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1. THESIS DEFENCE Monday, December 23, 2024 1

2. TITLE Maternal and Child Health Care Services Utilization and the Nutritional Status of Infants at Banadir Hospital, Somalia IBRAHIM ABDI HASSAN Student’s ID: 0242220007273087 MPH program Major in (Nutrition ) Monday, December 23, 2024 2

3. Justification The first two years of a child's life are essential for healthy growth and development. Insufficient health and nutrition can lead to impaired growth and increased illness and mortality risks. Evaluate maternal and child health services during pregnancy, childbirth, and nursing. Inform effective community interventions to address health needs (who, 2016). And supports sustainable development goal (SDG) 3. Focuses on reducing maternal mortality and preventable deaths in children under five and maternal and child health care must be culturally acceptable and responsive improves service utilization and health outcomes and this study assess appropriate utilization of health services by mothers. And analyze health outcomes and inform policies for culturally relevant services ( ismail , 2020). Monday, December 23, 2024 3 .

4. Research question What is the relationship between Maternal and Child Health Care Services Utilization and the nutritional status of infants at Banadir Hospital, Somalia? Monday, December 23, 2024 4

5. Objectives of the study BROAD OBJECTIVE: The purpose of this research is to establish the relationship between Maternal and Child Health Care Services Utilization and the nutritional status of infants at Banadir Hospital, Somalia. SPECIFIC OBJECTIVES: To establish the prevalence/percentage of Maternal and Child Health Care Services Utilization on nutritional status of infants in Banadir Hospital To establish the prevalence/percentage of utilization of maternal and health services in Banadir Hospital, Somalia To find out the influence of utilization of maternal and child health services on nutritional status of infants at Banadir Hospital, Somalia Monday, December 23, 2024 5

6. Methodology STUDY DESIGN A cross-sectional study design was adapted to assess the Investigates the utilization of maternal and child health care services and also to Assesses the nutritional status of infants at Banadir Hospital, Somalia STUDY AREA This study was conducted in Moghishu. Mogadishu is one of the old cities in East Africa along the coast of the Indian Ocean. Over many centuries, it has emerged as the most important urban trade centre in Somalia. Geographically, Mogadishu is, situated strategically along the Indian Ocean coast. Since independence, Mogadishu is the capital city of Somalia . Monday, December 23, 2024 6 .

7. STUDY POPULATION The target population of this study was involved Maternal and Child Health Care Services Utilization and the nutritional status of infants at Banadir Hospital, Somalia. A sample of respondents was distributed questionnaires to assess the different methods of family planning they use and the most used methods Monday, December 23, 2024 7

8. SAMPLING TECHNIQUE Probability sampling was used especially simple random sampling as the best sampling since all the Maternal and Child Health Care Services Utilization and the nutritional status of infants was Banadir Hospital, Somalia. DATA COLLECTION TOOL In this study, data was collected by using interviewer-administered questionnaire. The main contents of the questionnaire related question to obtain the required and related information of the different and most used child spacing techniques Monday, December 23, 2024 8

9. SAMPLE SIZE To determine the sample size of this study was calculated by using kish lies formula( Leish , 1995): P = 0.17) (the estimated proportion of malnutrition cases in south and central Somalia) q = 1-P = 1 - 0.64 = z^2 = 1.96^2 = 3.8416) (for a 95% confidence level) D^2 = 0.1^2 = ) (the squared margin of error ) the sample size of this study was 85 respondents Monday, December 23, 2024 9 n=1.96*1.96*0.64*0.83 = n= 85 0.1^2

10. DATA PROCESSING AND ANALYSIS After the collection of data, the researcher verified and checked the data and then enter in to the computer. Data was analyzed by the researcher by using a software package used for statistical analysis i.e. Statistical Package for Social Sciences (SPSS) version 25 according to key variables Descriptive analysis was done using frequencies and percentages to describe the participants and their responses to the questionnaire . Monday, December 23, 2024 10

11. SELECTION CRETERIA INCLUSION CRITERIA This study covered the maternity staff of Banadir Hospital in Mogadishu, Somalia. EXCLUSION CRITERIA Everyone else on staff who wasn't employed by Banadir Hospitals' Maternity section and wasn't supposed to take part in this study Monday, December 23, 2024 11

12. Ethical issues Introductory letter was obtained from Horsed International University. In addition Inform Consent of the respondents obtained from the study participants to confirm their willingness to participate in the study after explaining to them the objectives of the study. The researcher was thought about the ethical issues throughout research project, and kept the privacy and confidentiality of the respondents from the public. The undisclosed information stayed confidential; the researcher used it only for academic purpose Monday, December 23, 2024 12

13. STUDY RESULT Monday, December 23, 2024 13

14. Characteristics of the Sample Mothers 85 mothers and infants at Banadir Hospital participated. Majority well-educated with secondary and above education. Employment: 47.1%, Unemployed; 29.4%, Self-Employed; 23.5%, Formal Employment. Income: < 50K (70.2%), 50K - 100k (21.4%), over 100k (8.3%). Religion: Muslim (80.0%), Christians (20.0%). Marital Status: Single (32.9%), Married (67.1%). Monday, December 23, 2024 14

