Socio demographic characteristics of the study participants
From the total 444 sample size, 431 charts were reviewed with the response rate of 97.1%. Thirteen charts of the study participants were not included in this study as they have missed some important variables due to inappropriate documentation. The median age of the study participants was 27 years with IQR of ± 7. Minimum age was 18 years and maximum age was 43 years with the range of 25 years. Eighty percent of the study participants were from the age group of 21–34 years.
Most, 394(91.4%), of the study participants were married. Ninety five percent of the mothers were Tegaru in ethinicity. Majority, 348(80.7%), of the study participants were Orthodox religion followers. More than two-third 309(71.7%) of the study paricipants were in urban residence. Of the study participants, 57(51.4%) cases were rural residence, whereas 65(20.3%) controls were from rural residence (Table 2).
Obstetrics and Gynecologic characteristics of study participants
Around two-third, 260(60.3%), of the study participants were multiparas. Among the participants, 51(45.9%) cases were primipara, but 72(22.5%) controls were primipara. Almost all, 427(99.1%), of the mothers were delivered in health institutions. Most of, 391(90.7%), were delivered at term gestational age (37–42 weeks), and 23(5.3%) were delivered at less than 37 completed weeks of gestation. Among the study participants, 10(9%), cases were post term, while 7(2.2%), controls were post term in their gestational age during their last delivery.
Eighty four percent of the study participant’s onset of labor was started spontaneously. Around three-fourth 327 (75.9%) mothers were evaluated per vaginally for less than 5 times. However, 57(51.4%), cases and 47(14.7%), controls were evaluated five or more times. Eighty one percent of the mothers were delivered within 24 h of labor duration. Among the mothers, 50(45%) cases and 31(9.7%) controls were stayed in labor for more than 24 h.
Majority, 307(71.2%), of the mothers were delivered spontaneously through SVD. However, 47(42.3%) cases and 61(19.1%) controls were delivered through cesarean section. Most, 354(82.1%), of the study participants had no episiotomy during their last labor and delivery. Of the study participants, 2(1.8%) cases and 3(0.9%) controls had IUFD birth outcome; 3(2.7%) cases and 4(1.3%) controls had still birth. Among the study participants, 30(7%), had developed PPH and 19(4.4%) were diagnosed with anemia during labor and delivery.
Around one-fifth, 80 (18.6%), mothers were referred from one to another health institution during labor. Most, 376(87.2%), of the mothers were admitted for less five days during their last labor and delivery. More than three-fourth, 335(77.7%), of the study participants had no PNC follow up after discharged from labor and delivery. However, 9 (8.1%) cases and 87 (27.2%) controls had PNC follow up of at least one visit after discharged (Table 3).
Maternal health characteristics of the study participants
Most, 421(97.7%), of the study participants had no pre-existed medical health problems. However, 3(2.7%), cases and 7(2.2%) controls had preexisted medical health problems. Few, 10(2.3%), of mothers had STI during their last pregnancy. Among those 4(3.6%) mothers were cases and 6(1.9%) mothers were controls. Ninety six percent of the study participants had no UTI during their last pregnancy (Table 4).
Determinant factors of puerperal sepsis among post-partum mothers
In this study the independent variables that had associated with puerperal sepsis during the Binary logistic regression were age of the mother, residence, parity, ANC follow up, length of gestational age, duration of rupture of membrane, duration of labor, number of vaginal examination, mode of delivery and PNC follow up. However, Age of the mother, parity and length of gestational age were found to have no association with the dependent variable during the Multivariable analysis.
Residence was the independent variable associated with puerperal sepsis which indicates that mothers who live in the rural areas were 3 times more likely to develop puerperal sepsis than mothers who were from the urban areas [AOR:3, 95% CI 1.50–5.90]. ANC follow up was also another variable associated with puerperal sepsis. It shows that mothers who had no ANC follow up were 2.7 times more likely to have puerperal sepsis when compared to mothers who have ANC follow up of 4 or more times [AOR:2.7, 95% CI 1.08–6.71].
Duration of rupture of membrane was also found as the determinant factor of puerperal sepsis in this study. It reveals that mothers whose amniotic fluid membrane was ruptured for more than 24 h before the onset of labor were 4.1 times more likely to develop puerperal sepsis than those mothers whose amniotic fluid membrane rupture was less than 12 h before the onset of labor[AOR:4.1, CI 1.60–10.58]. Duration of labor was also the other variable strongly associated with puerperal sepsis which shows mothers who stayed in labor for more than 24 h were 4.3 times more likely to have puerperal sepsis compared to mothers who was delivered within 24 h of duration of labor during their last labor and delivery [AOR:4.3, 95% CI 1.86–9.92].
Furthermore, the number of vaginal examination during labor and delivery was another independent variable associated with puerperal sepsis that indicates mothers who undergone vaginal examination of five or more times were 2.8 times more likely to develop puerperal sepsis than mothers who had vaginal examination of less than five times during their last labor and delivery [AOR: 2.8, 95% CI 1.26–6.26]. In addition to this mode of delivery was also identified as the determinant factor of puerperal sepsis. It shows that mothers who delivered through cesarean section were 2.8 times more likely to develop puerperal sepsis when compared to those who delivered by SVD [AOR:2.8, 95% CI 1.48–5.20].
Moreover, PNC follow up was also another variable associated with puerperal sepsis which indicated mothers who had no PNC follow up were 3.9 times more likely to develop puerperal sepsis than those who have PNC follow up of at least one visit after discharged [AOR:3.9, 95% CI 1.60–9.36] (Table 5).