I
n
t
e
r
n
at
ion
al
Jou
r
n
a
l
of
P
u
b
l
ic
Hea
l
t
h
S
c
ience
(
I
JP
HS
)
Vo
l
.
8
,
N
o
.
2,
J
un
e
2019
,
pp.
202~210
I
S
S
N:
2252
-
8806,
DO
I
:
10
.
11591/i
j
p
h
s
.
v
8
i
2.
19476
202
Jou
r
n
al
h
o
m
e
page
:
ht
tps
:
//
w
w
w
.
iaes
c
or
e
.
c
om/
jou
r
nals
/i
nde
x
.
php/I
J
P
HS
P
r
e
gn
an
t
m
ot
h
e
r
s’
k
n
ow
le
d
ge
, at
t
itu
d
e
an
d
p
r
ac
t
ic
e
t
o
w
a
r
d
s
p
r
e
ve
n
t
io
n
s of
i
r
on
d
e
f
ic
ie
n
c
y an
e
m
ia
i
n
H
ar
ar
T
ow
n
,
E
t
h
io
p
ia
Abd
u
Ou
m
e
r
1
,
Ar
if
Hu
s
s
e
in
2
1
Co
l
l
e
g
e
o
f
H
e
al
t
h
S
c
i
en
ce
s
an
d
M
e
d
i
c
i
n
e,
D
e
p
art
men
t
o
f
Pu
b
l
i
c
H
e
a
l
t
h
,
U
n
i
v
e
rs
i
t
y
,
E
t
h
i
o
p
i
a
2
D
e
p
art
men
t
o
f
N
u
rs
i
n
g
,
H
arar
H
e
a
l
t
h
S
c
i
en
ce
Co
l
l
eg
e
,
E
t
h
i
o
p
i
a
Ar
t
ic
l
e
I
n
f
o
AB
S
T
RA
CT
A
r
ti
c
le
h
is
tor
y
:
R
e
c
e
i
ve
d
M
a
r
14
,
201
9
R
e
vi
s
e
d
A
pr
1
9
,
201
9
A
c
c
e
pt
e
d
M
a
y
1
3
,
201
9
L
o
w
m
at
e
rn
a
l
ri
s
k
p
e
r
ce
p
t
i
o
n
,
p
o
o
r
d
i
e
t
ar
y
p
rac
t
i
ce
an
d
l
o
w
ad
h
e
r
e
n
ce
t
o
i
r
o
n
an
d
fo
l
at
e
t
ab
l
e
t
s
a
m
o
n
g
p
r
e
g
n
an
t
w
o
men
ar
e
m
a
j
o
r
co
n
t
ri
b
u
t
o
rs
f
o
r
h
i
g
h
e
r
b
u
rd
en
o
f
a
n
em
i
a.
I
r
o
n
d
e
fi
ci
e
n
cy
an
emi
a
co
n
t
ri
b
u
t
e
t
o
mo
r
e
t
h
an
h
al
f
o
f
A
n
em
i
a
a
m
o
n
g
p
r
e
g
n
an
t
w
o
men
.
T
h
u
s
t
h
e
l
e
v
el
o
f
m
a
t
e
rn
al
a
w
ar
en
e
s
s
an
d
at
t
i
t
u
d
e
t
o
w
ar
d
s
d
i
e
t
ar
y
an
d
o
t
h
e
r
p
rev
e
n
t
i
o
n
p
rac
t
i
ce
s
o
f
an
emi
a
are
n
o
t
w
e
l
l
e
s
t
ab
l
i
s
h
ed
i
n
t
h
e
s
t
u
d
y
ar
e
a.
T
h
i
s
s
t
u
d
y
w
as
t
o
as
s
e
s
s
k
n
o
w
l
ed
g
e,
at
t
i
t
u
d
e
a
n
d
p
rac
t
i
ce
o
f
p
reg
n
a
n
t
mo
t
h
e
rs
t
o
w
ard
s
t
h
e
p
re
v
en
t
i
o
n
o
f
i
r
o
n
d
e
f
i
c
i
en
cy
a
n
em
i
a
i
n
E
t
h
i
o
p
i
a,
2
0
1
8
.
H
o
s
p
i
t
al
b
as
ed
C
r
o
s
s
s
ec
t
i
o
n
al
s
s
t
u
d
y
w
as
co
n
d
u
c
t
e
d
o
n
ran
d
o
ml
y
s
e
l
ec
t
e
d
,
1
2
8
p
re
g
n
an
t
m
o
t
h
e
rs
at
t
e
n
d
i
n
g
an
t
e
n
a
t
al
c
ar
e
s
e
r
v
i
ce
i
n
H
arar
t
o
w
n
.
D
at
a
w
e
r
e
co
l
l
ec
t
ed
b
y
h
e
al
t
h
p
ro
f
e
s
s
i
o
n
al
s
u
s
i
n
g
p
re
t
e
s
t
ed
q
u
e
s
t
i
o
n
n
ai
r
e
co
n
t
ai
n
i
n
g
s
o
c
i
o
d
em
o
g
rap
h
i
c
,
k
n
o
w
l
e
d
g
e,
at
t
i
t
u
d
e
a
n
d
p
ra
c
t
i
c
e
re
l
at
e
d
q
u
e
s
t
i
o
n
s
.
A
t
t
i
t
u
d
e
q
u
e
s
t
i
o
n
s
w
e
r
e
o
r
g
an
i
z
e
d
i
n
f
i
v
e
L
i
k
e
rt
s
c
al
e
fr
o
m
s
t
ro
n
g
l
y
d
i
s
ag
r
ee
t
o
s
t
ro
n
g
l
y
a
g
r
ee
u
s
i
n
g
p
o
s
i
t
i
v
e
s
t
at
eme
n
t
s
.
Si
m
i
l
arl
y
,
p
rac
t
i
ce
s
w
er
e
as
s
e
s
s
e
d
i
n
y
e
s
/
n
o
(a
p
p
ro
p
ri
at
e
p
rac
t
i
ce
s
w
er
e
s
co
r
e
d
as
y
e
s
o
r
n
o
o
t
h
e
r
w
i
s
e
).
D
at
a
w
as
an
al
y
z
e
d
u
s
i
n
g
SP
SS
v
e
rs
i
o
n
2
0
u
s
i
n
g
fre
q
u
e
n
cy
,
t
ab
l
e
s
,
g
rap
h
s
a
n
d
me
an
s
.
P
e
ars
o
n
c
o
rr
el
at
i
o
n
w
i
t
h
r
w
as
u
s
e
d
t
o
as
s
e
s
s
t
h
e
r
el
at
i
o
n
s
h
i
p
b
e
t
w
ee
n
k
n
o
w
l
e
d
g
e
,
at
t
i
t
u
d
e
a
n
d
p
rac
t
i
ce
.
A
n
a
l
y
s
i
s
o
f
V
ari
an
ce
w
as
u
s
e
d
t
o
co
m
p
are
t
h
e
me
a
n
p
ra
c
t
i
ce
b
y
d
i
ff
e
ren
t
fa
c
t
o
rs
.
K
n
o
w
l
ed
g
e,
at
t
i
t
u
d
e
a
n
d
p
ra
c
t
i
ce
o
f
p
reg
n
a
n
t
w
o
me
n
o
n
p
re
v
en
t
i
o
n
s
o
f
ID
A
are
n
o
t
s
at
i
s
fac
t
o
r
y
.
T
h
u
s
p
o
o
r
p
rac
t
i
ce
t
o
w
ar
d
s
p
rev
e
n
t
i
o
n
o
f
ID
A
i
s
t
h
e
m
ai
n
c
o
n
t
ri
b
u
t
i
n
g
fa
c
t
o
r
f
o
r
h
i
g
h
b
u
r
d
e
n
o
f
a
n
em
i
a.
K
e
y
w
o
r
d
s
:
A
t
t
i
t
ude
I
r
o
n
De
f
i
c
i
e
n
c
y
A
n
e
mi
a
(
I
DA
)
Kn
o
w
l
e
dge
P
r
a
c
t
i
c
e
s
P
r
e
v
e
n
t
i
o
n
Co
p
yr
i
g
h
t
©
2
0
19
In
s
t
i
t
u
t
e
o
f
A
d
va
n
ced
E
n
g
i
n
ee
r
i
n
g
a
n
d
S
ci
e
n
ce
.
A
l
l
r
i
g
h
t
s
r
e
s
er
ved
.
C
or
r
e
s
pon
din
g
A
u
th
or
:
Ab
du
Ou
m
e
r
,
L
e
c
t
ur
e
r
,
E
t
hi
o
p
i
a
,
De
pa
r
t
m
e
n
t
o
f
P
ubl
i
c
He
a
l
t
h
,
Uni
ve
r
s
i
t
y
,
E
t
h
i
o
p
i
a
.
E
m
a
i
l
:
p
hn
a
b
u
@
g
m
a
il
.
c
o
m
1.
I
NT
RODU
C
T
I
ON
An
e
mi
a
i
s
a
c
o
n
d
i
t
i
o
n
i
n
w
hi
c
h
h
u
m
a
n
b
o
d
y
do
n'
t
ha
v
e
e
n
o
ugh
he
a
l
t
hy
r
e
d
bl
o
o
d
c
e
l
l
s
t
o
c
a
r
r
y
a
d
e
qua
t
e
o
xy
ge
n
to
t
h
e
b
o
dy
's
t
i
s
s
ue
s
whi
c
h
m
a
y
b
e
c
a
us
e
d
by
n
u
m
e
r
o
us
n
ut
r
i
t
i
o
n
a
l
a
n
d
ot
h
e
r
c
a
us
e
s
.
A
c
c
o
r
di
n
g
to
W
o
r
l
d
He
a
l
t
h
o
r
ga
ni
z
a
t
i
o
n
(
W
HO
)
de
f
i
n
i
t
i
o
n
o
f
An
e
mi
a
i
s
“
a
pa
t
h
o
l
o
g
i
c
s
i
t
ua
t
i
o
n
i
n
whi
c
h
t
h
e
R
e
d
B
l
o
o
d
C
e
l
l
m
a
s
s
(
R
B
C
s
)
o
r
i
t
s
o
xy
ge
n
-
c
a
r
r
yi
ng
c
a
pa
c
i
t
y
i
s
i
n
a
de
qu
a
t
e
to
m
e
e
t
phy
s
i
o
l
o
g
i
c
de
m
a
n
ds
of
t
h
e
b
o
dy
.
T
hi
s
pr
o
bl
e
m
in
pr
e
gn
a
n
t
s
i
s
i
de
n
t
i
f
i
e
d
by
us
i
ng
h
e
m
o
g
l
o
bi
n
c
ut
s
o
f
f
po
i
n
t
b
e
l
o
w
11g/dl
[
1
-
2]
.
A
ne
m
i
a
i
s
c
o
n
s
i
de
r
e
d
a
s
to
p
m
a
j
o
r
h
e
a
l
t
h
pr
o
bl
e
m
wo
r
l
d
w
i
d
e
.
G
l
o
b
a
ll
y
,
m
o
r
e
t
h
a
n
o
ne
t
hi
r
ds
o
f
wo
r
l
d
po
pu
l
a
t
i
o
n
a
r
e
vi
c
t
i
m
s
o
f
a
n
e
mi
a
.
An
e
mi
a
is
c
o
m
m
o
n
h
e
a
l
t
h
r
e
l
a
t
e
d
pr
o
bl
e
m
wo
r
l
dw
i
de
w
i
t
h
gr
e
a
t
b
ur
de
n
i
n
l
o
w
a
n
d
mi
l
e
i
nc
o
m
e
c
o
un
t
r
i
e
s
i
n
c
hil
dr
e
n
a
nd
a
du
l
t
s
.
An
e
s
t
i
m
a
t
e
d,
43
%
a
n
d
9%
o
f
wo
r
l
d
po
pul
a
t
i
o
n
i
s
a
f
f
e
c
t
e
d
by
a
n
e
mi
a
i
n
d
e
ve
l
o
p
i
n
g
a
n
d
we
s
t
e
r
n
c
o
un
t
r
i
e
s
,
r
e
s
pe
c
t
i
v
e
ly
[
3]
.
Nut
r
i
t
i
o
n
i
s
a
f
u
n
da
m
e
n
t
a
l
p
i
ll
a
r
f
o
r
t
h
e
h
u
m
a
n
b
e
i
n
g,
f
o
r
t
h
e
h
e
a
l
t
h
a
n
d
de
v
e
l
o
p
m
e
n
t
o
f
e
n
t
i
r
e
li
f
e
[
4
-
6]
.
N
o
w
a
da
y
s
f
o
r
b
o
t
h
de
v
e
l
o
pe
d
a
n
d
de
v
e
l
o
p
i
ng
c
o
un
t
r
y
m
a
l
nut
r
i
t
i
o
n
i
s
t
h
e
gr
e
a
t
p
r
o
bl
e
m
g
l
o
ba
l
ly,
m
o
r
e
s
pe
c
if
i
c
a
ll
y
u
n
de
r
-
n
ut
r
i
t
i
o
n
a
n
d
m
i
c
r
o
n
ut
r
i
e
n
t
de
f
i
c
i
e
nc
i
e
s
a
r
e
w
i
de
s
pr
e
a
d
pr
o
bl
e
m
s
i
n
d
e
v
e
l
o
p
i
n
g
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t
.
J
.
P
ubl
i
c
He
a
l
t
h
S
c
i
.
I
S
S
N:
2252
-
8806
P
r
e
gnant
mothe
r
s
’
k
no
w
ledg
e
,
att
it
ude
and
pr
ac
ti
c
e
to
w
ar
d
s
pr
e
v
e
nti
on
s
of
ir
on
de
f
icie
nc
y
…
(
A
bdu
Oum
e
r
)
203
c
o
un
t
r
i
e
s
[
7
-
8]
.
M
a
l
n
ut
r
i
t
i
o
n
dur
i
n
g
t
hi
s
pe
r
i
o
ds
o
f
li
f
e
i
s
a
s
s
o
c
i
a
t
e
d
wi
t
h
poo
r
m
a
t
e
r
n
a
l
h
e
a
l
t
h
a
n
d
d
i
f
f
e
r
e
n
t
p
oo
r
n
e
o
n
a
t
a
l
a
n
d
a
d
u
l
t
h
o
o
d
c
h
r
o
ni
c
i
ll
ne
s
s
r
i
s
ks
.
T
h
us
m
i
c
r
o
n
ut
r
i
e
n
t
de
f
i
c
i
e
n
c
i
e
s
dur
i
n
g
t
h
e
f
i
r
s
t
1
,
000
d
a
y
s
o
f
l
if
e
a
r
e
a
s
s
o
c
i
a
t
e
d
w
i
t
h
poo
r
m
a
t
e
r
n
a
l
h
e
a
l
t
h
a
n
d
n
e
o
n
a
t
a
l
o
ut
c
o
m
e
s
li
ke
m
o
r
bi
d
i
t
y
,
m
o
r
t
a
l
i
t
y
,
c
o
gni
t
i
ve
l
o
s
s
a
nd
c
o
n
ge
ni
t
a
l
de
f
o
r
m
i
t
i
e
s
.
L
o
w
bi
r
t
h
we
i
g
h
t
f
r
o
m
a
n
e
mi
a
a
n
d
o
t
h
e
r
c
a
us
e
s
a
c
c
o
un
t
s
m
o
r
e
t
h
a
n
800,
000
de
a
t
h
s
e
a
c
h
y
e
a
r
i
n
n
e
o
n
a
t
a
l
de
a
t
h
[
9
-
10]
.
