High Rates of Surgical Site Infection after Cesarean Delivery in Cameroonian Referral Hospitals: A Prospective Cohort Study

High Rates of Surgical Site Infection after Cesarean Delivery in Cameroonian Referral Hospitals: A Prospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article High Rates of Surgical Site Infection after Cesarean Delivery in Cameroonian Referral Hospitals: A Prospective Cohort Study Robert Tchounzou, Theophile Nana Njamen, Fulbert Mangala Nkwele, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4739976/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Caesarean sections (CS) are associated with a higher incidence of surgical site infections (SSI) compared to vaginal delivery. International studies and research from peripheral hospitals in Cameroon have documented the prevalence and risk factors for SSI after CS. However, data from referral hospitals in Douala, Cameroon remains scarce. This prospective study aims to investigate the incidence and risk factors for SSI following CS in Laquintinie and Douala Gynaeco-obstetric and Paediatric hospital, two major referral hospitals in Douala. By identifying modifiable factors associated with SSI, this study hopes to contribute to the development of strategies to control this significant hospital-acquired complication. Methods: Between February 1st and July 31st, 2022, 444 women undergoing caesarean section were enrolled in a prospective study conducted at two referral hospitals (Laquintinie hospital and Douala Gynaeco-Obstetric Hospital) in Douala, Cameroon. Standardized data collection captured sociodemographic, obstetric, and management details (pre-operative, intra-operative and post-operative information) for patients presenting with surgical site infection. Patients were followed up for 30 after caesarean section and SSI. Descriptive statistics and multivariable logistic regression analysis identified factors associated with SSI (p < 0.05). Results: The overall incidence of SSI was 45/444 (10.13%). Laquintinie Hospital had a higher rate (11.11%) compared to Douala Gynaeco-Obstetric Hospital (6.45%). Multivariate analysis identified obesity (aOR = 5.9, p = 0.032), pre-surgical anemia (aOR = 4.7, p = 0.03), and diabetes (aOR = 15.7, p = 0.013) as independent risk factors for SSI. Blood transfusion also emerged as a risk factor (aOR = 0.05, p = 0.013). Conclusion: This study revealed a concerningly high rate of SSI after CS in Douala referral hospitals. Addressing pre-surgical anemia, diabetes, and obesity may contribute to reducing SSIs. Further research is needed to identify causative bacteria and optimize antibiotic strategies. Surgical site infection Caesarean section Referral hospitals incidence risk factors Figures Figure 1 Introduction Caesarean sections (CS), surgical deliveries through the abdomen, are increasingly favoured over vaginal births worldwide. Despite WHO recommendations for CS rates between 10–15%, many countries, including Cameroon, experience a rise in CS procedures. While CS offers life-saving advantages in certain situations, it is associated with higher complication rates compared to vaginal delivery. One such complication is surgical site infection (SSI) [ 1 , 2 , and 3 ]. Defined by the European Centre for Disease Control (ECDC) as an infection near the surgical incision involving the skin, the deep soft tissue and/or any organ or spaces other than that was manipulated and within 30 days of procedure [ 5 ], SSIs are the most common healthcare-associated infection in both the developed and low- and middle-income countries (LMICs) like Cameroon. World Health organization highlights figures of up to 11.8% of SSI following surgical procedures and 3 to 15% in case of CS in LMICs [ 7 ]. While antibiotic prophylaxis, improved surgical techniques, and surveillance systems have reduced SSI rates in developed countries, it remains a challenge in resource-limited settings [ 8 ]. Several factors like prolonged labor, high body mass index (BMI), hypertension, length of procedure, and anemia have been linked to increased SSI risk [ 8 – 12 ]. Trends of CS rates in Cameroon are in the increase with global reported change from 12% in 2000 to 21% in 2015 [ 13 ]. Previous studies in Cameroon reported varying SSI rates following CS; 10.8% in Douala Laquintinie hospital [ 4 ] and 20% in Yaoundé Central Hospital [ 14 ]. However, these studies were limited in duration and scope. This current research aims to determine the true incidence and predictors of SSI by following patients for 30 days after CS in two referral hospitals in Douala. This information will be crucial for developing evidence-based protocols for managing post-caesarean SSIs in Cameroon. Materials and methods Study design This prospective study was conducted over six months, from February 01, 2022, to July 31, 2022, at two referral hospitals in Douala, Cameroon: Laquintinie Hospital and Douala Gynaeco-Obstetric and Paediatric Hospital (DGOPH). Study Sites A. Laquintinie Hospital Laquintinie Hospital, a high-volume teaching hospital, manages the most caesarean sections (CS) (approximately 950/2900 annual births) in the Douala region. It serves a diverse patient population, with patients primarily covering their own treatment costs. The obstetrical theatre unit handles CS deliveries and various gynecological surgeries. Due to the presence of trainees and high patient turnover, aseptic conditions might be suboptimal. B. Douala Gynaeco-Obstetric and Paediatric Hospital (DGOPH) DGOPH, a public first-category hospital specializing in maternal and child care, conducts an average of 550-600 deliveries annually, with about 25% performed by CS. Labor management adheres to established guidelines incorporating infection prevention measures. CS procedures are performed by obstetricians or senior residents under consultant supervision. The dedicated theatre unit separates obstetrical and gynecological surgeries from abscess cases. Rigorous infection prevention protocols are implemented for theatre access, surgical attire, and equipment use. Inclusion and exclusion criteria All women undergoing CS during the study period were approached for informed consent and inclusion. We excluded women who: Failed to complete the questionnaire. Died immediately or before 30 days after CS without an SSI diagnosis. Presented other surgical or infectious complications. Sampling and sample size Patients were recruited consecutively using a convenience sampling method. Data collection procedure Standardized data collection tool captured preoperative, intraoperative, and postoperative information for each woman undergoing CS. A. Preoperative Data included sociodemographic data (age, phone number, education level, and occupation), obstetrical data (parity, gestational age, previous CS, labor duration, ruptured membranes duration), mode of admission (elective or emergency), and in-hospital or referred patient status. Body mass index (BMI), Hemoglobin level, urinary catheter insertion time, and surgical site shaving time B. Intraoperative Data were anesthesia type, surgeon’s qualification (obstetrician or resident doctor), surgery duration, antibiotic use, quantity of blood loss quantity, and any intraoperative complications. C. Postoperative Data comprise antibiotic use, outcome measures( occurrence of superficial surgical site infection (SSSI), deep incisional infection (DII), or organ/space infection (OI)). Diagnosis of SSI Criteria We used the CDC criteria for diagnosing SSIs: Superficial Incisional Infection (SSSI): Involves skin and subcutaneous tissues. Requires at least one of the following: purulent discharge, isolated organism, infection symptom, or surgeon’s diagnosis. Deep Incisional Infection (DII): Involves deep tissues (muscles and fascia). Requires at least one of the following: purulent discharge, dehiscence/reopening of the incision by the surgeon due to suspected infection, evidence of abscess formation, or other deep infection diagnosed by the surgeon. Organ/Space Infection (OI): Involves any organ other than the incision site but related to the surgery. Requires at least one of the following: purulent discharge from a drain placed in the organ, isolated organism from the organ, abscess, or infection involving the organ. Participant Follow-Up Participants were systematically reviewed at: Day 4: Surgical site dressing change as per hospital protocol. Every 2 days until day 12 at Laquintinie Hospital. Day 3 at DGOPH. Following this monitoring period, patients with SSI were identified and received appropriate treatment based on hospital protocols. Patients without infection were discharged home. Before discharge, participants received education on potential SSI signs, including pain, fever, localized swelling, redness, purulent drainage, skin heat, and wound dehiscence. This enabled them to recognize infection at home and inform the research team. All participants were reviewed at day 30 for final assessment and study closure. Data management and analysis Data from the questionnaires were securely stored. Information was extracted and entered into Microsoft Office 365 Excel for initial analysis to create a usable database. This database was then exported into EpiInfo 7 for further analysis. Categorical variables (occupation, education level, comorbidity) were summarized using counts and percentages, presented using a tabular form. Continuous variables (age, gestational age, BMI etc) were summarized using mean, standard deviations, medians and interquartile range where necessary. A chi square test was utilized to identify categorical risk factors that exhibit a statistically significant association with the occurrence of SSI (p < 0.05). Following the chi-square test, we calculated the Odds Ratio (OR) with a 95% confidence interval (CI) for each significant risk factor identified. Multivariate logistic regression analysis with adjusted Odds ratio (aOR) to account for potential interactions and confounding effects of factors found to be significant after bivariate analysis was finally used; the level of significance was set at p<0.05. II-6 Ethical considerations and consent to participate Ethical clearance was obtained from the institutional Review Board of the Faculty of Health sciences, University of Buea under the registration number 2021/1546-01/UB/SG/IRH/FHS. Administrative authorization was obtained from the directors of Laquintinie and Douala Gynaecology obstetric and Paediatric hospitals. All participants provided written informed consent after a thorough explanation of the study's purpose, procedures, potential risks and benefits, and the right to withdraw at any time without penalty. Results Results chart Figure 1: participant’s flow diagram for SSI following CS Socio-demographic characteristics of participants As summarized in table 1 below, the median age of study participants was 29 years and the mean age 29.24±6.46 with extremes of 18 and 42 years. Most of the participants were between the age group 20 to 29 (48.4%). Over fifty-five per cent of participants has no employment (55.9%) and most of them had tertiary level education (49.6%). General characteristics of study population Over 72% of participants (332) had an abnormal body mass index (BMI) and within this group 112 (25.3%) having class II or III obesity. Repeated CS were performed in 34.7% of cases. The majority of patients had a normal haemoglobin (Hb) level above 11 g/dl whereas 61(13.7%) were identified as anaemic. Caesarean section was done as emergency in over 57.9% of cases. The duration of rupture of membranes (ROM) ranged from 0 to 216 hours with a mean of 8.2±32.32 hours and median of 0 (IQRː0-3) hours; in most cases, ROM has lasted less than 12 hours (57.9%). Obstetricians were the primary surgeons in (83.1%) and The duration of surgery ranged from 40 minutes to 80 minutes with a mean of 56.09±7.98 minutes and median of 55 (IQRː50-60). Adherence to antibiotic guidelines (prophylaxis or treatment) was observed in 304 (68.5%) cases the remaining 31.5% had either delayed or no use. Over ten per cent of patients had comorbidity with Diabetes mellitus in 4.5% of cases (see table 2). Incidence of SSI This study examined the occurrence of SSIs among 444 patients. A total of 45 patients (10.13%) developed SSI (see figure 1). The incidence was lower in the DGOPH group (6.45%, 6 out of 93 patients) compared to the LQ group (11.11%, 39 out of 351 patients). Most SSIs (63.33%) occurred between the 6th and 14th day after surgery, with a median time to occurrence of 9 days (IQR 7-12 days). The distribution of SSI types was as follows: Superficial SSI: 19 cases (42.22%) Deep SSI: 24 cases (53.33%) Organ space SSI: 2 cases (4.45%) Bivariate and multivariate analysis of determinants of SSI The table 3 below presents