Surgical Site Infection and Associated Factors Among Cesarean Delivery in Selected Comprehensive Emergency Obstetric and Newborn Care Providing Health Centers in Addis Ababa, Ethiopia

Surgical Site Infection and Associated Factors Among Cesarean Delivery in Selected Comprehensive Emergency Obstetric and Newborn Care Providing Health Centers in Addis Ababa, Ethiopia | 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 Surgical Site Infection and Associated Factors Among Cesarean Delivery in Selected Comprehensive Emergency Obstetric and Newborn Care Providing Health Centers in Addis Ababa, Ethiopia Fikre Yishere, Belete Getachew This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7887487/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Surgical site infection is the most common complication following surgery. Recent study was conducted at selected government hospitals in Addis Ababa and reported surgical site infection rate was 15%. Although, no study was conducted at health centers. Therefore, this study aims to determine the magnitude and factors associated with surgical site infection following cesarean delivery at comprehensive emergency obstetric and newborn care health centers in Addis Ababa. Methods A cross-sectional study was conducted from July 1 to August 29, 2024 at 5 randomly selected comprehensive emergency obstetric and new born care health centers in Addis Ababa. Data was extracted from the 215 randomly selected medical records of mothers. Statistical Package for Social Science software version 25 used for data analysis and finally, the result was then displayed using texts, tables and various graphs. Result Among 210 medical records of mothers who delivered by cesarean section, 24 (11.4%) of them developed surgical site infection following cesarean delivery (95%CI: (7.5%, 16.5%)). Hypertension (AOR = 6.848, 95% CI: (1.145, 40.945, P-value = 0.035), prolonged labor (AOR = 13.065, 95%CI; (2.185, 78.117, p-value = 0.002) and hemoglobin level of ≤ 11mg/dl (AOR = 7.158, 95% CI: (2.012, 25.463, p-value = 0.002) were factors significantly determine surgical site infection following cesarean delivery. Conclusion Pre-existing or pregnancy induced Hypertension, prolonged labor and pre-operative hemoglobin level were significantly associated with surgical site infection following cesarean delivery. To lower the magnitude of surgical site infection in certain populations, clinical preventions and interventions are necessary. Surgical site infection magnitude comprehensive emergency obstetric and newborn care health centers cesarean delivery Addis Ababa 2. Introduction Cesarean delivery, often known as C–section, is the surgical delivery of a fetus through an incision made in the mother's abdomen and uterine wall ( 1 , 2 ). The world health organization (WHO) recommends cesarean section (C/S) rates between 10 and 15% since 1985. When properly indicated, it can prevent poor obstetric outcomes and be a life-saving procedure for both the mother and the fetus ( 3 ). However, new study indicates that the number of C/S performed is steadily increasing, which could result in short-term, potential, and lifetime risks for mothers and newborns complications ( 4 , 5 ). Approximately, 18.5 million C/S are performed yearly worldwide and majority of the countries that did 18.5 million C/S were from Africa. Cesarean delivery reported rate in the Latin America and Caribbean region was 44.3%, on the other hand, 21.4–31.8% from Tanzania ( 6 , 7 ). In Ethiopia, cesarean delivery rate ranged from less than 1% in Somali region and Afar to 25% ( 8 ). Due to the worldwide continuous rise in the prevalence of cesarean delivery, the number of women with surgical site infection (SSI) is expected to increase ( 4 ). Among the obstetrical and gynecological surgeries, C/S is the most common which attributes to short time consequences like SSI ( 9 ). Globally, the reported prevalence of SSI after CS varies between 3% and 15% with greater burden on health-care systems, a person and communities at large, increasing the length of hospitalization, re-admission and costs of post-discharge care ( 4 ). According to Norway's 2021 data, the rates following elective and emergency cesarean deliveries were 0.4% and 5.4%, respectively ( 10 ). High rates of SSI after cesarean sections have been documented in a number of African nations; in Egypt and Rwanda, the rates range from 16.7% to 12.5%, respectively ( 11 , 12 ) However, the lowest rate 2.1% reported from Kenya in 2022 ( 13 ). In Ethiopia, the highest rate 15% in Addis Ababa in 2019 and the lowest rate reported 8.4% from Zewditu Memorial Hospital ( 14 ). According to prior studies factors that were associated with SSI following CS including, previous CS, rural residency, premature rupture of membrane (PROM), gestational age of women, age of the mother, pre-existing co-morbidities (hypertensive conditions, diabetes mellitus and HIVAIDS), pre-operative hemoglobin level, number of vaginal exams, prolonged labor, maternal weight, surgical methods, duration of operation and parity, influence the development of post-CS infection ( 7 , 10 ). Results cannot be generalized because hospitals and health centers serve different populations and provide different quality of care. The true extent and distinguishing characteristics of postoperative SSI after CS were measured in this study at the health center level ( 1 , 15 ). Although surgery is an essential component in health care, infections and complications after surgery greatly contribute for maternal morbidity and mortality ( 16 ). In Ethiopia, studies a 14.8% to 59% incidence of hospital acquired infections; and SSIs were indicated as the most common cause of nosocomial infection in obstetrics and gynecology than in general surgical wards ( 16 ). Due to the high incidence of CD, SSIs in obstetrics represent a significant burden on the healthcare system and the second most prevalent cause of maternal mortality after postpartum hemorrhage ( 16 ). Additionally, it lengthens hospital stays and raises the price of post-discharge community care ( 17 ). According to reports, SSI makes up 20% of all healthcare-associated infections (HAIs) and is linked to a 2-to 11-fold increase in mortality risk, with the SSI directly responsible for 75% of SSI-associated deaths.( 18 ). Furthermore, following a cesarean section, the morbidity rate for infections among mothers is eight times greater than that of vaginal deliveries ( 16 ). Ethiopia has been seen to have a notably higher prevalence of SSI following CS as a result of underdeveloped infection control infrastructures, scarce resources, noncompliance with infection control policies and guidelines, overcrowding, and understaffing ( 19 ). National SSI rates varies from 8.4% to 15% ( 1 , 2 , 16 ). Two recent facility based studies were conducted at Addis Ababa selected government hospitals and Zewditu hospital reported SSI rate was 15% and 8.4% respectively ( 1 , 16 ). There are several risk factors for the development of SSI following cesarean delivery include: emergency cesarean section, maternal older age, presence of maternal co-morbidity, parity, long surgery duration, premature rapture of membrane (PROM) and non-use of prophylactic antibiotics ( 20 ) However, improvements in surgical techniques, preventive strategies and methods that are designed to reduce SSI following CD and availability of prophylactic antibiotics. SSI following cesarean delivery is still an issue, especially in Addis Ababa, where the prevalence is high and the decline is not statistically significant when compared to wealthy nations ( 4 , 21 ). Therefore, this problem should be decreased through strict preventive strategies in the city. Nationally, very low C/S rate (1%) was reported ( 8 ). However, in the capital city, Addis Ababa, the rate was 21.8% according to the Ethiopian Demographic and Health Survey (EDHS) in 2011. The number of SSIs associated with cesarean sections are expected to increase as the rate of cesarean deliveries increases. However, conducted studies are not adequate and great majority of studies were conducted outside Addis Ababa, in the capital city that illustrate how the problem is distributed. Moreover, it is challenging to generalize since the SSI rate significantly varies, Even in the event that only two studies were carried out at particular Addis Ababa selected hospitals and Zewditu Memorial Hospital, the magnitude of SSI following CS was reported at 15% and 8.4% respectively, were focused on single and selected hospitals only, and no study was conducted at health centers providing comprehensive emergency obstetric and newborn care ( 1 , 16 ). Therefore, this study was aimed at finding out the magnitude of post cesarean section surgical site infection and associated factors of SSI in selected comprehensive emergency obstetric and newborn care health centers in Addis Ababa. 3. Methods 3.1 Study Area and Study Period The study was conducted in Addis Ababa, the capital city of Ethiopia to assess the magnitude of surgical site infection and factors associated among cesarean delivery at randomly selected comprehensive emergency obstetric and newborn health centers. Administratively, the city is divided into 11 sub-cities and 124 woredas. It has a population of about 4,022,125, of which 1,391,655 are women in reproductive age groups and 287,783 are children under five living in the region according to the 2007 population census, and with annual growth rate of 3.8%. There are 114 governmental healthcare facilities among this, 14 hospitals and 100 health centers and also more than 946 private healthcare facilities in the city. The region experiences woyenadega weather. In Addis Ababa, there are seventeen comprehensive emergency obstetric and newborn care service providing health centers. Among this, 5 health centers are randomly selected. These health centers are providing CEmONC service since 2017 by Integrated Emergency Surgical Officers. Maternal and child health department in these health centers incorporates labor ward, operation room for cesarean section, post-natal, post-operative and others. Moreover, there are an average bed number of 10 in each health center. The study was conducted in Addis Ababa at five selected comprehensive emergency obstetric and newborn care health centers: Akaki Health Center, Alem Bank Health Center, Gelan Health Center, Nifas Silk Lafto Sub City Woreda 9 Health Center and Meshuwalekeya Health Center from July 1 to August 29, 2024. 3.1 Study Design A facility-based cross-sectional study on patient card review was conducted among cesarean delivery at the selected comprehensive emergency obstetric and newborn care health centers in Addis Ababa to determine the magnitude and associated risk factors of surgical site infection following cesarean delivery. 3.2 Population Source Population A source population included all mothers who had delivered by cesarean section at comprehensive emergency obstetric and newborn care health centers in Addis Ababa, Ethiopia. Study Population All women who delivered by cesarean section during the study period at five selected Addis Ababa comprehensive emergency obstetric and newborn care health centers from December 31/2023 to June 27/2024. 3.3 Inclusion and Exclusion Criteria Inclusion criteria All women who had delivered by cesarean section at the selected facilities in the study period with complete chart was included. Exclusion criteria Women who died before the third day of post-operative was excluded from the study. Additionally, Women who are delivered less than 3 days after delivery, Women with infection occurs greater than 30 days after the operation and missed chart of women and who had cesarean section from other health facilities and referred in was excluded from the study. 3.5. Sample Size Determination and Sampling Procedure Sample Size Determination The desired sample size was determined for both objectives using single and double population proportion formula and the largest sample size was selected for this study. The minimum required sample size for the first objective was calculated by using the single population proportion formula as n= (zα/2) 2 * p(1-p)/d 2, based on the following assumptions, 95% confidence interval with a 5% margin of error, the expected proportion of surgical site infection following cesarean delivery taken from a study done in Addis Ababa selected public hospital which is (P)= 15% (1). For the second objective, double population proportion formula was used in EPI INFO version 7.2 by considering different significant variables from previous study. Sample size was determined using a formula for two population proportions by taking the confidence interval level of 95%, margin of error 5% and the power 80%. Duration of labor (>12 hours) was considered as risk factor of surgical site infection . P1= Proportion of women with a duration of labor >12 hours which was 20%. P2 = proportion of labor with ≤ 12 hours which was 3%. R is ratio of population among exposed to non-exposed and it was 1:1. Based on the above assumptions and 10% for possible incomplete charts, 215 women who gave birth by cesarean section were calculated as a final sample size. Sampling Procedure Among the 17 public comprehensive emergency obstetric and newborn care health centers in Addis Ababa 5 were selected by simple random sampling by using lottery method. Proportional allocation is assigned to the respective health centers based on their cesarean delivery performance in the 1 st 6-month of 2016. Finally, a systematic random sampling technique was employed to select 215 patient cards from all records of women who were delivered by cesarean section from December 31/2023 to June 27/2024. 