Utilization of obstetric analgesia in labor pain management and associated factors among obstetric caregivers in public health facilities of Kembata Tembaro Zone, Southern Ethiopia

Journal of Pain Research, Dec 2018

Utilization of obstetric analgesia in labor pain management and associated factors among obstetric caregivers in public health facilities of Kembata Tembaro Zone, Southern Ethiopia Teketel Ermias Geltore,1 Ayanos Taye,2 Abraham Getachew Kelbore3 1Midwifery Department, School of Nursing and Midwifery, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 2Nursing Department, School of Nursing and Midwifery, College of Health Sciences and Medicine, Jimma University, Jimma, Ethiopia; 3Dermatology Department, College of Health Sciences and Medicine, School of Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia Background: Nowadays, obstetric analgesia is provided routinely in most developed countries. However, in developing countries, labor pain management is not a well-established service. The poor utilization of labor analgesia in low-income countries including Ethiopia results in laboring mothers in unmeasured suffering, let alone analgesia. The aim of this study was to assess utilization of obstetric analgesia in labor pain management and associated factors among obstetric caregivers in public health facilities of KTZ, Kembata Tembaro zone, Southern Ethiopia. Materials and methods: A facility-based cross-sectional study design was conducted among all obstetric caregivers at KTZ in public health facilities from March to April 2017. Data were collected by a pretested, self-administered, and structured questionnaire. A convenient sampling technique was used and descriptive analysis was done to characterize the study population. Bivariate and multivariate logistic regressions were used to identify factors associated with utilization of labor analgesia. The adjusted odds ratio with 95% CI was used to show the strength of the association and a P-value <0.05 was used to declare the cutoff point in determining the level of significance. Results: Three hundred forty respondents participated in the study with a response rate of 93%. The prevalence of labor analgesia use by the respondents was 37.9%. On multivariable logistic regression analyses, inadequate knowledge, positive attitude, and unavailability of labor analgesia drugs were significant independent predictors of obstetric analgesia utilization. Conclusion: Proportion of analgesia utilization was low; inadequate knowledge, positive attitude, and unavailability of analgesia drugs in the facilities were significantly associated with obstetrics analgesia utilization. Health institutions and health personnel should work on provision of training for those obstetric care providers, and necessary drugs should be available in each facility. Keywords: pain management, analgesia, obstetric caregiver, Ethiopia, institution based

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Utilization of obstetric analgesia in labor pain management and associated factors among obstetric caregivers in public health facilities of Kembata Tembaro Zone, Southern Ethiopia

Authors Geltore TE, Taye A, Kelbore AG Received 13 February 2018 Accepted for publication 5 November 2018 Published 6 December 2018 Volume 2018:11 Pages 3089—3097 DOI https://doi.org/10.2147/JPR.S165417 Checked for plagiarism Yes Review by Single-blind Peer reviewers approved by Dr Colin Mak Peer reviewer comments 2 Editor who approved publication: Dr Michael Ueberall Teketel Ermias Geltore,1 Ayanos Taye,2 Abraham Getachew Kelbore3 1Midwifery Department, School of Nursing and Midwifery, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 2Nursing Department, School of Nursing and Midwifery, College of Health Sciences and Medicine, Jimma University, Jimma, Ethiopia; 3Dermatology Department, College of Health Sciences and Medicine, School of Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia Background: Nowadays, obstetric analgesia is provided routinely in most developed countries. However, in developing countries, labor pain management is not a well-established service. The poor utilization of labor analgesia in low-income countries including Ethiopia results in laboring mothers in unmeasured suffering, let alone analgesia. The aim of this study was to assess utilization of obstetric analgesia in labor pain management and associated factors among obstetric caregivers in public health facilities of KTZ, Kembata Tembaro zone, Southern Ethiopia. Materials and methods: A facility-based cross-sectional study design was conducted among all obstetric caregivers at KTZ in public health facilities from March to April 2017. Data were collected by a pretested, self-administered, and structured questionnaire. A convenient sampling technique was used and descriptive analysis was done to characterize the study population. Bivariate and multivariate logistic regressions were used to identify factors associated with utilization of labor analgesia. The adjusted odds ratio with 95% CI was used to show the strength of the association and a P-value <0.05 was used to declare the cutoff point in determining the level of significance. Results: Three hundred forty respondents participated in the study with a response rate of 93%. The prevalence of labor analgesia use by the respondents was 37.9%. On multivariable logistic regression analyses, inadequate knowledge, positive attitude, and unavailability of labor analgesia drugs were significant independent predictors of obstetric analgesia utilization. Conclusion: Proportion of analgesia utilization was low; inadequate knowledge, positive attitude, and unavailability of analgesia drugs in the facilities were significantly associated with obstetrics analgesia utilization. Health institutions and health personnel should work on provision of training for those obstetric care providers, and necessary drugs should be available in each facility. Keywords: pain management, analgesia, obstetric caregiver, Ethiopia, institution based Background Labor is characterized by regular, painful uterine contractions that increase in frequency and intensity in three stages of labor.1 During labor, pain originates from different sites during each stage of the labor, which is a physiological phenomenon and its evolution is associated with ischemia of the uterus during contraction, effacement, dilation of cervix, stretching of the vagina, perineum, and compression of pelvic structures.2–4 Women’s experience of pain during labor greatly varies from feeling of little pain to extremely distressing pain. Hence, reliving labor pain is one of the main concerns for pregnant women, her families, and health care providers. So effective utilization of labor analgesia has implications on the course of labor, best outcomes, and the quality of obstetric care.2,5 In high-income countries, many pharmacological and nonpharmacological treatments have been developed to alleviate labor pain. Among the methods, systemic opioids, nonopioids, epidural analgesia, combined spinal-epidural analgesia, inhalation agents, pudendal block, transcutaneous electrical nerve stimulation, massage, acupuncture, water immersion, yoga, music therapy, biofeedback, continuous support, positioning, ambulation, hypnosis, and breathing technique are used to manage labor pain.6,7 The effectiveness of these methods varies, but epidural analgesia remains the safest. It is the widely used analgesia that provides almost complete labor pain relief (90%) with a favorable birth experience.8 In Ethiopia, the practice of labor pain management is very low. In 2014, the Ethiopian Food, Medicine, and Health Care Administration and Control Authority (FMHACA) has developed and implemented standard treatment guidelines. Giving analgesics and anesthetics to pregnant mothers without affecting maternal and fetal condition must be a concern to the health care provider. Provision of physical and psychological support and use of pharmacologi (...truncated)


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Teketel Ermias Geltore, Ayanos Taye, Abraham Getachew Kelbore. Utilization of obstetric analgesia in labor pain management and associated factors among obstetric caregivers in public health facilities of Kembata Tembaro Zone, Southern Ethiopia, Journal of Pain Research, 2018, pp. 3089-3097, DOI: 10.2147/JPR.S165417