Worldwide research on puerperal infections is dominated by literature from developed countries due to paucity of data describing the infection from resource limited countries. There is therefore inadequate development of evidence based strategies to reduce morbidity and mortality associated with puerperal infections.

Aim. This project aims to reduce the burden of puerperal infections through surveillance and infection control

Methods. Between July 2018 through June 2019, a prospective survey focusing on the incidence of puerperal infection; knowledge, attitudes and practices that predispose new mother to puerperal infections; and the effect of surveillance and evidence-based infection control interventions on puerperal infections will be conducted in 2 hospitals to generate data on the epidemiology of puerperal infections and socio-cultural barriers to infection control.

Expected outcome. Findings from this study will contribute to improved infection prevention and control practices. The interventions are expected to reduce the burden of puerperal infections, and likely to result in cost savings, thereby allowing resources to be used for provision of other healthcare services.

Project Description

Infections are among the leading causes of preventable maternal mortality worldwide especially in low-income countries. Available evidence suggests that infections around childbirth substantially contribute to maternal morbidity, are underestimated, and are more frequent in hospital-based deliveries than in the community. Infections relating to childbirth are generally referred to as puerperal infections. Puerperal infections as specified in the international statistical classification of disease codes (ICD-10 codes 086) include infections of obstetric surgical wounds, genital tract and urinary tract infections occurring at any time between onset of rupture of membranes or labour; and the 42^nd day postpartum in which at least one of some specified clinical symptoms is present. Puerperal infections are usually reported as the third leading cause, accounting for up to 15% of maternal deaths in Asia and Africa. Globally, puerperal infections causes at least 75 000 maternal deaths every year, are the 3^rd major cause of maternal mortality and contributes about 10% of deaths around the time of pregnancy. They account for about 7.6% of total maternal deaths in Sub-Saharan Africa. In Ghana, a few published research findings on healthcare facility data attribute 3 to 10% of maternal deaths to puerperal infections.

Puerperal infections are serious and life threatening for the mother, infecting her womb, abdominal cavity and bloodstream, with associated fever and pain, and slow recovery of the mother during the postpartum period. The infections are also directly associated with early onset neonatal sepsis and can also affect newborn wellbeing indirectly, causing difficulties for example in breastfeeding and interfering with mother and child bonding. Despite the menacing problems, there is paucity of data to estimate the disease burden and also guide intervention programmes in sub-Saharan Africa and Ghana in particular. Key tools for reducing the burden of puerperal infections are surveillance and effective implementation of infection control interventions. The World Health Organisation estimates that the burden of puerperal infections can be reduced by approximately 50% through surveillance and appropriate infection control. The WHO has emphasised this over the past 10 years through campaigns such as “Safer Surgery Saves Lives” and “Clean care is Safe Care”. However, these infection control guidelines are being utilized by developing countries with varying degrees of success mainly because of the different physical, environmental, socioeconomic and cultural backgrounds. To ensure that infection control guidelines are adequately adapted to the specific needs and challenges of the health care workers in developing countries, there is a need to develop interventions based on local evidence. There are currently no surveillance programmes on puerperal infections in Ghana and very few publications exist on the subject. These publications have been largely based on healthcare facility data with limited community-based postpartum follow-ups and the true incidence of puerperal infections versus live-births is often underestimated. The absence of surveillance data means there are currently no benchmarks for assessing infection prevention and control activities on puerperal infections.  

Project Description

This project aims to reduce the burden of puerperal infections through surveillance and infection control

Objectives

The specific objectives are to

1. determine the incidence of puerperal infections in relation to maternal mortality

2. identify infecting bacterial organisms, antibiotic use, drug susceptibility patterns and treatment outcomes

3. assess practices, perceptions and conditions that influence the burden of puerperal infections and the uptake of infection control interventions of health care providers, patients and their relatives

4. identify and implement effective infection control interventions to prevent puerperal infections

Project Partners

Responsible supervisor

Dr Nelson Damale (Department of Obstetrics and Gynaecology, Korle-Bu Teaching Hospital)

 Primary Research Scientist

Christiana Akufo (PhD student; School of Public Health; University of Ghana, Legon)

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 Dr Noah Obeng-Nkrumah (PostDoc, Department of Clinical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Legon)

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 Institutional PhD supervisors

Professor Kwasi Torpey (School of Public Health, University of Ghana, Legon)

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Dr. Abubakar Manu (School of Public Health, University of Ghana, Legon)

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Dr. Abraham Hodgson (Research and Development Division, Ghana Health Service, Headquarters, Accra)

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