P
r
e
gn
a
n
c
y
i
s
a
pe
r
i
o
d
o
f
s
i
g
nif
i
c
a
n
t
i
n
c
r
e
a
s
e
i
n
i
r
o
n
r
e
qu
i
r
e
m
e
n
t
;
t
h
e
de
m
a
n
d
f
o
r
i
r
o
n
i
s
hi
g
h
e
r
a
r
e
s
u
l
t
o
f
n
u
m
e
r
o
us
m
a
t
e
r
n
a
l
a
da
pt
a
t
i
o
n
s
li
ke
i
nc
r
e
a
s
e
i
n
n
u
m
be
r
o
f
r
e
d
bl
o
o
d
c
e
l
l
a
n
d
hi
g
h
e
r
n
e
e
d
s
f
o
r
i
r
o
n
b
y
de
v
e
l
o
p
i
ng
a
n
d
gr
o
w
i
n
g
o
r
ga
n
s
,
p
l
a
c
e
n
t
a
a
n
d
f
e
t
us
[
6]
.
I
r
o
n
i
s
n
e
e
de
d
i
n
s
i
g
ni
f
i
c
a
n
t
a
m
o
un
t
to
s
upp
o
r
t
m
a
t
e
r
n
a
l
a
n
d
f
e
t
a
l
gr
o
w
t
h
.
De
s
pi
t
e
i
n
c
r
e
a
s
e
d
i
r
o
n
r
e
qu
i
r
e
men
t
s
,
pr
e
gn
a
n
c
y
i
s
a
l
s
o
a
pe
r
i
o
d
o
f
i
nc
r
e
a
s
e
d
r
i
s
k
f
o
r
a
n
e
mi
a
whi
c
h
i
s
hi
g
h
e
r
t
h
a
n
i
n
n
o
n
-
pr
e
g
n
a
n
t
s
t
a
t
e
[
5,
1
1]
.
I
r
o
n
De
f
i
c
i
e
n
c
y
An
e
mi
a
(
I
DA
)
a
m
o
n
g
pr
e
g
na
n
t
h
a
v
e
a
pot
e
n
t
i
a
l
to
c
a
us
e
c
o
gni
t
i
v
e
de
c
li
ne
,
i
n
c
r
e
a
s
e
d
pr
e
v
a
l
e
nc
e
o
f
u
n
de
r
we
i
g
h
t
c
hi
l
dr
e
n
a
n
d
hi
g
he
r
e
a
r
l
y
n
e
o
n
a
t
a
l
a
n
d
i
nf
a
n
t
m
o
r
t
a
l
i
t
y
[
12]
.
Am
o
n
g
t
h
e
m
a
i
n
c
a
u
s
e
s
o
f
a
n
e
mi
a
,
i
n
a
de
qua
t
e
i
r
o
n
i
n
t
a
ke
or
hi
g
h
e
r
i
r
o
n
l
o
s
s
a
r
e
t
h
e
pr
e
d
o
m
i
na
n
t
one
a
c
c
o
un
t
i
n
g
f
o
r
a
b
o
v
e
50%
o
f
c
a
s
e
s
.
E
s
pe
c
i
a
l
ly
i
n
l
o
w
i
nc
o
m
e
c
o
un
t
r
i
e
s
whe
r
e
a
b
o
ut
38%
o
f
pr
e
gn
a
n
t
wo
m
e
n
h
a
d
i
r
o
n
de
p
l
e
t
i
o
n
,
i
t
h
a
s
e
v
e
n
gr
e
a
t
e
r
s
h
a
r
e
i
n
a
n
e
mi
a
c
a
us
a
t
i
o
n
[
13]
.
Ou
t
o
f
t
h
e
tot
a
l
g
l
o
ba
l
b
ur
de
n
o
f
a
ne
m
i
a
,
o
v
e
r
40
m
il
li
o
n
a
r
e
pr
e
gn
a
n
t
wo
m
e
n
a
r
e
a
ne
m
i
c
,
i
n
w
hi
c
h
I
D
A
a
c
c
o
un
t
f
o
r
75%
-
95
%
o
f
c
a
s
e
s
[
1,
6]
.
B
ut
t
h
e
m
a
j
o
r
i
t
y
o
f
pr
e
gn
a
n
t
m
o
t
h
e
r
s
l
a
c
k
c
o
r
r
e
c
t
pe
r
c
e
pt
i
o
n
[
14]
.
A
s
g
l
o
b
a
l
e
f
f
o
r
t
to
a
c
hi
e
v
e
t
h
e
s
us
t
a
i
na
bl
e
de
v
e
l
o
p
m
e
n
t
go
a
l
s
,
a
s
o
n
e
o
f
t
h
e
s
t
r
a
t
e
gi
c
o
bj
e
c
t
i
v
e
a
wa
r
e
n
e
s
s
r
a
i
s
i
ng
h
a
s
got
a
gr
e
a
t
de
a
l
e
s
pe
c
i
a
ll
y
w
i
t
h
i
nv
i
s
i
b
l
e
f
o
r
m
s
o
f
m
a
l
nut
r
i
t
i
o
n
l
i
ke
a
n
e
mi
a
.
I
n
2018,
a
n
e
s
t
i
m
a
t
e
d
264
m
i
ll
i
o
n
wo
m
e
n
a
r
e
we
r
e
vi
c
t
i
m
s
o
f
I
DA
.
W
i
t
h
t
h
e
c
ur
r
e
n
t
gl
o
ba
l
e
f
f
o
r
t
to
e
l
i
mi
na
t
e
t
h
e
c
ur
r
e
n
t
gl
o
b
a
l
m
a
l
nut
r
i
t
i
o
n
by
2025,
I
DA
i
s
o
n
e
o
f
t
h
e
gr
e
a
t
Nut
r
i
t
i
o
na
l
c
o
n
c
e
r
n
wo
r
l
dw
i
de
[
15]
.
W
o
r
l
dw
i
de
e
s
t
i
m
a
t
e
s
o
f
I
D
A
s
h
o
we
d
t
h
e
pr
e
v
a
l
e
n
c
e
o
f
a
ne
m
i
a
i
n
Af
r
i
c
a
,
r
e
a
c
h
e
s
up
to
52
%
.
T
h
us
a
b
o
ut
18%
a
n
d
52%
o
f
po
pul
a
t
i
o
n
wa
s
a
f
f
e
c
t
e
d
i
n
de
v
e
l
o
pe
d
a
n
d
de
v
e
l
o
p
i
ng
c
o
un
t
r
i
e
s
r
e
s
pe
c
t
i
v
e
ly
.
G
l
o
b
a
ll
y
,
a
b
o
ut
29.
4
w
o
m
e
n
w
e
r
e
a
f
f
e
c
t
e
d
by
a
n
e
mi
a
w
hil
e
,
m
a
g
ni
t
ude
o
f
38.
2%
(
32
.
4
m
il
li
o
n
pr
e
gna
n
t
wo
m
e
n
)
wa
s
r
e
por
t
e
d
a
m
o
n
g
pr
e
gna
n
t
.
[
16
]
.
E
v
e
n
t
h
o
ugh
t
h
e
b
ur
de
n
o
f
a
n
e
mi
a
a
m
o
n
g
pr
e
gn
a
n
t
m
o
t
h
e
r
s
h
a
s
de
c
l
i
ne
d
f
r
o
m
43%
to
38
%
o
v
e
r
t
h
e
pa
s
t
de
c
a
de
s
,
i
t
s
t
i
ll
s
ho
we
d
t
h
a
t
t
h
e
w
o
r
l
d
He
a
l
t
h
As
s
e
m
bly
(
W
H
A
)
t
a
r
ge
t
o
f
50%
(
a
s
c
o
m
pa
r
e
d
to
12%
)
,
r
e
duc
t
i
o
n
o
f
a
n
e
mi
a
by
202
5
i
s
f
a
r
a
n
d
c
o
un
t
r
i
e
s
ne
e
d
to
f
o
c
us
o
n
a
c
hi
e
vi
ng
t
h
i
s
t
a
r
ge
t
i
n
n
e
a
r
f
ut
ur
e
[
6]
.
I
n
E
t
hi
o
p
i
a
,
a
b
o
ut
17%
o
f
wo
m
e
n
i
n
r
e
pr
o
duc
t
i
v
e
a
ge
gr
o
up
h
a
d
a
n
e
mi
a
,
whil
e
a
b
o
ut
22%
o
f
pr
e
gn
a
n
t
we
r
e
a
n
e
mi
c
[
17]
.
A
dd
i
t
i
o
na
l
ly
,
m
a
g
ni
t
ude
o
f
a
n
e
mi
a
va
r
i
e
s
a
s
27.
9%
i
n
s
o
ut
h
e
a
s
t
E
t
hi
o
p
i
a
[
15]
a
nd
39.
4%
i
n
s
o
u
t
h
e
r
n
E
t
hi
o
p
i
a
[
18]
.
H
i
g
he
r
b
ur
de
n
o
f
a
n
e
mi
a
i
s
r
e
po
r
t
e
d
i
n
d
i
f
f
e
r
e
n
t
pa
r
t
s
o
f
E
t
hi
o
pi
a
[
19
-
21]
.
L
a
c
k
o
f
a
wa
r
e
n
e
s
s
,
p
oo
r
di
e
t
a
r
y
pr
a
c
t
i
c
e
a
n
d
i
na
p
pr
o
p
r
i
a
t
e
d
i
e
t
a
r
y
c
o
un
s
e
ll
i
ng
o
f
pr
e
gna
n
t
m
o
t
h
e
r
s
a
r
e
m
a
j
o
r
c
o
n
t
r
i
b
ut
or
s
to
t
h
e
hi
g
h
b
ur
de
n
o
f
a
n
e
mi
a
.
A
dd
i
t
i
o
n
a
l
ly
,
i
t
i
s
e
vi
de
n
t
t
h
a
t
o
nl
y
72%
o
f
m
o
t
h
e
r
s
a
r
e
a
wa
r
e
o
f
a
n
e
mi
a
.
An
e
mi
a
i
s
a
l
s
o
a
s
e
v
e
r
e
publ
i
c
h
e
a
l
t
h
i
m
po
r
t
a
n
t
p
r
o
bl
e
m
i
n
E
t
hi
o
p
i
a
i
n
whi
c
h
gr
e
a
t
e
r
th
a
n
40%
o
f
pr
e
gn
a
n
t
wo
m
e
n
we
r
e
a
n
e
mi
c
[
17]
.
De
s
p
i
t
e
an
e
mi
a
h
a
v
e
b
e
e
n
m
a
j
o
r
publi
c
h
e
a
l
t
h
pr
obl
e
m
f
o
r
de
c
a
de
s
,
n
o
pr
o
m
i
s
i
ng
m
o
ve
m
e
n
t
s
h
a
s
b
e
e
n
o
b
s
e
r
v
e
d
t
o
wa
r
ds
r
e
duc
i
n
g
a
ne
m
i
a
b
ur
de
n
by
h
a
lf
,
s
t
i
ll
a
n
e
mi
a
i
s
hi
g
h
g
l
o
b
a
ll
y
[
1]
.
S
tr
a
t
e
gi
e
s
f
o
r
t
h
e
r
e
duc
t
i
o
n
a
n
d
c
o
n
t
r
o
l
o
f
a
ne
m
i
a
i
n
v
u
l
ne
r
a
bl
e
gr
o
ups
a
s
wo
m
e
n
i
s
o
n
e
o
f
t
h
e
pr
i
o
r
i
t
y
a
ge
n
da
s
g
lo
b
a
l
ly
[
2]
.
I
n
a
dd
i
t
i
o
n
,
i
m
pr
o
vi
ng
t
h
e
kn
o
wl
e
dge
,
a
t
t
i
t
ude
a
n
d
d
i
e
t
a
r
y
pr
a
c
t
i
c
e
o
f
t
h
e
m
o
t
h
e
r
s
t
h
r
o
ugh
di
e
t
a
r
y
d
i
v
e
r
s
i
f
i
c
a
t
i
o
n
,
f
o
r
t
i
f
i
c
a
t
i
o
n
(
I
r
o
n
a
n
d
ot
h
e
r
s
upp
l
e
m
e
n
t
s
)
a
r
e
i
m
po
r
t
a
n
t
n
ut
r
i
t
i
o
n
s
pe
c
if
i
c
i
n
t
e
r
ve
n
t
i
o
ns
t
o
a
l
l
e
vi
a
t
e
a
ne
m
i
a
[
10]
.
T
h
e
r
e
f
o
r
e
,
t
h
e
a
i
m
o
f
t
hi
s
pa
r
t
i
c
u
l
a
s
ur
v
e
y
wa
s
to
a
s
s
e
s
s
kn
o
w
l
e
dg
e
,
a
tt
i
t
ude
a
n
d
pr
a
c
t
i
c
e
o
f
P
r
e
gn
a
n
t
m
o
t
h
e
r
s
a
tt
e
n
d
i
n
g
An
t
e
n
a
t
a
l
C
a
r
e
(
A
NC
)
o
n
pr
e
v
e
n
t
i
o
n
a
n
d
c
o
n
t
r
o
l
o
f
I
DA
.
T
hi
s
s
t
udy
w
i
ll
g
i
ve
b
a
s
e
li
ne
e
vi
de
n
c
e
o
n
t
h
e
l
e
v
e
l
o
f
m
a
t
e
r
n
a
l
a
w
a
r
e
ne
s
s
a
n
d
i
n
t
e
n
t
i
o
n
t
o
pr
a
c
t
i
c
e
go
o
d
di
e
t
a
r
y
pr
a
c
t
i
c
e
s
a
m
o
n
g
pr
e
gna
n
t
.
T
h
us
,
i
t
w
i
ll
be
v
a
l
ua
bl
e
i
nput
f
o
r
t
a
r
ge
t
e
d
b
e
h
a
vi
o
r
a
l
i
n
t
e
r
v
e
n
t
i
o
n
s
a
t
c
o
m
m
u
ni
t
y
o
r
f
a
c
i
li
t
y
l
e
v
e
l
i
n
o
r
de
r
to
i
m
pr
o
v
e
t
h
e
h
e
m
o
g
l
o
bi
n
l
e
ve
l
a
n
d
o
v
e
r
a
ll
h
e
a
l
t
h
o
f
pr
e
g
n
a
n
t
.
2.
RE
S
E
AR
CH
M
E
T
HO
D
2.
1.
S
t
u
d
y
s
e
t
t
in
g
Ho
s
pi
t
a
l
b
a
s
e
d
s
ur
v
e
y
w
a
s
e
m
p
l
o
y
e
d
i
n
Ha
r
a
r
to
wn
,
Ha
r
a
r
i
r
e
g
i
o
n
,
E
a
s
t
e
r
n
E
t
hi
o
p
i
a
w
i
t
h
tot
a
l
po
pul
a
t
i
o
n
o
f
250,
903
i
n
2018.
Out
o
f
t
h
e
s
e
,
13
9,
200
(
6
0%
)
r
e
s
i
de
s
i
n
ur
b
a
n
w
hil
e
116,
928
a
r
e
m
a
l
e
s
w
i
t
h
e
s
t
i
m
a
t
e
d
64,
939
we
r
e
i
n
r
e
pr
o
duc
t
i
v
e
a
ge
gr
o
up
s
.
