Burden of puerperal sepsis and its associated factors in Ethiopia: a systematic review and meta-analysis

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.

Determinants of puerperal sepsis among postpartum women at a tertiary care hospital in Ethiopia: an unmatched case-control study

BACKGROUND

Puerperal sepsis, is a significant factor in maternal morbidity and mortality, especially in regions with lower income levels where maternal mortality rates are highest. However, it can be largely avoided if detected in time. Recognizing and dealing with the root causes early is essential in addressing this problem. Therefore, this study aimed to identify the determinants of puerperal sepsis among postpartum women at a tertiary care hospital in Ethiopia.

METHODS

An institutional-based unmatched case-control study was conducted among 266 postpartum women (88 cases and 178 controls) from October 1, 2023 to November 30, 2023. For each case, two controls were chosen using a systematic random sampling approach. Data were collected using an interviewer-administered, structured questionnaire and medical record review. The collected data were entered into Epi Info version 7.2 and analyzed using SPSS version 27. Binary logistic regression analysis was used to model the association between puerperal sepsis and independent variables. variables that had a crude association in the bivariable analysis (p < 0.25) were entered and analyzed by a multivariable binary logistic regression model to identify statistically significant factors. In the final model, Adjusted odds ratios with their 95% confidence intervals were calculated to determine the strength of the association. Statistical significance was declared at p < 0.05.

RESULT

Rural residence (AOR = 6.9; 95% CI:2.77-17.10), having no formal education (AOR = 3.8; 95% CI: 2.55, 10.76), cesarean section delivery (AOR: 5.1; 95% CI: 1.30, 11.00) and complication during pregnancy (AOR: 4.6, 95% CI: 1.96, 11.10) were independent determinants of puerperal sepsis.

CONCLUSION

Place of residence, maternal education level, mode of delivery, and complication during pregnancy were determinants of puerperal sepsis. It is crucial to implement education and awareness initiatives aimed at mothers, ensure universal access to healthcare services, advocate for evidence-based delivery protocols, and conduct comprehensive antenatal screenings.

Nanomaterial-based methods for sepsis management

Sepsis is a serious disease caused by an impaired host immune response to infection, resulting in organ dysfunction, tissue damage and is responsible for high in-hospital mortality (approximately 20%). Recently, WHO documented sepsis as a global health priority. Nevertheless, there is still no effective and specific therapy for clinically detecting sepsis. Nanomaterial-based approaches have appeared as promising tools for identifying bacterial infections. In this review, recent biosensors are introduced and summarized as nanomaterial-based platforms for sepsis management and severe complications. Biosensors can be used as tools for the diagnosis and treatment of sepsis and as nanocarriers for drug delivery. In general, diagnostic methods for sepsis-associated bacteria, biosensors developed for this purpose are presented in detail, and their strengths and weaknesses are discussed. In other words, readers of this article will gain a comprehensive understanding of biosensors and their applications in sepsis management.

Prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa: a systematic review and meta-analysis

Objectives

This study aimed to determine the prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa.

Methods

This systematic review and meta-analysis used the PRISMA guideline on sepsis data in sub-Saharan Africa. The bibliographic search was carried out on the following databases: Medline/PubMed, Cochrane Library, African Index Medicus, and Google Scholar. Additionally, the reference lists of the included studies were screened for potentially relevant studies. The last search was conducted on 15 October 2022. The Joanna Briggs Institute quality assessment checklist was applied for critical appraisal. Estimates of the prevalence of maternal and neonatal sepsis were pooled using a random-effects meta-analysis model. Heterogeneity between studies was estimated using the Q statistic and the I2 statistic. The funnel plot and Egger's regression test were used to assess the publication bias.

Results

A total of 39 studies were included in our review: 32 studies on neonatal sepsis and 7 studies on maternal sepsis. The overall pooled prevalence of maternal and neonatal sepsis in Sub-Saharan Africa was 19.21% (95% CI, 11.46-26.97) and 36.02% (CI: 26.68-45.36), respectively. The meta-analyses revealed that Apgar score < 7 (OR: 2.4, 95% CI: 1.6-3.5), meconium in the amniotic fluid (OR: 2.9, 95% CI: 1.8-4.5), prolonged rupture of membranes >12 h (OR: 2.8, 95% CI: 1.9-4.1), male sex (OR: 1.2, 95% CI: 1.1-1.4), intrapartum fever (OR: 2.4, 95% CI: 1.5-3.7), and history of urinary tract infection in the mother (OR: 2.7, 95% CI: 1.4-5.2) are factors associated with neonatal sepsis. Rural residence (OR: 2.3, 95% CI: 1.01-10.9), parity (OR: 0.5, 95% CI: 0.3-0.7), prolonged labor (OR: 3.4, 95% CI: 1.6-6.9), and multiple digital vaginal examinations (OR: 4.4, 95% CI: 1.3-14.3) were significantly associated with maternal sepsis.

