Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda

Joseph Ngonzi, Lisa M. Bebell, Yarine Fajardo, Adeline A. Boatin, Mark J. Siedner, Ingrid V. Bassett, Yves Jacquemyn, Jean Pierre Van geertruyden, Jerome Kabakyenga, Blair J. Wylie, David Bangsberg, Laura E. Riley

Research output: Contribution to journalArticle

2 Citations (Scopus)

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). Conclusions: Among rural Ugandan women, postpartum infection incidence was low overall, and cesarean delivery was independently associated with postpartum infection while antenatal clinic attendance was protective.

Original languageEnglish (US)
Article number270
JournalBMC Pregnancy and Childbirth
Volume18
Issue number1
DOIs
StatePublished - Jun 28 2018

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Uganda
Postpartum Period
Referral and Consultation
Fever
Incidence
Infection
Cross Infection
Maternal Death
Hypothermia
Malaria
Urine
Postnatal Care
Endometritis
Urinalysis
Vital Signs
Africa South of the Sahara
Urinary Tract Infections
Sample Size
Sepsis
Retrospective Studies

Keywords

  • Africa
  • Incidence
  • Infection
  • Labor
  • Postpartum
  • Pregnant women
  • Puerperal sepsis
  • Resource limited
  • Risk factors
  • Uganda

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

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]. https://doi.org/10.1186/s12884-018-1891-1

Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda. / Ngonzi, Joseph; Bebell, Lisa M.; Fajardo, Yarine; Boatin, Adeline A.; Siedner, Mark J.; Bassett, Ingrid V.; Jacquemyn, Yves; Van geertruyden, Jean Pierre; Kabakyenga, Jerome; Wylie, Blair J.; Bangsberg, David; Riley, Laura E.

In: BMC Pregnancy and Childbirth, Vol. 18, No. 1, 270, 28.06.2018.

Research output: Contribution to journalArticle

Ngonzi, J, Bebell, LM, Fajardo, Y, Boatin, AA, Siedner, MJ, Bassett, IV, Jacquemyn, Y, Van geertruyden, JP, Kabakyenga, J, Wylie, BJ, Bangsberg, D & Riley, LE 2018, 'Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda', BMC Pregnancy and Childbirth, vol. 18, no. 1, 270. https://doi.org/10.1186/s12884-018-1891-1
Ngonzi, Joseph ; Bebell, Lisa M. ; Fajardo, Yarine ; Boatin, Adeline A. ; Siedner, Mark J. ; Bassett, Ingrid V. ; Jacquemyn, Yves ; Van geertruyden, Jean Pierre ; Kabakyenga, Jerome ; Wylie, Blair J. ; Bangsberg, David ; Riley, Laura E. / Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda. In: BMC Pregnancy and Childbirth. 2018 ; Vol. 18, No. 1.
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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). Conclusions: Among rural Ugandan women, postpartum infection incidence was low overall, and cesarean delivery was independently associated with postpartum infection while antenatal clinic attendance was protective.",
keywords = "Africa, Incidence, Infection, Labor, Postpartum, Pregnant women, Puerperal sepsis, Resource limited, Risk factors, Uganda",
author = "Joseph Ngonzi and Bebell, {Lisa M.} and Yarine Fajardo and Boatin, {Adeline A.} and Siedner, {Mark J.} and Bassett, {Ingrid V.} and Yves Jacquemyn and {Van geertruyden}, {Jean Pierre} and Jerome Kabakyenga and Wylie, {Blair J.} and David Bangsberg and Riley, {Laura E.}",
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T1 - Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda

AU - Ngonzi, Joseph

AU - Bebell, Lisa M.

AU - Fajardo, Yarine

AU - Boatin, Adeline A.

AU - Siedner, Mark J.

AU - Bassett, Ingrid V.

AU - Jacquemyn, Yves

AU - Van geertruyden, Jean Pierre

AU - Kabakyenga, Jerome

AU - Wylie, Blair J.

AU - Bangsberg, David

AU - Riley, Laura E.

PY - 2018/6/28

Y1 - 2018/6/28

N2 - 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). Conclusions: Among rural Ugandan women, postpartum infection incidence was low overall, and cesarean delivery was independently associated with postpartum infection while antenatal clinic attendance was protective.

AB - 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). Conclusions: Among rural Ugandan women, postpartum infection incidence was low overall, and cesarean delivery was independently associated with postpartum infection while antenatal clinic attendance was protective.

KW - Africa

KW - Incidence

KW - Infection

KW - Labor

KW - Postpartum

KW - Pregnant women

KW - Puerperal sepsis

KW - Resource limited

KW - Risk factors

KW - Uganda

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