Prevalence and Factors Associated With Puerperal Sepsis among Postnatal Women at Queen Elizabeth Central Hospital, Blantyre by Priscabell Ndasauka Kalumbi
| dc.contributor.author | Kalumbi, Ndasauka | |
| dc.date.accessioned | 2021-12-21T10:47:38Z | |
| dc.date.available | 2021-12-21T10:47:38Z | |
| dc.date.issued | 15-07-21 | |
| dc.description.abstract | Executive Summary Study Type: An analytical cross-sectional study of hospital records. The problem: Globally 6 million women developed puerperal sepsis and around 77,000 mothers died from it in 2017(Atlaw et al,2017). Puerperal sepsis is the fifth common cause of maternal mortality worldwide. In Malawi a confidential inquiry into maternal deaths indicated that puerperal sepsis is the leading cause of maternal death (MOH, 2019) and it contributes to 9.3 % of all maternal deaths in the country. Anecdotal statistics from Queen Elizabeth Central Hospital(QECH) in 2019 showed there are 12.2 % puerperal sepsis cases out of 30 % caesarean section deliveries performed (QECH, HMIS ,2019). Despite its great impact on maternal mortality and morbidity, there is not enough literature on the prevalence and associated factors of puerperal sepsis among postnatal mothers in Malawi. With this backdrop, the aim of this study is to estimate prevalence and associated factors of puerperal sepsis among postnatal mothers at Queen Elizabeth Central Hospital - a tertiary referral hospital in Malawi. Objectives Main Objective To determine prevalence and associated factors of puerperal sepsis among postnatal mothers at Queen Elizabeth Central Hospital. Specific Objectives 1. To describe the demographic and clinical characteristics of women with puerperal sepsis during the postpartum period at Queen Elizabeth Central Hospital. 2. To determine factors associated with puerperal sepsis in postpartum women at Queen Elizabeth Central Hospital. 3. To assess relationship between puerperal risk factors and poor maternal outcomes at Queen Elizabeth Central Hospital. Methodology This study will deploy an analytical cross-sectional design with a non-predetermined sample size of postnatal women records in Chatinkha postnatal ward. Purposive total sampling technique will be used to select the study participants into the study. Data will be extracted from files of patients admitted from January 2020 to June 2020 and analysed using SPSS version 20. The data will be presented in form of percentages, frequencies through tables, graphs and charts. Logistic regression will be used to establish relationship between maternal factors and poor outcomes. Possible Constraints The major constraint in the study is missing data from the use of medical records. Multiple imputation will be done where data is missing. Expected Findings This will study will describe the burden of puerperal sepsis in postpartum women in QECH and Identify factors associated with it. The generated data will help health care providers and policy makers to develop interventions that focus on the primary causes of sepsis and prioritise the factors that will be associated with Sepsis. . It will also enable policy-makers and managers to consider integrating puerperal sepsis education with emphasis on factors that have shown to have poor maternal outcomes. Expected findings and dissemination: The results will be presented in tables showing summary statistics and odds ratios. A final master’s dissertation will be written and presented to the post graduate committee at the Kamuzu College of Nursing. The final dissertation will be shared with the Kamuzu College of Nursing library and The College of Medicine Research and Ethics Committee. Results from this research will be published in an open access peer reviewed journal and presented at research dissemination conferences. Background information and introduction Introduction Puerperal Sepsis has been defined by the World Health Organization as the infection of the genital tract occurring at any time between the onset of labour, rupture of membranes and the 42nd day postpartum. The Puerperal sepsis presents commonly with fever (oral temperature of 38.5 degrees Celsius or higher on any given occasion) and other symptoms such as pelvic pain, abnormal vaginal discharge, abnormal smell/foul odour discharge or delay in uterine involution (less than 2cm/day) during the first eight days (WHO, 2015). Puerperal sepsis accounts for a substantial contribution to the Maternal Mortality Rate (MMR). Global estimates suggest that direct (obstetric) infections are the third most common cause of maternal mortality, representing about 10.7% of deaths, a majority of which occur in Low- and Middle-Income Countries (LMIC) (WHO, 2020). The toll is higher in LMICs compared to high income countries (HICs) (Say et.al., 2014). In sub-Saharan Africa, maternal sepsis is one of the leading causes of over 70% of maternal deaths, others include: