Knowledge, attitude and practice of labor analgesia at two tertiary level hospitals in Rwanda: Case study of Rwanda Military Hospital (RMH) and Kigali University Teaching Hospital (CHUK)

Abstract

Background: Despite availability of methods to manage labor pain, there is a big disparity in labor analgesia knowledge and access between low and high-income countries. Laboring women have significant pain. Healthcare workers can underestimate intensity and severity of the patient experience. A survey was carried out to assess patient knowledge about labor analgesia and current attitudes and practices about labor analgesia in 2 referral hospitals. Methods: We recruited all patients undergoing labor at the Kigali University Teaching Hospital (CHUK), Rwanda Military Hospital (RMH) within a one month period beginning in October 2018 meeting inclusion criteria - Prospectively 91 postpartum women were surveyed and interviewed during a one month period, October 2018, and 77 healthcare professionals at CHUK and RMH were surveyed. - Analysis was done using descriptive statistics. Results Patients: 91 patients were interviewed: 57 at CHUK and 34 at RMH. Most of the participants have never heard about labor analgesia treatments options. We found that 22(38.6%) at CHUK and 1(2.9%) at RMH have heard about labor analgesia .Only 16(17.6%) had labor analgesia and are all received care at CHUK and no patient at RMH had labor analgesia and 83(91.2%) wish labor pain medicine to be offered to them for their next pregnancy. 51(56.0%) do agree that labor pain medicine should be given to all parturient women, whereas 18(19.8%) disagree. Healthcare providers: 77 staffs: 32 midwives, 4 anesthesiologists, 5 obstetricians, 17 residents in anesthesia, 19 residents in Obstetrics working at CHUK and RMH .We found that current treatment options for labor pain include non-pharmacological treatment: soothing words by family member or friends 45(58.4%); breathing technique 16(20.7%), meditation/prayer 3(1.7%). There is non-use of pharmacological treatment options for 16(59.3%) at RMH and 2(4.0%) at CHUK respectively. At CHUK, the commonly used pharmacological treatment include the combination of paracetamol and pethidine 32(64.0%), the other combination include pethidine and tramadol 8(16.0%). The other drugs used are pethidine alone 1(2.0%) and Paracetamol 7(14.0%). Conclusion: There is a wide gap between knowledge, desire for labor analgesia and its provision and significant effort should be put in place for education of staff and patients about labor analgesia.)