Final Van Repoert

EVALUATING THE KNOWLEDGE AND PREVENTION PRACTICES OF PUERPERAL SEPSIS AMONG POST
PARTUM WOMEN IN THE BAMENDA REGIONAL HOSPITAL
TITLE PAGE
EVALUATING THE KNOWLEDGE AND PREVENTION PRACTICES AMONG
POSTPARTUM WOMEN IN THE BAMENDA REGIONAL HOSPITAL
Written and presented by FORTU VANESSA ANWI

CERTIFICATION
This is to certify that this research project entitled EVALUATING THE KNOWLEDGE AND
PREVENTION PRACTICES OF PUERPERAL SEPSIS AMONG POSTPARTUM WOMEN
IN THE BAMENDA REGIONAL HOSPITAL is an original carried out by FORTU VANESSA
ANWI in the partial fulfilment for the award of the Higher National Diploma (HND) in nursing
sciences from the Higher Institute of Professional Excellence (HIPE).
SUPERVISOR HEAD OF DEPARTMENT
MISS CHELSEA KUNBID MR NUKONG HADISON
SIGNATURE ………….. SIGNATURE …………
DATE……………………. DATE………………..

DEDICATION
I dedicate this piece of work to my lovely family

AKNOWLEDGEMENT
My sincere gratitude goes to the CEO of HIPE Mr. NDE CHRISTOPHER SARAKANG, the
director of HIPE Mr. MOBIT OLIVER, my humble supervisor Mr. NDUKONG HADISON of
his guidance, support, valuable criticism and experience that contributed immensely to the
completion of my work
I also wish to express my special gratitude to my lovely parents MR AND MRS FORTU and my
brother MR FORTU WALTERS for their words of encouragement, prayers, love, financial and
material support that they contributed positively to my research work.
A special thanks to GOD ALMIGHTY for his guidance, protection, good health, abundant
blessings, knowledge, love, wisdom and understanding during the period of my research.

PREFACE
The quest for professionalism of young graduates for the job market is the main reason that let to
the creation of Higher Institute of Professional Excellence (HIPE). HIPE was created to permit
young Cameroonians acquire the appropriate skills needed by employees in the competitive job
market. HIPE University is located at Ancient Route Bonaberi, adjacent pharmacy de
Bonambappe and Chauteau Bonaberi-Douala. HIPE was created in May 2017 with authorization
NO-17-05219/L/MINESUP/DDES/ESUP/SDA/OPC to run the following specialties
TABLE 1: Higher Institute of Professional Excellence and its specialties
School of School of Biomedical School of Tourism
School of Business Engineering Sciences
-Accountancy -Civil Engineering -Nursing Sciences -Food Processing
-Banking and Finance -Computer -Laboratory -Fashion Textile
-Logistics and Engineering Technology -Beauty care
Transport -Electrical -Midwifery -Cosmetics
-Human Resource Engineering -Physiotherapy -Hotel Management
Management -Mechanical -Tourism
-Exeutive Secretarial Engineering
-Project Management -Wood Technology
ABSTRACT
Background: Puerperal sepsis is defined as infection of the genital tract occurring at any time
between the rupture of membrane and onset of labor, and the 42 nd day postpartum day
postpartum is still a major contributor to maternal morbidity and mortality. Despite diagnosis,
medical management and antimicrobial therapy for sepsis having significantly advanced,
puerperal sepsis remains an important cause of maternal mortality accounting for 10.7% of all
maternal deaths worldwide. In developing countries, most of the risk factors for development of
puerperal sepsis exist and cases of puerperal sepsis have been reported. Adverse outcome
ranging from prolong length of hospital stay to death do occur. Information about this matter is
scarce in this region and thus this study was about the prevalence, knowledge and prevention
practices of puerperal sepsis among postpartum women in the Bamenda Regional Hospital.
Method: A cross sectional, descriptive study design was employed that was base chiefly on
administration of questionnaire and collection and data from women who were diagnosed of
puerperal sepsis and involves 82 postpartum women at the Bamenda regional hospital.
Results: The prevalence of puerperal sepsis was 19(23%) with caesarean section and repeated
vagina examination 45(54%) being significant contributors to puerperal sepsis. With regard to
the knowledge on puerperal sepsis, majority 72(88%) responded that puerperal sepsis is the
infection of the genital tract after delivery. Majority of the participants in this study 72(88%)
responded that the symptom of puerperal sepsis is foul smelling vagina discharge. Base on the
risk factors of puerperal sepsis, majority 45(54%) responded that repeated vagina examination is
a risk factor of puerperal sepsis. With regards to prevention practices of puerperal sepsis,
majority 72(88%) responded that puerperal sepsis can be prevented through the administration of
antibiotics.

Conclusion: Prevalence of puerperal sepsis in the Bamenda Regional Hospital though higher
19(23%) than that of the WHO-reported range of 2-10%, needs to drop to even zero if possible
and caesarean section stood out as the strongest predictor of puerperal sepsis. Repeated vaginal
examination was also seen as a significant risk factor for puerperal sepsis.
This study concluded that there was a high statistical improvement in mothers knowledge and
practice regarding puerperal sepsis after applying the instructional guidelines, this evident that
this guidelines was effective in raising mothers knowledge regarding puerperal sepsis and
improving their practices regarding puerperal sepsis prevention.
Key words: knowledge, prevention practices, puerperal sepsis and postpartum.
RESUME

LIST OF ABBRIVATION
WHO: World health organization.
PROM: Premature rupture of membrane.

SDN: Sustainable development network.
UK: United kingdom.
E.coli: Escherichia coli.
CBC: Complete blood count.
IV: Intravenous.
GBOD: Global burden of disease.
SPSS: Statistical package for social science.
HIPE: Higher institute of professional excellence.
C/S: Caesarean section.
R/L: Ringer lactate.
LIST OF FIGURES
Figure 1: Map of Bamenda regional hospital
Figure 2: Distribution of participants according to age range.

Figure 3: Distribution of participants according to their level of education.
Figure 4: Distribution of participants according to employment status
Figure 6: Distribution of participants according to their number of children
Figure 7: Distribution of participants according to religion status
Figure 8: Distribution of participants regarding their knowledge on what is puerperal sepsis.
Figure 9: Determinants of participants according to their knowledge on the symptoms of
puerperal sepsis
Figure 10: Distribution of respondents regarding their knowledge on the possible cause of
puerperal sepsis.
Figure 11: Distribution of participants with respect to the risk fact of puerperal sepsis
Figure 12: Distribution of participants according to their knowledge on individuals vulnerable to
puerperal sepsis.
Figure 13; distribution of participants according to their knowledge on the period of time of
occurrence of puerperal sepsis
Figure 14; Distribution of participants according to their knowledge on the prevention of
puerperal sepsis
Figure 15; Distribution of participants according to their knowledge on the management of
puerperal sepsis

LIST OF TABLES
Table 1: Higher Institute of Professional Excellence and its specialties
Table 2; guide on prevalence study
Table 3: study time line

