Prevalence And Factors Associated with Post-Caeserean Section Wound Sepsis in A Hospital in Ghana (A Retrospective Audit)

Abstract

Caesarean Section (CS) is one of the most common obstetric procedures in Ghana. Post CS wound sepsis constitute a substantial burden to health systems in developing countries. The risk factors observed for CS wound infections are obesity, diabetes, immune-suppressive disorders, a previous CS, certain medications like steroids, the lack of pre-incision antimicrobial care, prolonged labour and surgery. Puerperal sepsis remains a notable direct cause of maternal mortality in developing and developed countries of which post CS wound sepsis contributes up to 3% especially in health units that have no facilities to carry out safe CS or treat post-CS complications. One predominant risk factor for developing puerperal sepsis is delivery by caesarean section, with some sources quoting up to a 20-fold increased risk as compared with vaginal delivery. Aims: The goal of this study is to determine the prevalence and risk factors of post CS wound sepsis in Family Health Hospital. Methods: This study is a retrospective audit of patient records of all women who delivered by Caesarean Section at Family Health Hospital in a 1-year period between 1st January 2019 and 31st December 2019. All women who delivered by caesarean section and met the inclusion criteria within the above study period were sampled. Data was collected and captured electronically by the principal researchers and then subsequently entered into Microsoft Excel and analysed using IBM SPSS version 25. The results were presented in bar charts, pie charts, frequencies and tables. Chi square test was performed on categorical data to test association between selected independent variable and the proportions of women with surgical site infection. Results: The prevalence of Post-CS wound sepsis was low (5.17%) which was within the lower end of the global prevalence range (3.7% - 24.2%) and there was no statistical significance between the risk factors and post-CS wound sepsis. The number of CS done was equally distributed across the 1-year period, with an average of 9 procedures per month. Most (73%) of the women were between 31 and 40 years. The median age of the patient population was 33 years while the mean age was 33.7 years. About 63 (60%) of the women were multiparous and 43 (40%) were nulliparous at the time of CS. Only 1 (0.95%) woman was known to be HIV Positive, however there was no additional information such as when the diagnosis was made, when antiretroviral therapy was started, compliance, etc. Diabetes Mellitus was diagnosed or known in 5.71% of the women. This included both pre-gestational and gestational diabetes. The number of women who had antepartum infection was 21 which was 20 % of the study population., whilst another 20% went into labour before caesarean section was done for them. For those who went into labour, the duration of labour was not stated. Those with a history of premature rupture of membranes before CS were 7 (6.7%). Also, the number of vaginal examinations was not indicated in the clinical notes. Out of the 105 women who were identified for the study, it was difficult to find the percentage of women that had emergency CS as compared to elective CS as some of the notes lacked this. Conclusion: The prevalence of post-CS wound sepsis in the hospital audited was low, and falls within the lower spectrum of the global prevalence for post- CS wound sepsis. Unfortunately, due to poor documentation, the influence of risk factors could not be clearly linked to the development of sepsis after this obstetric procedure in this hospital. Nevertheless, there is a dire need for further studies investigating post- CS wound sepsis prevalence especially in under resourced areas and tertiary centres in Ghana as there is no national data on its prevalence. This can contribute immensely in reducing maternal mortality in the nation. Key words: post-caesarean section; sepsis, maternal mortality, Ghana