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tem
is
in
e
P
ip
era
q
u
in
e
(
DHP)
th
er
a
p
y
.
Alth
o
u
g
h
th
e
im
p
lem
en
tati
o
n
o
f
t
h
is
p
r
o
g
r
am
h
as
b
ee
n
f
ac
ilit
ated
b
y
m
i
d
wiv
es
,
th
e
ac
h
iev
em
e
n
t
is
s
till
s
u
b
o
p
tim
al,
with
lo
w
ac
ce
s
s
to
an
ten
atal
ca
r
e
(
ANC
)
s
er
v
ices
(
5
0
%),
r
ed
u
ce
d
s
cr
ee
n
in
g
co
v
e
r
ag
e
(
2
4
.
7
%),
a
n
d
d
e
cr
e
ased
u
s
e
o
f
m
o
s
q
u
ito
n
ets
(
7
0
.
3%
)
.
T
h
is
s
h
o
ws
th
e
n
ee
d
to
id
en
tify
th
e
r
o
le
o
f
m
id
wiv
e
s
in
im
p
lem
en
tin
g
MCH
to
p
r
ev
en
t
an
d
m
a
n
ag
e
m
alar
ia
ca
s
es,
p
ar
ticu
lar
ly
in
p
r
eg
n
an
t w
o
m
e
n
.
Sev
er
al
s
tu
d
ies
h
av
e
f
o
cu
s
ed
o
n
p
r
ev
en
tin
g
m
alar
ia
in
p
r
eg
n
an
t
wo
m
e
n
g
lo
b
ally
ac
c
o
r
d
in
g
to
W
HO
r
ec
o
m
m
en
d
atio
n
s
b
y
m
a
x
im
iz
in
g
th
e
u
s
e
o
f
in
s
ec
ticid
e
n
ets
an
d
S
u
lfa
d
o
xin
e
P
yrimeth
a
mi
n
e
(
SP
)
[
1
1
]
,
[
1
2
]
.
Ho
wev
er
,
in
I
n
d
o
n
esia,
o
n
ly
a
f
ew
in
v
esti
g
atio
n
s
h
av
e
b
ee
n
ca
r
r
ied
o
u
t,
e
x
p
lo
r
in
g
th
e
u
s
e
o
f
s
in
g
le
s
cr
ee
n
in
g
an
d
tr
ea
tm
en
t
as
a
n
in
ef
f
ec
tiv
e
m
eth
o
d
o
f
p
r
ev
en
tio
n
[
1
3
]
.
An
o
th
er
s
tu
d
y
ex
a
m
in
ed
th
e
a
ttit
u
d
es
o
f
h
ea
lth
wo
r
k
er
s
an
d
p
r
e
g
n
an
t
wo
m
en
,
s
h
o
win
g
co
n
ce
r
n
r
eg
a
r
d
in
g
th
e
av
ailab
ilit
y
o
f
r
ap
id
d
iag
n
o
s
tic
test
s
(
R
DT
s
)
as
a
m
alar
ia
s
cr
ee
n
in
g
to
o
l.
M
o
r
eo
v
e
r
,
p
r
eg
n
an
t
wo
m
e
n
wer
e
o
b
s
er
v
ed
to
r
ec
eiv
e
co
m
p
r
eh
en
s
iv
e
s
er
v
ices,
in
clu
d
in
g
an
tim
alar
ial
tr
e
atm
e
nt
f
o
r
s
elf
-
p
r
o
tectio
n
an
d
f
e
tu
s
es
f
r
o
m
i
n
f
ec
tio
n
[
1
4
]
.
H
o
wev
er
,
n
o
s
p
ec
if
ic
r
ep
o
r
ts
h
av
e
ex
p
lain
e
d
th
e
ex
t
en
t o
f
th
e
r
o
le
o
f
m
id
wiv
es in
p
r
ev
en
ti
n
g
m
alar
ia
am
o
n
g
p
r
e
g
n
an
t w
o
m
e
n
.
Mid
wiv
es
ar
e
ess
en
tial
h
ea
lth
c
ar
e
p
r
o
v
id
er
s
,
p
lay
in
g
a
cr
u
cial
r
o
le
i
n
p
r
o
v
id
i
n
g
p
r
en
atal
ca
r
e
,
ass
is
tin
g
with
ch
ild
b
ir
th
,
a
n
d
o
f
f
e
r
in
g
p
o
s
tn
atal
s
u
p
p
o
r
t
to
m
o
t
h
er
s
an
d
in
f
a
n
ts
,
p
a
r
ticu
lar
ly
in
r
em
o
t
e
ar
ea
s
wh
e
r
e
ac
ce
s
s
to
h
ea
lth
ca
r
e
f
ac
ilit
ies
is
lim
it
ed
.
T
o
en
h
a
n
ce
th
e
c
o
v
er
a
g
e
o
f
in
teg
r
ated
MCH
s
er
v
ices
in
m
alar
ia
-
en
d
em
ic
r
eg
io
n
s
,
m
id
wiv
es
n
ee
d
to
u
n
d
er
s
tan
d
th
e
n
u
an
ce
s
o
f
th
e
p
r
o
g
r
am
[
1
5
]
,
[
1
6
]
.
T
h
e
r
ef
o
r
e
,
th
is
s
tu
d
y
aim
e
d
to
ex
p
lo
r
e
th
e
r
o
le
o
f
m
i
d
wiv
es
p
r
o
v
i
d
in
g
a
n
ten
atal
ca
r
e
s
er
v
ices
in
th
e
im
p
lem
en
tatio
n
o
f
in
teg
r
ate
d
MCH
s
er
v
ices
in
h
ig
h
m
alar
ia
-
en
d
e
m
ic
ar
ea
s
to
p
r
ev
en
t
m
alar
ia
in
p
r
eg
n
a
n
t
wo
m
en
.
T
h
e
r
esu
lts
wer
e
ex
p
ec
ted
to
p
r
o
v
id
e
v
alu
ab
le
i
n
f
o
r
m
atio
n
to
d
ev
elo
p
co
m
p
lem
e
n
tar
y
p
r
o
g
r
am
s
ca
p
ab
le
o
f
im
p
r
o
v
i
n
g
th
e
im
p
lem
en
tatio
n
o
f
in
teg
r
ated
MCH
s
er
v
ices,
as
well
as
p
r
ev
e
n
tin
g
m
alar
ia
am
o
n
g
v
u
ln
e
r
ab
le
p
o
p
u
latio
n
s
,
p
a
r
ticu
lar
ly
p
r
eg
n
a
n
t
wo
m
en
an
d
ch
ild
r
e
n
u
n
d
er
f
i
v
e.
2.
M
E
T
H
O
D
2
.
1
.
Study
l
o
c
a
t
io
n
T
h
e
s
tu
d
y
was
co
n
d
u
cted
b
etwe
en
b
etwe
en
J
u
ly
to
Sep
tem
b
er
of
2
0
2
3
,
in
So
u
th
-
west
Su
m
b
a,
a
d
is
tr
ict
with
a
h
ig
h
p
r
ev
ale
n
ce
o
f
m
alar
ia.
T
h
is
lo
ca
tio
n
was
d
et
er
m
in
ed
p
u
r
p
o
s
ef
u
lly
,
h
av
in
g
a
to
tal
o
f
elev
en
s
u
b
d
is
tr
icts
an
d
1
2
co
m
m
u
n
ity
h
ea
lth
ce
n
ter
s
.
Am
o
n
g
th
es
e
s
u
b
d
is
tr
icts
,
No
r
th
Ko
d
i
d
is
t
r
ict
was
r
ep
o
r
ted
to
h
av
e
th
e
h
ig
h
est
m
alar
ia
in
cid
en
ce
in
2
0
2
1
,
with
2
1
v
illag
es,
two
g
o
v
er
n
m
en
t
-
o
wn
ed
,
a
n
d
o
n
e
p
r
iv
ate
h
ea
lth
ce
n
ter
.
T
h
e
two
C
o
m
m
u
n
ity
H
ea
lth
C
en
ter
s
in
th
e
d
is
tr
icts
,
n
am
ely
Ko
r
i
a
n
d
B
illacen
g
e
h
av
e
v
er
y
lo
w
co
v
er
ag
e
f
o
r
th
e
f
ir
s
t
ANC
v
is
it.
T
h
er
ef
o
r
e,
No
r
th
K
o
d
i
d
is
tr
ict
was
s
elec
ted
as
th
e
s
tu
d
y
lo
ca
tio
n
d
u
e
to
its
ex
ten
s
iv
e
m
alar
ia
p
r
e
v
alen
ce
a
n
d
ce
n
tr
al
So
u
th
-
west
Su
m
b
a
,
with
an
A
n
n
u
al
P
ar
asit
e
I
n
cid
en
ce
(
API
)
o
f
1
1
.
9
6
p
er
1
,
0
0
0
in
h
ab
itan
ts
in
2
0
2
1
.
Acc
o
r
d
i
n
g
to
th
e
I
n
d
o
n
esian
Min
is
tr
y
o
f
Hea
lth
class
if
i
ca
tio
n
,
an
API
g
r
ea
ter
th
a
n
f
iv
e
is
co
n
s
id
er
ed
h
ig
h
e
n
d
em
ic.
A
d
d
itio
n
ally
,
th
er
e
wer
e
1
6
ca
s
es
o
f
m
alar
ia
r
ep
o
r
ted
i
n
p
r
e
g
n
an
t
wo
m
en
,
ac
co
u
n
tin
g
f
o
r
2
7
.
5
%
o
f
ca
s
es
in
th
e
So
u
t
h
-
west
Su
m
b
a
R
eg
en
cy
T
h
is
s
u
b
-
d
is
tr
ict
h
as
th
e
lar
g
est
ar
ea
,
with
2
4
3
.
8
2
s
q
u
ar
e
k
ilo
m
eter
s
,
an
d
ele
v
atio
n
r
an
g
i
n
g
f
r
o
m
0
to
3
0
0
m
eter
s
ab
o
v
e
s
ea
lev
el
.
T
h
e
wid
e
an
d
h
ig
h
al
titu
d
e
o
f
th
e
No
r
t
h
Ko
d
i
d
is
tr
ict
is
a
s
u
itab
le
h
a
b
it
at
f
o
r
th
e
d
ev
el
o
p
m
en
t
o
f
m
ala
r
ia.
T
h
e
ab
u
n
d
a
n
ce
o
f
API
an
d
th
e
h
ig
h
p
r
ev
alen
ce
o
f
m
alar
ia
a
m
o
n
g
p
r
eg
n
a
n
t
wo
m
en
h
a
v
e
p
r
o
m
p
te
d
th
e
r
eg
io
n
al
g
o
v
er
n
m
en
t,
s
p
ec
if
ically
th
e
So
u
th
-
west
Su
m
b
a
Dis
tr
ict
Hea
lth
Ser
v
ice,
to
p
r
io
r
itize
th
e
m
alar
ia
elim
in
atio
n
p
r
o
g
r
am
.
