infection in this study
All pregnant women admitted to the Debre Markos Referral Hospital (DMRH) labor ward who underwent an elective or emergency CS were eligible for enrolment within 24-h post-CS and followed for 30 days to detect surgical site infection (SSI), in accordance with the Centers for Disease Control and Prevention (CDC) Classification [6]
Summary
Following delivery by caesarean section, surgical site infection is the most common infectious complication. This study aimed to estimate the incidence of surgical site infection following caesarean section at Debre-Markos Referral Hospital in Amhara region, North-west Ethiopia. SSI is a healthcareassociated infection, especially in low-income countries including Ethiopia [7,8,9], with reported rates ranging from 3 to 15% [10, 11]. Despite the fact that improvements have been made in sterilization methods, operating room ventilation, surgical technique, and accessibility of antimicrobial prophylaxis; SSI following CS delivery remains a significant cause of maternal illness, extended hospitalization, increased medical costs, and maternal death [9, 12,13,14,15,16,17]
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