Socio-demographic Characteristics of respondents shows that two hundred fifty-seven women participated in this study and thus yielding a response rate of 95%. Half of the respondents 50.2% belonged to the age group between 25 and 31 years, and 15(5.8%) belonged to the age group of > 39 years. The majority of them had an educational level of secondary school, followed by college and university. Of the respondents, 40.1%% had <1000 income and were housewives by occupation. Also, more than 80% (206) lived in Addis Ababa, and 44.1% of them were para 1 mothers. (Table 1)
The previous Surgery and Anesthesia exposure History of the respondent shows that out of 257 participants, 128(49.8%) of them had history of exposure to surgery and anesthesia, where CS took place in 38.1% while both CS and other surgery were conducted among 25(9.7%) of the respondent. From all respondents 78 (30.4%) of them experienced SA, 34 (13.2%) experienced GA and 17 (6.6%) of them experienced both of GA and SA. From all those exposed to anesthesia 71 of them had experienced complication related to anesthesia 81.7% from spinal anesthesia and 18.3% from GA.
From all participants only 81.7 % of them had information about presence of different anesthesia type for CS, while 18.3 % have no information on presence of different anesthesia type options for CS. The highest source of information of the respondent was from health professionals and from previous surgery exposure. (Table 2)
According to APAIS anxiety measuring score 46% of the population included in the study was anxious or total anxiety score above 11 and 56.4% need information on surgery and anesthesia.
Table 1. Socio-demographic characteristics of respondents in Addis Ababa governmental MCH Hospitals
Variable
|
Categories
|
Frequency
|
Percentage %
|
Age
|
18-24
|
39
|
15.2
|
25-31
|
129
|
50.2
|
32-38
|
74
|
28.8
|
>39
|
15
|
5.8
|
Total
|
257
|
100.0
|
Education status
|
Uneducated
|
34
|
13.2
|
Primary
|
64
|
24.9
|
Secondary
|
85
|
33.1
|
college, university and above
|
74
|
28.8
|
Total
|
257
|
100.0
|
Income
|
<1000
|
103
|
40.1
|
1001-4000
|
56
|
21.8
|
>4001
|
98
|
38.1
|
Total
|
257
|
100.0
|
Occupation
|
house wife
|
100
|
38.9
|
Employed
|
84
|
32.7
|
private work
|
73
|
28.4
|
Total
|
257
|
100.0
|
Residency
|
Addis Ababa
|
206
|
80.2
|
Major regional city
|
42
|
16.3
|
Rural area
|
9
|
3.5
|
Total
|
257
|
100.0
|
Previous pregnancy number
|
NONE
|
63
|
24.5
|
1
|
114
|
44.4
|
>1
|
80
|
31.1
|
Total
|
257
|
100.0
|
Table 2. Source of information
Source of information
|
Frequency
|
Percent %
|
Health professionals
|
77
|
30.0
|
Previous surgery
|
77
|
30.0
|
Relatives
|
5
|
1.9
|
Friends
|
40
|
15.6
|
Media
|
11
|
4.3
|
Total
|
210
|
81.7
|
The preferred anesthesia type was 62.3% (160) Spinal anesthesia, 15.2% (39) General anesthesia and 22.6% (58) of them were not decided anesthesia type to prefer.
Bivariable and Multivariable logistic regression analysis of factors associated with anesthesia type preference
Since the dependent variable has more than two category, multinomial logistic regression was used to assess the association between the independent variable and the dependent variables. According to the Bivariate analysis of multinomial logistic regression, there were significant relationships between some independent variables and preferred anesthesia types except residency, income, complication of general anesthesia, previous pregnancy number and Good previous Anesthesia. Variables having a p-value ≤ 0.2 in the bivariate analyses were used for multivariable logistic regression to control the confounding effect.
The findings of multivariable logistic regression show that six (6) risk factors (educational status, occupation, type of previous surgery, type of previous anesthesia, source of information, and having information about different anesthesia types for CS) were identified to be significantly associated with anesthesia type preference.
The odds of uneducated pregnant mothers not deciding anesthesia types rather than spinal anesthesia preference is nearly 8 times higher compared to mothers having college and above education status. (AOR = 7.760, 95% (CI 2.428, 24.803)).
