title: Cesarean section surgical site infections in sub-Saharan Africa: a multi-country study from Medecins Sans Frontieres.
abstract: BACKGROUND
  Surgical site infections (SSI) are a significant cause of post-surgical morbidity and mortality and can be an indicator of surgical quality. The objectives of this study were to measure post-operative SSI after cesarean section (CS) at four sites in three sub-Saharan African countries and to describe the associated risk factors in order to improved quality of care in low and middle income surgical programs.
  
  
  METHODS
  This study included data from four emergency obstetric programs supported by Medecins sans Frontieres, from Burundi, the Democratic Republic of Congo (DRC), and Sierra Leone. Women undergoing from August 1 2010 to January 31 2011 were included. CS post-operative SSI data were prospectively collected. Logistic regression was used to model SSI risk factors.
  
  
  RESULTS
  In total, 1,276 women underwent CS. The incidence of SSI was 7.3 % (range 1.7-10.4 %). 93 % of SSI were superficial. The median length of stay of women without SSI was 7 days (range 3-63 days) compared to 21 days (range 5-51 days) in those with SSI (p < 0.001). In multivariate analysis, younger age, premature rupture of the membranes, and neonatal death were associated with an increased risk of SSI, while antenatal hemorrhage and the Lubutu, DRC project site were associated with a lower risk of developing an SSI.
  
  
  CONCLUSIONS
  This study demonstrates that surgery can be performed with a low incidence of SSI, a proxy for surgical safety, in sub-Saharan Africa. Protocols such as perioperative antibiotics and basic infrastructure such as clean water and sterilization can be achieved. Simple data collection tools will assist policymakers with monitoring and evaluation as well as quality control assurance of surgical programs in low and middle income countries.
authors.affiliation: Médecins sans Frontières, 49 Jorrisen St, Braamfontein, Johannesburg, 2017, South Africa, Kathryn_chu@yahoo.com.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Chu
authors.forename: Rebecca
authors.initials: R
authors.lastname: Maine
authors.forename: Miguel
authors.initials: M
authors.lastname: Trelles
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002063:Burundi / Q000453:epidemiology; D002585:Cesarean Section / Q000009:adverse effects*; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D066087:Perinatal Death; D011247:Pregnancy; D058996:Quality Improvement; D012307:Risk Factors; D012807:Sierra Leone / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult