The finding of this study revealed that the overall proportion of timely recovery (within 4 days) after a maximum of 19 days is 96.2% [95%CI: 94.04–98.4%]. The median (IQR) time of recovery was 2.00 (2, 3) days. The overall incidence density rate (IDR) of recovery in the cohort was 0.34 per Person-days or 2.38 per person-week. On the other hand the overall mean survival time was 3.07(95%CI: 2.75–3.40) days. Women who had ANC follow-up and discharge from the wound site were identified as significant positive and negative predictors of time-to- recovery after CS delivery respectively.
The finding of this study revealed that early recovery rate of 96.2%, which is similar to WHO recommended average stay 3–4 days in hospital after a CS delivery . The result of this study is in line with other similar study conducted in Ethiopia: Butajira and Attat hospitals . However, the result is lower than a large population based study conducted in the North-Eastern Italy, where the recovery-time was 4.7 days  and in India, the recovery-time was 8.6 days . The most likely reason for the similarity of the recovery rate might be due to the participants socio-demographic chracteristics, and the health care providers who performed the CS. Moreover, the hospitals are serving as a teaching institutions and lower rates of most comorbid conditions. Four years back a study conducted at the same hospital found that amongst the total mothers underwent CS, 65(11.0%) developed surgical site infection . However, in our study, only 11 (3%) of women were developed surgical site infection. This shows the progress of quality service delivery of the hospital.
On the other hand, our study found that the median (IQR) time of recovery-time was 2.00 (2,3) days. This is corroborated by studies conducted outside Ethiopia, where the avarage of the women were discharged within 2 days [13, 17]. However, the finding of this study was inconsistent with other study conducted in Ethiopia: Butajira and Attat hospitals where the mean recovery time was 3.27  and a study conducted in 30 low and mid-income countries showed that the mean (± SD) hospitalization after cesarean section was 5.9 (± 3.4) days in the studied localities . This implies that, the study hospital has an improved and quality of pre, intra and post-operative services which help the women to recover early. Moreover, all the women underwent CS at the study hospital were discharged alive; this indicates that the quality of the procedure was at optimal level.
In this study we used Log-rank test to see the patterns of time-to-recovery after CS for selected variables. We found that the mean time-to-recovery among women whose age were ≤ 30 and ≥ 31 years was 2.75 and 5.69 days respectively (Log rank test = 11.357,P = 0.001). The same finding was reported by different studies where younger women were discharged earlier [3, 11, 17, 18]. This might be due to the fact that, an increased age has been associated with different comorbidities which affects the length of stay at hospital. Similarly women who had had and had not had chronic disease had statistically significant difference in the recovery times (Log-rank test = 12.445, P < 0.001). This result is supported by different studies; the hospital stay of women with complications and comorbidities was longer [1, 15, 17, 18]. This is due to the reason that women with complications and/or with co-morbities needs additional service for the mnagement. So, this might prolongs her length of stay at hospital. Moreover, the study hospital is serving as referral for the surrounding and adjacent woredas and zones of Oromia region and Gedio Zones catchment populations. This could over estimated the number of complicated mothers.
Our study revelaed that the women who have discharge from the wound site had 87% reduced recovery time than those women who did not have dischagre from the wound site (AHR = 0.13, 95%, CI: 0.03–0.56). This finding is supported by studies conducted in Ethiopia [1, 11]. Another study conducted in England found that women undergoing CS are at higher risk of developing postnatal infection and this makes the recovery time longer . Evidence suggested that the occurrence of surgical site infection is expected to increase as the incidence of CS increases . The magnitude of wound infection (2.9%) found in this study hospital is comparable to the global guidelines for prevention of surgical infection (2.9%) following cesarean section delivery . This implies improvements in hygiene conditions, antibiotic prophylaxis, sterile procedures, and other practices in our study hospital. However, still women undergoing a CS had better to be equipped with pertinent information on how to keep the surgical site clean, post-operative recovery and infection prevention advices.
Use of ANC designed to guide and support women on the mode of birth after a primary caesarean delivery have been found to be advantageous . Accordingly, our study found that, women who had ANC follow-up were 1.5 times more likely to recover early as compared to thier counter parts (AHR = 1.49, 95%, CI: 1.05–2.10). This result is by supported another study that reported, ANC and correctly indicated CS can positively impact on health outcomes of the mother .
The possible reason might be due to the that fact that during ANC follow-up women’s with a previous caesarean birth, chronic diseases and women with pregnancy related complications could be identified and decision for mode of birth could be agreed upon by the woman preference.
This study has added weight to the existing literature by quantifying the time-to-recovery following cesarean section delivery; as a result it could be used as an input for policymakers and health program developers on maternal health services. Nevertheless, the findings from this study would be difficult to infer to the wider population, because the study was hospital, HUCSH is tertiary type of hospital which is serving as a teaching institution for different disciplines including specialties. So this might positively affect the quality of the services given to the mothers unlike that of the general and primary hospitals where scare obstetrics and gynecologist found. Moreover, the sample were relatively small, some of the variable, such as qualification of person performed the CS, type of health facility where the CS performed as we have included the referral cases were not assessed.