Results
Social- demographic characteristics of the participants.
The study involved 384 couples who met inclusion criteria. Among them, female were 384 and male also were 384 which made a total of 768 participants. Results indicated that Majority of the participants 270 (36.0%) were in the age group, The mean age was 31.71± 8.056, median age 30.00, minimum age 18 and maximum age was 59. Regarding the education level of the participants, the large proportion of respondents 465 (60.0%) had primary education and a small proportion 92 (12.5%) had secondary education. Majority of the participants 665 (84%) were peasants and those who had three or more children were 260 33.9%). Majority of the participants 605 (78.0%) had an income of less than 1000 T.shs per day. Large proportion 599 (78.0%) were able to access health facility when they face problems. (Table 3).
Table 3: Social-demographic distribution of the participants (N=768)
Variable
|
Frequency (n)
|
Percentage (%)
|
Age group
|
|
|
18-25
|
197
|
25.0
|
26-33
|
270
|
36.0
|
34-41
|
188
|
24.0
|
42+
|
113
|
15.0
|
Sex
|
|
|
Male
|
384
|
50.0
|
Female
|
384
|
50.0
|
Education level
|
|
|
No formal education
|
211
|
27.5
|
Primary
|
465
|
60.5
|
Secondary
|
92
|
12.5
|
Occupation
|
|
|
Employed
|
16
|
2.1
|
Unemployed
|
61
|
7.9
|
Self employed
|
46
|
6.0
|
Peasant
|
665
|
84.0
|
Religion
|
|
|
Christian
|
161
|
21.0
|
Muslim
|
607
|
79.0
|
Ethnicity
|
|
|
Makonde
|
285
|
37.1
|
Makuwa
|
335
|
43.6
|
Yao
|
82
|
10.7
|
Others
|
66
|
8.6
|
Number of children
|
|
|
One
|
162
|
21.1
|
Two
|
193
|
25.1
|
Three or more
|
260
|
33.9
|
None
|
153
|
19.9
|
Access to health facility
|
|
|
Yes
|
599
|
78.0
|
No
|
169
|
22.0
|
Distance to health facility
|
|
|
< than 5 Kilometer
|
586
|
76.3
|
>than 5 Kilometer
|
182
|
23.7
|
Daily income
|
|
|
<than 1000 T.shs
|
605
|
78.8
|
>than 1000 T.shs
|
163
|
21.2
|
Level of knowledge about preeclampsia and eclampsia among pregnant women and their male partners
Majority of respondents 217(56.5%) male and 213(55.5%) female had inadequate knowledge on pre-eclampsia and eclampsia, only 167(43.5) of male partners and 171(44.5) of pregnant women had adequate knowledge on pre-eclampsia and eclempsia (figure 1)
Responses to specific questions involved in assessing knowledge on pre-eclampsia and eclampsia
Majority of both pregnant women 248(64.6%) and their male partners 220(57.3%) did not know whether pre eclampsia is a hypertensive disorder; majority of them did not respond correctly on the risk factors of preeclampsia [268(69.8% of pregnant women and 302(78.6) did not know whether pre existing history of high blood pressure can lead to pre eclampsia]; Also majority of respondents failed to repond correctly on the signs of pre-eclampsia [201(52.3%)of pregnant women and 198(51.6) responded incorrectly on severe headache; 285(74.2%) of pregnant women and 269 (70.1%) on visual disturbance ] Table 4
Table 4: Responses to specific questions involved in assessing knowledge on pre-eclampsia and eclampsia
Variable
|
Pregnant Women
|
Male partners
|
|
Frequency
|
Percent
|
Frequency
|
Percent
|
Preeclampsia is Hypertension in Pregnancy
|
|
|
|
|
Correct response
|
136
|
35.4
