Ceaseraen section related post-operative morbidity in two busy hospitals in Kampala.

Abstract

Background Morbidities following cesarean sections (CS) are a huge problem in health facilities of Kampala district and never reported. The study determined the prevalence of morbidities after CS and assessed the factors associated with postoperative morbidity/illnesses in CS mothers in two busy hospitals of Kampala district. Methods This was a cross-sectional study conducted between August and September 2018, semi-structured interviews were administered to 297 CS mothers randomly selected from two busy hospitals of Kampala district. 6 key informant interviews with health practitioners and 2 observation checklists were conducted to assess availability of equipment and services for CS in these facilities. We computed means, proportions and percentages at univariate analysis. Modified Poisson regression analysis was employed at bivariate and multivariate analysis to assess the factors associated with CS postoperative morbidities in CS mothers. Results 297 CS mothers participated in the study, 180 from Mulago hospital and 117 in Nsambya hospital. Their mean age was 27±5.7 years and majority 96(64%) were admitted primarily for CS and 53(36%) referred for CS to the study facilities. Additionally, the prevalence of morbidities after CS in Mulago hospital was 47%, and 26.5% in St. Francis Nsambya hospital. Postpartum sepsis had the highest prevalence in study facilities, at 38% in Mulago hospital and 8% in Nsambya hospital. This was followed by severe pain at 31% in Mulago hospital and 13% in St Francis Nsambya hospital. Not Consuming local herbal medicine/concoctions during pregnancy and after CS (Adjusted Prevalence Ratio (APR)= APR=0.76, 95%CI: 0.60-0.96), not knowing and completing antibiotics dose after CS(APR= APR=1.34, 95%CI: 1.07-1.69), (APR= APR=2.1, 95%CI:1.39-3.09), CS mothers age-group 20-24 years, 25-29, 30-35 years (95%CI: 0.41-0.84), APR= 0.60 (95%CI: 0.42-0.89) and 0.55 (95%CI: 0.33-0.93) respectively, and attending antenatal care (APR=(APR=0.62; 95% CI: 0.50-0.78)) were associated with illnesses after CS. Health facility factors associated with morbidity after CS included: stock out of antibiotics and second line pain killers, understaffing and unavailability of materials, overcrowding and delays in obtaining CS services were common in Mulago National referral hospital. St. Francis Nsambya Hospital overall had quality CS services and well-staffed.

Conclusion and recommendation Prevalence of morbidities after CS in Mulago hospital was high and surgical site infections were the leading cause of morbidity followed by severe pain in the study facilities. There was tendency of overprescribing second line pain killers in either study facilities to CS mothers. Failure to complete antibiotics dose after CS, use of herbal concoctions during and after pregnancy, antenatal care attendance and age group 40-49 years of mother were associated with CS postoperative morbidity in study facilities. Additionally, poor supervision and staffing, stock-out of CS medicines, sundries, inadequate infrastructure plus beddings were some of the health system factors identified and associated with CS morbidity in study facilities. Health workers should sensitize mothers on the benefits of antenatal care and attending all the ANC times this strategy is effective in preventing morbidity after CS.