# CHAPTER THREE: RESEARCH METHODOLOGY 3.0. Introduction

CHAPTER THREE: RESEARCH METHODOLOGY
3.0. Introduction
This chapter presents the methodologies of this study includes the place where the study was conducted the design being used in constructing the research, sampling design was used in getting the population size, the subjects, the tools and techniques that was utilized in analyzing and interpreting the data was taken and the instrument to be used in data gathering, Data Analysis, ethical consideration and finally dissemination of the study.
3.1. Study area
The study area of this research was Berbera regional hospital, The Berbera Regional hospital was found in 1953 Which the largest public hospital in Berbera city Somaliland which serves a total population of 500,000 according to the National Electoral Commission (NEC) declares the last election. The hospital consists of different department to provide general health care service for the population of Berbera city including medical department, surgical, emergency, orthopedic, outpatients, laboratory, pediatric, gynecology, maternity, pharmacy, ICU and payment department where this particular study focuses only on the maternity services provided for mothers during delivery.
3.2. Study period
This research was carried out from March to June 2022.
3.3. Study designed
Facility based Descriptive cross-sectional study design was conducted to asses Prevalence of C-section and associated factors among expectant mothers attending delivery service at Berbera regional hospital.
3.4. Study population
The study population focuses on all women who give birth in Berbera regional Hospital during the data collection period. Who were randomly select to be enroll in this study were consider as study population.
Our target number of population is 60 who living in Berbera city [HA1]
3.5. Sample size

 Where n = sample population N= total population e= Error tolerance

The requiring sample size was calculate by using statistical formula for population sample size estimation so we use Slovene’s formula about the target population which was in or from Berbera Regional hospital
n=N/ [1+N/ (e)2
=60/1+60/ (0.05)2
=60/1+60(0.0025)
= 60/1+0.15
= 60/1.15= 52
[HA2]3.6. Sampling technique [HA3]
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3.7. Inclusion and exclusion criteria
3.7.1. Inclusion criteria

• All expectant pregnant mothers who live in Berbera city and has been admitted to the maternity ward of Berbera regional hospital for the purpose of delivery service during the data collection period and give their voluntary consent to participate in the study.

3.7.2. Exclusion criteria

• All other patients that were admitted in the other departments of the hospital
• Mothers who came for only ANC were excluded
• Expectant pregnant mothers who were not able to give their consent were also excluded

3.8. Variables
3.8.1. Dependent variables

• The dependent variable of the study is the prevalence of C-section

3.8.2. Independent variables

• Socio demographic factors including (Maternal education, occupation, Gravidity, Parity)
• Obstetric complications leading to C-section which includes (Cephalo pelvic disproportion, Premature rupture of amniotic membrane, Fetal distress, Multiple pregnancy, Breech presentation and Pre-eclampsia)
• Previous cesarean section

3.9. Operational definitions [HA4]

• Prevalence is the proportion of a population who has a specific characteristic in given time period
• Breech Presentation: is when the fetus presents buttocks or feet first (rather than head first – a cephalic presentation). It has significant implications in terms of delivery – especially if it occurs at term >37 weeks
• Caesarean section rate; is the total number of resident cesarean deliveries among woman divide by the total number of deliveries for a specified geographical area (country, state, county etc.) during a specified time period per 100 live births.
• Fetal distress: is an emergency pregnancy, labor, and delivery complication in which a baby experiences oxygen deprivation (birth asphyxia). This may include changes in the baby’s heart rate (as seen on a fetal heart rate monitor), decrease fetal movement, and meconium in the amniotic fluid, among other signs.
• Birth Weight: The weight of a new born infant obtains preferably within one hour of birth.

3.10. Data collection procedure
The data was collect through face to face interview administer technique using a pretest structure questionnaire. The questionnaire was first prepared in English then translated in to local language (Somali) and it use questionnaire as the main tool for gathering data on CS. The questionnaire was developed base on previous studies and it was constituted of 3 sections; the first one is the Socio Demographic factors of the respondent and the second one is the Obstetric complications and the third one is The previous C-section of the respondent towards CS delivery and current mode of delivery.
3.11. Data analysis
Data were statistical packages for social sciences (SPSS) version 20 statistical software for further analysis. Frequency distribution and cross tabulation was done against the variables of interest
3.12. Pre-test
Data quality was ensure before data collection, during data collection, coding, entry and analysis. Before data collection pre-testing the questionnaire and adequate training will be provide to data.
During data collection, fill questionnaires were check for completeness, accuracy, and consistency by supervisors & principal investigator after the data collection on daily base. Consequently, any problems encounter was discuss among the survey team and solve immediate[HA5].
3.13. Ethical consideration
In order to make sure that the study will ethically sound the researchers was fulfill the academic ethical issues and the approval letter obtained from the research and ethics of Edna Adan UniversityBefore the start of the study institutional permission was obtained from the director of Berbera Regional Hospital. Also to get sign letter of inform consent of respondents, the researchers will introduce them self to the participant and the study was explaining the participant on the procedure. The purpose of the study will explain to the respondents they will also inform about the criteria of being select to the participant in the study. They were also informing about the duration of the study, and they will assure the confidentiality was ensured. The researchers avoided anything against the norms, customs, cultural and religious of the community, the researchers consider any request of the responding population, also during the data collection process the researcher was avoid anything against the value and moral of the responding individuals during the process of data collection.
3.14. Dissemination of findings
The result of the study was submitted to EDNA ADAN UNIVERSITY and disseminated to relevant stakeholders through publication and presentations on relevant forums. These papers were publishing in peer-review scientific journal. Public outreach activities for realizing research findings, for example through conference, were also being important avenue for dissemination.

[HA1]Bishii ugu danbaysay ee March ama February kolba kii laydiin helo waxad soo ogataan intee dumar ah baa ku umulay Berbera hospital nooc kasta oo delivery ah marka laysu wada geeyo ? (just total number of delivery)
Marka kalmadaha aan definitionkooda filayo waxa ka mid ah

1. Prevalence of C-section
2. Maternal education
3. Maternal occupation
4. Gravidity
5. Parity
6. Cephalo pelvic disproportion
7. Premature rupture of amniotic membrane,
8. Fetal distress,
9. Multiple pregnancy,
10. Breech presentation
11. Pre-eclampsia
12. Previous cesarean section

Ugu yaraan kalmadahan midwalba ugu badnaan ilaa labao line ku qeexa waxa uu yahay iyo sida loo cabirayo [HA5]Ciwaanka iyo warbixintu isma laha markaa ciwaankaa bal dib ugu noqda
Pre test waxa weeyaan in la iska tijaabiyo questionnairka inta aan la isticmaalin ka hor markaa idinku ma samaynaysaan sided u samaynaysaan? Waxyabaha ka warbixiya maaha qoraal aad si fudud meel uga soo qadan kartaan o idin shaqaynaya iska ilaaliya direct copy paste ka