 Thank you so much Alla Fenney and I've gone ahead and pressed the record button. It's a great day to be a midwife. But it's also a sad day for us at Virtual International Day of the Midwife. And we always think those of us that are born, we have adopted moms, or we have our birth moms. A sad day for us was two or three weeks ago that our wonderful Chris Woodhouse's mom, Deepa, passed away at the age of 90. So this session is concurrently running with Deepa's funeral. So we're making a memorial today for her and thinking about Chris, our wonderful IP guy. We miss him very much and Deepa was obviously a wonderful person. So this session today is in dedication to Deepa Woodhouse. So we think about our moms today. It's very special women and ladies on International Day of the Midwife. And thank you Alla Fenney. Okay, thank you Jane. Now, the presenters are from Ethiopia. Nygos, sorry if I didn't pronounce that name very well, has more than half a decade experience as a midwife. And presently an assistant lecturer in Midwifery at Wodea University in Ethiopia. He's undergoing his master's degree in clinical midwifery in Hawazah University, Ethiopia. He has undergone a number of training courses in antinatal care, published some papers in the field and had some research publications to his credit. It's all yours now as I hand over the microphone to Nygos. Nygos? Okay, thank you very much. Dr. Rourou for me and Ms. Jane, my facilitators. So I'm going to present on obstetric dunger signs, on the knowledge of obstetric dunger signs, and on reproductive age of women in the study area. So I have conducted this research with my colleague Mr. Tostam Latu. He's a public health expert there in the university. So these have the outline of presentation, an introduction section, an objective, and mater and materials, followed by results and discussion, and conclusion, and finally, those strengths and limitations, please. Okay. Nygos, can you please... Yes, I can hear you. There's background noise at your end. Can you please check that? Background noise. Yeah, I tried to minimize. Yeah. I'm telling them that I tried to decrease, and ask you to just... wait a second, please. Thank you. I'm coming with you now. Yes, of course. Go on. So thank you. The introduction session has 2015 target for the MDGs near the preventable costs of maternal mortality, as well as mobility, remained critical challenges for the globe, despite, I mean, a significant progress over the past decade, even in Ethiopia. There were a different amount of maternal mortality to 350 per 100,000 light-years. So, although the global maternal days have decreased by about 45% since 1990, still there are an estimated 800 women die each year, globally. This is the report of the WTO 2015 report. And still 99% of the global maternal days were in the developing region, especially in the sub-Saharan Africa. Sorry, I think the presentation has changed to another presentation. Can you adjust it, please? Is that alive? Yeah. So, about 99% of the global maternal days are in the developing countries, still about 66% in sub-Saharan Africa, including Ethiopia. And for every 100,000 light-years, 450 men die during the three periods and the prognosis, labor and delivery, and the postpartum period. These are the three periods. And delay in taking care. This is one of the first delay in the three delays. It's one of the factors leading to maternal days, which can be adjusted with a lot of knowledge about obstetric danger signs. So, these are the basic, the key obstetric danger signs during the prognosis, delivery, and postpartum period, as you can see on the slide. During prognosis, there is a severe vaginal bleeding, which may be the most symptom of signs for antipartum hemorrhage, and swollen hands or face and blood vision can be severe signs for hypertensive disorders during prognosis. And again, similarly, during labor and childbirth, there is severe vaginal bleeding, prolonged labor, which can be associated with obstructive labor and conversions and retained protein type, more than a certain meaning in the intro. And in the third period, severe vaginal bleeding, again, the postmortem vaginal discharge and high fever, which can be associated with infections, especially postpartum infections, including endometriques and prophylaxis. These are the basic and the key obstetric danger signs during the three periods. So, the leading cause of maternal diabetes in Ethiopia are Z4 hemorrhage, hypertensive disorders during prognosis, abortion and sepsis. And the fetal ministry of Ethiopia aspires to defeat maternal mortality to 199 per 1,000 micros by Tony Tony. This is a plan prepared by the sustainable development goal. I mean, health service transformation plan. And these are some research conducted in Kenya shows, for example, heavy vaginal bleeding before expected delivery. I'm pleased on the vaginal discharge and what's operating before today. And so on are the obstetric danger signs cited by the respondents of ZC study in Kenya. And in Ethiopia, again, about 32% to 27% and 22% of study participants were neologiable about this obstetric danger signs during pregnancy, delivery and postpartum period respectively. And these are the predictors of maternal awareness on obstetric danger signs, different social demographic and obstetrical or maternal characteristics like maternal education labor, antenatal care follow-up, place of delivery, and occupation and health. So, our significant this study is very significant because knowledge of obstetric danger signs during this period is an important step for appropriate management and timely repair. And it's also a better strategy to enhance skill and emergency obstetric care in low-income countries, especially like Ethiopia. And increasing the knowledge of this obstetric danger signs for prognome plates will reduce delay in seeking care to improve ill-intentional obstetric complications, especially obstetrical emergencies arise during pregnancy during delivery and postpartum period. So, this is the objective. The general objective is to assess the awareness and the patterns associated