3.6 Operational Definition The Centers for Disease Control and Prevention's 1992 classification and definition of the term served as the basis for the SSI definition used in this study (18). A surgical site infection after a caesarean section is defined as an infection that appears within the first 30 days after the cesarean section and includes at least one of the following signs and/or symptoms; Purulent drainage from the wound , Pain or tenderness, localized swelling , Redness , Malodor and fever 3.7 Data Collection Tool and Procedure Data was extracted from the 215 selected medical records of women who gave birth by cesarean sections from December 31/2023 to June 27/2024 after systematic random sampling method. Semi-structured checklist was used after pre-tested which was adjusted according to the contextual circumstances after the review of similar literature conducted in South Africa and Ethiopia (1,22) This checklist translated from English into Amharic by professionals in the language. The checklist has three parts: socio-demographic and obstetric related variables, intrapartum related factors and procedure related factors. Finally, Kobo collect mobile Application tool was used to collect data based on the check list developed. Data collection was made by 5 BSC Midwives Nurses who had access of smart phone and 2 supervisors after one day training session including orientation on Kobo collect data collection by the principal investigator. One data collector was assigned for each health center. Two public health officers with an experience in data collection assigned as a supervisor following a one-day training by the investigator and 1 supervisor for two or three health centers with the principal investigator supervise the whole data collection process. The criteria used to evaluate surgical site infections were derived from the Centers for Disease Control and Prevention. The outcome variable, post-cesarean section surgical site infection, was assessed using four yes/no items. Purulent discharge from the surgical site, at least one inflammatory symptom (pain or tenderness, localized edema, redness, or heat), an abscess, and a wound infection that has been diagnosed by a doctor or surgeon are among the things employed. If, within 30 days of Cesarian section, at least one "yes" response is given to any one of the four elements, the post- Cesarian section surgical site infection was considered. 3.8 Study Variables Dependent Variable Surgical site infection Independent Variables Socio-demographic and obstetric related variables (residence, maternal age, gestational age, parity, previous cesarean delivery, history of hypertension, history of diabetes mellitus and history of HIV), intrapartum related factors (gestational diabetes mellitus, HIV, anemia, number of vaginal examinations, extended labor before surgery, and PROM), procedure related (duration of urinary catheter stayed, the type of anesthesia, indication for CD, solution used for surgeon’s hand preparation, vaginal preparation with 10% povidone-iodine, skin closure technique, post-partum hemorrhage, type and duration of the operation, surgical wound classification, hair removal/clipping and timing of antibiotics prophylaxis and qualifications of the individual who carried out the cesarean section were independent variables identified (1,10). 3.9 Data Quality Control The goal of the study, the methods for gathering data, and the data collection instrument was covered in the training provided to data collectors. The data collection instrument was adjusted for contextual factors and derived from a study conducted in Ethiopia and South Africa, especially the kobo collect App was validated and access secured. From June 15 to 22, 2024, 10% of a similar population in Akaki Kality Sub City Gelan Health Center the tool was pre-tested to ensure its validity and make any necessary modifications. The investigators have supervised the process during the time of data collection. Additionally, has analyzed and verified the accuracy and completeness of the obtained data every day. Variance inflation factor (VIF) and tolerance test was used to check for presence of multicollinearity (Tolerance, >0.1, VIF, 0.05 (0.93). 3.10 Data Analysis After being entered, cleaned, coded and verified, all of the data input using the checklists using the Kobo Collect App was checked for completeness in the server online using Chrome and offline using an Android app. It was then exported to Microsoft Excel and then to the Statistical Package for Social Science (SPSS) for further analysis. The dependent variable was coded as 1 "if post-cesarean section SSI was present" and 2 "if not." To ascertain the statistical relationship between independent and outcome variables. Descriptive statistics was computed and presented using text, frequency tables, graphs, percentage, mean, standard deviation, skewness, and kurtosis followed by Bi-variable and multivariable logistic regression analysis to determine statistical association between independent and dependent variables. Factors from the bivariate analysis with a significance level of ≤ 0.2 was used in the multivariable logistic regression analysis. The degree of association between dependent and independent factors was evaluated by AOR with 95% CI with p value <0.05. Finally, level of statistical significance was declared at p-value<0.05 4. Result 4.1 Socio-Demographic Characteristics and Obstetric Related Factors From a total of 215 selected medical records of women who underwent cesarean delivery, 210 were eligible and reviewed in this study. The majority (82.9%) of the study participants were living in urban setting and 60.5% of them were greater than 30 years old. Near half of participants 106 (50.5%) were multiparous, 84 (40%) primiparous and 20 (9.5%) grand-multipara only as shown Table 1 below. Among participants a smaller number of them only 17 (8%) were hypertensive. Majority of women 91(43.3%) gestational age was 37–40 weeks whereas 79(37.6%) of them were > 40 weeks. Majority of the study participants 196 (93.3%) had no previous history of cesarean section as shown in Table 1 below Table 1 Frequency table of socio-demographic and obstetric related factors of women those who underwent cesarean section at randomly selected health centers in Addis Ababa, Ethiopia, 2024 Variables Category Frequency Percent Age =30 127 60.50% Total 210 100% Residence Urban 174 82.90% Rural 36 17.10% Total 210 100% Parity Primiparous 84 40% Multiparous 106 50.50% Grand multipara 20 9.50% Total 210 100% Underlying condition (Hypertension) Yes 17 8% No 193 92% Total 210 100% Gestational age of Mother 40 weeks 79 37.60% Total 210 100% Previous cesarean section Yes 14 6.70% No 196 93.30% Total 210 100% 4.2 Intrapartum Related Factors Majority of the participants 153 (72.9%) had preoperative hemoglobin of greater than or equal to 11mg/dl and about 71 (33.8%) of the study participants had no labor prior to surgery. Women with greater than 12-hour premature rupture of membrane also accounted for only 9% of the participants and only 12.4% of them had indication of failed induction. Moreover, before operation 1–4 times vaginal examinations was performed nearly half of women (43.8%) as shown Table 2 below. Table 2 Frequency table of intrapartum of women those who underwent cesarean section at randomly selected health centers in Addis Ababa, Ethiopia, 2024 Variables Category Frequency Percent Hemoglobin at Cs 11g/dl 153 72.90% Total 210 100% Duration that mother was in labor no labor 71 33.80% 24 hours 22 10.50% Total 210 100% Number of vaginal examinations before CD No vaginal examination 81 38.60% 1–4 vaginal examinations 92 43.80% ≥ 5 vaginal examinations 37 17.60% Length of time membranes ruptured prior to No rupture 85 40.50% 12 hours 19 9% Total 210 100% Failed induction Yes 26 12.40% No 184 87.60% Total 210 100% Meconium-stained amniotic fluid Yes 24 11.40% No 186 88.60% Total 210 100% 4.3 Procedure or Operation Related Factors Preoperative antibiotics prophylaxis was provided for the great majority 194 (92.4%) of the women and three fourth of them (66.7%) had less than or equal to 30-hour duration of operation. More than half of technique of skin closure was continuous sutures (55.2%). All cesarean section was provided by IESO and also more than half (59.5%) of operation was emergency. The detail is shown in Table 3 Table 3 Frequency table of procedure related of women those who underwent cesarean section at randomly selected health centers in Addis Ababa, Ethiopia, 2024 Variables Category Frequency Percent Duration of operation 30 70 33.30% Total 210 100% Type of operation Elective 85 40.50% Emergency 125 59.50% Total 210 100% Skin closure Interrupted sutures 94 44.80% Continuous 116 55.20% Total 210 100% The operation was provided by IESO 210 100% Did antibiotic prophylaxis provided? Yes 194 92.40% No 16 7.60% Total 210 100% Type of anesthesia provided General 6 2.90% Spinal 204 97.10% Total 210 100% 4.4 Magnitude of Surgical Site Infection Following Cesarean Delivery Among 210 women included in the study 24 (11.4%) of them developed surgical site infection following cesarean delivery (95%CI: (7.5% − 16.5%)). 4.5 Factors Associated with SSI Following Cesarean Section During bivariable logistic regression analysis, those variables which had p-value of ≤ 0.2 were considered in multivariable logistic regression. Out of 30 independent variables, seven variables; pre-existing or pregnancy induced hypertension, hemoglobin prior to operation, gestational age, labor duration, failed induction, meconium-stained amniotic fluid and previous history of cesarean section had shown an association in bivariable analysis with p-value ≤ 0.2, and those variables were fitted to a multivariate logistic regression analysis. The results showed that, at a p-value < 0.05 with 95% confidence interval, surgical site infection after cesarean birth was significantly correlated with pre-existing or pregnancy induced hypertension, pre-operative hemoglobin ≤ 11.5 mg/dl, and labor lasting longer than 24 hours. Women with a history of preexisting or pregnancy-induced hypertension had a 6.8-fold increased risk of developing surgical site infection after cesarean section (AOR = 6.848, 95% CI: (1.145, 40.945, P-value = 0.035) compared to those without hypertension. Compared to women who were not in labor, those who had labor for > 24 hours had a 13-fold (AOR = 13.065, 95%CI; 2.185, 78.117, p-value = 0.002) increased risk of developing SSI following cesarean delivery. Moreover, the odds of develop surgical site infection following cesarean section among women who had a pre-operative hemoglobin level of ≤ 11mg/dl were 7.2 times higher than those who had hemoglobin level of greater than 11mg/dl (AOR = 7.158, 95% CI: (2.012, 25.463, p-value = 0.002).