Factors Influencing Pueperal Sepsis among Postpartum Women at Hoima Regional Referral Hospital, in Hoima District Western Uganda.
Faculty of Clinical Medicine and Dentistry Kampala International University Western Campus, Uganda.
The main objective of the study was to identify factors influencing puerperal sepsis among post-partum women at Hoima regional referral hospital, in Hoima district, Western Uganda. The specific objectives were; To determine the prevalence of puerperal sepsis at Hoima regional referral hospital, to assess the social demographic factors affecting puerperal sepsis at Hoima regional referral hospital, to determine Patients factors affecting puerperal sepsis at Hoima regional referral hospital and to determine the healthcare factors affecting the prevalence of puerperal sepsis at Hoima regional referral hospital. The study adopted the descriptive cross-sectional method. The study population was all mothers in the maternity ward of Hoima regional referral hospital who developed puerperal sepsis and consented to the study. The two sets of data; qualitative and quantitative data were analyzed separately using Microsoft Excel manually and interpreted into averages and percentages and presented on tables, graphs, and pie charts. It was found that the prevalence of puerperal sepsis was 37.5%, with most participants (51.7%) delivered by cesarean section, and 35.5% by spontaneous vaginal delivery. The study concluded that the majority of puerperal sepsis occurs due to poverty, low income, and low maternal age and that the caesarian section is a very high-risk factor. The study further recommended that the government through the Ministry of Health should partner with hospitals creating affordable costs for mothers whenever serious conditions arise. Also, the promotion of education of girl children to higher levels would reduce low maternal age and also directly reduce puerperal sepsis. Furthermore, healthcare workers should work in a skilled way to prevent sepsis in postpartum mothers.
Keywords: Puerperal sepsis, Mothers, Health care workers, Spontaneous vaginal delivery, Caesarian section.
Puerperal sepsis is defined as an infection of the genital tract occurring at any time between the rupture of membranes or the onset of labor, and the 42nd day postpartum, in which a fever (temperature 38.5°C or higher) is present. This can be accompanied by one or more of the following signs and symptoms: Pelvic pain, abnormal vaginal discharge, e.g. presence of pus, abnormal smell/foul odor of discharge, sub-involution, i.e. delay in the rate of reduction of the size of the uterus (<2cm/day during the first 8 days) , . Diagnosis, medical management, and antimicrobial therapy for sepsis have significantly advanced. Despite this, puerperal sepsis remains an important cause of maternal mortality accounting for 10.7% of all maternal deaths annually worldwide . In 2010, puerperal sepsis alone caused at least 75,000 maternal deaths, mostly in low-income countries. Studies from high-income countries report the incidence of maternal morbidity due to sepsis of 0.1-0.6 per 1000 deliveries. The causative microorganisms are generally polymicrobial with beta-hemolytic streptococci group A often being the cause of severe cases of puerperal fever. The single most important risk factor for postpartum infection seems to be a cesarean section, and prophylactic antibiotics during the procedure substantially reduce the infection risk , . Improvements in service provision, as promoted through the Surviving Sepsis Campaign, can reduce the overall risk of mortality and morbidity from maternal sepsis in high-income as well as in low-income countries . In developing countries, most of the risk factors for the development of puerperal sepsis exist and cases of puerperal sepsis have been reported. For example, in a Hospital in Johannesburg, South Africa, out of 272 women who delivered via Caesarean section, 4 (1.5%) were readmitted with puerperal sepsis, and 30 (11.0%) with possible mild wound infection  while in a rural Hospital in Sudan in 2012, the incidence of puerperal sepsis was found to be very high . Out of 170 samples, 124 (72.9%) were pathogen-positive . Another study was done in Tanzania with a sample size of 3,262 women who were selected and only 27% (877) claimed that the birth attendant inserted his /her hands in the vagina, and 25% (830) reported that the birth attendant first did hand washing before delivering her. Of those (830) women, 98% reported that the attendant used soap and water before inserting hands, while 1.5% were attended to by birth assistants who washed hands but developed puerperal sepsis compared to two (8.0%) of the 25 women who reported that the birth attendant did not wash their hands before inserting them into the vagina . In Uganda, a study conducted in Mbarara Regional Referral Hospital in 2016, showed that maternal sepsis contributed the largest proportion of maternal mortality. Direct causes of mortality accounted for 77.7 % while indirect causes contributed 22.3 %. The most frequent cause of maternal mortality was puerperal sepsis (30.9 %) . Over 70% of maternal deaths in developing countries are caused by puerperal sepsis among other causes including hemorrhage culminating in anemia, hypertension, unsafe abortion, and obstructed labor -. The government of Uganda has enforced antenatal care (ANC) services. It has also collaborated with NGOs and partnerships with private Hospitals to offer service to all pregnant women so as to control infections and other complications after delivery but many mothers report back to health settings with puerperal sepsis. In Hoima regional referral Hospital, in Hoima District, Western Uganda, mothers tend to return to the Health facility a few days after delivery with complaints concerning different infections without proper origin which can, however, lead to morbidity and mortality. World Health Organization (WHO) recommends that pregnant women should have a written plan for births and for dealing with unexpected adverse events such as complications or emergencies that may occur during pregnancy, childbirth, or the immediate post-natal period, and should discuss and review this plan with a skilled attendant at each antenatal assessment and at least one month prior to the estimated date of delivery .
In Africa, retrospective studies estimate that puerperal sepsis causes nearly 10% of maternal deaths, a figure close to the world effect of puerperal sepsis on maternal mortality . Maternal mortality is highest in sub-Saharan Africa. 86% of all maternal deaths occur in low and lower-middle-income countries . In Uganda, the WHO- MDG 5 (aimed at reducing maternal mortality by 75 % between 1990 and 2015) was not attained despite the fact that the maternal mortality ratio (MMR) has improved from 550 per 100,000 in 1990 to 438 per 100,000 live births . Further, there is limited data to show the factors and causes of maternal death due to puerperal sepsis in Uganda though available data ranks it as one of the leading causes of maternal death. It’s upon this background statement that the researcher may wish to identify factors influencing puerperal sepsis among post-partum women at Hoima regional referral Hospital, in Hoima District, Western Uganda.
The study revealed that the majority of puerperal sepsis occurs during natal and postnatal periods in general. Rural residence, Educational level of a primary or less, monthly income of mother or family <=0.88 US DOLLARS per day, being in labor for > 24 h, delivered by cesarean section, low maternal age, and prime parity, assisted by nurse compared to assisted by a doctor, were identified determinants of puerperal sepsis. Employing more doctors, scaling up the educational level of the community, and supporting those of low socioeconomic status were recommended interventions.
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