|
164
|
42.7
|
Incorrect response
|
248
|
64.6
|
220
|
57.3
|
Risk factor for preeclampsia is history of high blood pressure before conception
|
|
|
|
|
Correct response
|
116
|
30.2
|
82
|
21.4
|
Incorrect response
|
268
|
69.8
|
302
|
78.6
|
Risk factor for preeclampsia is Overweight
|
|
|
|
|
Correct response
|
152
|
39.6
|
116
|
30.2
|
Incorrect response
|
232
|
60.4
|
268
|
69.8
|
Symptom of preeclampsia is severe headache
|
|
|
|
|
Correct response
|
183
|
47.7
|
186
|
48.4
|
Incorrect response
|
201
|
52.3
|
198
|
51.6
|
Symptom of preeclampsia is Increase urine out put
|
|
|
|
|
Correct response
|
240
|
62.5
|
204
|
53.1
|
Incorrect response
|
144
|
37.5
|
180
|
46.9
|
Symptom of preeclampsia is Visual disturbance
|
|
|
|
|
Correct response
|
99
|
25.8
|
115
|
29.9
|
Incorrect response
|
285
|
74.2
|
269
|
70.1
|
Symptom of preeclampsia is Epigastric pain ( central just below the ribs
|
|
|
|
|
Correct response
|
131
|
34.1
|
125
|
32.6
|
Incorrect response
|
253
|
65.9
|
259
|
67.4
|
Symptom of preeclampsia is Sudden swelling of the face, hands or feet
|
|
|
|
|
Correct response
|
135
|
35.2
|
133
|
34.6
|
Incorrect response
|
249
|
64.8
|
251
|
65.4
|
Sign of preeclampsia is Convulsions(fits)
|
|
|
|
|
Correct response
|
176
|
45.8
|
157
|
40.9
|
Incorrect response
|
208
|
54.2
|
227
|
59.1
|
Sign of preeclampsia is Loss of consciousness
|
|
|
|
|
Correct response
|
165
|
43
|
151
|
39.3
|
Incorrect response
|
219
|
57
|
233
|
60.7
|
Complication of preeclampsia is Maternal death
|
|
|
|
|
Correct response
|
121
|
31.5
|
135
|
35.2
|
Incorrect response
|
263
|
68.5
|
249
|
64.8
|
Complication of preeclampsia is Fetal death
|
|
|
|
|
Correct response
|
193
|
50.3
|
169
|
44
|
Incorrect response
|
191
|
49.7
|
215
|
56
|
Use of salt free diet
|
|
|
|
|
Correct response
|
194
|
50.5
|
139
|
36.2
|
Incorrect response
|
190
|
49.5
|
245
|
63.8
|
The relationship between socio-demographic characteristics and level of knowledge
The variable which showed significant relationship with knowledge were employment status (p<0.001), ethnicity (p<0.001), parity (p<0.001), access to health facility (p<0.001),walking distance to a nearby health facility (p<0.001) and access to mobile phone (p=0.004)Table 5
Table 5: The relationship between socio-demographic characteristics and level of
knowledge
Variable
|
Adequate knowledge n(%)
|
Inadequate knowledge n(%)
|
X
|
P-Value
|
Education level
|
|
|
|
|
No formal education
|
86(40.8)
|
125(59.2)
|
|
|
Primary
|
211(45.4)
|
254(54.6)
|
|
|
Secondary
|
41(44.6)
|
51(55.4)
|
1.269a
|
0.53
|
Occupation
|
|
|
|
|
Employed
|
10(62.5)
|
6(37.5)
|
|
|
Unemployed
|
20(32.8)
|
41(67.2)
|
|
|
Self employed
|
9(19.6)
|
37(80.4)
|
|
|
Peasant
|
299(46.4)
|
346(53.6)
|
17.934a
|
<0.001
|
Religion
|
|
|
|
|
Christian
|
63(39.1)
|
98(60.9)
|
|
|
Muslim
|
275(45.3)
|
332(54.7)
|
1.969a
|
0.161
|
Ethinicity
|
|
|
|
|
Makonde
|
85(29.8)
|
200(70.2)
|
|
|
Makuwa
|
167(49.9)
|
168(50.1)
|
|
|
Yao
|
39(47.6)
|
43(52.4)
|
|
|
Others
|
47(71.2)
|
19(28.8)
|
48.151a
|
<0.001
|
Parity
|
|
|
|
|
One
|
52(32.1)
|
110(67.9)
|
|
|
Two
|
73(37.8)
|
120(62.2)
|
|
|
Three or more
|
125(48.1)
|
135(51.9)
|
|
|
none
|
88(57.5)
|
