Burden of surgical site infection following cesarean section in sub-Saharan Africa: a narrative review

Abstract

Angie Sway,1 Peter Nthumba,2 Joseph Solomkin,3 Giorgio Tarchini,4 Ronald Gibbs,5 Yanhan Ren,6 Anthony Wanyoro7 1Medical Writing, World Surgical Infection Society, Cincinnati, OH, USA; 2Plastic, Reconstructive and Hand Surgery, AIC Kijabe Hospital, Kijabe, Kenya; 3Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA; 4Department of Infectious Disease, Cleveland Clinic Florida, Weston, FL, USA; 5Department of Obstetrics and Gynecology, University of Colorado Hospital, Denver, CO, USA; 6Research and Implementation, World Surgical Infection Society, Cincinnati, OH, USA; 7Department of Obstetrics and Gynecology, School of Medicine, Kenyatta University, Nairobi, Kenya Abstract: Cesarean section (CS) is the most common operative procedure performed in sub-Saharan Africa (SSA), accounting for as much as 80% of the surgical workload. In contrast to CSs performed in high-income countries, CSs performed in SSA are accompanied by high morbidity and mortality rates. This operation is the most important known variable associated with an increased probability of postpartum bacterial infection. The objective of this review was to assess surgical outcomes related to CS in SSA. PubMed (including Medline), CINAHL, Embase, and the World Health Organization’s Global Health Library were searched without date or language restrictions. A total of 26 studies reporting surgical site–infection rates after CS were identified, representing 14,063 women from 14 countries. The vast majority (76.7%) of CSs performed were emergency operations. The overall CS rate for women included in this review was 12.4% (range: 1.0%–41.9%). Only 17 of 26 total studies reported a significant proportion of women receiving antimicrobials of any kind. The surgical site–infection rate was 15.6% and the wound-infection rate 10.3%. Keywords: cesarean section, maternal mortality, surgical site infection, wound infection, sepsis, sub-Saharan Africa

Keywords

• cesarean section
• maternal mortality
• surgical site infection
• wound infection
• sepsis
• sub-Saharan Africa