 Rwy'n gwybod i gydnodbod yn wych i fwy rai, yn ni'n teimlo'n gofiol Gwasu'r Ynol, fewn i'r tanlygu ysgol rhywun meidfaith ym Mhyshwyth, a'r ysgolau hefydol gyntafol beth sy'n�w am y dwellion o'r cyfunio yn gyfnodol mewn hwn. Mae'n rhesweriol, a'r ysgolau a dros gyflym diddol i diddol gwedadol a'r cyfnodol hwnnw. ynna mae'n wneud eich hefyd yn ei lefydlio, a ddod i'r ddafodol i'r ddweygu a bod ymgyrch gweithreu gwahol ar y Shwrthwyr y Mydwyr yn y Gondor Gondor, Eethiopio. Rydyn ni'n ddechrau'r ffordd o'r ddod o'r Eethiopio'r ddod o'r Ddod i'r Rhaid Ddod? O'r Belynyddech chi, rydyn ni'n gofio'r ffordd o'r ddod i'n gwybod. Rydyn ni'n gwybod i'n gwybod i'r ddod i'r camera o'u'r rhaid, rydyn ni'n gwybod i'n gwybod, But hello, I'm here. All right, thank you very for your nice introduction and good morning gold and happy international day of the midwifes place. So I will proceed with the presentation. Our study focused on the depression anxiety and stress during the COVID pandemic among midwifes in Ethiopia, which was done at the international wide cross-sectional study. And here are the team members involved within the development of the study till the final delivery of the results. And here are my presentation outlines. And as you all remember, like the COVID-19 is an infectious disease that is being caught by a new strain of novel coronavirus, which was just first confirmed in December 2019 in Wuhan, China. And it rapidly cross borders. In fact, lots of people throughout the world and its emergence as well as the spread really caused the confusion and anxiety as well as fear among the general public including those healthcare providers. And because of their direct contact with patients, headscape workers are among the highest, the risk of being affected by the COVID-19. And particularly the life-saving support that midwifes provides for those pre-gnantly wearing a postpartum woman, which presents a unique challenge and require close and permanent contact with women and their newborns. And the limitations in availability of personal protective equipment also has raised concerns and worries about the risk of COVID-19 infection on the healthcare providers. Therefore, our study tried to assess the depression anxiety and stress during the COVID pandemic among midwifes providing services in its facilities. And when we come to the objectives of the study, the study aimed to assess the like the prevalence of depression anxiety and stress, and the factors affecting the presence of these outcome barriers. Then as a summary of the methods that we applied, it was a quantitative cross-sectional study which was being conducted from the end of May to end of August in 2020. And it was a nationwide study which was done among all the list of midwifes sensors in the country. And the source population was on midwifes currently providing clinical care in Ethiopia. And those midwifes currently providing clinical care during the study period and we randomly selected that samples have been taken as the study population and the total sample size of 1,691 samples were selected using a simple random sampling technique. And this 1,691 sample was taken under the 16,925 midwifes in the country, which was the 2019 database and the sample size being done using the single population proportion formula. So we used the list of contacts of midwifes in Ethiopia during the 2019. It was the national census which takes all those midwifes practising in facilities and we proportionally allocate the total number of midwifes for each of the nine regions in the country and two city administrations based on the number of midwifes in their respective facilities. And we used to apply the simple random sampling to select those study participants. Then the dependent variables were the depression, anxiety and stress. And the as-is-un-independent variables we used to assess the multiple social demography characteristics, their knowledge towards the COVID-19, their attitude towards the disease, and their self-reported preventive practice were considered as un-independent variables. And we measured the depression, anxiety and stress using the depression, anxiety and stress test two on one scale, which was currently largely used tool and still validated in Ethiopia to be used among others. The knowledge as well as the attitude and practice were also measured using the mean score of midwifes. And finally, after identifying those study participants, the data were collected through telepoint interview. And we used 15 data collectors who were maintaining well health care providers and two supervisors involved in the data collection process. And we tried to test the tools among those instructors in the University of Gondor. And we tried to train those data collectors and when identifying information collected from those participants, then the data was analyzed using spaces that are present in the course of the way. And we used frequencies, cost evaluations were used to summarize those descriptive statistics and private and non-trial risk preparation analysis applied. Then the study, the Gotanity Calculance from the Australian Board of World University. Support later was also obtained from the Ethiopian Red Substitution for us to take their list, their contact numbers and consent on behalf of the midwifes. And the informed consent was obtained from participants. Sorry. And when we come to the results, when we see the social demographic characteristics, a total of 1,495 midwifes, which makes almost the response rate of 88.6%. And the median age of those participants was 27, with an interquartile range of 4.25 years. And among those participants, 52.1% were male and 51.3% were