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ARBA MINCH UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCE


DEPARTMENT OF NURSING

ASSESSMENT OF BIRTH PREPAREDNESS AMONG


ANTENATAL CLIENTS IN ARBAMINCH HOSIPITAL AND TWO
URBAN HEALTH CENTER IN GAMO GOFA ZONE,
SOUTHERN ETHIOPIA

BY: TSIGEREDA ABATHUN


A RESEARCH PROPOSAL SUBMITTED TO AGEGNEHU BANTE

MAY 2018
ARBA MINCH
ETHIOPIA

0
Name of Investigator TSIGEREDS ABATHUN
ASSESSMENT OF BIRTH PREPAREDNESS
Full Title Of The Research Project AMONG ANTENATAL CARE CLIENTS.

Study Area ARBAMINCH TOWN

Total Cost of the project 4900 Eth, Birr

Source(s) of Funding SELF SPONSOR


Cell phone: 0924362725
ADDERES Email;mimolove123@gmail.com

Name of Advisors ALL NURSING INSTIRACTER

1
Acknowledgements
I am grateful to God the almighty for giving me the knowledge and to prepare this proposal.

I also wish to express my deep appreciation to instructor Agegnehu Bante and Dinkalem for
the influence they have had on my professional growth

Lastly I would like to thank the south regional government health burro and my Hospital for
giving me the chance to study my BSC degree.
Acronyms
AMU -Arba Minch University
ANC -Antenatal care
BMO -Basic management of obstetric
CI -Confidence interval
EDHS -Ethiopian Demographic and Health Survey
EMOC –Emergency Management of Obstetric Care
JHPIEGO-Johns Hopkins Program for International Education in Gynecology and
Obstetrics
MMR -Maternal mortality ratio
NMR -Neonatal Mortality Rate
SNNPR -Southern nation’s nationalities and peoples region
OR -Odds Ratio
SBA -skilled birth attendance
SPSS -statistical package for social science
SSA -Sub Saharan Africa
WHO - World health organization
Summary
Introduction: Birth preparedness and complication readiness is the process of planning for
normal birth and anticipating the actions needed in case of an emergency. It promotes active
preparation and decision making for delivery by pregnant women and their families. Lack of
advance planning for use of a skilled birth attendant for normal births, and particularly
inadequate preparation for rapid action in the event of obstetric complications, are well
documented factors contributing to delay in receiving skilled obstetric care.

Study objective: To assess birth preparedness and associated factors among antenatal clients
in Arbminch hospital and two urban health center, Gamo Gofa zone, Ethiopia, 2018.

Methods: A quantitative cross -sectional study design will be conducted from May 2018 to
Jun 2018 in Arbaminch town . A A total of 354 pregnant mothers will be taken from
Arbaminch general hospital, Arbaminch Health center and Shecha health centre study
subjects will be selected by systematic sampling technique. Data will be collected using
structured interviewer administered questionnaire. Six diploma graduate nurse data
collectors. Descriptive, binary and multiple logistic regression analyses will be conducted.
Statistically significant tests will be declared at a level of P value < 0.05.

Budget and work plan: The study will be conducted from May2018 to November 2019
starting from data collection through final dissemination, with an estimated Budget of 18169
Eth birr.
Contents
Acknowledgements...................................................................................................................iii
Acronyms...................................................................................................................................iv
Summary.....................................................................................................................................v
1. INTRODUCTION..................................................................................................................1
1.1 BACK GROUND..............................................................................................................1
1.2 STATEMENT OF THE PROBLEM.................................................................................2
1.3. JUSTIFICATION OF THE PROPOSED STUDY...........................................................3
2. LITERATURE REVIEW........................................................................................................4
2.1 Definition and concepts of birth preparedness..................................................................4
2.2 Magnitude of maternal morbidity and mortality...............................................................4
2.3 Components of birth preparedness....................................................................................5
2.4 Causes for less preparedness for birth...............................................................................6
2.5 Factors affecting birth preparedness..................................................................................6
2.5.1 Socioeconomic and demographic factors:..................................................................6
2.5.2 Knowledge on danger signs during pregnancy...........................................................7
2.5.3 Obstetric factors:.........................................................................................................8
3. OBJECTIVES.........................................................................................................................9
3.1 General Objective..............................................................................................................9
3.2 Specific objectives.............................................................................................................9
4. METHODS...........................................................................................................................10
4.1 Study design and Study period........................................................................................10
4.2Study area.........................................................................................................................10
4.3Source population and Study population:........................................................................10
4.4 Sample size and Sampling procedures............................................................................10
4.5 Variables of the study......................................................................................................13
4.6 Operational definitions....................................................................................................13
4.7 Data collection tools and procedures..............................................................................13
4.8 Data quality management................................................................................................14
4.9Data processing and analysis............................................................................................15
5. ETHICAL CONSIDERATION.............................................................................................16
6. DISSEMINATION OF RESULTS........................................................................................17
7. WORK PLAN.......................................................................................................................18
8. COST OF THE PROJECT....................................................................................................19
9. REFERENCE........................................................................................................................21
10. ANNEXES..........................................................................................................................23
Annex-1: Declaration............................................................................................................23
Annex-2: Assurance of Investigator......................................................................................23
Annex 3፡Participant information sheet and consent form.....................................................25
Annex 4.English and Amharic version questionnaires..........................................................27
1. INTRODUCTION

1.1 BACK GROUND


Globally, maternal mortality remains a public health challenge (1).The fifth Millennium
Development Goal (MDG5) calls for the reduction of Maternal Mortality Ratio (MMR) by
75% between 1990 and 2015. However, only 47% decline had been achieved till 2011
globally (2). As a result, about 287,000 mothers die because of problems related to pregnancy
and child birth each year. About 99% of maternal mortality occurs in developing countries.
Sub-Saharan Africa and Southern Asia account for 85% (3).
Ethiopia is also among the countries committed to achieve the MDG5 target by reducing
maternal mortality by three-quarter. However, the decline in the last 15 years was found to be
non-significant with MMR of 676 per 100,000 live-births in the Ethiopian Demographic and
Health Survey (EDHS) of 2011 as compared to 673 and 871 per 100,000 live-births in EDHS
2005 and EDHS 2000 respectively (4-6).
Lack of advance planning for use of a skilled birth attendant for normal births, and
particularly inadequate preparation for rapid action in the event of obstetric complications, are
well documented factors contributing to delay in receiving skilled obstetric care (7).Every
pregnant woman faces the risk of sudden, unpredictable complications that could end in death
or injury to herself or to her infant. Pregnancy related complications cannot be reliably
predicted (3). Hence, it is necessary to employ strategies to overcome such problems as they
arise.
Skilled care during and immediately after delivery and emergency obstetric care have been
identified as key strategies and one of the indicators to track the MDG in reducing maternal
mortality. However, recent estimates show that the proportion of deliveries attended by skilled
attendant in many African countries remained below 50 % (8, 9). And also in Ethiopia,
according to 2011 EDHS report, the proportion of births assisted by a skilled provider ranged
from 84 percent in Addis Ababa, 6 percent in the SNNP region.