65(42.5)
|
25.397a
|
<0.001
|
Access to H/F
|
|
|
|
|
Yes
|
286(47.7)
|
313(52.3)
|
|
|
No
|
52(30.8)
|
117(69.2)
|
15.417a
|
<0.001
|
Walking distance to a nearby H/F
|
|
|
|
|
Less than 5KM
|
287(49)
|
299(51)
|
|
|
5Km or more
|
51(28)
|
131(72)
|
24.745a
|
<0.001
|
Sex
|
|
|
|
|
Male
|
167(43.5)
|
217(56.5)
|
|
|
Female
|
171(44.5)
|
213(55.5)
|
.085a
|
0.771
|
Own Mobile phone
|
|
|
|
|
No
|
52(34.2)
|
100(65.8)
|
|
|
Yes
|
286(46.6)
|
328 (53.4)
|
7.561
|
0.004
|
Predictors of knowledge on pre eclampsia and eclampsia
After controlling for confounders, predictors of knowledge were occupation status [Unemployed AOR=0.17at 95% CI=0.049-0.592, p=0.005; self employed AOR=0.095 at 95% CI= 0.024-0.373, p=0.001]; Ethnicity [Makuwa AOR=2.814 at 95% CI= 1.944-4.074,p<0.001; Yao AOR=5.48 at 95% CI=2.977-10.086, p<0.001; Others AOR=4.902 at 95% CI=2.599-9.244, p<0.001]; Parity [One AOR=0.344 at 95% CI=0.203-0.584,p<0.001;Two AOR= 0.4 at 95% CI=0.239-0.668, p<0.001]; Walking distance [5km or more AOR=0.093 at 95% CI=0.02 -0.434, p=0.003] Table 6
Table 6: Predictors of knowledge on pre eclampsia and eclampsia
Variable
|
|
95%CI
|
p-value
|
|
AOR
|
Lower
|
Upper
|
|
Occupation
|
|
|
|
|
|
Employed
|
1
|
|
|
|
|
Unemployed
|
0.17
|
0.049
|
0.592
|
0.005
|
|
Self employed
|
0.095
|
0.024
|
0.373
|
0.001
|
|
Peasant
|
0.518
|
0.171
|
1.57
|
0.245
|
|
Ethinicity
|
|
|
|
|
|
Makonde
|
1
|
|
|
|
|
Makuwa
|
2.814
|
1.944
|
4.074
|
<0.001
|
|
Yao
|
5.48
|
2.977
|
10.086
|
<0.001
|
|
Others
|
4.902
|
2.599
|
9.244
|
<0.001
|
|
Parity
|
|
|
|
|
|
None
|
1
|
|
|
|
|
One
|
0.344
|
0.203
|
0.584
|
<0.001
|
|
Two
|
0.4
|
0.239
|
0.668
|
<0.001
|
|
Three or more
|
0.689
|
0.426
|
1.116
|
0.13
|
|
Access to H/F
|
|
|
|
|
|
Yes
|
1
|
|
|
|
|
No
|
4.518
|
0.955
|
21.382
|
0.057
|
|
Walking distance to a nearby H/F
|
|
|
|
|
|
Less than 5KM
|
1
|
|
|
|
|
5Km or more
|
0.093
|
0.02
|
0.434
|
0.003
|
|
|
|
|
|
|
Yes
|
1
|
|
|
|
No
|
0.715
|
0.474
|
1.08
|
0.111
|
|
|
|
|
|
|
|
|
|
Myths about preeclampsia and eclampsia among pregnant women and their male partners.
The findings revealed that the majority of the participants 236 (30.7%) reported that the local name for preeclampsia and eclampsia is the devils disease and 12(1.6%) said that it is a big illness. Majority of the participants 286 (37.2%) said preeclampsia and eclampsia is due to devils living in the wild, sea and big trees while 145 (18.9%) said that mistreatment from in-law was the cause. 191 (24.9%) reported that the presentation of preeclampsia and eclampsia is heart burn (Kyokombe) while 139 (18.1%) said eye rolling back. Regarding the consequence of preeclampsia and eclampsia, 392 (51.0%) reported mental illness while 192 (25.0%) reported intrauterine fetal death (Litulilye). (Table 7)
Table 7: Myths about preeclampsia and eclampsia (N= 768)
Variable
|
Frequency
|
Percentage
|
|
(n)
|
(%)
|
Local name for preeclampsia and eclampsia
The devil disease
Snake illness
God-made disease
Magic disease
Big illness
Homa ya mdudu
Illness of the moon
|
236
180
41
102
12
92
105
|
30.7
23.4
5.3
13.3
1.6
12
13.7
|
Myths regarding the cause of preeclampsia and eclampsia
Devils living in the wild, sea and big trees.