female midwives. And their mean work experience was 5.72 years of experience. And three-fifes of them had less than five years of work experience. It is the summary of their social demographic characteristics. And like the 54.5% of the participants who were working in the hospital and the remaining 45.5% were working in health centers. And like the 55.9% of those participants were on bachelor degree and 36.6% of those participants for the diploma in military. And when we come to the COVID-related knowledge up to then preventive practice among our participants, like the 58.5%, 79.4% and 57% of midwives are like good knowledge, good attitude and good self-reported preventive practice of COVID-19 respectively. And like the 80.4% of those participants feel that they may probably get infected while caring for those pregnant women, labouring and those clients. And like 92.5% of those participants feel that they may still transmit the disease to their family when they came back to their home. And besides this, like 92.1% of those midwives reported that they are still interested to give care for their women with COVID. Then when we come to the outcome variables, like the depression, anxiety and stress among the midwives, like 41% of the midwives reported like mild to extremely severe forms of depression. The 29.6% of those midwives reported to have mild to extremely severe forms of anxiety and 90% of those midwives still found to have mild to extremely severe forms of stress with the indicated levels of confidence interval. Then this prevalence has had some differences, like there is more than some studies conducted like in Ethiopia, some years back, as well as in another study in Turkey, as well as in China. But also it was found to be higher than studies which were done in like Singapore. And like this differences could be the first thing that the time that we conduct the study was like the COVID pandemic is one of one of the issues which may create such differences that the emergence and the transmission of the disease may create still the differences in perceived exposure among those care providers. And the nature of still the care that midwives provide may not allow the life to keep midwives away from their clients, so that they need to be together, they need to provide their care close with their clientus and prolong the contact is still there, so that's the difference could be due to this. And when we see the factors which shown the 12 physicians with depression, like the female midwives have found to have the positively associated with developing or having the depression, working in rural and facilities also one of the factors and working in government facilities still had an increased also by developing the depression and having poor knowledge and attitude towards the disease and use of substances found to have an association with developing the depression. And like the working in government facilities are also still shown the positive association in developing anxiety and poor practice of prevention practices as well as poor attitude towards the disease also associated with anxiety. And when we come to stress like the rural residents use of those substances poor knowledge of the disease and poor self-reported preventive practice are still associated with developing stress, particularly working in rural facilities is found to be like protective or reduced also developing stress. Then female midwives were like 1.35 times more likely to develop depression as per the study when we compare with those males and that they this finding was still in line with another study which was done in China during like the emergence of the pandemic and still in our context this could be like the due to the like the intersect effects of the genetic biological hormonal as well as social and psychological factors which may influence the woman and the cultural context particularly in Ethiopia those female midwives are still additional responsibilities in taking care of the family, control the household activities and the lack could still increase their liabilities to develop depression. And the those midwives who are working in rural facilities were 1.39 times more likely to develop depression as compared with those midwives working in urban areas and this could be like due to the lockdown influences and particularly the access for information as well as personal protective equipment was limited in rural areas and still this finding is also my contradict with the situation that isolation quarantine and treatment centers were located in urban areas which may still pose fear and the risk of acquiring the infection on urban dwellers but still we find like that. And also developing depression and stress among midwives with full knowledge on COVID-19 were 1.4 times higher when compared to the those full knowledge and this could be due to the fact that providers who are good knowledge of the disease could have better understanding of the situation and they may have updates and this may still increase their fear. And midwives with poor COVID-19 prevention practice were 1.5 phase 3, 1.4 southern and 1.6 times more likely to develop depression anxiety and stress respectively and this could be the like midwives with poor prevention practice are less likely to acquire the infection and taking care of hope language that these prevention strategies could give them a sense of protection. And doors of depression and stress were 1.69 times and 2.06 times higher respectively among those midwives who were substance users and this finding is also in agreement with other studies like in India and this might be due to the triggering effect of substances which