the results of a bivariate analysis investigating potential risk factors associated with Surgical Site Infections (SSI) following Caesarean Section (CS). It compares the frequency of SSI occurrence (Yes/No) across different categories within each risk factor. Factors associated the occurrence of SSI are the following: Body Mass Index (BMI): Patients with obesity (BMI ≥ 30) had a significantly higher risk of SSI compared to those with normal weight (OR = 0.021, p-value = 0.03). Pre-surgical Hemoglobin (Hb) level: Anaemic patients (Hb level ≤ 11 g/dl) were more likely to develop SSI compared to non-anaemic patients (OR = 4.7, p-value = 0.03). Comorbidity - Diabetes: Patients with diabetes had a significantly increased risk of SSI compared to those without any comorbidities (OR = 8.4, p-value = 0.04). Blood Transfusion: Patients who received blood transfusions had a higher risk of SSI compared to those who did not (OR = 1, p-value = 0.06). Note that a p-value of 0.06 suggests a trend towards significance, but further investigation might be needed. The sociodemographic characteristics had no significant association with the occurrence of SSI Multivariate analysis of factors associated to the occurrence of SSI The table 4 builds upon the findings from the bivariate analysis (Table 3) by performing a multivariate logistic regression analysis to examine the independent associations between risk factors and SSI. Adjusted Odds Ratios (aOR) with 95% confidence intervals (CI) and p-values for each risk factor were determined. Patients with obesity (BMI ≥ 30) had a nearly six-fold increased risk of SSI compared to those with normal weight (aOR = 5.9, p-value = 0.032). This finding aligns with the trend observed in the bivariate analysis. The presence of diabetes remained a significant risk factor for SSI even after considering other factors in the model (aOR = 15.7, p-value = 0.013). Having received a blood transfusion emerged as a significant protective factor in the multivariate analysis (aOR = 0.05, p-value = 0.004). Tables Table 1: Sociodemographic characteristics of the study participants VARIABLE FREQUENCY (n= 444) PERCENTAGES (%) Age group <20 47 10.6 20-29 215 48.4 30-39 145 32.7 ≥40 37 8.3 Occupation Employed 196 44.1 Unemployed 248 55.9 Level of education No formal education 37 8.3 secondary 187 42.1 Tertiary 220 49.6 Table 2 : General characteristics (personal, obstetrical and surgical) of study participants Variables Frequency n = 444 Percentage (%) BMI(n=444) Underweight 9 2.0 Normal weight 103 23.2 Overweight 220 49.5 M. obesity 112 25.3 Previous CS ( n=444) No 290 65.3 Yes 154 34.7 Pre-surgical Hb ( n=444) 11 mg/dl 200 45.1 Management site(n=444) Study site 271 61.0 Referred 173 39.0 Rupture membranes ( n= 444) 18 hours 37 8,3 Type of CS ( n=444) Elective 187 42.1 Emergency 257 57.9 Grade of surgeon (n= 444) G. practitioner/ Resident Obgyn 75 16.9 Obstetrician 369 83.1 Antibiotic use (n = 444) Appropriate 304 68.5 Inappropriately 140 31.5 Comorbidity (n= 444) None 396 89.2 Diabetes 20 4.5 Others’ 28 6.3 Blood transfusion (n=444) Yes 23 5.2 No 421 94.8 Table 3: Bivariate analysis of risk factors of SSI Variables SSI (n= 45) OR(95% CI) P value YES NO Age <20 4 (8.88) 43 (10.77) 1 20-29 21 (46.66) 195 (48.87) 1.1 (0.1-10.6) 0.94 30-39 16 (35.55) 128 (32.08) 1.33 (0.1-13.53) 0.81 ≥40 4 (8.88) 33 (8.27) 1.2 (0.07-24.38) 0.87 Occupation Not emoployed 16 (35.55) 233 (58.40) 0.4 (0.1-1.5) 0.2 Employed 29 (64.45) 166(41.60) 1 Education level No formal 4(8.88) 33 (8.27) Secondary 16 (35.56) 171 (42.86) 0.83 University 25 (55.56) 195 (48.87) 0.98 BMI Underweight 0 (0.0) 9 (2.26) - Normal weight 16(35.56) 87 (21.80) Overweight 9 (20) 211 (52.88) 0.48 (0.13-1.81) 0.2 Obesity 20(44.44) 92 (23.06) 0.021(0.01-0.93) 0.03 Previous CS YES 9(20) 154 (38.60) 0.56 (0.04-2.93) 0.54 NO 36(80) 245 (61.40) 1 - Pre-surgical Hb level Anaemia 16 (35.56) 228 (57.14) 4.7 (1.2-19.5) 0.03 No Anaemia 29 (64.34) 171(42.86) 1 Type of CS Emergency 37 (8.22) 220 (55.14) Elective 8 (17.78) 179 (45.86) Antibiotic use Appropriate 8 (17.78) 132 (34.34) 1.5 (0.3-7.5) 0.62 inappropriate 37 (82.22) 262 (65.56) 1 Rupture of membranes 0-12 hours 29(64.44) 228(57.14) 1 12-18 hours 12(26.67) 138(34.58) 0.7 (0.17-2.9) >18 hours 4(8.89) 33(8.27) 0.9 (0.1-9.2) Grade of surgeon Obstetrician 37(82.22) 332 (83.21) 1 MD/Resident 8(17.78) 67(16.79) 1.1 (0.2-5.7) 0.9 Comorbidity None 37(82.22) 359 (89.98) 1 Diabetes 8(17.78) 12 (3.00) 8.4 (1.06-28.0) 0.04 Others 0(0) 28 (7.01) Blood transfusion Yes 12(26.67) 11(2.76) 1 1 No 33(73.33) 388(97,24) 0.06 (0.01-0.4) 0.06 Table 4: Multivariate logistic regression analysis of significant factors after bivariate analysis. Variable SSI aOR(95% CI) P value Yes No BMI (Obesity 20 (44.44) 92(23.06) 5.9 (1.17-30.0) 0.032 Anaemia Yes 16 (35.56) 228 (57.14) 4.7 (1.2-19.5) 0.03 No 29 (64.34) 171(42.86) 1 Comorbidties None 37(82.22) 359(89.97) - - Diabetes 8 (17.77) 12(3.0) 15.7 (1.7-24.4) 0.013 Others 0(0.0) 28(7.01) - Blood transfusion No 33(73.33) 379(94.98) 0.05 (0.008-0.39) 0.004 Yes 12(26.66) 11(2.75) 1 - Discussion Incidence of SSI This study investigated the incidence and risk factors of surgical site infections (SSI) in two Cameroonian referral hospitals known for their high standards of care. Our active surveillance for 30 days post-surgery aligns with international SSI criteria [5], unlike prior studies limited to hospital stay durations. This likely contributes to a more accurate picture of SSI incidence. The observed cumulative incidence of SSI was 10.13%, with Laquintinie hospital (LQ) exhibiting a higher rate (11.11%) compared to DGOPH (6.45%). Although statistically non-significant, this difference might be attributed to the availability of written infection prevention guidelines in DGOPH's maternity and theatre units. The diversity of patients who receive care in LQ including the most economically constraint and the large number of trainees using the theater may also account for suboptimal aseptic measures. Our findings on SSI rates in developing countries highlight a wide range. Relatively low rates reported in some studies (e.g., 1.81% by Fouedjio et al. [14]) likely underestimate the true burden due to methodological limitations such as retrospective design, short follow-up periods, or restricting observation to hospital stays. This aligns with previous research demonstrating the underestimation of SSI when surveillance is limited [17]. Several studies conducted in settings with similar care standards report comparable SSI rates to ours [9, 12, 18 and 19]. Conversely, other studies in Asia and sub-Saharan Africa documented higher rates (18.8% by Jasim et al. [7] to 20.7% by Ngowe Ngowe et al. [20]). Compared to developed countries (1-3.9% incidence [17, 21, 22]), our findings suggest a greater magnitude of SSI, possibly due to less stringent infection prevention measures. Risk Factors for SSI Bivariate analysis identified several potential predictors of SSI: obesity (OR = 0.021; CI: 0.01-0.93; p = 0.03), pre-surgical anemia (OR = 4.7; CI: 1.2-19.5; p = 0.03), diabetes (OR = 8.4; CI: 1.06-28.0; p = 0.04), and blood transfusion (OR = 0.01; CI: 0.01-0.4; p = 0.06). Inappropriate antibiotic use (OR = 1.5; CI: 0.3-7.50; p = 0.62) did not reach statistical significance and was excluded from the multivariate analysis. Multivariate logistic regression analysis confirmed obesity (aOR = 5.9; CI: 1.17-30.0; p = 0.032), pre-surgical anemia (aOR = 4.7; CI: 1.2-19.5; p = 0.03), and diabetes (aOR = 15.7; CI: 1.7-24.4; p = 0.013) as independent risk factors for SSI. Interestingly, blood transfusion emerged as a protective factor (aOR = 0.05; CI: 0.008-0.39; p = 0.004). This unexpected finding warrants further investigation, potentially due to limitations like sample size or the presence of confounding factors. Our study identified different risk factors compared to previous Cameroonian research by Tebeu et al. [23] and Fouedjio et al. [14] which reported factors like prolonged premature rupture of membranes, resident doctors’ involvement, and midline incision type. These discrepancies might be explained by the rarity of midline incisions at our study site and the close supervision of resident doctors by senior consultants during CS procedures. The independent risk factors of anemia and blood transfusion identified in our study are consistent with findings from other studies [1, 24-26]. Anemia, prevalent due to financial constraints and limited health coverage, can delay surgical healing. Blood transfusions administered to address anemia might introduce immunomodulation, increasing the risk of post-surgical infections [27]. Obesity and diabetes mellitus also demonstrated a strong association with SSI. Obesity is a known risk factor for diabetes, and both conditions can compromise vascular and immune function [28, 29]. The link between increasing body weight and surgical safety is well-documented [30, 31]. While not statistically significant, inappropriate antibiotic use was observed at LQ, encompassing late administration of prophylaxis in emergencies and irregular or absent post-operative antibiotics. This practice has a 1.5-fold increased likelihood of predicting SSI. Financial constraints and resulting non-adherence to treatment protocols in emergency cases could be contributing factors [32]. The importance of proper antibiotic prophylaxis in elective surgery and appropriate therapy in contaminated surgery is well-documented [29, 6, 33, and 34]. Other reported risk factors, such as number of vaginal exams, prolonged labor, and prolonged rupture of membranes, were not significant in our study. Study limitations While the prospective design of the study strengthens the accuracy of its findings, the use of convenience sampling introduces potential selection bias. This means that the participants may not be fully representative of the entire population of women undergoing caesarean section at these two hospitals, limiting the generalizability of the results. Recruiting all the cases was an attempt to reduce this bias. Additionally, the study focused primarily on risk factors and did not delve deeply into potential protective factors, such as specific surgical techniques or postoperative care protocole Conclusion This study underscores the substantial burden of surgical site infections (SSIs) following caesarean section in our setting. It identifies potentially modifiable risk factors, including obesity, diabetes mellitus, and severe anemia, suggesting that stricter infection prevention protocols and addressing obesity could be crucial strategies to reduce SSI rates. Further research within the region is warranted to explore the potential protective effects of factors such as specific antibiotic prophylactic regimens, surgical techniques, and postoperative care protocols. Additionally, the unexpected finding of blood transfusion as a protective factor against SSI warrants further investigation to elucidate the underlying mechanisms and potential confounding variables. Declarations Authors’ contributions RT, TNN, FGMN, and EMEM conceptualized and designed the study. Participants were recruited at the sites by HE, DK and EMEM. DK participated in in participants ‘recruitment and reviewed the manuscript. RT, EMEM, DK and FGMN in addition wrote the manuscript. HE, TNN and MNN revised and scrutinized the study for important intellectual content. All the authors read and approved the final version of the manuscript. Funding There was no funding for this research. Availability of data The dataset that was used and analyzed in this study is not publicly available due to ethical considerations. Upon reasonable request, the dataset used can availed with permission of the corresponding author Dr Robert Tchounzou (email: [email protected] ). Ethical considerations and consent to participate Ethical clearance was obtained from the institutional Review Board of the Faculty of Health sciences, University of Buea under the registration number 2021/1546-01/UB/SG/IRH/FHS. Administrative authorization was obtained from the directors of Laquintinie and Douala Gynaecology obstetric and Paediatric hospitals. All participants provided written informed consent after a thorough explanation of the study's purpose, procedures, potential risks and benefits, and the right to withdraw at any time without penalty. Consent for publication : not applicable Conflict of interests : None declared References Gelaw KA, Aweke AM, Astawesegn FH, Demissie BW, Zeleke LB. Surgical site infection and its associated factors following cesarean section: a cross sectional study from a public hospital in Ethiopia. Patient Saf Surg. 2017;11:18. C-Section Rates by Country 2023. World population review. Available from: https://worldpopulationreview.com/country-rankings. WHO statement on caesarean section rates. Available from: https://www.who.int/publications-detail-redirect/WHO-RHR-15.02 Henri E, Valere MK, Paul EJ, Merlin B, Felix E, Grâce TT, et al. Caesarean Section in African Setting: Current Situation, Problematic and Qualitative Approaches at Laquintinie Hospital (Douala, Cameroon). Open J Obstet Gynecol. 