T
h
e
r
e
gi
o
n
i
s
c
o
m
po
s
e
d
o
f
9
d
i
s
t
r
i
c
t
s
w
i
t
h
19
ur
b
a
n
a
nd
17
r
u
r
a
l
K
e
b
e
l
e
s
[
22]
.
A
c
c
o
r
di
n
g
to
Ha
r
a
r
i
He
a
l
t
h
B
ur
e
a
u
r
e
p
o
r
t
e
d
i
n
2015
Ha
r
a
r
i
r
e
g
i
o
n
h
e
a
l
t
h
c
o
ve
r
a
ge
wa
s
e
s
t
i
m
a
t
e
d
to
b
e
100
%
.
T
h
e
r
e
a
r
e
t
h
r
e
e
publ
i
c
h
o
s
p
it
a
l
s
,
t
w
o
pr
i
v
a
t
e
h
o
s
pi
t
a
l
,
e
i
g
h
t
h
e
a
l
t
h
c
e
n
t
e
r
s
,
20
h
e
a
l
t
h
po
s
t
s
a
n
d
a
b
o
ut
18
p
r
i
va
t
e
c
l
i
n
i
c
s
i
n
t
h
e
r
e
g
i
o
n
.
T
h
e
r
e
we
r
e
a
n
e
s
t
i
m
a
t
e
d
7169
p
r
e
gn
a
n
t
w
o
m
e
n
i
n
t
h
e
r
e
g
io
n
.
2.
2.
S
am
p
l
e
s
i
z
e
d
e
t
e
r
m
in
at
ion
T
h
e
s
a
m
p
l
e
s
i
z
e
wa
s
e
s
t
i
m
a
t
e
d
by
u
s
i
n
g
po
pu
l
a
t
i
o
n
pr
o
p
o
r
t
i
o
n
f
o
r
m
u
l
a
us
i
ng
t
h
e
pr
e
v
a
l
e
n
c
e
e
s
t
i
m
a
t
e
o
f
goo
d
kn
o
wl
e
dg
e
(
p1)
,
a
tt
i
t
ude
(
p2)
a
n
d
pr
a
c
t
i
c
e
(
p3)
f
r
o
m
pr
e
vi
o
us
s
t
ud
i
e
s
.
T
h
us
t
a
ki
n
g
kn
o
w
l
e
dg
e
to
wa
r
ds
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
S
N
:
2252
-
8806
I
n
t
.
J
.
P
ubl
i
c
He
a
l
t
h
S
c
i
.
Vo
l
.
8
,
N
o
.
2
,
J
un
e
201
9
:
20
2
–
2
10
204
n
ut
r
i
t
i
o
n
a
l
a
ne
m
i
a
a
m
o
n
g
pr
e
gna
n
t
wo
m
e
n
(
P
1)
,
a
s
69%
h
a
d
go
o
d
kn
o
wl
e
dg
e
a
b
o
ut
p
r
e
v
e
n
t
i
o
n
o
f
I
DA
[
23]
,
m
a
r
g
i
n
o
f
e
r
r
o
r
(
5
%
)
,
z
α
/2
t
h
e
c
r
i
t
i
c
a
l
v
a
l
ue
w
i
t
h
95%
c
o
nf
i
de
nc
e
l
e
v
e
l
a
s
1.
96,
t
h
e
m
i
n
im
u
m
s
a
m
p
l
e
s
i
z
e
b
e
c
a
m
e
329.
S
i
mi
l
a
r
l
y
us
i
ng
a
t
t
i
t
ude
to
wa
r
ds
n
ut
r
i
t
i
o
n
a
l
a
n
e
mi
a
a
m
o
n
g
pr
e
gn
a
n
t
wo
m
e
n
(
P
2=
82.
2%
)
a
n
d
59.
5%
A
NC
a
t
t
e
n
d
i
n
g
wo
m
e
n
we
r
e
f
o
l
l
o
w
i
ng
go
o
d
pr
a
c
t
i
c
e
s
to
pr
e
v
e
n
t
a
ne
m
i
a
i
n
pr
e
g
n
a
n
c
y
[
23]
,
t
h
e
s
a
m
p
l
e
s
i
z
e
go
e
s
73
a
n
d
372
r
e
s
pe
c
t
i
v
e
ly
.
S
i
nc
e
t
h
e
e
x
pe
c
t
e
d
m
o
n
t
hl
y
f
l
o
w
o
f
a
n
t
e
n
a
t
a
l
m
o
t
h
e
r
s
we
r
e
b
e
l
o
w
t
h
e
s
t
a
t
e
d
s
a
m
p
l
e
s
i
z
e
,
t
h
us
us
i
n
g
t
h
e
f
i
n
i
t
e
po
pul
a
t
i
o
n
c
o
r
r
e
c
t
i
o
n
t
h
e
f
i
na
l
s
a
m
p
l
e
s
i
z
e
be
c
a
m
e
128.
2.
3.
S
am
p
l
in
g
t
e
c
h
n
iq
u
e
/
p
r
oc
e
d
u
r
e
s
T
h
e
tot
a
l
s
a
m
p
l
e
s
i
z
e
wa
s
pr
o
p
o
r
t
i
o
n
a
l
ly
a
l
l
o
c
a
t
e
d
to
Hi
wo
t
F
a
n
a
s
pe
c
i
a
li
z
e
d
Uni
ve
r
s
i
t
y
Ho
s
p
i
t
a
l
a
nd
J
ugo
l
Ho
s
p
i
t
a
l
.
J
ugo
l
Ho
s
p
i
t
a
l
w
i
t
h
a
n
a
v
e
r
a
ge
m
o
n
t
hly
f
l
o
w
o
f
pr
e
gna
n
t
m
o
t
h
e
r
s
(
n
=
70)
a
n
d
H
i
wo
t
F
a
n
a
s
pe
c
i
a
li
z
e
d
u
ni
ve
r
s
i
t
y
Ho
s
p
i
t
a
l
(
n
=
116)
.
T
h
us
48
a
n
d
80
c
li
e
n
t
s
we
r
e
s
e
l
e
c
t
e
d
f
r
o
m
J
ugo
l
a
n
d
H
i
wo
t
F
a
n
a
s
pe
c
i
a
li
z
e
d
u
ni
ve
r
s
i
t
y
Ho
s
p
i
t
a
l
r
e
s
pe
c
t
i
ve
ly
.
2.
4.
Dat
a
c
ol
l
e
c
t
ion
m
e
t
h
od
s
Da
t
a
we
r
e
c
o
l
l
e
c
t
e
d
us
i
n
g
pr
e
pr
e
pa
r
e
d
s
t
r
uc
tur
e
d
que
s
t
i
o
nn
a
i
r
e
,
c
o
n
t
a
i
ni
n
g
s
o
c
i
o
-
de
m
o
gr
a
phi
c
,
kn
o
w
l
e
dge
r
e
l
a
t
e
d,
a
tt
i
t
ude
a
n
d
pr
a
c
t
i
c
e
r
e
l
a
t
e
d
que
s
t
i
o
ns
o
n
pr
e
v
e
n
t
i
o
n
o
f
I
DA
a
m
o
n
g
pr
e
gna
nt
w
o
m
e
n
.
T
h
e
too
l
wa
s
pr
e
pa
r
e
d
by
E
n
g
li
s
h
ve
r
s
i
o
n
a
n
d
tr
a
ns
l
a
t
e
d
i
n
to
t
h
e
l
o
c
a
l
l
a
n
gua
ge
by
t
r
a
i
n
e
d
n
ur
s
e
pr
of
e
s
s
i
o
n
a
l
s
.
A
s
e
t
s
o
f
que
s
t
i
o
n
s
we
r
e
a
da
pt
e
d
f
r
o
m
pr
e
vi
o
us
s
t
ud
i
e
s
a
n
d
li
t
e
r
a
t
ur
e
s
wa
s
us
e
d
t
o
a
s
s
e
s
s
kn
o
w
l
e
dge
,
a
tt
i
t
ude
a
n
d
pr
a
c
t
i
c
e
to
wa
r
ds
I
DA
.
On
e
da
y
s
uppo
r
t
i
ve
t
r
a
i
ni
ng,
c
l
o
s
e
s
upe
r
vi
s
i
o
n
a
n
d
da
i
ly
c
he
c
kup
o
f
t
h
e
c
o
l
l
e
c
t
e
d
da
t
a
wa
s
d
o
n
e
to
i
m
pr
o
v
e
t
h
e
qua
l
i
t
y
o
f
da
t
a
.
T
h
e
c
o
l
l
e
c
t
e
d
da
t
a
we
r
e
e
n
t
e
r
e
d
i
n
c
o
m
put
e
r
s
of
t
wa
r
e
a
n
d
c
h
e
c
ke
d
f
o
r
c
o
n
s
i
s
t
e
n
c
y
a
n
d
o
u
t
l
i
e
r
s
b
e
f
o
r
e
a
na
l
y
s
is
.
2.
5.
Me
t
h
od
s
of
d
a
t
a
a
n
al
ys
is
S
P
S
S
v
e
r
s
i
o
n
20
wa
s
us
e
d
to
pr
o
c
e
s
s
a
n
d
a
n
a
ly
z
e
t
h
e
da
t
a
.
T
h
e
da
t
a
we
r
e
pr
e
s
e
n
t
e
d
us
i
n
g
f
r
e
que
nc
y
,
pe
r
c
e
n
t
a
ge
,
t
a
bl
e
a
n
d
gr
a
ph
.
I
n
a
dd
i
t
i
o
n
t
h
e
kn
o
w
l
e
dge
,
a
tt
i
t
ude
a
n
d
pr
a
c
t
i
c
e
s
c
o
r
e
wa
s
do
n
e
by
us
i
ng
t
h
e
c
o
m
put
e
c
o
m
m
a
n
d.
T
h
e
k
n
o
w
l
e
d
ge
,
a
tt
i
t
ude
a
n
d
pr
a
c
t
i
c
e
s
c
o
r
e
we
r
e
c
a
t
e
g
or
i
z
e
d
i
n
t
o
g
oo
d
v
e
r
s
us
poo
r
kn
ow
l
e
dge
a
nd
pr
a
c
t
i
c
e
a
n
d
po
s
i
t
i
ve
ve
r
s
us
n
e
ga
t
i
v
e
a
tt
i
t
ude
us
i
n
g
t
h
e
m
e
a
n
s
c
o
r
e
a
s
c
ut
o
f
f
po
i
n
t
.
T
h
us
o
n
e
wa
y
a
n
a
ly
s
i
s
o
f
v
a
r
i
a
n
c
e
wa
s
do
n
e
w
i
t
h
F
s
t
a
t
i
s
t
i
c
s
a
n
d
p
v
a
l
ue
.
A
s
s
o
c
i
a
t
i
o
n
a
t
p
v
a
l
ue
b
e
l
o
w
0.
05
wa
s
us
e
d
to
de
c
l
a
r
e
s
t
a
t
i
s
t
i
c
a
ll
y
s
i
g
nif
i
c
a
n
t
di
f
f
e
r
e
n
c
e
i
n
m
e
a
n
pr
a
c
t
i
c
e
l
e
v
e
l
o
f
t
h
e
m
o
t
h
e
r
s
.
2.
6.
E
t
h
ical
c
on
s
id
e
r
at
ion
B
e
f
o
r
e
a
c
t
ua
l
f
i
e
l
d
wo
r
k
,
f
o
r
m
a
l
e
t
hi
c
a
l
c
l
e
a
r
a
n
c
e
wa
s
i
s
s
ue
d
by
e
t
hi
c
a
l
r
e
vi
e
w
c
o
m
mi
t
t
e
e
f
r
o
m
Ha
r
a
r
He
a
l
t
h
S
c
i
e
n
c
e
C
o
l
l
e
g
e
.
R
e
s
po
n
de
n
t
’
s
w
i
ll
i
ng
n
e
s
s
t
o
pa
r
t
i
c
i
p
a
t
e
i
n
t
h
e
s
t
ud
y
wa
s
o
b
t
a
i
n
e
d
v
e
r
ba
l
ly
w
i
t
h
a
n
h
o
ne
s
t
e
x
p
l
a
n
a
t
i
o
n
o
f
t
h
e
o
bj
e
c
t
i
v
e
s
o
f
t
h
e
s
t
ud
y
.
No
pe
r
s
o
n
a
l
i
d
e
n
t
i
f
i
e
r
s
we
r
e
c
o
l
l
e
c
t
e
d
f
r
o
m
t
h
e
r
e
s
po
n
de
n
t
s
.
3.
RE
S
UL
T
S
A
ND
DI
S
CU
S
S
I
ON
T
hi
s
s
t
ud
y
a
s
s
e
s
s
e
d
t
h
e
k
n
o
w
l
e
dge
,
a
t
t
i
t
ude
a
n
d
pr
a
c
t
i
c
e
t
o
wa
r
ds
a
p
r
e
v
e
n
t
i
o
n
m
e
t
h
o
d
o
f
I
DA
.
I
n
t
hi
s
s
t
ud
y
,
a
wa
r
e
n
e
s
s
r
e
l
a
t
e
d
to
c
a
us
e
o
f
a
ne
m
ia
m
o
s
t
h
a
d
kn
o
wn
poo
r
n
utr
i
t
i
o
n
,
bl
e
e
d
i
ng
dur
i
ng
pr
e
gn
a
n
c
y
a
n
d
m
u
l
t
i
p
l
e
pr
e
g
n
a
n
c
y
a
s
c
a
u
s
e
f
o
r
I
DA
.
A
s
im
il
a
r
s
t
udy
do
n
e
i
n
P
a
l
e
s
t
i
ne
[
25]
,
i
na
de
qua
t
e
n
ut
r
i
t
i
o
n
,
i
nc
l
ud
i
ng
n
o
t
h
a
vi
ng
a
b
a
l
a
n
c
e
d
d
i
e
t
c
o
n
t
a
i
ni
n
g
pr
ot
e
i
n
-
r
i
c
h
f
o
o
ds
,
n
ot
c
o
n
s
u
m
i
ng
i
r
o
n
s
upp
l
e
m
e
n
t
s
a
n
d
t
h
e
pr
e
s
e
nc
e
o
f
m
a
l
a
r
i
a
we
r
e
r
e
p
o
r
t
e
d
a
s
t
h
e
m
a
i
n
c
a
u
s
e
o
f
a
n
e
mi
a
.
B
ut
s
t
udy
i
n
a
n
o
t
h
e
r
pa
r
t
[
14]
s
h
o
we
d
t
h
a
t
o
nl
y
3%
o
f
m
o
t
h
e
r
s
e
l
i
c
i
t
e
d
i
r
o
n
de
f
i
c
i
e
n
c
y
a
s
a
c
a
us
e
o
f
a
n
e
mi
a
.
W
hil
e
s
im
il
a
r
s
t
ud
y
[
11]
s
h
o
we
d
t
h
a
t
m
a
l
a
r
i
a
is
m
a
i
n
c
a
us
e
o
f
a
n
e
mi
a
.
I
n
a
n
o
t
h
e
r
s
t
udy
[
26]
s
h
o
we
d
m
o
r
e
t
h
a
n
ha
l
f
,
(
68.
1%
)
r
e
c
o
gni
z
e
d
l
a
c
k
o
f
i
r
o
n
i
n
f
o
o
d
a
s
t
h
e
c
a
us
e
f
o
r
a
n
e
m
i
a
.
