Study Site
The study was conducted in rural Eastern Rwanda at Kirehe District
Hospital (KDH), which provides maternal and child health services to a
catchment area of approximately 370,000 people. In 2017, 1,465 women
delivered by c-section at KDH. The vast majority of c-sections are
performed by the 14 GPs, with a few performed by a resident obstetrician
at KDH. In the absence of complications, a mother is routinely
discharged on post-operative day three and instructed to attend a
follow-up visit at her local health centre for wound care. We analysed
use of antibiotics pre-operatively relative to the hospital
leadership-reported protocol of administering antibiotic prophylaxis
within 1-hour prior to incision, similar to the United States SHEA/IDSA
recommendations.15