Study Site
The study was conducted in rural Eastern Rwanda at Kirehe District Hospital (KDH), which provides maternal and child health services to a catchment area of approximately 370,000 people. In 2017, 1,465 women delivered by c-section at KDH. The vast majority of c-sections are performed by the 14 GPs, with a few performed by a resident obstetrician at KDH. In the absence of complications, a mother is routinely discharged on post-operative day three and instructed to attend a follow-up visit at her local health centre for wound care. We analysed use of antibiotics pre-operatively relative to the hospital leadership-reported protocol of administering antibiotic prophylaxis within 1-hour prior to incision, similar to the United States SHEA/IDSA recommendations.15