1.2 STATEMENT OF THE PROBLEM


Birth preparedness and complication readiness is the process of planning for normal birth and
anticipating the actions needed in case of an emergency. It promotes active preparation and
decision making for delivery by pregnant women and their families. This stems from the fact
that every pregnant woman faces risk of sudden and unpredictable life threatening
complications that could end in death or injury to herself or to her infant(5,7).
With different effort from government as well as nongovernmental organization working on
maternal issues, pregnant women were not found to be well prepared for birth and its
complication. For example, only 47.8% women who have already given birth in Indore city in
India (12) and 35% of pregnant women in Uganda were prepared for birth and its
complication (13). Additionally, according to the research done in some part of Ethiopia, only
22% of pregnant women in Adigrat town (14) and 17% of pregnant women in Aleta wondo of
southern region were prepared for birth and its complication (15).
In many societies in the world, cultural beliefs and lack of awareness inhibit preparation in
advance for delivery and expected baby. Since no action is taken prior to the delivery, the
family tries to act only when labour begins. The majority of pregnant women and their
families do not know how to recognize the danger signs of complications. When
complications occur, the unprepared family will waste a great deal of time in recognizing the
problem, getting organized, getting money, finding transport and reaching the appropriate
referral facility (14). It is difficult to predict which pregnancy, delivery or post delivery period
will experience complications; hence birth preparedness plan is recommended with the notion
of pregnancy is risk (7).
Birth preparedness has been suggested by the World Health Organization (WHO) as a
comprehensive approach for increasing coverage of skilled delivery care and reducing the
three delays to care seeking during obstetric emergencies. Many countries in Sub-Saharan
Africa including Ethiopia have adopted this approach and included in the routine focused
antenatal care. However, its effectiveness has not been well studied (16, 17).

1.3. JUSTIFICATION OF THE PROPOSED STUDY


Despite the fact that birth preparedness and complication readiness is essential for further
improvement of maternal and child health and prevention of maternal deaths, little is known
about the status of birth preparedness and complication readiness in rural Ethiopia in general
and in Southern Region in particular. The existing evidences show that the status of birth
preparedness and complication readiness is low (14).

As to researcher’s knowledge no study was found in Gamo Gofa Zone, therefore, this study
will provide basic data on the issue that may help health workers and policy makers to
implement and scale up safe mother hood program in an attempt to reduce the highest
maternal mortality rate and neonatal mortality rate of Ethiopia. Therefore, this paper is
designed to evaluate birth preparedness and factors associated with their practices among
antenatal care clients, in Arbaminch town governmental institutions
2. LITERATURE REVIEW

2.1 Definition and concepts of birth preparedness


Birth Preparedness and Complication Readiness is a strategy to encourage women to be
informed of danger signs of obstetric complications and emergencies, choose a preferred birth
place and attendant at birth, make advance arrangement with the attendant at birth, arrange for
transport to skilled care site in case of emergence, saving or arranging alternative funds for
costs of skilled and emergency care, and finding a companion to be with the woman at birth
or to accompany her to emergency care source. The applications of the concept in birth
preparedness and complication readiness are varied and there is no single agreed upon
definition, however, it is employed by numerous groups implementing safe motherhood
programs (7, 18).

2.2 Magnitude of maternal morbidity and mortality

Pregnancy and childbirth and their complications are the leading causes of death, disease and
disability among women of reproductive age in developing countries more than any other
single health problem (16).

Globally, it is estimated that half a million women die each year during pregnancy and
childbirth, with over half of these deaths occurring in Africa. This is particularly worrying in
sub-Saharan Africa where more than 300,000 women still die each year during pregnancy and
childbirth; most of them die because they lack access to skilled delivery attendance and
emergency care (19, 20).

In Ethiopia, maternal mortality was still unacceptably high at 1.14 maternal deaths per 1000
woman-years in 2011.There was no significant reduction in the maternal mortality rate
between 2005 and 2011, according to the Ethiopian Demographic and Health Surveys (21,
22).

Based on the study done in different part of the world pregnant women were not found to be
well prepared for birth and its complication. For example only 47.8% women who have
already given birth in Indore city in India (12), 35% of pregnant women in Uganda (13) and
27.5% in Northern Nigeria were prepared for birth and its complication (23).

Additionally, studies conducted in some parts of Ethiopia showed that only 29.9% women
who have already given birth in Goba woreda of Oromia region (24), 16.5% women who have
already given birth in Robe woreda of Oromia region (25), and 22% of pregnant women in
Aleta wondo of Southern region were prepared for birth and its complication (15).

2.3 Components of birth preparedness


Components of birth preparedness promote active preparation and decision-making for births,
including pregnancy and postpartum periods, by shared responsibilities of pregnant women,
their families, the community and the service providers (16).

The components mostly used by researchers to measure birth preparedness and complication
readiness are varied, and some researchers used mean score by taking the three components;
plan where to give birth, plan to save money and plan for transportation (14, 26).

Identification of place of delivery is very important especially in the setting where the main
means to get a skilled provider is to deliver at health institutions. Money saved by woman or
her family can pay for health services and supplies, vital for transport, or others costs (7, 13).

A study done in rural Uganda, considering the four birth preparedness practices; 61% of the
respondents had identified a health professional, 91% had saved money, and 61% had
identified means of transport while 71% had bought delivery kits/birth materials during their
most recent pregnancy (13).

Additionally, cross-sectional studies conducted in Robe woreda and Adigrat town, of the total
respondents 76.3% ,68.9% saved money ,45.6%,78% identified place of
delivery,28.5%,24.7% identified a mode of transport and 3%,65% identified a skilled provider
respectively (25,14).

