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1. Thesis presentation Topic: INDICATIONS AND FACTORS ASSOCIATED WITH CESAREAN SECTION AMONG BEARING AGE WOMEN AT HGH HOSPITAL IN HARGEISA, SOMALILAND . Master’s Degree in Reproductive Health New Generation University Gabiley campus, Presenting by: Ahmedtahir Moumin Mohamed Supervisor Dr. Ahmed Farah Kamil (MPH, PGed & BSc )

2. Thesis presentation outline: It consist of 5 chapters Chapter 01: Introduction Chapter 02: literature review Chapter 03: Methodology Chapter 04: presentation of study findings Chapter 05: Findings and Conclusions

3. ABSTRACT Background : Caesarean section is the operation to deliver babies. A caesarean section is often required when the baby or mother would be at risk from a vaginal delivery. The main reasons for this could include: obstructed labor, twin pregnancy, high mothers with BP/DM , breech birth , placenta or umbilical cord problems . Objective : The general objective of this study is to describe the indications and factors associated with cesarean section among bearing age women at selected hospital in Hargeisa city, Somaliland

4. Over view A Cesarean section (C-section) is a surgical procedure used to deliver a baby through incisions in the abdomen and uterus. - The increasing global rates of C-sections necessitate a deeper understanding of the factors influencing these trends and their indications. Studies have shown that the global rate of C-sections has increased from approximately 12% in 2000 to 21% in 2015 ( Betrán et al., 2016) and continues to rise, reflecting a complex interplay of medical and non-medical factors ( Boerma et al., 2018).

5. PROBLEM STATEMENT Since the cesarean section became increase globally and locally we need to decline this rate, as we know cesarean section is a lifesaving procedure, there are several indications participating this increase, Therefore the more we solve these indications the more C-section rate will decrease. The increasing rates of C-sections globally have raised significant concerns about the medical and non-medical factors influencing trend.

6. The WHO reports in Somaliland revealed that C-section rates are growing but limited studies exist about the factors and Indications contributing this trend. This study aims to investigate the factors and Indications of c section in Hargeisa Somaliland An other report by UNFP has also mentioned the increase of C-section rates in Somalia generally and in Somaliland specifically.

7. INDICATIONS I nclude : obstructed labor, twin pregnancy, high BP/DM in the mother, breech birth, or problems with the placenta/umbilical cord, shape of the mother's pelvis or history of a previous C-section. WHO recommends that caesarean section performed only when its medically necessary.

8. RESEARCH OBJECTIVES General objective The general objective of this study is to describe the Indications and factors that were associated with the high Caesarean section rates in Hargeisa, Somaliland. Specific Objectives To describe the socio-economic and demographic factors associated with Caesarean section in HGH, Somaliland. To explain the indications in which Caesarean sections were performed HGH Hargeisa, Somaliland. To describe the factors of obstetric associated with Caesarean sections in HGH at Hargeisa, Somaliland. To assess Maternal and perinatal outcome after cesarean section, at Hargeisa Somaliland.

9. RESEARCH QUESTIONS What are the socio-economic and demographic factors associated with Caesarean section in HGH at Hargeisa , Somaliland? What are the indications associated with cesarean section among women delivering at HGH? What are the obstetric factors regarding with the cesarean section among women delivering at HGH? What is the Maternal and perinatal outcome after cesarean section is done ? What are the doctor’s economic benefits from the C-section ?

10. SIGNIFICANT OF THE STUDY The study provides crucial data for healthcare policy and planning, enabling the government to develop targeted strategies aimed at reducing unnecessary C-sections and improving maternal and child health outcomes. Additionally , the insights gained can guide the creation of targeted training programs for healthcare providers, enhancing their ability to manage labor complications and reduce reliance on surgical interventions

11. Scope of the Study Content scope This study focused the factors and indications associated with cesarean section in Hargeisa, Somaliland. The study stressed on the socio-demographic characteristics, obstetric of maternal and fetus for respondents. Geographical scope and Time scope The study was conducted at Hargeisa group hospital (HGH) in Hargeisa, the capital city of Somaliland . The study was conducted on January , 2024 up July, 2024

12. CONCEPTUAL FRAMEWORK Cesarean Section Outcome of the fetus & Maternal 1 . Alive and Normal 2 . Stillbirth 3 . IUFD 4 . Admission to ICU 5 . Normal or PPH in Maternal Obstetric Data 1 .parity, 2.gravity, 3.# of living babies, 4.Hx of abortion. . Indication of C/S 5 . Elective or 6 Emergency C/s . Primary or Repeated 7 C/S 8 . Decision of the C/s Socia - demographic 1 . Age in years 2 . Educations 3 . Occupational Status

13. CHAPTER THREE RESEARCH METHADOLOGY   Introduction This chapter outlines the major approaches in the study methodology including the methods and tools that were used to conduct the research, design, data collection methods, tools and research sample sizes.   Study Design (Research Design) A descriptive cross sectional study design which is institutional based was used while conducting this research and the aim of this study was determine the prevalence of cesarean section among pregnant women delivering at HGH hospital .

14. Target population (Study Population ) The study population of this research are all women delivered by C/S during period of the data collection on January , 2024 up July, 2024 in HGH at Hargeisa Somaliland.   The target population of this hospital is 100, academic staff were 20 and the non academic staff were 80 .

