Baklola Mohamed, Terra Mohamed, Elsehrawy Mohamed Gamal, Alali Hatoun, Aljohani Sereen Saleem, Alomireeni Aseel Ali, Alqahtani Razan Mubarak, Albalawi Norah Majed, Jafail Kawthar Abdulaziz, Mohammed Alaa Jaffar, Al-Bawah Naji, Hafez Mayas, Elkhawaga Ghada
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Nursing Administration and Education Department, College of Nursing, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Saudi Arabia.
BMC Pregnancy Childbirth. 2025 Apr 22;25(1):465. doi: 10.1186/s12884-025-07526-y.
Surgical site infections (SSIs) are among the most common postoperative complications following cesarean section, particularly in Africa. These infections pose maternal health risks, including prolonged hospitalization, increased healthcare costs, and mortality. This systematic review and meta-analysis aimed to evaluate the epidemiology, pooled prevalence, and risk factors for SSIs after cesarean section in Africa.
A systematic search of PubMed/MEDLINE, Scopus, and Web of Science databases was conducted to identify studies published between January 2000 and December 2023. The review followed PRISMA 2020 guidelines, and 41 studies spanning 18 African countries met the inclusion criteria. Data on SSI prevalence and risk factors were extracted, and the quality of studies was assessed using the Newcastle-Ottawa Scale. A random-effects model was used to estimate pooled prevalence, with subgroup analysis, sensitivity analyses, and meta-regression exploring variations across study characteristics. Publication bias was assessed using funnel plots.
The pooled prevalence of SSIs after cesarean section was 11% (95% CI: 9-12.9%) with substantial heterogeneity (I = 97%, < 0.001). Regional variations were observed, with the highest prevalence in Tanzania (34.1%) and Uganda (15%), and the lowest in Tunisia (5%) and Egypt (5.3%). Temporal trends revealed a peak in prevalence (16%) during 2011-2015, declining to 9.8% by 2016-2020. Prolonged rupture of membranes (PROM) was the most frequently reported risk factor (OR: 4.45-13.9), followed by prolonged labor (> 24 h) (OR: 3.48-16.17) and chorioamnionitis (OR: 4.37-9.74). Potential publication bias indicated by asymmetrical funnel plots.
SSIs following cesarean section remain a burden in Africa, with wide regional variations and multiple preventable risk factors. The findings highlight the need for targeted interventions, including improved infection control practices, antenatal care, and timely management of obstetric complications.
手术部位感染（SSIs）是剖宫产术后最常见的并发症之一，在非洲尤为如此。这些感染对产妇健康构成风险，包括住院时间延长、医疗费用增加和死亡。本系统评价和荟萃分析旨在评估非洲剖宫产术后手术部位感染的流行病学、合并患病率和危险因素。
对PubMed/MEDLINE、Scopus和Web of Science数据库进行系统检索，以识别2000年1月至2023年12月期间发表的研究。该评价遵循PRISMA 2020指南，来自18个非洲国家的41项研究符合纳入标准。提取了手术部位感染患病率和危险因素的数据，并使用纽卡斯尔-渥太华量表评估研究质量。采用随机效应模型估计合并患病率，并进行亚组分析、敏感性分析和元回归，以探讨不同研究特征之间的差异。使用漏斗图评估发表偏倚。
剖宫产术后手术部位感染的合并患病率为11%（95%CI：9-12.9%），存在显著异质性（I = 97%，P < 0.001）。观察到区域差异，坦桑尼亚（34.1%）和乌干达（15%）的患病率最高，突尼斯（5%）和埃及（5.3%）的患病率最低。时间趋势显示，2011-2015年患病率达到峰值（16%），到2016-2020年降至9.8%。胎膜早破（PROM）是最常报告的危险因素（OR：4.45-13.9），其次是产程延长（>24小时）（OR：3.48-16.17）和绒毛膜羊膜炎（OR：4.37-9.74）。漏斗图不对称表明存在潜在的发表偏倚。
剖宫产术后手术部位感染在非洲仍然是一个负担，存在广泛的区域差异和多种可预防的危险因素。研究结果强调了针对性干预措施的必要性，包括改善感染控制措施、产前护理和及时处理产科并发症。