with this obstetric danger signs. And here are the specific objectives to determine the level of knowledge and to assess the predictors of obstetric danger signs. So, this study is conducted in one... in northern district of Ethiopia, Raya Koppu District. This is one of the 13 districts of northern lozo around Wojtya University where I'm working. So, this is about 507 km away from Addis Aba, the capital city of Ethiopia. And there were about 42 health posts, seven health centers and eight private clinics with two health extension workers. And in each health post, this is a report from the 2000 people. The design of this study is committee-based processional study design. It includes mothers who have lived for at least six months in the district who have given birth within the last few months regardless of the birth outcome. Maybe live births or stillbirths. We include both mothers. And some size was determined using single-proportion-proportion formula by assuming a proportion P from another study conducted in Goba district of Ethiopia and 95.10 interval and plus of 5% absolute precision and we had 1.5% of design effect and 5% of non-sponsored rate. So, the final sum size was 570. Sampling procedure First, we made a stratification to R1 in rural Kabbalah place listeners. Kabbalah is the smallest administrative unit next to Warradah or district in Ethiopia. Having in mind that Next, we do simple random sampling SRS By using simple random sampling method to R1 Kabbalah and rural Kabbalah and the proportional locational sum size was done according to the number of Kabbalahs to R1 and rural Kabbalahs. And again, systematic sampling SRS were used to select study subjects at the household label. And again, the low-term method was used to select the first household to be interviewed. SRS operational definitions are knowledge of obstetric complications means any system of obstetric complications mentioned by the study participants doing pregnancy, delivery of the postpartum period. And in this study, the mother were considered as knowledgeable if she can mention at least three obstetric danger signs for each of the three periods. This is the standard of Japango, the Maternal and Neonatal Program of Japango. So the questionnaire was adopted from the Japango Maternal and Neonatal Program and it was translated from English to the local language Amharic, then back to English. It was translated from Amharic languages used to collect the data. And pretext was also done. And the internal consistency and content validity of the two-way check, actually the internal consistency was checked by calculating from the pretext questionnaire. It was about 0.8, which is greater than 0.7. So we haven't made any changes because at Kronowata Alpha is greater than 0.7. This was very best for our data. And training for the data collectors and supervisors were given by the principal investigator of the study. And the statistical analysis was basically done by SPSS, a statistical package for social science version of TION and both binary and multiple logistic regression analysis were employed. And they took to compounding those also control. And finally, variables with a p-value less than 0.05, the multivariable logistic regression were considered as the independent predictors for knowledge of all sorts of dangerous science. The ethical approval, the ethical approval by the institutional research review board of University and informal verbal concern and confidentiality were also actually doing data collection. So when we go to the results and discussion part, the first section is social demographic characteristics of participants. And we got a response rate of 95 percent and the mean age was TION 9. And regarding the religion, Ethiopian also Christianity was the dominant region and 2.2 percent of the respondents were married. And about 50 percent of the respondents were illiterate. They come to it on the right. And housewives account 88 percent. This is the table showing the social demographic characteristics of the respondents. The first section is obstetrical characteristics. About 40 percent of the respondents spent more than 30 minutes to which heads the institutions. And 72.6 percent of the participants are at least one end the follow up for the last pregnancy. And majority of the respondents start their end visit for less than 16 weeks of gestational age. And many mothers gave birth to their last child after the birth. This is the table showing the obstetrical characteristics of the respondents. And the other section was the knowledge of obstetric gender science, which was the outcome variable for this study. More than a half of 53.3 percent of the mothers were not knowledgeable about obstetric gender science during the postpartum period. These are the most frequently cited obstetric gender science during the three periods. For example, during pregnancy, vaginal bleeding, breast cancer, breast cancer, breast cancer, breast cancer, breast cancer, breast cancer, breast cancer, breast cancer, breast cancer, breast cancer, breast cancer, breast cancer, breast cancer, breast cancer, breast cancer, breast cancer, breast cancer, breast cancer, breast cancer, breast cancer, the study participants, which is a table. As we can see from the table, vaginal bleeding in all the sleep areas, doing pregnancy, labor and delivery in postpartum period, vaginal bleeding is the most frequently cited obstetric dungeon science during sleep areas. So this finding regarding the knowledge of obstetric dungeon science during the sleep areas is higher than in rural Tanzania and Somalia regional state of Ethiopia. And this might be due to relatively high antenatal care visits covered in this study. And it is also consistent with study conducted in Ethiopia, in Goba district, doing labor and delivery. And higher prevalence was reported during postpartum period and delivery. And this finding is lower than findings from similar study, as we are doing from now. And this defense might be due to the fact that a mother was considered as knowledgeable if she could mention to dungeon science in a study conducted