Risk factors for surgical site infections following cesarean section in Ethiopia: umbrella review

In Africa, the pooled prevalence of Surgical Site Infection (SSI) following cesarean section (CS) was 11%. The SSI is the most frequent complication that women experience after CS. Despite an increasing number of systematic reviews and meta-analyses (SRMAs) about SSI following CS among Ethiopian women, no umbrella review has yet been conducted. Consequently, the common risk factors for SSI following CS in Ethiopia have not been comprehensively consolidated. The aim of this review was to synthesize evidence on the risk factors contributing to SSI following CS among women in Ethiopia. We searched several electronic databases, including PubMed, SCOPUS, Research4Life, and ScienceDirect, between 3rd November and 22nd December 2025. Additionally, we used Google Scholar and Ethiopian scholarly repositories. The search was restricted to the studies published in English and Ethiopian national language. The AMSTAR approach was used to evaluate the quality of the included SRMAs. The protocol for this umbrella review was documented in PROSPERO with the registration number CRD420251231671. Data were extracted using Microsoft Excel 2016, and heterogeneity was estimated using STATA version 17. The modified coverage area was used to calculate the overlap between the primary studies included in the SRMAs considered in this analysis. This umbrella review synthesized the pooled effect sizes from four systematic reviews and meta-analyses (SRMAs), encompassing 30 primary studies and a total population of 31,803 participants. The synthesis identified several significant risk factors for post-cesarean SSI, categorized into four primary domains: maternal demographics, including rural residence; maternal medical conditions, specifically anemia and subcutaneous tissue thickness exceeding 2 centimeters; obstetric complications, such as prolonged labor, chorioamnionitis, and rupture of membranes before CS; and procedural factors, encompassing vertical skin incisions and the use of general anesthesia. The study shows that surgical site infection following CS remains a significant public health concern in Ethiopia, with a reported prevalence of approximately 10%. The identified risk factors enable caregivers to promptly recognize high-risk patients and implement measures to reduce and prevent SSI among Ethiopian women undergoing CS.