(Table 4 ) Table 4 Bi-variable and Multivariable logistic regression analysis of factors associated with SSI following cesarean section among women who underwent cesarean section at randomly selected health centers in Addis Ababa, Ethiopia, 2024 Variables Category Was SSI detected? COR (95% CI) AOR (95% CI) P-Value Yes No Underlying condition Hypertension Yes 7 10 7.247(2.445, 21.482) 6.848(1.145, 40.945) 0.035 No 17 176 1 1 History of previous cesarean section Yes 6 8 7.416(2.315, 23.759) 4.109(0.642, 26.311) 0.136 No 18 178 1 1 Hemoglobin at time of cesarean section 11g/dl 11 142 1 1 Gestational age of Mother 40 weeks 10 69 2.053(0.622, 4.783) 1.533(0.416, 5.648) 0.98 Duration that mother was in labor > 24 hours 8 14 7.543(2.145, 26.523) 13.065(2.185, 78.117) 0.002 < 24 hours 11 106 1.370(0.456, 4.119) 2.040(0.581, 7.161) 0.266 no labor 5 66 1 1 Failed induction Yes 5 21 2.067(0.699, 6.118) 4.869(0.904, 26.210) 0.065 No 19 165 1 1 Meconium-stained amniotic fluid Yes 6 18 3.111(1.095, 8.837) 2.787(0.513, 15.124) 0.235 No 18 168 1 1 5 Discussion The aim of this study was to ascertain the prevalence and contributing variables of surgical site infections after cesarean sections in comprehensive emergency obstetric and neonatal care health centers in Addis Ababa that were chosen at random. As reported in many other studies in developing countries including Ethiopia, the prevalence of surgical site infection in the present study was higher than in developed countries ( 1 , 7 , 23 ) This could be explained by patient populations and standard of hygiene practiced in developed countries ( 22 ). In the current study the incidence of SSI following cesarean section was 11.4%, which is lower than previously reported in Ethiopia. As study at selected government hospitals of Addis Ababa reported an incidence rate of 15%, which could be explained by type of study design; the study added follow-up surveillance after mothers have been discharged, post-operative hospital stay and small sample size used ( 1 ). Due to the study's only reliance on medical record review and lack of post-discharge follow-up, the rate may have been underestimated. Increased SSI rate in this study area might result in significant health care costs, including financial loss to family and hospital income from extended hospital stays, more work for healthcare professionals, and the possibility of complications that could cause mother and newborn deaths. The findings of this study in line with the worldwide incidence rate of 3–15% ( 17 ); a study in Nigeria (11%), Rwanda (10.9%) ( 12 , 24 ) The reason could be because surgical procedures, such as the routine use of prophylactic antibiotics to lower the risk of infection, are of similar quality, all studies used chart reviews to collect data, the studies were conducted in an institutional setting, the sample sizes were comparable, and the definition of SSI used to measure the outcome variable was similar. Additionally, the current study's rate was consistent with prior cross-sectional research carried out in Nekemte Town (8.9%), Jima (11.4%) and Ayder Comprehensive Specialized Hospital (11.7%), Ethiopia ( 14 ), ( 25 ), ( 9 ). This might be due to similar means of data collection (retrospective data review), post-SSI definition and similar socio-economic status. The finding was higher than the result reported from different studies which revealed that the rate of SSI in studies done in Norway o.4% and 5.4% after elective and emergency cesarean section, respectively, UAE (2.4%) and Israel (3.7%) ( 6 , 10 , 20 ). This disparity could potentially be caused by variations in health care systems and socioeconomic position. Furthermore, those studies were carried out at general and specialty hospitals with higher standards of care delivery. This could be because operating rooms in developing nations, such as Ethiopia, are of lower quality than those in developed nations, which increases the risk of a sterility technique breakdown during surgery. However, in contrast to studies conducted in Ethiopia, the rate of SSI following cesarean delivery in this study was lower than that of a study carried out ; in Addis Ababa (15%), Wolayta Sodo (13%) and Dessie Referral Hospital (14.5%) ( 1 , 26 , 27 ). This may be because previous studies used a prospective cohort study design with post-discharge follow-up, in contrast to the current cross-sectional analysis with secondary record review and no post-operative discharge follow-up. Following discharge, women may develop post-cesarean section SSI and seek treatment at nearby medical facilities outside the study area, which could understate the current magnitude. Similar to research conducted in Egypt, Nigeria, Gojam Zone, and Nekemte Town, women who underwent labor for more than 24 hours prior to cesarean section had a 13-fold higher risk of SSI than those who were not in labor. ( 4 , 14 , 24 , 28 , 29 ) One explanation is because the number of vaginal examinations rises with the length of labor, which might result in increased contamination and ascending infection that could cause post-operative infection ( 28 ). This suggests that in order to minimize the length of time that patients are exposed to infection before a cesarean section, midwives and surgeons must identify labor dystocia early on, as this may prolong labor. Women who had pre-existing or pregnancy induced hypertension were 6.8 times more likely to develop SSI following cesarean section than those who were not hypertensive. This report was comparable with the prior studies in Israel, Gojam Zone and Nekemte Town; Ethiopia ( 4 , 14 , 20 ) The peripheral vasoconstriction effect of hypertension may be the cause of the wound's hypoperfusion. Additionally, women who have this issue may have edematous wound margins that allow organisms to enter and cause infection. Hypoxic wound conditions and oxygen depletion may result from vascular disruption and metabolically active cells' high oxygen consumption. ( 28 ). This emphasizes that before a CS procedure, medical professionals should monitor and treat hypertensive mothers. In this study, pre operative hemoglobin ≤ 11 mg/dl was significantly associated with SSI following cesarean section. Women with hemoglobin ≤ 11 mg/dl were 7.2 times more likely to develop SSI, similar with previous studies conducted in India, Nigeria and Gojam Zone ; Ethiopia ( 4 , 24 , 30 ) This is true that anemia reduces the oxygen transportation at the wound site and raise the risk of SSI by impairing macrophage activity and slowing the rate of wound healing. ( 31 ). This suggests that during ANC and in the community, health care providers should inform mothers about meals high in iron. They should also give ferrous tablets to all pregnant women and assessment of utilization. 6 Conclusion According to this report, the extent of surgical site infection following cesarean section at selected comprehensive emergency obstetric and newborn care services providing health centers in Addis Ababa was found to be relatively lower, which was 11.4% when compared to a previous hospital-based study in Addis Ababa. However, relatively higher when compared to developed countries. A list of factors including preexisting or pregnancy induced hypertension, pre-operative hemoglobin level ≤ 11mg/dl and prolonged labor were significantly associated with SSI following cesarean section. We would recommend further prospective study, which involve post-discharge follow-up at comprehensive emergency obstetric and new born care health center level, which was not included in the current study. Health care providers and Addis Ababa Health Bureau policy makers should give due attention the proper utilization of partograph in order to prevent prolonged labor, early screening and management of hypertension and develop strategies to improve iron folate utilization of pregnant women in all health care facilities. Limitation of the Study The study did not cover post-discharge follow-up and was only based on medical chart reviews, which lacked certain variables, such as body mass index. Furthermore, because the study was cross-sectional, it may not have been possible to establish a cause-and-effect relationship, which could have underestimated the magnitude of the problem. Declarations Human ethics and consent to participate This study is involving human participants was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the institutional review board (IRB) of Yekatit 12 Hospital Medical College with reference number RPO/556/24. The approval was subsequently submitted to the Addis Ababa Regional Health Bureau, where clearance was granted. The clearance letter was presented to the relevant authorities, who were briefed on the study, and permission was obtained before data collection. During data collection, informed consent was obtained from each respondent after a clear explanation of the study’s objectives and their rights, including the right to voluntarily participate or withdraw at any stage. Further information and documentation supporting this ethical approval can be made available to the Editor upon request. Consent for publication I Confirm I give my full consent that I have read and approved the final version of the manuscript and take full responsibility for its content. I affirm that I have the necessary authority to grant this consent and have obtained any required permissions for the publication of this work. Furthermore, I acknowledge that once published, the manuscript will be publicly accessible in print, online, and other formats as determined by the publisher. I confirm that the manuscript does not infringe upon any copyright, confidentiality, or legal obligations. Additionally, I agree that the publisher may make minor editorial modifications, provided they do not alter the integrity of the content. Availability of data and material All the data generated in this study are included in this manuscript. The datasets used and analyzed to produce the current manuscript will be obtained from the corresponding author upon request. Competing interest The authors declare that there are no competing interests. Funding This study did not receive any funding. Authors’ contributions FY designed the study, write a literature review, applied for data access, conducted the data analyses, and, provided advice in data analysis, BG drafted the manuscript. All authors read and approved the final manuscript. Acknowledgement First of all, I would like to thank department of public health, Yekatit 12 Hospital Medical College for giving me the chance to conduct this study. I am also grateful to the leaders, staff and data collectors at the respective Sub Cities and Health Centers in Addis Ababa where the study was conducted for their co-operation, contribution and support during data collection. Author detail Fikre Yishere 1*, Belete Getachew 2 Authors Affiliation 1 Department of public health, Yekatit 12 hospital medical college, Addis Ababa, Ethiopia 2 School of Public health, St. Paul hospital millennium medical college, Addis Ababa, Ethiopia Corresponding author Fikre Yishere Department of public health, Yekatit 12 hospital medical college, Addis Ababa, Ethiopia [email protected] References Lijaemiro H, Berhe Lemlem S, Tesfaye Deressa J. Incidence of Surgical Site Infection and Factors Associated among Cesarean Deliveries in Selected Government Hospitals in Addis Ababa, Ethiopia, 2019. Obstet Gynecol Int. 2020;2020(23):2. Bezatu Mengistie FT. Prevalence of Cesarean Section in Urban Health Facilities and Associated Factors in Eastern Ethiopia: Hospital Based Cross Sectional Study. J Pregnancy Child Heal. 2015;02(03):122–256. Regmi A, Ojha N, Singh M, Ghimire A, Kharel N. Risk Factors Associated with Surgical Site Infection following Cesarean Section in Tertiary Care Hospital, Nepal. Int J Reprod Med. 2022;2022(3):1–11. 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;16(12 December):234–567. Kawakita T, Landy HJ. Surgical site infections after cesarean delivery: epidemiology, prevention and treatment. Matern Heal Neonatol Perinatol. 2017;3(1):12–4. Alnajjar MS, Alashker DA. Surgical site infections following caesarean sections at Emirati teaching hospital: Incidence and implicated factors. Sci Rep. 2020;10(1):234–123. 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;3(1):25–67. ESOG. Facility Assessment Report of CEmONC Services in 15 health facilities of Developing Regional States in Ethiopia. 2023. Wendmagegn TA, Abera GB, Tsehaye WT, Gebresslasie KB, Tella BG. Magnitude and determinants of surgical site infecion among women underwent cesarean section in Ayder comprehensive specialized hospital Mekelle City, Tigray region, Northern Ethiopia, 2016. BMC Pregnancy Childbirth. 2018;18(1):45–67. Kvalvik SA, Rasmussen S, Thornhill HF, Baghestan E. Risk factors for surgical site infection following cesarean delivery: A hospital-based case–control study. Acta Obstet Gynecol Scand. 2021;100(12):2167–75. Abdallah, Ameer MESR. Risk Factors of Surgical Site Infection of Cesarean Section and Role of Skin Cleansing and Prophylactic Antibiotic -. Int J Reprod Med Gynecol. 2020;2(October):15–8. Nkurunziza T, Kateera F, Sonderman K, Gruendl M, Nihiwacu E, Ramadhan B, et al. Prevalence and predictors of surgical-site infection after caesarean section at a rural district hospital in Rwanda. Br J Surg. 2019;106(2):121–8. Odada D, Shah J, Mbithi A, Shah R. Surgical site infections post cesarean section and associated risk factors: a retrospective case-control study at a tertiary hospital in Kenya. Infect Prev Pract. 2024;6(1):10–34. Ayala D, Tolossa T, Markos J, Yilma MT. Magnitude and factors associated with surgical site infection among mothers underwent cesarean delivery in Nekemte town public hospitals, western Ethiopia. PLoS ONE. 2021;16(4 April 2021):23–56. Jaime JM. Post Cesarean Surgical Site Infection Reduction Through Vaginal Preparation. Master’s Proj Capstones. 2021;12(3):7–9. Gelaw MW, Abdella A. Prevalence of surgical site infection and associated factors among mothers after cesarean delivery in zewditu memorial hospital. Ethiop J Reprod Heal. 2018;10(4):34–67. Zuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: Prevalence, impact, prevention, and management challenges. International Journal of Women’s Health. Volume 9. Dove Medical Press Ltd; 2017. pp. 81–8. CDC. Surgical Site Infection Event (SSI) Introduction. In: National Healthcare Safety Network. 2024. pp. 1–39. Mezemir R, Olayemi O, Dessie Y, Incidence. Bacterial Profile and Predictors of Surgical Site Infection After Cesarean Section in Ethiopia, A Prospective Cohort Study. Int J Womens Health. 