2019 Sep 25;9(10):1392–406. Zejnullahu VA, Isjanovska R, Sejfija Z, Zejnullahu VA. Surgical site infections after cesarean sections at the University Clinical Center of Kosovo: rates, microbiological profile and risk factors. BMC Infect Dis. 2019 Aug 28;19(1):752. Pathak A, Mahadik K, Swami MB, Roy PK, Sharma M, Mahadik VK, et al. Incidence and risk factors for surgical site infections in obstetric and gynecological surgeries from a teaching hospital in rural India. Antimicrob Resist Infect Control. 2017 Jun 14;6(1):66. Jasim HH, Sulaiman SAS, Khan AH, Dawood OT, Abdulameer AH, Usha R. Incidence and Risk Factors of Surgical Site Infection Among Patients Undergoing Cesarean Section. Clin Med Insights Ther. 2017 Jan 1;9:117. Sawadogo YA, Komboigo E, Kiemtore S, Zamane H, Ouedraogo I, Kain DP, et al. Parietal suppurations after cesarean section at the Yalgado Ouédraogo University Hospital, Burkina Faso: epidemiological clinical, therapeutic and prognostic aspects. Pan Afr Med J. 2019 Jan 1;32. Wodajo S, Belayneh M, Gebremedhin S. Magnitude and factors associated with post-cesarean surgical site infection at Hawassa University Teaching and referral hospital, southern Ethiopia: a cross-sectional study. Ethiop J Health Sci. 2017 May 5;27(3):283–90. Bizuayew H, Abebe H, Mullu G, Bewuket L, Tsega D, Alemye T. Post-cesarean section surgical site infection and associated factors in East Gojjam zone primary hospitals, Amhara region, North West Ethiopia, 2020. PLoS ONE. 2021 Dec 31;16(12):e0261951. Ghuman M, Rohlandt D, Joshy G, Lawrenson R. Post-caesarean section surgical site infection: rate and risk factors. N Z Med J. 2011 Jul 29;124(1339):32–6. Opøien HK, Valbø A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097–102. Mbakwa MR, Tendongfor N, Ngunyi YL, Ngek ESN, Alemkia F, Egbe TO. Indications and outcomes of emergency obstetric hysterectomy; a 5-year review at the Bafoussam Regional Hospital, Cameroon. BMC Pregnancy Childbirth. 2021 Apr 23;21(1):323. Fouedjio JH, Mbongo JA, Kamdem TA, Meka EJ, Fouelifack YF, Nkwabong E, et al. Facteurs Associés aux Infections du Site Opératoire après Césarienne à Yaoundé.: Infections du site opératoire après césarienne. Health Sci Dis. Oct 3;22(10). SCHLESSELMAN JJ. Sample size requirements in cohort and case-control studies of disease. Am J Epidemiol. 1974 Jun 1;99(6):381–4. Gomaa K, Abdelraheim AR, El Gelany S, Khalifa EM, Yousef AM, Hassan H. Incidence, risk factors and management of post cesarean section surgical site infection (SSI) in a tertiary hospital in Egypt: a five year retrospective study. BMC Pregnancy Childbirth. 2021 Sep 18;21(1):634. Ferraro F, Piselli P, Pittalis S, Ruscitti LE, Cimaglia C, Ippolito G, et al. Surgical site infection after caesarean section: space for post-discharge surveillance improvements and reliable comparisons. New Microbiol. 2016 Apr 1; 39 (2): 134-8 Mpogoro FJ, Mshana SE, Mirambo MM, Kidenya BR, Gumodoka B, Imirzalioglu C. Incidence and predictors of surgical site infections following caesarean sections at Bugando Medical Centre, Mwanza, Tanzania. Antimicrob Resist Infect Control. 2014 Aug 11;3(1):25. Shrestha S, Shrestha R, Shrestha B, Dongol A. Incidence and risk factors of surgical site infection following cesarean section at Dhulikhel Hospital. Kathmandu Univ Med J KUMJ. 2014;12(46):113–6. M. Ngowe Ngowe. FF, Mouafo Tambo and M A Sosso. Prevalence and Risk Factors Associated with Post Operative Infections in the Limbe Regional Hospital of Cameroon. Open Surg J. 2014 Oct 1;8(1):1–8. Barbut F, Carbonne B, Truchot F, Spielvogel C, Jannet D, Goderel I, et al. [Surgical site infections after cesarean section: results of a five-year prospective surveillance]. J Gynecol Obstet Biol Reprod (Paris). 2004 Oct;33(6 Pt 1):487–96. Douville SE, Callaway LK, Amoako A, Roberts JA, Eley VA. Reducing post-caesarean delivery surgical site infections: a narrative review. Int J Obstet Anesth. 2020 May;42:76–86. Tebeu PM, Kamdem A, Ngou-Mve-Ngou JP, Meka E, Antaon JSS, Loic MT, et al. Risk factors for surgical site infections after caesarean section at Yaounde, Cameroon. Int J Reprod Contracept Obstet Gynecol. 2021 Nov 1;10(11):4048–52. Yerba K, Failoc-Rojas V, Zeña-Ñañez S, Valladares-Garrido M. Factors Associated with Surgical Site Infection in Post-Cesarean Section: A Case-Control Study in a Peruvian Hospital. Ethiop J Health Sci. 2020 Jan;30(1):95–100. Jido T, Garba I. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Ann Med Health Sci Res. 2012;2(1):33–6. Mukagendaneza MJ, Munyaneza E, Muhawenayo E, Nyirasebura D, Abahuje E, Nyirigira J, et al. Incidence, root causes, and outcomes of surgical site infections in a tertiary care hospital in Rwanda: a prospective observational cohort study. Patient Saf Surg. 2019;13:10. Youssef LA, Spitalnik SL. Transfusion-related immunomodulation: A reappraisal. Curr Opin Hematol. 2017 Nov;24(6):551–7. Kawakita T, Landy HJ. Surgical site infections after cesarean delivery: epidemiology, prevention and treatment. Matern Health Neonatol Perinatol. 2017;3:12. Martin ET, Kaye KS, Knott C, Nguyen H, Santarossa M, Evans R, et al. Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol. 2016 Jan;37(1):88–99. Vermillion ST, Lamoutte C, Soper DE, Verdeja A. Wound infection after cesarean: effect of subcutaneous tissue thickness. Obstet Gynecol. 2000 Jun;95(6 Pt 1):923–6. Myles TD, Gooch J, Santolaya J. Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery. Obstet Gynecol. 2002 Nov;100(5 Pt 1):959–64. Ntembe A, Tawah R, Faux E. Redistributive effects of health care out-of-pocket payments in Cameroon. Int J Equity Health. 2021 Oct 18;20(1):227. Misganaw D, Linger B, Abesha A. Surgical Antibiotic Prophylaxis Use and Surgical Site Infection Pattern in Dessie Referral Hospital, Dessie, Northeast of Ethiopia. BioMed Res Int. 2020 Mar 18;2020:1695683. Alsaeed OM, Bukhari AA, Alshehri AA, Alsumairi FA, Alnami AM, Elsheikh HA, et al. The Use of Antibiotics for the Prevention of Surgical Site Infections in Two Government Hospitals in Taif, Saudi Arabia: A Retrospective Study. Cureus. 2022 Jul 11;14(7). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4739976","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":327130455,"identity":"a3f0ab18-49af-4f00-974b-218b6b2b7a48","order_by":0,"name":"Robert Tchounzou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYHACNijNfICBsQFCE9IA08KWANECpInVwmNAnBbz+c3PHnxsu2PPL5HzTeLnDhs5BjbeB3i1yBxjMzec2faMWXJG7jbJ3jNpxgxs7AZ4tUiw8bBJ87YdZjO4kbtNAshIbJBvw+8wmBYegxs5zyT/grSwsRGnRQKoBcwgRkuameSMc4cNJHueGVvLtqUZsxHUwnz4mcSHssP2/OzJD2++bbOR4yekBRmwSIBIEjQAU8oHUlSPglEwCkbByAEAa5E5651vXikAAAAASUVORK5CYII=","orcid":"","institution":"Faculty of Health Sciences, University of Buea","correspondingAuthor":true,"prefix":"","firstName":"Robert","middleName":"","lastName":"Tchounzou","suffix":""},{"id":327130456,"identity":"a14cd8d9-1782-449f-bf72-1edac60a1a39","order_by":1,"name":"Theophile Nana Njamen","email":"","orcid":"","institution":"Faculty of Health Sciences, University of Buea","correspondingAuthor":false,"prefix":"","firstName":"Theophile","middleName":"Nana","lastName":"Njamen","suffix":""},{"id":327130457,"identity":"1d6daf77-0feb-442e-813f-2a1d1b649860","order_by":2,"name":"Fulbert Mangala Nkwele","email":"","orcid":"","institution":"Faculty of Medicine and Pharmaceutical Sciences, University of Douala","correspondingAuthor":false,"prefix":"","firstName":"Fulbert","middleName":"Mangala","lastName":"Nkwele","suffix":""},{"id":327130458,"identity":"56e6641c-8b9a-4c9c-b0b0-90307c0085de","order_by":3,"name":"Elise Mylène Essama Mimesse","email":"","orcid":"","institution":"Faculty of Health Sciences, University of Buea","correspondingAuthor":false,"prefix":"","firstName":"Elise","middleName":"Mylène Essama","lastName":"Mimesse","suffix":""},{"id":327130459,"identity":"ddea6112-b192-4737-8391-71fd750117d7","order_by":4,"name":"Diane Estelle Kamdem","email":"","orcid":"","institution":"Faculty of Medicine and Pharmaceutical Sciences, University of Dschang","correspondingAuthor":false,"prefix":"","firstName":"Diane","middleName":"Estelle","lastName":"Kamdem","suffix":""},{"id":327130460,"identity":"ac8d221d-1d39-4b9e-80b2-15f345c65cbe","order_by":5,"name":"Henri Essome","email":"","orcid":"","institution":"Faculty of Medicine and Pharmaceutical Sciences, University of Douala","correspondingAuthor":false,"prefix":"","firstName":"Henri","middleName":"","lastName":"Essome","suffix":""},{"id":327130461,"identity":"e49e51f8-e6b3-497e-9084-ba957353de92","order_by":6,"name":"Marcelin Ngowe Ngowe","email":"","orcid":"","institution":"Faculty of Medicine and Pharmaceutical Sciences, University of Douala","correspondingAuthor":false,"prefix":"","firstName":"Marcelin","middleName":"Ngowe","lastName":"Ngowe","suffix":""}],"badges":[],"createdAt":"2024-07-14 23:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4739976/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4739976/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60434655,"identity":"c7348ddf-a5f7-4ffb-99c6-ee8e1141307a","added_by":"auto","created_at":"2024-07-16 17:11:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":18602,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eparticipant’s flow diagram for SSI following CS\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4739976/v1/330c318f510b6fbc79e937e8.png"},{"id":60435175,"identity":"2b95abe6-2e37-4678-903c-63f52e72d9fb","added_by":"auto","created_at":"2024-07-16 17:19:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1060847,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4739976/v1/7b8801fb-357c-4915-8221-d6afac1ec5dc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"High Rates of Surgical Site Infection after Cesarean Delivery in Cameroonian Referral Hospitals: A Prospective Cohort Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCaesarean sections (CS), surgical deliveries through the abdomen, are increasingly favoured over vaginal births worldwide. Despite WHO recommendations for CS rates between 10\u0026ndash;15%, many countries, including Cameroon, experience a rise in CS procedures. While CS offers life-saving advantages in certain situations, it is associated with higher complication rates compared to vaginal delivery. One such complication is surgical site infection (SSI) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, and \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDefined by the European Centre for Disease Control (ECDC) as an infection near the surgical incision involving the skin, the deep soft tissue and/or any organ or spaces other than that was manipulated and within 30 days of procedure [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], SSIs are the most common healthcare-associated infection in both the developed and low- and middle-income countries (LMICs) like Cameroon. World Health organization highlights figures of up to 11.8% of SSI following surgical procedures and 3 to 15% in case of CS in LMICs [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. While antibiotic prophylaxis, improved surgical techniques, and surveillance systems have reduced SSI rates in developed countries, it remains a challenge in resource-limited settings [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Several factors like prolonged labor, high body mass index (BMI), hypertension, length of procedure, and anemia have been linked to increased SSI risk [\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTrends of CS rates in Cameroon are in the increase with global reported change from 12% in 2000 to 21% in 2015 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Previous studies in Cameroon reported varying SSI rates following CS; 10.8% in Douala Laquintinie hospital [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and 20% in Yaound\u0026eacute; Central Hospital [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, these studies were limited in duration and scope. This current research aims to determine the true incidence and predictors of SSI by following patients for 30 days after CS in two referral hospitals in Douala. This information will be crucial for developing evidence-based protocols for managing post-caesarean SSIs in Cameroon.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis prospective study was conducted over six months, from February 01, 2022, to July 31, 2022, at two referral hospitals in Douala, Cameroon: Laquintinie Hospital and Douala Gynaeco-Obstetric and Paediatric Hospital (DGOPH).