Table 4: Budgeting

APPENDIX
Appendix 1: Consent form
Appendix 2: Questionnaire
TABLE OF CONTENT

TITLE PAGE....................................................................................................................................i
CERTIFICATION...........................................................................................................................ii
LIST OF FIGURES.......................................................................................................................vii
LIST OF TABLES...........................................................................................................................x
Table 1: Result for Analysis............................................................................................................x
Table 2; guide on prevalence study.................................................................................................x
TABLE OF CONTEN...................................................................................................................xii
INTRODUCTION.......................................................................................................................1
BACKGROUND.........................................................................................................................1
1.2 PROBLEM STATEMENT....................................................................................................2
1.3 SIGNIFICANT OF THE STUDY.........................................................................................3
1.4 RESEARCH HYPOTHES.....................................................................................................3
RESEARCH QUESTION............................................................................................................4
1.6 RESEARCH OBJECTIVE....................................................................................................4
1.6.1 GENERAL OBJECTIVE....................................................................................................4
1.6.2 SPECIFIC OBJECTIVES...................................................................................................4
1.7 RESEARCH SCOPE AND DELIMINATION.....................................................................4
1.7.1 RESEARCH SCOPE..........................................................................................................4
1.7.2 RESEACH DELIMINATION............................................................................................4
1.8 DEFINITION OF CONCEPTS.............................................................................................5

CHAPTER TWO......................................................................................................................7
LITERATURE REVIEW.........................................................................................................7
2.1.1 Definition of puerperal sepsis..........................................................................................7
2.1.2 EPIDEMIOLOGY OF PUERPERAL SEPSIS...............................................................8
2.1.3 ETIOLOGY OF PUERPERAL SEPSIS.........................................................................9
2.1.4 SIGNS AND SYMPTOMS OF PUERPERAL SEPSIS.................................................9
2.1.5 RISK FACTORS OF PUERPERAL SEPSIS.................................................................9
2.1.6 DIAGNOSIS OF PUERPERAL SEPSIS......................................................................10
2.1.7 PREVENTION OF PUERPERAL SEPSIS..................................................................11
2.1.8 MANAGEMENT OF PUERPERAL SEPSIS..............................................................12
2.2 THEORITICAL REVIEW...............................................................................................13
2.2.1: Theories about the causes of puerperal sepsis in the 18TH and 19TH centuries.............13
2.2.2: The milk metastasis theory...........................................................................................14
2.3 Empirical Review.............................................................................................................14
2.3.1: Prevalence of Postpartum Sepsis..................................................................................14

CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND
According to the WHO report of 2015, puerperal sepsis was defined as infection of the
genital tract occurring any time between rupture of membrane, labour and the 42-day
postpartum [1]. The report also showed that two or more of the following clinical criteria
must be present: pelvic pain, fever, abnormal vagina discharge or delay in uterine
involution [1]. Puerperal sepsis is one of the major cause of maternal death and accounts
for 15% of all maternal deaths in developing countries. If it does not cause death,
puerperal sepsis can cause long term health problems such as chronic Pelvic
Inflammatory disease, and infertility [2]. Puerperal sepsis is the fourth common cause of
maternal mortality after postpartum bleeding unsafe abortion and hypertensive disorder
of pregnancy. It causes about 8% of maternal deaths [3]. Between 2003 and 2009, about
73% (1771000) of all maternal deaths worldwide were from direct obstetric causes, and
puerperal sepsis contributed to 10.7% (261000) of all maternal deaths [4]. The number of
deaths from puerperal sepsis has decreased significantly in high-income countries but still
account for the highest number of deaths in countries with limited resources. The
incidence of puerperal sepsis is relatively low in high income countries (between 0.1 and
0.6 per 1000 births); it is nonetheless an important direct cause of maternal mortality. But
in developing regions such as sub-Saharan Africa and Southern Asia, major maternal
deaths were due to postpartum sepsis [5]. Puerperal sepsis affects 11.2%, 0.9%, 17.9%,
and 39% of postpartum women in Africa respectively, in Tanzania, Nigeria, Cameroon
and Uganda [6-9]. Pre-existing maternal illnesses like (malnutrition, diabetes, obesity,
severe anaemia, bacterial vaginitis, and group B streptococcal infections), prolong
rupture of membrane, manual placenta removal, and caesarean section were significant
factors associated with postpartum sepsis [5]. Prophylactic use of antibiotics for high risk
obstetric conditions such as PROM, meconium stained amniotic fluid, perinea tear,
manual placenta removal, operative vagina delivery , caesarean section, and use of minor
routine procedures (such as perinea shaving) are recommended practices to prevent
morbidity and mortality caused by puerperal sepsis [5]. The postpartum period is the
most vulnerable period for the mother and the born. Puerperal sepsis is still one of the
causes of death in developing countries, mainly in Egypt post natal infection is the fourth
leading cause of maternal death (WHO 2014). The inadequate access to skilled care
during and after childbirth, or neglect to provide the mother with adequate knowledge
and practice to prevent the puerperal sepsis, that can put the mother at risk for infection
[10]. Knowledge among postnatal women on prevention of puerperal sepsis has been
shown to be a determining factor of self-care reported practice on prevention of puerperal
sepsis [5]. Therefore, this study is aimed to evaluate the knowledge, attitude and
prevention practices among postpartum women in the Bamenda regional hospital.
1.2 PROBLEM STATEMENT
Puerperal sepsis is one of the five leading causes of maternal mortality worldwide, and account
for 15% of all maternal death. According to the WHO, puerperal sepsis was attributed for 15% of
358000 maternal deaths that occurred during labour and delivery [11]. Puerperal sepsis is still the

major cause of preventable maternal mortality worldwide, more so in developing countries of
sub-Saharan Africa. It is the most common cause of maternal mortality worldwide [12]. The
millennium development goal 5 and sustainable development goal 3 target improving maternal
health and ensuring good health and wellbeing respectively (the United Nations 2015) wish some
developed countries have made strides towards achieving these targets. Countries in developing
regions especially in sub-Saharan Africa still have a problem as far as reduction of mortality
(SDN, 2014). With global rate decreasing as progress is being made towards sustainable
development goals [13]. However postpartum sepsis remains a leading contributor to maternal
morbidity and mortality especially in sub-Saharan Africa, where 66% of maternal deaths occur
[14]. Estimate of postpartum sepsis rate in Africa are inconsistent, with rates higher than 64%
served in a Nigeria study in 2012 [15]. Studies in Yaounde’ and Maroua central hospital reports
that puerperal sepsis (the leading cause of postpartum sepsis) account for approximately 4.2 and
14.3% maternal deaths respectively. Notable puerperal sepsis has been ranked as the fourth
leading cause maternal death by the WHO [13]. Therefore, this study felt the need to educate the
postpartum mothers about puerperal sepsis and the steps of precaution to prevent puerperal
sepsis using the instructional guideline to improve the knowledge regarding puerperal sepsis and
its prevention.
1.3 SIGNIFICANT OF THE STUDY
The study aims at determining the knowledge, and prevention practices of puerperal sepsis
among postpartum women in the Bamenda regional hospital. More so, the findings of this study
will serve as a guide for health care providers especially nurses to easily identify, evaluate and
prevent postpartum sepsis in the early stage in other to improve patient outcome and hence
promote the overall health of postpartum women with this condition.

Also, the findings of this study will promote planning, implementation and evaluation of
interventional programs and strategies among postpartum women with puerperal sepsis and
reduce the prevalence rate. Moreover, it also create awareness for the nurses and other health
practitioners to device a nursing care plan and take measures towards preventing the disease
condition and improving the health of these women. In addition, the findings of this research will
form a base line for further research on puerperal sepsis in Cameroon.
1.4 RESEARCH HYPOTHES
1. There is a high prevalence of puerperal sepsis among women postpartum in the Bamenda
regional hospital.
2. Postpartum women in the Bamenda regional hospital have limited knowledge about
puerperal sepsis.
3. There is increased level of prevention of puerperal sepsis among postpartum women in
the Bamenda regional hospital.
RESEARCH QUESTION
What is the prevalence of puerperal sepsis among postpaturm women (15-50years) in the
Bamenda regional hospital
What level of knowledge do postpartum women in the Bamenda regional hospital have on
puerperal sepsis
What are the prevention practices of puerperal sepsis among postpartum women in the Bamenda
regional hospital.