B
ut
o
ur
s
t
udy
a
l
s
o
s
h
o
we
d
a
p
oo
r
a
wa
r
e
n
e
s
s
l
e
ve
l
(
31.
3%
)
o
n
t
h
e
r
o
l
e
o
f
I
r
o
n
i
n
c
a
us
i
n
g
a
n
e
mi
a
.
T
h
us
,
a
s
m
o
r
e
t
h
a
n
h
a
lf
o
f
a
n
e
mi
a
i
s
a
t
t
r
i
b
ut
e
d
to
I
r
o
n
de
f
i
c
i
e
n
c
y
,
m
o
t
h
e
r
s
h
a
d
po
o
r
kn
o
wl
e
dge
o
f
t
h
e
m
a
j
o
r
c
a
us
e
o
f
a
n
e
mi
a
[
1]
.
T
hi
s
d
i
f
f
e
r
e
n
c
e
c
a
n
b
e
due
to
t
h
e
d
i
f
f
e
r
e
n
c
e
i
n
s
o
c
i
o
e
c
o
n
o
m
i
c
l
e
v
e
l
o
f
pa
r
t
i
c
i
pa
nt
s
a
n
d
t
h
e
qua
l
i
t
y
o
f
h
e
a
l
t
h
c
a
r
e
(
A
NC
)
g
i
v
e
n
i
n
t
h
e
t
wo
c
oun
t
r
i
e
s
.
T
hi
s
e
m
p
h
a
s
i
z
e
s
t
h
e
n
e
e
d
f
o
r
b
e
t
t
e
r
i
n
t
e
gr
a
t
i
o
n
a
nd
im
p
l
e
m
e
n
t
a
t
i
o
n
o
f
c
o
un
s
e
ll
i
ng
s
c
h
e
du
l
e
s
w
i
t
h
e
a
c
h
vi
s
i
t
.
A
wa
r
e
ne
s
s
l
e
v
e
l
t
o
wa
r
ds
I
DA
i
s
a
b
o
ve
a
v
e
r
a
g
e
(
88.
1
%
)
w
hi
c
h
i
s
s
i
mi
l
a
r
i
n
a
s
t
udy
do
n
e
S
i
e
r
r
a
L
e
o
n
e
[
26]
s
h
o
ws
99%
h
a
d
h
e
a
r
d
a
b
o
u
t
a
n
e
m
i
a
.
W
hil
e
58.
6%
o
f
m
ot
h
e
r
s
we
r
e
f
o
un
d
t
o
b
e
a
wa
r
e
o
f
pr
e
v
e
n
t
i
o
n
o
f
I
D
A
.
Alm
o
s
t
h
a
l
f
o
f
m
o
t
h
e
r
s
a
r
e
n
o
t
a
wa
r
e
t
h
a
t
t
h
e
r
o
l
e
o
f
f
i
be
r
s
,
c
o
f
f
e
e
a
n
d
t
e
a
a
f
t
e
r
m
e
a
l
s
i
n
de
c
r
e
a
s
i
n
g
t
h
e
f
r
a
c
t
i
o
n
a
l
a
b
s
o
r
pt
i
o
n
i
r
o
n
by
a
lm
o
s
t
70%
r
e
s
po
n
de
d
n
e
ga
t
i
v
e
ly
.
T
h
e
r
e
i
s
a
n
e
e
d
f
o
r
f
o
c
us
e
d
a
n
d
s
im
p
l
e
c
o
un
s
e
l
li
ng
by
h
e
a
l
t
h
pr
o
f
e
s
s
i
o
n
a
l
s
(
s
pe
c
if
i
c
a
ll
y
A
NC
c
a
r
e
g
i
v
e
r
s
)
o
n
t
h
e
c
a
us
e
s
a
n
d
m
a
n
a
ge
m
e
n
t
s
o
f
I
DA
.
De
s
p
i
t
e
t
hi
s
s
c
i
e
n
t
i
f
i
c
f
a
c
t
,
a
l
m
o
s
t
46%
o
f
pr
e
gn
a
n
t
r
e
p
o
r
t
e
d
to
h
a
v
e
a
h
a
bi
t
o
f
dr
i
n
k
i
ng
c
o
f
f
e
e
o
r
tea
im
m
e
d
i
a
t
e
l
y
a
f
t
e
r
m
e
a
l
s
.
S
t
udy
do
n
e
i
n
E
t
hi
o
pi
a
s
h
o
we
d
t
h
a
t
c
o
n
s
u
m
i
ng
t
e
a
/co
f
f
e
e
im
m
e
d
i
a
t
e
l
y
a
f
t
e
r
m
e
a
l
(
A
OR
=
3.
58)
a
n
d
n
o
t
e
a
t
i
n
g
m
e
a
t
f
r
e
que
n
t
l
y
(
A
O
R
:
2.
07)
we
r
e
a
s
s
o
c
i
a
t
e
d
w
i
t
h
s
i
g
nif
i
c
a
n
t
r
i
s
k
o
f
a
n
e
mi
a
[
27]
.
T
hi
s
l
o
w
a
wa
r
e
n
e
s
s
l
e
v
e
l
i
n
c
o
nj
u
n
c
t
i
o
n
w
i
t
h
l
o
w
pr
a
c
t
i
c
e
o
f
t
h
r
e
e
da
y
m
e
a
l
,
us
e
o
f
i
r
o
n
r
i
c
h
f
o
o
ds
a
n
d
l
o
w
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t
.
J
.
P
ubl
i
c
He
a
l
t
h
S
c
i
.
I
S
S
N:
2252
-
8806
P
r
e
gnant
mothe
r
s
’
k
no
w
ledg
e
,
att
it
ude
and
pr
ac
ti
c
e
to
w
ar
d
s
pr
e
v
e
nti
on
s
of
ir
on
de
f
icie
nc
y
…
(
A
bdu
Oum
e
r
)
205
c
o
m
p
li
a
n
c
e
to
i
r
o
n
t
a
bl
e
t
s
(
32
%
)
,
i
t
’
s
hi
g
h
l
i
ke
ly
t
h
a
t
t
h
e
s
t
udy
pa
r
t
i
c
i
pa
n
t
s
a
r
e
a
t
hi
g
h
e
r
r
i
s
ks
o
f
a
n
e
m
i
a
.
B
ut
i
n
o
t
h
e
r
s
i
de
o
f
t
h
e
f
a
c
t
s
h
o
ws
t
h
a
t
a
l
m
o
s
t
50%
o
f
I
DA
c
a
n
be
pr
e
ve
n
t
e
d
by
i
r
o
n
s
upp
l
e
m
e
n
t
a
t
i
o
n
[
16]
.
Al
s
o
,
r
e
ga
r
di
n
g
a
wa
r
e
n
e
s
s
o
n
s
i
g
n
a
n
d
s
ym
pto
m
s
o
f
I
DA
,
b
o
d
y
we
a
k
n
e
s
s
(
f
a
t
i
gue
)
a
n
d
s
h
o
r
t
n
e
s
s
o
f
b
r
e
a
t
h
wa
s
m
o
s
t
l
y
,
b
ut
s
t
i
ll
m
a
j
o
r
i
t
y
d
i
d
n
ot
m
e
n
t
i
o
n
t
h
e
l
i
s
t
e
d
m
a
nif
e
s
t
a
t
i
o
ns
i
n
a
d
v
a
n
c
e
.
T
hi
s
w
il
l
gr
e
a
t
l
y
im
pe
d
e
t
h
e
h
e
a
l
t
h
c
a
r
e
s
e
e
k
i
ng
b
e
h
a
vi
o
r
s
o
f
m
o
t
h
e
r
s
by
e
a
r
ly
d
e
t
e
c
t
i
o
n
o
f
m
i
n
o
r
s
ym
pt
o
m
s
.
T
hi
s
i
n
t
ur
n
gr
e
a
t
l
y
a
d
v
a
n
c
e
t
h
e
s
t
a
ge
o
f
a
ne
m
i
a
a
n
d
i
t
s
a
d
v
e
r
s
e
pr
e
gna
n
t
a
n
d
n
e
o
n
a
t
a
l
o
ut
c
o
m
e
s
[
12]
.
I
n
t
hi
s
s
t
ud
y
m
o
s
t
o
f
t
h
e
pa
r
t
i
c
i
p
a
n
t
s
a
gr
e
e
a
n
d
s
t
r
on
g
ly
a
gr
e
e
d
o
n
us
e
o
f
f
a
mi
ly
p
l
a
nni
ng
a
n
d
c
o
n
s
u
m
ing
o
f
i
r
o
n
t
a
bl
e
t
s
i
n
o
r
de
r
to
pr
e
v
e
n
t
I
DA
.
I
t
i
s
a
d
vi
s
e
d
t
h
a
t
pr
e
gn
a
n
t
wo
m
e
n
s
h
o
u
l
d
b
e
s
upp
l
e
m
e
n
t
e
d
wi
t
h
i
r
o
n
a
n
d
f
o
l
i
c
a
c
i
d
f
o
r
a
pe
r
i
o
d
o
f
s
i
x
m
o
n
t
h
s
w
i
t
h
a
i
m
t
o
r
e
duc
e
a
ne
m
i
a
a
n
d
n
e
ur
a
l
t
ub
e
de
f
e
c
t
s
.
I
n
a
dd
i
t
i
o
n,
i
t
i
s
we
l
l
kn
o
wn
t
h
a
t
bi
r
t
h
s
pa
c
i
n
g
pr
a
c
t
i
c
e
by
m
o
t
h
e
r
pr
e
v
e
nt
s
a
n
e
m
i
a
[
1,
5
]
.
S
i
mi
l
a
r
l
y
,
a
l
m
o
s
t
gr
e
a
t
e
r
t
h
a
n
h
a
lf
o
f
m
o
t
h
e
r
r
e
por
t
e
d
t
h
a
t
t
h
e
y
s
t
r
o
n
g
l
y
r
e
c
o
m
m
e
nd
i
r
o
n
s
upp
l
e
m
e
n
t
a
t
i
o
n
,
f
a
mi
ly
p
l
a
nni
ng
f
o
r
t
h
e
pr
e
v
e
n
t
i
o
n
o
f
I
D
A
[
25,
28]
,
whi
c
h
i
s
s
im
il
a
r
f
i
nd
i
ng
w
i
t
h
t
h
e
r
e
s
po
n
s
e
s
o
f
pr
e
gn
a
n
t
m
o
t
h
e
r
s
i
n
t
hi
s
s
t
ud
y
.
S
t
udy
do
n
e
o
n
400
a
d
m
i
t
t
e
d
pr
e
gn
a
n
t
w
o
m
e
n
[
29]
o
nl
y
45.
3%
o
f
pa
r
t
i
c
i
pa
n
t
s
ha
d
us
e
d
i
r
o
n
s
upp
l
e
m
e
n
t
s
dur
i
n
g
pr
e
gn
a
n
c
y
,
w
hi
c
h
i
s
hi
g
h
e
r
i
n
o
ur
s
t
udy
.
De
s
p
i
t
e
t
h
e
uni
ve
r
s
a
l
r
e
c
o
m
m
e
n
da
t
i
o
n
to
us
e
i
r
o
n
t
a
bl
e
t
dur
i
n
g
r
e
c
o
m
m
e
n
da
t
i
o
n
,
i
n
o
ur
s
t
udy
o
nl
y
32
%
h
a
d
r
e
por
t
e
d
t
h
a
t
t
h
e
y
r
e
gu
l
a
r
l
y
t
oo
k
a
n
i
r
o
n
f
o
l
i
c
a
c
i
d
t
a
bl
e
t
f
o
r
pr
e
v
e
n
t
i
o
n
o
r
tr
e
a
t
m
e
n
t
o
f
a
n
e
mi
a
.
W
hil
e
,
r
e
l
a
t
i
v
e
ly
hi
g
h
e
r
a
d
h
e
r
e
n
c
e
to
I
r
o
n
t
a
bl
e
t
us
e
o
f
62%
wa
s
r
e
po
r
t
e
d
by
79.
4%
o
f
pa
r
t
i
c
i
pa
n
t
s
ha
v
e
h
a
d
r
e
gu
l
a
r
m
e
a
l
w
hi
c
h
i
s
t
h
r
e
e
t
i
m
e
s
i
n
a
da
y
.
S
t
i
l
l,
t
h
e
r
e
i
s
a
gr
e
a
t
ge
o
g
r
a
phi
c
a
l
v
a
r
i
a
t
i
o
n
i
n
t
h
e
p
r
a
c
t
i
c
e
o
f
I
DA
pr
e
v
e
n
t
i
o
n
s
t
r
a
t
e
gi
e
s
.
I
n
a
s
t
udy
c
o
n
duc
t
e
d
i
n
E
t
hi
o
p
i
a
r
e
ga
r
d
i
n
g
kn
o
wl
e
dge
a
n
d
pr
e
v
e
n
t
i
o
n
pr
a
c
t
i
c
e
s
,
57.
3
%
a
n
d
50%
o
f
pr
e
gn
a
n
t
w
o
m
e
n
h
a
d
a
goo
d
kn
o
wl
e
dge
a
d
g
oo
d
a
tt
i
t
ude
r
e
s
pe
c
t
i
v
e
ly
[
30]
.
Ge
n
e
r
a
l
ly
61%
(
95%
C
I
=
52
.
6%
to
69.
5
%
)
o
f
pr
e
gn
a
n
t
wo
m
e
n
h
a
d
a
g
oo
d
kn
o
wl
e
dge
o
n
pr
e
v
e
n
t
i
o
n
m
e
t
h
o
ds
o
f
I
DA
.
M
o
r
e
t
h
a
n
h
a
lf
,
52.
3%
(
95%
C
I
=
43.
7%
to
61.
0%
)
h
a
d
a
f
a
v
o
r
a
bl
e
a
t
t
i
t
ude
to
wa
r
ds
pr
e
v
e
n
t
i
o
n
o
f
I
D
A
.
W
hi
l
e
m
a
j
o
r
i
t
y
o
f
pr
e
gn
a
n
t
w
o
m
e
n
,
58.
6%
(
95
%
C
I
=
50
.
1%
to
67
.
1%
)
h
a
d
poor
a
dh
e
r
e
n
c
e
t
o
pr
e
v
e
n
t
i
o
n
pr
a
c
t
i
c
e
o
f
I
DA
.
E
v
e
n
i
f
t
h
e
r
e
s
u
l
t
s
a
r
e
c
o
m
pa
r
a
bl
e
w
i
t
h
ot
h
e
r
s
t
udi
e
s
[
14,
23,
30]
,
t
h
e
l
e
v
e
l
o
f
kn
o
w
l
e
dge
,
a
tt
i
t
ude
a
n
d
pr
a
c
t
i
c
e
s
to
wa
r
ds
I
DA
pr
e
v
e
n
t
i
o
n
we
r
e
n
o
t
s
a
t
i
s
f
a
c
t
or
y
.
I
n
t
h
a
t
i
t
s
t
i
ll
n
e
e
d
s
gr
e
a
t
e
f
f
o
r
t
by
h
o
s
p
i
t
a
l
s
a
n
d
t
h
e
go
v
e
r
nm
e
n
t
a
t
l
a
r
ge
to
i
m
pr
o
v
e
t
h
e
i
r
a
wa
r
e
n
e
s
s
a
n
d
pr
a
c
t
i
c
e
.
