 Our speaker for this session is Aisha Salih Abdullahi, who is a midwife based in Nigeria. Aisha Salih is an experienced senior academic that is interested, who has conducted a lot of research in maternal and childhood nursing. She's actually interested in intrapartial nursing. She has published a number of review articles both in international and national papers and also participated in so many conferences. She has also participated in a number of training programs for midwife on enhancing life-saving skills and essential obstetric and newborn care. And also enhancing midwife educational skills. She has been working in the Amadebello University, which is a very famous university in Nigeria for the last 10 years, during which she has coordinated many activities in the Department of Nursing Sciences, College of Medical Sciences, Amadebello University, all in the zeal of mentoring and producing highly qualified, versatile and resilient midwife and of course workforce to provide care to the teaming population in Nigeria. Before joining the ABU, she's also a midwife instructor. She's a registered member with the nursing and midwifery council of Nigeria and currently at the verge of completing her PhD program in midwifery. So I should start with you. We are very happy for your sharing your experience with us. I'm going to hand over the presenter right to you right away. You're welcome to this great day. Thank you so much Halima Abdul. Thank you very much. I'm very happy to be here. And my Shasailu, as my facilitator has rightly mentioned, my research is on assessing the satisfaction of midwives with the epipyles patrograph as a tool for monitoring label in secondary healthcare facilities in the state of Africa country in Africa country. This is an introduction as to the search. I start with introducing the midwife as a primary service provider, especially to the back of the woman, especially in this in Nigeria and this part of the world. And you'll find out that these services, midwife advice, provide range. They range from simple advices that they give to complicated procedures such as vacuum to the land. For that reason, you'll find importance is put into the ability of the midwife's to participate in various strategies. So long as those strategies are aiming at improving the lives of the family. And we know the woman as the unimportant member of each family. So this increased visibility and recognition of the midwife as a key provider of Madala and nearby health services. This lead to a lot of challenges. And in Nigeria, you find out that the workforce we have, the middle-freak workforce to be in particular is in agreement with a lot of resource deprivation. And this can be associated or rather has to be reported to be associated with interdictive studies and cultural dedications on gender-based discriminations that occur in our societies and some conflicts. Sorry, turn to the light, thank you. Monitor of labor is very essential and considering the nature of activities during the collaboration, it is imperative to make service provision easier. And in a bit to do that, tools are usually being employed. Activities of the middle-freak service provider are made simple. And part of those two that I've been approved for use to monitor the first labor is the part. Now, the part of that can approve the effective in monitoring especially the first stage of labor. As the healthcare provider, the midwife in this case, in taking decisions promptly. That's a lot of confine. The part of that has been heralded by a lot of cost-effectiveness problems preventing, or rather it's hindering its ability to prevent that unnecessary delay in labor. So this is through continuous monitoring of labor. The patograph can prevent delays in labor. And it gives the midwives, so the midwife the chance to guide her decisions but when to make decisions and what will be the right decision to make, which is always crucial in preventing adverse obstetric outcomes, which imminently will lead to reducing maternal morbidities and mortality. Now, what is this patograph? The patograph is a tool that is approved by the World Health Organization. In fact, it's developed from what we call a cervical graft since the 20th century. And it develops into a tool in which in 2000 the WHO was able to modify it for each to be used, searching from the active phase of labor. So it has been used, especially in resource deprived countries like mine, but though it is confound effect, there are a lot of factors that are found to contribute to the root of patograph use. Some include lack of awareness, training, inabilities among the healthcare providers. Sometimes you complain about inability, inability to have a tool. Sometimes it is a negative perception or a negative perception to some of these are the factors that hinder effective use of the patograph. And also additionally, some argue that the patograph is a risk. So you will need a lot of time to fill in the patograph patient. So find your own history where you have a lot of clients at hand and not enough as midwives in the facility. It becomes difficult for you to use the patograph for each woman in labor. It's as this, as a result of this, that the paper list part has been developed. It's the old risk rules that we mentioned. And what happens is that in 2008, an Indian gynecologist developed an approach they call the repalice patograph. What this does is to ensure that the idea behind the use of the patograph is being employable in labor. It's using the chat in the graph. So they are using the data in using it. What happens is that you are in agreement with the point that it's at one centimeter per hour in the active stage of labor. This is being used as a medium within which two time frames are calculated for every woman. So it's actually in the first stage of labor. So it means that when one comes in labor, you do the first for the woman, you identify the cervical dilatation. Now, based on where the alert line and the action of the pattern, the uplift order of 2000, add specific us and give the one time frame with which you expect a woman to deliver. What I mean is that from the time, for instance, she's forced dilated, that is when you start to open the patograph for the woman. So when you, you rather take the exam dialy first as long as she maintains that line of the patograph. So on the people's patograph approach, you add those six hours to the time where you are involved on the chat of the woman, be it a etiquette, a treatment, whatever you are documenting the care you give to the woman. So