T
h
er
ef
o
r
e
,
in
No
v
e
m
b
er
2
0
2
0
,
th
is
s
u
b
-
d
is
tr
ict
b
ec
am
e
th
e
f
ir
s
t to
s
o
c
ialize
with
th
e
p
r
o
g
r
am
.
2
.
2
.
Study
p
a
rt
icipa
nt
Par
ticip
an
ts
wer
e
d
elib
er
ately
s
elec
ted
to
in
v
esti
g
ate
th
e
s
p
ec
if
ic
asp
ec
ts
o
f
h
o
w
m
id
wiv
es
c
an
p
r
ev
e
n
t
m
alar
ia
in
p
r
eg
n
an
t
wo
m
e
n
.
T
h
e
in
clu
s
io
n
cr
iter
ia
wer
e
d
eter
m
in
ed
b
ased
o
n
d
is
cu
s
s
io
n
s
with
p
o
licy
m
ak
er
s
,
m
alar
ia
s
p
ec
ialis
ts
,
an
d
p
u
b
lic
h
ea
lth
ex
p
er
ts
.
T
h
ese
in
clu
d
e
d
d
ir
ec
t
en
g
a
g
em
en
t
in
in
teg
r
a
ted
MCH
s
er
v
ices,
s
er
v
in
g
in
t
h
e
No
r
t
h
Ko
d
i
d
is
tr
ict
wo
r
k
r
eg
io
n
,
as
well
as
an
ten
atal
ca
r
e
an
d
m
alar
ia
s
er
v
ic
es.
T
h
is
s
tu
d
y
also
in
clu
d
ed
all
m
id
wiv
es,
c
o
n
s
is
tin
g
o
f
2
0
p
a
r
ticip
an
ts
in
N
o
r
th
K
o
d
i
Dis
tr
ict,
with
th
eir
ch
ar
a
cter
is
tics
p
r
esen
ted
in
T
ab
le
1
.
T
a
b
le
1
s
h
o
ws
th
at
th
e
p
a
r
ticip
an
ts
h
av
e
a
d
iv
er
s
e
r
an
g
e
o
f
ch
ar
ac
ter
is
tics
,
with
th
e
m
ajo
r
ity
p
r
im
ar
ily
a
g
ed
b
etwe
en
3
6
an
d
4
5
y
ea
r
s
.
T
h
e
s
e
p
ar
ticip
an
ts
p
o
s
s
ess
ed
a
Dip
lo
m
a
lev
el
o
f
ed
u
ca
tio
n
an
d
h
ad
s
er
v
ed
f
o
r
a
p
er
i
o
d
o
f
5
to
1
0
y
ea
r
s
.
2
.
3
.
Study
des
ig
n
T
h
e
s
tu
d
y
u
s
ed
a
q
u
alitativ
e
m
eth
o
d
,
co
n
s
id
er
e
d
s
u
p
er
io
r
i
n
f
ac
ilit
atin
g
co
m
p
r
eh
en
s
iv
e
ex
p
lo
r
atio
n
o
f
in
d
iv
id
u
als'
ex
p
er
ien
ce
s
a
s
we
ll a
s
in
s
ig
h
ts
in
to
th
eir
v
alu
es,
m
o
tiv
es,
attitu
d
es,
an
d
b
eh
av
i
o
r
s
.
T
h
is
m
eth
o
d
is
h
ig
h
ly
ef
f
icien
t
f
o
r
p
r
o
v
id
in
g
a
m
o
r
e
co
m
p
r
eh
e
n
s
iv
e
an
aly
s
i
s
o
f
a
p
h
e
n
o
m
en
o
n
o
r
ev
en
t
[
1
7
]
.
T
h
er
ef
o
r
e,
th
is
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Th
e
r
o
le
o
f m
id
w
ives in
p
r
ev
en
tin
g
ma
la
r
ia
in
p
r
eg
n
a
n
t
…
(
Dewa
A
yu
P
u
tu
Ma
r
ia
n
a
K
en
ca
n
a
w
a
ti
)
383
s
tu
d
y
was
ca
r
r
ied
o
u
t
to
ex
a
m
in
e
an
d
ac
q
u
ir
e
a
th
o
r
o
u
g
h
co
m
p
r
eh
en
s
io
n
o
f
th
e
v
iewp
o
in
ts
o
f
m
id
wiv
es,
m
alar
i
a
m
an
ag
er
s
,
a
n
d
v
illag
e
m
alar
i
a
in
ter
p
r
eter
s
r
eg
ar
d
i
n
g
in
f
ec
tio
n
s
am
o
n
g
p
r
e
g
n
an
t
wo
m
e
n
.
T
h
e
r
esu
lts
wer
e
ex
p
ec
ted
to
p
r
o
v
id
e
v
alu
ab
le
i
n
f
o
r
m
atio
n
to
m
id
wiv
es
to
u
n
d
er
s
tan
d
t
h
eir
r
o
le
in
p
r
ev
e
n
tin
g
m
alar
ia
an
d
th
e
p
er
ce
iv
ed
d
if
f
icu
lties
d
u
r
i
n
g
t
h
e
im
p
lem
en
t
atio
n
o
f
MCH
s
er
v
ice
s
,
as p
ar
t o
f
g
o
v
e
r
n
m
e
n
t in
itiativ
es.
T
ab
le
1
.
C
h
ar
ac
ter
is
tics
o
f
th
e
s
tu
d
y
p
ar
ticip
an
ts
C
h
a
r
a
c
t
e
r
i
s
t
i
c
s
N
u
mb
e
r
(
p
e
r
so
n
)
A
g
e
25
-
35
8
36
-
45
10
45
-
55
2
>
5
5
0
Ed
u
c
a
t
i
o
n
a
l
l
e
v
e
l
A
sso
c
i
a
t
e
D
e
g
r
e
e
4
B
a
c
h
e
l
o
r
D
e
g
r
e
e
16
H
i
g
h
sc
h
o
o
l
0
Le
n
g
t
h
o
f
s
e
r
v
i
c
e
<
5
y
e
a
r
s
3
5
-
1
0
y
e
a
r
s
9
11
-
1
5
y
e
a
r
s
6
>
1
5
y
e
a
r
s
2
2
.
4
.
Da
t
a
c
o
llect
io
n
I
n
-
d
ep
t
h
in
te
r
v
iew
was c
o
n
d
u
cted
with
m
i
d
wiv
es f
o
r
d
ata
c
o
llectio
n
,
last
in
g
f
o
r
ap
p
r
o
x
im
ately
40
-
50
m
in
u
tes.
T
h
e
d
ata
wer
e
c
o
llected
b
ased
o
n
in
ter
v
iew
g
u
id
e
d
ev
elo
p
ed
f
o
llo
win
g
in
te
g
r
ated
MCH
s
er
v
ice
g
u
id
elin
es
p
u
b
lis
h
ed
b
y
th
e
I
n
d
o
n
esian
Min
is
tr
y
o
f
Hea
lth
in
2
0
1
9
.
Af
ter
th
e
p
r
ep
ar
atio
n
,
th
e
in
ter
v
iew
g
u
id
e
was e
v
alu
ated
to
v
er
if
y
c
o
m
p
l
ian
ce
with
th
e
s
tu
d
y
o
b
jectiv
e
s
.
T
h
e
co
n
ten
t o
f
t
h
is
in
s
tr
u
m
en
t
was v
alid
ated
b
y
Pu
b
lic
h
ea
lth
s
p
ec
ialis
ts
f
r
o
m
th
e
Facu
lty
o
f
Pu
b
lic
Hea
lth
,
Un
iv
er
s
ity
o
f
I
n
d
o
n
esia,
an
d
Ma
lar
ia
s
p
ec
ialis
t
s
f
r
o
m
th
e
I
n
d
o
n
esia
n
Min
is
tr
y
o
f
Hea
lth
.
T
h
ese
s
p
ec
ialis
ts
al
s
o
v
er
if
ied
th
e
in
ter
v
iew
tr
an
s
cr
ip
ts
an
d
id
en
tifie
d
th
e
s
tu
d
y
'
s
th
em
es
,
f
o
llo
wed
b
y
r
ev
is
io
n
an
d
an
o
t
h
er
co
n
s
u
lt
atio
n
.
Af
ter
ap
p
r
o
v
al,
th
is
in
s
t
r
u
m
en
t
was
test
ed
in
o
th
er
C
o
m
m
u
n
ity
Hea
lth
C
en
ter
r
eg
io
n
s
th
at
h
a
d
a
ls
o
b
e
en
in
f
o
r
m
ed
a
b
o
u
t
i
n
teg
r
ated
MCH
s
er
v
ice
.
T
h
e
t
esti
n
g
was
co
n
d
u
cted
by
th
e
W
allan
d
im
u
C
o
m
m
u
n
ity
Hea
lth
C
en
ter
in
Ko
d
i
B
ag
ed
o
Dis
tr
ict.
T
h
e
o
u
tco
m
e
s
wer
e
s
lig
h
tly
m
o
d
if
ied
,
wh
e
r
e
ce
r
tain
ter
m
s
wer
e
s
u
b
s
titu
ted
with
lan
g
u
ag
e
th
at
wa
s
m
o
r
e
wid
ely
u
s
ed
in
th
e
f
ield
.
T
h
e
ex
p
er
im
en
t
r
esu
lts
also
ev
alu
ated
th
e
d
u
r
atio
n
a
n
d
ef
f
ec
tiv
en
ess
o
f
co
n
d
u
ctin
g
in
ter
v
iews.
Af
ter
th
e
m
o
d
if
icatio
n
p
r
o
ce
s
s
,
th
is
s
tu
d
y
f
u
r
th
er
u
s
e
d
th
e
in
s
tr
u
m
en
t
f
o
r
d
ata
co
llectin
g
.
T
h
e
s
tu
d
y
team
in
ter
v
iewe
d
all
p
ar
ticip
an
t
r
eg
ar
d
in
g
th
e
ir
k
n
o
wled
g
e
o
f
m
ala
r
ia
p
r
e
v
en
tio
n
in
p
r
eg
n
a
n
cy
as
well
as
th
e
in
teg
r
ated
MCH
s
er
v
ices.
T
h
e
in
ter
v
iew
g
u
id
e
co
n
tain
e
d
th
r
ee
s
e
ctio
n
s
o
f
q
u
esti
o
n
s
r
eg
ar
d
in
g
,
f
ir
s
t,
m
alar
ia
d
is
ea
s
e,
s
u
ch
as
k
n
o
wled
g
e
o
f
p
ar
t
icip
an
ts
ab
o
u
t
ca
u
s
es,
s
y
m
p
to
m
s
,
an
d
im
p
ac
t
o
n
pr
eg
n
a
n
t
wo
m
en
.
