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.