1.6 RESEARCH OBJECTIVE
1.6.1 GENERAL OBJECTIVE
To evaluate the knowledge, attitude and prevention practices of puerperal sepsis among
postpartum women
1.6.2 SPECIFIC OBJECTIVES
To estimate the prevalence of puerperal sepsis among postpartum women (15-50year)
To assess the knowledge of puerperal sepsis in postpartum women
To identify the prevention practices of puerperal sepsis among postpartum women
1.7 RESEARCH SCOPE AND DELIMINATION
1.7.1 RESEARCH SCOPE
This study was carried out the Bamenda regional hospital to evaluate the knowledge, attitude and
prevention practices of puerperal sepsis among postpartum women. It also included the
demographic data, obstetric and gynecological history of the participants.
1.7.2 RESEACH DELIMINATION
The political crisis in the North West region of Cameroon made it difficult for me since I could
not go to collect data on days like Mondays that was lockdown.
It was difficult to collect data from some participants since they were well educated and were
unable to read the questionnaire on their own.
1.8 DEFINITION OF CONCEPTS
Sepsis

Sepsis is a life threatening illness caused by your body’s response to an infection. Your immune
system protects you from many illnesses and infections but it’s also possible for it to go into
overdrive in response to an infection.
Puerperal sepsis: It is an infection of the genital tract occurring at labour or within 42 days of
the postpartum period.
Prevention: It is the act of stopping something from happening. It can also be defined as any
action taken to keep people healthy and well and avoid risk of poor health, illness, injury and
early death.
Knowledge: It refers to a fact or condition of knowing something we familiarity gain through
experience or association.
Postpartum period: It is the period that starts from the birth of a new born baby. It last about 40
days; it is in this period that maternal lactation starts and the recovery of the baby to its situation
prior to the pregnancy. It is a time of great physical changes, both psychological and social.
Prevalence: It is the number of new and old cases affected by a disease condition within a
population in a particular geographical area or worldwide during a particular time period.

CHAPTER TWO
LITERATURE REVIEW
2.1 CONCEPTUAL REVIEW
2.1.1 Definition of puerperal sepsis
Puerperal sepsis is generally defined as any bacterial infection of the female reproductive tract
following child birth or miscarriage. Signs and symptoms usually a fever greater than 38°c
(100.4°f), chills, lower abdominal pain and possible foul smelling vagina discharge. [16]
puerperal sepsis is the pregnancy related infection that causes the greatest concern because of its
severity. While various definition of sepsis have been used in the literature [17]. The WHO
convened a group of experts to propose an up-to-date global definition of maternal sepsis,
defined as “a life- threatening condition defined as organ dysfunction resulting from infection
during pregnancy, childbirth, post abortion, or postpartum period [18]. in the eighteen and
nineteenth centuries it is estimated that there were roughly 6-9 cases of sepsis per 1000 deliveries
in Europe with far more occurring during epidemics of puerperal fever [19] .
There is a growing body of evidence that the single most important risk for postpartum infection
is caesarean section [20]. women who undergo caesarean section have a five to twenty – folds
more risk for infection (and infections morbidity compared with vagina birth) [21].

2.1.2 EPIDEMIOLOGY OF PUERPERAL SEPSIS
Sepsis was one of the most common cause of maternal mortality in the 19 TH century, responsible
for half of all cases [22]. Improvement of socioeconomic circumstances and the initiation of
antiseptic techniques, breakthrough of antibiotics caused a sustained fall in death until 1980 [22].
Since then in a view of maternal deaths in the UK, it was surprisingly noted that maternal
mortality due to sepsis was actually on a rise. Although as a result of pregnancy related sepsis is
not common the UK and some other high income countries, mortality rate due to sepsis have
more than doubled over the last two decades in the UK and has also increased in other European
countries [23].
Dushyant D et al study reported that puerperal fever and sepsis are highly preventable problems
that are among the leading causes of maternal morbidity and mortality not only in the developing
countries but also the developed countries as well [24]. In a systematic review of the top four
causes of maternal deaths including hemorrhage and hypertensive disorders, those as a result of
sepsis showed the highest inequity between developed and developing countries, with odd ratio
of 2.7 in Africa, 1.9 in Asia as compared to developed countries [25]. Individual study in
developing countries suggest that the incidence of puerperal sepsis is between 0.1 to 10% of
deliveries [26]. Case fatality rate are recorded between 4 and 40% in sub Saharan Africa [27].
15% of maternal mortality in West Kenya where accounted by puerperal sepsis between 2003-
2008 [28]. Most estimate of puerperal sepsis in sub- Saharan Africa are from retrospective study
of maternal deaths, thus theses shows the burden of clinically defined puerperal sepsis as a cause
of mortality, rather than the actual incidence of puerperal sepsis [29].

2.1.3 ETIOLOGY OF PUERPERAL SEPSIS
Infections may either be outside the health facility or may be nosocomial. Some of the most
common bacteria are: streptococci, Escherichia coli (E.coli), clostridium tetani, clostridium
welchii, chlamydia, and gonococci [30]. Uterine infections usually result from infection
ascending from the vagina into the uterine cavity. different regions have different bacteriological
profiles that change with time. A study done in 1988 by Achola et al showed Neisseria
gonorrhoeae or chlamydia trachomatis, or both, were isolated from the endometrium of 5 out of
35 women with clinical postpartum endometritis compared with none of the control group of 30
puerperal women without endometritis (p less than 0.05) in Nairobi, kenya [31].
2.1.4 SIGNS AND SYMPTOMS OF PUERPERAL SEPSIS
General signs of puerperal sepsis are like a typical infection, such as:
Fever
body ache
Chills
Loss of appetite
Overall discomfort.
More severe symptoms include:
Pain below the waist or in the pelvic bone area caused by an inflamed uterus

Pale clammy skin related to a large amount of blood loss
Foul-smelling vagina drainage revealing an infection
Increase heart rate from blood loss
2.1.5 RISK FACTORS OF PUERPERAL SEPSIS
Your risk of developing puerperal sepsis after you deliver differs depending on the method used
to deliver your baby. Your chance of contracting an infection is;
1-3% of standard vagina deliveries
5-15% of scheduled caesarean delivery performed before labour begins
15-20% of non-scheduled caesarean deliveries performed after labour begins
An additional risk may include females with no previous pregnancy and extreme age such as
very young or old.
Medical conditions such as obesity, anaemia, diabetes, high blood pressure, and immune system
problems may add the chance of infection. Other risk may include;
Multiple vagina examination during labour
Monitoring the fetus inside the uterus
Delay between amniotic sac rupture and delivery or prolonged labor
Manual removal of placenta

Having remains of the placenta in the uterus after delivery
Excessive bleeding after delivery
Baby’s stool found in amniotic fluid
Use of a catheter to soften the opening of the uterus for birth
Overgrowth of bacteria in the vagina (group B streptococcus) bacteria naturally living in the
vagina tract
Sexually transmitted infections
2.1.6 DIAGNOSIS OF PUERPERAL SEPSIS
History taking; the doctor will ask the patient about the previous delivery, fever, pain and foul
smelly vagina discharge.
A complete blood count test (CBC); it is done for white blood cells and hemoglobin estimation.
A platelet count may indicate septicemia (blood stream infection)
Vagina and endocervical swabs; these are required for culture in aerobic and anaerobic media
Urine examination; it is done for routine and microscopic examination
Pelvic ultrasound; the test is used to locate any abscess in the pelvic and any retained pieces of
the placenta
Chest x-rays; a chest x-ray is used to detect any lung pathology