Conclusion

The prevalence of maternal and neonatal sepsis was high in sub-Saharan Africa. Multiple factors associated with neonatal and maternal sepsis were identified. These factors could help in the prevention and development of strategies to combat maternal and neonatal sepsis. Given the high risk of bias and high heterogeneity, further high-quality research is needed in the sub-Saharan African context, including a meta-analysis of individual data.Systematic review registration: PROSPERO (ID: CRD42022382050).

Maternal complications and risk factors associated with assisted vaginal delivery

OBJECTIVE

This study aimed to elucidate the maternal complications and risk factors linked with assisted vaginal delivery.

METHODS

We conducted a retrospective, descriptive analysis of hospital records, identifying 3500 cases of vaginal delivery between 2020 and 2022. Data encompassing demographics, complications from the vaginal delivery including post-partum haemorrhage, birth passage injuries, puerperal infection and other pertinent details were documented. Various critical factors, including the duration of the second stage of labor, maternal anemia, underlying maternal health conditions such as diabetes mellitus and hypertension, neonatal birth weight, maternal weight, the expertise of the attending surgeon, and the timing of deliveries were considered.

RESULTS

The rates for assisted vacuum and forceps delivery were 6.0% (211/3500 cases) and 0.3% (12/3500), respectively. Postpartum haemorrhage emerged as the predominant complication in vaginal deliveries, with a rate of 7.3% (256/3500; P < 0.001). Notably, postpartum haemorrhage had significant associations with gestational diabetes mellitus class A1 (adjusted odds ratio [AOR] 1.46; 95% confidence interval [CI] 1.01-2.11; P = 0.045), assisted vaginal delivery (AOR 5.11; 95% CI 1.30-20.1; P = 0.020), prolonged second stage of labour (AOR 2.68; 95% CI 1.09-6.58; P = 0.032), elevated maternal weight (71.4 ± 12.2 kg; AOR 1.02; 95% CI 1.01-1.03; P = 0.003) and neonates being large for their gestational age (AOR 3.02; 95% CI 1.23-7.43; P = 0.016).

CONCLUSIONS

The primary complication arising from assisted vaginal delivery was postpartum haemorrhage. Associated factors were a prolonged second stage of labour, foetal distress, large-for-gestational-age neonates and elevated maternal weight. Cervical and labial injuries correlated with neonates being large for their gestational age. Notably, puerperal infections were related to maternal anaemia (haematocrit levels < 33%).

CLINICAL TRIAL REGISTRATION

Thai Clinical Trials Registry: 20220126004.

One size does not fit all: an application of stochastic modeling to estimating primary healthcare needs in Ethiopia at the sub-national level

BACKGROUND

Primary healthcare systems require adequate staffing to meet the needs of their local population. Guidelines typically use population ratio targets for healthcare workers, such as Ethiopia's goal of two health extension workers for every five thousand people. However, fixed ratios do not reflect local demographics, fertility rates, disease burden (e.g., malaria endemicity), or trends in these values. Recognizing this, we set out to estimate the clinical workload to meet the primary healthcare needs in Ethiopia by region.

METHODS

We utilize the open-source R package PACE-HRH for our analysis, which is a stochastic Monte Carlo simulation model that estimates workload for a specified service package and population. Assumptions and data inputs for region-specific fertility, mortality, disease burden were drawn from literature, DHS, and WorldPop. We project workload until 2035 for seven regions and two charted cities of Ethiopia.

RESULTS

All regions and charted cities are expected to experience increased workload between 2021 and 2035 for a starting catchment of five thousand people. The expected (mean) annual clinical workload varied from 2,930 h (Addis) to 3,752 h (Gambela) and increased by 19-28% over fifteen years. This results from a decline in per capita workload (due to declines in fertility and infectious diseases), overpowered by total population growth. Pregnancy, non-communicable diseases, sick child care, and nutrition remain the largest service categories, but their priority shifts substantially in some regions by 2035. Sensitivity analysis shows that fertility assumptions have major implications for workload. We incorporate seasonality and estimate monthly variation of up to 8.9% (Somali), though most services with high variability are declining.

CONCLUSIONS

Regional variation in demographics, fertility, seasonality, and disease trends all affect the workload estimates. This results in differences in expected clinical workload, the level of uncertainty in those estimates, and relative priorities between service categories. By showing these differences, we demonstrate the inadequacy of a fixed population ratio for staffing allocation. Policy-makers and regulators need to consider these factors in designing their healthcare systems, or they risk sub-optimally allocating workforce and creating inequitable access to care.

Adverse Maternal and Perinatal Outcomes of Meconium-Stained Amniotic Fluid in Term Labor at Hospitals in South Gondar Zone, Northwest Ethiopia: A Prospective Cohort Study

Background

The passage of meconium during labor increased the chance of undesirable birth outcomes. The adverse effects of meconium are worsening in resource-limited countries. In Ethiopia, there is an argument concerning meconium's negative effects and management on pregnant women and their babies. Therefore, this study was intended to assess the adverse maternal and perinatal outcomes of meconium in term labor in the South Gondar Zone, Ethiopia.

