Prevalence of surgical site infection and its associated factors after cesarean section in Ethiopia: systematic review and meta-analysis

Abstract

Background Surgical site infection (SSI) affects up to one third of patients who have undergone a surgical procedure. It is a significant cause of surgical patient morbidity, mortality and human and financial costs threat. The national prevalence of SSI among mothers who undergo for cesarean section and its risk factors are not well investigated in Ethiopia. Therefore, this systematic and meta-analysis conducted to estimate the pooled prevalence of surgical site infection and its associated factors after cesarean section in Ethiopia.Methods Original articles were searched in PubMed/MEDLINE, EMBASE, CINAHL, Google Scholar, HINARI portal (which includes the SCOPUS, African Index Medicus, and African Journals Online databases), and Cochrane Library. Data were extracted using a standard data extraction checklist that developed according to Joanna Briggs Institute (JBI). The I2 statistic was used to quantify heterogeneity across studies. Funnel plot asymmetry and Egger’s tests were used to check for publication bias. A fixed effect model was used to estimate the pooled prevalence of surgical site infection. Odds Ratio (OR) with 95% Confidence Interval (CI) was also used to determine the association of identified variables with surgical site infection. Statistical analysis was conducted using STATA software.Result From initial 179 identified articles, 11 were eligible for inclusion in the final meta-analysis. The pooled estimate of surgical site infection after cesarean section in Ethiopia was 9.72% (95%CI: 8.38, 11.05). PROM >12hrs (OR=5.02, 95%CI: 2.65, 9.51), duration of labor>24hrs (OR=3.69, 95%CI: 2.41, 5.65), chorioamnionitis (OR=9.11, 95%CI: 5.21, 15.93), anemia (OR=4.75, 95%CI: 2.42, 9.33) and having vertical skin incision (OR=4.17, 95%CI: 2.90, 6.02) were factors significantly associated with surgical site infection after cesarean section.Conclusion The prevalence of surgical site infection after cesarean section in Ethiopia was high. Therefore, Minister of Health with its stake holders should emphasis on community and institution based programs in manner to prevent those factors listed above that have significant effect on surgical site infection.

Surgical Site Infection after Caesarean Section: Epidemiology, Microbiology, Management and Prevention in a Tertiary Health Facility in Niger Delta Region, Nigeria

“…The incidence of surgical site infection following caesarean section from this study was 9.4%. This was comparable to the findings from other studies, [5,14,15] higher than other reports, [7,[16][17][18] and lower than 11.0% -15.6% in other reports [5,[19][20][21][22][23]. Variation in patients characteristics, institutional theater policies and practices, surgical procedure and study design may account for the wide range of incidences of SSIs across the studies [3,22].…”

“…Decision for the type of skin incision is mostly made intraoperative. Midline subumblical vertical skin incision increased the risk for SSI by 60% though this was not statistically significant and this was supported by the findings by other workers reporting significant risk of SSI in vertical incision [5,20,29]. Unlike the Pfannenstiel transverse suprapubic skin incision through tissues with better blood supply, the midline incision passes through less perfused tissue.…”

“…Short preoperative hospital admission, short duration of surgical procedure, prevention of obstetric complications like prolonged PROM, prolonged obstructed labor, prolonged labor, chorioamnionitis reduced the likelihood of SSI. These conditions have been previously supported [5,36]. Others are the use of transverse suprapubic skin incision and subcuticular skin closure.…”

“…Infection of the surgical site following caesarean delivery increases the maternal morbidity, financial burden and risk of mortality in addition to burden to the care providers. The severity of SSI ranges from superficial incisional skin infection(superficial; involving the skin and subcutaneous tissues) through deep incisional(involving the deeper soft tissues of incision; muscle and fascia) to organ-space infections(involving any part of the anatomy other than the incised body layers above; that is, skin, subcutaneous, fascia and muscle) [2,5].…”

The risk factors and care measures of surgical site infection after cesarean section in China: a retrospective analysis

“…However, the risks of postoperative thrombosis, intraoperative bleeding, uterine rupture, and placenta previa of repregnancy after cesarean delivery are significantly higher than those of women delivered via vaginal delivery [3][4][5]. Besides, the surgical site infection after cesarean section is a common yet serious complication, which has raised the attentions of health care providers [6]. It's been reported the incidence of surgical site infection after cesarean section is relatively high, which ranges from 8.18 [7] to 39.17% [8].…”