Determinants of puerperal sepsis and maternal outcomes in a Nigerian tertiary health institution: a retrospective case-control study

Objectives: To examine how sociodemographic and obstetric factors are related to puerperal sepsis. The study also assessed the consequences of puerperal sepsis on the health of mothers diagnosed with puerperal sepsis. Design: This is a retrospective case-control study. The health records of 8990 mothers who delivered at the health facility within five years (January 2015–December 2019) were retrieved from the hospital's health record department. A total of 6479 had antenatal registration, 2511 did not, and 660 patients were randomly selected to participate in the study. A validated checklist was used for data collection from 660 health records included in the study. Logistic regression using odd ratios at 95%CI was used to identify factors associated with puerperal sepsis. Also, Chi-square was used to examine the significant association between puerperal sepsis and the mother’s sociodemographic characteristics. Additionally, frequency and percentage were used to describe the maternal outcomes. Setting: Obstetrics and Gynaecology unit of the University College Hospital, Ibadan, Nigeria. Participants: A total of 660 postpartum women with and without antenatal registration at the hospital were included in the study. Primary outcome measures: Puerperal sepsis, and the resultant maternal outcomes within the five years of the study. Results: A total of 21.1% of 660 postpartum women were diagnosed with puerperal sepsis. The analysis revealed that women with fewer numbers of ANC attendance had an increased likelihood of developing puerperal sepsis, with an AOR of 4.76(2.32 – 49.78), indicating that they were 4.76 times more likely to have this condition compared to those with more numbers of ANC attendance. Also, women who had tertiary education were 5.4 times more likely to have puerperal sepsis [AOR = 5.40 (1.31 – 22.33)] compared to those who had primary education. Similarly, women with PCV < 25 were found to be 4.8 times more likely to have puerperal sepsis [ AOR = 4.84(1.62 – 14.59)] compared with their counterparts with PCV > 33. Also, there were significant associations between the diagnosis of puerperal sepsis and maternal age (X2 = 22.03; p < 0.001), occupation (X2 = 27.75; p < 0.001), marital status (X2 = 4.53; p = 0.033), length of stay (X2 = 73.50; p < 0.001) and place of delivery (X2 = 38.70; p < 0.001). Additionally, maternal outcomes include septicemia (12.4%), septic shock (11.5%), pelvic abscess (7.3%), peritonitis (6.4%), and death (5.0%). Conclusions: Both sociodemographic and obstetric factors are strong determinants of puerperal sepsis. The puerperal sepsis has consequences on the health of the mother. Therefore, it is recommended that effective interventions targeting prevention of puerperal sepsis should be planned, and implemented by care providers and policy makers in charge of maternal health.