AFJOG

African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 3 | 2024 | 33 ORIGINAL RESEARCH African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 3 | 2024 | An Assessment of Risk factors for Post Caesarean Section Sepsis in Tembisa Provincial Tertiary Hospital However, only 3 (7%) of the 43 sepsis cases did not attend antenatal care. There were 206 (28%) HIV positive women. There was a statistically significant difference between HIV positive and HIV negative women (72% vs. 25%, p<0.01), respectively. Elective CS cases had a lower prevalence of sepsis as compared to the emergency CS procedures (63% vs 37%, p<0.05). There was a statistically significant difference in the BMI scores of those in the non-sepsis and sepsis groups (mean of 27.8 vs. 32.71, range, p<0.01), respectively. Table 1, showed no statistically significant difference between the sepsis cases group and non-sepsis group regarding age, previous CS and the presence of comorbidities, such as hypertension and diabetes. Table 1. Obstetrics and Clinical characteristics No SSI n=699 With SSI n=43 p-value n % % Antenatal care Attended 406 58 (n=40) 93 Did not attend 293 42 (n=3) 7 24.4% (11) Age ≤19 years 98 14 (n=3) 7 20-35years 389 53 (n=22) 49 >35 years 222 33 (n=5) 44 Previous CS Yes 352 50 23 55 No 347 50 19 45 HIV status Positive (n=175) 25 31 72 <0.01 Negative (n=524) 75 12 28 Comorbidity Yes 226 32 17 17 No 473 68 26 26 CS type Emergency (n=556) 80 (n=26) 63 <0.05 Elective (n=143) 20 (n=15) 37 BMI a 27.80 32.71 <0.01 Key: p-values: a – t-test of mean differences was conducted. CS- caesarean sections, BMI- body mass index, HIV - human Immune deficiency syndrome. SSI - surgical site infection The results of multivariate analysis using logistic regression are shown in Table 2. The results corroborate those of Table 1. There is no statistically significant differences in the following variables: age, previous caesarean sections and comorbidity. However, higher BMI scores increased the likelihood of having sepsis (p<0.01). HIV positive status (p<0.01) also increased the likelihood of developing sepsis. Table 2. Multivariate analysis: Logistic regression Dep. Variable: Sepsis coefficient p-value ANC (Booked) Yes 7.938 0.002 BMI 1.144 0.000 Age grp age <19 1.000 age 20-35 1.201 0.777 age >35 1.936 0.318 HIV status Positive 6.493 0.000 Comorbidity Yes 0.721 0.378 CS type Emergency 0.511 0.078 Previous CS 1.153 0.694 Yes ANC- antenatal care, CS- caesarean sections, BMI- body mass index, HIV- Human Immune Deficiency Syndrome . DISCUSSION: The incidence of sepsis or surgical site infection in this study population was 5.8% and comparable with other local and international studies where the surgical site infection incidence rate ranged between 3-15%. 8,18-23 Most of the CS deliveries were emergency cases. There was an association between sepsis and type of CS type using the chi-square test of independence (p=0.018), however using the logistic regression we could not demonstrate a statistically significant relationship (p= 0.078). Furthermore, we found that being obese (BMI>=30) increased the likelihood of sepsis (27.8% vs 32.7%). This finding is consistent with prior studies which noted that there is “poorer vasculature and blood flow” in adipose tissue of obese women, which increases the risk of infection. 24-27 Obesity is known to be a pre- and post- operative risk factor for surgical site infection due to increased operative time, delayed wound healing and wound separation. 26 Sensitising women of reproductive age to the subject of obesity and the importance of healthy eating pre-conception and during pregnancy needs to be highlighted during preconception care and antenatal care. Healthcare providers, among other initiatives, ought to monitor women’s weight and provide counselling and information sessions on the dangers of being overweight. HIV status was associated with a significant increased incidence of sepsis. A high proportion of women with sepsis were HIV positive (72%) compared to the HIV negative group. However, data on women’s CD4 count, HIV viral load and whether they were on HAART was not considered due to none consent and disclosure from the women. This result is in keeping with that of Moodliar et al., 17 and Ferrero et al., 27 who found an increased morbidity and post operation complications in women with HIV. Women on HAART with high CD4 counts do not present with immunosuppressive conditions and are more likely to not have sepsis complications after a CS delivery. 17 Healthcare providers must emphasise the importance initiating on appropriate HAART and keeping the viral load low for better pregnancy outcomes especially for women undergoing surgical procedures. This can be in the form of encouragement to consistently take antiretroviral treatment and periodically monitor the viral load and CD4 count during pregnancy as recommended by local HIV vertical prevention guideline. 28 Health care providers and health policy makers should put emphasis on the dangers of obesity in pregnancy; increase monitoring and care for HIV positive women, and improving surgical vigilance during emergency CS deliveries as a way of mitigating surgical site infection. The limitations of this study include different forms of bias including attrition bias and self-selection bias. TPTH is a