# Determinants of puerperal sepsis among postpartum women at public hospital in Gedeo Zone, southern Ethiopia, 2023: unmatched case–control study

## TL;DR

This study identifies risk factors for puerperal sepsis among postpartum women in southern Ethiopia, including lack of antenatal care and prolonged labor.

## Contribution

The study provides new insights into local determinants of puerperal sepsis in Gedeo Zone, Ethiopia, using a case–control design.

## Key findings

- No antenatal care follow-up significantly increases the risk of puerperal sepsis.
- Prolonged labor and cesarean section are independently associated with puerperal sepsis.
- Postpartum hemorrhage and anemia are significant risk factors for puerperal sepsis.

## Abstract

The World Health Organization records 295,000 maternal deaths during childbirth each year, of which 15% are due to postpartum sepsis. In Ethiopia, it is the third cause of maternal death after hemorrhage and hypertension. However, data on the determinants of puerperal sepsis in the study area are scarce.

This study aimed to identify determinants of puerperal sepsis among postpartum women at a public hospital in Gedeo Zone, southern Ethiopia, in 2023.

A hospital-based, unmatched case–control study was conducted among 475 postpartum women (119 cases and 356 controls with a ratio of 1:3) at public hospitals in the Gedeo Zone from July 1 to September 20, 2023. All cases were included, and Systematic random sampling was employed to select controls. A pretested and structured face-to-face interview questionnaire was conducted. Data were entered, cleared, and edited using EPI-data software 4.6 and then exported to Statistical Package for Social Science version 26 for analysis. Binary logistic analysis was executed, and all variables with a p-value of < 0.25 were entered into multivariable logistic regression. Finally, multivariable logistic regression analysis was employed to identify independent determinants of puerperal sepsis. A P-value of > 0.05 at the 95% CI was considered the cut-off point to declare a statistically significant association.

Four hundred seventy-five (119 cases and 356 controls) were included in this study with a 98.96% response rate. Variables identified as significantly associated with puerperal sepsis were no ANC follow-up (AOR = 4.19, 95% CI (2.32, 7.58), cesarean section (AOR = 2.74, 95% CI (1.19, 6.31), postpartum hemorrhage (AOR = 2.57, 95% CI (1.39, 4.74), duration of rupture of membrane ≥ 24 h (AOR = 3.31, 95% CI(1.89, 5.83), duration labor ≥ 24 h (AOR = 3.15 95% CI(1.09, 9.43), and anemia (AOR = 2.46, 95% CI (1.39, 4.32).

In this study, variables significantly associated with puerperal sepsis were the absence of antenatal care, cesarean section, postpartum hemorrhage, prolonged PROM, duration of labor ≥ 24 h, and anemia. Puerperal sepsis associated with these factors should be minimized by following labor management protocol and emphasizing information on dietary diversification.