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Sites\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA. Laquintinie Hospital\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLaquintinie Hospital, a high-volume teaching hospital, manages the most caesarean sections (CS) (approximately 950/2900 annual births) in the Douala region. It serves a diverse patient population, with patients primarily covering their own treatment costs. The obstetrical theatre unit handles CS deliveries and various gynecological surgeries. Due to the presence of trainees and high patient turnover, aseptic conditions might be suboptimal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eB. Douala Gynaeco-Obstetric and Paediatric Hospital (DGOPH)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDGOPH, a public first-category hospital specializing in maternal and child care, conducts an average of 550-600 deliveries annually, with about 25% performed by CS. Labor management adheres to established guidelines incorporating infection prevention measures. CS procedures are performed by obstetricians or senior residents under consultant supervision. The dedicated theatre unit separates obstetrical and gynecological surgeries from abscess cases. Rigorous infection prevention protocols are implemented for theatre access, surgical attire, and equipment use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll women undergoing CS during the study period were approached for informed consent and inclusion.\u0026nbsp;We excluded women who:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eFailed to complete the questionnaire.\u003c/li\u003e\n \u003cli\u003eDied immediately or before 30 days after CS without an SSI diagnosis.\u003c/li\u003e\n \u003cli\u003ePresented other surgical or infectious complications.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eSampling and sample size\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients were recruited consecutively using a convenience sampling method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStandardized data collection tool captured preoperative, intraoperative, and postoperative information for each woman undergoing CS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA. Preoperative Data included\u0026nbsp;\u003c/strong\u003esociodemographic data (age, phone number, education level, and occupation), obstetrical data (parity, gestational age, previous CS, labor duration, ruptured membranes duration), mode of admission (elective or emergency), and in-hospital or referred patient status. Body mass index (BMI), Hemoglobin level, urinary catheter insertion time, and surgical site shaving time\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eB. Intraoperative Data were\u0026nbsp;\u003c/strong\u003eanesthesia type, surgeon’s qualification (obstetrician or resident doctor), surgery duration, antibiotic use, quantity of blood loss quantity, and any intraoperative complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC. Postoperative Data comprise\u0026nbsp;\u003c/strong\u003eantibiotic use, outcome measures( occurrence of superficial surgical site infection (SSSI), deep incisional infection (DII), or organ/space infection (OI)).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnosis of SSI Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe used the CDC criteria for diagnosing SSIs:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eSuperficial Incisional Infection (SSSI):\u003c/strong\u003e Involves skin and subcutaneous tissues. Requires at least one of the following: purulent discharge, isolated organism, infection symptom, or surgeon’s diagnosis.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eDeep Incisional Infection (DII):\u003c/strong\u003e Involves deep tissues (muscles and fascia). Requires at least one of the following: purulent discharge, dehiscence/reopening of the incision by the surgeon due to suspected infection, evidence of abscess formation, or other deep infection diagnosed by the surgeon.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eOrgan/Space Infection (OI):\u003c/strong\u003e Involves any organ other than the incision site but related to the surgery. Requires at least one of the following: purulent discharge from a drain placed in the organ, isolated organism from the organ, abscess, or infection involving the organ.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Participant Follow-Up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were systematically reviewed at:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eDay 4: Surgical site dressing change as per hospital protocol.\u003c/li\u003e\n \u003cli\u003eEvery 2 days until day 12 at Laquintinie Hospital.\u003c/li\u003e\n \u003cli\u003eDay 3 at DGOPH.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eFollowing this monitoring period, patients with SSI were identified and received appropriate treatment based on hospital protocols. Patients without infection were discharged home. Before discharge, participants received education on potential SSI signs, including pain, fever, localized swelling, redness, purulent drainage, skin heat, and wound dehiscence. This enabled them to recognize infection at home and inform the research team. All participants were reviewed at day 30 for final assessment and study closure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData management and analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData from the questionnaires were securely stored. Information was extracted and entered into Microsoft Office 365 Excel for initial analysis to create a usable database. This database was then exported into EpiInfo 7 for further analysis.\u003c/p\u003e\n\u003cp\u003eCategorical variables (occupation, education level, comorbidity) were summarized using counts and percentages, presented using a tabular form. Continuous variables (age, gestational age, BMI etc) were summarized using mean, standard deviations, medians and interquartile range where necessary.\u0026nbsp;A chi square\u0026nbsp;test was utilized to identify categorical\u0026nbsp;risk factors that exhibit a statistically significant association with the occurrence of SSI (p \u0026lt; 0.05).\u0026nbsp;Following the chi-square test, we calculated the Odds Ratio (OR) with a 95% confidence interval (CI) for each significant risk factor identified.\u0026nbsp;Multivariate logistic regression analysis with adjusted Odds ratio (aOR) to account for potential interactions and confounding effects of factors found to be significant after bivariate analysis was finally used; the level of significance was set at p\u0026lt;0.05. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eII-6 Ethical considerations and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from the institutional Review Board of the Faculty of Health sciences, University of Buea under the registration number 2021/1546-01/UB/SG/IRH/FHS. Administrative authorization was obtained from the directors of Laquintinie and Douala Gynaecology obstetric and Paediatric hospitals. All participants provided written informed consent after a thorough explanation of the study's purpose, procedures, potential risks and benefits, and the right to withdraw at any time without penalty.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eResults chart\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 1: participant\u0026rsquo;s flow diagram for SSI following CS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocio-demographic characteristics of participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs summarized in table 1 below, the median age of study participants was 29 years and the mean age\u0026nbsp;29.24\u0026plusmn;6.46\u0026nbsp;with extremes of 18 and 42 years.\u0026nbsp;Most of the participants were between the age group 20 to 29 (48.4%). Over fifty-five per cent of participants has no employment (55.9%) and most of them had tertiary level education (49.6%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral characteristics of study population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOver 72% of participants (332) had an abnormal body mass index (BMI) and within this group 112 (25.3%) having class II or III obesity. Repeated CS were performed in 34.7% of cases. The majority of patients had a normal haemoglobin (Hb) level above 11 g/dl whereas 61(13.7%) were identified as anaemic. Caesarean section was done as emergency in over 57.9% of cases. The duration of rupture of membranes (ROM) ranged from 0 to 216 hours with a mean of 8.2\u0026plusmn;32.32 hours and median of 0 (IQRː0-3) hours; in most cases, ROM has lasted less than 12 hours (57.9%). Obstetricians were the primary surgeons in (83.1%) and The duration of surgery ranged from 40 minutes to 80 minutes with a mean of 56.09\u0026plusmn;7.98 minutes and median of 55 (IQRː50-60).\u0026nbsp;Adherence to antibiotic guidelines (prophylaxis or treatment) was observed in 304 (68.5%) cases the remaining 31.5% had either delayed or no use. Over ten per cent of patients had comorbidity with Diabetes mellitus in 4.5% of cases (see table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eIncidence of SSI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study examined the occurrence of SSIs among 444 patients. A total of 45 patients (10.13%) developed SSI (see figure 1). The incidence was lower in the DGOPH group (6.45%, 6 out of 93 patients) compared to the LQ group (11.11%, 39 out of 351 patients).\u003c/p\u003e\n\u003cp\u003eMost SSIs (63.33%) occurred between the 6th and 14th day after surgery, with a median time to occurrence of 9 days (IQR 7-12 days).\u0026nbsp;The distribution of SSI types was as follows:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eSuperficial SSI: 19 cases (42.22%)\u003c/li\u003e\n \u003cli\u003eDeep SSI: 24 cases (53.33%)\u003c/li\u003e\n \u003cli\u003eOrgan space SSI: 2 cases (4.45%)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eBivariate and multivariate analysis of determinants of SSI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe table 3 below presents the results of a bivariate analysis investigating potential risk factors associated with Surgical Site Infections (SSI) following Caesarean Section (CS). It compares the frequency of SSI occurrence (Yes/No) across different categories within each risk factor. Factors associated the occurrence of SSI are the following:\u003c/p\u003e\n\u003cul class=\"decimal_type\"\u003e\n \u003cli\u003e\u003cstrong\u003eBody Mass Index (BMI):\u003c/strong\u003e Patients with obesity (BMI \u0026ge; 30) had a significantly higher risk of SSI compared to those with normal weight (OR = 0.021, p-value = 0.03).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePre-surgical Hemoglobin (Hb) level:\u003c/strong\u003e Anaemic patients (Hb level \u0026le; 11 g/dl) were more likely to develop SSI compared to non-anaemic patients (OR = 4.7, p-value = 0.03).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eComorbidity - Diabetes:\u003c/strong\u003e Patients with diabetes had a significantly increased risk of SSI compared to those without any comorbidities (OR = 8.4, p-value = 0.04).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eBlood Transfusion:\u003c/strong\u003e Patients who received blood transfusions had a higher risk of SSI compared to those who did not (OR = 1, p-value = 0.06). Note that a p-value of 0.06 suggests a trend towards significance, but further investigation might be needed.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eThe sociodemographic characteristics\u003c/strong\u003e had no significant association with the occurrence of SSI\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eMultivariate analysis of factors associated to the occurrence of SSI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe table 4 builds upon the findings from the bivariate analysis (Table 3) by performing a multivariate logistic regression analysis to examine the independent associations between risk factors and SSI. Adjusted Odds Ratios (aOR) with 95% confidence intervals (CI) and p-values for each risk factor were determined. Patients with obesity (BMI \u0026ge; 30) had a nearly six-fold increased risk of SSI compared to those with normal weight (aOR = 5.9, p-value = 0.032). This finding aligns with the trend observed in the bivariate analysis. The presence of diabetes remained a significant risk factor for SSI even after considering other factors in the model (aOR = 15.7, p-value = 0.013). \u0026nbsp;Having received a blood transfusion emerged as a significant protective factor in the multivariate analysis (aOR = 0.05, p-value = 0.004).