The odds of primarily educated mothers not deciding anesthesia types rather than spinal anesthesia preference is nearly 4 times higher compared to mothers having college and above education status. (AOR = 3.757, 95% (CI 1.469, 9.604)).
The odds of employed pregnant mothers not deciding anesthesia types rather than spinal anesthesia is 76% less likely compared to mothers working at private. (AOR=.241 (.094,.618))
The odds of with previous only CS history pregnant mothers preferring general anesthesia rather than spinal anesthesia is 6.5 times higher compared to mothers who had previous both CS and other types of surgery. (AOR = 6.469, 95% (CI 1.415, 29.573)).
The odds of pregnant mothers who had previous exposure to only spinal anesthesia preferring general anesthesia rather than spinal anesthesia is 94% less likely compared to mothers exposed to both spinal anesthesia and general anesthesia. (AOR= .060, (CI.012,.301))
The odds of pregnant mothers who had information about different anesthesia types for CS not deciding anesthesia types rather than spinal anesthesia is 99.8% less likely compared to mothers who had no information about different anesthesia types for CS. (AOR =.002, 95% (CI.001, 0.014)).
The odds of pregnant mothers who hadn’t information about different types not deciding anesthesia types rather than spinal anesthesia is 38 times more likely compared to mothers who had get information from media. (AOR= 38.302 (5.196,282.333))
The odds of pregnant mothers who had information from health professionals preferring general anesthesia rather than spinal anesthesia is 96% less likely compared to pregnant mothers who had information from the media. (AOR =.041, 95% (CI 0.013, 0.129)). (Table 3)
Goodness of fit table showed that the model adequately fits the data well. Pearson Chi-square (p-value = .324) and deviance (p-value =.759) which showed multinomial logistic regression model with predictor variables indicated a good fit.
Table 3. Multinomial Logistic regression analysis of factors associated with anesthesia type preference for elective C/S at Addis Ababa governmental MCH Hospitals.
|
|
General anesthesia VS Spinal Anesthesia.
|
Not decided VS Spinal Anesthesia.
|
Variables
|
Categories
|
COR
|
AOR (95%CI)
|
COR
|
AOR (95%CI)
|
Age
|
18-24
|
.69(.010,.459)
|
.428(.034,5.373)
|
.276(.064,1.195)
|
.137(.028,2.666)
|
25-31
|
.351(.094,1.312)
|
.324(.205,1.514)
|
.392(.106,1.455)
|
.419(.275,1.637)
|
32-38
|
.295(.074,1.181)
|
.245(.130,1.460)
|
.386(.099,1.505)
|
.265(.144,1.489)
|
>39(ref)
|
1
|
1
|
1
|
1
|
Education status
|
Uneducated
|
1.429(.435,4.688)
|
.540(.013,2.218)
|
6.190(2.242,17.090)
|
7.760*(2.428,24.803)
|
Primary
|
1.375(.550,3.436)
|
.610(.019,1.196)
|
3.792(1.547,9.293)
|
3.757*(1.469,9.604)
|
Secondary
|
1.259(.557,2.849)
|
1.123(.049,1.311)
|
1.498(.597,3.758)
|
1.339(.141,2.813)
|
College and above(ref)
|
1
|
1
|
1
|
1
|
Occupation
|
House wife
|
3.628(1.485,8.860)
