Incidence of Postpartum Infection, Outcomes and Associated Risk Factors at Mbarara Regional Referral Hospital in Uganda

Authors

Joseph Ngonzi, Mbarara University of Science and Technology
Lisa M. Bebell, Massachusetts General Hospital
Yarine Fajardo, Mbarara University of Science and Technology
Adeline A. Boatin, Massachusetts General Hospital Center for Global Health
Mark J. Siedner, Massachusetts General HospitalFollow
Ingrid V. Bassett, Massachusetts General HospitalFollow
Yves Jacquemyn, Global Health Institute
Jean-Pierre van Geertruyden, Global Health Institute
Jerome Kabakyenga, Mbarara University of Science and Technology
Blair J. Wylie, Massachusetts General Hospital
David R. Bangsberg, Portland State UniversityFollow
Laura E. Riley, Massachusetts General Hospital

Sponsor

LMB—Salary supported by NIH Research Training Grant # R25 TW009337 funded by the Fogarty International Center and the National Institute of Mental Health, NIH T32 Ruth L. Kirschstein National Research Service Award #5T32AI007433–22, KL2/Catalyst Medical Research Investigator Training award (an appointed KL2 award) from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award KL2 TR001100) and the Charles H. Hood Foundation; travel supported by the MGH Center for Global Health. IVB—Harvard University Center for AIDS Research (CFAR), an NIH funded program (P30 AI060354), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, NIDDK, NIGMS, NIMHD, FIC, and OAR. MJS—NIH (K23 MH09916). DRB—Sullivan Family Foundation. BJW—National Institutes of Health (NIH K23 ES021471).

Published In

BMC Pregnancy and Childbirth

Document Type

Article

Publication Date

6-2018

Subjects

Women -- Mortality -- Africa, Infection in postpartum women -- Risk factors, Pregnant women -- Uganda, Cesarean section -- Complications

Physical Description

11 pages

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).

Description

Originally appeared in BMC Pregnancy and Childbirth, volume 18, number 1. May be accessed at https://doi.org/10.1186/s12884-018-1891-1.

Locate the Document

© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

DOI

10.1186/s12884-018-1891-1

Persistent Identifier

https://archives.pdx.edu/ds/psu/26155

Publisher

BioMed Central

Citation Details

Ngonzi, J., Bebell, L. M., Fajardo, Y., Boatin, A. A., Siedner, M. J., Bassett, I. V., ... & Riley, L. E. (2018). Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda. BMC pregnancy and childbirth, 18(1), 270.