Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda
Abstract Background There is a paucity of recent prospective data on the incidence of postpartum infections and associated risk factors in sub-Saharan Africa. Retrospective studies estimate that puerperal sepsis causes approximately 10% of maternal deaths in Africa. Methods We enrolled 4231 women pr...
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| Format: | Article |
| Language: | English |
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BMC
2018-06-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12884-018-1891-1 |
| _version_ | 1819163090779897856 |
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| author | Joseph Ngonzi Lisa M. Bebell Yarine Fajardo Adeline A. Boatin Mark J. Siedner Ingrid V. Bassett Yves Jacquemyn Jean-Pierre Van geertruyden Jerome Kabakyenga Blair J. Wylie David R. Bangsberg Laura E. Riley |
| author_facet | Joseph Ngonzi Lisa M. Bebell Yarine Fajardo Adeline A. Boatin Mark J. Siedner Ingrid V. Bassett Yves Jacquemyn Jean-Pierre Van geertruyden Jerome Kabakyenga Blair J. Wylie David R. Bangsberg Laura E. Riley |
| author_sort | Joseph Ngonzi |
| collection | DOAJ |
| description | Abstract Background There is a paucity of recent prospective data on the incidence of postpartum infections and associated risk factors in sub-Saharan Africa. Retrospective studies estimate that puerperal sepsis causes approximately 10% of maternal deaths in Africa. Methods We enrolled 4231 women presenting to a Ugandan regional referral hospital for delivery or postpartum care into a prospective cohort and measured vital signs postpartum. Women developing fever (> 38.0 °C) or hypothermia (< 36.0 °C) underwent symptom questionnaire, structured physical exam, malaria testing, blood, and urine cultures. Demographic, treatment, and post-discharge outcomes data were collected from febrile/hypothermic women and a random sample of 1708 normothermic women. The primary outcome was in-hospital postpartum infection. Multivariable logistic regression was used to determine factors independently associated with postpartum fever/hypothermia and with confirmed infection. Results Overall, 4176/4231 (99%) had ≥1 temperature measured and 205/4231 (5%) were febrile or hypothermic. An additional 1708 normothermic women were randomly selected for additional data collection, for a total sample size of 1913 participants, 1730 (90%) of whom had complete data. The mean age was 25 years, 214 (12%) were HIV-infected, 874 (51%) delivered by cesarean and 662 (38%) were primigravidae. Among febrile/hypothermic participants, 174/205 (85%) underwent full clinical and microbiological evaluation for infection, and an additional 24 (12%) had a partial evaluation. Overall, 84/4231 (2%) of participants met criteria for one or more in-hospital postpartum infections. Endometritis was the most common, identified in 76/193 (39%) of women evaluated clinically. Twenty-five of 175 (14%) participants with urinalysis and urine culture results met criteria for urinary tract infection. Bloodstream infection was diagnosed in 5/185 (3%) participants with blood culture results. Another 5/186 (3%) tested positive for malaria. Cesarean delivery was independently associated with incident, in-hospital postpartum infection (aOR 3.9, 95% CI 1.5–10.3, P = 0.006), while antenatal clinic attendance was associated with reduced odds (aOR 0.4, 95% CI 0.2–0.9, P = 0.02). There was no difference in in-hospital maternal deaths between the febrile/hypothermic (1, 0.5%) and normothermic groups (0, P = 0.11). Conclusions Among rural Ugandan women, postpartum infection incidence was low overall, and cesarean delivery was independently associated with postpartum infection while antenatal clinic attendance was protective. |
| first_indexed | 2024-12-22T17:38:37Z |
| format | Article |
| id | doaj.art-32d7e646bc3f4bc4a68d2081abe6e7b2 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-22T17:38:37Z |