As
t
h
e
r
o
l
e
o
f
h
us
b
a
n
ds
i
s
tr
e
m
e
n
do
us
l
y
im
pr
o
vi
ng
t
h
e
h
e
a
l
t
h
c
a
r
e
pl
a
n
o
f
wo
m
e
n
,
h
us
b
a
n
ds
n
e
e
d
to
b
e
pa
r
t
of
t
h
e
A
N
C
s
e
r
vi
c
e
.
T
h
us
,
t
h
e
r
e
a
r
e
tr
e
m
e
n
do
us
f
a
c
to
r
s
t
h
a
t
a
ggr
a
v
a
t
e
a
n
d
m
a
de
pr
e
gn
a
n
t
a
t
r
i
s
k
s
o
f
a
n
e
mi
a
i
n
a
dd
i
t
i
o
n
t
o
t
h
e
phy
s
i
o
l
o
g
i
c
a
l
v
u
l
ne
r
a
bil
i
t
y
.
T
h
e
s
e
b
e
h
a
vi
o
r
a
l
a
n
d
ot
h
e
r
f
a
c
t
o
r
s
n
e
e
d
to
b
e
a
ddr
e
s
s
e
d
i
n
t
h
e
c
o
un
t
r
y
s
pe
c
i
f
i
c
t
a
r
ge
t
s
f
o
r
m
a
k
i
ng
t
h
e
S
us
t
a
i
n
a
bl
e
De
v
e
l
o
p
m
e
n
t
go
a
l
s
i
n
r
e
a
l
i
t
y
i
n
t
h
e
n
e
a
r
f
ut
ur
e
a
n
d
de
c
r
e
a
s
i
ng
a
ne
m
i
a
by
h
a
lf
i
n
t
h
e
c
o
m
i
ng
2025
[
6]
.
3.
1
.
S
oc
io
-
d
e
m
ogr
ap
h
ic
c
h
ar
ac
t
e
r
i
s
t
ics
of
t
h
e
p
ar
t
icip
an
t
s
Out
o
f
t
h
e
tot
a
l
128
pr
e
gn
a
n
t
wo
m
e
n
,
m
a
j
o
r
i
t
y
39
(
30.
5%
)
f
o
un
d
u
n
de
r
a
ge
c
a
t
e
g
o
r
y
o
f
23
-
27
y
e
a
r
s
a
nd
107
(
83.
6
%
)
we
r
e
m
a
r
r
i
e
d.
A
t
ot
a
l
o
f
50
(
39.
1
%
)
,
a
tt
e
n
de
d
t
h
e
i
r
e
duc
a
t
i
o
n
a
t
l
e
ve
l
o
f
d
i
p
l
o
m
a
a
n
d
a
b
o
v
e
,
w
i
t
h
59
(
46.
1%
)
w
o
r
ki
n
g
i
n
go
v
e
r
nm
e
n
t
a
l
i
ns
t
i
t
ut
i
o
n
.
R
e
ga
r
d
i
n
g
f
a
mi
ly
s
i
z
e
,
78
(
60.
9%
)
h
a
v
e
t
wo
f
a
m
il
y
m
e
m
be
r
s
,
w
i
t
h
t
h
e
m
a
j
o
r
i
t
y
,
10
6
(
82.
8
%
)
o
f
t
h
e
m
li
ve
i
n
ur
b
a
n
,
S
o
c
i
o
-
de
m
o
gr
a
phi
c
c
h
a
r
a
c
t
e
r
i
s
t
i
c
s
o
f
pr
e
g
n
a
n
t
wo
m
e
n
a
t
t
e
n
d
i
n
g
a
n
t
e
-
n
a
t
a
l
c
a
r
e
i
s
s
h
o
wn
i
n
T
a
bl
e
1.
T
a
bl
e
1
.
S
o
c
i
o
-
de
m
o
gr
a
phi
c
c
h
a
r
a
c
t
e
r
i
s
t
i
c
s
o
f
pr
e
g
n
a
n
t
wo
m
e
n
a
tt
e
n
d
i
n
g
a
n
t
e
-
n
a
t
a
l
c
a
r
e
V
a
r
ia
bl
e
s
O
pt
io
ns
F
r
e
qu
e
n
c
y
P
e
r
c
e
nt
a
ge
A
ge
c
a
t
e
g
o
r
i
e
s
i
n
y
e
a
r
s
18
–
22
38
29.7
23
–
27
39
30.5
28
–
32
33
25.7
33
–
37
13
10.2
38
–
42
2
1.6
43
–
47
3
2.3
M
a
r
it
a
l
s
ta
tu
s
S
in
gl
e
3
2.3
M
a
r
r
ie
d
107
83.6
D
iv
o
r
c
e
d
15
11.7
W
id
o
w
e
d
3
2.3
E
duc
a
ti
o
na
l
S
ta
tu
s
P
r
im
a
r
y
s
c
h
oo
l
28
21.9
S
e
c
o
nda
r
y
s
c
h
oo
l
50
39.1
D
ip
lo
ma
a
nd a
bove
50
39.1
O
c
c
upa
ti
o
na
l
s
ta
tu
s
F
a
r
me
r
13
10.2
G
ove
r
nm
e
nt
a
l
59
46.1
P
r
i
v
a
te
34
26.6
H
o
us
e
w
i
f
e
22
17.2
N
umbe
r
of
f
a
mi
li
e
s
2
78
60.9
3
43
33.6
≥3
7
5.5
F
a
mi
l
y
m
o
n
th
l
y
i
n
c
o
me
(
E
T
B
)
1 E
T
B
=
$ 28.34
1000
-
1500
27
21.1
1500
-
2500
42
32.8
≥ 25
00
59
46.1
L
i
v
in
g a
r
e
a
U
r
ba
n
106
82.8
R
ur
a
l
22
17.2
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
S
N
:
2252
-
8806
I
n
t
.
J
.
P
ubl
i
c
He
a
l
t
h
S
c
i
.
Vo
l
.
8
,
N
o
.
2
,
J
un
e
201
9
:
20
2
–
2
10
206
3.
2.
M
a
t
e
r
n
al
c
h
a
r
ac
t
e
r
i
s
t
ics
R
e
ga
r
d
i
n
g
a
ge
a
t
f
i
r
s
t
m
a
r
r
i
a
ge
,
a
b
o
ut
65
(
50.
8%
)
o
f
pr
e
gn
a
n
t
wo
m
e
n
m
a
r
r
i
e
d
a
t
a
ge
b
e
t
we
e
n
16
-
20
y
e
a
r
s
.
Ab
o
ut,
65
(
50.
8%
)
ga
v
e
t
h
e
i
r
f
i
r
s
t
bi
r
t
h
a
t
a
ge
o
f
18
-
22
y
e
a
r
s
.
A
m
a
j
o
r
i
t
y
,
103
(
80.
5%
)
o
f
t
h
e
r
e
s
po
n
de
n
t
s
d
i
d
n
o
t
s
uf
f
e
r
f
r
o
m
he
a
l
t
h
r
e
l
a
t
e
d
pr
o
b
l
e
m
du
r
i
n
g
t
h
e
f
i
r
s
t
bi
r
t
h
.
Al
m
o
s
t
h
a
l
f
o
f
t
h
e
m
we
r
e
th
e
i
r
i
ni
t
i
a
l
vi
s
i
t
t
o
t
h
e
h
o
s
p
i
t
a
l
a
s
c
a
n
be
s
e
e
n
i
n
T
a
bl
e
2
.
T
a
bl
e
2
.
M
a
t
e
r
n
a
l
r
e
l
a
t
e
d
c
h
a
r
a
c
t
e
r
i
s
t
i
c
s
o
f
pr
e
gn
a
n
t
wo
m
e
n
a
tt
e
n
d
i
n
g
a
n
t
e
n
a
t
a
l
c
a
r
e
a
t
h
o
s
pi
t
a
l
s
V
a
r
ia
bl
e
s
O
pt
io
ns
F
r
e
qu
e
n
c
y
P
e
r
c
e
nt
a
ge
A
ge
a
t
f
ir
s
t
ma
r
r
ia
ge
i
n Y
e
a
r
s
16
-
20
65
50.8
21
-
25
33
25.8
26
-
30
26
20.3
≥31
4
3.1
A
ge
in
Y
e
a
r
s
18
-
22
65
50.8
23
-
27
41
32
28
-
32
22
16.4
≥33
1
0.8
N
umbe
r
of
pr
e
gna
n
c
y
(
G
r
a
v
id
it
y
)
1
66
51.6
2
42
32.8
3
18
14.1
4
2
1.6
Y
e
a
r
s
of
c
hi
ld
s
pa
c
in
g
<
3 Y
e
a
r
s
51
39.8
3
-
4 Y
e
a
r
s
11
8.6
N
o
c
hi
ld
e
v
e
r
66
51.6
S
ta
ge
of
p
r
e
gna
n
c
y
1
st
tr
im
e
s
t
e
r
50
39.1
2
nd
tr
im
e
s
te
r
50
39.1
3
rd
tr
im
e
s
t
e
r
28
21.9
D
o
y
ou s
u
f
f
e
r
in
g
f
r
o
m h
e
a
lt
h pr
o
bl
e
m
Y
e
s
25
19.5
No
103
80.5
N
umbe
r
v
is
it
t
o
t
h
e
he
a
lt
h i
ns
ti
tu
ti
o
n
1
st
time
60
46.9
2
nd
time
43
33.6
3
rd
time
25
19.5
3.
3.
Kn
owl
e
d
ge
on
ir
on
d
e
f
icie
n
c
y
an
e
m
ia
Out
o
f
t
h
e
tot
a
l
,
113
(
88.
3%
)
o
f
pr
e
g
n
a
n
t
m
oth
e
r
s
h
a
ve
e
v
e
r
h
e
a
r
d
a
b
o
ut
I
DA
,
i
n
w
hi
c
h
h
e
a
lt
h
pr
o
f
e
s
s
i
o
n
a
l
s
we
r
e
m
a
i
n
s
o
ur
c
e
o
f
i
nf
o
r
m
a
t
i
o
n
.
Abo
u
t
40
(
31.
3
%
)
o
f
pr
e
gn
a
n
t
m
o
t
h
e
r
s
c
o
r
r
e
c
t
l
y
de
f
i
n
e
d
t
h
e
m
a
in
c
a
us
e
o
f
a
ne
m
i
a
a
s
i
r
o
n
de
f
i
c
i
e
n
c
y
.
W
hil
e
o
nl
y
s
m
a
ll
pr
o
p
o
r
t
i
o
n
,
18
(
14.
1%
)
o
f
r
e
s
po
n
de
n
t
s
i
de
n
t
if
i
e
d
s
o
m
e
c
o
m
m
o
n
s
ym
pt
o
m
s
o
f
I
D
A
n
a
m
e
ly
ge
n
e
r
a
l
b
o
d
y
we
a
kne
s
s
,
di
z
z
i
ne
s
s
o
r
f
a
i
n
t
i
n
g,
poo
r
a
ppe
t
i
t
e
a
n
d
s
h
o
r
t
n
e
s
s
o
f
b
r
e
a
t
hi
ng
a
s
m
a
i
n
s
i
g
n
a
n
d
s
y
m
pt
o
m
o
f
a
ne
m
i
a
.
O
n
kn
o
w
l
e
dge
r
e
l
a
t
e
d
to
pr
e
v
e
n
t
i
o
n
o
f
a
n
e
mi
a
.
M
a
j
o
r
i
t
y
,
75
(
58.
6
%
)
o
f
r
e
s
po
n
de
n
t
s
kn
e
w
h
o
w
a
ne
m
i
a
c
a
n
be
pr
e
v
e
n
t
e
d.
A
b
o
ut
o
n
e
t
hi
r
d,
40
(
31
.
3%
)
o
f
m
o
t
h
e
r
kn
e
w
t
h
a
t
a
n
e
m
i
a
c
a
n
b
e
pr
e
v
e
n
t
e
d
by
h
e
a
l
t
hy
a
n
d
b
a
l
a
n
c
e
d
n
ut
r
i
t
i
o
n
a
s
s
h
o
w
n
i
n
T
a
bl
e
3
.
Ge
n
e
r
a
ll
y
61%
(
61%
(
95%
C
I
:
52
.
6%
to
69
.
5
%
)
o
f
pr
e
gn
a
n
t
w
o
m
e
n
h
a
d
a
goo
d
kn
o
wl
e
dge
o
n
pr
e
v
e
n
t
i
o
n
m
e
t
h
o
ds
o
f
I
DA
.
W
hil
e
39%
o
f
pr
e
gna
n
t
wo
m
e
n
h
a
d
l
o
w
kn
o
w
l
e
dg
e
s
c
o
r
e
to
wa
r
ds
pr
e
v
e
n
t
i
o
n
o
f
I
DA
.
(
T
h
o
s
e
wh
o
s
c
o
r
e
a
b
o
v
e
t
h
e
m
e
a
n
a
f
t
e
r
c
o
di
n
g
a
ll
c
o
r
r
e
c
t
o
p
t
i
o
ns
a
s
1
a
n
d
t
h
e
o
th
e
r
a
s
0
)
,
as
s
h
o
wn
i
n
F
i
gur
e
1
.
F
i
gur
e
1
.
O
v
e
r
a
l
l
k
n
o
w
l
e
dge
s
c
o
r
e
o
f
pr
e
gna
n
t
m
o
t
h
e
r
s
o
n
I
DA
i
n
E
t
hi
o
p
i
a
,
2018.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t
.
J
.
P
ubl
i
c
He
a
l
t
h
S
c
i
.
I
S
S
N:
2252
-
8806
P
r
e
gnant
mothe
r
s
’
k
no
w
ledg
e
,
att
it
ude
and
pr
ac
ti
c
e
to
w
ar
d
s
pr
e
v
e
nti
on
s
of
ir
on
de
f
icie
nc
y
…
(
A
bdu
Oum
e
r
)
207
T
a
bl
e
3
.
K
n
o
w
l
e
dge
o
f
m
o
t
h
e
r
s
o
n
pr
e
v
e
n
t
i
o
n
o
f
I
DA
a
m
o
n
g
pr
e
gn
a
n
t
wo
m
e
n
a
tt
e
n
d
i
n
g
A
N
C
V
a
r
ia
bl
e
s
F
r
e
qu
e
n
c
y
P
e
r
c
e
nt
a
ge
E
ve
r
he
a
r
d
of
I
D
A
Y
e
s
113
88.3
No
15
11.7
C
a
us
e
s
of
a
ne
mi
a
P
oor
nut
r
it
i
o
n
33
25.8
I
r
o
n de
f
i
c
ie
n
c
y
40
31.3
L
o
w
h
e
m
o
gl
o
bi
n
7
5.5
I
do
n
'
t
kn
o
w
48
37.5
S
ig
n a
nd s
y
mpt
o
m
of
a
n
e
mi
a
s
ho
r
tn
e
s
s
of
b
r
e
a
th
in
g
14
10.9
E
xc
e
pt
i
o
na
l
f
a
ti
gu
e
12
9.4
G
e
ne
r
a
l
b
o
d
y
w
e
a
kn
e
s
s
18
14.1
P
oor
a
ppe
ti
t
e
15
11.7
D
iz
z
in
e
s
s
o
r
f
a
in
ti
ng
18
14.1
A
ll
c
a
n be
o
bs
e
r
ve
d
3
2.3
I
do
n
'
t
kn
o
w
48
37.5
C
a
us
e
s
of
I
D
A
P
oor
nut
r
it
i
o
n
45
35.2
B
l
e
e
di
ng du
r
in
g pr
e
gna
nc
y
26
20.3
M
ul
ti
pl
e
pr
e
gna
nc
y
3
2.3
A
ll
l
is
te
d a
b
ov
e
6
4.7
I
do
n
'
t
kn
o
w
48
37.5
A
w
a
r
e
ne
s
s
o
n
P
r
e
ve
nt
i
o
n
of
I
D
A
Y
e
s
75
58.6
No
53
41.4
W
a
y
s
t
o
P
r
e
v
e
nt
I
D
A
B
y
g
oo
d nutr
it
i
o
n
40
31.3
U
s
in
g I
r
o
n s
uppl
e
m
e
nt
25
19.5
D
r
in
ki
ng or
E
a
ti
ng
f
r
ui
ts
7
5.5
A
ll
l
is
te
d a
b
ov
e
3
2.3
I
do
n
'
t
kn
o
w
53
41.4
D
r
in
ki
ng t
e
a
,
c
of
f
e
e
a
nd mi
lk
c
a
n c
a
us
e
a
ne
mi
a
Y
e
s
39
30.5
No
89
69.5
S
pa
c
in
g
c
hi
ld
c
a
n pr
e
ve
nt
a
n
e
mi
a
Y
e
s
78
60.9
No
50
39.1
3.
