Results
Of the 506 women enrolled, 357 (70.6%) were aged between 18 and 30 years (Table 1). Most were either married (n=228, 45.1%) or living with a partner (n=228, 45.1%), had at least a primary education (n=443, 87.5%) and reported farming (n=356, 70.4%) as their principle occupation. For 453 (89.5%) women, the reported monthly household income was less than 30,000 RWF (approximately 33.30 USD).
Nearly all women underwent a c-section for either emergent indications (n=140, 27.7%)— requiring an immediate intervention—or urgent indications (n=355, 70.2%), for which the patient could wait for intervention until she was medically stable. The indications for a c-section included foetal distress (n=174, 34.4%) and a previous c-section scar (n=160, 31.6%) as most prevalent, followed by cephalopelvic disproportion (n=82, 16.2%), prolonged or obstructed labour (n=60, 11.9%) and malpresentation (n=54, 10.7%).
A majority (n=409, 80.8%) of the 506 enrolled patients received a pre-operative antibiotic (Table 2). Of these, 239 (58.4%) had data on timing of the pre-operative dose, with 161 (67.4%) receiving the antibiotic within an hour prior to incision. The median time between antibiotic prophylaxis and the surgical incision was 40 minutes (interquartile range (IQR): 25, 74 minutes). For the 409 women who received pre-operative prophylaxis, the antibiotics most frequently prescribed were Ceftriaxone (n=343, 83.9%) and Ampicillin (n=62, 15.2%)—almost exclusively as a single dose (n=405, 99.3%).
After surgery and before hospital discharge, 485 (98.6%) of the 492 patients with post-operative prescription data, were given at least one antibiotic (Figure 1). Apart from one patient who received therapeutic antibiotics for a surgical site infection, all antibiotics (n=484, 99.8%) were prescribed for prophylaxis only . The median time between surgery completion and the first post-operative dose was 15.6 hours (IQR: 10.9, 21.7 hours). Of the 485 patients who received post-operative antibiotics, most were prescribed two antibiotics (n=464, 95.7%). Ampicillin was the most commonly prescribed (n=481, 99.2%), and almost always in combination with Gentamicin (n=468, 98.5%). Ten patients (2.1%) received only one antibiotic and another ten (2.1%) patients received three antibiotics. Among those who received a third antibiotic, four received Metronidazole, five received Gentamicin and one received Cloxacillin.
At discharge, 134 (27.8%) of the 482 patients with discharge antibiotic prescription data were not prescribed any antibiotics (Figure 2). Among patients who received antibiotics at discharge, 332 (96.2%) patients were prescribed only one antibiotic, while 13 (3.8%) patients were prescribed two antibiotics. The most prevalent monotherapies prescribed upon discharge were Amoxicillin (n=265, 76.1%) and Cloxacillin (n=74, 21.3%). Among the 13 patients who were prescribed two antibiotics at discharge, 11 (84.6%) were prescribed Metronidazole as one of the two antibiotics.