T
h
e
s
ec
o
n
d
q
u
esti
o
n
was
ab
o
u
t
in
teg
r
a
ted
MCH
s
er
v
ice,
co
m
p
r
is
in
g
th
e
p
o
licy
s
u
p
p
ly
lo
g
is
tics
f
o
r
m
alar
ia
elim
in
ati
o
n
p
ar
ticu
lar
ly
f
o
r
p
r
e
g
n
an
t
w
o
m
en
,
th
e
im
p
lem
e
n
tatio
n
in
th
eir
wo
r
k
f
ield
,
an
d
m
alar
ia
wo
r
k
s
h
o
p
f
o
r
m
id
wiv
es.
Mo
r
eo
v
e
r
,
t
h
e
th
i
r
d
q
u
esti
o
n
f
o
cu
s
ed
o
n
th
e
r
o
le
o
f
m
id
wiv
es
in
clu
d
in
g
th
e
ass
es
s
m
en
t o
f
p
r
o
ce
d
u
r
e
s
tan
d
ar
d
s
,
an
d
s
u
p
er
v
is
io
n
.
2
.
5
.
E
t
hica
l
clea
ra
nce
E
th
ical
ap
p
r
o
v
al
was
o
b
tain
ed
f
r
o
m
th
e
Pu
b
lic
Hea
lth
Dep
a
r
tm
en
t
o
f
Un
iv
e
r
s
itas
I
n
d
o
n
es
ia,
E
th
ical
R
esear
ch
C
o
m
m
is
s
io
n
wit
h
th
e
r
eg
is
tr
atio
n
n
u
m
b
er
Ket
-
6
1
8
/UN2
.
F1
0
.
D1
1
/PP
M.
0
0
.
0
2
/2
0
2
3
,
f
o
llo
win
g
th
e
p
r
in
cip
les
o
f
th
e
Helsin
k
i
Dec
l
ar
atio
n
.
I
n
f
o
r
m
ed
co
n
s
en
t
was
o
b
tain
ed
f
r
o
m
all
p
ar
ticip
an
ts
i
n
clu
d
in
g
f
o
r
a
u
d
io
r
ec
o
r
d
in
g
,
an
d
u
s
in
g
ex
ce
r
p
ts
in
p
u
b
licatio
n
s
.
Af
ter
ex
p
lain
i
n
g
th
e
in
ten
tio
n
s
,
ad
v
an
ta
g
es,
an
d
p
o
s
s
ib
le
r
is
k
s
o
f
p
a
r
ticip
atin
g
i
n
th
is
s
tu
d
y
,
i
n
f
o
r
m
e
d
c
o
n
s
en
t
was
ac
q
u
ir
ed
.
Par
ticip
an
ts
h
ad
th
e
f
r
ee
d
o
m
to
d
is
co
n
tin
u
e
th
ei
r
in
clu
s
io
n
at
a
n
y
p
o
in
t
with
o
u
t
f
ac
in
g
an
y
p
e
n
alties.
Ad
d
itio
n
a
lly
,
th
e
r
esu
lt
s
f
r
o
m
th
e
d
ata
o
b
tain
ed
wer
e
f
u
r
th
e
r
an
aly
ze
d
a
n
d
m
ad
e
p
u
b
licly
av
ailab
le.
B
ased
o
n
willin
g
n
ess
to
p
ar
ticip
ate
,
th
e
in
f
o
r
m
e
d
c
o
n
s
en
t
d
o
cu
m
e
n
t
was
r
eq
u
ir
ed
to
b
e
c
o
m
p
leted
b
y
al
l p
ar
ticip
an
ts
.
2
.
6
.
T
rus
t
wo
rt
hin
ess
/
rig
o
r
T
h
e
s
tu
d
y
ass
ess
ed
th
e
tr
u
s
two
r
th
in
ess
an
d
r
eliab
ilit
y
o
f
in
ter
v
iew
d
ata
u
s
in
g
cr
ed
ib
ilit
y
,
tr
an
s
f
er
ab
ilit
y
,
d
e
p
en
d
a
b
ilit
y
,
an
d
c
o
n
f
o
r
m
ab
ilit
y
.
T
h
e
e
x
p
er
ien
ce
o
f
p
ar
ticip
an
ts
wa
s
v
er
if
ied
th
r
o
u
g
h
tr
ian
g
u
latio
n
wh
ich
em
p
h
asize
d
th
e
r
esu
lts
g
en
er
aliza
tio
n
an
d
m
em
b
e
r
-
ch
ec
k
in
g
[
1
8
]
,
[
1
9
]
.
Dep
en
d
a
b
ilit
y
was
en
s
u
r
ed
t
h
r
o
u
g
h
au
d
itin
g
th
e
s
tu
d
y
p
r
o
ce
s
s
,
wh
ile
c
o
n
f
o
r
m
ab
ilit
y
test
in
g
was
co
n
d
u
cte
d
b
y
c
o
m
m
u
n
icatin
g
s
tu
d
y
m
eth
o
d
s
to
th
e
h
ea
d
o
f
th
e
So
u
th
-
west
Su
m
b
a
d
is
tr
ict
h
ea
lth
s
er
v
ice.
T
h
e
s
tu
d
y
was
ca
r
r
ied
o
u
t
b
y
s
elec
tin
g
p
ar
ticip
an
ts
f
r
o
m
th
e
C
o
m
m
u
n
ity
Hea
lth
C
en
ter
in
th
e
No
r
th
Ko
d
i
d
is
tr
ict
ar
ea
to
o
b
tain
th
e
r
e
q
u
ir
ed
Evaluation Warning : The document was created with Spire.PDF for Python.
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2
5
2
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8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
4
,
No
.
1
,
Ma
r
ch
20
2
5
:
3
8
1
-
390
384
d
ata.
Me
m
b
er
ch
ec
k
i
n
g
was
u
s
ed
to
en
s
u
r
e
co
n
f
o
r
m
ity
,
a
n
d
clar
if
icatio
n
was
co
n
d
u
cte
d
with
p
ar
ticip
an
ts
r
eg
ar
d
in
g
th
e
tr
an
s
cr
ip
t.
Su
b
s
eq
u
en
tly
,
tr
ian
g
u
latio
n
was
u
s
ed
,
in
clu
d
in
g
th
e
h
ea
d
o
f
t
h
e
co
m
m
u
n
ity
h
ea
lth
ce
n
ter
in
No
r
th
Ko
d
i
Dis
tr
ict
an
d
th
e
m
alar
ia
p
r
o
g
r
am
m
a
n
ag
er
at
th
e
d
is
tr
ict
lev
el,
to
v
a
lid
ate
th
e
d
ata
an
d
en
s
u
r
e
r
eliab
ilit
y
f
o
r
f
u
r
th
er
a
n
aly
s
is
.
2
.
7
.
Da
t
a
a
na
ly
s
is
T
h
e
in
ter
v
iew
r
esu
lts
wer
e
ev
alu
ated
th
em
atica
lly
an
d
all
s
ess
io
n
s
wer
e
r
ec
o
r
d
ed
d
ig
itally
,
f
o
llo
wed
b
y
v
er
b
atim
tr
a
n
s
cr
ip
t
io
n
.
Su
b
s
eq
u
en
tly
,
th
e
ac
cu
r
ac
y
an
d
r
eliab
ilit
y
o
f
in
ter
v
iew
r
esu
lts
wer
e
co
n
f
ir
m
ed
th
r
o
u
g
h
a
p
r
o
ce
s
s
o
f
v
alid
atio
n
with
p
ar
ticip
a
n
ts
(
m
em
b
e
r
c
h
ec
k
)
.
Af
te
r
r
ea
ch
i
n
g
a
m
u
tu
a
l
u
n
d
er
s
tan
d
i
n
g
o
f
th
e
g
iv
en
i
n
f
o
r
m
atio
n
,
a
tr
a
n
s
cr
ip
t
was
cr
ea
ted
in
I
n
d
o
n
esian
.
T
h
e
a
n
s
wer
s
wer
e
ass
ig
n
ed
a
co
d
e
b
ased
o
n
th
e
p
ar
ticip
an
t'
s
p
r
o
v
is
io
n
,
f
o
llo
wed
b
y
th
e
ap
p
licatio
n
o
f
an
a
n
aly
tical
f
r
am
ewo
r
k
f
o
r
th
e
d
ata
o
b
tain
ed
with
a
p
r
ed
eter
m
in
e
d
co
d
e
in
ea
ch
q
u
esti
o
n
s
ec
tio
n
ac
co
r
d
i
n
g
t
o
th
e
in
ter
v
iew
g
u
id
e
.
R
ec
en
t
id
ea
s
t
h
at
o
cc
u
r
r
e
d
d
u
r
in
g
th
e
in
ter
v
iew
p
r
o
ce
s
s
wer
e
als
o
co
n
s
id
er
ed
,
wh
ile
th
e
d
ata
wer
e
f
u
r
th
er
an
aly
ze
d
b
y
r
ea
d
i
n
g
an
d
r
e
-
r
ea
d
i
n
g
th
e
tr
an
s
cr
ip
ts
to
id
en
tify
co
n
ce
p
ts
an
d
m
ain
is
s
u
es
r
elate
d
to
th
e
o
b
jectiv
es
an
d
f
r
a
m
ewo
r
k
o
f
t
h
e
s
tu
d
y
.
Nu
m
e
r
ical
co
d
es
wer
e
ass
ig
n
ed
f
o
r
ea
c
h
id
en
tifie
d
an
s
wer
,
r
elatio
n
s
h
i
p
s
wer
e
estab
lis
h
ed
,
a
n
d
a
th
em
atic
m
atr
ix
was
cr
ea
ted
.
T
h
e
t
h
em
es we
r
e
f
u
r
th
er
in
ter
p
r
eted
to
a
d
d
r
ess
th
e
f
o
r
m
u
lated
q
u
esti
o
n
s
.
T
h
e
ass
o
ciatio
n
b
etwe
en
th
e
th
em
es
o
f
ea
ch
i
n
ter
v
iew
i
d
en
tifi
ed
was
in
v
esti
g
ated
I
n
itially
,
t
h
e
p
r
o
ce
s
s
o
f
co
d
in
g
a
n
d
s
ea
r
c
h
in
g
f
o
r
t
h
em
es
was
co
n
d
u
cted
m
a
n
u
a
lly
,
f
o
llo
wed
b
y
v
er
if
icatio
n
an
d
r
e
-
ch
ec
k
in
g
o
f
r
esu
lts
b
y
f
i
r
s
t
au
th
o
r
.
Du
r
in
g
th
e
an
aly
s
is
,
all
au
t
h
o
r
s
g
a
th
er
ed
a
n
d
en
g
a
g
ed
i
n
d
is
cu
s
s
io
n
s
r
eg
ar
d
i
n
g
t
h
e
d
o
m
in
an
ce
an
d
s
im
ilar
ity
o
f
th
e
th
em
es.
