Reducing postpartum infections: An interrupted time series intervention study in Gujarat state, India

Background: Infection control during childbirth is given little attention especially in developing countries, despite infection being the third major cause of maternal deaths. In particular, evidence on the effectiveness of infection control interventions is lacking. We evaluated the effects of introducing a multifaceted intervention on post partum infection rates after delivery in India.

Method: Appreciative Inquiry, a multifaceted intervention involving infection surveillance, feedback, infection committees and behaviour change, was introduced in three hospitals, matched with three control hospitals. Levels of postpartum infections among women who had delivered in control and intervention hospitals were measured every month for 16 months. A total of 8,124 women were followed up in hospital and after discharge at home till day 42 postpartum.

Results: Puerperal sepsis, urinary tract infections, episiotomy and caesarean section wound infections were the main postpartum infections reported. Levels of postpartum infection rates dropped in intervention hospitals from 4.28% (pre-intervention), to 2.51% (intervention) and 1.69% (post intervention). Control hospitals also experienced reductions in infection rates. Logistic regression analysis examining infection and interactions between intervention and control groups showed a larger reduction in the intervention group but the difference was not statistically significant (p value 0.37).

Conclusion: Infection control is a key, but often neglected component in the improvement of quality of maternity care. Multifaceted interventions have a potential to reduce unnecessary mortality and morbidity but unequivocal effect is difficult to demonstrate. Simply raising awareness of the dangers of infection by conducting a study can help prevent lives from being lost to sepsis.