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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. I. Background Global statistics indicate that nearly 213 million women conceive and deliver yearly. Approximately 18.5 million deliver through caesarean section (WHO, 2012). In Kenya about fifteen years ago, all caesarean sections were performed under general anaesthesia. As expected, there was a large proportion of maternal and neonatal morbidity attributable mainly to difficult or failed endotracheal intubations and aspiration of regurgitated gastric contents. In keeping with current obstetric anaesthesia guidelines, it was recommended that regional anaesthesia for caesarean section be introduced in our operating institutions. Another factor that has encouraged the introduction of spinal anaesthesia for caesarean section in Kenya, is its lower cost as compared to general anaesthesia (Casey, 2000). The last fifteen years or so have seen spinal anaesthesia gradually escalated in Kenyan hospitals to become the choice anaesthesia procedure for caesarean delivery. 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. As much as spinal anaesthesia is easy to administer there are complications that accompany it for both the mother and the neonate. These complications can severely impact on maternal satisfaction with care.There are no definitive protocols that have been found to totally eliminate the risks of maternal complications during and after caesarean section under spinal anaesthesia. It is, therefore, important to establish the level of client satisfaction with spinal anaesthesia which is one of the indicators of quality of care. Research studies conducted on maternal satisfaction vary, especially after caesarean section. Within the upper income countries, studies indicate higher rates of maternal satisfaction with healthcare delivery: South Australia, 86.1%. Contrary to a research carried out in a low income country, satisfaction was between 2.4 and 21%(Melese, Gebrehiwot, Bisetegne, & Habte, 2014; South Australian Patient Evaluation of Health Services (PEHS), 2007). Low levels of maternal satisfaction have similarly been reported in other African Countries; 51.9% in South Africa Effective management of pain was the highest rated area of dissatisfaction with studies indicating 82% of mothers report dissatisfaction (Melese et al., 2014) Determinant Maternal Satisfaction with Spinal Anaesthesia Care for Caeserian Delivery at the DOI: 10.9790/1959-0601089195 www.iosrjournals.org 92 | Page II. Methodology This was a cross-sectional study of patients who underwent caesarean section under spinal anaesthesia in the operating rooms of KCH was conducted between June and October 2016. A total of 99 patients were surveyed as calculated using Taro Yamane formula. Post-operative survey of patients on the day after surgery up to one month was conducted by collecting data on a structured questionnaire. Post-operative survey of patients on the day after surgery was conducted by collecting pre-operative and intra-operative data on a constructed 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. Data analysis was done using SPSS version 21. Bivariate analysis was conducted on the data with chi-square statistics used to determine the homogeneity in proportions. Odd ratios and 95% CI were used to show strength of association with P value used to show significance of the relationships. III. Results Socio-demographic Characteristics of the respondents The table 1 below depicts a summary of the backdrop of socio-demographic aspects of the respondents. The respondents below 30 years of age were 71.7% with a mean age of 23.3 years and minimum and maximum age being 17 and 40 years respectively. Most of the respondents (56.6%) had attained secondary and above level of education. Fifty three percent were from urban areas and 82% were married. Table 1: Socio-demographic Characteristics of the Respondents Characteristic Grouping Frequency Percent Age Below 30 71 71.7 30 and Above 28 28.3 Total 99 100.0 Av=26.3,Mod=20, SD=6.3, Min=17, Max=40 Education Level Did not School 7 7.1 Primary 36 36.4 Secondary 41 41.4 Tertiary 15 15.2 Total 99 100.0 Residence Type Urban 53 53.5 Rural 45 45.5

Determinants of Maternal Satisfaction with Spinal Anaesthesia Care for Caesarian Delivery at the Kisumu County Hospital