2.4 Causes for less preparedness for birth


Every pregnant woman is at risk of pregnancy complications which are unpredictable and can
lead to morbidity or mortality of herself or her baby. The high maternal mortality and slow
progress in low and middle income countries, in part, are explained by the low coverage of
maternal health care and the three delays (delays in deciding to seek care, delays in reaching
care and delays in receiving care) to health care seeking behaviour of mothers. These delays
have many causes; including logistic and financial concerns, unsupportive policies and gaps
in services, as well as inadequate community and family awareness and knowledge about
obstetric complication issues. These problems are again influenced by demographic, poor
socio-economic status and poor quality of services (12, 14,18).

2.5 Factors affecting birth preparedness

2.5.1 Socioeconomic and demographic factors:

Regarding some of the factors affecting birth preparedness and complication readiness, the
study conducted in different parts of Ethiopia shows; age of the woman, marital status,
educational status of the women, husband's occupation of employed or merchant, third or
above wealth quintiles, were found to increase the likelihood of preparation for birth and its
complications. (14, 27)

Across sectional study conducted in Robe woreda of Oromia region indicated that educated
mothers were six time more likely to be prepared for birth and its complication than illiterate.
Similarly the study showed that monthly income also found to be predictor for birth
preparedness and complication readiness and mothers who had better income were two times
more likely to prepare for birth and its complication than mothers who had less monthly
income (25)

2.5.2 Knowledge on danger signs during pregnancy


Knowledge of the danger signs during pregnancy is the first step to seek timely care at
appropriate health facility. These key danger signs of pregnancy are severe vaginal bleeding,
swollen hands/face and blurred vision (28).
Based on the study conducted in Robe woreda of Oromia region indicates that knowledge of
danger sign of obstetric complications was also significantly associated with birth
preparedness and complication readiness. Mothers who know the presence of obstetric
complications were three times more likely to prepare for birth and its complications than
mothers who didn’t know the presence of complications (25).Moreover in a cross sectional
study conducted in Adigrat town; one third of the (30.9%) of respondents mentioned at least
two danger signs of pregnancy(14).

2.5.3 Obstetric factors:


Among the obstetric related factors frequency of ANC visits, gravidity and parity were found
to be factors associated with birth preparedness and complication readiness based on the study
conducted in different parts of Ethiopia (14, 24).
Knowledge on danger sign
during pregnancy Increase
Household Factors s
 Income, assets Prepared
 Educational (husband) Socio Demographic ness for
 Family Size birth
 Husband occupation  Age
 Decision Making  education
 Occupation
 Marital Status
 Religion
 Ethnicity

Obstetric Factors
 Gravidity
 Parity
 ANC visit
 Pregnancy outcome
 Gestational age

Figure 1: Conceptual framework to describe interrelation between factors of birth


preparedness.

Source: Adapted from JHPIEGO monitoring tool of birth preparedness.


3. OBJECTIVES

3.1 General Objective


To assess birth preparedness among antenatal clients in Arba Minch town governmental
institutions

3.2 Specific objectives.


1. To assess practices related to birth preparedness among antenatal clients in Arba
Minch town governmental institutions
2. To identify factors associated with the practice of birth preparedness among antenatal
clients in Arba Minch town governmental institutions
4. METHODS

4.1 Study design and Study period


Institution based cross-sectional study will be conducted May 2018 from to November 2019
in Arba Minch town governmental institutions to assess birth preparedness among antenatal
clients in Arba Minch town governmental institutions.

4.2Study area
Arbaminch town is the administrative sit of Gamo Gofa Zone, located at 505Km in south of
Addis Ababa, the capital city of Ethiopia and 275km south west of Hawassa, the capital city
of Southern Nations Nationalities and Peoples of regional government. It has 2 subdivisions;
Secha and Sikela, each 5kms apart and it has a total population of 125,411, of which
reproductive age women accounted 29,220. The town has 1 zonal hospital & 2 governmental
health centers.

It will be conducted from May,2018 to November 2019

4.3Source population and Study population


Institution based cross-sectional study will be conducted from May,2018 to November 2019
Arbaminch General Hospital, Arbaminch health center and Shecha health center.

Inclusion criteria:
Pregnant mothers who are attending first and above ANC visits.
Exclusion criteria:

Pregnant mothers who are seriously ill to be interviewed.

4.4 Sample size and Sampling procedures


Sample size:

The required sample size of clients is determined by using the formula for single population
proportion= (z α/2)2* p (1-p)/d2.

The sample size is calculated using single proportion formula taking the following
assumption.

 ”p” is assumed to be proportion level,29.9% has been taken(24).


 95% confidence level and 5% degree of precision
 d=margin of error (0.05)
 Z±α/2 the standard normal value at 95% confidence level (1.96)
Fitting in to the formula the final sample size will be

( Z α /2)2 P(1−P)
n=
d2
(1.96 )2 0.299( 1−0.299)
n=
( 0.05)2
n= 322*0.1=32+322=354
Adding 10% for non-response rate the final sample size becomes 354.

Sample size calculation using explanatory variables:

According to studies done in Ethiopia, proportion for birth preparedness is 25.3% for
educational status of mothers, 43.5% for history of still birth, 26.9% for parity (14) and 21.1%
for knowledge on danger sign during pregnancy (15).Assumed proportion in birth
preparedness of educational status of mothers 25.3 % is the bigger sample size than the other
independent variables. So the assumed total sample size will be 458 clients. Epi info Version 7
is applied to calculate the sample size.

Table1. Sample size calculated for different independent variables for birth
preparedness.

Variables Proportion of birth CI Power OR Sam Total


preparedness (%) ple
size
Educationn status None 95% 90%
Secondary and above 13% 2.26 229 458
25.3% 229
Still birth no yes 21.1% 95% 90% 99
43.5% 2.88 99 198
Knowledge on danger 48.6%
sign no 21.1% 69 138
yes 95% 90% 3.53 69

Parity >5 2-4


10.1% 95% 90% 3.27 122 244
26.9% 122

Sampling procedure
. A systematic population proportion sampling technique will be used to select study
participants from pregnant mothers attending ANC in all Governmental health institutions
during the time of data collection. From previous records there were around 750 recorded
ANC visits in Arbaminch general hospital, Arbaminch health center and Secha Health center
within a single month. Based on this assumption the same number of clients will be expected
to visit the ANC clinic within the study period. So that the sample population will be selected
from both areas proportional to their clients; which was 420, 250 and 40 clients in AMGH,
AMHC and SHC respectively. Therefore the interval for the sample will be total samples over
the sample size needed. i.e. k= 710/354 2. For each health institution the sampling will be
started from the client who comes first or second by determining in lottery method and the
next will be by adding the interval

One general hospital and two


health centre

Simple random sampling………………….

