Strengths and Limitations
This study is one of few studies characterizing antibiotic use in the
context of c-section care in rural Africa. The study team prospectively
enrolled patients, worked closely with the hospital teams and collected
high-quality data. However, while interpreting study findings, a number
of limitations should be considered. Collection of antibiotic-related
data was by chart review at the time of discharge, rather than direct
recording at the time of administration, which may affect accuracy of
timing and proper charting of antibiotics prescribed and administered.
Since the data collection occurred as part of a larger prospective
study, providers may have been somewhat aware that the study team was
looking at SSI rates in their patients, potentially causing an
artificial increase in antibiotic prescribing in an effort to keep SSI
rates low. Lastly, some of the patient exposures, including the
peri-operative antibiotics received, may reflect prescribing practices
specific to providers at the district hospital, limiting
generalizability.