2023;15(2):1547–60. Krieger Y, Walfisch A, Sheiner E. Surgical site infection following cesarean deliveries: trends and risk factors. J Matern Neonatal Med. 2017;30(1):8–12. Azeze GG, Bizuneh AD. Surgical site infection and its associated factors following cesarean section in Ethiopia: A cross-sectional study. BMC Res Notes. 2019;12(1):23–34. Shiferaw S, Mehari M, Zenebe K, Gebrezgher BWA. Determinants of post-cesarean delivery surgical site infection in Mekelle public hospitals, Tigray, North Ethiopia. Int J Gynaecol Obs. 2025;170(20):783–92. 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;9(2):12–3. Ojiyi EC, Dike EI, Okeudo C, Ejikem EC. Nzewuihe a EC. Wound Infection following Caesarean Section in a University Teaching Hospital in South-East Nigeria. Orient J Med. 2013;25(1–2):8–13. Amenu D, Belachew T, Araya F. Surgical site infection rate and risk factors among obstetric cases of jimma university specialized hospital, southwest ethiopia. Ethiop J Heal Sci. 2011;21(2):91–100. Awoke N, Arba A, Girma A. Magnitude of surgical site infection and its associated factors among patients who underwent a surgical procedure at Wolaita Sodo University Teaching and Referral Hospital, South Ethiopia. PLoS ONE. 2019;14(12):5–6. Ali A, Ababa A. Incidence of surgical site infection, predisposing factors and associated costs at Dessie Referral Hospital, Dessie, Ethiopia. AGE Open Med. 2017;2(1):12–5. 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;21(1):45–78. Getachew B, Kibret A. Unmet need for family planning and associated factors among reproductive age women working in Bole Lemi industrial park, Addis Ababa, Ethiopia 2024: an institution based cross-sectional study. BMC Public Health. 2025;25(1):1–8. Shanbhag ER, Veena P. Surgical Site Infections Following Cesarean Section: A Longitudinal Study. South Asian Fed Obstet Gynaecol. 2021;13(3):1–4. Dacho AM, Angelo AT. Magnitude of Post Caesarean Section Surgical Site Infection and its Associated Factors among Mothers who Underwent Caesarean Section in Mizan Tepi University Teaching Hospital, South West Ethiopia, 2017. J Nurs Care. 2018;071(Dacho02):26–36. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 13 Jan, 2026 Reviews received at journal 13 Jan, 2026 Reviews received at journal 07 Jan, 2026 Reviewers agreed at journal 07 Jan, 2026 Reviewers agreed at journal 14 Nov, 2025 Reviewers invited by journal 10 Nov, 2025 Editor assigned by journal 21 Oct, 2025 Submission checks completed at journal 21 Oct, 2025 First submitted to journal 17 Oct, 2025 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. 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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-7887487","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":544992760,"identity":"9b2feff7-9479-4c6a-9232-d822712515a5","order_by":0,"name":"Fikre Yishere","email":"","orcid":"","institution":"Yekatit 12 hospital medical college","correspondingAuthor":false,"prefix":"","firstName":"Fikre","middleName":"","lastName":"Yishere","suffix":""},{"id":544992761,"identity":"224a6ba6-61e8-45aa-b0b3-78bf8e248ae8","order_by":1,"name":"Belete Getachew","email":"data:image/png;base64,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","orcid":"","institution":"St. Paul's Hospital Millennium Medical College","correspondingAuthor":true,"prefix":"","firstName":"Belete","middleName":"","lastName":"Getachew","suffix":""}],"badges":[],"createdAt":"2025-10-17 14:08:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7887487/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7887487/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96371212,"identity":"969c7534-06df-49b3-bae7-8ecbd3193d08","added_by":"auto","created_at":"2025-11-20 10:24:36","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":143896,"visible":true,"origin":"","legend":"","description":"","filename":"FikreYisheremanu.docx","url":"https://assets-eu.researchsquare.com/files/rs-7887487/v1/56047fb81d0aba1d8f5184fb.docx"},{"id":96371401,"identity":"8895a423-a072-4694-8e38-fd4ec3036cad","added_by":"auto","created_at":"2025-11-20 10:24:56","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":5077,"visible":true,"origin":"","legend":"","description":"","filename":"71ef149bc87745dc97db30b09b9541c5.json","url":"https://assets-eu.researchsquare.com/files/rs-7887487/v1/0f0d3d706fa2babe07f8cf8f.json"},{"id":96371211,"identity":"9bd239c9-c3c1-4d91-9613-856295fb86d0","added_by":"auto","created_at":"2025-11-20 10:24:36","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":112251,"visible":true,"origin":"","legend":"","description":"","filename":"71ef149bc87745dc97db30b09b9541c51enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7887487/v1/dbba2d83ab7e1915d3224012.xml"},{"id":96371185,"identity":"798fee99-cb8b-4f70-9b36-e8c3558891ee","added_by":"auto","created_at":"2025-11-20 10:24:33","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":113355,"visible":true,"origin":"","legend":"","description":"","filename":"71ef149bc87745dc97db30b09b9541c51structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7887487/v1/9aa4914d09e157dbc5f7c214.xml"},{"id":96371385,"identity":"24762ac7-b8fa-4106-826d-8c16bf0ba35d","added_by":"auto","created_at":"2025-11-20 10:24:52","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":118034,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7887487/v1/64e8ff4bf451a2d894cd2bed.html"},{"id":96453123,"identity":"530a5814-4080-49ef-8dad-7c57a83fdc5d","added_by":"auto","created_at":"2025-11-21 09:58:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1028070,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7887487/v1/2035062a-6d5b-45fd-be4b-2e989436502b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Surgical Site Infection and Associated Factors Among Cesarean Delivery in Selected Comprehensive Emergency Obstetric and Newborn Care Providing Health Centers in Addis Ababa, Ethiopia","fulltext":[{"header":"2. Introduction","content":"\u003cp\u003eCesarean delivery, often known as C\u0026ndash;section, is the surgical delivery of a fetus through an incision made in the mother's abdomen and uterine wall (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The world health organization (WHO) recommends cesarean section (C/S) rates between 10 and 15% since 1985. When properly indicated, it can prevent poor obstetric outcomes and be a life-saving procedure for both the mother and the fetus (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). However, new study indicates that the number of C/S performed is steadily increasing, which could result in short-term, potential, and lifetime risks for mothers and newborns complications (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eApproximately, 18.5\u0026nbsp;million C/S are performed yearly worldwide and majority of the countries that did 18.5\u0026nbsp;million C/S were from Africa. Cesarean delivery reported rate in the Latin America and Caribbean region was 44.3%, on the other hand, 21.4\u0026ndash;31.8% from Tanzania (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In Ethiopia, cesarean delivery rate ranged from less than 1% in Somali region and Afar to 25% (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Due to the worldwide continuous rise in the prevalence of cesarean delivery, the number of women with surgical site infection (SSI) is expected to increase (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Among the obstetrical and gynecological surgeries, C/S is the most common which attributes to short time consequences like SSI (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGlobally, the reported prevalence of SSI after CS varies between 3% and 15% with greater burden on health-care systems, a person and communities at large, increasing the length of hospitalization, re-admission and costs of post-discharge care (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). According to Norway's 2021 data, the rates following elective and emergency cesarean deliveries were 0.4% and 5.4%, respectively (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). High rates of SSI after cesarean sections have been documented in a number of African nations; in Egypt and Rwanda, the rates range from 16.7% to 12.5%, respectively (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) However, the lowest rate 2.1% reported from Kenya in 2022 (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In Ethiopia, the highest rate 15% in Addis Ababa in 2019 and the lowest rate reported 8.4% from Zewditu Memorial Hospital (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAccording to prior studies factors that were associated with SSI following CS including, previous CS, rural residency, premature rupture of membrane (PROM), gestational age of women, age of the mother, pre-existing co-morbidities (hypertensive conditions, diabetes mellitus and HIVAIDS), pre-operative hemoglobin level, number of vaginal exams, prolonged labor, maternal weight, surgical methods, duration of operation and parity, influence the development of post-CS infection (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eResults cannot be generalized because hospitals and health centers serve different populations and provide different quality of care. The true extent and distinguishing characteristics of postoperative SSI after CS were measured in this study at the health center level (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough surgery is an essential component in health care, infections and complications after surgery greatly contribute for maternal morbidity and mortality (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In Ethiopia, studies a 14.8% to 59% incidence of hospital acquired infections; and SSIs were indicated as the most common cause of nosocomial infection in obstetrics and gynecology than in general surgical wards (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Due to the high incidence of CD, SSIs in obstetrics represent a significant burden on the healthcare system and the second most prevalent cause of maternal mortality after postpartum hemorrhage (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Additionally, it lengthens hospital stays and raises the price of post-discharge community care (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAccording to reports, SSI makes up 20% of all healthcare-associated infections (HAIs) and is linked to a 2-to 11-fold increase in mortality risk, with the SSI directly responsible for 75% of SSI-associated deaths.(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Furthermore, following a cesarean section, the morbidity rate for infections among mothers is eight times greater than that of vaginal deliveries (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEthiopia has been seen to have a notably higher prevalence of SSI following CS as a result of underdeveloped infection control infrastructures, scarce resources, noncompliance with infection control policies and guidelines, overcrowding, and understaffing (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). National SSI rates varies from 8.4% to 15% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Two recent facility based studies were conducted at Addis Ababa selected government hospitals and Zewditu hospital reported SSI rate was 15% and 8.4% respectively (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThere are several risk factors for the development of SSI following cesarean delivery include: emergency cesarean section, maternal older age, presence of maternal co-morbidity, parity, long surgery duration, premature rapture of membrane (PROM) and non-use of prophylactic antibiotics (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eHowever, improvements in surgical techniques, preventive strategies and methods that are designed to reduce SSI following CD and availability of prophylactic antibiotics. SSI following cesarean delivery is still an issue, especially in Addis Ababa, where the prevalence is high and the decline is not statistically significant when compared to wealthy nations (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Therefore, this problem should be decreased through strict preventive strategies in the city.\u003c/p\u003e\u003cp\u003eNationally, very low C/S rate (1%) was reported (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, in the capital city, Addis Ababa, the rate was 21.8% according to the Ethiopian Demographic and Health Survey (EDHS) in 2011. The number of SSIs associated with cesarean sections are expected to increase as the rate of cesarean deliveries increases. However, conducted studies are not adequate and great majority of studies were conducted outside Addis Ababa, in the capital city that illustrate how the problem is distributed.\u003c/p\u003e\u003cp\u003eMoreover, it is challenging to generalize since the SSI rate significantly varies, Even in the event that only two studies were carried out at particular Addis Ababa selected hospitals and Zewditu Memorial Hospital, the magnitude of SSI following CS was reported at 15% and 8.4% respectively, were focused on single and selected hospitals only, and no study was conducted at health centers providing comprehensive emergency obstetric and newborn care (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTherefore, this study was aimed at finding out the magnitude of post cesarean section surgical site infection and associated factors of SSI in selected comprehensive emergency obstetric and newborn care health centers in Addis Ababa.