ARBAMINCH GGENERAL ARBAMINCH HEALTH


HOSPITAL CENTERE SECHA HC
Systematic
Random sampling……….

322 participants

Figure 2: Framework of sampling procedure.

4.5 Variables of the study


Dependent
Birth preparedness: Yes-----------1(prepared for birth)
No-----------0(not prepared for birth)

Independent
Socioeconomic and demographic factors:
 Age
 Marital status
 Religion
 Ethnicity
 Education
 Income
 Family size
 Husband’s factors
Age
Occupation
Education

Obstetric factors
 Gravidity
 Parity
 knowledge on danger signs during pregnancy
 History of still birth

4.6 Operational definitions


A woman will be considered as prepared for birth and its complication if she identifies place
of delivery, save money, and identifies a means of transport to place of childbirth or for the
time of obstetric emergencies ahead of childbirth (14).
Knowledge on danger signs during pregnancy: A woman will be considered as
knowledgeable; if she can mention at least two key danger signs for pregnancy (25).

4.7 Data collection tools and procedures


Data will be collected using a structured questionnaire format developed for selected variables
by the investigator. The questionnaire will be extruded from EDHS standard questionnaire
and from previously conducted similar studies. Four diploma graduate nurses will be recruited
as data collectors, and two BSC graduate nurses will be recruited as supervisors. All data
collectors and supervisors will be oriented for a day on data collection processes based on the
guide that will be developed by principal investigator for data collectors and clarifying how to
interview the questionnaire. Beside this, they will be trained on their responsibilities for
describing the purpose of the study, giving orientation, telling clients the importance of honest
and sincere reply, on responding to questions. At the time of the actual data collection, the
data collectors will be arrived early in the morning and clients will be interviewed after they
get the ANC service.

4.8 Data quality management


The English version of developed questionnaire will be translated to Amharic and back
translated to English to ensure its consistency by two persons who have medical background.
The questionnaire will be pre-tested in randomly selected 5% similar women in the Shele
health centres outside the study health centres and modification will be made if necessary.
Data collection will be carried out by trained nurses who are not working in the antenatal
clinic. During the data collection the collected data will be checked by the supervisor daily for
completeness and finally the principal investigator will monitor the overall quality of data
collection.

4.9Data processing and analysis


Data will be cleaned, coded and entered in to computer (Epi. Info Version 7) then transported
to SPSS version 20 statistical Software’s for analysis. Descriptive statistics will be done to
assess basic client characteristics. Bivariate analysis using logistic regression technique will
be done to see the crude association between the independent variables and the dependent
variable.

The model will be evaluated using backward stepwise selection method. Factors that show
association in bivariate analysis and which has P-value less than 0.2 will be entered in to
multiple logistic regression models for controlling confounding factors and to identify
significant factors. Chi-square test and their p-values at the level of significance of 5% will be
used to define statistical associations between variables. The strength of statistical association
will be measured by adjusted odds ratios, 95% confidence intervals, and P-value <0.05 will be
considered as significant.
5. ETHICAL CONSIDERATION

The survey will be conducted after obtaining ethical clearance from IRB (Institutional Review
board) of AMU and a letter of permission from IRB will be obtained from AMU, and in turn
the town Administration Office will write a letter for study Hospital and HC to get
recognition and collaboration. Informed written consent will be obtained from respondents
after explaining the objective of the study. At the end of the interview health information
regarding birth preparedness and how to respond to them will be provided. In addition, all the
responses will be kept confidential and by making the questionnaire anonymous.
6. DISSEMINATION OF RESULTS
Official result will be approved by the Research Committee of Arba Minch University. The
results will be communicated to Arbaminch town health department hard and soft copy will
be available in the library of AMU for graduate students as well as for other concerned
readers. Identify different partners and potential contributors for solving the existed problem
to promote utilization of research findings and disseminating information through appropriate
channels.
7. WORK PLAN

May Jun Jul Aug Sep. Oct Nov Responsible Person


Activities

Proposal preparation PI & Advisors

Proposal Finalization PI and Advisors

Obtaining ethical clearance AMU

Getting local permission PI

Study tool development PI

Training of data collectors PI & Data collectors

Pre-testing of instrument PI & data collectors

Actual data collection PI & data collectors

Data Entry PI

Data cleaning and processing PI

Data analysis and write-up PI

Draft report writing PI

Submission of draft report PI and Advisors


Final paper submissions
PI and Advisors

Thesis defense PI

Finalizing thesis PI

8. COST OF THE PROJECT


Descriptions /items Qualification No. of Daily No.of Total cost
allowance days
Persons (Eth. Birr)
(Eth birr)
I- Personnel Costs (Per Diem)