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Sociodemographic characteristics of the study participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"520\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.07692307692308%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVARIABLE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFREQUENCY\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 444)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePERCENTAGES\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.07692307692308%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.07692307692308%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.07692307692308%\" valign=\"top\"\u003e\n \u003cp\u003e20-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e48.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.07692307692308%\" valign=\"top\"\u003e\n \u003cp\u003e30-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e32.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.07692307692308%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.07692307692308%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.07692307692308%\" valign=\"top\"\u003e\n \u003cp\u003eEmployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e44.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.07692307692308%\" valign=\"top\"\u003e\n \u003cp\u003eUnemployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e55.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.07692307692308%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.07692307692308%\" valign=\"top\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.07692307692308%\" valign=\"top\"\u003e\n \u003cp\u003esecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e42.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.07692307692308%\" valign=\"top\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.69230769230769%\" valign=\"top\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e49.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eTable 2\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e: General characteristics (personal, obstetrical and surgical) of study participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.08818635607321%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.286189683860233%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en = 444\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.625623960066555%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.96339434276206%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBMI(n=444)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.124792013311147%\" valign=\"top\"\u003e\n \u003cp\u003eUnderweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.286189683860233%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.625623960066555%\" valign=\"top\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.19616204690831%\" valign=\"top\"\u003e\n \u003cp\u003eNormal weight\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.24733475479744%\" valign=\"top\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.556503198294244%\" valign=\"top\"\u003e\n \u003cp\u003e23.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.19616204690831%\" valign=\"top\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.24733475479744%\" valign=\"top\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.556503198294244%\" valign=\"top\"\u003e\n \u003cp\u003e49.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.19616204690831%\" valign=\"top\"\u003e\n \u003cp\u003eM. obesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.24733475479744%\" valign=\"top\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.556503198294244%\" valign=\"top\"\u003e\n \u003cp\u003e25.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.96339434276206%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious CS\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e( n=444)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.124792013311147%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.286189683860233%\" valign=\"top\"\u003e\n \u003cp\u003e290\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.625623960066555%\" valign=\"top\"\u003e\n \u003cp\u003e65.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.19616204690831%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.24733475479744%\" valign=\"top\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.556503198294244%\" valign=\"top\"\u003e\n \u003cp\u003e34.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.96339434276206%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-surgical Hb ( n=444)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.124792013311147%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 10 mg/dl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.286189683860233%\" valign=\"top\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.625623960066555%\" valign=\"top\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.19616204690831%\" valign=\"top\"\u003e\n \u003cp\u003e10-11 mg/dl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.24733475479744%\" valign=\"top\"\u003e\n \u003cp\u003e183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.556503198294244%\" valign=\"top\"\u003e\n \u003cp\u003e41.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.19616204690831%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;11 mg/dl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.24733475479744%\" valign=\"top\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.556503198294244%\" valign=\"top\"\u003e\n \u003cp\u003e45.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.96339434276206%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eManagement site(n=444)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.124792013311147%\" valign=\"top\"\u003e\n \u003cp\u003eStudy site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.286189683860233%\" valign=\"top\"\u003e\n \u003cp\u003e271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.625623960066555%\" valign=\"top\"\u003e\n \u003cp\u003e61.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.19616204690831%\" valign=\"top\"\u003e\n \u003cp\u003eReferred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.24733475479744%\" valign=\"top\"\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.556503198294244%\" valign=\"top\"\u003e\n \u003cp\u003e39.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.96339434276206%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRupture membranes\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;( n= 444)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.124792013311147%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 12 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.286189683860233%\" valign=\"top\"\u003e\n \u003cp\u003e257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.625623960066555%\" valign=\"top\"\u003e\n \u003cp\u003e57.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.19616204690831%\" valign=\"top\"\u003e\n \u003cp\u003e12- 18 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.24733475479744%\" valign=\"top\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.556503198294244%\" valign=\"top\"\u003e\n \u003cp\u003e33.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.19616204690831%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;18 hours\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.24733475479744%\" valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.556503198294244%\" valign=\"top\"\u003e\n \u003cp\u003e8,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.96339434276206%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of CS ( n=444)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.124792013311147%\" valign=\"top\"\u003e\n \u003cp\u003eElective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.286189683860233%\" valign=\"top\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.625623960066555%\" valign=\"top\"\u003e\n \u003cp\u003e42.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.19616204690831%\" valign=\"top\"\u003e\n \u003cp\u003eEmergency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.24733475479744%\" valign=\"top\"\u003e\n \u003cp\u003e257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.556503198294244%\" valign=\"top\"\u003e\n \u003cp\u003e57.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.96339434276206%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrade of surgeon (n= 444)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.124792013311147%\" valign=\"top\"\u003e\n \u003cp\u003eG. practitioner/\u003c/p\u003e\n \u003cp\u003eResident Obgyn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.286189683860233%\" valign=\"top\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.625623960066555%\" valign=\"top\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.19616204690831%\" valign=\"top\"\u003e\n \u003cp\u003eObstetrician\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.24733475479744%\" valign=\"top\"\u003e\n \u003cp\u003e369\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.556503198294244%\" valign=\"top\"\u003e\n \u003cp\u003e83.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.96339434276206%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntibiotic use (n = 444)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.124792013311147%\" valign=\"top\"\u003e\n \u003cp\u003eAppropriate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.286189683860233%\" valign=\"top\"\u003e\n \u003cp\u003e304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.625623960066555%\" valign=\"top\"\u003e\n \u003cp\u003e68.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.19616204690831%\" valign=\"top\"\u003e\n \u003cp\u003eInappropriately\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.24733475479744%\" valign=\"top\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.556503198294244%\" valign=\"top\"\u003e\n \u003cp\u003e31.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.96339434276206%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n= 444)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.124792013311147%\" valign=\"top\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.286189683860233%\" valign=\"top\"\u003e\n \u003cp\u003e396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.625623960066555%\" valign=\"top\"\u003e\n \u003cp\u003e89.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.19616204690831%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.24733475479744%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.556503198294244%\" valign=\"top\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.19616204690831%\" valign=\"top\"\u003e\n \u003cp\u003eOthers\u0026rsquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.24733475479744%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.556503198294244%\" valign=\"top\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.96339434276206%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlood transfusion (n=444)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.124792013311147%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.286189683860233%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.625623960066555%\" valign=\"top\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.19616204690831%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.24733475479744%\" valign=\"top\"\u003e\n \u003cp\u003e421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.556503198294244%\" valign=\"top\"\u003e\n \u003cp\u003e94.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Bivariate analysis of risk factors of SSI\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"680\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.705882352941174%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.91176470588235%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;SSI (n= 45)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.41176470588235%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.970588235294118%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.465437788018434%\" valign=\"top\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.534562211981566%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.470588235294116%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.235294117647058%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.147058823529411%\" valign=\"top\"\u003e\n \u003cp\u003e4 (8.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.764705882352942%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e43 (10.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.970588235294118%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.830985915492956%\" valign=\"top\"\u003e\n \u003cp\u003e20-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.133802816901408%\" valign=\"top\"\u003e\n \u003cp\u003e21 (46.