Methods

A prospective cohort study was conducted using 580 laboring mothers (145 exposed and 435 nonexposed groups). A two-stage sampling method was implemented to get study subjects. The data were collected using an interviewer-administered structured questionnaire and a medical chart review. SPSS version 25 was used for data analysis. Chi-squared and Fisher's exact tests were used to compare the two groups' differences. The strength of the association was measured using relative risk with a 95% CI.

Result

There was more operative delivery (28.3% versus 5.3%), puerperal sepsis (79.54% versus 2.06%), nonreassuring fetal heart rate pattern (29.7% versus 2.1%), meconium aspiration syndrome (7.58% versus 0.68%), neonatal sepsis (9% versus 4.1%), perinatal asphyxia (13.8% versus 7.6%), admission to the neonatal intensive care unit (23.4% versus 3.2%), and early neonatal deaths (4.8% versus 1.4%) among meconium stained groups as compared to the clear amniotic fluid groups.

Conclusion

Meconium-stained amniotic fluid significantly increased adverse maternal and perinatal outcomes in Ethiopia. The risk of perinatal asphyxia, nonreassuring fetal heart rate pattern, neonatal sepsis, meconium aspiration syndrome, admission to the NICU, early neonatal death, operative delivery, and puerperal sepsis were significantly higher in meconium-exposed groups. Special attention should be given to meconium-exposed mothers during the intrapartum period and in postnatal follow-up.

Predictors of early resumption of post-partum sexual intercourse among post-partum period women in Ethiopia: A multilevel analysis based on Ethiopian demographic and health survey 2016

Background

Early resumption of post-partum sexual intercourse has an adverse outcome on the health of women and indirectly unintended pregnancy might happen and affects both the health of women and the delivered baby. There is limited evidence that shows predictors at the individual and community level from the Ethiopian demographic and health survey. Therefore, the aim of this study was to assess predictors of early resumption of post-partum sexual intercourse among post-partum period women in Ethiopia: a multilevel analysis based on Ethiopian demographic and health survey 2016.

Methods

This study used an in-depth secondary data analysis of the survey using the 2016 main EDHS. A total weighted sample of 6447 post-partum women who have children aged 0 to 36 months (about 3 years) was included for the analysis. Multilevel binary logistic regression analysis was conducted considering the hierarchical nature of the EDHS data. Intra-class Correlation Coefficient (ICC), and deviance [-2 Log-Likelihood Ratio (LRR)] were used for model comparison and for assessing model fitness. In a multivariable analysis adjusted OR with a 95% CI (Confidence Interval) was reported with a p-value <0.05 was used to declare a significant association between the explanatory and the outcome variables.

Results

The proportion of early resumption of post-partum sexual intercourse was found to be 60.41% [95% CI 59.19–61.63]. Women with age group of 25–28 (AOR = 0.8; 95% CI 0.67–0.96), 29–32 (AOR = 0.79; 95% CI 0.63–0.98), and 33–49 (AOR = 0.67; 95% CI 0.53–0.85), women with sex of child female (AOR = 0.82; 95% CI 0.73–0.92), women whose child is alive (AOR = 0.52; 95% CI 0.38–0.69), women who delivered by cesarean section(AOR = 0.34; 95% CI 0.23–0.49), women with primary educational level (AOR = 1.27; 95% CI 1.09–1.48), women with secondary educational level (AOR = 1.61; 95% CI 1.19–2.17) and women with higher educational level (AOR = 1.6; 95% CI 1.05–2.45), Para 3–4 women (AOR = 1.45; 95% CI 1.21–1.73) and women with grand multi parity (AOR = 1.61; 95% CI 1.29–2), women with fertility desire wanted latter (AOR = 0.81; 95% CI 0.69–0.94), women with fertility desire wanted no more (AOR = 0.81; 95% CI 0.66–1.01), women who are on family planning use (AOR = 1.2; 95% CI 1.05–1.38) and participant with currently on working (AOR = 0.79; 95% CI 0.69–0.91) were significantly associated with early resumption of post-partum sexual intercourse.

Conclusions

The magnitude of early resumption of post-partum sexual intercourse was found to be high. Giving emphasis to the age groups of 25–28, 29–32, and 33–49 women, women with the sex of child female, women who delivered by cesarean section, currently working, the child is live, fertility desire wanted later and no more were suggested to reduce early resumption of post-partum sexual intercourse. On the other hand, improved educational attainments of women, women with parity 3–4, and >5, and family planning use were variables to increase early resumption of post-partum sexual intercourse. Therefore, the health care providers and program managers should act on early resumption of post-partum sexual intercourse through health education and promotion considering the significant factors.