Prevalence and predictors of surgical‐site infection after caesarean section at a rural district hospital in Rwanda

This study included adult women who underwent caesarean section at a rural district hospital in Rwanda between March and October 2017. Weighing more than 75 kg, spending more than €1·1 on transport to the nearest health centre, being a housewife, and skin preparation with a single solution were identified as predictors of surgical‐site infection (SSI) in the multivariable analysis. The relationship between travel costs and SSI risk may be related to access to postoperative care and needs further exploration.

Surgical‐site infection associated with markers of poverty

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.

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