Volume 3 Issue 3 2023

Knowledge Attitude and Practices of Health Workers on Puerperal Sepsis Preventions at Bundibugyo Hospital Bundibugyo District

Muhindo Emmanuel

Faculty of Clinical Medicine and Dentistry Kampala International University Western Campus Uganda.


Globally, puerperal sepsis is estimated to account for 15% of the 500,000 maternal deaths annually. It is the third most common cause of maternal death worldwide. The purpose of the study was to assess the Knowledge, Attitude and Practices of health workers in the prevention of puerperal sepsis at Bundibugyo Hospital, Bundibugyo district. The study was a cross-sectional descriptive study design that used quantitative methods. A consecutive sampling method was used to select respondents. The sample size was 96 but 73 respondents were interviewed using self-administered questionnaires, where data was coded, entered using SPPS 20.1 and presented in tables, graphs and pie charts. The results showed that health workers had inadequate knowledge of puerperal sepsis where 30(45.5%) correctly described puerperal sepsis. 31(38.3%) and 29(35.8%) reported repeated vaginal exams and caesarean section as risk factors for puerperal sepsis, respectively. The majority of the health workers had a positive attitude towards the prevention of puerperal sepsis. Practices of health workers to prevent puerperal sepsis are hand washing 45(55.5%), wearing gloves 81(100%), screening for risk factors 76(93.6%) and use of prophylactic antibiotics.  In conclusion, health workers have inadequate knowledge of puerperal sepsis prevention, a positive attitude and good practices on puerperal sepsis prevention. And the researcher recommends that all health workers on maternity wards should undergo special training on puerperal sepsis prevention methods.

Keywords: Puerperal sepsis, Maternal deaths, Health workers, Prophylactic antibiotics, Caesarean section.


Puerperal infections date back to at least the 5th century BCE in the writings of Hippocrates [1]. These infections were a very common cause of death around the time of childbirth starting in at least the 18th century until the 1930s when antibiotics were introduced. In 1847, in Austria, Ignaz Semmelweiss through the use of hand washing with chlorine. In the 19th century, Igaz Semmelweis showed that puerperal sepsis was contagious and that it could be prevented with adequate hand hygiene. An obstetrician called Alexander Gordon was the first to prove the contagious nature of puerperal sepsis and he also advocated the need for good hygiene for its prevention in a thesis published in 1795 [2]. Puerperal sepsis is a genital tract infection occurring at any time within the rupture of extra placental membranes or labour and the 42nd day postpartum, characterized by symptoms like pelvic pain, fever (oral temperature of 38.5°C or higher on any occasion), abnormal vaginal discharge (the presence of pus and abnormal smell/foul odour), and delay in the involution of the uterus [3]. The predisposing factors to puerperal sepsis include anaemia in pregnancy, prolonged labour, frequent vaginal examination, premature rupture of membranes, and use of unsterilized or unwashed instruments during delivery [4]. A variety of bacterial pathogens has been implicated in causing puerperal sepsis including a wide range of anaerobes like peptostreptococcus, clostridia, pseudomonas and Bacteroides fragilis and facultative aerobes such as E. coli, enterococci, klebsiella spp, beta-hemolytic Streptococci and staphylococci [5]. Group A streptococcus (GAS) is the most feared pathogen and up to 30% of the population are asymptomatic carriers of GAS [6]. Puerperal sepsis is one of the five leading causes of maternal mortality worldwide and accounts for 15% of all maternal deaths annually [7]. Postpartum sepsis accounts for most maternal deaths between three and seven days postpartum, the rate of incidence is very high and consequently the mother and newborn have virtually higher infection risk [8].  In developed countries such as the USA, the rate of puerperal sepsis has declined significantly. For example, in the USA, puerperal sepsis occurs in only 5.5% of vaginal deliveries and 7.4% of caesarean section deliveries [9]. Low-resource countries account for 99% (286000) of global maternal mortalities with sub-Saharan Africa responsible for the bulk of the maternal deaths and accounting for 62% followed by southern Asia at 24% [10]. A study conducted in Nandi County, Kenya revealed that there was a lack of knowledge on the aetiology of infection and the healthcare facilities were short of the adequate prerequisites to perform puerperal sepsis awareness both in the clinic and community [11]. In Uganda, puerperal sepsis is the leading cause of maternal death accounting for 30.9% of the direct causes of Maternal Mortality at Mbarara RR Hospital. The current Maternal Mortality Ratio (MMR) in Uganda is 438 per 100,000 live births coming from 550 per 100,000 in 1990. Mortality rates are thought to be higher in areas that lack proper sanitation [10].


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CITE AS: Muhindo Emmanuel (2023). Knowledge Attitude and Practices of Health Workers on Puerperal Sepsis Preventions at Bundibugyo Hospital Bundibugyo District. NEWPORT INTERNATIONAL JOURNAL OF SCIENTIFIC AND EXPERIMENTAL SCIENCES (NIJSES) 3(3): 68-88.