Anne NiyigenaSaidath GatoBarnabas AlayandeElizabeth MirandaBethany Hedt-GauthierAndrea S. GoodmanTheoneste NkurunzizaChristian MazimpakaSadoscar HakizimanaPatient NgamijeFredrick KateeraRobert RivielloAdeline A. Boatin2025-03-262025-03-262023-12-1310.1186/s12884-023-06159-3https://dspace.ughe.org/handle/123456789/506<jats:title>Abstract</jats:title><jats:sec> <jats:title>Introduction</jats:title> <jats:p>Women who deliver via cesarean section (c-section) experience short- and long-term disability that may affect their physical health and their ability to function normally. While clinical complications are assessed, postpartum functional outcomes are not well understood from a patient’s perspective or well-characterized by previous studies. In Rwanda, 11% of rural women deliver via c-section. This study explores the functional recovery of rural Rwandan women after c-section and assesses factors that predict poor functionality at postoperative day (POD) 30.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Data were collected prospectively on POD 3, 11, and 30 from women delivering at Kirehe District Hospital between October 2019 and March 2020. Functionality was measured by self-reported overall health, energy level, mobility, self-care ability, and ability to perform usual activities; and each domain was rated on a 4-point likert scale, lower scores reflecting higher level of difficulties. Using the four functionality domains, we computed composite mean scores with a maximum score of 4.0 and we defined poor functionality as composite score of ≤ 2.0. We assessed functionality with descriptive statistics and logistic regression.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Of 617 patients, 54.0%, 25.9%, and 26.8% reported poor functional status at POD3, POD11, and POD30, respectively. At POD30, the most self-reported poor functionality dimensions were poor or very poor overall health (48.1%), and inability to perform usual activities (15.6%). In the adjusted model, women whose surgery lasted 30–45 min had higher odds of poor functionality (aOR = 1.85, <jats:italic>p</jats:italic> = 0.01), as did women who experienced intraoperative complications (aOR = 4.12, 95% CI (1.09, 25.57), <jats:italic>p</jats:italic> = 0.037). High income patients had incrementally lower significant odds of poor physical functionality (aOR = 0.62 for every US$1 increase in monthly income, 95% CI (0.40, 0.96) <jats:italic>p</jats:italic> = 0.04).</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>We found a high proportion of poor physical functionality 30 days post-c-section in this Rwandan cohort. Surgery lasting &gt; 30 min and intra-operative complications were associated with poor functionality, whereas a reported higher income status was associated with lower odds of poor functionality. Functional status assessments, monitoring and support should be included in post-partum care for women who delivered via c-section. Effective risk mitigating intervention should be implemented to recover functionality after c-section, particularly among low-income women and those undergoing longer surgical procedures or those with intraoperative complications.</jats:p> </jats:sec>enpostoperative careCesarean deliveryWomenHealthcareRwandajournal-article