Prevalence and predictors of surgical-site infection after caesarean section at a rural district hospital in Rwanda

Background: There are few prospective studies of outcomes following surgery in rural district hospitals in sub-Saharan Africa. This study aimed to estimate the prevalence and predictors of surgical-site infection (SSI) following caesarean section at Kirehe District Hospital in rural Rwanda. Methods: Adult women who underwent caesarean section between March and October 2017 were given a voucher to return to the hospital on postoperative day (POD) 10 (±3 days). At the visit, a physician evaluated the patient for an SSI. A multivariable logistic regression model was used to identify risk factors for SSI, built using backward stepwise selection. Results: Of 729 women who had a caesarean section, 620 were eligible for follow-up, of whom 550 (88⋅7 per cent) returned for assessment. The prevalence of SSI on POD 10 was 10⋅9 per cent (60 women). In the multivariable analysis, the following factors were significantly associated with SSI: bodyweight more than 75 kg (odds ratio (OR) 5⋅98, 1⋅56 to 22⋅96; P = 0⋅009); spending more than €1⋅1 on travel to the health centre (OR 2⋅42, 1⋅31 to 4⋅49; P = 0⋅005); being a housewife compared with a farmer (OR 2⋅93, 1⋅08 to 7⋅97; P = 0⋅035); and skin preparation with a single antiseptic compared with a combination of two antiseptics (OR 4⋅42, 1⋅05 to 18⋅57; P = 0⋅043). Receiving either preoperative or postoperative antibiotics was not associated with SSI. Conclusion: The prevalence of SSI after caesarean section is consistent with rates reported at tertiary facilities in sub-Saharan Africa. Combining antiseptic solutions for skin preparation could reduce the risk of SSI.