T. Nkurunziza1, F. Kateera1, R. Riviello2,3, K. Sonderman2,3, A. Matousek2, E. Nahimana1, G. Ntakiyiruta4, E. Nihiwacu1, B. Ramadhan1, M. Gruendl3, E. Gaju5, C. Habiyakare5, B. L. Hedt-Gauthier3 1Partners In Health,Clinical/ Research,Kigali, CITY OF KIGALI, Rwanda 2Brigham And Women’s Hospital,Boston, MA, USA 3Harvard School Of Medicine,2. Department Of Global Health And Social Medicine,Brookline, MA, USA 4Ejo Heza Surgical Center,Kigali, CITY OF KIGALI, Rwanda 5Ministry Of Health,Kigali, CITY OF KIGALI, Rwanda
Introduction:
Surgical site infections (SSIs) are the most common healthcare-related infections, and can cause considerable morbidity or mortality if untreated. For cesarean deliveries in sub-Saharan Africa, most mothers are discharged 3 days postoperatively, and SSIs in most cases, develop following discharge and are left undetected. Therefore, there are few unbiased estimates of the prevalence of cesarean section related SSIs in sub-Saharan Africa. The aim of this study was to estimate the prevalence and predictors of SSIs following cesarean section at Kirehe District Hospital (KDH) in rural Rwanda.
Methods:
This prospective cohort study included women who underwent cesarean section over a 4 month study period (March – July 2017) at KDH. At discharge, consenting mothers provided their demographic information and were given a voucher to return to the hospital within a time frame of 7-13 days post operatively. At the return visit patients were examined by a physician, who evaluated for an SSI and other postoperative complications. Patients who were still admitted or readmitted to the hospital at 10 postoperative days were included and screened in the hospital on that day. A bivariate analyses assessing possible risk factors, such as patient demographics (age, occupation, education, income level, insurance, distance to health center and marital status) or clinical care variables (pre-morbidity, weight, smoking, skin preparation, ASA class, cadre of provider, surgery indication, type of anesthesia, duration of surgery and antibiotic therapy), were performed using Fisher’s exact test.
Results:
During the study period, there were 384 cesarean deliveries at KDH, of which 347 were eligible for the follow up and 307 (88.5%) were screened by the physician. Of these, 7 (2.3%) were still admitted at the hospital when they underwent screening. The majority (56.7%, n=174) were between 21 and 30 years old. 83.6% (n=168) received preoperative antibiotics within an hour of incision and 96.1 % (n=295) received at least one dose of postoperative antibiotics. The 10 postoperative day SSI prevalence was 10.3% (n=31). In the bivariate analysis, the only significant risk factor for surgical site infection was time for the patient to travel from home to the nearest health center to have dressing change. Patients who traveled more than one hour had greater risks of SSI (p=0.028). Interestingly, neither having had preoperative antibiotic nor postoperative antibiotic were significant for a SSI (both with p>0.999).
Conclusion:
The SSI prevalence was 10% which is consistent with the current literature throughout sub-Saharan Africa. Patients who travel farther distances have a greater risk of SSI development. The etiology of this increased risk is unclear and warrants further study.