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Eunice Geraldine

Faculty of Clinical Medicine and Dentistry Kampala International University Western Campus Uganda.

ABSTRACT

Puerperal sepsis is a widespread issue globally, causing maternal health complications across hospital maternity wards. Typically, around 4-6% of hospital-admitted patients within maternity wards contract clinical infections, including sepsis. The overarching aim of this study was to identify the contributing factors to puerperal sepsis among postnatal mothers in the maternity ward at Fort Portal Regional Referral Hospital. Conducted as a cross-sectional investigation, questionnaires were distributed to mothers in the maternity ward for self-completion. All postnatal mothers who delivered at Fort Portal Regional Referral Hospital and developed puerperal sepsis were included in the study. Quantitative data was manually analyzed using Microsoft Excel, summarized through averages and percentages, and presented via tables, graphs, and pie charts. The study uncovered that the prevalence of puerperal sepsis at Fort Portal Regional Referral Hospital stands at 22.4%. Key findings include that the majority of respondents were multiparous (80.6%), with 49.4% delivering at the hospital, 41.7% at home, and 8.8% with the assistance of a traditional birth attendant. Furthermore, 64.7% had spontaneous vaginal deliveries, while 35.3% underwent cesarean sections. Additionally, 58.8% were assisted by doctors, and 41.2% were assisted by midwives/nurses. Of note, 57.6% experienced normal labor duration, while 42.4% endured prolonged labor, and 12.9% encountered antepartum hemorrhage. The prevalence of puerperal sepsis was strongly associated with factors such as parity, mode of delivery, place of delivery, duration of labor, and concurrent medical conditions like diabetes, hypertension, and HIV infection. Recommendations stemming from these findings emphasize collaborative efforts between the government (particularly the Ministry of Health) and hospitals to alleviate costs for mothers during critical health situations. Moreover, aseptic techniques during delivery assistance should be rigorously practiced to mitigate the incidence of puerperal sepsis.

Keywords: Puerperal sepsis, Clinical infection, Patients, Postnatal mothers, Caesarean section, Vaginal delivery.

INTRODUCTION

Puerperal sepsis has been described since the time of Hippocrates. Puerperal fever (from Latin, puer means child) also called child bed fever is contracted by a woman during or shortly after child birth, miscarriage or abortion leading to septicemia and death. Along with pre-eclampsia and obstetrical hemorrhage it has formed the lethal triad of causes of maternal death for many decades. It is the leading cause of preventable maternal morbidity and mortality not only in developing countries but developed countries as well.1 It is ranked 3rd after hypertensive disorders and hemorrhage in Pakistan [1]. Puerperal sepsis is an abnormal condition that results from infections of placental site following delivery and is characterized; in mild form by fever of 38.6 degrees Celsius but may progress to endometritis or pass on to blood stream and produce septicemia. [2] Puerperal sepsis occurs in a period of six weeks after delivery, during this period, the woman’s body reverts into its pre-gravid state [3]. Puerperal sepsis is a global problem. It causes maternal morbidity in every hospital in the world. Some people acquire the sepsis after they have been admitted to the hospital maternity ward [4]. Usually about 4-6 percent of patients who come into the hospital and maternity ward acquire some kind of clinical infection [5]. There is also tissue trauma during labor, open wound of placental site, surgical incision and increased vaginal roomy after birth are all increased risks of postpartum hemorrhage [6]. Therefore, puerperal sepsis is an infection of the genital tract after child birth [7]. [8], marked that it’s probably the major cause of maternal morbidity throughout the world. Although the extent of puerperal sepsis on maternity ward is poorly understood in developing countries including Uganda, puerperal sepsis is one of the top five causes of maternal mortality [9]. Puerperal sepsis occurs when Streptococci colonizing the genital tract or acquired nosocomial invade the endometrium, adjacent structures, lymphatic and blood stream. Postpartum birth canal remains susceptible to invasion for several days after delivery. Predisposing factors leading to puerperal sepsis include home births in unhygienic conditions, low socioeconomic status, poor nutrition, prolonged rupture of membranes, prolonged labor and postpartum hemorrhage [1].

Recommendations of the study

There is more need to educate the community on hygienic practices especially for post-partum mothers so as to control infections through more community outreaches by community health workers. The government through the Ministry of Health should partner with hospitals creating affordable costs to mothers whenever serious conditions arise. Also, the provision of both surgical and disposable gloves to health facilities should be considered highly as this will promote hygiene. Increase recruitment and salary payment to health workers in time to motivate their work. Improving diet through a balanced diet to meet the body’s demands especially during pregnancy and after delivery. Mothers’ should be advised to always go for HIV screening tests during their ANC visits. Family planning methods should be emphasized as it gives time to cater for mothers’ life and the child.

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CITE AS Eunice Geraldine (2023). Prevalence and Factors Associated with Puerperal Sepsis among Women Attending the Postnatal Ward at Fort Portal Regional Referral Hospital. IAA Journal of Applied Sciences 10(2):13-22. https://doi.org/10.59298/IAAJAS/2023/2.2.1100

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