15. Sampling Procedures (techniques) Simple random sampling method was used to select patients. All patients who delivered by Caesarean section from March to June 2024 were identified from the operating theatre of the selected hospital . Inclusion Criteria A questionnaire will be included and obtained from the women delivering at the selected hospital from January 2024 to June 2024, together those fill out fully the required questions and conscious. Exclusion Criteria Respondents with missing questions from the questionnaire or missing information on key variables were excluded. The unconsciousness patients were excluded.

16. Data collection tools and methods The first was the data collection sheet describing demographic information such as age in years, parity, educational status, marital status and status of employment . The second , open question in which asking the respondents the indications of their cesarean section so that to know the causation. The third , was describing obstetric factors . This part also described the parity and gravity together with history of abortion and number of normal living babies. Finally (4 th ) the outcome of the fetal and maternal from the cesarean sections.

17. Validity and Reliability of the Instrument The advisor was checked the questionnaire and the questionnaire was consistence to ensure that the questions acquire the information anticipated reviewed the questions. Any missing data was confirmed before the start of the next day’s interviews. A pre-test method was used to ensure that the instruments are reliable. CVI = no of Qeustions declared total number of questions in questionnaire

18. Source of Data collection Source of data collection of our research was primary data and secondary data. The collection of primary data was involved the use of questionnaire from asking people . Data Analysis I had discussions regarding the approach to data analysis with statisticians from the research committee of New Generation University. The data were imported into statistical software in the Microsoft Excel spreadsheet and SPSS. For an analysis of the data. Tabulated frequencies of the various variables. These variables were tested for C-section association and were described as binary results, elective and emergency C- sections.

19. Ethics of the study I got permission to access information from the NGU research ethics committee which are responsible for the research issues. I also obtain clearance from the selected hospital including the medical directors of Hargiesa Grouop Hospital , patients were not disclosed their confidentiality was maintained; data from the patient’s files were password protected on the researcher’s computer.

20. limitations of study Time challenge: it needs more time to cover everything needed Financial problems: although it’s not too much but still exist Technical: using computers, writing, editing and printing Language (literature): to understand hundred percent is another challenge since its written in English Significance study: less mistakes should be done is a barrier .

21. Chapter Four Introduction This chapter represents the main contribution of the research during the descriptive field; I selected 80 sample populations in which was collected written questionnaires from the kept data at the maternity department of selected hospitals Age of the Respondents Frequency Percent % 17-25 36 43.9 26-34 38 46.3 35+ 6 9.3 Total   80 100 Table 4.2.1:- Age of the Respondents

22. Table 4.2.2:- Educational Level of the Respondents As the table below shows the majority level of education of the mothers were informal about 34 (46%), then Primary about 21 (26%) while Secondary level was 15 (18.3%) and finally Tertiary level 10 (12.2%). Educational Level of Respondents Frequency Percent % Informal 34 41.5 Primary 21 25.6 Valid Secondary 15 18.3 Tertiary 10 12.2 Total 80 100 Total 80 100.0 Figure 4.2.2: - Educational Level of Respondents Table 4.2.2:- Educational Level of the Respondents

23. Parity of the Respondents As the table below of parity of the mothers shows the majority those having viable pregnancy was 2 ranking 30 (36.6%), 3 ranking 16 (20%), 4 ranking 11 (13.4%), 1 ranking 10 (12.2%), 5 about 8 (10%), 6 ranking 4 (5%) and finally 8 which is ranking 1 (1.2%).   Frequency Percent % Valid   Total 1.00 2.00 3.00 4.00 5.00 10 12.2 30 36.6 16 19.5 11 13.4 8 9.8 6.00 4 4.9 8.00 1 1.2 Total 80 97.6 80 100.0 Figure 4.3: - Parity of Respondents Table 4.3:- Parity of the Respondents

24. Table 4.4:- Gravidity of the Respondents Is the table below of gravidity of the mothers shows the majority those had pregnancy was 2 ranking 25 (36%), 3 ranking 20 (24.4%), 4 ranking 10 (12.2%), 1 ranking 9 (11%), 5 about 8 (10%), 6 ranking 5 (6.1%), then 7 ranking 1 (1.2%) and finally 8 which is ranking 2 (3%).   Frequency Percent % Valid   1.00 9 11.0 2.00 25 30.5 3.00 20 24.4 4.00 10 12.2 5.00 8 9.8 6.00 5 6.1 7.00 1 1.2 8.00 2 2.4 Total 80 100

25. Recommendation of the study Proper antenatal care and advice concerning the planned delivery of hospitals. Fitting labor diagnosis. Partogram should be maintained for good monitoring of labor progress, particularly in patients with an earlier caesarean section. Good analgesia and adequate fetal supervision during labor. Avoiding undue labor inducements. VBAC trials should be encouraged where appropriate.

26. Conclusion My study has demonstrated for appropriate medical or obstetric indications, the Cesarean sections are life-saving for both the mother and the newborn. Therefore each case should be thoroughly evaluated to determine the possibility of vaginal delivery to reduce the high prevalence of Cs. More research on the indication and factors associated with the cesarean section together with the short- and long-term effects of the rising rates of the caesarean section are needed.

27. Conclusion : My study has demonstrated Cesarean sections performed for appropriate medical or obstetric indications are life saving for both the mother as well as the new born. Therefore to reduce the high prevalence of Cs, each case should be thoroughly evaluated and Diagnosed carefully to determine the possibility for vaginal delivery(SVD).

28. your bright questions and friendly suggestions gives me sense . Thanks

29. Thanks for panels, Thanks for guest $ Thanks to my colleuges