impairs their decision-making and judgmentability of those workers and reduced application of preventing. And doors of having depression were decreased by 69% among midwives who were working in government holidays facilities and midwives working in private excursions and this could be related to the issues related to job security during that time and more job security had been bearing government employees and lots of private facilities were reducing their number of employees that could be the reason. But doors of anxiety was 2.44 times higher among midwives who were working in government facilities as compared with those private workers which is contradicting but still this could be due to the critical shortage of personal protective equipment in those government facilities. And doors of anxiety among midwives who is poor attitude towards COVID-19 at 1.31 times higher compared to those who have good attitude and this might be due to the reason that those people who are not confident that this could finally be like controlled, the vaccines could be found out and the high perception of susceptibility and severity might cause them for anxiety. And finally, as the limitation of the study, as a study finding space on the self-report using subjective scale, there might be still reporting bias among study participants and as we use to collect data using telephones that there are participants who didn't include, would not have still mobile network access. And as a conclusion, like the findings of this study show why rates of depression, anxiety and stress among midwives in Ethiopia and the finding is cited the need for addressing COVID-19 knowledge and preventive practice gaps through like information training and provision of safety protocols and provision of adequate personal protective equipment is still very crucial. Thank you so much. This is all what I have. Thank you so much. Thank you Belene. Really interesting research and obviously on everybody's minds at the moment as well. We're all coming out of this pandemic and there's lots of questions about how it's actually impacted the healthcare professionals that have been working throughout. So this is a time for any questions that you may have for Belene about his study or anything that's come up from his research. I just wondered, Belene, why did you focus on midwives rather than looking at other professionals? You read the unimportant question. Like during the emergence of the pandemic, like lots of facilities have been just closed, has been just reassigned to just care for COVID cases and lots of other patients and other services have been just cancelled and the nationally recognised cancellations of those services have been happened. But during that time, the midwfric care, the midwfric services had been still maintained because the nature of the midwfric services is natural and it requires access for those services like you may not close the labor in delivery services. Like the nature of the services is very natural. The midwfric services still remain open and that was really a burden for those midwives and on the top of that like as the nature of the midwfric practice still requires very close and full contact, full of low contaminations and the like. The requirements for personal protective equipment are still increased on top of the previous limitations and shortages and this really created the burden on the ministry service on facilities and as a midwife we observed with the disufus and as lots of healthcare providers have still tried to make them away from the service with those midwives streaming on their practice and still all the disufus and our observations on our midwives, the frustrations still just initiated us to assess the implications of their psychological status. That was the issue that just led us to trust on that piece of stuff. I'm not sure if I understood the question. No, that's really interesting. I think in the UK where I work midwives were one profession that perhaps didn't get pulled to work in other areas because like you say the service with maternity continued but there was a lot more movement within maternity services so from delivery suite to community or postnatal ward so midwives were having to be more flexible and perhaps practice in areas out of their comfort zone and this no doubtedly added to levels of stress and anxiety as well. Did the health professionals in Ethiopia have this experience of moving out of their home during Covid so as not to increase the chance of bringing Covid back to their family? Yeah, there were some modalities like during the emergence of the pandemic like some of those midwives, those healthcare providers who were working in particularly Covid centres were just instructed and arranged to stay there in the centre all the times. But those healthcare providers like including midwives who provide routine services are not staying in the facilities like when they are working or taking back to their home. That was the issue that midwives were facing and still their family is concerned and they may transmit the business for the family was like that but those healthcare providers who were working in predefined Covid centres stayed there all the times. And did your study look at that group of midwives and how depression, stress, anxiety affected them compared to those that stayed in their family homes? Yeah, almost all those midwives who were working in mid-state units were with their families by that time. The country's modalities was to like quarantine those providers who were dedicated only for those working in Covid centres, right? So that this is just coming to their family workers for all those small