 Amina Abdul Rahim, I'd like to request each one of us to just welcome her as she makes this presentation this afternoon or this evening or this morning depending on where you are. Amina Abdul Rahim is a nurse, a midwife and a lecturer from the Department of Nursing. University of Maiguduri, Burno State, Nigeria. She studied in prestigious universities in Nigeria. Her first degree in Amud Bello University, Zaria, and a master's in maternal and child health nursing in University of Nigeria in Suka and Igustate. And is at the verge of completion of her PhD in maternal and child health nursing with research focus on adolescent and infant care in Amud Bello University, Zaria. She has presented papers in national conferences and published in high impact journals. Amina will be making a presentation on effect of education intervention program on thermal care of pregnant adolescents attending antenatal clinic at primary health care centers in Zaria town, Nigeria. So I'll make Amina a presenter and Amina you can continue from then on. Welcome. Thank you. Thank you Caroline. I'm privileged to be part of this year's Virtual International Day of PY. And to present my research findings on adolescent model. I'm Amina of the Rahimiya, as Radley said, from University of Maiguduri and I would like to share my findings on effect of educational program on thermal care of pregnant and adolescent attending antenatal clinic at primary health care centers in Zaria town, Nigeria. Thermal care is an essential part of neonatal daily care in order to prevent hypothermia. Hypothermia is known to be a major cause of neonatal mortality as it complicates other diseases at early neonatal period. Cardinal state is one of the northwestern Nigeria state with the highest prevalence about 522 per 1000 women of adolescent with child bearing. Occurring motley within marriage and in male-led household. More thermal care practices around the time of birth are common practices among adolescent models and probably due to their lack of experiences and knowledge of recommended optimal thermal care practices. This may also be complicated by the cultural practice, cultural behavior called kunya in the study region where first time models are expected to exhibit a high level of shyness while caring for their infant while interacting with their infant. Meanwhile, adult separate pregnancy is associated with pretend birth, low birth weight and mortality. The need for braver and cultural modifications through professional health education program can assist pregnant adolescent to adopt optimal thermal care practices and midwives have responsibilities in helping them through this stage through training and health education. This study aim to evaluate the effect of health educational program on thermal care knowledge, practice and satisfaction of pregnant adolescent attending antenatal clinic in Zareta. The objectives of this study is to assess the pregnant adolescent knowledge of thermal care before and after the educational program. To evaluate pregnant adolescent practice of thermal care after the educational program and to determine the pregnant adolescent satisfaction of thermal care after the educational program. Materials and methods. It is a quasi-experimental design that adopted control-interrupted time series approach. And the setting for the study is Zariath Adnastate, which is one of the Northwestern endurance states. And the target populations were pregnant adolescent who received antenatal care at selected primary 8K centers in Zareta. And this also extends and covers the women and their infants up to six months with pattern. The sample size determination. The sample size was determined using Coulton-Nandelin et al formula. And 151 participants per each group were determined, making a total of 302 pregnant adolescents that were recruited for the study. Then the multi-stage sampling techniques. At the first stage, the sample, the Zarya, the advanced stage Zarya, which is made, the Zarya term which is made out of two local government areas, was drafted into both Zarya and Savongari local government, which are the two main local government in the area. From that data to the second stage, whereby from each primary 8K centers, five primary 8K centers were randomly selected from each local government area by simple balloting. And at stage three, there was proportionate allocation of participants based on the average number of clients attended antinatal clinic weekly. And at stage four, there was systematic sampling technique to select the required respondents in each 8 centers. Still on materials and methods. The instrument for data collections. There were two instruments. The interview administrator questionnaire, which was used to elicit information on the demographic restoration of participants, the knowledge of time I care and the satisfaction of the time I care. While the other one, which is observation techniques was used to elicit information on the practice of time I care. So these instruments was a transforming to software application, open kits, open data kits, which was now installed into the mobile forms of site assistance. And that was used to collect data. The method of data collection. These were in three stages. At the pre-intervention, there was preparation and designing of intervention programs and instrument. The ethical clearance and permission was also obtained from appropriate authorities. There was also recruitment of research assistants at the stage. And then still at the pre-intervention stage, there was based data collection from both study and control groups. So at the second stage, which is intervention stage, this was also in two stages. At stage one, there was the dose in the study group where the intervention stage was mainly on dose in the study group, whereby they were trained on care, on thermo care. There was detailed description of what thermo care is all about. All these adult