Determinants of post-cesarean delivery surgical site infection in Mekelle public hospitals, Tigray, North Ethiopia, in 2024

Background: Due to the increased frequency of cesarean deliveries, the number of women with surgical site infections (SSIs) is rising. Surgical site infections remain a concern in low-resource countries, despite the implementation of prevention and control measures, as they lead to extended hospital stays and significant additional costs for the patient. While studies on SSIs exist in the developing world and Africa, to the best of our knowledge, there is limited research specifically examining their determinants, particularly in Ethiopia. Objective: This study aimed to assess the determinants of SSI after cesarean delivery in Mekelle public hospitals, Northern Ethiopia. Methods: An institutional-based retrospective chart review case-control study was conducted from February 18, 2021, to March 14, 2021, using maternal records from July 8, 2018, to July 7, 2020. The required sample size was 237 (158 controls and 79 cases). Data were collected using a pretested and structured checklist with systematic sampling, then entered into EpiData 3.5.1 and analyzed using SPSS version 23. Binary logistic regression and multivariable logistic regression were used to determine the association of independent variables with the dependent variable. Variables with P-values <0.25 in bivariate logistic regression were exported to multivariable analysis, and variables with P-values <0.05 in multivariable analysis were considered significantly associated with the outcome variable. Results: The multivariable logistic regression revealed the significant determinants of post-cesarean delivery SSI were ruptured membranes before cesarean delivery (adjusted odds ratio [AOR] = 4.7, 95% confidence interval [CI] = 2.02, 10.91), prolonged operation time (AOR = 3.24, 95% CI = 1.19, 8.78), estimated blood loss greater than 500 mL (AOR = 4.7, 95% CI = 2.16, 10.40), and postoperation hemoglobin level of <11 g/dL (AOR = 4.2, 95% CI = 1.94, 9.20). Conclusion: This study revealed that the determinants for developing post-cesarean delivery SSI were ruptured membranes before cesarean delivery, prolonged operation time, estimated blood loss greater than 500 mL, and postoperative hemoglobin levels less than 11 g/dL. Therefore, mothers with identified risk factors should receive preventive measures during the postoperative period until SSI is ruled out.