Factors Associated with Post-Caesarean Section Nursing Outcomes in Secondary Health Facilities in Anambra State

Background: Post-caesarean nursing care quality in Nigerian secondary facilities is challenged by resource constraints, staffing gaps, and inadequate protocol adherence, contributing to preventable maternal morbidity. Aim: This study identified factors associated with post-caesarean section nursing outcomes at secondary health facilities in Anambra State, South East Nigeria. Methods: A prospective cohort design followed 180 women who underwent caesarean section at six secondary hospitals over six months. Nursing care quality indicators, complications, and patient satisfaction were measured. Multilevel logistic regression identified independent predictors of adverse outcomes. Results: Post-operative complications including wound infections and deep vein thrombosis occurred in 21% of participants. Inadequate nurse-to-patient ratios, suboptimal pain assessment practices, and absence of structured mobilisation protocols were the strongest predictors of adverse outcomes. Higher nursing care quality scores were associated with significantly reduced complication risk. Conclusion: Nursing care quality is the most modifiable determinant of post-caesarean outcomes. Investment in midwifery training, standardised post-caesarean care bundles, and facility-level nursing quality audits are urgently recommended. Keywords: caesarean section, post-operative nursing, maternal outcomes, Anambra State, secondary hospitals.