Post-Caesarean Infection and the Associated Gaps in Obstetric Care in Rwanda Health Care Worker Perspectives

Our research team recently conducted stakeholder consultations to inform our understanding of the current status of the problem in Rwanda (June-July 2022; supported by a CIHR Planning & Dissemination Grant). Interviews (n=4) and focus groups (n=2) were conducted with health care workers at Rwanda’s three hospitals to understand the context of CD and related complications. Focus group participants included obstetric residents (n=3), midwives (n=3), obstetric interns (n=3), and one obstetrician. Interviews were conducted with the Head of Obstetrics Department (n=2) and nurse-midwives (n=2). These discussions confirmed that CD and post Caesarean infections are major concerns across Rwanda. Stakeholders consistently reported higher rate of infections at district hospitals. It was commonly mentioned that district hospitals lack health care staff with adequate competence, skills, training, resources, and equipment, and most CD are performed by general practitioners with no surgical training. Respondents reported a major dip in the quality of care annually at the time of year when new general practitioners are deployed to district hospitals without the necessary skills to safely perform operative deliveries. Despite the high rate of post-Caesarean infection, guidelines and protocols for managing complex obstetric cases exist in all surveyed facilities. Guidelines were reportedly easy to follow but were not always followed due to high patient volume. It was also reported that patient knowledge, adherence to recommendations, and follow-up contributed to cases of infection. Our investigation revealed the need for understanding the context from which Rwandan patients were presenting with post-Caesarean infection.