Principal Investigators Mph student 1 150 15 2250

Supervisor B.sc graduate 2 100 15 3000

Data collectors allowance nurse 4 100 15 6000

Training Person 7 100 1 700

Sub- Total 11,950

II- Equipments and Supplies

(for training or data collection) Unit of Quantity Unit cost Total


measurement

Writing pad(numbers) Number 6 15 90

Pens Number 8 4 32

Pencil & eraser Number 8 1 8

Clip board Number 8 15 120

Duplication paper Desta 1 100 100

Photo copies of proposal Each 200(4*50) 0.50 100

CD rewriteable Each 2 25 50

Duplication of questionnaires Each 1850(5*370) 0.50 925

Printing of final thesis Page 80 3.00 240

Photo copy of 6 final thesis Page 480 0.50 240

Binding service Each 8 8 64

Sub- Total 2069

III. Transport & communication Unit.of Frequency Unit price Total


measurment

Transportation for data collectors Round trip 20 50 1000

Transport for investigator Round trip 10 50 500

Transport for supervisor Round trip 5 50 250


Communication 400 400

Sub- Total 2150

Total( in Eth. Birr) 16169

Contingency (10%) 2000

Grand total 18169


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mortality for 181 countries: a systematic analysis of progress towards Millennium
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WHO, 2013.
3. WHO, UNICEF, UNFPA, the World Bank: Trends in Maternal Mortality:Geneva,
Switzerland. Geneva, Switzerland: UN Inter-agency Group for Maternal Mortality
Estimation (UN-IGMME), 2012.
4. Central Statistical Authority (CSA) [Ethiopia] and ORC Macro: Ethiopia
Demographic and Health Survey. Addis Ababa, Ethiopia and Calverton, Maryland:
USA: CSA & ORC Macro, 2001.
5. Central Statistical Authority (CSA) [Ethiopia] and ORC Macro: Ethiopia
Demographic and Health Survey. Addis Ababa, Ethiopia and Calverton, Maryland:
USA: CSA & ORC Macro, 2006.
6. Central Statistical Authority (CSA) [Ethiopia] and ORC Macro: Ethiopia
Demographic and Health Survey. USA: CSA & ORC Macro: Addis Ababa, Ethiopia
and Calverton, Maryland, 2012.
7. JHPIEGO. Maternal and neonatal health. Monitoring birth preparedness and
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Hopkins, Bloomberg school of Public Health, Center for communication
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http://pdf.dec.org/pdf_docs/ PNADA619.pdf.
8. World Health Organization (WHO): World Health Statistics 2013. Geneva,
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13. Kyenga J, Ostergren P, E ET, Pettersson K. Knowledge of obstetric danger signs and
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Swaziland: WHO Department of Making Pregnancy Safer; 2006.
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20. Gebrehiwot T, Goicolea I, Edin K, Sebastian M. Making pragmatic choices: women’s
experiences of delivery care. BMC Pregnancy and Childbirth. 2012;12(113):11.
21. Ethiopian Demographic and Health Survey (EDHS). Addis Ababa, Ethiopia: Central
Statistic Authority; 2005.
22. Ethiopian Demographic and Health Survey (EDHS). Addis Ababa, Ethiopia: Central
Statistic Authority, 2011.
1. Iliyasu Z, Abubakar I, Galadanci H, Aliyu M. Birth preparedness, complication
readiness and fathers’ participation in maternity care in a Northern Nigerian
Community. Afr J Reprod Health. 2010;14(1):21-32.
2. Markos, Bogale. Birth preparedness and complication readiness among women of
child bearing age group in Goba woreda, Oromia region, Ethiopia. BMC Pregnancy
and Childbirth. 2014;14(282).
23. Mohamed K, Mesfin A. Birth preparedness and complication readiness in Robe
Woreda, Arsi Zone, Oromia Region, Central Ethiopia: a cross-sectional study. .
Reproductive Health 2014;11(55):12.
24. DAVID PU, ANDREA BP, FATUMA M. Birth preparedness and complication
readiness among women in Mpwapwa district, Tanzania. Tanzania Journal of Health
Research. 2012;14(1).
25. Gurmesa TD, Mesganaw FA, Alemayehu WY. Factors affecting birth preparedness
and complication readiness in Jimma Zone, Southwest Ethiopia. Pan African Medical
Journal. 2014;19(272):14.
26. United Nations Children Fund. Maternal Death in Purulia, West Bengal: Trends: 2005-
2009. UNICEF, Office for West Bengal, Kolkata, India. 2010; 1
-44.
10. ANNEXES

Annex-1: Declaration

I, the undersigned, Neonatology student declare that this thesis is my original work in partial
fulfillment of the requirement for the degree.

Name: Tsigereda Abathun

Signature: ______________

Place of submission: Department of Nursing, College of Medicine and Health Sciences, Arba
Minch University.

Date of Submission May 2018

Advisors

Name Signature
___________________

__
Annex-2: Assurance of Investigator

The undersigned agrees to accept responsibility for the scientific, ethical and technical
conduct of the research project and for provision of required progress reports as pre terms and
conditions of the research and publications office of the Arba Minch University.

Name of the student: Tsigeareda Abathun

Date: _______________ Signature: ____________________

Approval of the advisor (s)

Advisors

Name Signature Date

1. _ _______________ _______________

2. ___ _____________ _______________


Arba Minch University

College of Medicine and Health Sciences

Department of Nursing

Annex 3፡Participant information sheet and consent form


Title: Assessment of birth preparedness and factors associated with their practices among
antenatal clients in Arbaminch general hospital and two urban health centre Southern
Ethiopia.

Name of Principal Investigator: Tsigereda Abathun

Name of the organization: Arba Minch University

Introduction: Dear respondent, I am going to include you in my study if you are willing to
participate. Please understand the situation with this study before deciding to participate or
not. You have information below.

Purpose of the study: To assess practices and factors that affect birth preparedness. This
study will be beneficial to identify areas of improvement in birth preparedness and produce
relevant information for policy makers which will be helpful in the planning and
implementation of intervention activities to improve maternal and neonatal health.

Procedure: Today, I am going to conduct face to face interview with you and other randomly
selected members of antenatal clients. If you are willing to participate in our project, you will
be asked to give your response. The interview will take approximately 20 minute.

Risks and/or Discomfort: There is no risk in participating in this research project.

Benefits of the study: The information you provide will benefit the general public (pregnant
mothers) when the findings of this study is acted upon.

Incentives: You will not be provided any payment to take part in this study.
Confidentiality and Anonymity: The information that we will collect from this research
project will be kept confidential and stored in a file which will not have your name on it, but a
code number assign to it. And also it will not be revealed to anyone except the principal
investigator.

Right to refuse or withdraw: You have the full right to refuse from participating in this
research, if you do not wish to participate; and this will not affect your health services you get
from any health facilities.

Person to contact: If you have any questions or concerns or more explanation about the
research, you can contact at the following address.

Name: Tsigereda Abathun

Telephone number: 0924362725 Email:mimolove123@gmail.com


Annex 4.English version questionnaires

My name is. ----------------------------------------------- (Interviewer)

I temporarily represent Arba Minch University, college of Medicine and health science,
Department of Nursing. The research is purely for the academic purpose. This is a study to be
conducted with the objective of assessing practices with respect to birth preparedness and
factors associated with their practices among women who are antenatal clients in Arbaminch
town . As this study is directly related to women who are antenatal clients, you are one of the
women who have been selected randomly to participate in this study. Participation to this
study is strictly voluntarily and anonymity will be respected.