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e195 (48.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e1.1 (0.1-10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.725352112676056%\" valign=\"top\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.830985915492956%\" valign=\"top\"\u003e\n \u003cp\u003e30-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.133802816901408%\" valign=\"top\"\u003e\n \u003cp\u003e16 (35.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e128 (32.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e1.33 (0.1-13.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.725352112676056%\" valign=\"top\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.830985915492956%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.133802816901408%\" valign=\"top\"\u003e\n \u003cp\u003e4 (8.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e33 (8.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e1.2 (0.07-24.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.725352112676056%\" valign=\"top\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.470588235294116%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.235294117647058%\" valign=\"top\"\u003e\n \u003cp\u003eNot emoployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.147058823529411%\" valign=\"top\"\u003e\n \u003cp\u003e16 (35.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.764705882352942%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e233 (58.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e0.4 (0.1-1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.970588235294118%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.830985915492956%\" valign=\"top\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.133802816901408%\" valign=\"top\"\u003e\n \u003cp\u003e29 (64.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e166(41.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.725352112676056%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.470588235294116%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.235294117647058%\" valign=\"top\"\u003e\n \u003cp\u003eNo formal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.147058823529411%\" valign=\"top\"\u003e\n \u003cp\u003e4(8.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.764705882352942%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e33 (8.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.970588235294118%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.830985915492956%\" valign=\"top\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.133802816901408%\" valign=\"top\"\u003e\n \u003cp\u003e16 (35.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e171 (42.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.725352112676056%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.830985915492956%\" valign=\"top\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.133802816901408%\" valign=\"top\"\u003e\n \u003cp\u003e25 (55.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e195 (48.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.725352112676056%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.470588235294116%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.235294117647058%\" valign=\"top\"\u003e\n \u003cp\u003eUnderweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.147058823529411%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.764705882352942%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e9 (2.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.970588235294118%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.830985915492956%\" valign=\"top\"\u003e\n \u003cp\u003eNormal weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.133802816901408%\" valign=\"top\"\u003e\n \u003cp\u003e16(35.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e87 (21.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.725352112676056%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.830985915492956%\" valign=\"top\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.133802816901408%\" valign=\"top\"\u003e\n \u003cp\u003e9 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e211 (52.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e0.48 (0.13-1.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.725352112676056%\" valign=\"top\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.830985915492956%\" valign=\"top\"\u003e\n \u003cp\u003eObesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.133802816901408%\" valign=\"top\"\u003e\n \u003cp\u003e20(44.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e92 (23.06)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e0.021(0.01-0.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.725352112676056%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.470588235294116%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious CS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.235294117647058%\" valign=\"top\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.147058823529411%\" valign=\"top\"\u003e\n \u003cp\u003e9(20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.764705882352942%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e154 (38.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e0.56 (0.04-2.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.970588235294118%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.830985915492956%\" valign=\"top\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.133802816901408%\" valign=\"top\"\u003e\n \u003cp\u003e36(80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e245 (61.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.725352112676056%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; -\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.470588235294116%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-surgical Hb level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.235294117647058%\" valign=\"top\"\u003e\n \u003cp\u003eAnaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.147058823529411%\" valign=\"top\"\u003e\n \u003cp\u003e16 (35.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.764705882352942%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e228 (57.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.7 (1.2-19.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.970588235294118%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.830985915492956%\" valign=\"top\"\u003e\n \u003cp\u003eNo Anaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.133802816901408%\" valign=\"top\"\u003e\n \u003cp\u003e29 (64.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e171(42.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.725352112676056%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.470588235294116%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of CS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.235294117647058%\" valign=\"top\"\u003e\n \u003cp\u003eEmergency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.147058823529411%\" valign=\"top\"\u003e\n \u003cp\u003e37 (8.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.764705882352942%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e220 (55.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.970588235294118%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.830985915492956%\" valign=\"top\"\u003e\n \u003cp\u003eElective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.133802816901408%\" valign=\"top\"\u003e\n \u003cp\u003e8 (17.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e179 (45.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.725352112676056%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.470588235294116%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntibiotic use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.235294117647058%\" valign=\"top\"\u003e\n \u003cp\u003eAppropriate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.147058823529411%\" valign=\"top\"\u003e\n \u003cp\u003e8 (17.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.764705882352942%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e132 (34.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e1.5 (0.3-7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.970588235294118%\" valign=\"top\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.830985915492956%\" valign=\"top\"\u003e\n \u003cp\u003einappropriate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.133802816901408%\" valign=\"top\"\u003e\n \u003cp\u003e37 (82.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.070422535211268%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e262 (65.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.239436619718308%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.725352112676056%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.44640234948605%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRupture of membranes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.208516886930983%\" valign=\"top\"\u003e\n \u003cp\u003e0-12 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.124816446402349%\" valign=\"top\"\u003e\n \u003cp\u003e29(64.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.740088105726873%\" valign=\"top\"\u003e\n \u003cp\u003e228(57.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.530102790014684%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.95007342143906%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.79261862917399%\" valign=\"top\"\u003e\n \u003cp\u003e12-18 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.101933216168717%\" valign=\"top\"\u003e\n \u003cp\u003e12(26.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.035149384885763%\" valign=\"top\"\u003e\n \u003cp\u003e138(34.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.7 (0.17-2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.695957820738137%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.79261862917399%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;18 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.101933216168717%\" valign=\"top\"\u003e\n \u003cp\u003e4(8.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.035149384885763%\" valign=\"top\"\u003e\n \u003cp\u003e33(8.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.9 (0.1-9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.695957820738137%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.44640234948605%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrade of surgeon\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.208516886930983%\" valign=\"top\"\u003e\n \u003cp\u003eObstetrician\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.124816446402349%\" valign=\"top\"\u003e\n \u003cp\u003e37(82.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.740088105726873%\" valign=\"top\"\u003e\n \u003cp\u003e332 (83.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.530102790014684%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.95007342143906%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.79261862917399%\" valign=\"top\"\u003e\n \u003cp\u003eMD/Resident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.101933216168717%\" valign=\"top\"\u003e\n \u003cp\u003e8(17.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.035149384885763%\" valign=\"top\"\u003e\n \u003cp\u003e67(16.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1.1 (0.2-5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.695957820738137%\" valign=\"top\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.44640234948605%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.208516886930983%\" valign=\"top\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.124816446402349%\" valign=\"top\"\u003e\n \u003cp\u003e37(82.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.740088105726873%\" valign=\"top\"\u003e\n \u003cp\u003e359 (89.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.530102790014684%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.95007342143906%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.79261862917399%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.101933216168717%\" valign=\"top\"\u003e\n \u003cp\u003e8(17.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.035149384885763%\" valign=\"top\"\u003e\n \u003cp\u003e12 (3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e8.4 (1.06-28.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.695957820738137%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.79261862917399%\" valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.101933216168717%\" valign=\"top\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.035149384885763%\" valign=\"top\"\u003e\n \u003cp\u003e28 (7.