Magnitude and Determinants of Surgical Site Infections Following Cesarean Section: A Retrospective Multi-Hospital Study in Addis Ababa, Ethiopia, 2024

Background: Over the past three decades, infections following cesarean sections have increased markedly, with surgical site infections (SSIs) emerging as a leading cause of maternal morbidity and mortality. This issue is especially critical in low- and middle-income countries, including Ethiopia, where reliable data on the magnitude and determinants of post-cesarean infections remain limited. These infections contribute to prolonged hospital stays, higher healthcare costs, and elevated risks for both mothers and newborns. Objective: This study aimed to assess the prevalence of post-cesarean section infections and identify associated risk factors in selected hospitals in Addis Ababa, Ethiopia, in 2024. Methods: An institution-based retrospective cross-sectional study was conducted in selected hospitals between June 10 and August 30, 2024. A total of 472 medical records of women who underwent cesarean sections from January 1, 2019, through December 31, 2023, were reviewed using a systematic random sampling method. Hospitals were selected using simple random sampling. Data were entered and cleaned using Epi Info version 7.2.1.0 and analyzed with SPSS version 26. Binary logistic regression was employed to identify factors associated with post-cesarean infections. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated, and statistical significance was determined at a p-value < 0.05. Results: The prevalence of post-cesarean section infection was 17%. Key factors significantly associated with increased risk included: presence of clinical signs of infection (AOR = 4.37, 95% CI: 3.25-6.22), underlying co-morbid conditions (AOR = 4.72, 95% CI: 3.34-6.23), and operation duration longer than 30 minutes (AOR = 3.43, 95% CI: 2.32-4.43). Conclusion and Recommendation: The prevalence of post-cesarean infections in Addis Ababa was alarmingly high. Major risk factors included signs of infection, co-morbid illnesses, prolonged labor (>24 hours), previous cesarean deliveries, and extended operative time. To reduce infection rates, hospitals should enforce strict infection prevention protocols and maintain high standards of surgical practice.