Antibiotic prescription pattern and maternal sepsis:a comparative assessment among women who underwent emergency cesarean delivery before and after the initiation of free maternity services at the kenyatta national hospital

Abstract

Introduction:in a health system, change of user fees alters access and coverage of services and hence utilization of health services. The introduction of free maternity services in kenya is such a policy. There is need to assess the impact of such healthcare policy on the incidence of maternal sepsis (a proxy indicator of quality of care) and utilization of services. Broad objective:this was to compare the antibiotic prescription pattern and the incidence of maternal sepsis among women who underwent emergency cesarean delivery before and after the initiation of free maternity services and followed up for 6 weeks after delivery at knh? Main outcome measures: incidence of maternal sepsis and antibiotic prescription pattern Methodology Study design:a comparative retrospective study Study site:kenyatta national hospital Study population- all patients whose gestation was ≥34 weeks and underwent emergency cesarean delivery at knh general maternity unitbefore and after the initiation of free maternity services. Results:there was increased utilization of services by vulnerable populations: patients aged ≤19 years, patients with primary level of education,and the unemployedwhose p-values were 0.023,0.017 and 0.032respectively. There was no significant change in the incidence of maternal sepsis, 0.4% before and 0.2% after fms, p-value 0.584 despite increase in the population of women being attended to. Therewas a significant increasein antibiotic prescription pattern intraoperative: inthe use of amoxycillin-clavulinic acid 1.2g and iv ceftriaxone 1g whose p-value was <0.001 for both

Groups and an increase in theuse of postoperative: in the use of po amoxycillin-clavulinic acid 625mgandpo amoxycillin-clavulinic acid 1g whose p-values was <0.001 for both groups. Therewas a significant increase inthe documentation of antibiotic prescriptionafter fms p-value was <0.001. Conclusion: Theintroduction of free maternity services led to increased utilization ofservices by the vulnerable populations and a significant increase in the intraoperative and postoperative antibiotic use. In spite of the higher cesarean section numbers after fms, there was no significant change in sepsis rates. There was a variable antibiotic prescription pattern in both before and after fms. Recommendations: There is need to standardize the antibioticuse during cesarean births because different regimes are in use in both periods. There is need to conduct prospective study to determine the incidence ofmaternal sepsis after emergency cesarean section using the strict diagnostic criteria. Key words:emergency cesarean section, maternal sepsis, free maternity services,vulnerable populations