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. 2025 Feb 18;5(2):100456.
doi: 10.1016/j.xagr.2025.100456. eCollection 2025 May.

Practice of pharmacological labor pain management and associated factors among healthcare providers in Ethiopia: a systematic review and meta-analysis

Agerie Mengistie Zeleke  1 , Yeshiewas Ayale Ferede  2 , Worku Chekol Tassew  3 , Yosef Aragaw Gonete  1
Affiliations

Practice of pharmacological labor pain management and associated factors among healthcare providers in Ethiopia: a systematic review and meta-analysis

Agerie Mengistie Zeleke et al. AJOG Glob Rep. .

Abstract

Background: Achieving positive obstetric health outcomes is a global priority, and the implementation of pharmacological and evidence-based interventions for pain relief during labor is strongly recommended. However, there is a notable scarcity of systematic review evidence concerning the practice of pharmacological labor pain management services. Therefore, this study aimed to evaluate the pooled practices of pharmacological labor pain management and the associated factors among healthcare providers in Ethiopia.

Methods: Studies systematically searched electronic databases including Scopus, Medline/PubMed, Web of Science, Science Direct, African Journal Online, the Wiley Online Library, and National Digital Library repositories from April 1, 2024, to April 30, 2024. Data extracted from Microsoft Excel were imported into STATA version 11 for further analysis. A modified version of the Newcastle-Ottawa scale employed for cross-sectional studies used for quality assessment. A random-effects model was used to estimates pooled prevalence. Cochran's Q test and I 2 statistics were used to assess the heterogeneity of the studies. Percentages and odds ratios (OR) with 95% CI were used to pool the effect measure. The symmetry of the funnel plot and Egger's test were used to check for publication bias. A subgroup analysis was done on the study years, and sample sizes.

Results: The pooled practice of pharmacological labor pain management services among healthcare providers was found to be 43.83% (95% CI: 37.45-50.20). Caregivers with sufficient knowledge (AOR: 2.36; 95% CI: 1.99-2.81), those who held positive attitudes (AOR: 3.66; 95% CI: 3.13-4.31), caregivers who received training related to obstetric protocols (AOR: 3.42; 95% CI: 2.36-4.97), laboring mothers expressed a preference for such interventions (AOR=2.33; 95% CI: 1.50, 3.63) were associated with practicing pharmacological labor pain management.

Conclusion: The overall pooled practice of pharmacological labor pain management among healthcare providers was found to be inadequate. Key factors such as obstetric care-related training, knowledge, attitudes, and the availability of options for labor pain management were strongly associated with this outcome. Therefore, it is crucial to provide training on labor pain management techniques to enhance healthcare providers' knowledge and attitudes toward these interventions across all levels of the healthcare system. Moreover, recommend that all healthcare providers offer pain relief in a manner that aligns with the preferences of laboring women, ensuring that care is both responsive and respectful.

Keywords: Ethiopia; healthcare providers; pharmacological labor pain management; practice.

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Figures

Figure 1
Figure 1
PRISMA flow chart for the systematic review and meta-analysis
Figure 2
Figure 2
Forest plot of the pooled practice of pharmacological labor pain management among obstetric healthcare providers
Figure 3
Figure 3
Practice of pharmacological labor pain management by study publication year among obstetric healthcare providers
Figure 4
Figure 4
Practice of pharmacological labor pain management by sample size among obstetric healthcare providers
Figure 5
Figure 5
Sensitivity analysis in 15 included studies
Figure 6
Figure 6
Funnel plot representation showing the absence of publication bias
Figure 7
Figure 7
Forest plot showing the pooled odds ratios of the sociodemographic and the practice of pharmacological labor pain management
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