Improving care for women after c-section in rural Rwanda

Improving care for women after c-section in rural Rwanda
August 21, 2019 Center for Surgery and Public Health

Recently, Dr. Robert Riviello, Director of Global Surgery Programs at CSPH, took time to share some of the ongoing research in improving care for women after c-section in rural Rwanda.

Cesarean sections (c-sections) are the most common surgical procedure performed worldwide and in Rwanda, c-sections account for over 60% of all major surgeries at district hospitals. Since 2016, Harvard Medical School (HMS), the Center for Surgery and Public Health (CSPH) at Brigham and Women’s Hospital (BWH), Inshuti Mu Buzima (IMB)/ Partners in Health-Rwanda, and Rwanda Ministry of Health have been carrying out research around c-section, including a randomized control trial assessing the feasibility and impact of a community health worker (CHW) intervention to help women with surgical site infections (SSIs) return to care, in Kirehe District in rural eastern Rwanda.

Key lessons from the research to-date include: 1) About 11% of women develop SSIs post-c-section; 2) Even heavily subsidized c-section can be financially catastrophic for the patients; 3) Although water, sanitation, and hygiene (WASH) infrastructure at the district hospital was good, 92% of women returned post-c-section to home environments were WASH conditions were insufficient; 4) There were gaps between antibiotic prescribing practices and international guidelines for c-section patients; and 5) In-person follow-up of post-c-section women by CHWs was feasible with about 90% of the mothers visited by CHWs. Ways forward for this work include leveraging the existing maternal CHWs to improve post-c-section follow-up and exploring the feasibility and accuracy of real-time diagnoses of SSIs based on photos.

In addition to providing valuable data for important research questions, these studies have transformed practice at the study site, Kirehe District Hospital, and have been used to facilitate research capacity-building, developing and promoting local Rwandan research talent.