T
h
e
f
in
al
th
em
e
was
tr
an
s
lated
an
d
in
te
r
p
r
ete
d
with
th
e
s
elec
ted
q
u
o
tatio
n
s
i
n
to
I
n
d
o
n
esian
,
w
h
ich
was
tr
a
n
s
lated
in
to
E
n
g
li
s
h
f
o
r
p
u
b
licatio
n
.
T
h
e
s
o
u
r
ce
s
o
f
citatio
n
s
in
th
e
r
esu
lts
s
ec
tio
n
wer
e
id
en
tifie
d
b
y
u
s
in
g
th
e
p
r
o
v
id
ed
a
b
b
r
e
v
iatio
n
s
.
Fu
r
th
er
m
o
r
e,
th
e
tr
a
n
s
f
er
ab
ilit
y
o
f
th
e
s
tu
d
y
was
en
s
u
r
ed
b
y
t
h
o
r
o
u
g
h
l
y
ex
p
lain
in
g
th
e
a
n
aly
s
is
an
d
p
h
ases
to
th
e
p
ar
ticip
an
ts
.
2
.
8
.
Study
lim
it
a
t
io
n
T
h
e
s
tu
d
y
p
r
esen
ted
a
co
m
p
r
eh
en
s
iv
e
ex
a
m
in
atio
n
o
f
t
h
e
s
ig
n
if
ican
t
r
o
le
o
f
m
id
wi
v
es
in
th
e
p
r
ev
en
tio
n
o
f
m
alar
ia
am
o
n
g
p
r
eg
n
a
n
t w
o
m
en
.
T
h
e
m
eth
o
d
u
s
ed
was h
ig
h
ly
ef
f
ec
tiv
e
in
ac
q
u
ir
in
g
a
th
o
r
o
u
g
h
u
n
d
er
s
tan
d
i
n
g
o
f
m
id
wiv
es'
e
n
g
ag
em
e
n
t
an
d
th
e
im
p
lem
en
tatio
n
o
f
in
teg
r
ate
d
MCH
s
er
v
ices.
Ho
wev
er
,
th
e
s
tu
d
y
was
lim
ited
to
th
e
v
ie
ws
o
f
h
ea
lth
s
er
v
ice
p
r
o
v
id
er
s
an
d
d
id
n
o
t
e
x
p
lo
r
e
t
h
e
p
er
s
p
ec
tiv
e
o
f
p
r
eg
n
a
n
t
wo
m
en
an
d
f
am
ilies
.
T
h
e
an
aly
s
is
al
s
o
f
o
cu
s
ed
o
n
a
r
eg
io
n
with
th
e
h
ig
h
est
p
r
ev
alen
ce
o
f
m
alar
ia
,
ac
co
u
n
tin
g
f
o
r
2
7
% o
f
ca
s
es in
th
e
So
u
t
h
-
west Su
m
b
a
R
eg
en
cy
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
A
to
tal
o
f
th
r
ee
th
em
es
wer
e
i
d
en
tifie
d
f
r
o
m
th
e
th
em
atic
an
aly
s
is
,
r
elate
d
to
th
e
r
o
le
o
f
m
id
wiv
es
in
p
r
ev
en
tin
g
m
alar
ia
d
u
r
in
g
p
r
e
g
n
an
cy
.
T
h
e
in
itial
th
em
e
r
ef
er
s
to
th
e
g
en
er
al
u
n
d
er
s
tan
d
i
n
g
o
f
m
alar
ia
th
at
m
id
wiv
es
p
o
s
s
ess
.
T
h
e
K
o
d
i
Utar
a
Dis
tr
ict's
im
p
lem
en
tatio
n
o
f
th
e
m
alar
ia
p
r
e
v
en
tio
n
p
r
o
g
r
am
f
o
r
p
r
eg
n
a
n
t
wo
m
en
in
I
n
d
o
n
esia
is
th
e
s
u
b
ject
o
f
th
e
s
ec
o
n
d
th
em
e.
T
h
e
th
ir
d
th
em
e
r
elate
s
to
th
e
r
o
le
o
f
m
id
wiv
es
in
th
e
im
p
lem
en
tatio
n
o
f
th
e
m
alar
ia
p
r
ev
en
tio
n
p
r
o
g
r
a
m
f
o
r
p
r
e
g
n
an
t w
o
m
en
as sh
o
wn
i
n
T
ab
le
2
.
T
ab
le
2
.
T
h
em
e
an
d
d
im
en
s
io
n
Th
e
m
e
D
i
me
n
si
o
n
K
n
o
w
l
e
d
g
e
a
b
o
u
t
m
a
l
a
r
i
a
i
n
p
r
e
g
n
a
n
c
y
G
e
n
e
r
a
l
k
n
o
w
l
e
d
g
e
a
b
o
u
t
m
a
l
a
r
i
a
i
n
p
r
e
g
n
a
n
c
y
(
c
a
u
s
e
,
v
e
c
t
o
r
,
a
n
d
sy
m
p
t
o
ms)
I
mp
a
c
t
o
f
m
a
l
a
r
i
a
o
n
p
r
e
g
n
a
n
t
w
o
m
e
n
a
n
d
t
h
e
i
r
f
e
t
u
s
I
mp
l
e
me
n
t
a
t
i
o
n
o
f
i
n
t
e
g
r
a
t
e
d
ma
l
a
r
i
a
a
n
d
M
C
H
serv
i
c
e
s
D
e
r
i
v
a
t
i
v
e
r
e
g
u
l
a
t
i
o
n
s a
r
e
a
v
a
i
l
a
b
l
e
f
o
r
mal
a
r
i
a
ser
v
i
c
e
s
d
u
r
i
n
g
p
r
e
g
n
a
n
c
y
.
Th
e
i
m
p
l
e
me
n
t
a
t
i
o
n
o
f
i
n
t
e
g
r
a
t
e
d
M
C
H
serv
i
c
e
s
i
s
i
n
p
r
o
g
r
e
ss
.
Ef
f
o
r
t
s
t
o
i
m
p
r
o
v
e
t
h
e
sk
i
l
l
s
o
f
m
i
d
w
i
v
e
s r
e
g
a
r
d
i
n
g
m
a
l
a
r
i
a
a
r
e
f
o
l
l
o
w
e
d
b
y
mi
d
w
i
v
e
s.
M
i
d
w
i
f
e
r
o
l
e
i
n
ma
l
a
r
i
a
p
r
e
v
e
n
t
i
o
n
Th
e
r
o
l
e
o
f
m
i
d
w
i
v
e
s
i
n
p
r
e
v
e
n
t
i
n
g
m
a
l
a
r
i
a
i
n
p
r
e
g
n
a
n
c
y
t
h
r
o
u
g
h
i
n
t
e
g
r
a
t
e
d
M
C
H
s
e
r
v
i
c
e
s
3
.
1
.
T
hem
e
1
:
k
no
wledg
e
a
bo
ut
m
a
la
ri
a
in preg
na
ncy
T
h
e
s
tu
d
y
s
h
o
wed
th
at
p
ar
ti
cip
an
ts
h
ad
a
lim
ited
u
n
d
er
s
tan
d
in
g
o
f
m
alar
ia
d
u
r
in
g
p
r
eg
n
a
n
cy
.
M
id
wiv
es
r
ec
o
g
n
ize
d
th
e
n
e
g
a
tiv
e
ef
f
ec
ts
o
f
th
e
d
is
ea
s
e
o
n
b
o
th
p
r
eg
n
a
n
t
wo
m
e
n
a
n
d
f
etu
s
es,
in
clu
d
in
g
s
ev
er
e
m
ater
n
al
illn
ess
,
an
em
ia
,
lo
w
b
ir
th
weig
h
t
b
a
b
ies,
ab
o
r
tio
n
,
p
r
o
lo
n
g
ed
lab
o
r
,
a
n
d
d
ea
th
.
H
o
wev
er
,
t
h
er
e
was
n
o
awa
r
en
ess
ab
o
u
t
th
e
p
o
ten
tial
s
p
r
ea
d
o
f
m
alar
ia
b
e
y
o
n
d
th
e
A
n
o
p
h
eles
m
o
s
q
u
ito
,
w
h
ich
c
o
u
ld
o
cc
u
r
t
h
r
o
u
g
h
in
f
ec
ted
f
am
ily
o
r
co
m
m
u
n
ity
m
em
b
er
s
.
T
h
e
s
tu
d
y
also
s
h
o
wed
th
e
h
ig
h
in
cid
en
ce
o
f
m
o
s
q
u
ito
-
b
o
r
n
e
d
is
ea
s
es,
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Th
e
r
o
le
o
f m
id
w
ives in
p
r
ev
en
tin
g
ma
la
r
ia
in
p
r
eg
n
a
n
t
…
(
Dewa
A
yu
P
u
tu
Ma
r
ia
n
a
K
en
ca
n
a
w
a
ti
)
385
alth
ough
s
o
m
e
s
tr
u
g
g
led
t
o
d
is
tin
g
u
is
h
b
etwe
en
m
alar
ia
an
d
d
en
g
u
e
h
em
o
r
r
h
a
g
ic
f
ev
er
,
as
p
r
o
v
id
ed
i
n
t
h
e
s
tatem
en
t.
“
Ma
la
r
ia
is
in
d
ee
d
a
d
a
n
g
ero
u
s
d
is
ea
s
e,
in
o
u
r
p
la
ce
,
th
ere
h
a
ve
b
ee
n
s
ev
era
l
d
ea
th
s
d
u
e
to
ma
la
r
ia
.
B
u
t
th
ere
is
a
ls
o
d
en
g
u
e
h
emo
r
r
h
a
g
ic
feve
r
,
w
h
ich
r
esu
lt
s
in
mo
r
e
d
ea
th
s
.
Th
e
ca
u
s
e
o
f
b
o
t
h
d
is
ea
s
es
is
mo
s
q
u
ito
es …
.
”
(
M.
3
)
“
…
th
e
mo
s
t
co
mmo
n
co
mp
lic
a
tio
n
is
a
n
emia
.
B
esid
es,
w
h
e
n
a
n
in
fecte
d
w
o
ma
n
r
ec
o
ve
r
s
a
n
d
g
ives
b
ir
th
,
s
ev
era
l
co
mp
lica
tio
n
s
ten
d
to
o
cc
u
r
,
s
u
ch
a
s
p
r
o
lo
n
g
ed
la
b
o
r
a
n
d
l
o
w
-
b
ir
th
-
w
eig
h
t
b
a
b
ies.
Th
ere
a
r
e
a
ls
o
s
p
o
n
ta
n
eo
u
s
a
b
o
r
tio
n
s
a
n
d
p
r
ema
tu
r
e
b
ir
th
s
.
”
(
M.
7
,
M.
1
0
)
“……
.
.
Th
is
d
is
ea
s
e
ca
n
a
ls
o
kill b
o
th
th
e
mo
th
er a
n
d
h
er b
a
b
y.
”
(
M.
4
,
M.
5
,
M.
1
3
)
T
h
e
r
esu
lts
s
h
o
wed
th
at
m
id
wiv
es
f
ac
ed
ch
allen
g
es
in
id
en
tif
y
in
g
th
e
s
y
m
p
to
m
s
o
f
m
ala
r
i
a
d
u
e
to
th
e
s
im
ilar
ity
b
etwe
en
s
y
m
p
to
m
s
an
d
ea
r
ly
s
ig
n
s
o
f
p
r
eg
n
a
n
cy
.
Ho
wev
er
,
p
r
e
g
n
an
t
w
o
m
en
in
f
ec
ted
with
m
alar
ia
ty
p
ically
ex
p
er
ie
n
ce
s
y
m
p
to
m
s
s
u
ch
as n
au
s
ea
,
v
o
m
itin
g
,
lo
s
s
o
f
ap
p
etite,
ch
ills
,
an
d
in
ter
m
itten
t f
ev
er
.
“S
ymp
to
ms
o
f
ma
la
r
ia
in
p
r
eg
n
a
n
t
w
o
men
a
r
e
d
iffi
cu
lt
to
r
ec
o
g
n
iz
e
b
ec
a
u
s
e
th
e
s
ymp
to
ms
a
r
e
s
imila
r
to
ea
r
ly
p
r
eg
n
a
n
cy
s
ymp
to
ms.”
(
M4
)
“…
We
a
r
e
o
ften
mis
ta
ke
n
,
th
in
kin
g
p
r
eg
n
a
n
t
w
o
men
ju
s
t
feel
u
n
w
ell,
b
u
t
it
tu
r
n
s
o
u
t
th
ey
h
a
ve
ma
la
r
ia
.
”
(
M5
,
M2
,
M.
1
,
M.
2
0
)
“
Usu
a
l
ly
th
e
mo
th
er
co
mp
la
i
n
s
o
f
s
ev
ere
vo
mitin
g
a
n
d
i
n
a
b
ilit
y
to
ea
t,
s
u
ch
a
s
eme
s
is
g
r
a
vid
a
r
u
m.
Ho
w
ev
er,
th
is
is
a
cc
o
mp
a
n
ied
b
y
in
termit
ten
t c
h
ills
a
n
d
feve
r
.
”
(
M.
6
,
M.
9
)
Sin
ce
No
v
em
b
er
2
0
2
0
,
So
u
th
-
west Su
m
b
a
R
eg
en
cy
h
as b
ee
n
co
m
m
itted
to
m
alar
ia
elim
in
atio
n
,
with
th
e
I
n
d
o
n
esian
Min
is
tr
y
o
f
H
ea
lth
lau
n
ch
in
g
th
e
I
n
teg
r
ate
d
Ser
v
ices
f
o
r
Ma
lar
ia
with
MCH
Ser
v
ices.
T
h
e
p
r
o
g
r
a
m
h
as
f
i
v
e
p
r
io
r
ities
,
n
am
ely
i
)
to
elim
in
ate
m
alar
ia
in
p
r
eg
n
an
t
wo
m
en
,
ii
)
s
cr
ee
n
in
g
d
u
r
in
g
th
e
f
ir
s
t
an
ten
atal
v
is
it,
iii
)
u
s
e
o
f
lo
n
g
-
last
in
g
in
s
ec
ticid
al
n
ets
(
L
L
I
Ns
)
th
r
o
u
g
h
o
u
t
th
e
p
r
e
g
n
an
c
y
p
er
i
o
d
,
iv
)
th
r
ea
t
m
an
ag
em
en
t
f
o
r
th
o
s
e
d
iag
n
o
s
ed
p
o
s
itiv
ely
th
r
o
u
g
h
h
o
m
e
v
is
its
,
an
d
h
ea
lth
p
r
o
m
o
tio
n
ab
o
u
t
m
alar
ia
p
r
ev
en
tio
n
f
o
r
f
am
ily
an
d
co
m
m
u
n
ity
.
I
n
th
is
p
r
o
g
r
am
,
m
i
d
wiv
es
ar
e
m
an
d
ated
to
c
o
llab
o
r
a
te
with
o
th
er
h
ea
lt
h
p
r
ac
titi
o
n
er
s
s
u
ch
as
d
o
cto
r
s
,
s
an
itar
ian
s
,
an
d
lab
o
r
ato
r
y
an
aly
s
ts
,
p
ar
ticu
lar
ly
f
o
c
u
s
in
g
o
n
v
u
ln
er
ab
le
p
o
p
u
latio
n
s
,
in
clu
d
in
g
p
r
e
g
n
a
n
t w
o
m
en
a
n
d
ch
ild
r
en
u
n
d
er
f
iv
e
[
2
0
]
.
T
h
is
s
tu
d
y
i
n
v
esti
g
ated
th
e
en
g
ag
em
e
n
t
o
f
m
id
wiv
es
in
in
teg
r
atin
g
m
alar
ia
s
er
v
ices
i
n
to
MCH
p
r
o
g
r
a
m
s
.
T
h
e
r
esu
lts
s
h
o
wed
th
e
s
ig
n
if
ican
t
r
o
le
o
f
m
id
wiv
es
in
p
r
o
v
id
in
g
ANC,
en
s
u
r
in
g
th
e
well
-
b
ein
g
o
f
p
r
eg
n
a
n
t w
o
m
en
,
m
alar
ia
s
cr
e
en
in
g
s
,
d
is
tr
ib
u
tin
g
i
n
s
ec
ticid
e
-
tr
ea
ted
n
ets,
an
d
p
r
o
v
id
in
g
e
d
u
ca
tio
n
o
n
m
alar
ia
[
2
1
]
.
Alth
o
u
g
h
th
e
r
e
h
as
b
ee
n
g
lo
b
al
ad
v
an
ce
m
e
n
t,
th
e
im
p
le
m
en
tatio
n
o
f
m
alar
ia
in
p
r
eg
n
a
n
cy
(
MiP)
s
er
v
ices
th
r
o
u
g
h
ANC
is
s
ti
ll
r
elativ
ely
s
lu
g
g
is
h
.
T
h
er
ef
o
r
e,
m
id
wiv
e
s
m
u
s
t
p
o
s
s
e
s
s
a
co
m
p
r
eh
en
s
iv
e
u
n
d
er
s
tan
d
i
n
g
o
f
th
e
d
is
ea
s
e,
in
clu
d
in
g
tr
a
n
s
m
is
s
io
n
,
p
r
ev
en
tio
n
,
tr
ea
tm
en
t,
a
n
d
co
n
s
eq
u
en
ce
s
f
o
r
th
e
p
r
e
g
n
an
t
wo
m
en
,
f
etu
s
,
an
d
f
a
m
ily
[
2
2
]
,
[
2
3
]
.
I
n
r
u
r
al
r
eg
io
n
s
,
h
ea
lth
p
r
o
v
i
d
er
s
n
ee
d
to
h
av
e
a
th
o
r
o
u
g
h
u
n
d
er
s
tan
d
in
g
o
f
p
r
eg
n
an
cy
-
re
lated
m
alar
ia
to
en
s
u
r
e
ef
f
ec
tiv
e
im
p
lem
en
t
atio
n
,
b
o
th
i
n
d
e
p
en
d
en
tly
an
d
c
o
llab
o
r
ativ
el
y
.
T
h
e
r
esu
lts
s
h
o
wed
a
s
ig
n
if
i
ca
n
t
d
ec
r
ea
s
e
i
n
k
n
o
wled
g
e
ab
o
u
t
m
alar
ia
f
r
o
m
m
id
wiv
e
s
.
Desp
ite
s
u
cc
ess
f
u
lly
co
n
v
ey
in
g
th
e
in
f
o
r
m
atio
n
th
at
th
e
d
is
ea
s
e
wa
s
ca
u
s
ed
b
y
th
e
p
lasmo
d
iu
m
p
ar
asit
e,
s
p
r
ea
d
b
y
m
o
s
q
u
ito
es,
an
d
co
u
ld
lead
to
co
m
p
licatio
n
s
in
b
o
th
t
h
e
m
o
th
er
an
d
f
etu
s
,
th
e
s
y
m
p
to
m
s
in
p
r
eg
n
an
t
wo
m
en
we
r
e
n
o
t
r
ec
o
g
n
ize
d
,
r
esem
b
lin
g
th
o
s
e
o
f
ea
r
ly
p
r
eg
n
an
c
y
.
Ad
d
itio
n
ally
,
m
id
wiv
es
d
i
d
n
o
t
h
av
e
a
clea
r
u
n
d
er
s
tan
d
i
n
g
o
f
th
e
m
ec
h
an
is
m
o
f
tr
a
n
s
m
is
s
io
n
f
o
r
th
is
d
is
ea
s
e.
M
iP
p
r
ev
en
tio
n
h
as
b
ee
n
ac
h
i
ev
ed
th
r
o
u
g
h
v
ar
i
o
u
s
m
eth
o
d
s
,
with
s
cr
ee
n
in
g
b
ein
g
a
cr
u
ci
al
f
ac
to
r
in
p
r
o
tectin
g
p
r
e
g
n
an
t
wo
m
e
n
.
Acc
o
r
d
in
g
to
W
HO,
m
alar
ia
p
r
ev
en
tio
n
co
u
l
d
b
e
ac
h
iev
ed
th
r
o
u
g
h
th
r
ee
ess
en
tial
m
ea
s
u
r
es
as
im
p
lem
en
ted
b
y
ANC
s
er
v
ices,
n
am
ely
th
e
u
se
o
f
in
s
ec
ticid
e
b
ed
n
ets,
s
cr
ee
n
in
g
an
d
p
r
ev
en
tiv
e
m
ed
icatio
n
,
a
s
well
as
ca
s
e
m
an
ag
em
en
t
[
2
4
]
.
A
p
r
e
v
io
u
s
s
tu
d
y
s
tated
th
at
th
er
e
was
a
s
tr
o
n
g
r
elatio
n
s
h
ip
b
etwe
en
th
e
lev
el
o
f
ANC
an
d
o
p
tim
al
m
alar
ia
p
r
ev
e
n
tio
n
m
eth
o
d
s
d
u
e
t
o
th
e
p
r
o
v
is
io
n
o
f
h
ea
lth
s
er
v
ices
o
r
wo
r
k
er
s
,
s
o
cio
ec
o
n
o
m
ic
co
n
d
itio
n
s
,
an
d
in
d
i
v
id
u
al
b
e
h
av
io
r
[
2
5
]
.
T
h
e
l
o
w
ac
ce
p
tan
ce
an
d
co
m
p
lian
ce
wit
h
MiP
p
r
ev
en
tio
n
co
u
ld
b
e
att
r
ib
u
ted
t
o
in
s
u
f
f
icien
t
awa
r
e
n
ess
am
o
n
g
h
ea
lt
h
ca
r
e
p
r
ac
ti
tio
n
er
s
an
d
lim
ited
u
n
d
er
s
tan
d
i
n
g
,
th
e
r
eb
y
r
eq
u
i
r
in
g
in
ter
v
en
tio
n
f
r
o
m
h
ea
lt
h
ca
r
e
p
r
o
v
id
er
s
a
n
d
co
m
m
u
n
ity
s
er
v
ice
g
r
o
u
p
s
.
