Prevalence and factors associated with surgical site infections among mothers after cesarean section at Mbarara Regional Referral Hospital, Uganda: an observational retrospective study

Abstract

Background: The risk of infection following cesarean delivery is 5–20 times higher than that following normal delivery, contributing to 10% of pregnancy-related mortality. In 2019, Mbarara Regional Referral Hospital (MRRH) performed cesarean section for 40% of deliveries, surpassing the WHO’s recommended 15%–20%. The availability and provision of effective prophylactic antibiotics are crucial in preventing surgical site infections (SSIs). Objectives: To determine the prevalence and predictors of SSIs among mothers after cesarean section, length of hospital stay, and antibiotic use at MRRH. Design: This was an observational retrospective study conducted in the maternity ward of the MRRH. Methods: Data on the diagnosis of SSI, length of hospital stay, and antibiotic use were extracted and entered into EpiData software version 3.1 and analyzed using STATA version 15. We conducted logistic regression analysis to identify factors independently associated with SSIs. We also compared the length of hospital stay. Results: The prevalence of post-cesarean SSIs was 7.9% (95% CI: 6.3%–9.9%). Mothers aged 25 years and younger were less likely to develop SSIs (adjusted odds ratio (aOR): 0.53, 95% CI: 0.30–0.93; p = 0.027). Those with more than six pregnancies were more likely to develop SSIs (aOR: 3.4; 95% CI: 1.35–8.58; p = 0.009). The median length of stay was 8 days for mothers who developed an SSI (interquartile range (IQR): 5, 16) and 3 (IQR: 3, 4) days for those who did not (p < 0.001). Prophylactic antibiotics were prescribed to 83.4% of the women (95% CI: 80.7– 85.8). Ampicillin (88.2%) was the most prescribed prophylactic antibiotic, and metronidazole was the most prescribed postoperatively (97.8%) and at discharge (77.6%). Conclusion: The current prevalence of post-cesarean SSIs is higher in Uganda than in developed countries. Older age and having had more than six pregnancies are independent predictors of SSIs, and post-cesarean SSI significantly prolonged hospital stay.