Prevalence and Factors Associated with Postpartum Infections among Mothers Attending Immunization Service at Health Centers of Nyanza District, Rwanda

Abstract

Postpartum infections are life-threatening conditions leading to 10% of maternal deaths worldwide; in sub-Saharan Africa, the estimated prevalence of postpartum infections is 11.5%. In Rwanda maternal sepsis contribute up to 56% of all maternal complications, where 5% of them die and most cases come from rural areas. In line with the above-mentioned background, this research aimed to find out the prevalence and factors contributing to postpartum infections in Nyanza District/ Rwanda. This study employed a cross-sectional design, with participants being mothers attending immunization services at health centers in Nyanza district. A sample size of 384 was determined for all health centers, with systematic sampling used to select individual participants. Data collection involved a structured questionnaire and a review of medical records. A case of postpartum infection was identified if self-reported signs or symptoms were also documented in the participant's medical records. Data analysis was conducted using IBM® SPSS 21. Descriptive statistics were utilized, and a bivariate analysis was performed to identify independent variables associated with postpartum infections. Variables significantly associated with the outcome were further analyzed using a multivariate logistic regression model. As results, the prevalence of postpartum infection among mothers attending immunization service at health centers of Nyanza District was 9.6%; and the identified  factors associated with postpartum infections were delivering by caesarean (aOR=6, 95%CI: 5.082-8.229, P<0.001); frequent vaginal examinations (≥5 times) during labor (aOR= 2.7, 95% CI: 1.331-5.843, P<0.001); prolonged labor (>24 hours) (aOR=2.0, 95% CI: 1.205-6.010, P<0.001); and Farming occupation (aOR=1.9, 95% CI: 1.120-4.966, P=0.048). Hence, the study recommends that healthcare professionals should aim to minimize C-section deliveries and the frequency of vaginal examinations when possible. Prophylactic antibiotics and aseptic techniques should be employed during delivery, especially for mothers with prolonged labor, frequent examinations, C-section deliveries, and farming occupations. Policymakers should develop guidelines to reduce cesarean sections, discourage frequent vaginal examinations, and promote prophylactic antibiotic use for high-risk mothers. Healthcare workers should prioritize infection prevention practices for mothers undergoing C-sections. Additionally, efforts should focus on reducing labor duration and ensuring timely interventions to prevent complications leading to postpartum infections. High-risk groups should be targeted for health education programs promoting hygiene practices and preventing exposure to microbial reservoirs. Further research is needed countrywide to determine the real burden of postpartum infections and identify measures to mitigate these life-threatening infections. Keywords: Postpartum infections, mothers, immunization service, Health Centers, Nyanza District, Rwanda