by Balinda and his colleagues. But in this study, mother was considered to be knowledgeable about obstetric dungeon science if she only could mention three obstetric dungeon science. And then accelerated or decreased state of movement and water breaks without labor, where other frequently mentioned dungeon science during pregnancy by mothers in our study. And lower prevalence of knowledge about this dungeon science were reported by studying northern parts of Ethiopia, Sagarek. Additionally, in this study, remain placenta and prolonged labor were known by 59% and 48.4% of state participants during delivery respectively. And this finding is again in line with study conducted in Goba district of Ethiopia. Additionally, offensive vaginal discharge and severe headache were also postnatal dungeon science frequently mentioned by the respondents of our study. And similarly, in studies in Kenya and Ethiopia showed offensive vaginal discharge was frequently mentioned as postpartum dungeon science. High fever was mentioned by only 5% of the state participants of our research. But this figure is lower than findings from Goba and Sagarek districts of Ethiopia. When we proceed to the factors or the predictors are shared with knowledge of obstetric dungeon science, in this study the mothers' educational stars, occupational stars, and number of antenatal cavities and place of delivery were found to be predictors of knowledge about obstetric dungeon science in this study. As you can see from this figure, for example, in the first row, you can see mothers with secondary and above education were about 3.6 times more likely typically knowledgeable about obstetric dungeon science doing pregnancy than their illiterate counterparts. And similarly, during the postpartum period, the mothers were about 5 times more likely to be knowledgeable about postpartum dungeon science than their again illiterate counterparts. And similarly, the private employees were about 5.4 times more likely to be knowledgeable on this dungeon science. And as you can see from this, institutional delivery was also main predictor for knowledge of obstetric dungeon science during delivery about mothers who gave birth, they last birth at Hansen Institute, so about 2 times more likely to be knowledgeable about obstetric dungeon science during labor and delivery. So these are the factors that they are shared with, knowledge of obstetric dungeon science. So in the present study, secondary and above education level, increase the orders of knowledge about dungeon science about 3.6 times as you have seen on the table. Similar findings were reported by study conducted in Tanzania, Nigeria and Ethiopia. And this could be an indication for intervention to encourage access for education for women and women should be empowered to decide on their own health matters. Again, in this study, private employees mothers were more knowledgeable about dungeon science of obstetric complications. This study is similar with studies conducted in Gopa District of Ethiopia by Pogale and his colleagues. This could be explained by the fact that women who have their own source of income have better access to health related information and they eventually they will get good knowledge about obstetric dungeon science and after that they can protect themselves from obstetrical emergencies. And additionally, the present study revealed the number of PNSE visits was associated with the knowledge of these science. And a similar study conducted in Tanzania showed a similar finding. And other studies conducted in Nigeria and different parts of Ethiopia showed entrepreneurial visits were a predictor of knowledge about obstetric dungeon science. And this implies stakeholders need to promote NSE follow-up, including the frequency of visit according to the standard. And this finding of the study showed mothers who gave their last births at health institutions were more knowledgeable about obstetric dungeon science. And again, this is similar to a study conducted in Tanzania and Ethiopia. And NSE should be promoted to increase the knowledge of mothers about this obstetric dungeon science. And finally, the strengths and limitations of this study. The strongest this study employed a commit-based approach when selecting the study participants. This makes a representative of this study and we can generalize to the whole population in around the district where the study conducted. And additionally, we have minimized record bias by selecting recently delivered mothers within two hours because we are asking them about their previous obstetrical characteristics and some lifestyle characteristics. So we should select the mothers to minimize record bias this way. And however, we cannot indicate the direction of position to the associated relationships. We have nothing to do with this because the nature of the cross-sectional study is that it can't indicate the direction of position. So as a conclusion, as you can see from the previous slides, the knowledge of mothers about obstetric dungeon science was low in the study area. And the most frequently mentioned obstetric dungeon science, during the three periods for grants, delivery and postpartum period was vaginal bleeding. And the factors or the predictors, significant we are shattered with knowledge of obstetric dungeon science where maternal and educational styles, mothers occupation, number of NSE visit and place of delivery. And these are the recommended interventions. First one, empowerment of the women. I mean to have a very educational status, to have a better health status. So women empowerment is very crucial to boost the knowledge of mothers about obstetric dungeon science. So we can minimize maternal morbidity and mortality by empowering women. And second one, improving the quality of health information about dungeon science, spring and sepulok. This recommendation is basically directed towards the health professionals. So health professionals should educate the mothers about the key of obstetric dungeon science during the three periods. And the third one, promotional organizational delivery. As you