practice called skin-to-skin contact. They are standardized care with their infant, the lumine, they are how to keep warming their babies, exclusive breastfeeding, all that. And the audiovisual use were used to show all those on how to carry that out. So after the detailed description of what thermo care is all about, they were subjected to demonstrate what they've learned to really show that they really got what they've been trained for using their models. And that was mainly for the study group, so the intervention, the control group were not involved at the stage. So at the post-intervention, the post-test data collection were in five stages because it was a control-interrupted time series, which data needed to be collected in repeated stages over a long period of time. So at that post-test data collection was in five stages and this was scheduled based on their time of immunization. So the first data collection was that the first week when they came for BCG, the second one at six weeks when they came for Painter 1, the third one was at 10 weeks when they are for Painter 2. And the fourth one was 14th week when they come for Painter 3. And the last one, which is the last data, post-data was at six months when they came for their measles immunization. And this post-age was both for the study and control group. So the method of data analysis, the data collected was analysable, discreetly and inferentially using XOL, SPSS and STERTA. And the chi-square test mean as a dementia person regression was also used and result. So this is a sociodemographic analysis of the respondent. And then we look at the group, the age group, the ethnic group, the religion, marital status, poverty, and education. And from the test, the chi-square test was used and the P-value from the beginning of all the variables, it shows there was no statistical significance or sociodemographic characteristics of both study and control groups, which now confirmed the homogeneity of the two groups. So the next slide is talking about the knowledge of family care before and after the intervention. So before, the knowledge, aggregate mean knowledge was 45 for the study group and 43 for control group. And the aggregate mean percentage was 30 and 28, respectively for study and control group. And the chi-square of 0.236 and P-value of 0.62732 was obtained, which shows there was no significant difference between the knowledge of both study and control group before the intervention. But after the intervention, the knowledge of the study group improved to 99 percent, while that of control group was still 43 percent and the P-value of less than 0.00 was obtained. So this result shows no significant difference in the pre-test. The pre-test mean knowledge between the studied groups and at post-test, the knowledge of study group improved significantly compared to that of pre-test of both group and post-test of the study of control group. So these findings in line with the study in Egypt by Ali Abdul El-Salam, 2019 and that of the NICERETR 2017 in Indonesia, would discover low knowledge mean score of infant family care in the pre-test and statistical significant improvement at post-test. So this is the practice after the intervention. So the practice at the post-test for the study group was 93, which is 68 percent, while the knowledge of the practice for the control group was the 3 percent, but the P-value was less than 0.00. So these results shows this result revealed improvement in the practice of family care after the intervention and statistical significant difference between the study and control groups. This study is, the finding of this study similar to that of study in Nigeria but allow you in 2021, who reported group practice of kongoro modern care among mothers, although this study was a cross-sectional study and the improved knowledge could be associated with the fact that the center where the study was conducted was a center that was designated for excellence for the care of neonatal mothers or preterm babies in the intensive care unit. And due to the effort of Federal Ministry of Health to its dedication and training of neonatal intensive care mothers, this could be the result why despite the fact that this study is a cross-sectional but is a form of intervention that is being carried out in that area. So that may be the reason why there is increase in the practice at that setting despite the fact that the cross-sectional study. However, the finding is in line with the quasi-experimental study conducted in Indonesia in which mothers in the study group should improve termite care practices after the educational intervention. Then the next slide is satisfaction of termite care after the intervention. So the mean score was for the study group was 4.8, which is 96 percent while that of a control group was 3.6 to 72 percent. So this finding and the p-value of 0.005 was obtained. This finding, the finding of this study shows 96 as 72 of all that the study and control group respectively were satisfied with termite care rule and there are statistical differences existed between the study and control group after this multiple pattern. The finding is similar to the result of studying in Iran where there is improved maternal satisfaction in study group and statistical skin can differ in the level of satisfaction between the study and control group after the educational training. So the next slide is depicting the line chart. So the effect of intervention is showing the effect of the intervention on the knowledge over this multiple pattern. And from the chart, you can see that both the study and control group have almost the same intervention knowledge. So after the intervention, we can see that the knowledge for the study group improved. There was great increase in increment in the knowledge on the study group and this was sustained throughout the period of observation. However, for the control group, the increase is very