Blood urea and; these test are prescribed to detect renal failure
2.1.7 PREVENTION OF PUERPERAL SEPSIS
The concept of infection control encompasses a range of technologies, interventions and
strategies of varying complexity [32]. Infection control measures of interest to puerperal sepsis
include: hand washing, clean equipment and delivery kits, surgical asepsis, and prophylactic
antibiotics during caesarean section [32].
The infection control campaign by WHO placed hand hygiene as its first priority, and as an
underlying action promoting clean products, practices and equipment [32]. In a study done in
Tanzania, to determine the effectiveness of an intervention that incorporated education about the
use of clean delivery kit in preventing cord infection and puerperal sepsis, women who used the
kit for delivery were 3.2 times less likely to develop puerperal sepsis than women who did not
use the kit [33]. Daily need to clean the intimate area with clean water and do not douche the
genital deeply. In addition, to prevent infection after giving birth, pregnant women need to; do
not have sexual intercourse immediately after giving birth while the health has not recovered.
Reproductive organs needs to be “rested” after going through pregnancy, labour, early
postpartum sex will easily cause damage to the vagina and reproductive organ, leading to
infection (bacteria infection). Every day, keep the intimate area dry and clean, do not use rough
paper or scented wet towels to clean the vagina. Avoid working a lot, avoid earl exercise in the
first month postpartum period. Regularly clean change beddings .clean the intimate area with
look warm, absolutely do not douche deep in the vagina to avoid causing damage. Do not be
excessively abstinent after giving birth. Constantly change under wear to keep the genital area
dry to avoid postpartum infection. Clean breast before and after breast feeding, change bras

often. If you notice a discharge that changes colour or has a foul odour or is painful or swollen,
you should notify a doctor immediately. Two weeks after giving birth, take the initiative to check
back to make sure your health status, prevent postpartum infection and detect problems, come up
with a timely treatment plan.
2.1.8 MANAGEMENT OF PUERPERAL SEPSIS
Nursing management of puerperal sepsis
Promote resolution of the infectious process
Inspect the perineum twice daily for redness, edema, ecchymosis, and discharge
Evaluate for abdominal pain, fever, malaise, tachycardia, foul-smelling lochia
Obtain spacimen for laboratory analysis; report findings
Offer a balanced diet, frequent fluids, and early ambulation
Administer prescribed antibiotics or medications; document the clients reponse
Provide client and family teaching
Describe and demonstrate self-care stressing careful perineal hygiene and hand washing
MEDICAL MANAGEMENT OF PUERPERAL SEPSIS
Puerperal sepsis is primarily treated with broad-spectrum antibiotics given intravenously (IV) if
you are still in the hospital. Broad spectrum antibiotics cover a variety of bacteria and are used
when the type of bacteria is unknown. If you have symptoms of an infection after you return

home, your doctor may readmit you in the hospital for treatment. Once your condition is under
control with IV antibiotics, the doctor will likely switch to oral antibiotics upon discharge, Oral
antibiotics include;
Augmentin (amoxicillin and clavulanate)
Vibramycin (doxycycline) plus flagyl (metronidazole)
Levaquin (levofloxacin) plus flagyl (metronidazole)
2.2 THEORITICAL REVIEW
2.2.1: Theories about the causes of puerperal sepsis in the 18TH and 19TH
centuries
Like with smallpox, the theories about the cause of puerperal sepsis that flourished during this
period mirrored medicine’s disjointed evolutions away from the humoral theory and toward the
concept of contagion. Theories progressed during the 18 TH century from the belief that the
disease had its origin inside the human body to the one in which the origin was outside the
human body.
A popular 18TH century theory of puerperal fever was that the lochia was retained, stagnating to a
putrid mess in the womb. At first physicians reasoned that the retention was due to the returned
humors that built up in early pregnancy due to tight clothing, but the reason for retention
evolved. One theory suggested that retention occurred when a woman’s blood becomes “too
thick” or when the vessels of the uterus narrowed. A later concept was that cold air inadvertently
exposed to the uterus near the time of delivery could cause uterine constriction and the retention

of the fluid. Even drinking cold water or exposing one’s feet to the cold might begin the process.
Nearly any shock to a woman’s system late in pregnancy was deemed a possible trigger to
childbed fever.
2.2.2: The milk metastasis theory
The development of breast milk was thought to occur because of transformation of menstrual
fluid from the uterus to the breast following delivery. As strange as that sounds physician were
convinced that an anatomic connection exist between the top of the uterus and the breast,
Leonardo de vinci even depicted the duct in a drawing, even though he was never able to
visualize it in his dissections, when autopsies were performed on women who died on puerperal
sepsis, the abdomens were filled with a fluid so similar in appearance in to breast milk that it was
assumed that the woman had the pathologically retained the precursor to breast milk in the
uterus. This conjecture explained why woman suffer from childbirth fever would stop lactation.
According to the theory, eventually, the milk fluid would build up, obstructed from taking its
normal part to the breast for unknown reasons, and spill over, or metastasize to other organs in
the abdomen, pelvis, or elsewhere in the body via the blood stream. This retained milky fluid
seen throughout an inflicted woman’s body at autopsy was in reality, pus inflamed fluids with
WBCs, bacteria and decayed tissues. This pus-filled was evident all over a woman’s abdomen
after a death from puerperal sepsis. Autopsies from women who died from puerperal sepsis were
not for the faint of heart. The Stench released from the affected uterus was sufficient to cause
fainting among those who had not Previously Experienced It.

2.3 Empirical Review
2.3.1: Prevalence of Postpartum Sepsis
The prevalence of postpartum sepsis varies worldwide, with reports between 2-10% and varies
by risk factors. The world health organization used an estimate of 5% incidence for the global
burden of disease (GBOD) work [34]. According to WHO estimate, maternal sepsis among live
births has a prevalence of 4.4% globally, representing more than 5.7 million cases per year
[35].important variations exist between regions with high incidence in low income and middle
income countries (up to 7%) compared with high income countries(1-2%). In 2013, over 30,000
maternal deaths (11%) were attributed to postpartum sepsis, the third most frequent cause of the
approximately 290,000 maternal death worldwide. Almost all these deaths occurred in low
resource setting and the region with the greatest proportion of maternal deaths due to sepsis was
south Asia (14%).
Despite the relatively low prevalence and the availability of intervention for its prevention and
treatment, maternal sepsis remains a life-threatening condition and one of the leading direct
causes of maternal mortality worldwide, accounting for up to 10% of maternal death [35] over 5
million per year of maternal sepsis occurs globally with an estimate 75,000 maternal deaths [36].
The risk of puerperal sepsis in high income countries is 2.1% of all maternal deaths, while in low
income countries it is 11.6% for example 2-2.7-fold high in Africa, Asia, Latin America and the
Caribbean than in developed countries [36].
Low resource countries account for 99% (286,000) of global maternal mortalities with sub
Saharan Africa responsible for the bulk of the maternal deaths and accounting for 62% followed
by southern Asia at 24%. The biggest contribution to these deaths is puerperal sepsis [37]. In
Uganda there have being a slow decline in maternal mortality ratio between 1990 and 2010
(from 550 in 1990 to 438 in 2012) [37]. A study was carried out by [38] who studied the
“Associated factors with puerperal sepsis among reproductive age women in Nandi county,
Kenya” and found that nearly two third of the studied sample was aged between 20-25 years. It
was also reported in a published study conducted in the university of Gondar referral hospital
Ethiopia by [39] entitled “puerperal sepsis and its associated factors among mothers in university
of Gondar referral hospital, Ethiopia 2017” that the majority of the study sample was aged
between 18-29 years.
2.3.2: knowledge on puerperal sepsis
Puerperal sepsis is a serious type of septicaemia contracted by mothers during or soon after child
birth, miscarriage or unsafe abortion. It arises from several causes, mothers susceptibility to
developing an infection is related to such factors as caesarean section, prolong labour and obesity
[40]. A study was carried out by [41] who studied the “impact of puerperal sepsis nursing
guideline on mothers knowledge and practice” in Egypt, he found that less than two third of the
study sample had unsatisfactory knowledge regarding puerperal sepsis in pre-test. While this
study is not in the same line with [42] who reported that less than two third of the studied sample
had an average knowledge regarding puerperal sepsis. A study was also carried out by [43] in
Ethiopia who found that postpartum women having more than five times per-vaginal
examination during labour are at risk of puerperal sepsis.
2.3.3: prevention of puerperal sepsis
Puerperal sepsis is the cause of preventable maternal morbidity and mortality. Concerning the
practice level of puerperal sepsis, a study carried out by [44] who reported that more than half of

