Determinants of puerperal sepsis among postpartum women: a case-control study in East Shoa Zone public hospitals, Central Ethiopia.

OBJECTIVE: To identify determinants of puerperal sepsis among postpartum women attending East Shoa Zone public hospitals, Central Ethiopia, 2023. DESIGN AND SETTING: An institutional-based, unmatched case-control study was conducted from 19 June 2023 to 4 September 2023, in East Shoa Zone public hospitals. PARTICIPANTS: 495 postpartum women (100 cases and 395 controls) were selected using systematic sampling techniques. Data were collected through face-to-face interviews and from medical charts using a pretested, structured questionnaire. The AOR with its corresponding 95% CI was used to identify determinant variables. Findings were presented in texts and tables. OUTCOME MEASURES: The medical charts of participants were reviewed to identify those who had developed puerperal sepsis. RESULTS: Anaemia (AOR 6.05; 95% CI 2.57 to 14.26), undernourishment (AOR 4.43; 95% CI 1.96 to 10.01), gestational diabetes mellitus (AOR 3.26; 95% CI 1.22 to 8.74), postpartum haemorrhage (AOR 3.17; 95% CI 1.28 to 7.87), obstructed labour (AOR 2.76; 95% CI 1.17 to 6.52), multiparity (AOR 2.54; 95% CI 1.17 to 5.50), placenta previa (AOR 2.27; 95% CI 1.11 to 4.67) and vaginal examination ≥5 times (AOR 2.19; 95% CI 1.05 to 4.54) were the independent determinants of puerperal sepsis in this study. CONCLUSION: This study found that gestational diabetes mellitus, anaemia, undernourishment, placenta previa, obstructed labour, postpartum haemorrhage and five or more per-vaginal examinations during labour were the determinants of puerperal sepsis. Therefore, it is recommended that obstetric care providers strictly adhere to guidelines on the number of vaginal exams that should be performed throughout labour and that they perform these exams using the appropriate infection-prevention techniques. In addition, they should provide comprehensive health education on nutrition during pregnancy and postnatal periods and the importance of iron supplements.

A five-year trend in pre-eclampsia admission and factors associated with inpatient eclampsia: a retrospective study from a resource-limited hospital in northeast Ethiopia.

OBJECTIVE: To investigate the 5-year trend of pre-eclampsia admission, magnitude and factor associated with inpatient eclampsia among deliveries involving pre-eclampsia which have been attended at one of the resource-limited public hospitals in northeast Ethiopia. DESIGN: Retrospective medical record review study. SETTING: Woldia General Hospital Medical archive, Woldia town, Ethiopia. PARTICIPANTS: All antenatal admission and deliveries involving pre-eclampsia attended from 2011 to 2016 at the hospital were included in the review. PRIMARY AND SECONDARY OUTCOME MEASURES: Trend of pre-eclampsia admission was determined using non-parametric Mann-Kendall correlation. Case management, clinical and patient-related factors were tested for possible association with the development of inpatient eclampsia using binary logistic regression. P value less than 0.05 considered significant. RESULT: Across the 5-year period, there were 8764 deliveries attended at the hospital's labour and delivery ward, of them 241 (2.76%) were co-diagnosed with pre-eclampsia. The trend showed marginal decrement through years (tau-b correlation coefficient (Tb)=-0.4, p=0.035) with the highest caseload (4.4%) observed on year 2013/2014. The rate of inpatient eclampsia was 19.6 per 10 000 births and the likelihood of its occurrence among pre-eclamptic women was 7.1% (95% CI 2.7% to 11.5%). In multivariate analysis, being multigravida (adjusted OR (AOR) 0.154, 95% CI 0.029 to 0.831) and spontaneous onset of labour (AOR 5.628, 95% CI 1.1247 to 9.401) were associated with inpatient eclampsia. CONCLUSION: In the study setting, the overall magnitude of pre-eclampsia admission was comparable with the global average, but its yearly trend showed marginal decrement from 2011 to 2016. High rate of inpatient eclampsia might indicate undertreatment which alarms further study and/or corrective measures. Waiting for spontaneous onset of labour could increase the risk of developing inpatient eclampsia whereas neither type of anticonvulsant nor duration of its usage has made significant association.