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.695957820738137%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.44640234948605%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlood transfusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.208516886930983%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.124816446402349%\" valign=\"top\"\u003e\n \u003cp\u003e12(26.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.740088105726873%\" valign=\"top\"\u003e\n \u003cp\u003e11(2.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.530102790014684%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.95007342143906%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.79261862917399%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.101933216168717%\" valign=\"top\"\u003e\n \u003cp\u003e33(73.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.035149384885763%\" valign=\"top\"\u003e\n \u003cp\u003e388(97,24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.374340949033392%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.06 (0.01-0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.695957820738137%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cstrong\u003e0.06\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Multivariate logistic regression analysis of significant factors after bivariate analysis.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"652\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.02304147465438%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.87557603686636%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;SSI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.81566820276498%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eaOR(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"49.25373134328358%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50.74626865671642%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.02304147465438%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (Obesity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.2073732718894%\" valign=\"top\"\u003e\n \u003cp\u003e20 (44.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.668202764976959%\" valign=\"top\"\u003e\n \u003cp\u003e92(23.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.81566820276498%\" valign=\"top\"\u003e\n \u003cp\u003e5.9 (1.17-30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u003cstrong\u003e\u0026nbsp;0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.098159509202453%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnaemia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.024539877300615%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.184049079754601%\" valign=\"top\"\u003e\n \u003cp\u003e16 (35.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.644171779141104%\" valign=\"top\"\u003e\n \u003cp\u003e228 (57.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.78527607361963%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.7 (1.2-19.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.263803680981596%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.786516853932586%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.53932584269663%\" valign=\"top\"\u003e\n \u003cp\u003e29 (64.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.10112359550562%\" valign=\"top\"\u003e\n \u003cp\u003e171(42.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.15730337078652%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.415730337078653%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.098159509202453%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidties\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.024539877300615%\" valign=\"top\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.184049079754601%\" valign=\"top\"\u003e\n \u003cp\u003e37(82.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.644171779141104%\" valign=\"top\"\u003e\n \u003cp\u003e359(89.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.78527607361963%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.263803680981596%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.786516853932586%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.53932584269663%\" valign=\"top\"\u003e\n \u003cp\u003e8 (17.77)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.10112359550562%\" valign=\"top\"\u003e\n \u003cp\u003e12(3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.15730337078652%\" valign=\"top\"\u003e\n \u003cp\u003e15.7 (1.7-24.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.415730337078653%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.013\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.786516853932586%\" valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.53932584269663%\" valign=\"top\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.10112359550562%\" valign=\"top\"\u003e\n \u003cp\u003e28(7.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.15730337078652%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.415730337078653%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.098159509202453%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlood transfusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.024539877300615%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.184049079754601%\" valign=\"top\"\u003e\n \u003cp\u003e33(73.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.644171779141104%\" valign=\"top\"\u003e\n \u003cp\u003e379(94.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.78527607361963%\" valign=\"top\"\u003e\n \u003cp\u003e0.05 (0.008-0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.263803680981596%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.786516853932586%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.53932584269663%\" valign=\"top\"\u003e\n \u003cp\u003e12(26.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.10112359550562%\" valign=\"top\"\u003e\n \u003cp\u003e11(2.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.15730337078652%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.415730337078653%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003eIncidence of SSI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study investigated the incidence and risk factors of surgical site infections (SSI) in two Cameroonian referral hospitals known for their high standards of care. Our active surveillance for 30 days post-surgery aligns with international SSI criteria [5], unlike prior studies limited to hospital stay durations. This likely contributes to a more accurate picture of SSI incidence.\u003c/p\u003e\n\u003cp\u003eThe observed cumulative incidence of SSI was 10.13%, with Laquintinie hospital (LQ) exhibiting a higher rate (11.11%) compared to DGOPH (6.45%). Although statistically non-significant, this difference might be attributed to the availability of written infection prevention guidelines in DGOPH's maternity and theatre units. The diversity of patients who receive care in LQ including the most economically constraint and the large number of trainees using the theater may also account for suboptimal aseptic measures.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur findings on SSI rates in developing countries highlight a wide range. Relatively low rates reported in some studies (e.g., 1.81% by Fouedjio et al. [14]) likely underestimate the true burden due to methodological limitations such as retrospective design, short follow-up periods, or restricting observation to hospital stays. This aligns with previous research demonstrating the underestimation of SSI when surveillance is limited [17].\u003c/p\u003e\n\u003cp\u003eSeveral studies conducted in settings with similar care standards report comparable SSI rates to ours [9, 12, 18 and 19]. Conversely, other studies in Asia and sub-Saharan Africa documented higher rates (18.8% by Jasim et al. [7] to 20.7% by Ngowe Ngowe et al. [20]). Compared to developed countries (1-3.9% incidence [17, 21, 22]), our findings suggest a greater magnitude of SSI, possibly due to less stringent infection prevention measures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk Factors for SSI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBivariate analysis identified several potential predictors of SSI: obesity (OR = 0.021; CI: 0.01-0.93; p = 0.03), pre-surgical anemia (OR = 4.7; CI: 1.2-19.5; p = 0.03), diabetes (OR = 8.4; CI: 1.06-28.0; p = 0.04), and blood transfusion (OR = 0.01; CI: 0.01-0.4; p = 0.06). Inappropriate antibiotic use (OR = 1.5; CI: 0.3-7.50; p = 0.62) did not reach statistical significance and was excluded from the multivariate analysis.\u003c/p\u003e\n\u003cp\u003eMultivariate logistic regression analysis confirmed obesity (aOR = 5.9; CI: 1.17-30.0; p = 0.032), pre-surgical anemia (aOR = 4.7; CI: 1.2-19.5; p = 0.03), and diabetes (aOR = 15.7; CI: 1.7-24.4; p = 0.013) as independent risk factors for SSI. Interestingly, blood transfusion emerged as a protective factor (aOR = 0.05; CI: 0.008-0.39; p = 0.004). This unexpected finding warrants further investigation, potentially due to limitations like sample size or the presence of confounding factors.\u003c/p\u003e\n\u003cp\u003eOur study identified different risk factors compared to previous Cameroonian research by Tebeu et al. [23] and Fouedjio et al. [14] which reported factors like prolonged premature rupture of membranes, resident doctors’ involvement, and midline incision type. These discrepancies might be explained by the rarity of midline incisions at our study site and the close supervision of resident doctors by senior consultants during CS procedures.\u003c/p\u003e\n\u003cp\u003eThe independent risk factors of anemia and blood transfusion identified in our study are consistent with findings from other studies [1, 24-26]. Anemia, prevalent due to financial constraints and limited health coverage, can delay surgical healing. Blood transfusions administered to address anemia might introduce immunomodulation, increasing the risk of post-surgical infections [27].\u003c/p\u003e\n\u003cp\u003eObesity and diabetes mellitus also demonstrated a strong association with SSI. Obesity is a known risk factor for diabetes, and both conditions can compromise vascular and immune function [28, 29]. The link between increasing body weight and surgical safety is well-documented [30, 31].\u003c/p\u003e\n\u003cp\u003eWhile not statistically significant, inappropriate antibiotic use was observed at LQ, encompassing late administration of prophylaxis in emergencies and irregular or absent post-operative antibiotics. This practice has a 1.5-fold increased likelihood of predicting SSI. Financial constraints and resulting non-adherence to treatment protocols in emergency cases could be contributing factors [32]. The importance of proper antibiotic prophylaxis in elective surgery and appropriate therapy in contaminated surgery is well-documented [29, 6, 33, and 34]. Other reported risk factors, such as number of vaginal exams, prolonged labor, and prolonged rupture of membranes, were not significant in our study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile the prospective design of the study strengthens the accuracy of its findings, the use of convenience sampling introduces potential selection bias. This means that the participants may not be fully representative of the entire population of women undergoing caesarean section at these two hospitals, limiting the generalizability of the results. Recruiting all the cases was an attempt to reduce this bias. \u0026nbsp;Additionally, the study focused primarily on risk factors and did not delve deeply into potential protective factors, such as specific surgical techniques or postoperative care protocole\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study underscores the substantial burden of surgical site infections (SSIs) following caesarean section in our setting. It identifies potentially modifiable risk factors, including obesity, diabetes mellitus, and severe anemia, suggesting that stricter infection prevention protocols and addressing obesity could be crucial strategies to reduce SSI rates. Further research within the region is warranted to explore the potential protective effects of factors such as specific antibiotic prophylactic regimens, surgical techniques, and postoperative care protocols. Additionally, the unexpected finding of blood transfusion as a protective factor against SSI warrants further investigation to elucidate the underlying mechanisms and potential confounding variables.