You are required to fill this questionnaire with the options that best represent your response
and your responses will be kept confidential and there will be no way of linking your
individual responses to the final results of the study findings. We would like to inform you
that the responses that you provide to the questions are very essential, not only, for the
successful accomplishment of the study, but also for producing relevant information which
will be helpful in the planning and implementation of intervention activities to prevent delays
and improve maternal and neonatal health.

Are you voluntary to respond to the questions?

Yes; ----proceed with the interview No; ---- thank her and End.

Name of interviewer who seek the consent: _____________________________


Signature: _____________________
Name of supervisor: _______________________

1 .Households Identification ________


01. Questionnaire code --------------------
02. Woreda -----------------
03. Kebele-----------------------
04. Health center----------------
Instruction: Circle the responses for questions with alternatives and write for open ended
questions on the space provided.

Part One; Respondents Socio-demographic information

S.n Questions Alternative /choice of response Code Skip

101 What is your age in


completed years?
--------------
102 What is the highest 1.Cannot read and write
grade you completed? 2. Read and write.
3. 1-6 grade
4. 7 and above grade
97.Other, specify-----
103 To which religion do 1. Orthodox
you belong? 2. Muslim
3. Protestant
4. Catholic
5. Traditional
97. Other, specify-----
104 To which ethnic group 1. Gamo
do you belong? 2. Gofa
3. Wolayta
4. Amahara
97. Other, specify-------
105 What is your 1. House wife
occupation? 2. Farmer
3. Gov’t employee
4. Private employee
5. Merchant
6. Housemaid
7. Student
97. Other, Specify-----
106 How much do you earn
per month in ETB
from this employment? -----------
107 What is your current 1. Married
marital status? 2. Divorced
3. Separated
4. Widowed
5. Never married
6. Other specify------
108 What is the highest 1. Cannot read and write
grade your husband 2. Read and write.
completed? 3. 1-6 grade
Ask for those currently 4. 7 and above grade
married. 97. Other, specify------

109 What is your husband’s 1. Farmer


current occupation? 2. Gov’t employee
3. Private employee
4. Merchant
5. Daily laborer
97.Other specify----------
110 How much do your
husband earn from the
work? ------------ETB/month
111 How many are you
usually living in your
house hold? ---------------
112 How much is your
total household income
per month in ETB? -------------

Part Two; Obstetric Information

S.N Questions Alternative /Choice of response Code Skip


201 How many times you have been
pregnant in your life ?Probe for
abortions, still births and current
conception -------------------------
202 How many times in total you gave
birth? ----------------------------
What were the outcomes of the 1. Total live birth-------
203 pregnancies? (Ask for each item and 2. Still birth--------
put numbers on the space provided.)
204 How many months pregnant are you? -------------------

Part Three: knowledge on danger sign during pregnancy

S.N Questions Alternative /Choice of response Skip


301 Do you know any danger signs of 01.Yes If, No
Pregnancy? 02.No 303

302 If yes, what are the danger signs? Circle the 1. Swelling of leg/face
mentioned responses. 2. Vaginal bleeding
3. Reduced/absence of fetal movement
4. Severe headache
5. Severe abdominal pain
6. Excessive weight gain
7. Convulsion
8. Severe difficulty of breathing
9. Leakage of amniotic fluid without
labor
10. High fever
11. Blurring of vision
97.Other specify-----

303 Have you heard the term “birth 01.Yes If No,


preparedness?” 02.No 401
304 From whom did you get the information? 01.Health professional
02.TTBA
03.CHW
04.Mothers
05.Media
97.Other (specify)-------------

Part four: Practices on preparation for birth

401 Have you identified place of delivery? 01.Yes


02.No
402 Are you saving money? 01.Yes
02.No
403 Are you preparing essential items for clean 01.Yes
delivery and postpartum? 02.No
404 Have you identified skilled provider? 01.Yes
02.No
405 Can you detect early signs of an emergency? 01.Yes
02.No
406 Have you designated decision maker? 01.Yes
02.No
407 Have you arranged for emergency funds? 01.Yes
02.No
408 Have you identified mode of transportation? 01.Yes
02.No
409 Have you arranged blood donors? 01.Yes
02.No
410 Have you identified institution with 24 hour 01.Yes
Emoc services? 02.No

This is the end of the interview.


THANK YOU!
Date of data collection ____________________________________
Name of data collector ____________________________________
Signature ___________________________
Name of supervisor __________________________________
Signature ____________________________
የጥናቱ ተሳታፊዎች ስለጥናቱ መረጃና መጠይቅ

የጥናቱ ርዕስ: ይህ ጥናት የሚካሄደው እርጉዞች ለወሊድ ዝግጅትና ልያጋጥሙ የሚችሉ ችግሮች ተዘጋጅቶ ስለመጥበቅ
ያላቸው እውቀትና ተግባር እንዲሁም ከተግባር ጋር የተያያዙ ጉዳዮችን ለመፈተሽ ነው።

የአጥኚው ስም፡

የመስሪያ ቤቱ ስም፡ አርባሚንጭ ዩንቨርሲቲ

የስፖንሰር ስም፡ ዬለም(የግል)

የጥናቱ ዓላማ: ጥናት ዉስጥ ለማጥናት የተፈለገዉ በእርግዝና ውቅት፣ በመውለድ ጊዜ እና ከውሊድ በኋላ ለሚያጋጥሙ
የጤና ችግሮች ለመፍታት ያለመዘናጋት ለመቀነስ አስፈላጊ የሆነ እቅድ ለማውጣትና በተግባር ለማዋል የእናቶችና አዲስ
ለሚወለዱ ህፃናት ህይወት ለማዳን የሚጠቅም ማስረጃ ለማግኘት ። ይህም ጥናት በአርባምንጭ ዩኒቨርስቲ ትምህርት
ዲግሪ ለሚሰጠዉ ትምህርት እንደማማያ ነዉ::

ድርጊት: እኛ የምናደርገዉ እርሶን በራስዎ ቃንቃ ቃለመጠይቅ ማድረግ ነዉ::

አደጋ/ጉዳት: በዚህ ጥናት ዉስጥ በመሳተፎ የሚደርስቦት ጉዳት ወይም አደጋ ምንም የለም::