15. Characteristics of the Sample Mothers Monday, December 23, 2024 15 Characteristics of the Sample Mothers Participants: 85 mothers and infants at Banadir Hospital. Education: Well-educated, with 45.9% having college education. Employment: 47.1% unemployed, 29.4% self-employed, 23.5% formally employed. Income: Majority (70.2%) have incomes < 50K. Number of Children: 29.4% have no other children, 34.1% have two other children. Religion: 80.0% Muslim, 20.0% Christians. Marital Status: 32.9% single, 67.1% married. Insights: Education: Most have secondary and above education. Employment: Half are employed, with over 70% having low income (< 50k). Children: Majority have more than one child. Religion: Majority are Muslims (80.0%). Relationship: 67.1% are married.

16. Table 4.2 Descriptive Statistics of Age Monday, December 23, 2024 16 Descriptive Statistics Category N Minimum Maximum Mean Std. Deviation Age 85 19 42 29.56 5.130 Valid N (listwise) 85         This table provides the descriptive statistics for age, including the number of observations (N), minimum and maximum values, mean, and standard deviation, along with the valid count of observations. The average age of the mothers was 29.56 with a standard deviation of 5.13 years reflecting a quite a youthful cohort of mothers.

17. Monday, December 23, 2024 17 Table 4.3 Preprocessing of data was first undertaken   Component       Initial Eigenvalues Extraction Sums of Squared Loadings Rotation Sums of Squared Loadings Total % of Variance Cumulative % Total % of Variance Cumulative % Total % of Variance Cumulative % 1 4.816 48.157 48.157 4.816 48.157 48.157 3.643 36.433 36.433 2 2.044 20.440 68.597 2.044 20.440 68.597 3.216 32.164 68.597 3 .914 9.139 77.736             4 .556 5.561 83.297             5 .402 4.022 87.319             6 .323 3.232 90.550             7 .300 2.999 93.549             8 .246 2.464 96.013             9 .225 2.253 98.266             10 .173 1.734 100.000             Extraction Method: Principal Component Analysis.   The independent variable is the utilization of Maternal &Child Health Service and DV is nutritional status both was measured using 5-point Likert scale items giving 10 total items. All the 10 were subjected to Factor Analysis to assess the Factorial validity. That is, to test if indeed the items measure 2 different constructs. The results shows.  

18. Monday, December 23, 2024 18 Table 4.4 Rotated Component Matrix Category   Component 1 2 Maternal and child health services are important for nutrition. .909   Services help monitor my family's nutritional status .895   Antenatal care services helped identify my nutritional needs .863   Services supported adequate nutrition recovery after birth. .839   Postnatal care of mother’s health is very important after birth .878   You exclusively breastfed your infant for the first 6 months   .850 You breastfeed on demand, whenever the infant wants the breast   .849 You normally continue breastfeeding up until 2 years and beyond.   .881 You feed infant a diverse diet from different food groups.   .795

19. Monday, December 23, 2024 19 Factor Analysis Purpose: Factor analysis was utilized to determine how various items measuring the utilization of Maternal & Child Health Services in the study align to form a single construct . Convergence of Variables: The analysis revealed that the five items related to the independent and dependent variables combined to form two distinct components. This indicates that the items are measuring different aspects within the construct. Strong Loading: Each item within the components displayed strong loading to one construct, illustrating construct validity. For instance, the item "Services help monitor my family's nutritional status" had a high loading of 0.895, close to 1, in component one. Summative Score: The items within each construct were aggregated to generate a total score. Specifically, the five nutritional items were combined to calculate the overall nutritional status score for each mother, ranging from 5 to 25. Higher scores indicated a better nutritional status. Utilization Score: Similarly, the utilization of Maternal & Child Health Services for each mother was assessed and summarized in a table to provide a comprehensive view of service utilization among the participants. This Factor Analysis process helped identify and validate the underlying constructs related to the utilization of Maternal & Child Health Services, providing valuable insights into the study variables.

20. Monday, December 23, 2024 20 Table 4.5 Descriptive Statistics Category N Minimum Maximum Mean Std. Deviation Utilization of Maternal &Child Health Service Score 85 5.00 23.00 12.1176 4.35182 Nutritional status Score 85 5.00 25.00 13.9529 4.92783 Group Formation: Two groups were created based on the scores obtained, with one group comprising women scoring below the mean and the other group including women scoring above the mean. This division allowed for a comparative analysis between the two groups. Objective: The primary aim was to assess the prevalence rates of the utilization of Maternal & Child Health Services among the participants. Utilization Score Analysis: Total Respondents: 85 Utilization Score Range: From the lowest score of 5.00 to the highest score of 23.00 Mean Utilization Score: 12.12 Standard Deviation: 4.35, indicating the variation in scores across the sample. Nutritional Status Score Analysis: Total Respondents: 85 Nutritional Score Range: Ranging from 5.00 to 25.00 Mean Nutritional Score: 13.95 Standard Deviation: Reflects the variability in nutritional status scores among the participants.

