Surgical site infection and associated factors among women who underwent cesarean delivery at Gandhi Memorial Hospital, Addis Ababa, Ethiopia

TL;DR

This study examines surgical site infections after cesarean deliveries at a hospital in Ethiopia, identifying key risk factors and suggesting ways to reduce infection rates.

Contribution

The study provides new insights into the local risk factors for surgical site infections in Ethiopia and suggests targeted interventions to reduce them.

Findings

31 out of 485 women (6.4%) who had cesarean deliveries developed surgical site infections.

Repeated digital vaginal examination, delayed antibiotic administration, lack of vaginal cleansing, and low hemoglobin levels were significantly associated with surgical site infections.

The study found lower infection rates than previous Ethiopian studies but still highlights the importance of preventive measures.

Abstract

Surgical site infection continues to be among the most serious postoperative complications of cesarean delivery, leading to maternal morbidity and additional healthcare cost. Despite the rising trend of cesarean deliveries, evidence on the magnitude and risk factors of surgical site infection in local hospitals in Ethiopia remains limited. This study aimed to assess the magnitude and associated factors of surgical site infection among women who underwent cesarean delivery at Gandhi Memorial Hospital, Addis Ababa, Ethiopia.

An institution-based retrospective cross-sectional study was conducted from 25 August to 15 September 2025 among women who underwent cesarean delivery at Gandhi Memorial Hospital Addis Ababa, Ethiopia between 1 May 2023 and 30 April 2025. A total of 485 medical records were selected using a systematic sampling technique. Data were collected from women’s medical records via a structured checklist and analyzed using Statistical Package for Social Science (SPSS) version 25. Descriptive statistics were used to summarize the data, and bivariable and multivariable logistic regression analyses were performed. Statistical significance was declared at a p- value < 0.05 with a 95% CI.

Among the reviewed records, 31 (6.4%; 95% CI: 4.49–8.36) women developed surgical site infection. Repeated digital vaginal examination (AOR = 2.44 (1.41, 5.19) increases the risk of bacterial introduction; delayed timing of prophylactic antibiotic (AOR = 2.32 (1.23, 4.29) reduces protective coverage at the time of incision; absence of vaginal cleansing right before surgery (AOR = 3.75 (1.26, 11.17) likely increases bacterial load and postoperative hemoglobin level < 11 g/dl (AOR = 5.16 (1.76, 11.19)) may reduce immune capacity. All were significantly associated with surgical site infection.

This study found lower surgical site infection rates compared to previous Ethiopian studies; however, it remains a critical postoperative concern. Reducing frequent digital vaginal examinations, ensuring timely prophylactic antibiotics, promoting preoperative vaginal cleansing, and maintaining adequate maternal hemoglobin levels are critical to further reduce the risk of SSI. The retrospective nature of the study limits assessment of some factors, including operating room conditions.

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