A Comparative Analysis for Inhospital and Postdischarge Puerperal Sepsis (Readmissions) Among Mothers Admitted in Mbarara Regional Referral Hospital

Abstract

Introduction: Puerperal sepsis is defined as an infection of the genital tract occurring within 42 days after delivery. It is characterized by symptoms such as chills, fever, foul-smelling vaginal discharge, pelvic pain, and delayed uterine involution. The condition is more prevalent in low-income countries, with Uganda among those reporting higher rates. Puerperal sepsis can be acquired either during the initial birth hospital admission or after discharge, resulting in readmission. Although the risk of infection exists during the antenatal period, it increases significantly during delivery and remains elevated throughout the postnatal period. Knowledge of self-care and use of postnatal care services are often limited in low-resource settings, increasing the risk of infection. Understanding the differences between mothers readmitted and those who acquire puerperal sepsis while hospitalized provides information for designing targeted interventions in its prevention. Therefore, we compared the magnitude, maternal characteristics, and associated factors among mothers who developed puerperal sepsis during their initial admission and those readmitted with post discharge puerperal sepsis at Mbarara Regional Referral Hospital. Methods: A retrospective chart review was conducted on a total of 316 files from 2017 to 2024 of mothers diagnosed with puerperal sepsis who had been admitted to the maternity and gynecology wards of Mbarara Regional Referral Hospital. Information was extracted using a predesigned checklist. The data were then cleaned, entered into MS Excel (Microsoft Corporation, Redmond, Washington, United States), and imported into IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York, United States) for analysis. Readmissions were summarized as proportions, and binary logistic regression was performed for both bivariate and multivariate analyses. Additionally, the Mann-Whitney U test was used to assess differences in length of hospital stay. Results: The proportion of readmissions (66.8%, n = 211) was higher than that of mothers who acquired puerperal sepsis while still hospitalized. Most readmitted mothers had delivered by cesarean section (86.5%, n = 186) and were from rural areas (67.3%, n = 142). Factors significantly associated with readmission included age 15-19 years (adjusted odds ratio (AOR): 6.815; 95% CI: 1.786-26.018) and being prim parous (AOR: 0.424; 95% CI: 0.186-0.968). There was also a significant difference in length of hospital stay between readmitted and non-readmitted mothers (Mann-Whitney U: 7974; Z: −4.085; p < 0.001). Conclusion and recommendation: Despite the observed reduction in admissions due to puerperal sepsis, the predominance of post discharge cases, particularly among mothers who underwent cesarean section and younger mothers, remains a significant challenge to achieving Sustainable Development Goal 3. Targeted interventions focusing on the prevention of puerperal sepsis, with emphasis on post discharge self-care, are therefore essential.