Aga Khan posts one of Africa's highest C-section safety levels

With the increased Caesarian sections in Kenya, it is expected cases of post-Caesarean wound infections will increase in parallel.

Most hospitals do not reveal the rate of C-sections that end up with wound infections, but globally, it is about three to 15 per cent.

However, one hospital in Kenya has posted an impressively low rate, which is below the global figure.

The Aga Khan University Hospital in Nairobi says from about 1,262 Caesarians performed between November 1, 2021 and October 31, 2022, only about 27 women (2.1 per cent), developed infections at the surgical site.

The hospital said most infections are superficial, mostly caused by bacterial infection.

“The most common surgical site infection (SSI) symptom was oozing from the wound in 67 per cent cases,” David Odada, a clinical nurse at the facility, and his three colleagues said.

The others are Jasmit Shah, Annastacia Mbithi and Reena Shah, all from the hospital’s Department of Internal Medicine.

The four did not indicate the share of C-sections compared to vaginal births at the hospital, but noted the Caesarians have been rising.

However, the facility appears to have bucked a trend where the infections also rise with the cut.

“There was no significant association of exposure to surgical site infection risk factors with surgical site infection despite a positive trend,” they said.

Infection can occur when bacteria get into the incision wound after a Caesarean delivery.

The type of Caesarean section (elective or emergency) was also not significant, contradicting findings from other studies that associated emergency CS with the occurrence of infections.

“Despite the findings from this study, preventing and managing SSI remains a critical goal in surgical practice,” the authors said.

Their paper, “Surgical site infections post-Caesarean section and associated risk factors: a retrospective case-control study at a tertiary hospital in Kenya,” will be published by the Infection Prevention in Practice journal.

Caesarian wound infections place physical and emotional burdens on the mother and are a significant financial burden on the healthcare system.

They are also associated with a maternal mortality rate of up to three per cent, according to the World Health Organisation.

According to the Ministry of Health, the share of Kenyans delivering babies via the Caesarian section is almost twice the average for Africa.

The ministry says the rate of C-sections in Kenya was at 16.4 per cent in 2021, while the average C-section rate for Africa is about 9.2 per cent.

Last year, the Kenya Demographic and Health Survey reported an extremely high rate of Caesarean section births in 19 rural counties.

In Kirinyaga and Kiambu, nearly half of all women are going for C-sections as opposed to vaginal birth, making this one of the highest rates in Africa.

The rate of C-sections in Kirinyaga is 40 per cent, Kiambu 33 per cent and Tharaka Nithi 30 per cent.

In total, 19 counties have already breached the World Health Organisation's recommended upper limit of 15 per cent, the Kenya Demographic and Health Survey 2022 showed.

This raises prospects of overuse of the procedure, which carries risks for both babies and mothers.

The National Health Insurance Fund also complains hospitals may be pushing some women into CS births because the surgery generates more money.

The insurer paid Sh621 million for C-sections in 2016-17, jumping to Sh1.5 billion in 2018-19.

In 2019-21 NHIF paid hospitals Sh2.5 billion for Caesarean section births, accounting for 44 per cent of NHIF’s maternity costs of Sh5.67 billion that financial year.

The KDHS 2022 survey suggested these procedures are probably being abused, despite the risks.

Past studies have indicated the death rate among women undergoing a C-section to deliver a baby is about 50 times higher in Africa than in most wealthy nations.

“Unnecessary Caesarean sections can be harmful to both the mother and the baby, leading to heavy bleeding, infection, slower recovery times, delays in breastfeeding and future complications in pregnancies,” the KDHS report said.