|
2.536(.241,6.194)
|
1.036(.990,4.184)
|
.586(.280,1.224)
|
G/employee
|
1.180(.447,3.118)
|
1.167(.071,2.397)
|
.509(.218,.788)
|
.241*(.094,.618)
|
Private employee
|
1
|
1
|
1
|
1
|
Surgery and anesthesia history
|
Yes
|
2.749(1.359,5.562)
|
2.087(.021,2.369)
|
1.015(.555,1.856)
|
14.704(.402,537.415)
|
No(ref)
|
1
|
1
|
1
|
1
|
Type of surgery
|
None
|
1.855(.392,8.780)
|
1.369(.280,6.691)
|
8.482(.097,65.564)
|
6.450(.023,62.391)
|
CS
|
7.250(1.583,9.200)
|
6.469*(1.415,9.573)
|
1.500(1.588,9.395)
|
.736(.001, 1.978)
|
Other
|
.667(.250,5.827)
|
.462(.336,3.636)
|
7.333(.357,150.708)
|
5.335(.239,112.526)
|
Both(ref)
|
1
|
1
|
1
|
1
|
Type of anesthesia
|
None
|
.104(.032,1.342)
|
.107(.054,1.213)
|
1.157(.222,6.031)
|
1.217(.281,4.618)
|
GA
|
.513(.137,1.923)
|
.600(.263,1.371)
|
.538(.424,15.211)
|
.667(.300,12.484)
|
SA
|
.187(.057,.614)
|
.060*(.012,.301)
|
.840(.152,4.628)
|
.600(.105,3.382)
|
Both(ref)
|
1
|
1
|
1
|
1
|
Anesthesia related complication
|
No history of surgery
|
.261(.056,1.225)
|
.440(.061,6.682)
|
.964(.178,5.222)
|
.617(.281,2.618)
|
Yes
|
.958(.210,4.384)
|
1.560(.428,15.318)
|
.500(.082,3.046)
|
.614(.045,1.287)
|
No
|
.486(.092,2.558)
|
.606(.097,12.657)
|
.771(.307,10.227)
|
.593(.319,1.100)
|
Not remind(ref)
|
1
|
1
|
1
|
1
|
SA complication
|
No Spinal Anesthesia complication
|
.073(.007,.728)
|
.045(.003,1.664)
|
.454(.028,7.391)
|
.317(.001,4.502)
|
Backache
|
.048(.002,1.040)
|
.286(.030,2.692)
|
.143(.004,4.612)
|
.455(.332,4.624)
|
Headache
|
.222(.020,2.451)
|
.444(.063,3.155)
|
.133(.006,3.081)
|
.113(.030,1.583)
|
Nausea and vomiting
|
.200(.017,2.386)
|
.364(.047,2.817)
|
.100(.003,3.153)
|
.019(.000,1.111)
|
Shivering
|
1
|
1
|
1
|
1
|
Have information about anesthesia types
|
Yes
|
.443(.072,2.735)
|
.232(.003,1.363)
|
.008(.002,.029)
|
.002*(.001,.014)
|
No(ref)
|
1
|
1
|
1
|
1
|
Source of information
|
Haven't information
|
1.333(.139,12.818)
|
.983(.091,10.627)
|
42.000(5.781,305.158)
|
38.302*(5.196,282.333)
|
Health professional
|
.171(.034,.864)
|
.041*(.013,.129)
|
.043(.003,1.544)
|
.044(.003,1.578)
|
Previous surgery
|
.870(.198,3.828)
|
.973(.220,1.631)
|
.717(.127,4.047)
|
.137(.062,1.302)
|
Relatives
|
.667(.047,9.472)
|
.583(.302,1.128)
|
1.000(.063,15.988)
|
.667(.111,3.990)
|
Friends
|
1.167(.251,5.413)
|
.333(.052,2.142)
|
.250(.029,2.156)
|
.083(.020,1.353)
|
Media
|
1
|
1
|
1
|
1
|
Want to avoid previous anesthesia complication
|
Yes
|
4.786(.216,10.335)
|
4.571(.353,15.441)
|
.261(.059,1.163)
|
1.183(.131,10.685)
|
No
|
1
|
1
|
1
|
1
|
Anxiety
|
No
|
.507(.258,.993)
|
.260(.110,1.616)
|
1.326(.715,2.457)
|
1.343(.797,2.263)
|
Yes(ref)
|
|
|
|
|
Information need
|
No
|
.520(.266,1.020)
|
.736(.336,1.613)
|
.165(.078,.350)
|
.071(.029,1.176
|
Yes(ref)
|
1
|
1
|
1
|
1
|
*P value is significant at P< .05 Ref = reference Spinal Anesthesia = Baseline out come
COR= Crudes Odds Ratio AOR =Adjusted Odds Ratio CI = Confidence Interval