This PhD thesis entitled “Postpartum Infection at Mbarara Regional Referral Hospital, South Western Uganda: epidemiology, microbiology and control” assessed the burden, causes and risk factors for maternal deaths at Mbarara Regional Referral Hospital (MRRH) in south-Western Uganda. With puerperal sepsis as the leading cause of maternal deaths at MRRH and the drivers of mortality being late referrals, non-attendance of antenatal care, un-education and HIV sero-positivity, further work was done to describe the microbiology and epidemiology of sepsis.
We described the incidence of postpartum infection among women with postpartum fever or hypothermia presenting for delivery or postpartum care, compared clinical outcomes and examined the risk factors associated with incident fever/hypothermia. A composite infection outcome sepsis among mothers delivering at MRRH was done. Cesarean section was independently associated with in-hospital postpartum infection while antenatal clinic attendance was associated with reduced odds of postpartum infection. With Cesarean section being the commonest operation done on the Maternity ward at MRRH, there’s need to explore factors contributing to the high Cesarean section rates at MRRH and other factors that contribute to the occurrence of post-operative infection before delivery, during delivery and post-operatively.
We further looked at whether vaginal colonization with GBS, E. coli, or Enterococcus was associated with increased morbidity among women with obstructed labor and determined the risk factors for colonization. There was no difference in maternal or neonatal morbidity between women with vaginal colonization with E. coli, GBS, and Enterococcus and those who were not colonized. Assessment of microbiology of infections is challenging especially in cases where the numbers are few. There are however contributors to infection and colonization such as poor hygiene and also nosocomial infections. Duration of labor was associated with increased risk of vaginal colonization in women with obstructed labor. This would mean that there are other factors that drive poor clinical maternal and neonatal outcomes in women who are colonized with potential pathogens and not necessarily the long labor duration.
An intervention of the WHO Surgical Safety Checklist and pre-operative antibiotics for Cesarean section was introduced there was an increase of 77.6% and 69% in the use of WHO checklist and pre-operative antibiotics for Cesarean respectively. There was also a drop in surgical site infection by 6.9%.