During the study period, 1553 files were reviewed. Thirty-three files were incomplete, so were excluded, giving a total of 1520 complete files which were included. Of the 1520 records included in the study, 1502 (98.8%) gave birth at the DGH, and 18 (1.2%) women were referred for postpartum care at the DGH following delivery in different hospitals.
Socio-demographic characteristics of the study population
Table 1 shows the sociodemographic and obstetric characteristics of participants. The subjects age ranged from 20 to 41 with mean age of 29.94 ± 4.9 years and majority, 1262 (83.0%) of the subjects were between the ages of 20-34 years.
.
Table 1: Sociodemographic characteristics of Study Population.
Variable
|
Frequency
|
Percentage (%)
|
|
|
|
Maternal age
|
|
|
20-34 years
|
1262
|
83
|
≥35
|
258
|
17.0
|
Marital status
|
|
|
Single
|
441
|
29.0
|
Married
|
1079
|
71.0
|
Education
|
|
|
Primary (primary school only)
|
145
|
9.5
|
Secondary (at most secondary and/or high school)
|
411
|
27.1
|
Tertiary (at least undergraduate level)
|
964
|
63.4
|
Parity
|
|
|
Primipara
|
238
|
15.7
|
Multipara (2 to 4 births)
|
1010
|
66.5
|
Grand Multipara (5 or more births)
|
272
|
17.9
|
Prevalence of postpartum pyrexia
Of the1520 files reviewed, 134 were cases of postpartum pyrexia, 88 out of 1018 vaginal delivery and 46 of the 502 caesarean section. This gave an overall postpartum pyrexia prevalence of 8.82%, with rates of 9.16% following caesarean section and 8.64% following vaginal delivery.
Risk factors of postpartum pyrexia
The risk factors associated with PP were: five or more vaginal examinations prior to delivery (OR 59.151, 95% CI: 21.463- 163.019; p<0.001), perineal tears (OR 45.157, 95% CI: 2.266-899.722; p<0.001), duration of labour greater than 18hours (OR 26.760, 95% CI: 7.100 -100.862; p<0.001), hemoglobin level < 8g/dl prior to delivery (OR 23.960, 95% CI: 9.081-63.218; p<0.001), pre-eclampsia (OR 5.710, 95% CI: 2.401 -13.583; p=0.040), grand multiparty (OR 3.878, 95% CI: 1.149-13.120; p=0.029),less than 4 antenatal visits (OR 2.379, 95% CI: 1.321 - 6.975; p<0.000) and caesarean delivery (OR 1.142, 95% CI: 0.000 – 8977.799; p<0.001)(Table 2).
Table 2: Risk factors of postpartum pyrexia (Multivariate analysis).
Factors
|
P-value
|
AOR
|
Confidence Interval (95%)
|
|
|
|
|
Parity
|
Primipara
|
0.131
|
1.683
|
0.856 - 3.311
|
Multipara
|
|
1
|
|
Grand multipara
|
0.029
|
3.878
|
1.149 – 13.120
|
|
|
|
|
|
Comorbidity
|
HIV
|
Yes
|
0.135
|
2.350
|
0.986 – 4.657
|
No
|
|
1
|
|
Diabetes
|
Yes
|
0.356
|
1.678
|
0.564 – 2.463
|
No
|
|
1
|
|
Pre-eclampsia
|
Yes
|
0.001
|
5.710
|
2.401 - 13.583
|
No
|
|
1
|
|
|
|
|
|
|
|
Number of ANCs
|
< 4
|
0.001
|
2.379
|
1.321 - 6.975
|
4 – 8
|
0.067
|
0.079
|
0.213 - 1.875
|
>8
|
|
1
|
|
|
|
|
|
|
Hemoglobin level
|
< 8 g/dl
|
0.001
|
23.960
|
9.081 - 63.218
|
8.1-10 g/dl
|
0.997
|
0.073
|
0.033 – 0.161
|
>10g/dl
|
|
1
|
|
|
|
|
|
|
Duration of labour
|
<18 hours
|
|
1
|
|
>18 hours
|
0.001
|
26.760
|
7.100 – 100.862
|
|
|
|
|
|
Number of VEs
|
<5
|
|
1
|
|
5 and above
|
0.001
|
59.151
|
21.463 – 163.019
|
|
|
|
|
|
Mode of delivery
|
Vaginal
|
|
1
|
|
Instrumental
|
0.977
|
0.210
|
0.098 - 0.448
|
Caesarean section
|
0.001
|
1.142
|
0.001 – 8977.799
|
|
|
|
|
|
Tears
|
Yes
|
0.013
|
45.157
|
2.266 – 899.722
|
No
|
|
1
|
|
AOR: Adjusted odd ratios, VE: vaginal examination, ANC: antenatal clinic
Etiologies of postpartum pyrexia in Douala general hospital
Malaria was the most common cause of postpartum pyrexia 70 (46.7%). Other causes identified included urinary tract infections, 28 (18.7%), endometritis, 20 (13.3%), pneumonia, 13 (8.7%), perineal wound infection, 5 (3.3%), CS wound infection, 4 (2.7%), acute appendicitis, 2(1.3%), typhoid fever, 2 (1.3%), vaginal candidiasis, 2 (1.3%), venous thromboembolism (1.3%), bacterial vaginosis, 1 (0.7%) and cholecystitis, 1 (0.7%). 12 (9.0%) of women had both malaria and UTI, 3 (2.2%) had UTI and endometritis and 2 (1.4%) had endometritis and perineal wound infection. (Figure 1).
