Prevalence and predictors of surgical-site infection after caesarean section at a rural district hospital in Rwanda.
Adolescent
Adult
Cesarean Section
/ adverse effects
Cohort Studies
Female
Hospitals, District
/ statistics & numerical data
Humans
Pregnancy
Prevalence
Prospective Studies
Risk Factors
Rural Health Services
/ statistics & numerical data
Rwanda
/ epidemiology
Surgical Wound Infection
/ epidemiology
Young Adult
Journal
The British journal of surgery
ISSN: 1365-2168
Titre abrégé: Br J Surg
Pays: England
ID NLM: 0372553
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
31
07
2018
revised:
30
09
2018
accepted:
30
10
2018
entrez:
9
1
2019
pubmed:
9
1
2019
medline:
7
5
2019
Statut:
ppublish
Résumé
There are few prospective studies of outcomes following surgery in rural district hospitals in sub-Saharan Africa. This study aimed to estimate the prevalence and predictors of surgical-site infection (SSI) following caesarean section at Kirehe District Hospital in rural Rwanda. Adult women who underwent caesarean section between March and October 2017 were given a voucher to return to the hospital on postoperative day (POD) 10 (±3 days). At the visit, a physician evaluated the patient for an SSI. A multivariable logistic regression model was used to identify risk factors for SSI, built using backward stepwise selection. Of 729 women who had a caesarean section, 620 were eligible for follow-up, of whom 550 (88·7 per cent) returned for assessment. The prevalence of SSI on POD 10 was 10·9 per cent (60 women). In the multivariable analysis, the following factors were significantly associated with SSI: bodyweight more than 75 kg (odds ratio (OR) 5·98, 1·56 to 22·96; P = 0·009); spending more than €1·1 on travel to the health centre (OR 2·42, 1·31 to 4·49; P = 0·005); being a housewife compared with a farmer (OR 2·93, 1·08 to 7·97; P = 0·035); and skin preparation with a single antiseptic compared with a combination of two antiseptics (OR 4·42, 1·05 to 18·57; P = 0·043). Receiving either preoperative or postoperative antibiotics was not associated with SSI. The prevalence of SSI after caesarean section is consistent with rates reported at tertiary facilities in sub-Saharan Africa. Combining antiseptic solutions for skin preparation could reduce the risk of SSI.
Sections du résumé
BACKGROUND
There are few prospective studies of outcomes following surgery in rural district hospitals in sub-Saharan Africa. This study aimed to estimate the prevalence and predictors of surgical-site infection (SSI) following caesarean section at Kirehe District Hospital in rural Rwanda.
METHODS
Adult women who underwent caesarean section between March and October 2017 were given a voucher to return to the hospital on postoperative day (POD) 10 (±3 days). At the visit, a physician evaluated the patient for an SSI. A multivariable logistic regression model was used to identify risk factors for SSI, built using backward stepwise selection.
RESULTS
Of 729 women who had a caesarean section, 620 were eligible for follow-up, of whom 550 (88·7 per cent) returned for assessment. The prevalence of SSI on POD 10 was 10·9 per cent (60 women). In the multivariable analysis, the following factors were significantly associated with SSI: bodyweight more than 75 kg (odds ratio (OR) 5·98, 1·56 to 22·96; P = 0·009); spending more than €1·1 on travel to the health centre (OR 2·42, 1·31 to 4·49; P = 0·005); being a housewife compared with a farmer (OR 2·93, 1·08 to 7·97; P = 0·035); and skin preparation with a single antiseptic compared with a combination of two antiseptics (OR 4·42, 1·05 to 18·57; P = 0·043). Receiving either preoperative or postoperative antibiotics was not associated with SSI.
CONCLUSION
The prevalence of SSI after caesarean section is consistent with rates reported at tertiary facilities in sub-Saharan Africa. Combining antiseptic solutions for skin preparation could reduce the risk of SSI.
Identifiants
pubmed: 30620071
doi: 10.1002/bjs.11060
pmc: PMC7938824
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e121-e128Subventions
Organisme : NIBIB NIH HHS
ID : R21 EB022369
Pays : United States
Organisme : FIC NIH HHS
ID : R21 TW011229
Pays : United States
Organisme : NIBIB NIH HHS
ID : R25 EB022368
Pays : United States
Organisme : National Institutes of Health (NIH)
ID : R21EB022368
Pays : International
Informations de copyright
© 2019 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.
Références
J Biomed Inform. 2009 Apr;42(2):377-81
pubmed: 18929686
PLoS One. 2016 Feb 05;11(2):e0148343
pubmed: 26849801
BMJ Open. 2018 May 8;8(5):e022214
pubmed: 29739786
Int J Gynaecol Obstet. 2014 Mar;124(3):244-7
pubmed: 24380609
Antimicrob Resist Infect Control. 2014 Aug 11;3:25
pubmed: 25126415
PLoS One. 2017 Apr 13;12(4):e0175456
pubmed: 28406949
Br J Surg. 2012 Mar;99(3):436-43
pubmed: 22237597
Lancet Infect Dis. 2016 Dec;16(12):e276-e287
pubmed: 27816413
Am J Infect Control. 2013 Dec;41(12):1258-63
pubmed: 23938001
Pan Afr Med J. 2016 Jun 29;24:171
pubmed: 27795768
Ethiop J Health Sci. 2011 Jul;21(2):91-100
pubmed: 22434989
Lancet Infect Dis. 2018 May;18(5):507-515
pubmed: 29519766
J Hosp Infect. 2016 Aug;93(4):355-9
pubmed: 27125664
World J Surg. 2015 Apr;39(4):822-32
pubmed: 25566979
BJOG. 2016 Apr;123(5):745-53
pubmed: 26331389
World J Surg. 2015 Feb;39(2):350-5
pubmed: 25358418
PLoS One. 2016 Mar 17;11(3):e0151419
pubmed: 26986725
Open Forum Infect Dis. 2017 Oct 06;4(4):ofx209
pubmed: 29226171
Br J Surg. 2016 Oct;103(11):1453-61
pubmed: 27428044
Health Policy Plan. 2004 Mar;19(2):69-79
pubmed: 14982885
BMJ Open. 2017 Jan 11;7(1):e013037
pubmed: 28077411
J Hosp Infect. 2006 Sep;64(1):30-5
pubmed: 16822582
J Hosp Infect. 2016 Aug;93(4):319-22
pubmed: 27388057
Int J Gynaecol Obstet. 2016 Nov;135 Suppl 1:S107-S110
pubmed: 27836076
Wound Repair Regen. 2007 Jul-Aug;15(4):474-81
pubmed: 17650090
Matern Health Neonatol Perinatol. 2016 Jul 08;2:6
pubmed: 27398224