postpartum mothers had unsatisfactory practices. Also this result was supported by [45] who
reported that majority of the mothers had unsatisfactory practices. In addition, these result come
in accordance with [46] who stated that the practices of the studied mothers were inadequate.
This result came inconsistent with [40] who reported satisfactory practice level about prevention
of puerperal sepsis. Another study carried out by [41] who mentioned that nearly more than half
(59.0%) of the studied sample were always committed with the guidelines to protect themselves
against puerperal sepsis.
CHAPTER THREE
METHODOLOGY
3.1 STUDY DESIGN
This study was a cross sectional quantitative study designs. Questionnaire was use to collect data
from active postpartum women so as to evaluate their knowledge and prevention practice of
puerperal sepsis during the postpartum period (women aged 15-50). A prevalence guide compose
of questions was used to determine the trend in the prevalence of puerperal sepsis and prevention
practices among postpartum women who were diagnosed of puerperal sepsis.
3.2.1 STUDY AREA
This study will be carried out in the Bamenda regional hospital in the North west region of
Cameroon

Figure 1: Picture of Bamenda regional hospital.
3.2.2 PRESENTATION OF THE STUDY AREA
Bamenda regional hospital is a major health care facility located in the North West Region of
Cameroon. It serves as a referral centre for smaller health facility in the region and provides a
whole range of medical services to the community.
The hospital is equipped with modern medical equipment and facilities, and it is staffed by a
team of highly trained and doctor experienced health care professionals including doctors, nurses
and support staff.

The services offered at the Bamenda regional hospital include emergency care, general medicine
surgery, obstetrics and gynaecology, paediatrics and specialized care for the condition such as
diabetes, hypertension, HIV/AIDS.
In addition to its medical service, the hospital also plays a key role in medical education and
research, hosting training programs for medical students and offering opportunities for health
care professionals to engage in research and professional development.
3.3 STUDY POPULATION
The study population will be made up of women postpartum (15-50years) in the Bamenda
regional hospital
3.3.1 INCLUSION CRITERIA
All postpartum women (15-50years) present in the maternity of Bamenda regional hospital
Women who will give their consent to participate in the study
3.3.2 EXCLUSION CRITERIA
Women who are still to put to birth
Women who will not give their consent to participate in this study
Sample population for the prevalence of puerperal sepsis
Inclusion criteria
All participants diagnosed of puerperal sepsis

Exclusion criteria
Participants who are not diagnosed puerperal sepsis
SAMPLE SIZE DETERMINATION
3.4.1 Sampling technique
This study employed non-probability sampling technique made up of purposive and
convenient sampling techniques, as well as a probability sampling made up of simple random
sampling technique. First the purposive sampling technique will be used to select participants
because they possess the characteristics relevant to the study. Secondly, a simple random
sampling in which the participant are selected at random to participate in the study.
3.4.2 Sample size calculations
This refers to an approximation of the representative segment of the population selected to
represent the population as a whole.
The sample size was calculated using the following formula.
no=Z2 p(1-p)/d2
where no = the sample size for a very large population greater than 1000
Z = 95% of confidence level and equals 1.96
d= degree of sample error 5% (0.05%)
p= estimated prevalence of estimated proportion 10% = 0.1

no= 1.962*0.1 (1-0.1)/(0.052)
no= 138.29 ≈ 138participants
The study will be adjusted for finite population using the formula stipulated [37].
n= no/1+ (no/N)
where n = desired sample for population less than 10,000
no= desired sample size population greater than 10000
N= estimation of the population size: 200
n= 138/1+(138/200)
n= 81.65 ≈ 82 participants
3.5 DATA COLLECTION
Data was collected using questionnaires with a close ended question. Furthermore, Data was
collected from Participants who have been diagnosed of puerperal sepsis using specific questions
(a prevalence study guide). The purpose of the study was explained to the participants and their
inform consent given before they will answer the questionnaire. The data capturing sheet will be
checked on daily basis to ensure correct entry of information.
3.5.1 METHOD OF DATA COLLECTION
Data was collected using questionnaire with close ended question. Data was collected from
participants diagnosed and those not diagnosed of puerperal sepsis using. Patient record was

checked to see those who meet the inclusion criteria. The purpose of the study was explained to
the participants and their consent was gotten before they answered the questionnaire. The data
capturing sheet was checked on daily basis to ensure correct entry of information. A simple
random sampling method was used since all the participants met the inclusion criteria was
studied and purposive sampling method was used because, the participants was purposefully
selected for a reason which provided answer to the research.
3.5.2 DESCRIPTION OF THE QUESIONNAIRE
The questionnaire was a close ended question. which include;
Section A: identification of the patient (demographic data)
Section B: puerperal sepsis knowledge
Part 1: puerperal sepsis definition, symptom, risk factors
Part 2: the time period of occurrence and the group of people affected by puerperal sepsis
Section C: prevention practices and management of puerperal sepsis
3.6 DATA MANAGEMENT AND ANALYSIS
3.6.1 DATA MANAGEMENT
Data was checked for, entered in to Microsoft excel 2010 and analysed using statistical package
for social sciences (SPSS) version 23.

3.6.2 DATA ANALYSIS
Descriptive statistics such as the mode, mean, median, standard deviation, minimum and
maximum values, and frequency and percentage distribution were computed. The results will be
analyzed and presented in the form of bar charts and pie charts.
3.7 ETHICAL CONSIDERATION
Ethical approval to conduct the study was obtained from head of department of HIPE university
and from the head of nursing department of the Bamenda regional hospital.
Consent was obtained from postpartum patients who participated in the study, after explanation
of the study and the voluntary nature of the participation
Confidentiality was guaranteed as; name and phone number of participants did not appear on the
questionnaire.

CHAPTER FOUR
RESULT
4.1 DEMOGRAPHIC DATA
4.1.1 AGE RANGE OF PARTICIPANTS
AGE RANGES
15-25 years 26-35 yeas 36-50 years
9(11%)
39(48%)
34(41%)
Figure 1: Distribution of participants according to age range.
From the figure above, it can be seen that among the 82 participants in this study, 39(48%) were
of age 15-25 years, 34(41%) were of age 26-35years while 9(11%) were of age 36-50 years of
age.
4.1.2 level of education.