E
n
h
an
cin
g
th
e
u
n
d
er
s
tan
d
in
g
an
d
attitu
d
es
o
f
h
ea
lth
ca
r
e
p
r
o
v
id
e
r
s
co
u
ld
b
e
co
n
d
u
c
ted
b
y
o
p
tim
izin
g
co
m
m
u
n
icatio
n
ab
o
u
t
MiP
,
a
n
d
en
h
a
n
cin
g
th
e
a
v
ailab
ilit
y
o
f
s
er
v
ices
[
2
6
]
.
Fu
r
t
h
er
m
o
r
e,
in
cr
ea
s
in
g
awa
r
en
ess
o
f
ANC
atten
d
an
ce
p
lay
e
d
a
n
im
p
o
r
tan
t
r
o
le
in
in
f
lu
e
n
ci
n
g
th
e
p
r
o
v
is
io
n
,
ac
ce
s
s
,
an
d
u
s
e
o
f
p
r
e
v
en
tio
n
in
ter
v
en
tio
n
s
in
p
r
eg
n
a
n
cy
[
2
7
]
.
Mid
wiv
es
wer
e
also
r
ec
o
m
m
en
d
ed
to
a
d
h
er
e
t
o
estab
lis
h
ed
s
tan
d
ar
d
s
f
o
r
ANC,
co
n
d
u
ct
m
ala
r
ia
s
cr
ee
n
in
g
s
d
u
r
in
g
th
e
i
n
itial
p
r
eg
n
a
n
cy
c
h
ec
k
-
u
p
,
ed
u
ca
te
p
r
eg
n
an
t
w
o
m
en
ab
o
u
t
m
alar
ia
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
2
5
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-
8
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6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
4
,
No
.
1
,
Ma
r
ch
20
2
5
:
3
8
1
-
390
386
p
r
ev
en
tio
n
,
d
is
tr
ib
u
te
in
s
ec
ticid
e
-
tr
ea
ted
m
o
s
q
u
ito
n
ets,
e
x
p
lain
th
eir
p
r
o
p
er
u
s
e,
c
o
llab
o
r
ate
with
o
th
er
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als
f
o
r
la
b
o
r
ato
r
y
test
s
,
an
d
m
alar
ia
t
r
ea
tm
en
t
in
p
r
e
g
n
an
t
wo
m
en
[
2
8
]
,
[
2
9
]
.
T
h
ese
r
esu
lt
s
em
p
h
asize
d
th
e
n
ee
d
f
o
r
co
o
r
d
in
ated
ef
f
o
r
ts
to
o
v
er
co
m
e
th
e
id
en
tifie
d
o
b
s
tacle
s
,
w
h
ich
was
a
cr
u
cial
im
p
licatio
n
.
T
h
e
s
tu
d
y
also
s
h
o
wed
th
at
a
lack
o
f
k
n
o
wled
g
e
ab
o
u
t
m
alar
ia
am
o
n
g
m
id
wiv
e
s
p
o
s
e
d
a
s
ig
n
if
ican
t
o
b
s
tacle
to
th
e
p
r
ev
en
tio
n
o
f
m
alar
ia
d
u
r
i
n
g
p
r
eg
n
an
cy
.
T
h
er
e
f
o
r
e,
th
e
g
o
v
er
n
m
e
n
t
s
h
o
u
ld
im
p
lem
e
n
t
im
m
ed
iate
ac
tio
n
to
en
h
an
ce
th
e
k
n
o
wled
g
e
an
d
awa
r
e
n
ess
o
f
m
id
wiv
es
r
eg
ar
d
in
g
th
e
p
r
ev
en
tio
n
o
f
MiP.
Stre
am
lin
e
tr
ain
in
g
is
also
e
s
s
en
tial
f
o
r
h
ea
lth
wo
r
k
er
s
to
d
e
v
elo
p
clea
r
m
ess
ag
es
ab
o
u
t
m
alar
ia
p
r
ev
en
tio
n
in
p
r
eg
n
a
n
t w
o
m
en
.
3
.
2
.
T
hem
e
2
:
i
m
plem
ent
a
t
i
o
n
o
f
t
he
i
n
t
e
g
r
a
t
i
n
g
ma
l
a
r
i
a
s
e
r
v
i
c
es
in
t
o
ma
t
e
r
n
a
l
a
n
d
c
hi
l
d
he
a
l
t
h
pr
o
g
r
a
m
T
h
e
r
esu
lts
s
h
o
wed
s
ev
er
al
ch
allen
g
es
in
im
p
lem
en
tin
g
in
te
g
r
ated
MCH
s
er
v
ice
at
th
e
s
tu
d
y
lo
ca
tio
n
.
Sp
ec
if
ically
,
th
e
d
is
tr
ict
f
ailed
to
ad
ju
s
t
o
p
er
atio
n
al
p
r
o
ce
d
u
r
es
to
en
s
u
r
e
p
r
o
p
er
im
p
lem
e
n
tatio
n
,
r
esu
ltin
g
in
n
u
m
er
o
u
s
ch
allen
g
es
in
im
p
le
m
en
tin
g
th
e
p
r
o
g
r
a
m
f
o
r
p
r
eg
n
an
t
wo
m
en
an
d
ch
ild
r
e
n
u
n
d
er
f
iv
e
.
T
h
e
s
er
v
ice
lack
ed
co
n
s
is
ten
cy
as
th
er
e
wer
e
n
o
s
p
ec
if
ied
o
p
e
r
atio
n
al
s
tan
d
ar
d
s
f
o
r
s
er
v
ice
p
r
o
ce
d
u
r
es.
Sev
er
al
is
s
u
es
wer
e
also
id
en
tifie
d
with
m
alar
ia
lo
g
is
tics
,
s
p
ec
if
ically
r
eg
ar
d
in
g
th
e
av
ailab
ilit
y
o
f
m
alar
ia
r
ap
id
d
ia
g
n
o
s
tic
test
(
m
R
DT
)
s
cr
ee
n
in
g
e
q
u
ip
m
e
n
t.
B
ased
o
n
th
e
r
esu
lt,
n
o
t
all
p
r
e
g
n
an
t
wo
m
e
n
h
a
d
th
e
o
p
p
o
r
tu
n
ity
to
p
ass
th
r
o
u
g
h
m
alar
ia
test
in
g
d
u
r
in
g
f
ir
s
t
v
i
s
it
d
u
e
to
a
s
h
o
r
tag
e
o
f
m
R
DT
s
an
d
a
h
ig
h
p
r
e
v
alen
ce
o
f
m
alar
ia
am
o
n
g
th
e
g
en
er
al
p
o
p
u
latio
n
.
Scr
ee
n
in
g
was
o
n
ly
g
iv
e
n
to
p
r
e
g
n
an
t
wo
m
en
wh
o
s
h
o
we
d
s
y
m
p
t
o
m
s
an
d
i
n
s
ec
ticid
e
-
tr
ea
ted
b
ed
n
ets
wer
e
g
iv
en
i
n
a
co
m
m
u
n
ity
-
b
ased
h
ea
lth
ce
n
ter
d
u
r
in
g
ch
ec
k
-
u
p
s
.
T
h
e
im
p
lem
en
tatio
n
o
f
in
teg
r
at
ed
MCH
s
er
v
ice
in
No
r
th
Ko
d
i
Dis
tr
ict
d
id
n
o
t
ad
h
er
e
to
th
e
g
u
id
elin
es
an
d
s
tan
d
ar
d
o
p
er
atin
g
p
r
o
ce
d
u
r
es
wer
e
n
o
t
estab
lis
h
ed
.
Ad
d
itio
n
ally
,
th
er
e
was
v
ar
iatio
n
in
t
h
e
im
p
lem
en
ta
tio
n
p
r
o
ce
s
s
ac
r
o
s
s
co
m
m
u
n
ity
h
ea
lth
ce
n
te
r
s
.
as
d
escr
ib
ed
in
th
e
s
tatem
en
t:
“
…We
d
o
n
o
t
test
a
ll
p
r
eg
n
a
n
t
w
o
men
h
ere
fo
r
ma
la
r
ia
b
ec
a
u
s
e
test
kits
a
r
e
limited
…
”
(
M
.
8
,
M.
1
1
)
“
L
a
ck
o
f
R
DT
fo
r
th
ese
t
h
r
ee
mo
n
th
s
ma
ke
s
a
ll
p
r
eg
n
a
n
t
w
o
men
u
n
a
b
le
to
c
a
r
r
y
o
u
t
ma
l
a
r
ia
test
.
”
(
M.
1
8
,
M.
6
)
“N
o
,
w
e
d
o
n
’
t h
a
ve
a
n
y
s
p
ec
if
ic
s
ta
n
d
a
r
d
o
p
era
tio
n
a
l p
r
o
ce
d
u
r
es fo
r
th
is
s
ervice.
”
(
M.
7
,
M.
1
)
“I
d
o
n
’
t
k
n
o
w
,
b
u
t
in
A
N
C
s
ervices,
w
e
u
s
ed
to
d
o
1
0
s
ta
n
d
a
r
d
A
N
C
p
r
o
ce
d
u
r
es
w
ith
n
o
ma
la
r
ia
a
s
s
ess
men
t in
it.
b
u
t I
d
o
n
’
t k
n
o
w
h
o
w
in
o
th
er c
o
mmu
n
ity
h
ea
lth
ce
n
ters
.
”
(
M.
1
2
)
Th
e
s
tu
d
y
f
o
u
n
d
t
h
at
m
id
wiv
e
s
h
ad
n
o
t
r
ec
eiv
e
d
an
y
s
p
ec
if
i
c
tr
ain
in
g
r
elate
d
to
m
alar
ia
,
a
s
o
n
ly
th
e
co
o
r
d
in
at
o
r
was
g
iv
e
n
s
o
cia
lizati
o
n
r
eg
ar
d
in
g
i
n
teg
r
ated
MCH
s
er
v
ices.
T
h
e
s
o
cializa
tio
n
was
f
o
u
n
d
in
ad
eq
u
ate
,
f
ail
in
g
to
e
q
u
ip
m
i
d
wiv
es
with
th
e
r
eq
u
ir
e
d
s
k
ill
s
an
d
k
n
o
wled
g
e
ab
o
u
t m
alar
i
a
an
d
p
r
e
v
en
tio
n
in
v
u
ln
er
ab
le
p
o
p
u
latio
n
s
.