\u003c/p\u003e"},{"header":"3. Methods","content":"\u003ch2\u003e3.1 Study Area and Study Period\u003c/h2\u003e\n\u003cp\u003eThe\u0026nbsp;study\u0026nbsp;was\u0026nbsp;conducted\u0026nbsp;in\u0026nbsp;Addis\u0026nbsp;Ababa,\u0026nbsp;the\u0026nbsp;capital\u0026nbsp;city\u0026nbsp;of Ethiopia to\u0026nbsp;assess the\u0026nbsp;magnitude of\u0026nbsp;surgical\u0026nbsp;site\u0026nbsp;infection\u0026nbsp;and\u0026nbsp;factors associated\u0026nbsp;among cesarean delivery at randomly selected comprehensive emergency obstetric and newborn health centers.\u0026nbsp;Administratively, the city\u0026nbsp;is\u0026nbsp;divided\u0026nbsp;into\u0026nbsp;11\u0026nbsp;sub-cities and 124\u0026nbsp;woredas.\u0026nbsp;It\u0026nbsp;has\u0026nbsp;a\u0026nbsp;population\u0026nbsp;of\u0026nbsp;about\u0026nbsp;4,022,125,\u0026nbsp;of\u0026nbsp;which\u0026nbsp;1,391,655\u0026nbsp;are\u0026nbsp;women\u0026nbsp;in\u0026nbsp;reproductive\u0026nbsp;age\u0026nbsp;groups\u0026nbsp;and\u0026nbsp;287,783\u0026nbsp;are\u0026nbsp;children\u0026nbsp;under\u0026nbsp;five\u0026nbsp;living\u0026nbsp;in\u0026nbsp;the\u0026nbsp;region according to the 2007 population census, and with annual growth rate of 3.8%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere are 114\u0026nbsp;governmental\u0026nbsp;healthcare\u0026nbsp;facilities\u0026nbsp;among this, 14\u0026nbsp;hospitals\u0026nbsp;and\u0026nbsp;100\u0026nbsp;health\u0026nbsp;centers\u0026nbsp;and also more than 946\u0026nbsp;private\u0026nbsp;healthcare\u0026nbsp;facilities\u0026nbsp;in\u0026nbsp;the\u0026nbsp;city.\u0026nbsp;The\u0026nbsp;region\u0026nbsp;experiences\u0026nbsp;woyenadega\u0026nbsp;weather. In\u0026nbsp;Addis\u0026nbsp;Ababa,\u0026nbsp;there are seventeen\u0026nbsp;comprehensive\u0026nbsp;emergency\u0026nbsp;obstetric\u0026nbsp;and\u0026nbsp;newborn\u0026nbsp;care\u0026nbsp;service providing health centers. Among\u0026nbsp;this, 5 health centers\u0026nbsp;are randomly selected. These health centers are providing CEmONC service since 2017 by Integrated Emergency Surgical Officers.\u0026nbsp;Maternal and child health\u0026nbsp;\u0026nbsp;department in these health centers incorporates labor ward, operation room for cesarean section, post-natal, post-operative and others. Moreover, there are an average bed number of 10 in each health center.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;study\u0026nbsp;was\u0026nbsp;conducted\u0026nbsp;in\u0026nbsp;Addis\u0026nbsp;Ababa\u0026nbsp;at five selected comprehensive emergency obstetric and newborn care\u0026nbsp;health centers: Akaki Health Center, Alem Bank Health Center, Gelan Health Center, Nifas Silk Lafto Sub City Woreda 9 Health Center and Meshuwalekeya Health Center from\u0026nbsp;July\u0026nbsp;1\u0026nbsp;to\u0026nbsp;August 29,\u0026nbsp;2024.\u003c/p\u003e\n\u003ch2 id=\"_Toc189768572\"\u003e3.1\u0026nbsp;Study Design\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eA facility-based\u0026nbsp;cross-sectional study\u0026nbsp;on patient card review\u0026nbsp;was\u0026nbsp;conducted\u0026nbsp;among\u0026nbsp;cesarean delivery\u0026nbsp;at\u0026nbsp;the\u0026nbsp;selected\u0026nbsp;comprehensive\u0026nbsp;emergency\u0026nbsp;obstetric\u0026nbsp;and\u0026nbsp;newborn\u0026nbsp;care\u0026nbsp;health\u0026nbsp;centers\u0026nbsp;in\u0026nbsp;Addis\u0026nbsp;Ababa\u0026nbsp;to\u0026nbsp;determine\u0026nbsp;the\u0026nbsp;magnitude\u0026nbsp;and\u0026nbsp;associated\u0026nbsp;risk\u0026nbsp;factors\u0026nbsp;of\u0026nbsp;surgical site infection\u0026nbsp;following\u0026nbsp;cesarean\u0026nbsp;delivery.\u003c/p\u003e\n\u003ch2 id=\"_Toc189768573\"\u003e3.2\u0026nbsp;Population\u0026nbsp;\u003c/h2\u003e\n\u003ch3 id=\"_Toc189768574\"\u003eSource Population\u0026nbsp;\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eA\u0026nbsp;source\u0026nbsp;population\u0026nbsp;included\u0026nbsp;all\u0026nbsp;mothers\u0026nbsp;who\u0026nbsp;had\u0026nbsp;delivered\u0026nbsp;by\u0026nbsp;cesarean\u0026nbsp;section\u0026nbsp;at comprehensive emergency obstetric and newborn care health centers in Addis\u0026nbsp;Ababa, Ethiopia.\u003c/p\u003e\n\u003ch3 id=\"_Toc189768575\"\u003eStudy\u0026nbsp;Population\u003c/h3\u003e\n\u003cp\u003eAll\u0026nbsp;women\u0026nbsp;who delivered\u0026nbsp;by\u0026nbsp;cesarean\u0026nbsp;section during\u0026nbsp;the\u0026nbsp;study\u0026nbsp;period at\u0026nbsp;five\u0026nbsp;selected Addis\u0026nbsp;Ababa\u0026nbsp;comprehensive emergency obstetric and newborn care\u0026nbsp;health\u0026nbsp;centers\u0026nbsp;from December 31/2023 to June 27/2024.\u003c/p\u003e\n\u003ch2 id=\"_Toc189768576\"\u003e3.3\u0026nbsp;Inclusion and Exclusion Criteria\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll women who had delivered by cesarean section at the selected facilities in the study period with complete chart was included.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWomen who died before the third day of post-operative was excluded from the study. Additionally, Women who are delivered less than 3 days after delivery, Women with infection occurs greater than 30 days after the operation and missed chart of women and who had cesarean section from other health facilities and referred in was excluded from the study.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc189768577\"\u003e3.5.\u0026nbsp;Sample Size Determination and Sampling Procedure\u003c/h2\u003e\n\u003ch3 id=\"_Toc189768578\"\u003eSample Size Determination\u003c/h3\u003e\n\u003cp\u003eThe desired sample size was determined for both objectives using single and double population proportion formula and the largest sample size was selected for this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;minimum required sample size for the first objective was\u0026nbsp;calculated\u0026nbsp;by\u0026nbsp;using\u0026nbsp;the\u0026nbsp;single\u0026nbsp;population\u0026nbsp;proportion\u0026nbsp;formula as n= (zα/2)\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e* p(1-p)/d\u003csup\u003e2,\u0026nbsp;\u003c/sup\u003ebased\u0026nbsp;on\u0026nbsp;the\u0026nbsp;following\u0026nbsp;assumptions,\u0026nbsp;95%\u0026nbsp;confidence\u0026nbsp;interval\u0026nbsp;with\u0026nbsp;a\u0026nbsp;5%\u0026nbsp;margin\u0026nbsp;of\u0026nbsp;error,\u0026nbsp;the\u0026nbsp;expected\u0026nbsp;proportion\u0026nbsp;of\u0026nbsp;surgical\u0026nbsp;site\u0026nbsp;infection\u0026nbsp;following\u0026nbsp;cesarean\u0026nbsp;delivery\u0026nbsp;taken\u0026nbsp;from\u0026nbsp;a\u0026nbsp;study\u0026nbsp;done\u0026nbsp;in\u0026nbsp;Addis\u0026nbsp;Ababa\u0026nbsp;selected\u0026nbsp;public\u0026nbsp;hospital\u0026nbsp;which\u0026nbsp;is\u0026nbsp;(P)=\u0026nbsp;15%\u0026nbsp;(1).\u003c/p\u003e\n\u003cp\u003eFor the second objective, double population proportion formula was used in EPI INFO version 7.2 by considering different significant variables from previous study. Sample size was determined using a formula for two population proportions by taking the confidence interval level of 95%, margin of error 5% and the power 80%. Duration of labor (\u0026gt;12 hours) was considered as risk factor of surgical\u0026nbsp;site\u0026nbsp;infection\u0026nbsp;. P1= Proportion of women with a duration of labor \u0026gt;12 hours which was 20%. P2 = proportion of labor with ≤ 12 hours which was 3%. R is ratio of population among exposed to non-exposed and it was 1:1. Based on the above assumptions and 10% for possible incomplete charts, \u003cstrong\u003e215\u003c/strong\u003e women who gave birth by cesarean section were calculated as a final sample size.\u003c/p\u003e\n\u003ch3 id=\"_Toc189768579\"\u003eSampling Procedure\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eAmong the\u0026nbsp;17\u0026nbsp;public\u0026nbsp;comprehensive\u0026nbsp;emergency\u0026nbsp;obstetric\u0026nbsp;and\u0026nbsp;newborn\u0026nbsp;care\u0026nbsp;health\u0026nbsp;centers\u0026nbsp;in\u0026nbsp;Addis\u0026nbsp;Ababa\u0026nbsp;5\u0026nbsp;were\u0026nbsp;selected by\u0026nbsp;simple\u0026nbsp;random\u0026nbsp;sampling by using lottery method.\u0026nbsp;Proportional\u0026nbsp;allocation\u0026nbsp;is\u0026nbsp;assigned\u0026nbsp;to\u0026nbsp;the\u0026nbsp;respective\u0026nbsp;health\u0026nbsp;centers\u0026nbsp;based\u0026nbsp;on\u0026nbsp;their\u0026nbsp;cesarean\u0026nbsp;delivery\u0026nbsp;performance\u0026nbsp;in\u0026nbsp;the\u0026nbsp;1\u003csup\u003est\u003c/sup\u003e 6-month of 2016.\u0026nbsp;Finally, a systematic random sampling technique was employed to select 215 patient cards from all records of women who were delivered by cesarean section from December 31/2023 to June 27/2024.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc189768580\"\u003e3.6 Operational Definition \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe Centers for Disease Control and Prevention's 1992 classification and definition of the term served as the basis for the SSI definition used in this study (18).\u003c/p\u003e\n\u003cp\u003eA surgical site infection after a caesarean section is defined as an infection that appears within the first 30 days after the cesarean section and includes at least one of the following signs and/or symptoms; Purulent drainage from the wound , Pain or tenderness, localized swelling , Redness , Malodor and fever\u003c/p\u003e\n\u003ch2 id=\"_Toc189768581\"\u003e3.7\u0026nbsp;Data Collection Tool and Procedure\u003c/h2\u003e\n\u003cp\u003eData was extracted from the 215 selected medical records of women who gave birth by cesarean sections from December 31/2023 to June 27/2024 after systematic random sampling method. Semi-structured checklist was used after pre-tested which was adjusted according to the contextual circumstances after the review of similar literature conducted in South Africa and Ethiopia\u0026nbsp;(1,22)\u0026nbsp;This checklist translated from English into Amharic by professionals in the language. The checklist has three parts: socio-demographic and obstetric related variables, intrapartum related factors and procedure related factors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFinally, Kobo collect mobile Application tool was used to collect data based on the check list developed. Data collection was made by 5 BSC Midwives Nurses who had access of smart phone and 2 supervisors after one day training session including orientation on Kobo collect data collection by the principal investigator. One data collector was assigned for each health center.\u003c/p\u003e\n\u003cp\u003eTwo public health officers with an experience in data collection assigned as a supervisor following a one-day training by the investigator and 1 supervisor for two or three health centers with the principal investigator supervise the whole data collection process. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe criteria used to evaluate surgical site infections were derived from the Centers for Disease Control and Prevention. The outcome variable, post-cesarean section surgical\u0026nbsp;site\u0026nbsp;infection, was assessed using four yes/no items. Purulent discharge from the surgical site, at least one inflammatory symptom (pain or tenderness, localized edema, redness, or heat), an abscess, and a wound infection that has been diagnosed by a doctor or surgeon are among the things employed. If, within 30 days of Cesarian section, at least one \"yes\" response is given to any one of the four elements, the post- Cesarian section surgical\u0026nbsp;site\u0026nbsp;infection\u0026nbsp;was considered.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc189768582\"\u003e3.8\u0026nbsp;Study Variables\u003c/h2\u003e\n\u003ch3 id=\"_Toc189768583\"\u003eDependent\u0026nbsp;Variable\u003c/h3\u003e\n\u003cp\u003eSurgical site infection\u003c/p\u003e\n\u003ch3 id=\"_Toc189768584\"\u003eIndependent\u0026nbsp;Variables\u0026nbsp; \u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eSocio-demographic and obstetric related variables (residence, maternal age, gestational age, parity,\u0026nbsp;previous cesarean delivery, history of\u0026nbsp;hypertension,\u0026nbsp;history of\u0026nbsp;diabetes mellitus and\u0026nbsp;history of\u0026nbsp;HIV),\u0026nbsp;intrapartum related factors (gestational diabetes mellitus, HIV, anemia, number of vaginal examinations, extended labor before surgery, and PROM), procedure related (duration of urinary catheter stayed, the type of anesthesia,\u0026nbsp;indication for CD, solution used for surgeon’s hand preparation, vaginal preparation with 10% povidone-iodine, skin closure technique, post-partum hemorrhage, type and duration of the operation, surgical wound classification, hair removal/clipping and timing of antibiotics prophylaxis and qualifications of the individual who carried out the cesarean section were independent variables identified (1,10).