LEVEL OF EDUCATION
40
35
30
25 university
secondary
20 primary
37(45%
15 31(39%)
10
13(16%)
5
0
primary secondary university
Figure 3: Distribution of participants according to their level of education.
From the figure above, it can be seen that among the 82 participants that took part in this study,
13(16%) were of primary level of education, 31(39%) were of the secondary level and 37(45%)
were of the university level of education.

4.1.3 Employment status
ENPLOYMENT STATUS
employed unemployed
29(35%)
53(65%)
From the figure above, we can see that among the 82 participants in this study, 29(35%) were
employed whereas 53(65%) were unemployed.

4.1.5 Marital status
MARITAL STATUS
single married
38(46%)
44(45%)
Figure 5: Distribution of participants according to marital status
From the above figure, it can be seen that amongst the 82 participants that took part in this study,
38(46%) were single, while 44(54%) were married.

4.1.6: number of children
NUMBER OF CHILDDREN
one child two children 3 and above children
22(27%)
29(35%)
31(38%)
Figure 6: Distribution of participants according to their number of children
From the above figure it can be seen that amongst the 82 participants that took part in this study,
22(27%) had one child, majority 31(38%) had two children, while 29(35%) had children and
above.

4.1.7: religion status
RELIGION STATUS
chistain muslim
4(5%)
78(95%)
Figure 7: Distribution of participants according to religion status
From the above figure it can be seen that amongst the 82 participants that took part in this study,
78(95%) were Christians while 4(5%) were Muslims.

4.2 KNOWLEDGE ON PUERPERAL SEPSIS
4.2.1 knowledge on puerperal sepsis
80
70
60
50
40
72(88%)
30
20 a respiratory infection
10 disease of the digestive system
3(4%) 7(8%) infection of the genital tract
0
ct m on
tra ste cti
la y e
it es nf
gen stiv r yi
e ge to
f th
e di p ira
o h es
tio
n
oft ar
c e
fe as
in ise
d
Figure 8: Distribution of participants regarding their knowledge on what puerperal sepsis
is.
From the figure above, it can be seen that among the 82 participants in this study, majority
72(88%) responded that puerperal sepsis is an infection of the genital tract after delivery,
minority 3(4%) responded that puerperal sepsis is a digestive infection and 7(8%) responded that
puerperal sepsis is a respiratory infection.

4.2.1 knowledge on the symptoms of puerperal sepsis
SYPMTOMS OF PUERPERAL SEPSISES

foul-smelling vagina dischage I don’t know
10(12%)
72(88%)
Figure 9: Determinants of participants according to their knowledge on the symptoms of
puerperal sepsis.
From the above figure, it can be seen that among the 82 participant, majority 72(88%) responded
that foul smelling discharge is a symptom of puerperal sepsis whereas a minority 10(12%)
responded that they don’t know the symptoms of puerperal sepsis.

4.2.3 knowledge on the possible cause of puerperal sepsis
70
60
50
40
30 65(79%)
20
10 drinking dirty water
10(12%) 5(7%) eating contaminated food
0 2(2%)
mosquito bite
ct te od er
ra bi fo at bacterial infection ot the genital
la t ito w tract
it ed rty
n squ at di
ge o in g
th
e m am in
of ont ink
r
n gc d
ctio atin
cfe e
nfe
li
eria
ct
ba
Figure 10: Distribution of respondents regarding their knowledge on the possible cause of
puerperal sepsis.
From the figure above, it can be seen that among the 82 participants in this study, majority that is
65(79%) responded that bacterial infection of the genital tract can cause puerperal sepsis, 2(2%)
responded that mosquito bite can cause puerperal sepsis, 5(7%) responded that eating
contaminated food can cause puerperal sepsis and 10(12%) responded that drinking dirty water
can cause puerperal sepsis.

4.2.4 Knowledge on the risk factors of puerperal sepsis
RISK FACTORS
repeated vagina examination high glucose level in the body
not getting enough sleep I don’t know
(8(10%) 8(10%
45(54%)
21(26%)
Figure 11: Distribution of participants according to their knowledge on the risk fact of
puerperal sepsis
From the figure above, we can see that among all the 82 participants, 45(54%) responded that
repeated vaginal examination is a risk factor to puerperal sepsis, 21(26%) responded that high
glucose level in the body is a risk factor to puerperal sepsis, 8(10%) responded that not getting
enough sleep is a risk factor of puerperal sepsis and 8(10%) responded they don’t know the risk
factor of puerperal sepsis.

4.2.5 knowledge on the group of individuals vulnerable to puerperal sepsis
60
50
40
30 I don’t know
55(67%) women who have put to birth
children
20 adulescent girls
10 18(22%)
6(7%) 3(4%)
0
adulescent children women who I don’t know
have put to
birth
Figure 12: Distribution of participants according to their knowledge on individuals
vulnerable to puerperal sepsis.
From the figure above, it can be seen that among the 82 women that took part in this study,
18(22%) responded that adolescent are vulnerable to puerperal sepsis, 6(7%) responded that
children are vulnerable to puerperal sepsis, 55(67%) responded that women that have just put to
birth are vulnerable to puerperal sepsis and 3(4%) responded they have no idea on individual that
are vulnerable to puerperal sepsis.

4.2.6 Knowledge on the period of time of occurrence of puerperal sepsis
PERIOD OF TIME OF OCCURRENCE OF PUERPERAL SEPSIS

during sexual intercourse at the time ofdelivery
six weeks after delivery I don’t know
5(7%)
16(19%)
40(49%)
21(25%)
Figure 13; distribution of participants according to their knowledge on the period of time
of occurrence of puerperal sepsis
From the figure above, out of the 82 participants in this study, 16(19%) responded that the period
of time of occurrence of puerperal sepsis is during sexual intercourse, 21(25%) responded that
the period of time of occurrence of puerperal sepsis is at the time of delivery, 40(49%) responded
that the period of occurrence of puerperal sepsis is six weeks after delivery meanwhile 5(7%)
responded that period of time of occurrence of puerperal sepsis.

4.3 prevention practices and management of puerperal sepsis
4.3.1 How can puerperal sepsis be prevented
80
70
60
50
40
72(88%)
30
20
10 I don’t know
0 4(5%) 2(2%) 4(5%) noneof the above
y adequate antenatal and antepar-
er re ve w tum care
rg ca
abo kno
su m e ’t through surgery
artu f th don
p
te eo I
an no
n
d
an
tal
na
nte
a
ate
u
eq
ad
Figure 14; Distribution of participants according to their knowledge on the prevention of
puerperal sepsis
From the above figure, it can be seen that among the 82 participants, 4(5%) responded that
puerperal sepsis can be prevented through surgery, 72(88%) responded that puerperal sepsis can
be prevented through adequate antenatal and antepartum care, 2(2%) participant responded none
of the above and 4(5%) responded that they don’t know.

4.3.2 How can puerperal sepsis be manage
80
70
60
50
40 75(91%)
30
20 by drinking alcohol
10 by the administration of an-
0 5(6%) 2(3%) tibiotics
l by not getting pregnan
nt cs ho
gna ioti lco
p re tib ga
an ik n
ng of in
tti
tg
r on dr
no tr ati by
by is
in
m
e ad
y th
b
Figure 15; Distribution of participants according to their knowledge on the management of
puerperal sepsis
From the above figure, out of the 82 participants in this study, 5(6%) responded that puerperal
sepsis can be managed by not getting pregnant, majority that is 75(91%) responded that
puerperal sepsis can be managed by the administration of antibiotics, 2(3%) responded that
puerperal sepsis can be managed by drinking alcohol and 0(0%) responded they don’t know.

