maternal cesarian section infection (macsi) in sierra leone

Conditions: Infection; Cesarean Section Complications; Site Infection; Maternal Death

Summary: up to 1 in 5 women in africa who deliver their baby by cesarean section get a wound infection. surgical site infections (ssis) are largely preventable, but they represent a considerable burden for health-care systems, particularly in low-income and middle-income countries. the prevention of these infections is complex and requires the integration of a range of preventive measures before, during, and after surgery. the aim of the proposed project is to determine the risk factors of surgical site infection post-cesarean section in women admitted to princess christian maternity hospital (pcmh) in freetown, sierra leone. secondary aims are to determine the incidence of ssi and the predictors of a negative outcome in women with post-cs ssi.

rationale: more than 1 in 10 people who have surgery in low and middle-income countries (lmics) get surgical site infection. people's risk of ssi in lmics is 3 to 5 times higher than in high-income countries. up to 1 in 5 women in africa who deliver their baby by cesarean section get a wound infection. surgical site infections (ssis) are largely preventable, but they represent a considerable burden for health-care systems, particularly in low-income and middle-income countries. the prevention of these infections is complex and requires the integration of a range of preventive measures before, during, and after surgery. objective: the aim of the proposed project is to determine the risk factors of surgical site infection post-cesarean section in women admitted to princess christian maternity hospital (pcmh) in freetown, sierra leone. secondary aims are to determine the incidence of ssi and the predictors of a negative outcome in women with post-cs ssi. study design: this is a prospective case-control (1:3 ratio) study. study population and methods: all women admitted or already hospitalized with suspected or confirmed infection after c/s will be screened for inclusion in the study as a case. case confirmation will be clinically established by an infectious disease expert. for each case, 3 patients undergoing the c/s on the same day and admitted to the same ward but not presenting ssi, will be selected as controls. sample size: no formal sample size calculation is performed. main study parameters/primary endpoints: ssi post c/s will be classified as: superficial incisional surgical site infection, deep incisional surgical site infection; organ/space surgical site infection nature and extent of the burden and risks associated with participation, benefit, and group relatedness: because all proceedings in the method of this study are based on common clinical practice, there are no serious adverse events (saes) expected.

Eligibility criteria:
inclusion criteria: * all pregnant women undergoing a c/s in on the hospitals during the study period will be eligible to participate in this study. exclusion criteria: the following conditions will not be considered as outcome, unless they present with systemic repercussion due to infection. for example: * vaginosis, candidiasis * lower tract urinary infection * fungal infections of the skin (athlete's foot, jockitch, ringworm, and yeast infections) * otitis * pharyngitis * herpes simplex, herpes zoster (shingles) * uncomplicated chronic infection * sexually transmitted infections (gonorrhoea, syphilis, trichomonas, chlamydia, hepatitis, hiv) * tuberculosis * bacterial colonization (presence of microorganisms without clinical signs/symptoms) * known vaginal, urethral and/or rectal gbs colonization * asymptomatic bacteriuria * known oropharyngeal colonization * non-infectious hypothermia/hyperthermia (e.g. related to epidural, thyroid storm, prostaglandin administration) during hospital stay

Keywords: site infection sierra leone africa cesarean infection maternal mortality