| publishDate | 2018-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-32d7e646bc3f4bc4a68d2081abe6e7b22022-12-21T18:18:28ZengBMCBMC Pregnancy and Childbirth1471-23932018-06-0118111110.1186/s12884-018-1891-1Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in UgandaJoseph Ngonzi0Lisa M. Bebell1Yarine Fajardo2Adeline A. Boatin3Mark J. Siedner4Ingrid V. Bassett5Yves Jacquemyn6Jean-Pierre Van geertruyden7Jerome Kabakyenga8Blair J. Wylie9David R. Bangsberg10Laura E. Riley11Department of Obstetrics and Gynecology, Mbarara University of Science and TechnologyDivision of Infectious Diseases, Massachusetts General HospitalDepartment of Obstetrics and Gynecology, Mbarara University of Science and TechnologyDepartment of Obstetrics and Gynecology, Massachusetts General HospitalDivision of Infectious Diseases, Massachusetts General HospitalDivision of Infectious Diseases, Massachusetts General HospitalGlobal Health Institute, University of AntwerpGlobal Health Institute, University of AntwerpInstitute of Maternal Newborn and Child Health, Mbarara University of Science and TechnologyDepartment of Obstetrics and Gynecology, Massachusetts General HospitalOregon Health & Science University-Portland State University School of Public HealthDepartment of Obstetrics and Gynecology, Massachusetts General HospitalAbstract Background There is a paucity of recent prospective data on the incidence of postpartum infections and associated risk factors in sub-Saharan Africa. Retrospective studies estimate that puerperal sepsis causes approximately 10% of maternal deaths in Africa. Methods We enrolled 4231 women presenting to a Ugandan regional referral hospital for delivery or postpartum care into a prospective cohort and measured vital signs postpartum. Women developing fever (> 38.0 °C) or hypothermia (< 36.0 °C) underwent symptom questionnaire, structured physical exam, malaria testing, blood, and urine cultures. Demographic, treatment, and post-discharge outcomes data were collected from febrile/hypothermic women and a random sample of 1708 normothermic women. The primary outcome was in-hospital postpartum infection. Multivariable logistic regression was used to determine factors independently associated with postpartum fever/hypothermia and with confirmed infection. Results Overall, 4176/4231 (99%) had ≥1 temperature measured and 205/4231 (5%) were febrile or hypothermic. An additional 1708 normothermic women were randomly selected for additional data collection, for a total sample size of 1913 participants, 1730 (90%) of whom had complete data. The mean age was 25 years, 214 (12%) were HIV-infected, 874 (51%) delivered by cesarean and 662 (38%) were primigravidae. Among febrile/hypothermic participants, 174/205 (85%) underwent full clinical and microbiological evaluation for infection, and an additional 24 (12%) had a partial evaluation. Overall, 84/4231 (2%) of participants met criteria for one or more in-hospital postpartum infections. Endometritis was the most common, identified in 76/193 (39%) of women evaluated clinically. Twenty-five of 175 (14%) participants with urinalysis and urine culture results met criteria for urinary tract infection. Bloodstream infection was diagnosed in 5/185 (3%) participants with blood culture results. Another 5/186 (3%) tested positive for malaria. Cesarean delivery was independently associated with incident, in-hospital postpartum infection (aOR 3.9, 95% CI 1.5–10.3, P = 0.006), while antenatal clinic attendance was associated with reduced odds (aOR 0.4, 95% CI 0.2–0.9, P = 0.02). There was no difference in in-hospital maternal deaths between the febrile/hypothermic (1, 0.5%) and normothermic groups (0, P = 0.11). Conclusions Among rural Ugandan women, postpartum infection incidence was low overall, and cesarean delivery was independently associated with postpartum infection while antenatal clinic attendance was protective.http://link.springer.com/article/10.1186/s12884-018-1891-1IncidenceRisk factorsPostpartumUgandaResource limitedPregnant women |
| spellingShingle | Joseph Ngonzi Lisa M. Bebell Yarine Fajardo Adeline A. Boatin Mark J. Siedner Ingrid V. Bassett Yves Jacquemyn Jean-Pierre Van geertruyden Jerome Kabakyenga Blair J. Wylie David R. Bangsberg Laura E. Riley Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda BMC Pregnancy and Childbirth Incidence Risk factors Postpartum Uganda Resource limited Pregnant women |
| title | Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda |
| title_full | Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda |
| title_fullStr | Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda |
| title_full_unstemmed | Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda |
| title_short | Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda |
| title_sort | incidence of postpartum infection outcomes and associated risk factors at mbarara regional referral hospital in uganda |
| topic | Incidence Risk factors Postpartum Uganda Resource limited Pregnant women |
| url | http://link.springer.com/article/10.1186/s12884-018-1891-1 |
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