Witch craft
Mnyama (animal)
Mistreatment by in-law
|
286
173
164
145
|
37.2
22.5
21.4
18.9
|
The consequence of preeclampsia & eclampsia
Njiti (Premature baby)
Loss of memory (Kuyiwa)
Death of the mother
Mental illness
Litulilye (intrauterine fetal death)
|
88
46
50
392
192
|
11.5
6
6.5
51
25
|
Local treatment of preeclampsia and eclampsia
Drinking boiled green leaves.
Special dance to expel demons/devils
Burning leaves or incense (kufukiza ubani)
Splashing of human urine over the mother`s body with eclampsia.
|
287
190
141
150
|
37.4
24.7
18.9
19.5
|
Local prevention of preeclampsia and eclampsia
Tie string of tree on the waist
Wear charms- (Hirizi) around the neck
Wear of black clothe on the hand
Boil the wood of trees and bathe
Lie the pregnant mother under the bed.
|
173
181
78
157
179
|
22.5
23.6
10.2
20.4
23.3
|
Myths about preeclampsia and eclampsia
The results showed that 51.6% had weak Myths and 48.4% had strong Myths about preeclampsia and eclampsia. Figure 2
Antenatal care service utilization.
The current study was also assessed ANC utilization among expecting mothers in Mtwara region N = 384. ANC utilization was defined as adequate if the women had at least two visits or more otherwise was inadequate keeping in mind that the current study dealt with the women who were in second and third trimester with the gestation age of 24 weeks and above together with their male partners. The total female participants were 384 and their findings regarding ANC services revealed that majority 244 (64%) had an adequate utilization since they attended two or more visits and 140 (36%) had an inadequate utilization as they attended less. Figure 3.
Association between the level of knowledge and antenatal care service utilization.
A Chi-square was done to show the relationship between knowledge and antenatal care services utilization then bivariate and Multivariate logistic regression was done. The findings showed that those who had adequate knowledge were all most 3 times more likely to utilize antenatal services compared to those who had inadequate knowledge (AOR = 2.827; CI = 1.719, 4.651; P = 0.000). Also those who had three or more children were 2 times more likely to utilize ANC services compared to those who had no children (AOR = 2.148; CI = 1.030, 4.483; P = 0.042). Other factors showed no association. More details as shown in table 8.
Table 8: Multivariate logistic regression between knowledge level about preeclampsia and eclampsia and ANC utilization (N =384).
Variable
|
AOR
|
p-value
|
95% confident interval
|
|
|
|
Lower
|
upper
|
Knowledge
|
|
|
|
|
Adequate
|
2.827
|
0.000
|
1.719
|
4.651
|
Inadequate(Ref)
|
|
|
|
|
Occupation
|
|
|
|
|
Employed
|
0.490
|
0.480
|
0.068
|
3.547
|
Unemployed
|
0.891
|
0.805
|
0.357
|
2.225
|
Self employed
|
3.385
|
0.076
|
0.878
|
13.047
|
Peasant (Ref.)
|
|
|
|
|
Ethnicity
|
|
|
|
|
Makonde
|
0.304
|
0.062
|
0.087
|
1.063
|
Makuwa
|
0.370
|
0.122
|
0.105
|
1.306
|
Yao
|
1.104
|
0.898
|
0.241
|
5.052
|
Others (Ref.)
|
|
|
|
|
Number of children
|
|
|
|
|
One
|
1.712
|
0.164
|
0.802
|
3.652
|
Two
|
1.315
|
0.489
|
0.606
|
2.851
|
Three or more
|
2.148
|
0.042
|
1.030
|
4.483
|
None (Ref.)
|
|
|
|
|
Access to health facility
|
|
|
|
|
Yes
|
2.072
|
0.353
|
0.445
|
9.637
|
No (Ref.)
|
|
|
|
|
Distance to health facility
|
|
|
|
|
Less than 5 kilometer
|
0.297
|
0.113
|
0.067
|
1.330
|
More than 5 Kilometer (Ref.)
|
|
|
|
|
Wealth index
|
|
|
|
|
Poorest (Ref.)
|
|
|
|
|
Poor
|
0.542
|
0.668
|
0.033
|
8.904
|
Middle
|
1.092
|
0.755
|
0.628
|
1.898
|
High
|
0.402
|
0.004
|
0.216
|
0.751
|
The association between myths about preeclampsia and eclampsia and antenatal care services utilization.
