Medical records were reviewed to find out the magnitude and associated factors of post-cesarean section infection (S.S.I) on women who underwent C/S ACSH. A total of 206 (193 non-elective and 13 elective) were eligible for analysis.
This study indicated that 24 (11.7%) of the study participant had SSI. This figure is higher than the result reported from different studies which revealed that the rate of SSI in US hospitals was 4.1%, in New Zealand 5%, in Brazil 1.44%, China 0.7%, Pakistan 5.8%, Estonian university 6.2%, Saudi Arabia 4–2.4%, and in Nizwa, Oman 2.66%. This discrepancy could be due to the difference in socioeconomic status and health care delivery system [10,11,12,13, 14,15,16,17].
Similarly, in this study the magnitude of SSI has also shown higher from the studies conducted in England, Nigeria and Jimma which, the rate of post C/S infection was 9.6, 9.3 and 8.55% respectively [7, 18, 19]. This variation might be due to the difference in study area and study participants. However, the results are approximately similar to those from studies conducted in Dhulikhel Hospital, Nepal and Tanzania in which the rates of post c/s infection were 12.6 and 10.9% respectively [20, 21].
This study found a number of factors associated with SSI following C/S. Women who had premature rupture of membrane are six times more likely to develop post C/S infection than those who had not. [AOR = 6.064, CI: (1.676–21.949)]. This finding is in line with the study conducted in US hospitals [OR = 3.0; 95% CI, (3.24–3.5)] and Nigeria (OR = 4.45) [10, 19]. This association could be due to the fetal membrane acting as a barrier to infection. However, when the fetal membrane is ruptured early, it loses its protective effect and microorganisms found in the vagina may easily migrate. This may expose the mother for SSI. This finding was also supported by other studies conducted in Brazil, China, Nepal and Sub-Saharan Africa [9,10,, 13, 20, 22].
The other factor that showed significant association were women who had chorioaminities was sixteen times more likely to have SSI following c/s than those who had not. [AOR = 16.17, 95%CI: (28.50–91.8190] This is also consistent with a study conducted in an Estonian university hospital revealing that women who had chorioaminities were 8.8 times more likely to have post C/S infection (OR, 8.8; 95%CI, 1.1–69.6) [15]. This variation might be related to socioeconomic difference between the countries. Another study conducted in Jimma as also shown significant association [7].
In this study, a rural setting has shown significant association. Women from rural areas were five times more likely to have post C/S infection than those women from urban areas. [(AOR = 5.666, 95% CI: 1.568–20.483)]. This could be due limited access to hygienic materials and poorer hygiene for women living in rural areas when compared to those in urban areas. However, a study conducted in a US urban setting showed significant association with post C/S infection [10].
This study also found that prolonged labor prior to surgery had shown a significant association with SSI following C/S. Women who had prolonged labor were six times more likely to have SSI than those who had not. Similar finding were also reported from a study conducted in New Zealand [11]. This relationship between duration of labor and SSI may be due to increased exposure time where infection can be acquired and to the fact that as duration of labor increase, number of vaginal examinations also increased. Studies conducted in Brazil, China and Tanzania [12, 13, 21] shown that post C/S infection had significant association with frequent vaginal examination.
The other factor that showed significant association was blood loss. Women with intra-operative blood loss of less than 1000 ml were 90% less likely to have SSI than those who had blood loss of more than 1000 ml [(AOR = 0.097,95% CI: 0.017–0.569)]. This finding is consistent with a study conducted in US revealing that women with excessive blood loss were 2.4 times [(OR, 2.42; 95% CI, 2.34–2.49)] more likely to develop post C/S infection [10]. This finding is also supported by a study conducted in Jimma [7]. This association could be due to excessive blood loss associated with poor control and tissue damage due to prolonged retraction, leading to use of extra sutures which may reduce local resistance mechanism.
Finally, the HIV status of women had shown a significant association. HIV positive women had about seven times more likely to have post C/S infection than those HIV negative women [(AOR = 6.982, CI: 1.382–35.269)]. However, other studies did not show its association.
In this study, the age of the mother, ANC follow up, parity, emergency C/S, skin incision, duration of operation, and skill of the person who performs the procedure had no significant association with post c/s infection. However, it is difficult to conclude that those variables are not totally important.