4.
A
t
t
i
t
u
d
e
of
p
r
e
gn
an
t
m
ot
h
e
r
s
on
I
DA
R
e
ga
r
d
i
n
g
t
h
e
m
o
t
h
e
r
’
s
a
tt
i
t
ude
to
wa
r
ds
I
DA
,
m
a
j
o
r
i
t
y
52
(
40.
6%
)
a
n
d
53
(
41
.
4%
)
we
r
e
s
tr
o
n
g
l
y
a
gr
e
e
d
a
n
d
a
gr
e
e
t
o
t
h
e
s
t
a
t
e
m
e
n
t
s
r
e
ga
r
d
i
n
g
r
e
gu
l
a
r
vi
s
it
h
a
v
e
b
e
n
e
f
i
t
s
b
o
t
h
f
o
r
t
h
e
m
o
t
h
e
r
a
n
d
f
e
t
us
h
e
a
l
t
h
dur
i
ng
pr
e
gn
a
n
c
y
r
e
s
pe
c
t
i
v
e
ly
.
T
h
e
s
i
g
nif
i
c
a
n
t
l
y
hi
g
h
e
r
pr
o
p
o
r
t
i
o
n
o
f
wo
m
e
n
,
a
b
o
ut
45
(
35
.
2%
)
a
n
d
35
(
27.
3
%
)
a
gr
e
e
d
a
n
d
s
t
r
o
n
g
l
y
a
gr
e
e
d
t
h
a
t
r
e
l
a
t
e
d
to
d
r
i
n
k
i
ng
o
f
tea
,
c
o
f
f
e
e
a
n
d
m
il
k
m
a
y
pr
e
d
i
s
po
s
e
a
n
i
nd
i
v
i
du
a
l
t
o
I
DA
r
e
s
pe
c
t
i
ve
ly
.
R
e
l
a
t
e
d
to
f
e
e
d
i
ng
r
e
gu
l
a
r
m
e
a
l
t
o
pr
e
v
e
n
t
a
n
e
mi
a
a
n
d
i
r
o
n
s
upp
l
e
m
e
n
t
,
a
l
m
o
s
t
h
a
l
f
64
(
5
0%
)
a
gr
e
e
d
a
n
d
r
e
c
o
m
m
e
n
d
t
h
e
us
e
o
f
a
n
e
x
t
r
a
i
r
o
n
t
a
bl
e
t
(
i
r
o
n
s
upp
l
e
m
e
n
t
a
t
i
o
n
)
f
o
r
pr
e
gn
a
n
t
i
n
a
dd
i
t
i
o
n
t
o
r
e
gu
l
a
r
d
i
e
t
to
pr
e
v
e
n
t
I
DA
.
A
b
o
ut
46
(
35
.
9%
)
a
n
d
15
(
11
.
7%
)
we
r
e
a
gr
e
e
d
a
n
d
s
t
r
o
n
g
l
y
a
gr
e
e
d,
t
h
a
t
f
a
mi
ly
p
l
a
nni
ng
ha
v
e
gr
e
a
t
e
r
r
o
l
e
i
n
t
h
e
pr
e
v
e
n
t
i
o
n
o
f
a
n
e
mi
a
.
Alm
o
s
t
h
a
l
f
o
f
pr
e
gn
a
n
t
w
o
m
e
n
,
a
gr
e
e
d
t
h
a
t
c
hi
l
d
s
pa
c
i
ng
i
s
i
m
po
r
t
a
n
t
to
p
r
e
v
e
n
t
I
DA
,
A
t
t
i
t
ude
o
f
pr
e
gn
a
n
t
m
o
t
h
e
r
s
to
w
a
r
ds
i
r
o
n
de
f
i
c
i
e
nc
y
a
n
e
mi
a
a
m
o
n
g
A
N
C
a
tt
e
n
da
nt
s
i
s
s
h
o
wn
i
n
T
a
bl
e
4
.
M
o
r
e
t
h
a
n
h
a
l
f
,
52.
3%
(
95
%
C
I
:
43.
7
%
to
61
.
0%
)
h
a
d
f
a
v
o
r
a
bl
e
a
t
t
i
t
ude
to
wa
r
ds
pr
e
v
e
n
t
i
o
n
o
f
I
DA
.
W
hil
e
67.
75
o
f
pr
e
gn
a
n
t
w
o
m
e
n
a
tt
e
n
d
i
n
g
A
NC
h
a
d
u
nf
a
v
o
r
a
bl
e
a
tt
i
t
ude
to
wa
r
ds
I
DA
,
a
tt
i
t
ude
l
e
v
e
l
o
f
pr
e
g
n
a
n
t
wo
m
e
n
a
t
t
e
n
d
i
n
g
A
N
C
o
n
t
h
e
pr
e
v
e
n
t
i
o
ns
o
f
I
r
o
n
de
f
i
c
i
e
n
c
y
a
n
e
mi
a
i
s
s
h
o
wn
i
n
F
i
gur
e
2.
F
i
gur
e
2
.
A
tt
i
t
ude
l
e
ve
l
o
f
pr
e
gn
a
n
t
wo
m
e
n
a
tt
e
n
d
i
n
g
A
NC
o
n
t
h
e
pr
e
v
e
n
t
i
o
ns
o
f
I
r
o
n
de
f
i
c
i
e
nc
y
a
n
e
mi
a
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
S
N
:
2252
-
8806
I
n
t
.
J
.
P
ubl
i
c
He
a
l
t
h
S
c
i
.
Vo
l
.
8
,
N
o
.
2
,
J
un
e
201
9
:
20
2
–
2
10
208
T
a
bl
e
4
.
A
tt
i
t
ude
o
f
pr
e
gn
a
n
t
m
o
t
h
e
r
s
to
wa
r
ds
i
r
o
n
de
f
i
c
i
e
nc
y
a
ne
m
i
a
a
m
o
n
g
A
NC
a
t
t
e
n
da
n
t
s
V
a
r
ia
bl
e
s
F
r
e
qu
e
n
c
y
P
e
r
c
e
nt
a
ge
R
e
gul
a
r
A
N
C
v
is
it
i
s
g
oo
d t
o
pr
e
ve
nt
I
D
A
.
S
tr
o
ngl
y
di
s
a
gr
e
e
5
3.9
D
is
a
gr
e
e
1
8
N
e
ut
r
a
l
17
13.3
A
gr
e
e
53
41.4
S
tr
o
ngl
y
a
gr
e
e
52
40.6
I
r
o
n s
uppl
e
m
e
nt
c
a
n a
f
f
e
c
t
m
o
th
e
r
a
nd
f
e
tu
s
he
a
lt
h?
S
tr
o
ngl
y
di
s
a
gr
e
e
1
.8
A
gr
e
e
45
35.2
N
e
ut
r
a
l
47
36.7
S
tr
o
ngl
y
a
gr
e
e
35
27.3
D
r
in
ki
ng
c
of
f
e
e
, t
e
a
o
r
m
il
k c
a
n a
f
f
e
c
t
i
r
o
n
a
bs
o
r
pt
i
o
n
D
is
a
gr
e
e
10
7.8
A
gr
e
e
37
28.9
N
e
ut
r
a
l
70
54.7
S
tr
o
ngl
y
a
gr
e
e
11
8.6
I
r
o
n s
uppl
e
m
e
nt
s
c
a
n pr
e
ve
nt
I
D
A
S
tr
o
ngl
y
di
s
a
gr
e
e
3
2.3
D
is
a
gr
e
e
2
1.6
A
gr
e
e
50
39.1
N
e
ut
r
a
l
52
40.6
S
tr
o
ngl
y
a
gr
e
e
21
16.4
R
e
gul
a
r
me
a
ls
o
r
f
e
e
di
ng
c
a
n pr
e
ve
nt
a
ne
mi
a
S
tr
o
ngl
y
di
s
a
gr
e
e
1
0.8
D
is
a
gr
e
e
2
1.6
A
gr
e
e
64
50.0
N
e
ut
r
a
l
48
37.5
S
tr
o
ngl
y
a
gr
e
e
13
10.2
P
r
e
gna
nt
w
o
m
e
n s
h
o
ul
d c
o
ns
um
e
I
r
o
n
ta
bl
e
ts
i
n s
pi
te
of
h
e
a
lt
h
y
di
e
t
S
tr
o
ngl
y
di
s
a
gr
e
e
4
3.1
D
is
a
gr
e
e
10
7.8
A
gr
e
e
46
35.9
N
e
ut
r
a
l
53
41.4
S
tr
o
ngl
y
a
gr
e
e
15
11.7
P
r
o
m
o
ti
o
n
of
f
a
m
il
y
pl
a
nni
ng me
th
o
ds
f
or
s
pa
c
in
g w
it
h pr
e
ve
nt
a
n
e
mi
a
S
tr
o
ngl
y
di
s
a
gr
e
e
1
0.8
D
is
a
gr
e
e
2
1.6
A
gr
e
e
60
46.9
N
e
ut
r
a
l
54
42.2
S
tr
o
ngl
y
a
gr
e
e
11
8.6
S
pa
c
in
g
c
hi
ld
c
a
n pr
e
ve
nt
a
n
e
mi
a
S
tr
o
ngl
y
di
s
a
gr
e
e
8
6.3
D
is
a
gr
e
e
0
0
A
gr
e
e
54
42.2
N
e
ut
r
a
l
51
39.8
S
tr
o
ngl
y
a
gr
e
e
15
11.7
A
n
y
pr
e
gna
nt
w
o
m
e
n c
a
n b
e
a
f
f
e
c
t
e
d b
y
a
ne
mi
a
S
tr
o
ngl
y
di
s
a
gr
e
e
4
3.1
D
is
a
gr
e
e
9
7.0
A
gr
e
e
53
41.4
N
e
ut
r
a
l
49
38.3
S
tr
o
ngl
y
a
gr
e
e
13
10.2
3.
5.
I
r
on
d
e
f
icie
n
c
y
an
e
m
ia
p
r
e
ve
n
t
ion
p
r
ac
t
ice
s
R
e
ga
r
d
i
n
g
I
D
A
pr
e
v
e
n
t
i
o
n
pr
a
c
t
i
c
e
o
f
pr
e
g
n
a
n
t
m
o
t
h
e
r
s
,
m
a
j
o
r
i
t
y
68
(
53.
1%
)
r
e
p
or
t
e
d
t
h
a
t
t
h
e
y
d
i
d
not
dr
i
n
k
t
e
a
,
c
o
f
f
e
e
a
n
d
m
il
k
a
l
o
n
g
w
i
t
h
t
h
e
i
r
m
e
a
l
.
W
hil
e
,
87
(
68%
)
o
f
pr
e
gn
a
n
t
wo
m
e
n
d
i
d
n
o
t
t
a
ke
a
n
i
r
o
n
t
a
bl
e
t
(
I
r
o
n
s
upp
l
e
m
e
n
t
a
t
i
o
n
)
r
e
gu
l
a
r
l
y
a
n
d
76
(
5
9.
4%
)
r
e
por
t
e
d
t
h
a
t
t
h
e
y
t
a
ke
r
e
gu
l
a
r
f
e
e
d
i
ng
t
h
r
e
e
t
i
m
e
s
pe
r
da
y
.
On
t
h
e
ot
h
e
r
h
a
n
d,
62
(
48.
4
%
)
h
a
d
a
h
a
bi
t
o
f
E
a
ti
ng
r
e
d
m
e
a
t
.
Ov
e
r
a
l
l
,
o
n
e
t
hi
r
d
41
(
32%
)
we
r
e
f
o
un
d
to
b
e
a
n
e
mi
c
(
Hg
b
<
11
m
g/d
l
)
.
W
hil
e
t
h
e
m
o
r
e
t
h
a
n
h
a
lf
o
f
pr
e
gna
n
t
wo
m
e
n
,
58.
6%
(
95
%
C
I
:
50.
1
%
to
6
7.
1%
)
h
a
d
a
poor
a
dh
e
r
e
n
c
e
t
o
pr
e
v
e
n
t
i
o
n
pr
a
c
t
i
c
e
o
f
I
DA
,
whil
e
41.
4%
o
f
A
N
C
a
tt
e
n
d
i
n
g
pr
e
g
n
a
n
t
w
o
m
e
n
h
a
d
a
goo
d
a
dh
e
r
e
n
c
e
to
p
r
e
v
e
n
t
i
o
n
pr
a
c
t
i
c
e
o
f
I
D
A
a
s
s
h
o
wn
i
n
T
a
bl
e
5.
T
h
e
m
e
a
n
kn
o
w
l
e
dg
e
,
a
tt
i
t
ude
a
n
d
pr
a
c
t
i
c
e
s
c
o
r
e
o
f
wo
m
e
n
wa
s
5.
4
(
S
D=
3.
7)
,
32.
8
(
S
D=
5.
4)
a
nd
3.
4
(
S
D=
0.
71
)
r
e
s
pe
c
t
i
v
e
ly
.
T
h
e
hi
g
he
r
kn
o
wl
e
dge
s
c
o
r
e
wa
s
p
o
s
i
t
i
v
e
ly
c
o
r
r
e
l
a
t
e
d
wi
t
h
a
tt
i
t
ude
s
c
o
r
e
(
r
=
0.
75
,
p<
0.
001)
.
S
i
m
il
a
r
ly
,
hi
g
h
e
r
a
tt
i
t
ude
i
s
a
s
s
o
c
i
a
t
e
d
wi
t
h
i
nc
r
e
a
s
e
d
pr
a
c
t
i
c
e
to
wa
r
ds
pr
e
v
e
n
t
i
o
n
o
f
I
DA
(
r
=
0.
55
,
p
<
0.
001)
.
R
a
t
h
e
r
,
t
h
e
r
e
i
s
r
e
l
a
t
i
v
e
ly
m
o
d
e
r
a
t
e
c
o
r
r
e
l
a
t
i
o
n
b
e
t
we
e
n
t
h
e
m
o
t
h
e
r
k
n
o
w
l
e
dg
e
a
n
d
pr
a
c
t
i
c
e
o
f
I
DA
(
r
=
0.
45,
p
<
0.
001
)
.
