Maternal caesarean section infection (MACSI) in Sierra Leone: a case-control study.

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Public Health

Background:

• Sierra Leone faces the world's highest maternal mortality rates, with infections contributing significantly to maternal deaths.
• The precise burden of surgical site infections (SSI) following caesarean sections (CS) in the country is not well-documented.

Purpose of the Study:

• To determine the incidence and identify risk factors for surgical site infection (SSI) in women undergoing caesarean section (CS).
• To provide data for improving maternal healthcare in Sierra Leone.

Main Methods:

• A prospective case-control study was conducted at Princess Christian Maternity Hospital (PCMH) in Freetown, Sierra Leone.
• 11 women with suspected or confirmed post-CS SSI were identified as cases and matched with 3 controls each (total 254 cases and 762 controls).
• Data were collected over one year (May 2018 - April 2019) and analyzed using multivariable logistic regression.

Main Results:

• The incidence of post-CS surgical site infection (SSI) was 10.9%.
• Significant risk factors identified included: being single (OR 1.48), low education level (OR 1.68), previous CS (OR 1.27), premature rupture of membranes (OR 1.49), prolonged decision-incision time (OR 2.08), and high rates of missed antibiotic doses (OR 2.52).

Conclusions:

• Surgical site infections (SSI) pose a considerable risk to women undergoing caesarean sections (CS) in Sierra Leone.
• Addressing identified risk factors, such as improving antibiotic administration and reducing surgical delays, is crucial for reducing maternal morbidity.