A Chi-square done to show the relationship between Myths about preeclampsia and eclampsia and antenatal care services utilization then Bivariate and Multivariate logistic regression done. The findings showed those who had weak myths were 63% less likely to utilize ANC services compared to those who had strong myths. (AOR = 0.370; CI = 0.229, 0.599; P = 0.000). Furthermore, other factors showed no association. Table 9.
Table 9: Multivariate logistic regression between myths about preeclampsia and eclampsia and ANC utilization N = 384
Variable
|
AOR
|
p-value
|
95% confident interval
|
|
|
|
Lower
|
upper
|
Myths
|
|
|
|
|
Weak myths
|
0.370
|
0.000
|
0.229
|
0.599
|
Strong myths (Ref.)
|
|
|
|
|
Occupation
|
|
|
|
|
Employed
|
0.495
|
0.499
|
0.064
|
3.807
|
Unemployed
|
0.696
|
0.435
|
0.279
|
1.732
|
Self employed
|
3.816
|
0.050
|
1.002
|
14.533
|
Peasant (Ref.)
|
|
|
|
|
Ethnicity
|
|
|
|
|
Makonde
|
0.346
|
0.100
|
0.098
|
1.225
|
Makuwa
|
0.411
|
0.169
|
0.116
|
1.460
|
Yao
|
1.467
|
0.620
|
0.323
|
6.660
|
Others (Ref.)
|
|
|
|
|
Number of children
|
|
|
|
|
One
|
1.540
|
0.258
|
0.729
|
3.254
|
Two
|
1.214
|
0.622
|
0.562
|
2.623
|
Three or more
|
1.772
|
0.125
|
0.853
|
3.680
|
None (Ref.)
|
|
|
|
|
Access to health facility
|
|
|
|
|
Yes
|
1.955
|
0.394
|
0.418
|
9.139
|
No (Ref.)
|
|
|
|
|
Distance to health facility
|
|
|
|
|
Less than 5 kilometer
|
0.291
|
0.108
|
0.065
|
1.310
|
More than 5 Kilometer (Ref.)
|
|
|
|
|
Wealth index
|
|
|
|
|
Poorest (Ref.)
|
|
|
|
|
Poor
|
0.407
|
0.539
|
0.023
|
7.185
|
Middle
|
0.963
|
0.893
|
0.556
|
1.669
|
High
|
0.361
|
0.001
|
0.194
|
0.672
|
Discussion
The results of the current study showed that 56.5% of the male partners and 55.5% of the pregnant women had inadequate knowledge about preeclampsia and eclampsia. The results of this study differ in findings of previous work done in Makole Dodoma [12 ] which revealed that 41% of the respondents had low knowledge. These differences might be due to geographical location where the study conducted as the current study conducted in Rural while the previous conducted in Urban, also it could be due to differences in the study population as the current study dealt with both pregnant women and their male partners while the previous study focused mainly on pregnant women who are attending Antenatal clinic and get health education regarding their status. This finding also differ with [13 ] findings which showed 60.0% of the respondents reported to have no knowledge.
The findings of the present study showed that those who had adequate knowledge about preeclampsia and eclampsia were 43.5% male partners and 44.5% pregnant women. The present findings seem to be in line with other research done in Same Moshi Tanzania [13 ] which found that 40% reported having adequate knowledge on preeclampsia and eclampsia [16].The findings might be due to the unplanned or absence of educational program regarding preeclampsia and eclampsia in the health facility and in the community.