4.4 Data on the prevalence of puerperal sepsis
prevalence of puerperal sepsis
2(3%)
prevalence of puerperal sepsis

19(23%) caesarean section
17(2O%) normal delivery
Figure 16: distribution of participant according to the prevalence of puerperal sepsis.
From the figure above it can be seen that out of the 82 participants, 19(23%) had puerperal
sepsis. 2(3%) normal delivery had Endometritis, 2(3%) caesarean section had urethritis.
Meanwhile majority that is 15(17%) caesarean section had endometritis, Therefore, there is a
high prevalence rate of puerperal sepsis among cases with caesarean delivery.

CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATION
5.1 DISCUSION
5.1.1 SOCIO-DEMOGRAPHIC FINDINGS
Based on the socio-demographic data collected in relation to age range in this study, majority of
the participants were aged 15-25 years that is 39(48%) which is similar to a study carried out by
Chepchirchir, Nyamari, and Keraka., [38]. who studied the “Associated factors with puerperal
sepsis among reproductive age women in Nandi county, Kenya” and found that nearly two third
of the studied sample was aged between 20-25 years which was 50.8%. While the moderate was
from 26-35 years that is 34(41%), and minority was from 36-50 years that is 9(11%). This could
be due to the difference in the study area and duration of the study.
5.1.2 PREVALENCE OF PUERPERAL SEPSIS
This study found out that, the prevalence of puerperal sepsis was 19(23%) which is higher than
that reported by Bartlett et al., [34].Though higher, these findings mirror closely those by Bonet
et al.,( 13.38%) [35].With difference being attributed to variation in religion, population
dynamics, study design and study periods. The other difference was evident by Bonet et al.,
which was [35] study which reported that puerperal sepsis contributed up to 10% of maternal
mortality. The case mortality in this study was zero! This too could be attributed to difference in
study population, sample size and duration of study. Also, there was an increase prevalence of
puerperal sepsis among women with caesarean delivery that is 17(20%). Though lower this

study is similar to a study carried out by [35] who reported that the prevalence of puerperal
sepsis among caesarean women was (50.70%) than normal delivery which was 2(3%). In this
study, mode of delivery significantly determined the occurrence and hence prevalence of
puerperal sepsis. It showed that 17(20%) who delivered by caesarean section had puerperal
sepsis which is higher than that of normal delivery that is 2(3%). this might be due to poor
aseptic techniques in operation room, poor hygienic practices of women after the procedure and
those women who undergo caesarean section might have other complications for the indication
of surgery like prolong labour, prolong rupture of membrane, haemorrhage. These complications
can increase the risk of infection. This finding is supported by study conducted in Oromia region
Ethiopia Chepchirchir, Nyamari and Kerak., [38]. And a systemic review and meta-analysis
conducted in Brazil Atlaw, Seyoum, Woldeyohanne and Berta., [39]. This findings contradict a
study conducted in Gondar referral hospital in which women who delivered by caesarean section
were two times less likely to develop puerperal sepsis than those who delivered by spontaneous
vagina birth [40]. This difference might be due to the difference in the application of aseptic
techniques in the study setting.
5.1.2 KNOWLEDGE OF PUERPERAL SEPSIS AMONG POSTPARTUM WOMEN IN
THE BAMENDA REGIONAL HOSPITAL
This study finding reveals that a greater percentage of postpartum women (45%) who were well
educated (university) had knowledge on puerperal sepsis. This study is consistent with the study
carried out in India. [44].In this study, majority of the participant 72(90%) defined puerperal
sepsis as an infection of the genital tract after delivery which is similar to the definition by WHO
[1] who defined puerperal sepsis as infection of the genital tract occurring any time between

rupture of membrane, labour and the 42-day postpartum. Majority of the participant 72(82%)
responded that foul-smelling vagina discharge is a symptom of puerperal sepsis which is similar
to that reported by WHO [1].
Regarding participant knowledge on the cause of puerperal sepsis, majority of the participant
that is 65(79%) responded that puerperal sepsis is caused by bacterial infection of the genital
tract. This study is in line with the study carried at by Geneva et al. [30] who reported that
puerperal sepsis can be caused by bacterial infection of the genital tract. Some of the most
common bacteria are: streptococci, Escherichia coli (E.coli), clostridium tetani, clostridium
welchii, chlamydia, and gonococci. With regards to participant knowledge on the risk factors of
puerperal sepsis, a greater percentage that is 45(54%) responded that the risk factor of puerperal
sepsis is repeated vagina examination. This findings is in line with the study carried out by G.A.
Demisse et al. [43] in Ethiopia who found that postpartum women having more than five times
per-vaginal examination during labour are at risk of puerperal sepsis. In addition, this study
found that caesarean section is also a significant contributing factor of
5.1.3: PREVENTION PRACTICES ON PUERPERAL SEPSIS
Puerperal sepsis, this is in line with a study that stated, mother susceptibility to developing an
infection is related to such factors as caesarean section, prolong labour and obesity Sultana et al.
[40]. Regarding mothers knowledge on the period of time of occurrence of puerperal sepsis,
majority of the participant that is 40(49%) responded that puerperal sepsis occur six weeks after
delivery. This study is similar to WHO [1] who reported that puerperal sepsis occurs from the
onset of labour and rupture of membrane to 42days postpartum.

Base on the prevention practices of puerperal sepsis, this study found that a greater percentage of
the participants that is 72(88%) responded that puerperal sepsis can be prevented through
adequate antenatal and antepartum care, which is similar to the study carried out by Gemel,
Genedy and Hassan.[41] who mentioned that nearly more than half (59.0%) of the studied
sample were always committed with the guidelines to protect themselves against puerperal
sepsis.
5.2: CONCLUSION
Prevalence of puerperal sepsis in the Bamenda Regional Hospital though higher than that of the
WHO-reported range of 2-10%, needs to drop to even zero if possible and caesarean section
stood out as the strongest predictor of puerperal sepsis. Repeated vaginal examination was also
seen as a significant risk factor for puerperal sepsis.
This study concluded that there was a high statistical improvement in mothers knowledge and
practise regarding puerperal sepsis after applying the instructional guidelines, this evident that
this guidelines was effective in raising mothers knowledge regarding puerperal sepsis and
improving their practices regarding puerperal sepsis prevention. The data collected from this
study provide answers to the objectives.
5.3: RECOMMENDATION

5.3.1: To the staffs of Bamenda regional hospital
Due to the increase prevalence of puerperal sepsis, much can be done to reduce it to almost near
to or equal zero. Timely screening, diagnosis and treatment of comorbid conditions together with
strict adherence to aseptic techniques and infection control measures could lower it even further.
5.3.2: To postpartum women
Postpartum women in the Bamenda Regional hospital should maintain proper personal hygiene
5.3.3: To fellow researchers
So many questions that need answers have come up with this study. Some aspects were out of
the scope of this study and thus they can pick up from where this study left or did not tackle. For
example, health- care associated factors affecting puerperal sepsis were not studied here plus
ways in reducing puerperal sepsis to almost zero could also be studied. Similar studies could be
conducted in other health facilities within the region or country.

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(2016). Maternal deathe audit in Rwanda 2009-2013: a nationwide facility - based
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… Riley, L. E. (2016). Incidence of postpartum infection, outcomes and associated
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sepsis among reproductive age women in Nandi country, Kenya. Journal of
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prevention of selected maternity hospital 2016.

