Improving C-section Safety

Tackling a common and devastating complication of surgery to improve maternal health

Cesarean section (C-section) is the most commonly performed major operation in the world. Patients undergoing C-sections are at risk of surgical site infection (SSI) – a common and devastating complication of surgery. Infection rates are particularly high in low- and middle-income countries (LMICs).

Lifebox is working with partners to adapt its surgical infection reduction program – Clean Cut – to improve the safety of C-sections in Ethiopia where the majority of C-sections are essential surgical procedures. In Ethiopia, there is an estimated SSI rate following C-section of 9% and infections and complications following C-sections are estimated to cause 15% of maternal deaths in the country.

We are currently implementing the program at nine maternity hospitals in Ethiopia as part of a rigorous study to evaluate its impact in C-section care, and improve the safety of women undergoing this common operation. So far, 7,000 patients have been observed as part of the study. 

Surgical team performing surgery

Publication of the CLEAN-CS Study Protocol in 'Trials'

This protocol describes the Lifebox trial evaluating Clean Cut's ability to reduce infections following cesarean sections in Ethiopia

“Surgical site infections from C-sections are a leading cause of harm for mothers in Ethiopia. By supporting Lifebox to adapt ‘Clean Cut’ – a proven program to reduce surgical infections – for C-sections, this grant funded by UBS Optimus Foundation as part of the Bill & Melinda Gates Foundation’s Grand Challenges initiative will enable Lifebox and partners to drive lasting improvements in maternal health across the country and, we hope, beyond.”
Dr. Tihitena Negussie Mammo, Program PI, Lifebox Global Clinical Director, surgeon, Addis Ababa.

The adaptation of Clean Cut for C-sections is part of a randomized control trial called CLEAN-CS. Find out more about the CLEAN-CS trial:


As with all of Lifebox’s work, our aim is to reach scale, partnering with the Ethiopian Society of Obstetricians and Gynecologiststhe Ethiopian Federal Ministry of Health, and Ariadne Labs – a joint center for health systems innovation at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health – to replicate this work across Ethiopia before scaling the approach in other resource-limited settings.

“Clean Cut was able to leverage teamwork and multidisciplinary action to dramatically improve compliance with essential perioperative infection prevention standards. This improvement in adherence to such critical standards resulted in profound reductions in postoperative infections. This Grand Challenge Initiative allows for a rigorous study of Clean Cut and its impact on the safety of C-sections.”
Dr. Thomas Weiser, Program PI, Lifebox Consulting Medical Officer, Associate Professor of Surgery, Stanford University

Thank you to the Bill & Melinda Gates Foundation Grand Challenges initiative and UBS Optimus Foundation for supporting Lifebox’s work to improve the safety of emergency obstetric care in Ethiopia to save women’s lives.

“The Ethiopian Society of Obstetricians and Gynecologists is delighted to partner with Lifebox to tackle the morbidity and mortality faced by Ethiopian mothers from complications arising from cesarean sections. We see firsthand the toll this takes on families across our country and we look forward to implementing change.”
Dr. Mekdes Daba, Program PI, President Ethiopian Society of Obstetricians and Gynecologists

Clean Cut

Our quality improvement program to reduce surgical infection

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Working to make surgery safer - for every patient, every time

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