{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T14:03:54Z","timestamp":1784642634536,"version":"3.55.0"},"reference-count":26,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"unspecified","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000683","name":"Royal Society of Tropical Medicine and Hygiene","doi-asserted-by":"crossref","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"10.13039\/501100000683","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"crossref","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"name":"UK International Development","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,7,9]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Routine prophylactic antibiotic use is not recommended following uncomplicated vaginal births because of the global threat of antimicrobial resistance (AMR). The study was conducted to determine the magnitude and underlying reasons for routine antibiotic use following uncomplicated vaginal births.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an explanatory sequential study among women with uncomplicated vaginal births. We interviewed 370\u2009women following facility discharge using interviewer-administered questionnaires. Eight in-depth interviews were conducted among midwives and clinical officers. Descriptive statistics and thematic analysis were used to analyse the data. The study obtained ethical clearance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median age of the participants was 25 (interquartile range 20\u201330). Out of the 370\u2009women, 34% (n=127\/370) had perineal tears, 19% (n=69\/370) had preterm prelabour rupture of membranes and 6% (n=23\/370) had preterm labour. Almost all (99%) women with uncomplicated vaginal births were prescribed prophylactic antibiotics during facility discharge. A combination of amoxicillin and metronidazole (49%, n=181\/366) and ampiclox and metronidazole (40%, n=147\/366) were the commonly prescribed drugs during discharge. Antibiotics were routinely given to prevent puerperal infections. Perineal tears, episiotomies and unsterile environment were additional justification given for antibiotic use. Sterility was seen to be untenable which necessitated antibiotic use to cover for gaps in maintaining infection prevention and control measures. In some cases, antibiotics were considered necessary regardless of the absence of medical indications and the risk of AMR. Healthcare providers had inadequate awareness of the risks of AMR and the guidelines on antibiotic use during discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Widespread routine antibiotic use after uncomplicated vaginal births reflected practices of overmedicalisation of childbirth and limited awareness of AMR. Developing local policies, strengthening infection prevention and control measures and innovating antimicrobial stewardship initiatives may be critical in reducing unnecessary antibiotic use after delivery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004168","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T13:30:20Z","timestamp":1784640620000},"page":"e004168","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Magnitude and the underlying reasons for routine prophylactic antibiotic use after uncomplicated vaginal births: A mixed-methods study in Eastern Uganda"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7148-5928","authenticated-orcid":false,"given":"Joshua","family":"Epuitai","sequence":"first","affiliation":[{"name":"Busitema University, Tororo, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose Chalo","family":"Nabirye","sequence":"additional","affiliation":[{"name":"Department of Nursing and Midwifery, Busitema University, Tororo, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Lume","sequence":"additional","affiliation":[{"name":"Department of Physiology, Busitema University, Tororo, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Proscovia","family":"Nabachenje","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Busitema University, Tororo, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah Racheal","family":"Akello","sequence":"additional","affiliation":[{"name":"Muni University, Arua, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Turyasiima","family":"Munanura","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Kampala International University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Nabawanuka","sequence":"additional","affiliation":[{"name":"Department of Nursing and Midwifery, Mountains of the Moon University, Fort Portal, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob Stanley","family":"Iramiot","sequence":"additional","affiliation":[{"name":"Busitema University, Tororo, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"2026072106301282000_4.3.e004168.1","unstructured":"World Health Organization . WHO recommendations for prevention and treatment of maternal peripartum infections. 2016. Available: https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/1ca2f289-26cd-4ea5-b715-23f903cff7e8\/content [Accessed 08 May 2026]."},{"key":"2026072106301282000_4.3.e004168.2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"2026072106301282000_4.3.e004168.3","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1186\/s12884-016-0986-9","article-title":"Puerperal sepsis, the leading cause of maternal deaths at a Tertiary University Teaching Hospital in Uganda","volume":"16","author":"Ngonzi","year":"2016","journal-title":"BMC Pregnancy Childbirth"},{"key":"2026072106301282000_4.3.e004168.4","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1111\/jmwh.12119","article-title":"Puerperal Infections of the Genital Tract: A Clinical Review","volume":"58","author":"Karsnitz","year":"2013","journal-title":"J Midwife Womens Health"},{"key":"2026072106301282000_4.3.e004168.5","doi-asserted-by":"crossref","unstructured":"Yadav G . Puerperal sepsis and septic shock. In: Infections and Pregnancy. 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