can see from the previous slide, institutional delivery was one of the predictors of knowledge of obstetric dungeon science. So promotional organizational delivery will decrease the maternal morbidity as well as mortality. So I think this brings to the end of my presentation. As Black Neologians, we are thankful for World University for financing this study. And we are so thankful to data collectors, providers and their study participants. And we're also grateful for organizers and positive also the idea. And if you want any positive reading, this paper is already published in the DMC Prognosis and Childbirth Journal. You can access it. Thank you very much. Now, I guess this is Jane Huston. All of them, he seems to have disappeared. So I'm going to be your facilitator for the rest of the session. Thank you. Nigeria and Lagos. So let's have some questions, please. So just meeting our questions now. So can you tell me what you like when you are in power? Sorry? You said in your slide that you are empowering women during childbirth pregnancy and late in your life. Sorry, Miss Jane, it's very difficult to hear your voice. Can you text me on the chat box, please? Yes, I do text. Thank you very much for the question. Yeah, empowerment of women in one power intervention or recommended intervention in YouTube. I'm not talking about Nigerian study. Of course, the Nigerian study recommended to empower women to boost the knowledge of domestic science going as a street artist, maybe. And we do our recommendations for this specific to our study only. If I get your question right, or maybe you can write clearly in the chat box. I'm just texting. Is my sound better now? All right. How is my sound now? Is it better? Yeah, much better now. Sorry, I was talking about any other questions for Nigus. All right. I thought that was fantastic. It's really great to have international midlife being able to talk with each other. Alicia has a question here. I'm curious about the type of providers providing out of hospital care. Who does that? Yeah, the type of providers providing care out of the hospital or health institutions are basically health extension workers. These are actors in the community, which give many health related information to the program ladies as well as the whole community. So I guess in Ethiopia there are health extension workers. So these health extension workers play a crucial role in providing any obstetric or other health information to the mothers. So we thank you for the question on the comment. And we will recommend these health extension workers to give more deep information about this obstetric danger signs at the community level. Thanks for the comment. And there's another question. Okay, thank you. There is a chat box that Barker said that the culture is an important user culture. I think thank you very much. I think qualitative study is very crucial in finding out this cultural things in the community. So our study is only in the quantitative part and it's very nice to conduct the research both qualitative and quantitative aspect. So we try to recommend from the whole paper and you can see the published paper I told you in the bio. Thank you very much. Another question? Okay, okay. Another question? I welcome. Norges, can you hear me? Is my sound okay? I've got there's another question there. Can you hear me? Yeah, I can hear you. Please continue. Tara Matty asks, does culture have an impact on your research? Sorry? In the chat box, Tara Matty asks, does culture have an impact on your research? Yeah, culture may have an impact on this research. You know, there are other different research conducted in the why women still deliver at home. I try to see published literatures on the factors associated with home delivery. You know, there are weird things here in Ethiopia. Women still deliver at home because they have no trust on the health professionals. And they think that giving birth at home will make the baby very outstanding life in his or her life. And there are so many weird things about factors associated with home delivery. Of course, as I have told you earlier, this research will be very interesting if it includes qualitative study design, qualitative. So the key informants like the traditional birth attendance will tell us so many things about, you know, the factors associated with home delivery. So I'll take a comment and I'll include the design in my future research activities. Thank you. Questions or comments? Okay, any other questions? I have a question, Nigus, if I may. It's Linda here. There it is. I think I'll talk to you back later. All right, hang on. Now it's better. Continue, please. Sorry, what is it? Yeah, please continue. Yeah, I think, do you enjoy what we asked? Hopefully, as a man, are you allowed to interview women? Yeah, that's an interesting question. Of course, we haven't faced any problem when we interview. Actually, I'm not here at data collector for this research. I am the principal investigator for this research. So there were eight diploma midwives. Interestingly, they were women, actually, and they could interview them freely. But I think the man is also allowed to interview women in our data. It's okay. But to gather more information, especially sensitive issues, regarding the world, the way we try to read through it, it's a key main midwives to call it. Thank you. Well, thank you so much, Nigus. I hope everyone can hear me okay this time. I think my laptop is complaining. So thank you, Nigus. And we're just going to finish up our presentation now, and hope everyone can hear me okay. So as we said at the beginning of your presentation, we're really memorising our dear friend and master facilitator and IT guy, Chris's mum, Zita Wupau. So Chris is at his mum's funeral today. So we just wanted to spend a moment or two talking about Chris's mum, Zita. And she was a lovely lady and she was a really great neighbour and friend and family member and mom too. So thank you, Nigus, for letting us memorise Chris's mum during this presentation as her fuel is on while we're having her on friends today. So thank you so much.