\u003c/p\u003e\n\u003ch2 id=\"_Toc189768585\"\u003e3.9\u0026nbsp;Data Quality Control\u003c/h2\u003e\n\u003cp\u003eThe\u0026nbsp;goal\u0026nbsp;of\u0026nbsp;the\u0026nbsp;study,\u0026nbsp;the\u0026nbsp;methods\u0026nbsp;for\u0026nbsp;gathering\u0026nbsp;data,\u0026nbsp;and\u0026nbsp;the\u0026nbsp;data\u0026nbsp;collection\u0026nbsp;instrument\u0026nbsp;was\u0026nbsp;covered\u0026nbsp;in\u0026nbsp;the\u0026nbsp;training\u0026nbsp;provided\u0026nbsp;to\u0026nbsp;data\u0026nbsp;collectors. The\u0026nbsp;data\u0026nbsp;collection\u0026nbsp;instrument\u0026nbsp;was\u0026nbsp;adjusted\u0026nbsp;for\u0026nbsp;contextual\u0026nbsp;factors and\u0026nbsp;derived\u0026nbsp;from\u0026nbsp;a\u0026nbsp;study\u0026nbsp;conducted\u0026nbsp;in\u0026nbsp;Ethiopia\u0026nbsp;and\u0026nbsp;South\u0026nbsp;Africa, especially the kobo collect App was validated and access secured.\u0026nbsp;From\u0026nbsp;June\u0026nbsp;15\u0026nbsp;to\u0026nbsp;22,\u0026nbsp;2024,\u0026nbsp;10%\u0026nbsp;of\u0026nbsp;a\u0026nbsp;similar\u0026nbsp;population\u0026nbsp;in\u0026nbsp;Akaki\u0026nbsp;Kality\u0026nbsp;Sub\u0026nbsp;City\u0026nbsp;Gelan\u0026nbsp;Health\u0026nbsp;Center\u0026nbsp;the\u0026nbsp;tool was pre-tested\u0026nbsp;to\u0026nbsp;ensure\u0026nbsp;its\u0026nbsp;validity\u0026nbsp;and\u0026nbsp;make\u0026nbsp;any\u0026nbsp;necessary\u0026nbsp;modifications.\u0026nbsp;The\u0026nbsp;investigators have\u0026nbsp;supervised\u0026nbsp;the\u0026nbsp;process\u0026nbsp;during\u0026nbsp;the\u0026nbsp;time\u0026nbsp;of\u0026nbsp;data\u0026nbsp;collection.\u0026nbsp;Additionally,\u0026nbsp;has\u0026nbsp;analyzed\u0026nbsp;and\u0026nbsp;verified\u0026nbsp;the\u0026nbsp;accuracy\u0026nbsp;and\u0026nbsp;completeness\u0026nbsp;of\u0026nbsp;the\u0026nbsp;obtained\u0026nbsp;data\u0026nbsp;every\u0026nbsp;day. Variance inflation factor (VIF) and tolerance test was used to check for presence of multicollinearity (Tolerance, \u0026gt;0.1, VIF, \u0026lt; 10) and Hosmer and Lem show goodness of fit test was used to check for model fitness \u0026gt;0.05 (0.93).\u003c/p\u003e\n\u003ch2 id=\"_Toc189768586\"\u003e3.10\u0026nbsp; \u0026nbsp;\u0026nbsp;Data Analysis \u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eAfter being entered, cleaned, coded and verified, all of the data input using the checklists using the Kobo Collect App was checked for completeness in the server online using Chrome and offline using an Android app. It was then exported to Microsoft Excel and then to the Statistical Package for Social Science (SPSS) for further analysis.\u003c/p\u003e\n\u003cp\u003eThe dependent variable was coded as 1 \"if post-cesarean section SSI was present\" and 2 \"if not.\" To ascertain the statistical relationship between independent and outcome variables. Descriptive statistics was computed and presented using text, frequency tables, graphs, percentage, mean, standard deviation, skewness, and kurtosis followed by Bi-variable and multivariable logistic regression analysis to determine statistical association between independent and dependent variables. Factors from the bivariate analysis with a significance level of ≤ 0.2 was used in the multivariable logistic regression analysis. The degree of association between dependent and independent factors was evaluated by AOR with 95% CI with p value \u0026lt;0.05. Finally, level of statistical significance was declared at p-value\u0026lt;0.05\u003c/p\u003e"},{"header":"4. Result","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Socio-Demographic Characteristics and Obstetric Related Factors\u003c/h2\u003e\u003cp\u003eFrom a total of 215 selected medical records of women who underwent cesarean delivery, 210 were eligible and reviewed in this study. The majority (82.9%) of the study participants were living in urban setting and 60.5% of them were greater than 30 years old. Near half of participants 106 (50.5%) were multiparous, 84 (40%) primiparous and 20 (9.5%) grand-multipara only as shown Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below. Among participants a smaller number of them only 17 (8%) were hypertensive. Majority of women 91(43.3%) gestational age was 37\u0026ndash;40 weeks whereas 79(37.6%) of them were \u0026gt;\u0026thinsp;40 weeks. Majority of the study participants 196 (93.3%) had no previous history of cesarean section as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFrequency table of socio-demographic and obstetric related factors of women those who underwent cesarean section at randomly selected health centers in Addis Ababa, Ethiopia, 2024\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39.50%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;=30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60.50%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eResidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e82.90%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17.10%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eParity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimiparous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMultiparous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50.50%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrand multipara\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.50%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eUnderlying condition (Hypertension)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e193\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eGestational age of Mother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;37 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37\u0026ndash;40 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.30%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;40 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePrevious cesarean section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.70%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e93.30%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Intrapartum Related Factors\u003c/h2\u003e\u003cp\u003eMajority of the participants 153 (72.9%) had preoperative hemoglobin of greater than or equal to 11mg/dl and about 71 (33.8%) of the study participants had no labor prior to surgery.\u003c/p\u003e\u003cp\u003eWomen with greater than 12-hour premature rupture of membrane also accounted for only 9% of the participants and only 12.4% of them had indication of failed induction. Moreover, before operation 1\u0026ndash;4 times vaginal examinations was performed nearly half of women (43.8%) as shown Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e below.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFrequency table of intrapartum of women those who underwent cesarean section at randomly selected health centers in Addis Ababa, Ethiopia, 2024\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eHemoglobin at Cs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;=11g/dl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27.10%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;11g/dl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72.90%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eDuration that mother was in labor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eno labor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.80%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;24 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55.70%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;24 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.50%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eNumber of vaginal examinations before CD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo vaginal examination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;4 vaginal examinations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.80%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;5 vaginal examinations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eLength of time membranes ruptured prior to\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo rupture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40.50%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;12 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50.50%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;12 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eFailed induction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.40%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eMeconium-stained amniotic fluid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.40%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e88.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Procedure or Operation Related Factors\u003c/h2\u003e\u003cp\u003ePreoperative antibiotics prophylaxis was provided for the great majority 194 (92.4%) of the women and three fourth of them (66.7%) had less than or equal to 30-hour duration of operation. More than half of technique of skin closure was continuous sutures (55.2%). All cesarean section was provided by IESO and also more than half (59.5%) of operation was emergency. The detail is shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFrequency table of procedure related of women those who underwent cesarean section at randomly selected health centers in Addis Ababa, Ethiopia, 2024\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eDuration of operation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;=30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66.70%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.30%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eType of operation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eElective\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40.50%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmergency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59.50%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSkin closure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterrupted sutures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.80%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eContinuous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55.20%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe operation was provided by\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIESO\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eDid antibiotic prophylaxis provided?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e194\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92.40%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eType of anesthesia provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.90%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpinal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97.10%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e4.4 Magnitude of Surgical Site Infection Following Cesarean Delivery\u003c/h2\u003e\u003cp\u003eAmong 210 women included in the study 24 (11.4%) of them developed surgical site infection following cesarean delivery (95%CI: (7.5% \u0026minus;\u0026thinsp;16.5%)).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e4.5 Factors Associated with SSI Following Cesarean Section\u003c/h2\u003e\u003cp\u003eDuring bivariable logistic regression analysis, those variables which had p-value of \u0026le;\u0026thinsp;0.2 were considered in multivariable logistic regression. Out of 30 independent variables, seven variables; pre-existing or pregnancy induced hypertension, hemoglobin prior to operation, gestational age, labor duration, failed induction, meconium-stained amniotic fluid and previous history of cesarean section had shown an association in bivariable analysis with p-value\u0026thinsp;\u0026le;\u0026thinsp;0.2, and those variables were fitted to a multivariate logistic regression analysis. The results showed that, at a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 with 95% confidence interval, surgical site infection after cesarean birth was significantly correlated with pre-existing or pregnancy induced hypertension, pre-operative hemoglobin\u0026thinsp;\u0026le;\u0026thinsp;11.5 mg/dl, and labor lasting longer than 24 hours. Women with a history of preexisting or pregnancy-induced hypertension had a 6.8-fold increased risk of developing surgical site infection after cesarean section (AOR\u0026thinsp;=\u0026thinsp;6.848, 95% CI: (1.145, 40.945, P-value\u0026thinsp;=\u0026thinsp;0.035) compared to those without hypertension.\u003c/p\u003e\u003cp\u003eCompared to women who were not in labor, those who had labor for \u0026gt;\u0026thinsp;24 hours had a 13-fold (AOR\u0026thinsp;=\u0026thinsp;13.065, 95%CI; 2.185, 78.117, p-value\u0026thinsp;=\u0026thinsp;0.002) increased risk of developing SSI following cesarean delivery. Moreover, the odds of develop surgical site infection following cesarean section among women who had a pre-operative hemoglobin level of \u0026le;\u0026thinsp;11mg/dl were 7.2 times higher than those who had hemoglobin level of greater than 11mg/dl (AOR\u0026thinsp;=\u0026thinsp;7.158, 95% CI: (2.012, 25.463, p-value\u0026thinsp;=\u0026thinsp;0.002).(Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBi-variable and Multivariable logistic regression analysis of factors associated with SSI following cesarean section among women who underwent cesarean section at randomly selected health centers in Addis Ababa, Ethiopia, 2024\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eWas SSI detected?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCOR (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAOR (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP-Value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eUnderlying condition Hypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.247(2.445, 21.482)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.848(1.145, 40.945)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.035\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHistory of previous cesarean section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.416(2.315, 23.759)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.109(0.642, 26.311)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.136\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHemoglobin at time of cesarean section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;=11g/dl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.814(1.596, 9.115)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.158(2.012, 25.463)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;11g/dl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eGestational age of Mother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;37 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.023(0.590, 3.551)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.203(0.272, 5.320)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.836\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37\u0026ndash;40 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;40 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.053(0.622, 4.783)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.533(0.416, 5.648)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eDuration that mother was in labor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;24 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.543(2.145, 26.523)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13.065(2.185, 78.117)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;24 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.370(0.456, 4.119)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.040(0.581, 7.161)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.266\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eno labor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFailed induction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.067(0.699, 6.118)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.869(0.904, 26.210)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e165\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMeconium-stained amniotic fluid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.111(1.095, 8.837)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.787(0.513, 15.124)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.235\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"5 Discussion","content":"\u003cp\u003eThe aim of this study was to ascertain the prevalence and contributing variables of surgical site infections after cesarean sections in comprehensive emergency obstetric and neonatal care health centers in Addis Ababa that were chosen at random.\u003c/p\u003e\u003cp\u003eAs reported in many other studies in developing countries including Ethiopia, the prevalence of surgical site infection in the present study was higher than in developed countries (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) This could be explained by patient populations and standard of hygiene practiced in developed countries (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn the current study the incidence of SSI following cesarean section was 11.4%, which is lower than previously reported in Ethiopia. As study at selected government hospitals of Addis Ababa reported an incidence rate of 15%, which could be explained by type of study design; the study added follow-up surveillance after mothers have been discharged, post-operative hospital stay and small sample size used (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Due to the study's only reliance on medical record review and lack of post-discharge follow-up, the rate may have been underestimated.\u003c/p\u003e\u003cp\u003eIncreased SSI rate in this study area might result in significant health care costs, including financial loss to family and hospital income from extended hospital stays, more work for healthcare professionals, and the possibility of complications that could cause mother and newborn deaths.\u003c/p\u003e\u003cp\u003eThe findings of this study in line with the worldwide incidence rate of 3\u0026ndash;15% (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e); a study in Nigeria (11%), Rwanda (10.9%) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) The reason could be because surgical procedures, such as the routine use of prophylactic antibiotics to lower the risk of infection, are of similar quality, all studies used chart reviews to collect data, the studies were conducted in an institutional setting, the sample sizes were comparable, and the definition of SSI used to measure the outcome variable was similar.\u003c/p\u003e\u003cp\u003eAdditionally, the current study's rate was consistent with prior cross-sectional research carried out in Nekemte Town (8.9%), Jima (11.4%) and Ayder Comprehensive Specialized Hospital (11.7%), Ethiopia (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). This might be due to similar means of data collection (retrospective data review), post-SSI definition and similar socio-economic status.\u003c/p\u003e\u003cp\u003eThe finding was higher than the result reported from different studies which revealed that the rate of SSI in studies done in Norway o.4% and 5.4% after elective and emergency cesarean section, respectively, UAE (2.4%) and Israel (3.7%) (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This disparity could potentially be caused by variations in health care systems and socioeconomic position. Furthermore, those studies were carried out at general and specialty hospitals with higher standards of care delivery. This could be because operating rooms in developing nations, such as Ethiopia, are of lower quality than those in developed nations, which increases the risk of a sterility technique breakdown during surgery.\u003c/p\u003e\u003cp\u003eHowever, in contrast to studies conducted in Ethiopia, the rate of SSI following cesarean delivery in this study was lower than that of a study carried out ; in Addis Ababa (15%), Wolayta Sodo (13%) and Dessie Referral Hospital (14.5%) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). This may be because previous studies used a prospective cohort study design with post-discharge follow-up, in contrast to the current cross-sectional analysis with secondary record review and no post-operative discharge follow-up. Following discharge, women may develop post-cesarean section SSI and seek treatment at nearby medical facilities outside the study area, which could understate the current magnitude.\u003c/p\u003e\u003cp\u003eSimilar to research conducted in Egypt, Nigeria, Gojam Zone, and Nekemte Town, women who underwent labor for more than 24 hours prior to cesarean section had a 13-fold higher risk of SSI than those who were not in labor. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) One explanation is because the number of vaginal examinations rises with the length of labor, which might result in increased contamination and ascending infection that could cause post-operative infection (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis suggests that in order to minimize the length of time that patients are exposed to infection before a cesarean section, midwives and surgeons must identify labor dystocia early on, as this may prolong labor.\u003c/p\u003e\u003cp\u003eWomen who had pre-existing or pregnancy induced hypertension were 6.8 times more likely to develop SSI following cesarean section than those who were not hypertensive. This report was comparable with the prior studies in Israel, Gojam Zone and Nekemte Town; Ethiopia (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) The peripheral vasoconstriction effect of hypertension may be the cause of the wound's hypoperfusion. Additionally, women who have this issue may have edematous wound margins that allow organisms to enter and cause infection. Hypoxic wound conditions and oxygen depletion may result from vascular disruption and metabolically active cells' high oxygen consumption. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). This emphasizes that before a CS procedure, medical professionals should monitor and treat hypertensive mothers.\u003c/p\u003e\u003cp\u003eIn this study, pre operative hemoglobin\u0026thinsp;\u0026le;\u0026thinsp;11 mg/dl was significantly associated with SSI following cesarean section. Women with hemoglobin\u0026thinsp;\u0026le;\u0026thinsp;11 mg/dl were 7.2 times more likely to develop SSI, similar with previous studies conducted in India, Nigeria and Gojam Zone ; Ethiopia (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) This is true that anemia reduces the oxygen transportation at the wound site and raise the risk of SSI by impairing macrophage activity and slowing the rate of wound healing. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). This suggests that during ANC and in the community, health care providers should inform mothers about meals high in iron. They should also give ferrous tablets to all pregnant women and assessment of utilization.\u003c/p\u003e"},{"header":"6 Conclusion","content":"\u003cp\u003eAccording to this report, the extent of surgical site infection following cesarean section at selected comprehensive emergency obstetric and newborn care services providing health centers in Addis Ababa was found to be relatively lower, which was 11.4% when compared to a previous hospital-based study in Addis Ababa. However, relatively higher when compared to developed countries. A list of factors including preexisting or pregnancy induced hypertension, pre-operative hemoglobin level\u0026thinsp;\u0026le;\u0026thinsp;11mg/dl and prolonged labor were significantly associated with SSI following cesarean section.\u003c/p\u003e\u003cp\u003eWe would recommend further prospective study, which involve post-discharge follow-up at comprehensive emergency obstetric and new born care health center level, which was not included in the current study. Health care providers and Addis Ababa Health Bureau policy makers should give due attention the proper utilization of partograph in order to prevent prolonged labor, early screening and management of hypertension and develop strategies to improve iron folate utilization of pregnant women in all health care facilities.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitation of the Study\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study did not cover post-discharge follow-up and was only based on medical chart reviews, which lacked certain variables, such as body mass index. Furthermore, because the study was cross-sectional, it may not have been possible to establish a cause-and-effect relationship, which could have underestimated the magnitude of the problem.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eHuman ethics and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is involving human participants was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the institutional review board (IRB) of Yekatit 12 Hospital Medical College with reference number RPO/556/24. The approval was subsequently submitted to the Addis Ababa Regional Health Bureau, where clearance was granted. The clearance letter was presented to the relevant authorities, who were briefed on the study, and permission was obtained before data collection.\u003c/p\u003e\n\u003cp\u003eDuring data collection, informed consent was obtained from each respondent after a clear explanation of the study\u0026rsquo;s objectives and their rights, including the right to voluntarily participate or withdraw at any stage. Further information and documentation supporting this ethical approval can be made available to the Editor upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI Confirm I give my full consent that I have read and approved the final version of the manuscript and take full responsibility for its content. I affirm that I have the necessary authority to grant this consent and have obtained any required permissions for the publication of this work. Furthermore, I acknowledge that once published, the manuscript will be publicly accessible in print, online, and other formats as determined by the publisher. I confirm that the manuscript does not infringe upon any copyright, confidentiality, or legal obligations. Additionally, I agree that the publisher may make minor editorial modifications, provided they do not alter the integrity of the content.