Ad
d
itio
n
ally
,
m
id
wiv
es
lack
ed
th
e
m
eth
o
d
o
f
e
v
alu
ate
th
e
p
o
te
n
tial
m
alar
ia
r
is
k
f
o
r
p
r
eg
n
a
n
t w
o
m
en
d
u
r
i
n
g
th
eir
an
ten
atal
v
is
its
,
as st
ated
:
“
We
h
a
ve
n
o
t rece
ived
a
n
y
tr
a
in
in
g
r
eg
a
r
d
in
g
ma
la
r
ia
…
”
(
M.
2
,
M.
4
,
M
6
)
“
We
d
id
n
o
t h
a
ve
a
n
y
tr
a
in
in
g
s
p
ec
ifica
lly,
b
u
t we
o
ften
h
ea
r
a
b
o
u
t it
fr
o
m
th
e
n
u
r
s
e
s
w
h
en
th
ey
ta
lk
a
b
o
u
t m
a
l
a
r
ia
.
”
(
M.
5
,
M
9
)
“
Yes
,
in
N
o
ve
mb
er
2
0
2
1
,
ma
l
a
r
ia
in
teg
r
a
tio
n
s
ervices
w
ith
K
I
A
w
ill
b
e
imp
leme
n
ted
.
B
u
t
w
e
a
r
e
n
o
t
eq
u
ip
p
e
d
w
ith
ma
la
r
ia
s
creen
in
g
meth
o
d
s
.
”
(
M
1
,
M1
1
)
Ap
p
r
o
p
r
iate
d
e
l
i
v
e
r
y
o
f
m
a
l
a
r
i
a
s
e
r
v
i
ce
s
t
o
p
r
e
g
n
a
n
t
w
o
m
e
n
d
e
p
e
n
d
s
o
n
t
h
e
p
r
e
s
e
n
c
e
o
f
a
d
e
q
u
a
t
e
g
u
i
d
e
l
i
n
e
s
,
h
u
m
a
n
r
es
o
u
r
c
e
s
,
s
u
p
p
l
i
e
s
,
a
n
d
l
o
g
is
t
ic
a
l
s
u
p
p
o
r
t
a
t
h
e
a
l
t
h
c
a
r
e
f
a
c
i
li
t
ie
s
.
T
h
is
s
tu
d
y
d
i
s
c
o
v
e
r
e
d
t
h
a
t
t
h
e
r
e
w
e
r
e
n
o
r
e
g
u
l
a
t
i
o
n
s
f
o
r
d
e
r
i
v
a
t
i
v
es
,
s
u
c
h
a
s
s
t
a
n
d
a
r
d
o
p
e
r
a
t
i
o
n
a
l
p
r
o
c
e
d
u
r
e
s
f
o
r
i
n
t
e
g
r
a
t
e
d
M
C
H
s
e
r
v
i
c
e
i
n
b
o
t
h
C
o
m
m
u
n
i
t
y
H
e
a
l
t
h
C
e
n
t
er
a
n
d
l
i
m
i
t
e
d
m
R
D
T
l
o
g
i
s
t
i
cs
.
T
h
e
r
e
f
o
r
e
,
n
o
t
a
l
l
p
r
e
g
n
a
n
t
w
o
m
e
n
w
e
r
e
s
c
r
e
e
n
e
d
d
u
r
i
n
g
t
h
e
i
r
f
i
r
s
t
A
NC
v
is
i
t
.
Th
e
g
o
v
e
r
n
m
e
n
t
’s
e
f
f
o
r
t
s
t
o
p
r
o
v
i
d
e
t
r
a
i
n
i
n
g
o
n
m
a
l
a
r
i
a
i
n
p
r
eg
n
a
n
c
y
w
e
r
e
l
i
m
i
t
e
d
,
a
n
d
n
o
t
a
l
l
m
i
d
w
i
v
e
s
w
e
r
e
i
n
f
o
r
m
e
d
a
b
o
u
t
t
h
e
i
n
t
e
g
r
a
t
e
d
M
C
H
s
e
r
v
i
c
e
.
I
n
N
o
r
t
h
K
o
d
i
D
i
s
t
r
i
c
t
,
t
h
i
s
p
r
o
g
r
a
m
c
o
u
l
d
n
o
t
b
e
i
m
p
l
e
m
e
n
t
e
d
i
n
a
cc
o
r
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a
n
c
e
w
i
t
h
t
h
e
g
u
i
d
el
i
n
es
p
r
o
v
i
d
e
d
b
y
th
e
I
n
d
o
n
esian
Min
is
tr
y
o
f
Hea
lth
.
Acc
o
r
d
in
g
to
a
s
tu
d
y
c
o
n
d
u
cte
d
in
B
u
r
k
in
a
Fas
o
,
th
e
s
u
p
p
ly
an
d
lo
g
is
tics
o
f
m
alar
i
a
-
r
elate
d
r
eso
u
r
ce
s
s
h
o
u
ld
b
e
p
r
io
r
itized
,
in
clu
d
in
g
in
s
ec
ticid
e
-
tr
ea
ted
b
ed
n
ets,
an
tim
alar
ial
d
r
u
g
s
,
m
alar
ia
d
i
ag
n
o
s
tic
to
o
ls
,
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d
m
alar
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p
r
o
p
h
y
lax
is
th
er
ap
y
f
o
r
p
r
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a
n
t
wo
m
en
.
T
h
is
is
n
ec
ess
ar
y
to
en
s
u
r
e
th
e
s
u
cc
ess
f
u
l
im
p
lem
en
tatio
n
o
f
m
ater
n
al
m
alar
ia
p
r
ev
en
tio
n
a
n
d
tr
ea
tm
en
t
p
r
o
g
r
am
s
.
Ad
d
itio
n
ally
,
th
e
p
r
o
g
r
am
ca
n
b
e
en
h
an
ce
d
b
y
e
n
g
ag
in
g
co
m
m
u
n
ity
h
ea
lth
wo
r
k
er
s
wh
o
h
av
e
r
ec
ei
v
ed
tr
ain
in
g
to
im
p
r
o
v
e
th
e
ef
f
icac
y
o
f
s
u
cc
ess
f
u
l
m
alar
ia
p
r
ev
en
tio
n
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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t J Pu
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lic
Hea
lth
Sci
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SS
N:
2252
-
8
8
0
6
Th
e
r
o
le
o
f m
id
w
ives in
p
r
ev
en
tin
g
ma
la
r
ia
in
p
r
eg
n
a
n
t
…
(
Dewa
A
yu
P
u
tu
Ma
r
ia
n
a
K
en
ca
n
a
w
a
ti
)
387
in
itiativ
es
tar
g
etin
g
p
r
eg
n
an
t
wo
m
en
[
3
0
]
.
W
HO
also
em
p
h
asizes
th
at
ANC
p
lay
s
a
c
r
u
ci
al
r
o
le
in
d
eliv
er
in
g
in
teg
r
ated
h
ea
lth
s
er
v
ices
f
o
r
p
r
eg
n
an
t
wo
m
e
n
,
in
clu
d
i
n
g
th
e
m
an
ag
em
en
t
o
f
in
f
ec
tio
u
s
d
is
e
ases
s
u
ch
as
h
u
m
an
im
m
u
n
o
d
ef
icien
cy
v
ir
u
s
(
HI
V
)
,
s
y
p
h
ilis
,
an
d
m
alar
ia.
T
h
e
ANC
s
er
v
ice
s
h
o
u
ld
p
r
io
r
itize
o
f
f
er
in
g
r
esp
ec
tf
u
l,
p
er
s
o
n
alize
d
,
an
d
p
atien
t
-
ce
n
t
er
ed
ca
r
e
d
u
r
in
g
ev
er
y
in
ter
ac
t
io
n
.
T
h
is
in
clu
d
es
im
p
lem
e
n
ti
n
g
ef
f
ec
tiv
e
clin
ical
p
r
ac
tices,
p
r
o
v
id
i
n
g
r
elev
a
n
t
a
n
d
tim
ely
in
f
o
r
m
atio
n
,
o
f
f
er
i
n
g
p
s
y
ch
o
s
o
cial
an
d
e
m
o
tio
n
al
s
u
p
p
o
r
t,
as
well
as
en
s
u
r
in
g
ex
ce
llen
t
cli
n
ical
an
d
in
ter
p
er
s
o
n
al
s
k
ills
o
f
h
ea
lth
ca
r
e
p
r
ac
titi
o
n
er
s
.
Alth
o
u
g
h
W
HO
s
u
g
g
ests
th
e
wid
esp
r
ea
d
d
is
tr
ib
u
tio
n
o
f
in
s
ec
ticid
e
-
tr
ea
ted
b
ed
n
ets
to
p
r
eg
n
an
t
wo
m
en
t
h
r
o
u
g
h
ca
m
p
aig
n
s
an
d
an
ten
atal
s
er
v
ices.
T
h
is
m
eth
o
d
r
e
q
u
ir
e
s
th
e
p
r
o
v
is
io
n
o
f
c
o
m
p
r
e
h
en
s
iv
e
g
u
id
elin
es,
s
er
v
ice
s
tan
d
ar
d
s
,
an
d
s
u
f
f
icien
t
s
u
p
p
lies
o
f
m
alar
ia
lo
g
is
tics
to
en
s
u
r
e
o
p
tim
al
co
v
er
a
g
e
[
3
1
]
.
A
p
r
ev
io
u
s
s
tu
d
y
s
u
g
g
ests
th
at
ef
f
ec
tiv
e
m
alar
ia
p
r
ev
en
tiv
e
p
r
o
g
r
am
s
r
eq
u
ir
e
m
o
tiv
atio
n
f
r
o
m
h
ea
lth
ca
r
e
p
r
ac
t
itio
n
er
s
,
f
r
eq
u
en
t
tr
ain
i
n
g
s
ess
i
o
n
s
,
f
ac
ilit
y
-
b
ased
wo
r
k
s
h
o
p
s
,
a
n
d
p
r
ec
is
e
p
atien
t
co
u
n
s
elin
g
f
o
r
s
u
cc
ess
f
u
l
er
ad
icatio
n
[
3
2
]
.
B
ased
o
n
th
e
d
escr
ip
tio
n
ab
o
v
e
,
s
ev
er
al
f
ac
to
r
s
co
n
tr
ib
u
te
to
th
e
s
u
cc
ess
f
u
l
im
p
lem
en
tatio
n
o
f
p
r
ev
e
n
tio
n
ef
f
o
r
ts
,
i
n
c
lu
d
in
g
g
o
o
d
h
ea
lth
r
eg
u
latio
n
s
an
d
s
y
s
tem
s
,
ad
e
q
u
ate
s
u
p
p
ly
an
d
lo
g
is
tics
o
f
m
alar
ia
s
er
v
ices,
th
e
av
ailab
ilit
y
o
f
tr
ain
in
g
an
d
wo
r
k
s
h
o
p
s
f
o
r
h
ea
lth
wo
r
k
e
r
s
,
as we
ll a
s
th
e
m
o
tiv
atio
n
to
c
ar
r
y
o
u
t p
r
e
v
en
tio
n
o
f
m
alar
ia
in
p
r
eg
n
an
cy
.