ጥቅም: በዚህ ጥናት ዉስጥ በመሳተፎ ምክንያት በጥናቱ የተገኘዉን ወቅታዊ መረጃ ተጠቃሚና ለሕብረተሰቡ በሚደረገዉ
የተሻለ የኑሮ ዕቅድ የሚያበረክቱት አስተዋፅዖ ከፍተኛ ነዉ::

ሚስጥራዊነት: የተሰበሰበዉ መረጃ ሚስጥራዊነቱ የተጠበቀ ነዉ:: በዚህ የመጠይቅ ወረቀት ላይ ስሞትን አንፅፍም::

መብት: በጥናቱ ያለመሳተፍ ሊያገኙት ከሚገባዉ የትኛዉም ጥቅም አያጎድሎትም:: በየትኛዉም የጥናቱ ጊዜ የማቃረጥ
መብትዎ የተጠበቀና ምንም ዓይነት ጉዳት የማያደርስ ነዉ::

ካሳ: በዚህ ጥናት ዉስጥ በመሳተፎ ምክንያት የሚያወጡት ወጪ ምንም የለም:: ከመረጃ ሰቢሳቢዎች ጋር ከሚታሳልፉት
የመጠይቅ ጊዜ ዉጪ ምንም ዓይነት ወጪ አይኖርም:: እባኮትን ለተጨማሪ መረጃና የጥናቱን ሂደት ለመጠየቅ
አያንገራግሩ::

ለተማላ አድራሻ

ቦታ፡አርባምንጭ

ስም: ዘለቀግርማ (ተመራማሪ) ስልክ ቁትር፡0926172375 ኢሜይል ፡zelekegirma4@gmail.com


Amharic data collection tools
በአርባ ምንጭ ዩንቬርስት ህክምናና ጤና ሳይንስና ኮለጅ
የህብረተሰብ ጤና የትምህርት ክፍል
የመደበኛ የድሬ ምረቃ ፕሮግራም

uS[Í cwdu=/‹/ ¾T>VL SÖÃp


¾S[Í cwdu¬ eU _____________________________________________
S[ͬ ¾}cwcwuƒ k” ____________
S[ͬ Scwcw ¾}ËS[uƒ c¯ƒ: ____________

SÓu=Á
Ö?“ ÃeØM”! ›”ÅU” c’u}‹G<!

›’@-----------------------------›vLKG<˜ ¾S×G<ƒ Ÿ----------------µ”/¨[Ç/Ÿ}T/kuK?/ eJ” u›`v


U”ß ¿”y?`eƒ ህክምናና ጤና ሳይንስ ኮለጅ የህብረተሰብ ጤና የትምህርት ክፍል የ 2007/2015 የድሬምረቃ ፕሮግራም
የጥናትና ምርምር ቡድን አባል ነኝ፡፡
ይህ ጥናት የሚካሄደው እርጉዞች ለወሊድ ዝግጅትና ልያጋጥሙ የሚችሉ ችግሮች ተዘጋጅቶ ስለመጥበቅ ያላቸው ተግባር
እንዲሁም ከተግባር ጋር የተያያዙ ጉዳዮችን ለመፈተሽ ነው።
ይህ ጥናት ከነፍሰጡር እናቶች ጋር በቀጥታ የተያያዘ ሰለሆነ በጥናቱ እንዲሳተፉ በእጣ ከተመረጡ ሴቶች አንዷ እርስዎ
ነዎት ስለዚህ እዚህ ጥናት ላይ እንዲሳተፉና አስፈላጊ መረጃ እንዲሰጡን በተህተና እንጠይቃለን። ይሁን እንጂ ማንኛውም
ጥያቄ አለመመለስ ይችላሉ። እንዲሁም በማንኛውም ጊዜ ጥይያቄውን ማቋረጥና በጥናቱ አለመሳተፍ ይችላሉ።
በጥናቱ ባለመሳተፍዎ ማግኘት ከሚገባዎ አገልግሎት ከማግኘት አያግድዎትም።
ይህ በግልዎ የሚሰጡት መልስም በሚስጥር የሚጠበቅ ስለሆነ ከጥናቱ ውጤት ጋር በምንም የሚያያዝ አይደለም።
ላረጋግጥልዎ የምንፈልገው ግን ይህ የሚሰጡት መልስ በጣም አስፈላጊ የሚሆነው ጥናቱን ለማጥናት ብቻ ሳይሆን
በእርግዝና ውቅት ፣ በወሊድ ጊዜ እና ከውሊድ በኋላ ለሚያጋጥሙ የጤና ችግሮች ለመፍታት ያለመዘጋጀት ለመቀነስ
አስፈላጊ የሆነ እቅድ ለማውጣትና በተግባር ለማዋል የእናቶች እና አዲስ ለሚወልዱ የህፃናትን ህይወት ለማዳን የሚጠቅም
አስተያየት ለማግኘትም ነው።
¾eUU’ƒ /ònŘ’ƒ/SÓKÝ
uØ“~ KSd}õ ònÅ— ’ƒ;
1.›”------------------SMc< ›¬ ŸJ’ ¨ÅUkØK¬ ØÁo ›Kõ/ò/
2.¾KU-------------------SMc< ¾KU ŸJ’ ›SeÓ’I/i/SÖÃl” ›s]ß
õnŘ’~” ¾[ÒÑÖ¬ S[Í cwdu=
eU----------------------------------k”-----------/-----------/ò]T----------------
¾}q××[¬ eU----------------------k”-------/----------ò]T--------------------

›ÖnLÃ ¾u}c?w S[Í


001. የመጠይቁ መለያ ቁጥር…………………………………….

002. ወረዳ………………………………

003. k በለ……………………………….

004. ጠና ጣቢያ……………………..

ክፍል. 1. ማህበራዊና ስነማህበራዊ መረጃዎች

ተ.ቁ አማራጭ መልሶች


. ጥያቄዎች ወደ
101
ዕድሜዎ ስንት አመት ነው? ……………………….ዓመት
1. የኮሌጅ ዲፕሎማና በላይ
102 ከፍተኛ የትምህርት ደረጃዎ ምንድነው? 2. ተክኒክና ሙያ ሰርተፍኬት
3. ከ 7 ኛ-12 ኛ ክፍል
4. ከ 0-6 ኛ ክፍል
5. ማንበብና መጻፍ እችላለሁ
6. ማንበብና መጻፍ ኣልችልም

103 1. ዐርቶዶክስ
የትኛው ሐይማኖት ተከታይ ነዎት? 2. እስልምና
3. ፕሮተስታነት
4. ባህላዊ
104 1. ጋሞ
የትኛው ብሔር አባል ነዎት? 2. ዎላይታ
3. Ôó
4. አማራ
97. ሌላ………………..

