Open AccessPrevalence and predictors of surgical‐site infection after caesarean section at a rural district hospital in Rwanda
Author(s) -
Nkurunziza T.,
Kateera F.,
Sonderman K.,
Gruendl M.,
Nihiwacu E.,
Ramadhan B.,
Cherian T.,
Nahimana E.,
Ntakiyiruta G.,
Habiyakare C.,
Ngamije P.,
Matousek A.,
Gaju E.,
Riviello R.,
HedtGauthier B.
Publication year - 2019
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1002/bjs.11060
Subject(s) - medicine , caesarean section , odds ratio , logistic regression , obstetrics , pregnancy , prospective cohort study , surgery , genetics , biology
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.