21. Monday, December 23, 2024 21 Table 4.6 Utilization of Mother and child health Service care MCHS Utilization Categories Frequency Percent Valid Percent Cumulative Percent Valid 1.00 44 51.8 51.8 51.8 2.00 41 48.2 48.2 100.0 Total 85 100.0 100.0   These findings highlight the varying levels of utilization of maternal and child health services among the participants, shedding light on potential challenges and opportunities for improving access and engagement with essential healthcare services.  Utilization Level 1: Frequency: 44 respondents (51.8%) Interpretation: Over half of the mothers (51.8%) reported a low level of utilization of maternal and child health services. This suggests potential barriers to accessing these services, such as lack of awareness, financial constraints, or limited availability of services.  Utilization Level 2: Frequency: 41 respondents (48.2%) Interpretation: A slightly smaller group of mothers (48.2%) reported a higher level of utilization of Maternal & Child Health Services. This indicates that nearly half of the respondents are actively engaging with maternal and child health services, possibly reflecting better access or awareness of the available services.  

22. Table 4.7 Nutritional status Monday, December 23, 2024 22     Frequency Percent Valid Percent Cumulative Percent Nutritional status Below Average 43 50.6 50.6 50.6   Above average 42 49.4 49.4 100.0 Nutritional Status Analysis: Below Average Nutritional Status: Frequency: 43 respondents (50.6%) Interpretation: Half of the participants (50.6%) are classified as having below-average nutritional status, indicating prevalent nutritional deficiencies or inadequacies among this group. Above Average Nutritional Status: Frequency: 42 respondents (49.4%) Interpretation: Nearly half of the mothers and their infants (49.4%) are classified as having above-average nutritional status, suggesting that they are likely meeting nutritional requirements adequately. Overall Analysis: The distribution between below-average and above-average nutritional status is nearly equal, with a slight majority falling in the below-average category. This highlights a significant concern regarding the nutritional health of infants, as a substantial portion of the population is not meeting optimal nutritional standards. Addressing the factors contributing to below-average nutritional status should be a priority for health interventions within the community to improve overall health outcomes.

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24. Monday, December 23, 2024 24 Maternal & Child Health Service Utilization and Nutritional Status: Association Analysis: A significant association is observed between Maternal & Child Health Service utilization levels and nutritional status (χ² = 8.155, p = .000). Mothers utilizing Maternal & Child Health Services above the mean show a higher percentage of infants with above-average nutritional status, indicating a positive correlation between service utilization and nutritional outcomes. Overall Analysis: The findings underscore the crucial role of education and Maternal & Child Health Service utilization in influencing the nutritional status of infants. Interventions focusing on enhancing education levels and improving access to maternal and child health services have the potential to positively impact the nutritional outcomes for infants within the community.

25. Conclusion Conclusions: Study Goals Achieved: The findings suggest that the objectives of the study were successfully achieved. The study investigated the influence of maternal and child health service utilization on the nutritional status of newborns at Banadir Hospital in Somalia. Significant Correlation: The results revealed a notable positive correlation between the independent and dependent variables impacting the nutritional status of patients at Banadir Hospital. In conclusion, the study effectively explored the relationship between maternal and child health service consumption and newborns' nutritional well-being, highlighting a significant positive association among patients at Banadir Hospital in Somalia. Monday, December 23, 2024 25

26. Recommendation Improve Access to Antenatal Care Services: The study underscores the importance of attending prenatal care appointments for better newborn nutritional outcomes . Enhancing the availability and utilization of prenatal care services in Banadir is recommended to support maternal and child health. Encourage Postnatal Care Attendance: Postnatal care visits positively impact newborns' nutritional status, as indicated by the study. Encouraging and facilitating postnatal care appointments for new mothers is advised to promote infant well-being. Enhance Baby and Young Child Feeding Practices: Optimal breastfeeding and supplemental feeding practices are linked to improved baby nutritional status. Implementing interventions to promote best feeding practices for newborns and young children is crucial for their health and development. Enhance Community-Based Health Education: Raising maternal awareness about hygiene, health, and nutrition practices is essential, as highlighted by the study. Expanding community-based health education initiatives can help bridge the knowledge gap and empower mothers to make informed health decisions. Assure Availability of Necessary Medicines and Supplies: Improving the distribution and accessibility of nutritional supplements and essential medications is recommended. Ensuring the availability of necessary resources is vital for addressing nutritional deficiencies and supporting maternal and child health outcomes effectively. Monday, December 23, 2024 26

27. THANK YOU ধন্যবাদ Monday, December 23, 2024 27