haemorrhage, hypertension disorders, unsafe abortion, and obstructed labour (Dillen et.al., 2010). Maternal sepsis, specifically, contributes 10.3% of all cause maternal deaths in SSA (Bonnet et.al., 2018). The Global Burden of Diseases Study reported a 30 % prevalence of maternal sepsis (James et al., 2018). A WHO maternal sepsis cohort study conducted in 713 health facilities found that 70.4 out of 1000 live births reported to health facilities with an infection (puerperal sepsis) (Group, 2020). Recent estimates suggest that in sub–Saharan Africa (SSA) the burden is highest compared to other regions with sepsis accounting for up to 45% (Rudd et.al., 2020). However, reliable estimates of the incidence and mortality of maternal sepsis in sub-Saharan Africa are incomplete (Otu et.al., 2020). In Malawi, a confidential inquiry showed that puerperal sepsis is the leading cause of maternal mortality accounting for 9.3 % of maternal deaths (MOH, 2019). Nevertheless, there is no programmatic interventions focused on prevention of puerperal sepsis. Malawi participated in the WHO-led Global Maternal Sepsis Study (GLOSS) and Awareness Campaign umbrella of the “Global Maternal and Neonatal Sepsis Initiative” the aims of which were to assess the burden of maternal sepsis, validate the identification criteria and raise awareness of maternal sepsis among health care workers. However, there is no evidence of Malawi’s implementation of this study following the campaign (GLOSS, 2017). According to Brizuela et.al., (2020), evaluation of countries that implemented the campaign shows improvements in service provision, reduced overall risk of mortality and morbidity from maternal sepsis in high-income as well as in low-income countries. The Malawi Emergency Obstetric and New-born Care Needs Assessment results showed that puerperal sepsis contributes to 18.9% of direct maternal deaths (MOH,2015). Nevertheless, there is paucity of evidence with regards to the epidemiology (when, where, who, what and why) of sepsis in maternal mortality and morbidity burden. As in many developing countries many cases of puerperal infections can go undiagnosed and underreported (Panelope et al., 2013). Hospital-based anecdotal evidence suggests that puerperal sepsis potentially carries the biggest morbidity burden at Queen Elizabeth Central Hospital, a tertiary hospital in southern Malawi. According to 2019 hospital records, there were over 2911 caesarean section deliveries performed at Queen Elizabeth Central Hospital (QECH), comprising 38 % of the total deliveries; 12.2% of these deliveries developed puerperal sepsis within 42 days of post-delivery (QECH HMIS, 2019). Given that puerperal sepsis significantly contributes to preventable maternal morbidity and mortality, combating sepsis is an integral part of realizing the Sustainable Development Goals (SDGs) targets 3.1 and 3.2 relating to maternal wellbeing, as well as target 3.3 on infectious diseases (WHO, 2020). Indirectly, sepsis is relevant to other targets in SDG 3 such as 3.8 on quality of care for all, and its prevention and management is inherently linked with vaccination, efforts to combat antimicrobial resistance (UN, 2020). For Malawi to achieve this lofty goal, reduction of maternal mortality rate must set targets that need urgent achievement. Consequently, identifying potential contributors or determinants to maternal mortality would assist in having focused interventions that respond to the specific causes of the problem. Sepsis is an ever-changing problem. The patterns of sepsis have been shown to differ in time. One of the factors related to the changes in patterns has been the increasing antimicrobial resistance. While several attempts have made to quantify the burden of sepsis by estimating the prevalence, not many have studied the factors associated with it at the individual level in Malawi. Hence the need for this study to bring evidence for developing of policies and guidelines to address the problem. Background Puerperal sepsis is a preventable postpartum complication, and has the potential to quickly progress to septic shock, which can eventually result into death (GLOSS, 2017). The global incidence of puerperal sepsis is 4.4 per 100 live births (Taskin et. al., 2016) and case fatality as high as 30-50 % has been reported in Low- and Middle-Income Countries (UNFPA, 2012). Regional disparities in the prevalence of puerperal sepsis exist. According | en_US |
| dc.description.sponsorship | Self sponsor | en_US |
| dc.identifier.uri | http://rscarchive.kuhes.ac.mw/handle/20.500.12988/669 | |
| dc.language.iso | en | en_US |
| dc.publisher | Kamuzu University of Health Sciencies | en_US |
| dc.relation.ispartofseries | Protocol;P.05/21/3327 | |
| dc.title | Prevalence and Factors Associated With Puerperal Sepsis among Postnatal Women at Queen Elizabeth Central Hospital, Blantyre by Priscabell Ndasauka Kalumbi | en_US |