slow, is very slight, is slight increment and gradual and this was also sustained throughout the period of observation. So this chart is depicting the strength of the design used for the study. In which it is able to distinguish the impact of intervention from the circular trend. What I mean by circular trend is that it changes upon even in the absence of the intervention and this has been shown in the control group. We can see that despite that there was no intervention, there was slight increment in the level of knowledge which is very slow and slight. That's for the impact of that intervention which makes those in the study group to have great increment in their knowledge and which was also sustained. So this is part of the strength of the study design which is contra-interrupted time series design that was used. It's able to distinguish the impact of intervention from the circular trend. It changes that upon even in the absence of the intervention. So by implication, the program has greatly improved and sustained the knowledge of the participant for a long time after the intervention. There is a slight decline towards the terminal end of the observation with assessment and this attributed to the nature of women being whereby there is likely for them to experience a slight decrease or extinction in the knowledge acquired after some period of time and this could be improved by continuous education. We can also deduce from these findings that the models that got the intervention, there is tendency for them to still have good practice in their subsequent delivery but there is need for continuous education. The next slide is line chart showing the effect of intervention on practice over six months postpartum. This also can consider, this also followed the trend of the knowledge but there is one thing that we need to see from here we can see clearly that there is no pre-intervention data collection for the practice. That is one of the limitations, that is the main limitation of this study in which was discovered during the pilot study that we cannot establish, we cannot establish the practice prior to delivery and the reason being that majority of the participants, their primary gravedure with no knowledge or experience about what can my care practice is all about so we cannot establish intervention. That is why and despite that after the intervention we could see a great increase in the practice that improved increase in the practice of those in study group compared to those in study group and that was also sustained throughout the period of observation. In conclusion, the result shows that at the education program who significantly improve knowledge, practice and satisfaction of adolescent models on thermo-ike therefore there is need for midwives to continue educating adolescent models and the recommendation there is need for continuous training and education of adolescent models on thermo-ike because the view to the world happened especially in the study region those with first-timer models they are expected to have a bit of level of shyness when interacting and caring for their baby and that may also influence or affect the way they do some of the essential care of their newborn so with this cultural orientation and the education it give them that confidence and give proper care to their infant and that's why there is need for us to especially these young models there is need for continuous training and educating them and we also encourage similar studies also be repeated in other parts of the country. As I earlier said this study could not establish baseline data which is the limitation of thermo-ike because most of the participants were primary Graphida would not have any experience on what thermo-ike practice is all about. Thank you very much for listening and this is some of the references. Yes, thank you very much Amina thank you for the presentation we appreciate and you've done a good job so there are few questions that have come in from the chat there are some comments and some questions there is a question from Peggy could you measure a clinical impact after the introduction of thermo-care that is the first question and there is another one that asks what satisfaction with the thermo-care knowledge really a question of interest in your study design. Okay, so the first one we say that we measure clinical that would be another aspect or another way of going about the measuring the impact of the intervention fine we can do that maybe going into the clinical area and see how the outcome the outcome of neonatal outcome has been in the areas compared to which is another area in which we can assess the impact of the and is a very nice one assess the impact of such intervention yes clinical impact yes what is satisfaction yes because it's known that when we're talking about the maternal role for you to say mothers are satisfied they are able to deliver what is expected as a mother having been delivered what is expected do the proper care you know the knowledge there is need to establish whether they are really satisfied with as a mother the motherhood is there that satisfaction needs to be the exam you need to evaluate that because it's part of when we're talking about the maternal role when we talk any form of maternal role when you give what is expected as a mother we would now like to assess whether are you really satisfied is it what you have compared to the training that was given and what you are giving what you give to your child as a mother are you really satisfied with it it's a nice one to teach thank you thank you for responding there are some comments thank you a lot of education is what is needed here such a detailed study and thank you for this research I'm not sure whether there are any more questions or comments indeed I think Amina you were very detailed and I think very clear and also I guess everybody was able to understand and to follow you clearly