Determinants of maternal satisfaction with spinal anaesthesia care for caesarian delivery at the Kisumu County Hospital

Abstract

Elective and emergency caesarean sections are increasing in the low income countries. Over the last fifteen years or so, spinal anaesthesia has been gradually escalated in Kenyan Hospitals. In Kisumu County Hospital (KCH), the cases of caesarean sections done under spinal anaesthesia have increased tremendously from one in every ten to seven in every ten cases in a span of 7 years. Despite documented safety for the procedure, complications can highly influence the mother’s perception of quality of care. This study was therefore undertaken to evaluate patient satisfaction after spinal anaesthesia for caesarean section. A crosssectional study of patients who underwent caesarean section under spinal anaesthesia in the operating rooms of KCH was conducted. Post-operative survey of patients on the day after surgery was conducted by collecting pre-operative and intra-operative data on a structured questionnaire. Post-operative data, including satisfaction and understanding the anaesthetist’s explanation regarding anaesthesia and satisfaction in receiving spinal anaesthesia were inquired by trained data personnel. A total of 99 pregnant patients, with age ranging from 17 to 40 years, were surveyed: Overall, 85 (85%) of the mothers interviewed were satisfied and 15 (15%) were dissatisfied the anaesthesia care they received. Income range (OR: 23.1; 95% CI: 2.77-192; P<0.001) and marital status (OR: 4.42; 95% CI 1.32-14.9; P<0.011) were significant demographic determinant of satisfaction with maternal satisfaction with anaesthesia care. Neonatal outcomes were also demonstrated to be associated with satisfaction were; neonate’s birth weight (OR: 3.29; 95% CI: 1.01-10.71; P:0.04) and APGAR score at 10 minutes (OR:4.74; 95% CI: 1.24-18.03; P:0.02). In comparison to studies elsewhere, maternal satisfaction in the surveyed population was low. Structured communication by anaesthesia team, exceptional clinical skill of the anaesthesia practitioners and prevention of side effects might improve patient satisfaction.