Approximately 73.3% of all cases of postpartum pyrexia started within days 1 to 3 postpartum. Malaria 60.0% (66/110) was the leading cause of fever within the first three days postpartum. Between days 4 to 6, postpartum pyrexia was mainly caused by pneumonia 28.6% (6/21), UTI 23.8% (5/21), malaria 19.0% (4/21) and endometritis 9.5% (2/21). From day 7 and above, the main cause of postpartum pyrexia was endometritis 72.2% (13/18), perineal wound infection 16.7% (3/18) and venous thromboembolism 11.1% (2/18) (Table 3).
Table 3: Aetiologies of PP in relation to day of onset postpartum, DGH 2017-2018, Cameroon.
Causes
|
Day of Onset of Postpartum
|
Day 1 to 3
|
Day 4 to 6
|
Day 7 to 10
|
Malaria
|
66
|
4
|
0
|
UTI (pyelonephritis)
|
23
|
5
|
0
|
Pneumonia
|
7
|
6
|
0
|
Endometritis
|
5
|
2
|
13
|
Acute appendicitis
|
2
|
0
|
0
|
CS wound infection
|
2
|
2
|
0
|
Typhoid fever
|
2
|
0
|
0
|
Vaginal candidiasis
|
2
|
0
|
0
|
Bacterial vaginosis
|
1
|
0
|
0
|
Perineal wound infection
|
0
|
2
|
3
|
Venous thromboembolism
|
0
|
0
|
2
|
TOTAL
|
110
|
21
|
18
|
Microbiological profile of causative agents of postpartum pyrexia
For infectious causes, 89 culture results were reviewed, 20 of which were sterile. The most commonly cultured specimen were urine and high vaginal swabs. E. coli (51.5%) was the most isolated organism (Table 4 and 5). Other microorganisms isolated were Klebsiella pneumoniae, Trichomonas vaginalis, Streptococcus pyogenes, Staphylococcus aureus, Streptococcus pneumonia, Streptococcus agalactiae, Neisseria gonorrhoea, Ureaplasma urealyticum, Candida albicans and Salmonella typhi.
Table 4: Isolated organisms of cultured specimens, DGH 2017-2018, Cameroon
Specimen
|
Frequency
|
Percentage
|
Isolated organisms
|
|
|
|
|
High vaginal swab
|
26
|
29.2
|
E. coli, S.pyogenes, N.gonorrhoea,
U.urealyticum, C.albicans,
S.agalactiae, T. vaginalis
|
Sputum
|
3
|
3.4
|
S. pneumonia
|
Urine
|
50
|
56.2
|
Escherichia coli,
Klebsiella pneumoniae
|
Wound swab
|
7
|
7.8
|
S. aureus
|
Blood
|
3
|
3.4
|
S.typhi
S. pneumonia
|
Total
|
89
|
100.0
|
10
|
Table 5: Results of patients with positive cultures, DGH 2017-2018, Cameroon.
Organism
|
Number
|
Percentage
|
Escherichia coli
|
34
|
49.3
|
Klebsiella pneumoniae
|
6
|
8.7
|
Trichomonas vaginalis
|
6
|
8.7
|
Streptococcus pyogenes
|
5
|
7.2
|
Staphylococcus aureus
|
4
|
5.8
|
Streptococcus pneumonia
|
4
|
5.8
|
Streptococcus agalactiae
|
2
|
2.9
|
Neisseria gonorrhoea
|
2
|
2.9
|
Ureaplasma urealyticum
|
2
|
2.9
|
Candida albicans
|
2
|
2.9
|
Salmonella typhi
|
2
|
2.9
|
TOTAL
|
69
|
100
|