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. 2020 Feb 27:148:e40.
doi: 10.1017/S0950268820000370.

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

F Di Gennaro  1   2 , C Marotta  2   3 , L Pisani  2   3   4 , N Veronese  5 , V Pisani  3 , V Lippolis  6 , G Pellizer  2 , D Pizzol  2 , F Tognon  2 , D F Bavaro  1 , F Oliva  3 , S Ponte  3 , P Nanka Bruce  7 , L Monno  1 , A Saracino  1 , M M Koroma  8 , G Putoto  2
Affiliations

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

F Di Gennaro et al. Epidemiol Infect. .

Abstract

Sierra Leone is the country with highest maternal mortality and infections are the underlying cause in 11% of maternal deaths, but the real burden remains unknown. This study aims to determine the incidence and risk factors of surgical site infection (SSI) post-caesarean section (CS) in women admitted to Princess Christian Maternity Hospital (PCMH) in Freetown, Sierra Leone. A prospective case-control (1:3 ratio) study was implemented from 1 May 2018 to 30 April 2019 and 11 women presenting with suspected or confirmed infection post-CS were screened for inclusion as a case. For each case, three patients undergoing CS on the same day and admitted to the same ward, but not presenting with SSI, were selected as controls. The post-CS infection rate was 10.9%. Two hundred and fifty-four clinically confirmed cases were enrolled and matched with 762 control patients. By multivariable analysis, the risk factors for SSI were: being single (odds ratio (OR) 1.48, 95% confidence interval (CI) 1.36-1.66), low education level (OR 1.68, 95% CI 1.55-1.84), previous CS (OR 1.27, 95% CI 1.10-1.52), presenting with premature membranes rupture (OR 1.49, 95% CI 1.18-1.88), a long decision-incision time (OR 2.08, 95% CI 1.74-2.24) and a high missing post-CS antibiotic doses rate (OR 2.52, 95% CI 2.10-2.85).

Keywords: Antibiotic; Sierra Leone; maternal death; surgical site infection.

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