participants that were in general. But still we just ask it that. Okay, if anyone else has any questions they can use the chat or if they have a microphone you're welcome to turn it on and ask the question. Have things improved Pelene? Now that the vaccine has emerged, is it a full programme of vaccination in Ethiopia? Yeah, actually it's not a full programme yet currently the first priority was meant for like those healthcare providers and those elders with like some comorbidities was the national priority because of the limitations in a number of those vaccines and recently the scope of the vaccine coverage is increasing. They still including the adults who are interested to be vaccinated and alike. But still there are problems on the acceptance of the vaccines among like those pregnant, postpartum, even healthcare providers. Lots of healthcare providers are still prepared to get vaccinated. That's also another challenge. Though the vaccine is still available there are limitations and lots of different attitudes among healthcare providers and among the general population is still here. But still the concern is related to the complications and like the normalisations related to the diseases and it's just protocols have been just becoming normalised and nationalised COVID-19 protocols have been revised. The restrictions related to personal protective equipment travels. Lots of restrictions have been left out and now things are still improving but that is related to the vaccines that need to be still involved and lots of efforts are required for respective stakeholders in this regard. And how are the numbers in Ethiopia of people getting infected with COVID now? Are they at the lowest levels or are they still quite high? Yeah, actually there are two things like the based on my observation like the testing abilities and the like are still not that much strong. Like the lots of facilities stop testing COVID-19 and the like and now the testing is limited to some of the centres. So that the number may look like reduced when we take the direct numbers which is comparably low based on the total number of testers but there are lots of clinical presentations that lots of people is being just demonstrating COVID-like symptoms and that's becoming just common need to be treated or to be just managed as like common quality in the right but let's do more observations. There are lots of COVID cases in the community but the testing is not that much strong and that could still underestimate the reporters but I think there are lots of cases. And are the other public still wearing masks in Ethiopia? Yeah, that's still, now the public is, still there are people who use masks but still lots of people are not using the masks, people see in the marketplace, even people see in the space in this, lots of people don't use just masks and like the people that are just coming to normalise the issues and I think that those of people are not that much better in my observation. Thank you so much. I can see that Hilary is typing but I'm not sure if she has a question. We'll give her a few minutes and just see if anything comes up. I think it's now all right. So Hilary says she was interested in the differences between male and female midwives. Do you think women in Ethiopia are more likely to be in touch with their feelings of anxiety and depression compared to men? I think that is. In the UK, I think it's commonly found that men are less likely to express these kinds of feelings. Do you find that in Ethiopia, Belene? Yeah, based on our findings, like women are more on top of sacrolethalcytum stem males. First of all, the number of midwives still in our country is almost the same compared to the 54, based on our national census, like 54% of those midwives are male in Ethiopia, which is very significant and a lot compared to other countries. Particularly, you are right with like men are less likely to express such kinds of feelings as per explanation. But the COVID pandemic was, it brings something different like those people having families, those people caring for those families are lots of burdens, particularly when they became male scape providers. We will be, we will care for those potential people. And when you come back to all, you are going to just, you fear that you may transmit diseases for your family members and the like still. As the Ethiopian culture influences those women's life to care for their families, their children, that social responsibility may still for those women's, female midwives just pose for additional burden compared to those males unless still male could be more likely, less likely to express such feelings, but in our study still the women's born to be pose for more psychological symptoms. But the plausible reason that we found finally was there are additional social and family responsibilities still will make them prostrating done males because the like the males may, may not have like intimate relationship like which means they may not care for the very children and families and that this responsibility is more on females in our country. So that may still create additional burden for those women. That was one of the reasons, but still it may be different because of the cultures and still the number of million male midwives in the particular facilities. I'm not sure if I got it right. No, thank you. So if there are no further questions, I just want to say a big thank you, Belene, for coming and presenting your research. It's been really interesting and I'm sure there'll be lots more studies on the effects of COVID on midwives and other healthcare professionals. So I think you'll need a way with this research. Thank you.