apart from that also, you add four hours to that initial time which will get accepted time. And that's also righted in. Expect that you will get all the specter agree by the specter of delivering in regs. So the time frames guide your activity in monitoring that woman's labor. So it is, you would try as simple to see that you have a time within which you are guided. You expect the woman to deliver the next six hours if you didn't deliver, if you come, you assess the woman and you consider the possibilities of maybe referring the woman to a situation of increasing the labor, depending on what whatever stage of labor the woman is. So this paper is already been tested in various situations. And one of the situations where it has been tested is. Can I interrupt just one second, Aisha? I'm just the master facilitator. Second-regal scale facility in Kazanah State, Nongan, Nijido. Aisha, can you hear us? So the aim of this study Aisha is to explore the level of medial satisfaction. Those medials that we provide are involved in using the people as part of our monitor women in labor. I've been asked to determine whether they are satisfied with views on that point of view as a tool for the women. Yes. Aisha, I don't know if you can hear us. Can you turn your video off? It's just causing a lot of interference. So we haven't heard the last couple of things that you've said. Thank you. That might make it better. Thank you. Yes, I can hear you. Now you're much clearer now. This sounds good. Yeah, this one is better now. Yeah. We can hear you now too. Can you hear? We are hearing you. Can you hear us? Hello? Can you hear us? We can hear you. Okay, thank you. Okay, thank you, thank you. Let me go back. I can hear you. I can hear you. All right, continue. Okay. The research involves is a descriptive cross-sectional study that was done on the population of midwifes that work in the particular delivery ward. And we used a questionnaire which had two sections. The first section gathers which would demographic information of the midwifes. The second section is a seven-point cemented differential scale that gives gather information on the satisfaction of the midwives with the paperless patograph. So the midwives exposed in using the paperless patographs were allowed to monitor 200 cases. And it is after this monitoring that we distribute the questionnaire to assess a certain section which we believe is necessary to influence the use of the paperless patograph which is a tool that is important in monitoring of labor. Ethical approval obtained from the state nature of health and it was communicated throughout the study to the staff and the medical director of the hospital that is involved and we try as much as possible to ensure confidentiality and anonymity of the participants. Now, the data that was generated was analyzed using statistical package for social sciences, version 23 and the social demographic characteristics of the midwives was analyzed using frequency and percentage as well. The data from the differential scale was analyzed using a mean and a mean of four was considered as a lower level of acrimony in considering that the cemented differential scale is a seven-point scale. This table shows the social demographic characteristics of the midwives. A lot of them, you'll see a good percentage of the midwives are young. Most of them are below 30 years of age. A lot of them are qualified nurses and midwives and a good number of them also considerable years of experience and there are a lot of them that have less years of experience when it's that they have a lot of their promising to remain with the system. Looking at the satisfaction of the midwives this table shows us the satisfaction level of the midwives including the ease of using the tool how availability it is how simple it can be to use it how feasible it will be to use in those kind of facilities that you find yourself and are not satisfaction with the tool. So an aggregate mean of 5.78 was obtained. The opinion of the midwives on ease, availability and feasibility of using the tool has been assessed and has been projected on the table below and it shows us that the midwives consider the tool easy to use with a mean of 5.8 and it is available at a mean of 6 and they generally showed a satisfaction level of 5.5.6 which is shows that the midwives shows that the satisfaction with the tool is really significant. So to conclude, we test a null hypothesis that there is no significant satisfaction among midwives. And the midwife satisfaction was used in a t-test and with the p-value of 0.007 we were able to conclude that the midwives are satisfied with using the p-value of 0.002. The t-test is a sample t-test so we use that for as a level of agreement and we computed with the satisfaction the mean satisfaction of the midwives. So the computed t-test was almost 8.6 and greater than the critical value of 0.9 at a 95% significant level and because of this we were able to conclude that there is significant satisfaction among the midwives with the use of the p-value so we can reject the null hypothesis. So as a result of this we developed the following discussion on looking at the socio-demographic information of the midwives. Majority of them are young midwives and it indicates that the midwife free workforce is promising. That means they will take time ranging care to the communities especially in a region where modern mobility is so high. This is very important. And we found out that this finding was in contrast with the finding that was reported in Popo by Popola in 2006 of an aging workforce there. A midwife free workforce here is quite young. More than half of the midwives are registered in the midwives so we are comfortable that they have the competency in rendering maternity services and in addition to that quite of them are experienced and a lot of them have more years of services to give. Apart from this also the number of midwives in the world for WHO recommended number of 10 midwives for comprehensive facilities because we have up to 16 midwives that work in that delivery suite alone. The passive effectiveness of the tool is very high and overall mean was high. This level of satisfaction has also recorded elsewhere. In India, Sharma did a study in 2015 that quoted that 66% of the labor attendants are satisfied with it and they are satisfied with the paperwork more than they are satisfied with the Hooper to graph. In Egypt also for two Aramadan compared the two and they foundness preference of using the paperless to graph to graph. In addition to the