Twice-Daily Topical Honey on Caesarean Section Wounds after Early Dressing Removal: A Randomized Controlled Trial at Bogodogo University Hospital, Ouagadougou, Burkina Faso

Abstract

Aims: To evaluate the effect of twice-daily topical honey on surgical site infection (SSI) and wound healing after elective caesarean section managed with early dressing removal. Study Design: Open-label, two-arm, parallel-group randomised controlled trial. Place and Duration of Study: Department of Gynaecology-Obstetrics and Reproductive Medicine, Bogodogo University Teaching Hospital, Ouagadougou, Burkina Faso, from 1 December 2021 to 31 May 2022. Methodology: Women undergoing elective (prophylactic, pre-labour) caesarean section with intact membranes were randomised 1:1 after providing informed consent. In both arms, the initial dressing was removed on postoperative day 1 and the wound was washed with plain water during twice-daily hygiene. In the honey arm, a thin layer of pharmaceutical-grade honey was then applied to the incision twice daily until healing; the control arm received no topical agent. Patients were reviewed on days 7, 11, 15 and 30. The primary outcome was SSI within 30 days (CDC criteria); secondary outcomes were time to wound healing and length of hospital stay. Factors associated with SSI were explored by logistic regression. The significance level was 5%. Results: A total of 440 women were randomised (220 per arm) and all completed follow-up. Mean age was 27.2 years (range 15–44). Surgical site infection occurred in 6/220 women (2.7%) in the honey arm versus 17/220 (7.7%) in the control arm (relative risk 0.35; 95% CI 0.14–0.88; p = 0.030), an absolute risk reduction of 5.0% (number needed to treat 20). All infections were superficial. The distribution of healing times was shifted towards shorter durations with honey (Mann–Whitney p = 0.031): 64.8% versus 55.3% of wounds were healed before day 14. Length of hospital stay did not differ between arms (p = 0.14). Medical history (comorbidity), maternal anaemia and operative duration were independently associated with SSI. Conclusion: After elective caesarean section with early dressing removal, twice-daily topical honey applied by the patient reduced the 30-day SSI rate by about two thirds and modestly shortened healing time. Honey is a cheap, locally available and acceptable adjunct to wound care in low-resource settings; confirmation in emergency caesarean sections and in a blinded multicentre trial is warranted.