Knowledge, Attitude and Willingness towards Analgesia for Labor among Pregnant Women Attending Antenatal Care in Two Hospitals, in Kigali, Rwanda

Globally an increasing number of women worldwide are using a pain management strategy during labor. However, there is a big variation on knowledge of labor analgesia between developing and developed countries from 27 % in Nigeria and 38.9% in Lagos to 98% in Australia. A cross-sectional study was used to assess the knowledge, attitude, and willingness towards analgesia for labor among 369 women attending antenatal care in two hospitals in Kigali, Rwanda. A systematic sampling technique was used to recruit participants and data was collected using a structured questionnaire. Majority, (66.1%) were from urban places, married (94.3%), completed college and above education 255 (69.1%), Government employed (45.26 %), primigravida (73.2%), (56.9%) have attended four and above ANCs. Overall, 73.2% of the women have heard about anesthesia in general. A high percentage of 55.1% had good knowledge and 89.97% positive attitude on analgesia for labor. However, only 46.87% of the participated women were willing to receive analgesia during labor while 53.13% not-willing to receive analgesia during labor. Age, number of pregnancies, deliveries, ANC attended in the current pregnancy, type of last delivery, and knowledge score on anesthesia for labor were significant associated with willingness (P<0.05). Family monthly income, number of pregnancies and previous deliveries, number of ANC attended for the current pregnancy, means of previous delivery, and attitude were found statistically associated with knowledge towards anesthesia for labor (P<0.05). Multivariate logistic regression indicated that women who attended four or more ANC were 2.65 times (OR=2.65; 95% CI: 1.75-4.57) more likely to have good knowledge about analgesia for labor than their counterparts, however after adjusting the association was not significant (P=0.388). Similarly, women who had history of cesarean section delivery were 8 times (AOR=8.41, 95%CI=4.368-16.201, P<0.001) more likely to be more knowledgeable than their counterparts. Women with positive attitude were three-fold times more likely to have a good knowledge about anesthesia for labor compared to women of their counterparts and the difference was significant (AOR=3.02, 95%CI =1.31 – 6.99, P=0.010). Women of primigravidae were 3.53 times (AOR: 3.53; 95 % CI: 1.095 to 11.38) more likely willing for analgesia during labor than women of multigravida and the different was found statistically significant (P=0.035). Compared to women with poor knowledge, women of good knowledge about analgesia were 2.58 times (AOR: 2.58; 95 % CI: 1. 55 to 4.31) more likely willing for analgesia during labor and the difference was significant (P<0.001). Despite a significant positive attitude towards analgesia for labor, knowledge and willingness was found low and a comprehensive intervention on information and awareness raising about analgesia during labor among pregnant women of ANC attendance should be improved. Keywords: Knowledge, Attitude, Willingness, Labor, Analgesia, anti-natal care, Pregnant women.