105 1. የመንግስት ቅጥረኛ


ስራዎት ምንድነው? 2. የ ቤት ዕመበት
3. የ ቤት አገልጋይ
4. ግብርና
5. የግል ቅጥረኛ
6. ነጋዴ
7. የቀን ጉልበት ሰራተኛ
8. ተማሪ
106
ከዚህ ስራ ምን ያህል ገቢ ያገኛሉ?
-----------ብር
107 1. ያገባ
አሁን የጋብቻ ሁኔታ ምንድነው? 2. የተፋታ
3. የተለያዩ
4. ባል የሞተባት
5. ፈፅሞ ያላገባ
97. ሌላ/ይጥቀሱ/
108 1. የኮሌጅ ዲፕሎማ በላይ
የባለቤቶዎ የትምህርት ደረጃ ምንድነዉ; አሁን አግብቶ ላለ ብቻ 2. ቴክኒክና ሙያ ሰርተፍኬት
የሚጠየቅ 3. ከ 7 ኛ -12 ኛ ክፍል
4. ከ 0-6 ኛክፍል
5. ማንበብና መጻፍ ይችላል
6. ማንበብና መጻፍ አይችልም
109 ባለቤቶት ሥራቸዉ ምንድነዉ; 1. ግብርና
2. የመንግስት ቅጥረኛ
3. የግል ቅጥረኛ
4. የቀን/የጉልበት/ ሰራተኛ
5. ነጋዴ
97. ሌላይጥቀሱ
110
ከዚሁ ሥራ ምን ያህል ገቢ ያገኛሉ; ------------------ብር በወር
111
አብዛኛዉን ጊዜ አንድ ላይ የሚኖረዉ የቤተሰባችሁ ቁጥር ምን ..............ሰው
ያህል ነዉ;
112
የቤተሰቡ የወር ገቢ ምን ያክል ነው; ................ብር በወር

ክፍል ሁለት ፡ እርግዛናና ጽንስ መረጃዎች

201
በህይወት ዘመንዎ ስንት ጊዜ አረገዙ; --------------------
202 u›ÖnLÃ U” ÁIM Ñ>²? MÏ
¨MŪM;
--------------------
203 የእርግዛናዎችዎ ዉጤቶች እንዴት ነበሩ; ጠቅላላ በህይወት የተወለዱ-------------
እርግዝናዎችን በማስታወስ ለእያንዳንዱ ሞቶ የተወለዱ --------------
በቁጥር ይሞላ

204 የስንት ወር እርጉዝ ነዎት; ----------ወራት

ክፍል ሶስት ፡ የእናቶች፣ ግንዛቤና አመለካከት ጥያቄዎች

301 በእርግዝና ጊዜ የሚከሰቱ አደገኛ ምልክቶች 1. አዎን


ያዉቃሉ; 2. አላዉቅም
302 አደገኛ ምልክቶቹ እነማን ናቸዉ; ከአንድ በላይ 1. የፊት ወይም እግር እብጠት
ምላሽ ሊሰጥ ይችላል 2. ከማህፀን ደም መፍሰስ
3. የጽንስ እንቅስቃሴ መቀነስ /መጥፋት
4. ከፍተኛ ራስ ምታት
5. ከፍተኛ የሆድ ህመም(ቁርጠት)
6. ከመጠን በላይ ክብደት መጨመር
7. የደም ግፊት መጨመር
8. ከፍተኛ የመተንፈስ ችግር
9. ከፍተኛ ትኩሳት
10. ያለምጥ የሽርት ዉሃ መፍሰስ
11. የዓይን ብዥታ
97. ሌላ ይጥቀሱ
303 ¾¨K=É ´ÓÌ’ƒ ¾T>M G[Ó cU}¨<
1. አዎን
Á¨<nK<;
2. አላዉቅም
304 SMe ›” ŸJ’ S[Í ዉ” ŸT” ›Ó˜}ªM; 1. ŸÖ?“ vKS<Á
2. ¾cKÖ’ ¾MUÉ ›ªLÏ
3. ¾Iw[}cw Ö?“ }q××]
4. እ“„‹ እ“ SÑ“— w²<H”
97. K?L "K ÃØkc<------------------------

¡õM 4. K¨K=É ÁK¨<” ´Óσ ›eSM¡„ ¾SMe cÜ‹ }Óv`

40
1 ¾¨K=É x ታን KÃ}¨< ›¨<kªM 01. › 02. ›ÃÅKU
40 Ñ”²w” ÁÖ^pTK<; 01. › 02. ›ÃÅKU
2
40
3 K”èI ¾¨K=É ›ÑMÓKAƒ እ“ 01. › 02. ›ÃÅKU
Ÿ¨K=É u%EL LK<ƒ Ñ<ÇÄ‹
›eðLÑ> ’Ña‹” እ Á²ÒÌ ’¨<;

40 MUÉ ÁK¨< ›ªLÏ KÃ}¨< ›¨<kªM;


4 01. › 02. ›ÃÅKU
40 ›ÅÒ” ¾T>ÖlS< UM¡„‹ KÃ}¨<
5 ›¨<kªM. 01. › 02. ›ÃÅKU

40 ¨<d’@ cÜ” ¨¡KªM”;


6 01. › 02. ›ÃÅKU
40 ¾›e†"Dà Ñ>²? Ñ”²w” ›²ÒÏ}ªM;
7 01. › 02. ›ÃÅKU
40 ¾ƒ^”eþ`ƒ ›Ã’ƒ” KÃ}¨<
8 ›¨<kªM”; 01. › 02. ›ÃÅKU
40 ÅU KÒj‹” ›²ÒÏ}ªM”; 01. › 02. ›ÃÅKU
9
41 ¾24 c¯ƒ ¾É”Ñ}— Q¡U“
0 ›ÑMÓKAƒ ¾T>cØ }sU” KÃ}¨< 01. › 02. ›ÃÅKU
›¨<kªM”;