Risk factors for sepsis among postpartum admitted to tertiary care hospital Karachi, Pakistan; a nested case control study
Date of Award
Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)
Community Health Sciences
To determine risk factors and clinical sign and symptoms for identification of sepsis among postpartum women admitted to public tertiary care hospital, Karachi Pakistan. Background: The high maternal mortality ratio in low and middle income countries accounts for 99% of global estimated maternal deaths. Sepsis is second highest cause of maternal mortality in Pakistan which contributes to 13.7% of all maternal deaths. Sepsis among postpartum women represents spectrum of severity so early recognition can reduce burden on maternal deaths. Systematic inflammatory response syndrome (SIRS) is one of the common methods used to identify sepsis. However, it requires laboratory investigation which may not be feasible in resource constrain setting. Therefore, the aim of this study was to develop a model based on risk factors and clinical signs and symptoms that can help in early identification of sepsis among postpartum women. Methods: A case control study was nested in large existing ongoing cohort of 4000 postpartum women. We conducted this study at Jinnah postgraduate medical Centre (JPMC) from January to July 2017 among reproductive age women who delivered or were admitted in hospital during their postpartum period. We recruited 100 cases and 498 controls. Cases were those who have sepsis and controls were without sepsis according to standard criteria of SIRS. Patient were interviewed for obtaining information on socio-demographic status, antenatal care and maternal life styles while information related to pregnancy and labor, comorbid and clinical sign and symptoms were retrieved from large existing ongoing cohort. Multivariable logistic regression method was performed and discriminative performance of the model was assessed using area under the curve (AUC) of the receiver operating characteristic (ROC). Data analysis was performed on Stata software version 12. Results: An analysis revealed that 1-4 antenatal visits (aOR 0.25 95% CI 0.01-0.62), >4 antenatal visits (aOR 0.82 95% CI 0.38-1.78), number of vaginal examinations (aOR 2.10 95% CI 1.21-3.65), place of delivery (aOR 9.29 95% CI 1.72-50.02), preterm delivery (aOR 3.15 95% CI 1.58-6.25), diabetes in pregnancy (aOR 6.22 95% CI 1.93-20.23), lower abdominal pain (aOR 1.99 95% CI 1.15-3.42), vaginal discharge (aOR 7.77 95% CI 2.97-20.21), Sp02 (aOR 13.0 95% CI 4.80-37.10) and blood glucose (aOR 1.01 95% CI 1.00-1.02) were significantly associated with sepsis. AUC was 0.84 (95% C.I 0.80- 0.89) which indicates that risk factors and clinical sign and symptoms based model have adequate ability to discriminate women with and without sepsis. Conclusion: We developed a model based on risk factors and clinical sign and symptoms for postpartum women. This model demonstrated adequate performance in terms of discrimination among women with and without sepsis and has a potential to be scaled up for community use by frontline health care workers after validation. Keywords: Sepsis and Postpartum women.
Bakhtawar, S. (2017). Risk factors for sepsis among postpartum admitted to tertiary care hospital Karachi, Pakistan; a nested case control study (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.