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRT, TNN, FGMN, and EMEM conceptualized and designed the study. Participants were recruited at the sites by HE, DK and EMEM. DK participated in in participants \u0026lsquo;recruitment and reviewed the manuscript. \u0026nbsp;RT, EMEM, DK and FGMN in addition wrote the manuscript. HE, TNN and MNN revised and scrutinized the study for important intellectual content. All the authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no funding for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset that was used and analyzed in this study is not publicly available due to ethical considerations. Upon reasonable request, the dataset used can availed with permission of the corresponding author Dr Robert Tchounzou (email: [email protected]).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was obtained from the institutional Review Board of the Faculty of Health sciences, University of Buea under the registration number 2021/1546-01/UB/SG/IRH/FHS. Administrative authorization was obtained from the directors of Laquintinie and Douala Gynaecology obstetric and Paediatric hospitals. All participants provided written informed consent after a thorough explanation of the study\u0026apos;s purpose, procedures, potential risks and benefits, and the right to withdraw at any time without penalty.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interests\u003c/strong\u003e: None declared\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eGelaw KA, Aweke AM, Astawesegn FH, Demissie BW, Zeleke LB. Surgical site infection and its associated factors following cesarean section: a cross sectional study from a public hospital in Ethiopia. Patient Saf Surg. 2017;11:18.\u003c/li\u003e\n \u003cli\u003eC-Section Rates by Country 2023. World population review. Available from: https://worldpopulationreview.com/country-rankings.\u003c/li\u003e\n \u003cli\u003eWHO statement on caesarean section rates. Available from: https://www.who.int/publications-detail-redirect/WHO-RHR-15.02\u003c/li\u003e\n \u003cli\u003eHenri E, Valere MK, Paul EJ, Merlin B, Felix E, Gr\u0026acirc;ce TT, et al. Caesarean Section in African Setting: Current Situation, Problematic and Qualitative Approaches at Laquintinie Hospital (Douala, Cameroon). Open J Obstet Gynecol. 2019 Sep 25;9(10):1392\u0026ndash;406.\u003c/li\u003e\n \u003cli\u003eZejnullahu VA, Isjanovska R, Sejfija Z, Zejnullahu VA. Surgical site infections after cesarean sections at the University Clinical Center of Kosovo: rates, microbiological profile and risk factors. BMC Infect Dis. 2019 Aug 28;19(1):752.\u003c/li\u003e\n \u003cli\u003ePathak A, Mahadik K, Swami MB, Roy PK, Sharma M, Mahadik VK, et al. Incidence and risk factors for surgical site infections in obstetric and gynecological surgeries from a teaching hospital in rural India. Antimicrob Resist Infect Control. 2017 Jun 14;6(1):66.\u003c/li\u003e\n \u003cli\u003eJasim HH, Sulaiman SAS, Khan AH, Dawood OT, Abdulameer AH, Usha R. Incidence and Risk Factors of Surgical Site Infection Among Patients Undergoing Cesarean Section. Clin Med Insights Ther. 2017 Jan 1;9:117.\u003c/li\u003e\n \u003cli\u003eSawadogo YA, Komboigo E, Kiemtore S, Zamane H, Ouedraogo I, Kain DP, et al. Parietal suppurations after cesarean section at the Yalgado Ou\u0026eacute;draogo University Hospital, Burkina Faso: epidemiological clinical, therapeutic and prognostic aspects. Pan Afr Med J. 2019 Jan 1;32.\u003c/li\u003e\n \u003cli\u003eWodajo S, Belayneh M, Gebremedhin S. Magnitude and factors associated with post-cesarean surgical site infection at Hawassa University Teaching and referral hospital, southern Ethiopia: a cross-sectional study. Ethiop J Health Sci. 2017 May 5;27(3):283\u0026ndash;90.\u003c/li\u003e\n \u003cli\u003eBizuayew H, Abebe H, Mullu G, Bewuket L, Tsega D, Alemye T. Post-cesarean section surgical site infection and associated factors in East Gojjam zone primary hospitals, Amhara region, North West Ethiopia, 2020. PLoS ONE. 2021 Dec 31;16(12):e0261951.\u003c/li\u003e\n \u003cli\u003eGhuman M, Rohlandt D, Joshy G, Lawrenson R. Post-caesarean section surgical site infection: rate and risk factors. N Z Med J. 2011 Jul 29;124(1339):32\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eOp\u0026oslash;ien HK, Valb\u0026oslash; A, Grinde-Andersen A, Walberg M. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study. Acta Obstet Gynecol Scand. 2007;86(9):1097\u0026ndash;102.\u003c/li\u003e\n \u003cli\u003eMbakwa MR, Tendongfor N, Ngunyi YL, Ngek ESN, Alemkia F, Egbe TO. Indications and outcomes of emergency obstetric hysterectomy; a 5-year review at the Bafoussam Regional Hospital, Cameroon. BMC Pregnancy Childbirth. 2021 Apr 23;21(1):323.\u003c/li\u003e\n \u003cli\u003eFouedjio JH, Mbongo JA, Kamdem TA, Meka EJ, Fouelifack YF, Nkwabong E, et al. Facteurs Associ\u0026eacute;s aux Infections du Site Op\u0026eacute;ratoire apr\u0026egrave;s C\u0026eacute;sarienne \u0026agrave; Yaound\u0026eacute;.: Infections du site op\u0026eacute;ratoire apr\u0026egrave;s c\u0026eacute;sarienne. Health Sci Dis. Oct 3;22(10).\u003c/li\u003e\n \u003cli\u003eSCHLESSELMAN JJ. Sample size requirements in cohort and case-control studies of disease. Am J Epidemiol. 1974 Jun 1;99(6):381\u0026ndash;4.\u003c/li\u003e\n \u003cli\u003eGomaa K, Abdelraheim AR, El Gelany S, Khalifa EM, Yousef AM, Hassan H. Incidence, risk factors and management of post cesarean section surgical site infection (SSI) in a tertiary hospital in Egypt: a five year retrospective study. BMC Pregnancy Childbirth. 2021 Sep 18;21(1):634.\u003c/li\u003e\n \u003cli\u003eFerraro F, Piselli P, Pittalis S, Ruscitti LE, Cimaglia C, Ippolito G, et al. Surgical site infection after caesarean section: space for post-discharge surveillance improvements and reliable comparisons. New Microbiol. 2016 Apr 1; 39 (2): 134-8\u003c/li\u003e\n \u003cli\u003eMpogoro FJ, Mshana SE, Mirambo MM, Kidenya BR, Gumodoka B, Imirzalioglu C. Incidence and predictors of surgical site infections following caesarean sections at Bugando Medical Centre, Mwanza, Tanzania. Antimicrob Resist Infect Control. 2014 Aug 11;3(1):25.\u003c/li\u003e\n \u003cli\u003eShrestha S, Shrestha R, Shrestha B, Dongol A. Incidence and risk factors of surgical site infection following cesarean section at Dhulikhel Hospital. Kathmandu Univ Med J KUMJ. 2014;12(46):113\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eM. Ngowe Ngowe. FF, Mouafo Tambo and M A Sosso. Prevalence and Risk Factors Associated with Post Operative Infections in the Limbe Regional Hospital of Cameroon. Open Surg J. 2014 Oct 1;8(1):1\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eBarbut F, Carbonne B, Truchot F, Spielvogel C, Jannet D, Goderel I, et al. [Surgical site infections after cesarean section: results of a five-year prospective surveillance]. J Gynecol Obstet Biol Reprod (Paris). 2004 Oct;33(6 Pt 1):487\u0026ndash;96.\u003c/li\u003e\n \u003cli\u003eDouville SE, Callaway LK, Amoako A, Roberts JA, Eley VA. Reducing post-caesarean delivery surgical site infections: a narrative review. Int J Obstet Anesth. 2020 May;42:76\u0026ndash;86.\u003c/li\u003e\n \u003cli\u003eTebeu PM, Kamdem A, Ngou-Mve-Ngou JP, Meka E, Antaon JSS, Loic MT, et al. Risk factors for surgical site infections after caesarean section at Yaounde, Cameroon. Int J Reprod Contracept Obstet Gynecol. 2021 Nov 1;10(11):4048\u0026ndash;52.\u003c/li\u003e\n \u003cli\u003eYerba K, Failoc-Rojas V, Ze\u0026ntilde;a-\u0026Ntilde;a\u0026ntilde;ez S, Valladares-Garrido M. Factors Associated with Surgical Site Infection in Post-Cesarean Section: A Case-Control Study in a Peruvian Hospital. Ethiop J Health Sci. 2020 Jan;30(1):95\u0026ndash;100.\u003c/li\u003e\n \u003cli\u003eJido T, Garba I. Surgical-site Infection Following Cesarean Section in Kano, Nigeria. Ann Med Health Sci Res. 2012;2(1):33\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eMukagendaneza MJ, Munyaneza E, Muhawenayo E, Nyirasebura D, Abahuje E, Nyirigira J, et al. Incidence, root causes, and outcomes of surgical site infections in a tertiary care hospital in Rwanda: a prospective observational cohort study. Patient Saf Surg. 2019;13:10.\u003c/li\u003e\n \u003cli\u003eYoussef LA, Spitalnik SL. Transfusion-related immunomodulation: A reappraisal. Curr Opin Hematol. 2017 Nov;24(6):551\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eKawakita T, Landy HJ. Surgical site infections after cesarean delivery: epidemiology, prevention and treatment. Matern Health Neonatol Perinatol. 2017;3:12.\u003c/li\u003e\n \u003cli\u003eMartin ET, Kaye KS, Knott C, Nguyen H, Santarossa M, Evans R, et al. Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol. 2016 Jan;37(1):88\u0026ndash;99.\u003c/li\u003e\n \u003cli\u003eVermillion ST, Lamoutte C, Soper DE, Verdeja A. Wound infection after cesarean: effect of subcutaneous tissue thickness. Obstet Gynecol. 2000 Jun;95(6 Pt 1):923\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eMyles TD, Gooch J, Santolaya J. Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery. Obstet Gynecol. 2002 Nov;100(5 Pt 1):959\u0026ndash;64.\u003c/li\u003e\n \u003cli\u003eNtembe A, Tawah R, Faux E. Redistributive effects of health care out-of-pocket payments in Cameroon. Int J Equity Health. 2021 Oct 18;20(1):227.\u003c/li\u003e\n \u003cli\u003eMisganaw D, Linger B, Abesha A. Surgical Antibiotic Prophylaxis Use and Surgical Site Infection Pattern in Dessie Referral Hospital, Dessie, Northeast of Ethiopia. BioMed Res Int. 2020 Mar 18;2020:1695683.\u003c/li\u003e\n \u003cli\u003eAlsaeed OM, Bukhari AA, Alshehri AA, Alsumairi FA, Alnami AM, Elsheikh HA, et al. The Use of Antibiotics for the Prevention of Surgical Site Infections in Two Government Hospitals in Taif, Saudi Arabia: A Retrospective Study. Cureus. 2022 Jul 11;14(7).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Surgical site infection, Caesarean section, Referral hospitals, incidence, risk factors","lastPublishedDoi":"10.21203/rs.3.rs-4739976/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4739976/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Caesarean sections (CS) are associated with a higher incidence of surgical site infections (SSI) compared to vaginal delivery. International studies and research from peripheral hospitals in Cameroon have documented the prevalence and risk factors for SSI after CS. However, data from referral hospitals in Douala, Cameroon remains scarce. This prospective study aims to investigate the incidence and risk factors for SSI following CS in Laquintinie and Douala Gynaeco-obstetric and Paediatric hospital, two major referral hospitals in Douala. By identifying modifiable factors associated with SSI, this study hopes to contribute to the development of strategies to control this significant hospital-acquired complication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Between February 1st and July 31st, 2022, 444 women undergoing caesarean section were enrolled in a prospective study conducted at two referral hospitals (Laquintinie hospital and Douala Gynaeco-Obstetric Hospital) in Douala, Cameroon. Standardized data collection captured sociodemographic, obstetric, and management details (pre-operative, intra-operative and post-operative information) for patients presenting with surgical site infection. Patients were followed up for 30 after caesarean section and SSI. \u0026nbsp;Descriptive statistics and multivariable logistic regression analysis identified factors associated with SSI (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The overall incidence of SSI was 45/444 (10.13%). Laquintinie Hospital had a higher rate (11.11%) compared to Douala Gynaeco-Obstetric Hospital (6.45%). Multivariate analysis identified obesity (aOR = 5.9, p = 0.032), pre-surgical anemia (aOR = 4.7, p = 0.03), and diabetes (aOR = 15.7, p = 0.013) as independent risk factors for SSI. Blood transfusion also emerged as a risk factor (aOR = 0.05, p = 0.013).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e This study revealed a concerningly high rate of SSI after CS in Douala referral hospitals. Addressing pre-surgical anemia, diabetes, and obesity may contribute to reducing SSIs. Further research is needed to identify causative bacteria and optimize antibiotic strategies.\u003c/p\u003e","manuscriptTitle":"High Rates of Surgical Site Infection after Cesarean Delivery in Cameroonian Referral Hospitals: A Prospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-16 17:10:57","doi":"10.21203/rs.3.rs-4739976/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"659ca15f-70cd-4fe5-bba4-3d7030e6a15c","owner":[],"postedDate":"July 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-16T17:10:58+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-16 17:10:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4739976","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4739976","identity":"rs-4739976","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}