Following the present results, previous studies have demonstrated that the local name was `Rt jho dabao vadhan` meaning that high blood pressure [14]. Another study was done in Southern Mozambique [17 ] reported that the local name for preeclampsia and eclampsia were falling disease, fainting disease, snake illness or childhood illness. This inconsistency of the findings might be due to the different study area and social demographic characteristics of the participants. Regarding the causes, the current study 37.2% of the participants reported that the cause was the devil living in the wild, sea, and big trees and 22.5% reported to be caused by frequency fever. These findings differ from the previous study [17 ] who reported the causes were mistreatment by in-laws, marital problems, and excessive thinking or worrying. These differences might be due to the cultural differences of the participants. Another important finding was that 10.5% of the respondents from the current study reported dizziness and Convulsions (kukwijula) were the signs and symptoms of preeclampsia and eclampsia. This is in line with the previous study [14 ] who reported the same findings. Drinking boiled green leaves was the local treatment of preeclampsia and eclampsia reported in the present study which accounts for 37.4% of the participants, special dance to expel demons/devils 24.7%, burning leaves or incense (ubani) 18.9%. These findings compared by the previous study [18]which showed that traditional treatment of preeclampsia were eating onions, drinking solution of the salt, bodily incisions and prayers. Another study [14] reported that the use of home remedies, spiritual treatment and alternative medicine. These findings imply that local treatment differs regarding culture, ethnicity and beliefs though there are some in common.
Antenatal care utilization among pregnant women who were in second and third trimester starting gestation age of 24 weeks and above. The results of the current study 64% of the pregnant women had adequate antenatal care service utilization. These results agree with the findings of other study done in Jordan [19] in which 63.4% of the respondents had adequate ANC service utilization. It seems possible that these results might be due to an increasing number of health facilities in each village also the effort done by the government to ensure that every pregnant woman should be attended by the trained personnel as well as free services offered to pregnant women. A similar study was done Eastern Napel [20] which showed that 69% of the participants had higher antenatal care service utilization. Furthermore, the current study indicated that those who had inadequate ANC service utilization were 36%. These results differ from the study done in Geita Tanzania [21] which showed the extremely low ANC attendance by 3.62%. This inconsistency might be due to the social cultural beliefs, lack of knowledge regarding the importance of ANC utilization. It might be also the nature of the participants regarding their activities as the majority of the participants in Geita engaged in animal keeping and they tends to move from one place to another to fetch food for their animals. Therefore, this might be the reason for inadequate ANC utilization.
The current study determine the association between knowledge of preeclampsia and eclampsia towards ANC utilization which showed statistically significant association whereby those who had adequate knowledge about preeclampsia and eclampsia were 3 times more likely to utilize antenatal care service compared to those who had inadequate knowledge (P–value <0.05). Different from the study done in Napel [20] which showed that those respondents who had knowledge were 5 times more likely to have antenatal care utilization compared to those who did not have knowledge .These findings seemed to have difference since the current study was conducted in a developing country where the majority of their people had a primary level of education and were not much exposed to social media where can search information compared to the previous study which was conducted in a developed country. Therefore, women should be equipped with knowledge regarding their health and this could facilitate them to utilize antenatal care services. Knowledge can influence an individual to see the importance of seeking health services. The current study showed that only 43.5% of the male partners had adequate knowledge on preeclampsia and eclampsia and are the ones who are decision maker within the family level, therefore empowering men with adequate knowledge about reproductive health issues including preeclampsia and eclampsia will facilitate them to encourage their partners to attend ANC care. The knowledge of preeclampsia and eclampsia will also help the community to Identify the early signs and symptoms of the problem and take appropriate measures without delaying in seeking care as well as motivate them to attend antenatal care since they know the consequence of the problem and eventually reducing maternal morbidity and mortality rate due to preeclampsia and eclampsia in the country.
The findings showed that those who had weak myths were less likely to utilize ANC services compared to those who had strong myths (P = 0.000). These findings differ from the previous study [20] which showed that those who believed from traditional healers were less likely to have antenatal care service utilization than those who did not believe tradition healers . These inconsistency results might be due to lack of adequate knowledge about preeclampsia and eclampsia though the participants had weak myths also resistance in behavior change. It might be also they did not see any benefit obtained through utilizing antenatal services. Furthermore, although the present study showed a number of respondents who had strong myths are low but still more effort is needed to dispel myths and misconceptions in the community at large and ensure all pregnant women are utilizing antenatal services for the benefit of both mother and unborn baby.
Strength and limitation of the study.
Strength
The researcher managed to conduct study in all selected district despite of poor infrastrucres.
Limitations.
This study conducted in Mtwara region involved four district and it was about knowledge and myths regarding preeclampsia and eclampsia therefore it might not reflect the whole country due to cultural diversity as in every region have their own myths and cultural differences.