T
h
e
m
e
a
n
pr
a
c
t
i
c
e
s
c
o
r
e
o
f
r
ur
a
l
m
o
t
h
e
r
wa
s
s
i
g
nif
i
c
a
n
t
l
y
l
o
w
e
r
th
a
n
ur
ba
n
(
F
=
12.
478
p
=
0.
01)
.
Hi
g
h
e
r
k
n
o
w
l
e
dge
s
c
o
r
e
,
f
a
v
o
r
a
bl
e
a
tt
i
t
ude
a
n
d
a
ge
we
r
e
po
s
i
t
i
ve
pr
e
d
i
c
t
o
r
s
o
f
goo
d
n
ut
r
i
t
i
o
n
a
l
pr
a
c
t
i
c
e
s
whil
e
f
a
mi
ly
s
i
z
e
i
s
i
nve
r
s
e
ly
r
e
l
a
t
e
d
w
i
t
h
i
t
,
s
h
o
ws
t
h
e
I
DA
pr
e
v
e
n
t
i
o
n
pr
a
c
t
i
c
e
o
f
P
r
e
g
n
a
n
t
m
o
t
h
e
r
a
ga
i
ns
t
R
e
s
i
de
nc
e
(
ur
b
a
n
v
e
r
s
us
r
ur
a
l
)
i
s
s
ho
wn
i
n
T
a
bl
e
6
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t
.
J
.
P
ubl
i
c
He
a
l
t
h
S
c
i
.
I
S
S
N:
2252
-
8806
P
r
e
gnant
mothe
r
s
’
k
no
w
ledg
e
,
att
it
ude
and
pr
ac
ti
c
e
to
w
ar
d
s
pr
e
v
e
nti
on
s
of
ir
on
de
f
icie
nc
y
…
(
A
bdu
Oum
e
r
)
209
T
a
bl
e
5
.
P
r
a
c
t
i
c
e
o
f
pr
e
g
n
a
n
t
m
o
t
h
e
r
s
o
n
pr
e
v
e
n
t
i
o
n
o
f
i
r
o
n
d
e
f
i
c
i
e
n
c
y
a
n
e
mi
a
a
m
o
n
g
A
NC
a
n
t
e
-
n
a
t
a
l
c
a
r
e
i
n
E
a
s
t
e
r
n
E
t
hi
o
p
i
a
,
2018.
V
a
r
ia
bl
e
s
O
pt
io
ns
F
r
e
qu
e
n
c
y
P
e
r
c
e
nt
a
ge
H
a
v
e
y
ou d
r
in
k t
e
a
, c
of
f
e
e
a
nd mi
lk
w
i
th
me
a
l
?
Y
e
s
60
46.9
No
68
53.1
H
a
v
e
y
ou us
e
d
r
e
gul
a
r
i
r
o
n
T
a
bl
e
ts
?
Y
e
s
41
32.0
No
87
68.0
H
a
v
e
y
ou us
e
t
hr
e
e
r
e
gul
a
r
m
e
a
ls
?
Y
e
s
76
59.4
No
52
40.6
H
a
v
e
y
ou
ta
ke
n F
o
li
c
a
c
id
s
uppl
e
m
e
nt
s
i
n
c
ur
r
e
nt
pr
e
gna
n
c
y
?
Y
e
s
76
59.4
No
52
40.6
D
o
y
ou ha
v
e
th
e
ha
bi
t
of
E
a
ti
ng r
e
d m
e
a
t,
l
i
ve
r
,
c
hi
c
ke
n,
f
is
h
Y
e
s
62
48.4
No
66
51.6
D
o
y
ou i
n
c
lu
d
e
f
ib
e
r
r
ic
h
f
ood
f
r
e
qu
e
nt
l
y
?
Y
e
s
72
56.3
No
56
43.8
D
o
y
ou i
n
c
lu
d
e
gr
e
e
n
le
a
f
y
ve
g
e
ta
bl
e
i
n
y
our
di
e
t
e
ve
r
y
da
y
?
Y
e
s
75
58.6
No
53
41.4
O
ve
r
a
ll
I
D
A
pr
a
c
ti
c
e
l
e
ve
l
I
D
A
pr
e
ve
nt
i
o
n
pr
a
c
ti
c
e
P
oor
75
58.6
G
oo
d
53
41.4
T
a
bl
e
6
.
S
h
o
ws
t
h
e
I
DA
pr
e
v
e
n
t
i
o
n
pr
a
c
t
i
c
e
o
f
p
r
e
gn
a
n
t
m
o
t
h
e
r
a
ga
i
n
s
t
r
e
s
i
de
n
c
e
(
ur
b
a
n
v
e
r
s
u
s
r
ur
a
l
)
S
um of
S
qua
r
e
s
df
M
e
a
n S
qua
r
e
F
S
ig
.
P
r
a
c
ti
c
e
s
c
o
r
e
*
R
e
s
id
e
n
c
e
B
e
twe
e
n
G
r
o
ups
5.767
1
5.767
12.478
.001
W
it
hi
n G
r
o
ups
58.233
126
.462
L
in
e
a
r
R
e
gr
e
s
s
io
n
o
ut
put
Β
(
c
oe
f
f
i
c
i
e
nt
)
S
e
(
s
ta
nda
r
d
e
r
r
or
of
β
)
P
v
a
lu
e
K
n
o
w
l
e
dge
s
c
o
r
e
0
.085
0
.015
0.0001
A
tt
it
ude
s
c
or
e
0
.073
0
.010
0.0001
A
ge
i
n
y
e
a
r
0.028
0.011
0.01
F
a
mi
l
y
0
-
.118
0.105
0.264
4.
CONC
L
USI
ON
Kn
o
w
l
e
dge
,
a
t
t
i
t
ude
a
n
d
pr
a
c
t
i
c
e
o
f
pr
e
g
n
a
n
t
wo
m
e
n
o
n
pr
e
v
e
n
t
i
o
ns
o
f
I
DA
a
r
e
n
o
t
s
a
t
i
s
f
a
c
t
or
y
.
T
h
us
po
o
r
p
r
a
c
t
i
c
e
t
o
wa
r
ds
pr
e
v
e
n
t
i
o
n
o
f
I
DA
a
r
e
t
h
e
m
a
i
n
c
o
n
t
r
i
b
ut
i
n
g
f
a
c
t
o
r
f
o
r
hi
g
h
b
ur
de
n
o
f
a
n
e
mi
a
.
T
h
us
,
i
t
i
s
a
dvi
s
e
d
to
h
a
v
e
f
o
c
us
e
d,
s
i
m
p
l
e
,
e
a
s
y
to
u
n
de
r
s
t
a
n
d
a
n
d
c
us
to
m
e
r
f
r
i
e
n
d
l
y
c
o
un
s
e
li
ng
s
e
r
vi
c
e
a
t
A
NC
f
a
c
il
i
t
i
e
s
.
I
t
s
h
o
ul
d
s
p
e
c
i
f
i
c
a
l
ly
f
o
c
us
o
n
s
y
m
p
to
m
s
o
f
a
n
e
mi
a
,
c
a
us
e
s
,
wh
a
t
m
a
k
e
s
pr
e
gna
n
c
y
a
t
r
i
s
k,
h
o
w
to
pr
e
v
e
n
t
I
DA
a
m
o
n
g
pr
e
gn
a
n
t
.
T
hi
s
pr
ogr
a
m
s
h
o
u
l
d
i
nv
o
l
v
e
m
a
l
e
s
/
h
u
s
b
a
n
ds
f
o
r
s
us
t
a
i
ne
d
i
m
pa
c
t
.
T
h
e
n
e
e
d
f
o
r
a
dhe
r
e
nc
e
c
o
un
s
e
l
li
ng
a
n
d
f
o
ll
o
w
up
o
n
I
r
o
n
s
upp
l
e
m
e
n
t
s
h
o
u
l
d
b
e
f
o
c
us
e
d
by
he
a
l
t
h
pr
o
f
e
s
s
i
o
n
a
l
s
.
AC
K
NOWL
E
DGE
M
E
NT
S
W
e
a
r
e
de
li
g
h
t
e
d
to
t
h
a
n
k
o
ur
s
t
udy
p
a
r
t
i
c
i
pa
n
t
s
(
p
r
e
gn
a
n
t
wo
m
e
n
)
a
n
d
o
ur
s
t
ude
n
t
s
f
o
r
t
h
e
i
r
va
l
u
a
bl
e
c
o
n
t
r
i
b
ut
i
o
ns
f
o
r
t
hi
s
r
e
s
e
a
r
c
h
.
AB
B
RE
VI
AT
I
ONS
A
N
C
:
An
t
e
Na
t
a
l
C
a
r
e
:
A
/C
O
R
:
a
d
j
us
t
e
d/C
r
ude
Odds
r
a
t
i
o
:
C
I
:
C
o
nf
i
de
n
c
e
I
n
t
e
r
v
a
l
:
I
DA
:
I
r
o
n
de
f
i
c
i
e
n
c
y
a
n
e
mi
a
:
r
:
c
o
r
r
e
l
a
t
i
o
n
c
o
e
f
f
i
c
i
e
n
t
:
W
HO
:
W
o
r
l
d
he
a
l
t
h
Or
ga
ni
z
a
t
i
o
n
,
UN
I
C
E
F
:
Uni
t
e
d
Na
t
i
o
n
s
C
hil
dr
e
n
E
duc
a
t
i
o
n
F
u
n
d
RE
F
E
R
E
NC
E
S
1
].
W
o
rl
d
H
e
al
t
h
o
rg
a
n
i
zat
i
o
n
(
W
H
O
),
H
a
emo
g
l
o
b
i
n
co
n
cen
t
rat
i
o
n
s
fo
r
t
h
e
d
i
a
g
n
o
s
i
s
o
f
an
emi
a
a
n
d
as
s
e
s
s
men
t
o
f
s
e
v
e
r
i
t
y
V
MN
I
S
V
i
t
a
m
i
n
an
d
M
i
n
e
ra
l
N
u
t
ri
t
i
o
n
In
fo
r
m
at
i
o
n
S
y
s
t
e
m,
E
d
i
t
o
r
2
0
1
1
,
W
H
O
:
G
en
eva
.
p
.
2
-
5.
[2
].
K
h
u
s
u
n
,
H
.
,
e
t
al
.
,
W
o
rl
d
H
e
a
l
t
h
O
rg
an
i
zat
i
o
n
H
emo
g
l
o
b
i
n
Cu
t
-
O
ff
Po
i
n
t
s
fo
r
t
h
e
D
e
t
ec
t
i
o
n
o
f
A
n
em
i
a
A
r
e
V
al
i
d
f
o
r
an
I
n
d
o
n
e
s
i
an
P
o
p
u
l
at
i
o
n
.
Th
e
Jo
u
r
n
a
l
o
f
Nu
t
r
i
t
i
o
n
,
1
9
9
9
.
1
2
9
(9
):
p
.
1
6
6
9
-
1
6
7
4
.
[3
].
W
H
O
,
Mi
c
r
o
n
u
t
ri
e
n
t
D
e
fi
ci
e
n
ci
e
s
:
Pr
e
v
en
t
i
o
n
an
d
C
o
n
t
r
o
l
G
u
i
d
e
l
i
n
e
s
,
W
o
rl
d
H
e
a
l
t
h
O
rg
an
i
zat
i
o
n
,
2
0
1
5
,
W
o
r
l
d
H
ea
l
t
h
O
r
g
a
n
i
z
a
t
i
o
n
:
G
en
eva
,
Sw
i
t
z
e
rl
a
n
d
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
S
N
:
2252
-
8806
I
n
t
.
J
.
P
ubl
i
c
He
a
l
t
h
S
c
i
.
Vo
l
.
8
,
N
o
.
2
,
J
un
e
201
9
:
20
2
–
2
10
210
[4
].
L
i
m
SS,
V
.
T
.
a
n
d
Fl
ax
m
an
A
D
e
t
a
l
.
,
A
c
o
m
p
arat
i
v
e
ri
s
k
as
s
e
s
s
me
n
t
o
f
b
u
r
d
e
n
o
f
d
i
s
e
as
e
a
n
d
i
n
j
u
r
y
at
t
ri
b
u
t
ab
l
e
t
o
6
7
ri
s
k
fac
t
o
rs
a
n
d
r
i
s
k
fa
c
t
o
r
c
l
u
s
t
e
rs
i
n
2
1
reg
i
o
n
s
,
1
9
9
0
–
2
0
1
0
:
a
s
y
s
t
em
at
i
c
an
a
l
y
s
i
s
fo
r
t
h
e
G
l
o
b
al
Bu
r
d
e
n
o
f
D
i
s
e
as
e
St
u
d
y
2
0
1
0
Th
e
La
n
cet
,
2
0
1
2
.
3
8
0
:
p
.
2
2
2
4
-
2
2
6
0
.
[5
].
N
o
ro
n
h
a
J
A
.
,
e
t
al
.
,
A
n
em
i
a
i
n
p
reg
n
a
n
cy
a
n
d
c
h
a
l
l
en
g
e
s
.
Jo
u
r
n
a
l
o
f
S
o
u
t
h
A
s
i
a
n
F
ed
er
a
t
i
o
n
o
f
O
b
s
t
e
t
r
i
c
s
a
n
d
G
yn
eco
l
o
g
y
,
4
(
1
):
6
4
-
70
.
2
0
1
2
.
[6
].
W
o
rl
d
H
e
al
t
h
o
rg
a
n
i
zat
i
o
n
(W
H
O
),
W
H
A
G
l
o
b
al
N
u
t
ri
t
i
o
n
T
arg
e
t
s
2
0
2
5
:
A
n
a
emi
a
P
o
l
i
cy
Bri
e
f,
N
u
t
ri
t
i
o
n
,
E
d
i
t
o
r
2
0
1
1
:
G
en
eva
.
[7
].
W
o
rl
d
H
e
a
l
t
h
O
rg
an
i
zat
i
o
n
(
W
H
O
)
an
d
F
o
o
d
an
d
A
g
r
i
cu
l
t
u
r
e
O
rg
a
n
i
zat
i
o
n
o
f
t
h
e
U
n
i
t
e
d
N
at
i
o
n
s
(FA
O
),
D
ri
v
i
n
g
c
o
mmi
t
men
t
fo
r
n
u
t
ri
t
i
o
n
w
i
t
h
i
n
t
h
e
U
N
D
ec
a
d
e
o
f
A
c
t
i
o
n
o
n
N
u
t
ri
t
i
o
n
:
p
o
l
i
cy
b
ri
e
f.
G
en
e
v
a
:
W
o
r
l
d
H
e
a
l
t
h
O
rg
an
i
zat
i
o
n
;
(W
H
O
/
N
MH
/
N
H
D
/
1
7
.
1
1
).
,
Nu
t
r
i
t
i
o
n
,
E
d
i
t
o
r
2
0
1
8
.
p
.
5
-
2
0
.
[8
].
E
n
d
a
n
g
,
e
t
al
.
,
G
l
o
b
al
N
u
t
ri
t
i
o
n
R
e
p
o
rt
A
c
t
i
o
n
a
n
d
a
c
co
u
n
t
ab
i
l
i
t
y
i
n
G
l
o
b
al
N
u
t
ri
t
i
o
n
R
e
p
o
rt
2
0
1
4
.
p
.
2
0
-
40.
[9
].
Bh
u
t
t
a,
Z
.
,
e
t
al
.
