Onset of First Symptoms and Timing of Clinician Notification of Surgical Site Infections Following Cesarean Section: Evidence from Six Tertiary Hospitals in Nigeria

SUMMARY Background Surgical site infections (SSIs) following caesarean section (CS) are a major cause of maternal morbidity in sub-Saharan Africa. Limited evidence exists on the timing of symptom onset and clinician notification, which are critical for surveillance and early intervention. This study aimed to (i) identify risk factors for SSI following CS, (ii) assess the timing of symptom onset within 30 days, and (iii) examine the timing of clinician notification. Methods A retrospective matched case–control study was conducted using post-CS SSI surveillance data from six tertiary hospitals in Nigeria. Cases (n=51) were matched with controls (n=153) at a 1:3 ratio based on maternal age, hospital, operating surgeon, and urgency of surgery. Associations were assessed using chi-square tests and conditional logistic regression. Symptom onset was evaluated over a four-week period, and Kaplan–Meier analysis was used to assess time to clinician notification. Results Prolonged duration of surgery was the only factor significantly associated with SSI (p=0.042); in conditional logistic regression, surgery exceeding 90 minutes was associated with SSI (OR 3.28, 95% CI 1.20–8.99). Most SSIs (72.1%) occurred within 1–14 days post-surgery, and 77.5% were detected after discharge. Symptom onset peaked in the second postoperative week, with wound discharge and localized swelling most frequently reported. Nearly three-quarters of clinician notifications occurred within the first two weeks. Conclusion SSIs following CS occurred predominantly within the first two postoperative weeks and were largely detected after discharge. Strengthening post-discharge surveillance, patient education, and early follow-up, particularly around two weeks postpartum, may improve SSI detection and maternal outcomes in Nigeria.