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i n t h e puerper ium will occur i n the tropical cou ntries.
Malarial f eve r for example occurs with increased frequency
during pregnancy an d possibly in the pue rperium since its
i ncreased i ncidence is attributed to the loss o f immunit y
during preg na ncy , a ph ys i ol ogic al f e a t ure that persists i nto
the early puerperium [1 11, 112) . Fevers due to endemic disease
l i ke malaria therefore, could ea s ily crea t e difficulties in
diagnosis of puerperal fever if the current definition is
considered.
Ther e have been calls i n recent years for a better
definition of puerperal sepsis and pyrexia, with the arguments
being t hat the current definitions wh i c h were obtained in past
years whe n t h e causes o f " ch i l d birth" fever we r e un known are
no l onger va lid fo r today' s world [3 0 ,451. I n Afri ca these
arguments are even more t rue .
Post-caesarean wound i nfection:
General l y , in f ectiou s complications fol lowing ca esar ean
section are more frequently r eport e d i n t he developing wor ld
than in the deve loped co untries [33,113, 114]. I n t he poor
countries emergency cesarean s ections are of t en perf ormed on
moribund pa tients with prolonged labours, who were already
infected from home by un hyg i e nic delivery attempts, or because
of long delays in s eeking medical he lp [113,114]. Surgery in
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