tool relief is an important determinant of its utilization so long as a service provider is satisfied with using it. That is when we will expect the person to continue using the tool and we expect the midwives to continue to use the paperless to graph labor so long as it can be approved for use in our delivery suite. If this is done we are hopeful that quality of the trick here will improve and this will also ensure low money appropriately and thereby prevention adversity in the mother and in the babies. So we conclude that the paperless to graph can be a tool that will provide a means of adequate monitoring of labor progress. When that is done it can improve the outcome of deliveries and this will ensure the satisfaction of the workforce with the resulted improvement of quality of obstetric care in our hospitals. So as a result of our findings we are able to comment that the paperless approach to using the paragraph should be adopted especially in low and middle income risk should be adopted by use in midwives so that we ensure that there is appropriate monitoring of labor in this woman. And also provider satisfaction service should continue to be done in health facilities so that we can identify hindrances and challenges in service delivery such as satisfaction or otherwise with the use of tools and equipment that are being used in facilities. Thank you. Thank you so much Aisha for the presentation. Thank you. We had a bit of participation because of the connection. You were able to take us there. Thank you very much. So we will be taking questions from the audience. If you have any question anyone in the audience please feel free to put it in the chat box there and we are already here to pick it and throw the question to the presenter. Thank you very much for your time and for joining us today for the virtual International Day of the Midwife. Thank you all from all across the world for joining us. Thank you. Please feel free to put up your questions please we are here to pick it up here. Yes, I could see there's a question from Sheila thank you for presenting this you have described satisfaction with use which is important for monitoring label. What assessment was done on the data that was entered in terms of accuracy and clinical decision made which is the critical outcome. Did you get that or do I say it again? No, I got it. Okay. I got it. Actually that was what led to our decision to use the 7-point differential scale so that we have opened up the level at which the midwives choose their options appropriately. So for us to ensure that there is accuracy for clinical decisions to be made we're able to also agree on using 95 percent level of agreement and that is why we're also further to do what do you call it one sample two tests so that we ensure that what the data we're able to get is actually what the presented for us. So there was not much data cleaning that was necessary because the sample of the population is small we had at least 16 midwives in the delivery suit and we're able to conduct our research to them 30 months and this part is actually part of a larger study conducted as a security of the population can be more appropriate to ask why we discussed the accuracy of the paperless pattern. Thank you. Sheila don't answer your question please. The next question here is Aisha are you there is the paperless category used offline or online please? Thank you. In fact the idea of using that line is one of the reasons why we propose the testing of the paperless pattern because anything that comes in with the use of light with the internet is really something that encounter a lot of challenges in this part of our world. So actually the paperless pattern is used offline is an idea that you use by your staff and you write it down and continue using those timeframes to monitor the label so it is offline actually. Thank you. Another question on the chat does the paperless pattern mean midwives will have to impute the figures electronically? Okay. What we are saying here is that there is no electronically application. You write it down on any the treatment sheet of the client paper where you record. We are still most of our health facilities actually a certain sense here are not yet at the level of electronic health services delivery. So we are still on paper and viral era actually so that is why my sisters over there do not understand much of what we are trying to say but we are still there hopefully to manage the electronic aspect of service delivery. Thank you. Yes, still on it. Iska just asked a question about the resource constraint facilities in rural areas cope with this? Thank you. The resource constraint is one of the major reasons why we justify the assessment of the paperless pattern because instead of a midwife to spend minutes entering and charting cervical dilatation, charting descent and all other things shading light light contractions strong contractions and so on so the health patrograph of course doing these activities where you calculate time and you put the time within which you use that to monitor it. It is actually a reason one of the major reason the resource constraints the major reason why the paperless pattern I am hopeful that rural area be able to do the paperless pattern effectively. Thank you. Any more questions Aisha? Is there any other thing? Yes. I think I have been able to put the questions for you from from Iska has just dropped another question how can we tell whether midwife just validated the research to reduce their workload? Wow. Thank you. Thank you Iska. That's a good question and I don't know if we will be able to validate whether the reason why we adopted and that is part of the limitations of the study so we cannot be able to validate the reason behind conducting a qualitative study on satisfaction with the paperless pattern will be helpful in us assessment and I am sure this research is part of the process. If at all the paperless pattern will be approved in the facilities continuous research will have to be conducted to ensure issues like the one that you have just raised. Thank you Iska. Thank you very much for all the contributions and the question. Thank you Isha for being able to tackle all the questions and then I have just sent your e-mail address to Sheila in case she wants to contact you because she didn't get to hear a bit of your explanation which have just dropped on the public chat and please every other one that have some questions please feel free and send Isha e-mail or contact her from her e-mail address Thank you all for joining us.