,
E
v
i
d
en
ce
-
b
as
e
d
i
n
t
e
rv
en
t
i
o
n
s
fo
r
i
m
p
ro
v
eme
n
t
o
f
m
at
e
r
n
al
a
n
d
c
h
i
l
d
n
u
t
ri
t
i
o
n
:
w
h
at
c
a
n
b
e
d
o
n
e
an
d
at
w
h
at
co
s
t
?
Mat
e
rn
a
l
an
d
C
h
i
l
d
N
u
t
ri
t
i
o
n
,
2
0
1
3
.
2
:
p
.
1
-
15.
[1
0
].
T
h
e
l
a
n
ce
t
,
Mat
e
rn
a
l
an
d
Ch
i
l
d
N
u
t
ri
t
i
o
n
E
x
ecu
t
i
v
e
S
u
mm
ar
y
o
f
T
h
e
L
a
n
ce
t
Mat
e
rn
a
l
an
d
C
h
i
l
d
N
u
t
ri
t
i
o
n
Se
ri
e
s
:
E
x
ec
u
t
i
v
e
s
u
mm
ar
y
.
Th
e
La
n
cet
.
,
2
0
1
3
:
p
.
2
-
5.
[1
1
].
T
ay
,
K
.
,
E
.
A
g
b
o
l
i
,
an
d
W
.
W
al
a
n
a,
Ma
l
ari
a
a
n
d
a
n
em
i
a
i
n
p
r
e
g
n
an
t
an
d
n
o
n
-
p
r
e
g
n
an
t
w
o
me
n
o
f
c
h
i
l
d
-
b
e
ar
i
n
g
ag
e
at
t
h
e
U
n
i
v
e
rs
i
t
y
H
o
s
p
i
t
al
,
K
u
m
as
i
,
G
h
an
a
.
O
p
en
Jo
u
r
n
a
l
o
f
M
ed
i
c
a
l
M
i
c
r
o
b
i
o
l
o
g
y
,
2
0
1
3
(3
):
p
.
1
9
3
-
2
0
0
.
[1
2
].
Ch
an
g
,
S.
,
e
t
a
l
.
,
E
ff
ec
t
o
f
I
ro
n
D
e
fi
ci
e
n
cy
A
n
emi
a
i
n
Pr
e
g
n
an
cy
o
n
Ch
i
l
d
M
en
t
al
D
e
v
el
o
p
me
n
t
i
n
Ru
ra
l
Ch
i
n
a.
P
ed
i
a
t
r
i
cs
,
2
0
1
3
.
1
3
1
(3
):
p
.
e
7
5
5
-
e
7
6
3
.
[1
3
].
J
ac
k
F.
,
A
g
o
s
t
i
n
o
D
.
,
a
n
d
S
u
n
u
n
t
n
as
u
k
,
N
u
t
ri
t
i
o
n
t
ec
h
n
i
cal
b
ri
e
f
:
A
s
i
m
p
l
e
me
t
h
o
d
f
o
r
m
a
k
i
n
g
a
rap
i
d
,
i
n
i
t
i
al
as
s
e
s
s
m
en
t
o
f
t
h
e
co
n
s
u
m
p
t
i
o
n
an
d
d
i
s
t
ri
b
u
t
i
o
n
o
f
i
ro
n
-
fo
l
i
c
a
ci
d
s
u
p
p
l
eme
n
t
s
amo
n
g
p
reg
n
a
n
t
w
o
men
i
n
d
e
v
el
o
p
i
n
g
C
o
u
n
t
ri
e
s
,
U
.
S.
Part
n
e
rs
h
i
p
s
,
E
d
i
t
o
r
2
0
1
4
.
[1
4
].
G
u
e
d
en
o
n
K
M,
e
t
al
.
,
K
n
o
w
l
e
d
g
e
,
at
t
i
t
u
d
e
an
d
p
ra
c
t
i
ce
o
f
t
h
e
mo
t
h
e
rs
w
i
t
h
an
emi
a
o
f
c
h
i
l
d
r
e
n
u
n
d
e
r
f
i
v
e
y
e
ars
o
l
d
i
n
t
h
e
p
e
ad
i
at
ri
c
d
e
p
art
men
t
at
S
y
l
v
an
u
s
O
l
y
m
p
i
o
t
e
a
ch
i
n
g
h
o
s
p
i
t
al
i
n
L
o
m
é.
Tu
n
i
s
M
ed
.
,
2
0
1
6
.
9
4
(
1
):
p
.
4
6
-
5
3
.
[1
5
].
Mo
h
a
mme
d
M
A
,
A
.
J
.
,
B
u
s
h
ra
A
W
,
A
l
j
ad
h
ey
H
S.
M
e
d
i
c
at
i
o
n
s
u
s
e
a
m
o
n
g
p
r
e
g
n
an
t
w
o
men
i
n
E
t
h
i
o
p
i
a:
A
c
ro
s
s
s
e
c
t
i
o
n
a
l
s
t
u
d
y
.
Jo
u
r
n
a
l
o
f
A
p
p
l
i
ed
P
h
a
r
m
a
ce
u
t
i
ca
l
S
ci
e
n
ce
,
2
0
1
3
;
3
(0
4
):
1
1
6
-
1
2
3
.
[1
6
].
W
o
rl
d
H
e
a
l
t
h
o
r
g
an
i
zat
i
o
n
(W
H
O
),
T
h
e
G
l
o
b
al
p
re
v
a
l
en
ce
o
f
an
emi
a
i
n
2
0
1
1
,
N
u
t
ri
t
i
o
n
,
E
d
i
t
o
r
2
0
1
5
,
W
o
r
l
d
H
ea
l
t
h
O
r
g
a
n
i
z
a
t
i
o
n
:
G
en
eva
.
[1
7
.
E
D
H
S,
E
t
h
i
o
p
i
a
M
i
n
i
D
em
o
g
rap
h
i
c
a
n
d
H
e
al
t
h
S
u
rv
ey
i
n
E
t
h
i
o
p
i
a
D
emo
g
rap
h
i
c
an
d
H
e
a
l
t
h
Su
r
v
ey
I
.
i
n
t
e
r
n
at
i
o
n
al
,
E
d
i
t
o
r
2
0
1
4
,
Ce
n
t
ral
St
at
i
s
t
i
c
al
A
g
e
n
cy
A
d
d
i
s
A
b
ab
a,
E
t
h
i
o
p
i
a
p
.
5
3
-
58.
[1
8
].
L
e
a
l
em
G
ed
e
fa
w
,
e
t
al
.
,
A
n
emi
a
an
d
A
s
s
o
ci
at
ed
Fa
c
t
o
rs
A
mo
n
g
Pr
e
g
n
an
t
W
o
men
A
t
t
en
d
i
n
g
A
n
t
en
at
al
Care
C
l
i
n
i
c
i
n
W
o
l
a
y
i
t
a
S
o
d
o
T
o
w
n
,
S
o
u
t
h
e
r
n
E
t
h
i
o
p
i
a.
E
t
h
i
o
p
J
H
ea
l
t
h
S
ci
.
,
2
0
1
5
2
5
(
2
):
p
.
1
5
5
-
1
6
2
.
[1
9
].
G
e
b
reme
d
h
i
n
S,
E
n
q
u
s
el
as
s
i
e
F,
an
d
U
me
t
a
M,
Pr
e
v
al
en
ce
an
d
co
rr
e
l
at
e
s
o
f
m
at
e
rn
a
l
an
emi
a
i
n
r
u
ra
l
Si
d
a
m
a,
So
u
t
h
e
r
n
E
t
h
i
o
p
i
a
.
A
f
r
i
ca
n
j
o
u
r
n
a
l
o
f
r
e
p
r
o
d
u
ct
i
ve
h
e
a
l
t
h
,
2
0
1
4
.
1
8
(1
):
p
.
4
4
-
53.
[2
0
].
J
u
far
A
H
an
d
Z
ew
d
e
T
,
Prev
al
en
ce
o
f
an
emi
a
a
m
o
n
g
p
re
g
n
a
n
t
w
o
m
en
at
t
e
n
d
i
n
g
an
t
e
n
at
al
c
ar
e
at
T
i
k
u
r
A
n
b
e
s
s
a
s
p
e
c
i
a
l
i
z
ed
h
o
s
p
i
t
al
,
A
d
d
i
s
A
b
ab
a
E
t
h
i
o
p
i
a.
Jo
u
r
n
a
l
o
f
H
em
a
t
o
l
o
g
y
&
Th
r
o
m
b
o
em
b
o
l
i
c
D
i
s
e
a
s
e
s
.
,
2
0
1
4
.
2
(
1
2
5
)
.
[2
1
].
L
e
b
s
o
M,
A
n
at
o
A
,
an
d
L
o
h
a
E
,
Pr
ev
al
en
ce
o
f
an
emi
a
an
d
as
s
o
c
i
at
e
d
fa
c
t
o
rs
a
mo
n
g
p
reg
n
a
n
t
w
o
men
i
n
S
o
u
t
h
e
rn
E
t
h
i
o
p
i
a
:
A
c
o
mmu
n
i
t
y
b
as
ed
c
ro
s
s
-
s
ec
t
i
o
n
al
s
t
u
d
y
.
P
l
o
S
o
n
e
,
2
0
1
7
.
1
2
(
1
2
).
[2
2
].
H
arari
R
eg
i
o
n
St
at
i
s
t
i
c
s
,
H
arari
R
e
g
i
o
n
al
s
t
at
i
s
t
i
c
s
:
A
p
o
p
u
l
at
i
o
n
p
ro
j
ec
t
i
o
n
fr
o
m
cen
s
u
s
2
0
0
7
,
2
0
1
5
:
H
arar.
p
.
0
5
-
1
7
.
[2
3
].
Maj
Si
v
ap
ri
y
a
S
.
an
d
L
ax
m
i
p
ri
y
a
P.
,
St
u
d
y
t
o
A
s
s
e
s
s
t
h
e
K
n
o
w
l
e
d
g
e
an
d
Pra
c
t
i
ce
s
R
e
g
a
rd
i
n
g
Pr
ev
e
n
t
i
o
n
o
f
A
n
aem
i
a
am
o
n
g
A
n
t
en
at
al
W
o
men
A
t
t
e
n
d
i
n
g
a
T
e
rt
i
ar
y
L
ev
e
l
H
o
s
p
i
t
al
i
n
Pu
n
e
,
In
t
er
n
a
t
i
o
n
a
l
Jo
u
r
n
a
l
o
f
S
c
i
en
ce
a
n
d
R
es
ea
r
c
h
(I
J
SR),
2
0
1
5
.
4
(3
).
[2
4
].
G
aw
d
e
SR
,
B.
S.
,
Pat
e
l
T
C.
D
r
u
g
u
t
i
l
i
zat
i
o
n
p
at
t
e
rn
i
n
p
r
e
g
n
an
t
w
o
me
n
at
t
en
d
i
n
g
an
t
en
at
al
o
u
t
Pat
i
en
t
D
e
p
art
m
en
t
o
f
a
t
e
rt
i
ar
y
c
ar
e
h
o
s
p
i
t
al
.
Br
i
t
i
s
h
j
o
u
r
n
a
l
o
f
p
h
a
r
m
a
ceu
t
i
c
a
l
r
es
e
a
r
c
h
,
2
0
1
3
;
3
(1
):
2
2
3
1
-
2
9
1
9
.
[2
5
].
A
m
an
i
W
al
eed
M.
,
I
r
o
n
D
e
fi
ci
e
n
cy
A
n
em
i
a
a
mo
n
g
P
re
g
n
an
t
W
o
me
n
i
n
N
ab
l
u
s
D
i
s
t
ri
c
t
;
Prev
al
en
ce
,
K
n
o
w
l
ed
g
e,
A
t
t
i
t
u
d
e
an
d
Pra
c
t
i
ce
s
,
at
An
-
N
a
j
ah
N
at
i
o
n
al
U
n
i
v
e
rs
i
t
y
,
N
ab
l
u
s
,
Pa
l
e
s
t
i
n
e
,
.
2
0
0
7
.
[2
6
].
Fre
d
a
n
n
a
A
D
.
,
C
o
r
m
a
c
k
M
.
,
a
n
d
J
u
d
y
C
D
,
A
s
s
e
s
s
men
t
o
f
A
n
em
i
a
K
n
o
w
l
e
d
g
e
,
A
t
t
i
t
u
d
e
s
an
d
B
e
h
a
v
i
o
rs
A
mo
n
g
Pre
g
n
an
t
W
o
m
en
i
n
S
i
e
rra
L
eo
n
e.
2
0
1
2
.
4
4
(2
).
[2
7
].
W
el
d
ek
i
d
an
,
F.
,
e
t
a
l
.
,
D
e
t
e
r
m
i
n
an
t
s
o
f
A
n
em
i
a
a
mo
n
g
Pre
g
n
an
t
W
o
men
A
t
t
e
n
d
i
n
g
A
n
t
en
at
al
C
l
i
n
i
c
i
n
P
u
b
l
i
c
H
e
a
l
t
h
Fac
i
l
i
t
i
e
s
at
D
u
ra
me
T
o
w
n
:
U
n
m
at
ch
e
d
Cas
e
C
o
n
t
ro
l
St
u
d
y
.
A
n
em
i
a
,
2
0
1
8
.
2
0
1
8
:
p
.
8
.
[2
8
].
H
u
s
s
ai
n
T
an
d
Sh
u
L
Y
,
A
w
ar
en
e
s
s
o
f
i
ro
n
d
e
fi
ci
e
n
cy
a
n
emi
a
a
m
o
n
g
w
o
me
n
o
f
re
p
ro
d
u
c
t
i
v
e
ag
e
i
n
H
u
b
ei
p
ro
v
i
n
ce,
Ch
i
n
a.
A
s
i
a
n
J
M
ed
S
ci
2
0
1
0
.
1
:
p
.
1
2
-
1
3
.
[2
9
].
A
l
i
n
a,
D
.
P
.
,
e
t
al
.
,
N
u
t
ri
t
i
o
n
a
l
k
n
o
w
l
e
d
g
e
as
a
d
e
t
e
r
m
i
n
a
n
t
o
f
v
i
t
a
m
i
n
an
d
mi
n
e
ra
l
s
u
p
p
l
eme
n
t
at
i
o
n
d
u
ri
n
g
p
reg
n
an
cy
.
B
M
C
P
u
b
l
i
c
H
ea
l
t
h
.
2
0
1
3
.
1
3
(1
1
0
5
).
[3
0
].
K
en
e
n
i
B
e
rh
a
n
u
,
D
.
,
J
a
y
a
n
t
h
i
g
o
p
al
,
a
n
d
D
.
D
e
r
ej
e
Ba
y
i
s
s
a,
A
s
s
e
s
s
me
n
t
o
f
K
n
o
w
l
ed
g
e
a
n
d
Pra
c
t
i
ce
T
o
w
ar
d
s
Pre
v
en
t
i
o
n
o
f
A
n
em
i
a
A
mo
n
g
Pr
eg
n
a
n
t
W
o
me
n
A
t
t
en
d
i
n
g
A
n
t
e
n
at
al
Car
e
at
G
o
v
e
rn
men
t
H
o
s
p
i
t
al
s
i
n
W
e
s
t
Sh
o
a
Z
o
n
e
,
E
t
h
i
o
p
i
a
Jo
u
r
n
a
l
o
f
H
ea
l
t
h
,
M
ed
i
c
i
n
e
a
n
d
N
u
r
s
i
n
g
2
0
1
8
5
0
(3
1
):
p
.
3
1
-
40.
Evaluation Warning : The document was created with Spire.PDF for Python.