Factors associated with demand for epidural analgesia among women in labor at a tertiary hospital in Nnewi, South-East, NigeriaFactors associated with demand for epidural analgesia among women in labor at a tertiary hospital in Nnewi, South-East, Nigeria

Abstract

Background: Epidural labor analgesia has become prevalent in high income countries, but its use in low and middle income countries such as Nigeria is poorly studied. Objectives: To determine the rate of demand, indications, post-dural puncture headache rate and factors affecting demand for epidural analgesia among women in labor. Method: This was a across sectional analytical study of women in labor who were managed at Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria from 1st January 2017 to 31st December 2017. Data was obtained from women’s case files from Medical record department, labor ward, and Anesthesiology departmental records. Information obtained included total number of deliveries, mode of delivery, those that received epidural: date and time of placement, indication and number of side effects. Univariate analysis models were applied to evaluate the association between patient demographic, socioeconomic factors, clinical and demand for labor epidural analgesia. A p-value of <0.05 was taken as significant. Results: Thirty-six women out of 1,373 women received epidural labor analgesia, giving the epidural labor analgesic rate of 2.6%. The most common indication for epidural labor analgesia was maternal voluntary request which accounted for 24 (66.7%) of the population receiving analgesia. One (2.8%) parturient developed post-dural puncture headache which resolved spontaneously within 24 hours. Parturient who utilized labor epidurals were significantly older than 30 years of age (OR 3.16; 95% CI 1.51-6.62; p=0.002), Multi-parous (OR 26.65; 95% CI 3.64-100.00; p=0.001), and with higher income (OR 9.02; 95% CI 4.38-18.57; p=<0.001), but not with higher level of education (OR 0.56; 95% CI 0.27-1.16; p=0.114). Conclusion: The demand for labor epidural in the study center was low with a demand rate of 2.6% and post-dural puncture headache rate of 2.8%. The significant factors related to a parturient’s request for epidural analgesia during labor included age greater than 30 years, multiparity and higher income. There is a need for an enhanced awareness programs on obstetrics epidural analgesia.