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data generated in this study are included in this manuscript. The datasets used and analyzed to produce the current manuscript will be obtained from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFY designed the study, write a literature review, applied for data access, conducted the data analyses, and, provided advice in data analysis, BG drafted the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst of all, I would like to thank department of public health, Yekatit 12 Hospital Medical College for giving me the chance to conduct this study. I am also grateful to the leaders, staff and data collectors at the respective Sub Cities and Health Centers in Addis Ababa where the study was conducted for their co-operation, contribution and support during data collection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor detail \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFikre Yishere\u003csup\u003e1*,\u003c/sup\u003e Belete Getachew\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Affiliation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u0026nbsp;\u003c/sup\u003eDepartment of public health, Yekatit 12 hospital medical college, Addis Ababa, Ethiopia\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u0026nbsp;\u003c/sup\u003eSchool of Public health, St. Paul hospital millennium medical college, Addis Ababa, Ethiopia\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFikre Yishere\u003c/p\u003e\n\u003cp\u003eDepartment of public health, Yekatit 12 hospital medical college, Addis Ababa, Ethiopia\u003c/p\u003e\n\u003cp\[email protected]\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLijaemiro H, Berhe Lemlem S, Tesfaye Deressa J. Incidence of Surgical Site Infection and Factors Associated among Cesarean Deliveries in Selected Government Hospitals in Addis Ababa, Ethiopia, 2019. Obstet Gynecol Int. 2020;2020(23):2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBezatu Mengistie FT. Prevalence of Cesarean Section in Urban Health Facilities and Associated Factors in Eastern Ethiopia: Hospital Based Cross Sectional Study. J Pregnancy Child Heal. 2015;02(03):122\u0026ndash;256.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRegmi A, Ojha N, Singh M, Ghimire A, Kharel N. Risk Factors Associated with Surgical Site Infection following Cesarean Section in Tertiary Care Hospital, Nepal. Int J Reprod Med. 2022;2022(3):1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\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;16(12 December):234\u0026ndash;567.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKawakita T, Landy HJ. Surgical site infections after cesarean delivery: epidemiology, prevention and treatment. Matern Heal Neonatol Perinatol. 2017;3(1):12\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlnajjar MS, Alashker DA. Surgical site infections following caesarean sections at Emirati teaching hospital: Incidence and implicated factors. Sci Rep. 2020;10(1):234\u0026ndash;123.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\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;3(1):25\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eESOG. Facility Assessment Report of CEmONC Services in 15 health facilities of Developing Regional States in Ethiopia. 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWendmagegn TA, Abera GB, Tsehaye WT, Gebresslasie KB, Tella BG. Magnitude and determinants of surgical site infecion among women underwent cesarean section in Ayder comprehensive specialized hospital Mekelle City, Tigray region, Northern Ethiopia, 2016. BMC Pregnancy Childbirth. 2018;18(1):45\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKvalvik SA, Rasmussen S, Thornhill HF, Baghestan E. Risk factors for surgical site infection following cesarean delivery: A hospital-based case\u0026ndash;control study. Acta Obstet Gynecol Scand. 2021;100(12):2167\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbdallah, Ameer MESR. Risk Factors of Surgical Site Infection of Cesarean Section and Role of Skin Cleansing and Prophylactic Antibiotic -. Int J Reprod Med Gynecol. 2020;2(October):15\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNkurunziza T, Kateera F, Sonderman K, Gruendl M, Nihiwacu E, Ramadhan B, et al. Prevalence and predictors of surgical-site infection after caesarean section at a rural district hospital in Rwanda. Br J Surg. 2019;106(2):121\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOdada D, Shah J, Mbithi A, Shah R. Surgical site infections post cesarean section and associated risk factors: a retrospective case-control study at a tertiary hospital in Kenya. Infect Prev Pract. 2024;6(1):10\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAyala D, Tolossa T, Markos J, Yilma MT. Magnitude and factors associated with surgical site infection among mothers underwent cesarean delivery in Nekemte town public hospitals, western Ethiopia. PLoS ONE. 2021;16(4 April 2021):23\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJaime JM. Post Cesarean Surgical Site Infection Reduction Through Vaginal Preparation. Master\u0026rsquo;s Proj Capstones. 2021;12(3):7\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGelaw MW, Abdella A. Prevalence of surgical site infection and associated factors among mothers after cesarean delivery in zewditu memorial hospital. Ethiop J Reprod Heal. 2018;10(4):34\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZuarez-Easton S, Zafran N, Garmi G, Salim R. Postcesarean wound infection: Prevalence, impact, prevention, and management challenges. International Journal of Women\u0026rsquo;s Health. Volume 9. Dove Medical Press Ltd; 2017. pp. 81\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCDC. Surgical Site Infection Event (SSI) Introduction. In: National Healthcare Safety Network. 2024. pp. 1\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMezemir R, Olayemi O, Dessie Y, Incidence. Bacterial Profile and Predictors of Surgical Site Infection After Cesarean Section in Ethiopia, A Prospective Cohort Study. Int J Womens Health. 2023;15(2):1547\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKrieger Y, Walfisch A, Sheiner E. Surgical site infection following cesarean deliveries: trends and risk factors. J Matern Neonatal Med. 2017;30(1):8\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAzeze GG, Bizuneh AD. Surgical site infection and its associated factors following cesarean section in Ethiopia: A cross-sectional study. BMC Res Notes. 2019;12(1):23\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShiferaw S, Mehari M, Zenebe K, Gebrezgher BWA. Determinants of post-cesarean delivery surgical site infection in Mekelle public hospitals, Tigray, North Ethiopia. Int J Gynaecol Obs. 2025;170(20):783\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\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;9(2):12\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOjiyi EC, Dike EI, Okeudo C, Ejikem EC. Nzewuihe a EC. Wound Infection following Caesarean Section in a University Teaching Hospital in South-East Nigeria. Orient J Med. 2013;25(1\u0026ndash;2):8\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmenu D, Belachew T, Araya F. Surgical site infection rate and risk factors among obstetric cases of jimma university specialized hospital, southwest ethiopia. Ethiop J Heal Sci. 2011;21(2):91\u0026ndash;100.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAwoke N, Arba A, Girma A. Magnitude of surgical site infection and its associated factors among patients who underwent a surgical procedure at Wolaita Sodo University Teaching and Referral Hospital, South Ethiopia. PLoS ONE. 2019;14(12):5\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAli A, Ababa A. Incidence of surgical site infection, predisposing factors and associated costs at Dessie Referral Hospital, Dessie, Ethiopia. AGE Open Med. 2017;2(1):12\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\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;21(1):45\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGetachew B, Kibret A. Unmet need for family planning and associated factors among reproductive age women working in Bole Lemi industrial park, Addis Ababa, Ethiopia 2024: an institution based cross-sectional study. BMC Public Health. 2025;25(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShanbhag ER, Veena P. Surgical Site Infections Following Cesarean Section: A Longitudinal Study. South Asian Fed Obstet Gynaecol. 2021;13(3):1\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDacho AM, Angelo AT. Magnitude of Post Caesarean Section Surgical Site Infection and its Associated Factors among Mothers who Underwent Caesarean Section in Mizan Tepi University Teaching Hospital, South West Ethiopia, 2017. J Nurs Care. 2018;071(Dacho02):26\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Surgical site infection, magnitude, comprehensive emergency obstetric and newborn care health centers, cesarean delivery, Addis Ababa","lastPublishedDoi":"10.21203/rs.3.rs-7887487/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7887487/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eSurgical site infection is the most common complication following surgery. Recent study was conducted at selected government hospitals in Addis Ababa and reported surgical site infection rate was 15%. Although, no study was conducted at health centers. Therefore, this study aims to determine the magnitude and factors associated with surgical site infection following cesarean delivery at comprehensive emergency obstetric and newborn care health centers in Addis Ababa.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted from July 1 to August 29, 2024 at 5 randomly selected comprehensive emergency obstetric and new born care health centers in Addis Ababa. Data was extracted from the 215 randomly selected medical records of mothers. Statistical Package for Social Science software version 25 used for data analysis and finally, the result was then displayed using texts, tables and various graphs.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e\u003cp\u003eAmong 210 medical records of mothers who delivered by cesarean section, 24 (11.4%) of them developed surgical site infection following cesarean delivery (95%CI: (7.5%, 16.5%)). Hypertension (AOR\u0026thinsp;=\u0026thinsp;6.848, 95% CI: (1.145, 40.945, P-value\u0026thinsp;=\u0026thinsp;0.035), prolonged labor (AOR\u0026thinsp;=\u0026thinsp;13.065, 95%CI; (2.185, 78.117, p-value\u0026thinsp;=\u0026thinsp;0.002) and hemoglobin level of \u0026le;\u0026thinsp;11mg/dl (AOR\u0026thinsp;=\u0026thinsp;7.158, 95% CI: (2.012, 25.463, p-value\u0026thinsp;=\u0026thinsp;0.002) were factors significantly determine surgical site infection following cesarean delivery.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003ePre-existing or pregnancy induced Hypertension, prolonged labor and pre-operative hemoglobin level were significantly associated with surgical site infection following cesarean delivery. To lower the magnitude of surgical site infection in certain populations, clinical preventions and interventions are necessary.\u003c/p\u003e","manuscriptTitle":"Surgical Site Infection and Associated Factors Among Cesarean Delivery in Selected Comprehensive Emergency Obstetric and Newborn Care Providing Health Centers in Addis Ababa, Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-20 10:16:29","doi":"10.21203/rs.3.rs-7887487/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-13T16:12:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-13T12:40:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-07T17:01:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"176094099049967519560894825174942544776","date":"2026-01-07T12:58:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"215900183927042192751338459644120182117","date":"2025-11-14T09:15:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-11T04:51:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-21T08:26:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-21T08:26:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"Reproductive Health","date":"2025-10-17T13:55:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"reproductive-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"reph","sideBox":"Learn more about [Reproductive Health](http://reproductive-health-journal.biomedcentral.com)","snPcode":"12978","submissionUrl":"https://submission.nature.com/new-submission/12978/3","title":"Reproductive Health","twitterHandle":"@Reprod_Health","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f3c35456-60ef-47e5-a9dd-ed16a09e81e5","owner":[],"postedDate":"November 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-12T05:38:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-20 10:16:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7887487","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7887487","identity":"rs-7887487","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}