Burden and determinants of puerperal sepsis in Ethiopia: a systematic review and meta-analysis.

Background: Puerperal sepsis is a leading cause of maternal morbidity and is responsible for nearly one-fifth of maternal deaths worldwide. In Ethiopia, it remains a significant contributor to maternal mortality; however, a comprehensive understanding of its determinants is still lacking. Therefore, the aim of this systematic review and meta-analysis is to estimate the pooled prevalence of puerperal sepsis and to identify its determinant factors in Ethiopia, thereby providing comprehensive and up-to-date evidence to inform maternal health interventions.

Methods: The review was conducted in accordance with the Joanna Briggs Institute methodological guidance for systematic reviews and meta-analyses and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Systematic review and meta-analysis protocol was pre-registered on PROSPERO with registration number CRD42024619492. Databases including Web of Science, PubMed, Google Scholar, Scopus, ScienceDirect and gray literature were explored. Initially, 668 studies were identified. Newcastle-Ottawa scale was used to appraise included studies. The review included primary observation studies including cross-sectional, cohort, and case-control studies conducted on postpartum women in Ethiopia. This review excludes reviews, commentaries, case studies and pure qualitative studies. After screening and assessing eligibility criteria sixteen were included in the meta-analysis and systematic review. Data were extracted using an Excel sheet, and STATA version 15 was used for the meta-analysis. Heterogeneity among studies was evaluated using the Cochrane Q test and I² statistic. A funnel plot and Egger's test were used to assess publication bias. Pooled prevalence of puerperal sepsis and effect sizes of determinant factors were assessed with 95% C. I. The pooled estimates were presented using a random effect model.

Results: This study involved 5247 postpartum women in Ethiopia. The prevalence of puerperal sepsis was 15.82% (95%CI 9.84-21.80). Determinant factors of puerperal sepsis were cesarean section deliveries AOR 2.86(95%CI 2.17-3.76), more than five repeated vaginal examinations AOR 4.91(95%CI 3.84-6.28), low number of antenatal care contact AOR 5.52 (95%CI 3.63-8.40), prolonged labor AOR 5.56(95%CI 4.14-7.47), premature rupture of membranes AOR 3.86(95%CI 3.00-4.96), rural residence AOR 5.15(95%CI 3.99-6.65),and home deliveries AOR 3.45(95%CI 2.28-5.24).

Conclusions: The prevalence of puerperal sepsis in Ethiopia is high. Cesarean delivery, more than five vaginal examinations, lack of antenatal care, prolonged labor, premature rupture of membranes, rural residence, home delivery, and gestational diabetes were identified as significant risk factors for puerperal sepsis in Ethiopia. Therefore, adhering to labor care guide, and infection prevention protocol are paramount.