APPENDIX I
CONSENT FORM
EVALUATING THE KNOWLEDGE AND PREVENTION PRACTICES OF
PUERPERAL SEPSIS AMONG POST PARTUM WOMEN IN THE REGIONAL
HOSPITAL.
Dear participant, I am FORTU VANESSA ANWI a level 300 student at the HIGHER
INSTITUDE OF PROFESSIONAL EXCELLENCE DOUALA (HIPE). I am currently
conducting a research project title “EVALUATING THE KNOWLEDGE AND
PREVENTION PRACTICES OF PUERPERAL SEPSIS AMONG POSTPARTUM
WOMEN IN THE BAMENDA REGIONAL HOSPITAL”. The purpose of this study is
to improve the knowledge and prevention practices of puerperal sepsis among women in
the Bamenda regional hospital in the partial fulfillment of the HND. Answering the
following questions will help me achieve my objectives. The information you will
provide will be kept confidentially and only use for educational purpose.
Fortu Vanessa anwi (research student)
Date ………………………….
Participant signature ………………
THANKS FOR PARTICIPATING.

APPENDIX II
QUESTIONNAIRE
SECTION A: socio-demographic data
1. Gender: female
2. Age: A) 15-25 B) 26-35 C) 36-50
3. Educational level: A) primary B) secondary C)university D)never

4. Employment status: A) Employed B) unemployed C)retired
5. Marital status: A) single B) married
6. Number of children: A) 1 B) 2 C) 3 and above
7. Religion: A) Christian B) Muslim C) pagan
SECTION B: knowledge on puerperal sepsis
8. What is puerperal sepsis?
A) It is an infection of the genital tract after delivery
B) It is a disease of the digestive system
C) It is a respiratory infection
D) It is an infection of the brain
9. Which of the following is a symptom of puerperal sepsis?
A) Chest pain
B) Nose bleed
C) Foul-smelling vagina discharges
D) I don’t know
10. What is a possible cause of puerperal sepsis?
A) Bacteria infection of the genital tract

B) Mosquito bite
C) Eating contaminated food
D) Drinking dirty water
11. Which of the following is a risk factor of puerperal sepsis?
A) High glucose level in the body
B) Repeated vagina examination
C) Not getting enough sleep
D) I don’t know
12. Which group of individuals are vulnerable to puerperal sepsis?
A) Adolescent’s girls
B) Children
C) women who have put to birth
D) I don’t know
13. What is the period of time of occurrence of puerperal sepsis?
A) During sexual intercourse
B) At the time of delivery

C) Six weeks after delivery
D) None of the above
SECTION C: prevention practices and management of puerperal sepsis
14. How can puerperal sepsis be prevented?
A) Through surgery
B) Through adequate antenatal and antepartum care
C) None of the above
D) I don’t know
15. How can puerperal sepsis be managed?
A) By not getting pregnant
B) Through the administration of antibiotics
C) By drinking alcohol
D) None of the above

GUIDE ON PREVALENCE STUDY
Table 2; guide on prevalence study
Date of admission …………………
Criteria Information on puerperal sepsis
Age
Number of children
Mode of delivery
Treatment plan


Study time line and budgeting
Table 3: study time line
Activities months
October November December January to March April
2023 2023 2023 February 2024 2024
202
Choosing a
research
topic
Writing a
research
proposal
Correcting,
submitting of

research
proposal
Collection of
data
Data analysis
writing
report
discussion
Corrections,
proof
reading, pre-
defence
Submission,
defence and
correction
Table 4: Budgeting
MATERIALS QUANTITY UNIT COST ESTIMATED
COST(FCFA)\
Amount use for 10,000 10,000
internet
Printing of research 1 copy 2,000 2,000

proposal to be
corrected by
supervisor
Printing of 2pages 20frs per page 4,000
questionnaires 82copies
Printing of research 1 copy 2,000 2,000
proposal for the
approval to carry out
data collection in the
Bamenda regional
hospital
Pens 2 200 400
Flash drive 1 3,500 3,500
Laptop 1 95,000 95,000
Transportation to the 3,000 21,000
hospital for data
collection for 3 weeks
Data analysis 5,000 5,000
Printing and binding 5 3,000 15,000
of final research work
Miscellaneous 5,000 5,000
Total 162,900FCFA


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EVALUATING THE KNOWLEDGE AND PREVENTION PRACTICES OF PUERPERAL SEPSIS AMONG POST

PARTUM WOMEN IN THE BAMENDA REGIONAL HOSPITAL

EVALUATING THE KNOWLEDGE AND PREVENTION PRACTICES AMONG

POSTPARTUM WOMEN IN THE BAMENDA REGIONAL HOSPITAL

Written and presented by FORTU VANESSA ANWI

PREVENTION PRACTICES OF PUERPERAL SEPSIS AMONG POSTPARTUM WOMEN

IN THE BAMENDA REGIONAL HOSPITAL is an original carried out by FORTU VANESSA

sciences from the Higher Institute of Professional Excellence (HIPE).

SUPERVISOR HEAD OF DEPARTMENT

MISS CHELSEA KUNBID MR NUKONG HADISON

SIGNATURE ………….. SIGNATURE …………

Written and presented by FORTU VANESSA ANWI

I dedicate this piece of work to my lovely family

Written and presented by FORTU VANESSA ANWI

material support that they contributed positively to my research work.

Written and presented by FORTU VANESSA ANWI

market. HIPE University is located at Ancient Route Bonaberi, adjacent pharmacy de

NO-17-05219/L/MINESUP/DDES/ESUP/SDA/OPC to run the following specialties

TABLE 1: Higher Institute of Professional Excellence and its specialties

School of School of Biomedical School of Tourism

School of Business Engineering Sciences

-Accountancy -Civil Engineering -Nursing Sciences -Food Processing

-Banking and Finance -Computer -Laboratory -Fashion Textile

-Logistics and Engineering Technology -Beauty care

Transport -Electrical -Midwifery -Cosmetics

-Human Resource Engineering -Physiotherapy -Hotel Management

Management -Mechanical -Tourism

-Exeutive Secretarial Engineering

-Project Management -Wood Technology

Written and presented by FORTU VANESSA ANWI

improving their practices regarding puerperal sepsis prevention.

Key words: knowledge, prevention practices, puerperal sepsis and postpartum.

Written and presented by FORTU VANESSA ANWI

WHO: World health organization.

PROM: Premature rupture of membrane.

Written and presented by FORTU VANESSA ANWI

SDN: Sustainable development network.

UK: United kingdom.

E.coli: Escherichia coli.

CBC: Complete blood count.

GBOD: Global burden of disease.

SPSS: Statistical package for social science.

HIPE: Higher institute of professional excellence.

C/S: Caesarean section.

R/L: Ringer lactate.

Figure 1: Map of Bamenda regional hospital

Figure 2: Distribution of participants according to age range.

Written and presented by FORTU VANESSA ANWI

Figure 3: Distribution of participants according to their level of education.

Figure 4: Distribution of participants according to employment status

Figure 4: Distribution of participants according to employment status

Figure 6: Distribution of participants according to their number of children

Figure 7: Distribution of participants according to religion status

Figure 8: Distribution of participants regarding their knowledge on what is puerperal sepsis.

Figure 9: Determinants of participants according to their knowledge on the symptoms of

Figure 12: Distribution of participants according to their knowledge on individuals vulnerable to

occurrence of puerperal sepsis

Figure 14; Distribution of participants according to their knowledge on the prevention of

Figure 15; Distribution of participants according to their knowledge on the management of

Written and presented by FORTU VANESSA ANWI

Table 1: Higher Institute of Professional Excellence and its specialties

Table 2; guide on prevalence study

Table 3: study time line