3.
3
.
T
hem
e
3
:
m
idwi
v
es’
ro
l
e
in inte
g
ra
t
ing
m
a
l
a
ria
s
er
v
ices int
o
m
a
t
er
na
l a
nd
child
hea
lt
h pro
g
ra
m
T
h
e
s
tu
d
y
s
h
o
wed
th
at
th
e
in
t
eg
r
atio
n
o
f
m
a
l
a
r
i
a
s
e
r
v
i
c
e
s
i
n
t
o
M
C
H
i
n
N
o
r
t
h
K
o
d
i
D
is
t
r
i
ct
w
a
s
n
o
t
i
m
p
l
e
m
e
n
t
e
d
i
n
l
i
n
e
w
i
t
h
t
h
e
e
s
t
a
b
li
s
h
e
d
r
e
c
o
m
m
e
n
d
a
t
i
o
n
s
.
I
n
t
e
r
v
i
e
w
r
e
s
u
lt
s
s
h
o
w
e
d
t
h
a
t
e
x
p
e
c
t
a
n
t
p
r
e
g
n
a
n
t
w
o
m
e
n
w
h
o
h
a
d
e
n
r
o
l
le
d
i
n
AN
C
w
o
u
l
d
a
tt
e
n
d
t
h
e
M
C
H
p
o
ly
c
l
i
n
i
c
t
o
b
e
e
x
a
m
i
n
e
d
b
y
m
i
d
w
i
v
e
s
.
W
h
e
n
m
a
l
a
r
ia
s
y
m
p
t
o
m
s
w
e
r
e
i
d
e
n
t
i
f
i
e
d
,
s
u
ch
a
s
f
e
v
e
r
,
c
h
i
l
ls
,
a
n
d
h
e
a
d
a
c
h
e
,
m
i
d
w
i
v
es
w
o
u
l
d
r
e
c
o
m
m
e
n
d
a
d
o
c
t
o
r
f
o
r
b
l
o
o
d
t
e
s
ts
.
M
o
r
e
o
v
e
r
,
p
r
e
g
n
a
n
t
w
o
m
e
n
w
e
r
e
a
b
l
e
t
o
o
b
t
a
i
n
m
o
s
q
u
i
t
o
n
e
t
s
b
y
a
c
c
e
s
s
i
n
g
h
e
a
l
t
h
s
e
r
v
i
c
es
t
h
r
o
u
g
h
t
h
e
C
o
m
m
u
n
i
t
y
H
e
a
lt
h
C
e
n
t
e
r
o
r
c
o
m
m
u
n
i
t
y
-
b
a
s
e
d
h
e
a
l
t
h
p
o
s
t
(
P
o
s
y
a
n
d
u
).
T
h
e
r
esp
o
n
s
ib
ilit
y
o
f
m
id
wiv
es
in
th
e
ex
ec
u
tio
n
o
f
in
teg
r
ated
MCH
s
er
v
ices
was to
ass
e
s
s
p
r
eg
n
an
t
wo
m
en
f
o
r
in
d
icatio
n
s
,
as st
ated
:
“
On
ly
p
r
eg
n
a
n
t wo
men
w
ith
s
ymp
to
ms a
r
e
ex
a
min
ed
…
”
(
M.
1
)
“W
e
h
elp
d
is
t
r
ib
u
te
mo
s
q
u
ito
n
ets
to
p
r
eg
n
a
n
t
w
o
men
a
t
P
o
s
ya
n
d
u
o
r
co
mmu
n
ity
h
ea
lth
ce
n
ters
.
”
(
M3
,
M5
,
M
7)
“
….
We
d
is
tr
ib
u
te
mo
s
q
u
ito
n
ets
to
ev
ery
p
r
eg
n
a
n
t
w
o
ma
n
w
h
o
co
mes
to
visi
t
th
e
P
u
s
ke
s
ma
s
o
r
P
o
s
ya
n
d
u
f
o
r
th
e
fir
s
t time
.
”
(
M1
,
M.
2
,
M.
4
,
M.
1
3
,
M.
1
8
,
M.
1
2
)
T
h
e
r
esu
lts
s
h
o
wed
th
at
m
i
d
wiv
es
d
id
n
o
t
p
r
o
v
id
e
e
d
u
ca
tio
n
ab
o
u
t
m
alar
ia
to
p
r
eg
n
a
n
t
wo
m
en
,
with
to
p
ics
s
u
ch
as
n
u
tr
itio
n
,
p
er
s
o
n
al
h
y
g
ien
e,
an
d
en
v
ir
o
n
m
en
ta
l
clea
n
lin
ess
.
Ad
d
itio
n
ally
,
th
er
e
was
an
em
p
h
asi
s
on
th
e
s
ig
n
if
ica
n
ce
o
f
p
r
en
atal
ch
ec
k
s
d
u
r
i
n
g
p
r
eg
n
a
n
cy
,
as
d
escr
ib
ed
:
“W
e
u
s
u
a
lly
o
n
ly
p
r
o
vid
e
ed
u
ca
tio
n
a
b
o
u
t
n
u
tr
itio
n
fo
r
p
r
eg
n
a
n
t wo
men
…”
(
M.
1
,
M.
1
3
)
“
….
.
ed
u
ca
tio
n
a
b
o
u
t
p
ers
o
n
a
l
h
yg
ie
n
e
a
n
d
en
viro
n
men
t
a
l
clea
n
lin
ess
o
r
co
mp
la
in
ts
felt
b
y
th
e
mo
th
er a
t th
a
t time
.
We
h
a
ve
n
o
t p
r
o
vid
ed
ed
u
c
a
tio
n
a
b
o
u
t
ma
la
r
ia
.
”
(
M1
1)
B
ased
o
n
th
ese
r
esu
lts
,
th
e
r
o
le
o
f
m
id
wiv
es
in
in
teg
r
atin
g
m
alar
ia
s
er
v
ices
in
to
MCH
in
No
r
th
Ko
d
i
d
is
tr
ict
was
v
er
y
lim
ited
.
Mid
wiv
es
wer
e
o
n
ly
r
esp
o
n
s
ib
le
f
o
r
th
e
in
itial
ev
al
u
atio
n
an
d
allo
ca
tio
n
o
f
in
s
ec
ticid
e
-
tr
ea
ted
b
ed
n
ets,
wh
ich
wer
e
d
is
tr
ib
u
ted
ex
cl
u
s
iv
ely
th
r
o
u
g
h
C
o
m
m
u
n
ity
Hea
lth
C
en
ter
s
o
r
Po
s
y
an
d
u
.
H
o
wev
er
,
m
alar
ia
s
cr
ee
n
in
g
was
n
o
t
p
er
f
o
r
m
e
d
,
an
d
m
id
wiv
es
lack
ed
th
e
r
e
q
u
ir
ed
e
q
u
ip
m
e
n
t
.
Ma
lar
ia
m
an
ag
er
s
ty
p
ically
f
o
cu
s
o
n
ad
d
r
ess
in
g
th
e
e
d
u
ca
tio
n
al
asp
ec
t a
t th
e
C
o
m
m
u
n
ity
Hea
lth
C
en
ter
lev
el,
with
o
u
t
s
p
ec
if
ic
em
p
h
asis
o
n
p
r
ev
en
ti
on
.
E
d
u
ca
tio
n
was
p
r
o
v
id
ed
o
n
n
u
tr
itio
n
,
p
er
s
o
n
al
,
an
d
en
v
ir
o
n
m
e
n
tal
h
y
g
ien
e,
b
u
t
d
id
n
o
t c
o
v
er
th
e
p
r
ev
en
ti
v
e
m
ea
s
u
r
es
.
Acc
o
r
d
in
g
to
t
h
e
in
teg
r
atio
n
o
f
m
alar
ia
s
er
v
ice
in
to
MCH
g
u
id
elin
es,
m
id
wiv
es
h
av
e
t
h
e
r
o
les
o
f
r
ec
o
g
n
izin
g
d
is
ea
s
e
r
is
k
,
m
o
n
ito
r
in
g
tr
ea
tm
e
n
t
f
o
r
th
o
s
e
r
ec
eiv
in
g
an
ti
-
m
alar
ial
d
r
u
g
th
er
ap
y
,
e
d
u
ca
tin
g
p
r
eg
n
a
n
t
wo
m
en
to
alwa
y
s
s
leep
in
in
s
ec
ticid
e
-
t
r
e
a
t
e
d
m
o
s
q
u
i
t
o
n
e
t
s
,
a
n
d
e
a
ti
n
g
n
u
t
r
i
t
i
o
u
s
f
o
o
d
.
I
n
a
d
d
i
t
i
o
n
t
o
m
a
l
a
r
i
a
,
m
o
t
h
e
r
s
a
n
d
f
a
m
i
l
i
es
s
h
o
u
l
d
b
e
e
d
u
c
a
t
e
d
a
b
o
u
t
o
t
h
e
r
p
r
e
g
n
a
n
c
y
c
o
m
p
l
i
c
a
t
i
o
n
s
.
M
id
w
i
v
e
s
a
r
e
r
e
q
u
i
r
ed
t
o
k
e
e
p
r
e
c
o
r
d
s
o
f
p
r
e
g
n
a
n
t
wo
m
e
n
w
h
o
r
e
c
e
i
v
e
m
a
l
a
r
i
a
s
c
r
e
e
n
i
n
g
w
i
t
h
m
R
D
T
,
m
o
s
q
u
i
t
o
n
e
t
s
,
t
h
e
r
a
p
y
,
a
n
d
a
d
h
e
r
e
t
o
t
r
e
a
t
m
e
n
t
.
A
s
t
u
d
y
c
o
n
d
u
c
t
e
d
i
n
M
y
a
n
m
a
r
f
o
u
n
d
t
h
a
t
t
h
e
s
u
c
c
es
s
f
u
l
i
m
p
l
e
m
e
n
t
a
t
i
o
n
o
f
m
a
l
a
r
i
a
p
r
e
v
e
n
t
i
o
n
d
u
r
i
n
g
p
r
e
g
n
a
n
c
y
w
a
s
a
tt
r
i
b
u
t
e
d
t
o
t
h
e
s
i
g
n
i
f
i
c
a
n
t
co
l
l
a
b
o
r
a
t
i
o
n
b
e
tw
e
e
n
t
h
e
N
a
t
i
o
n
a
l
M
a
l
a
r
i
a
C
o
n
t
r
o
l
P
r
o
g
r
a
m
a
n
d
i
m
p
l
e
m
e
n
t
i
n
g
p
a
r
t
n
e
r
s
,
a
l
o
n
g
w
it
h
s
u
f
f
i
ci
en
t
h
u
m
a
n
a
n
d
f
i
n
a
n
c
i
a
l
r
e
s
o
u
r
c
e
s
.
A
n
i
m
p
o
r
t
a
n
t
c
o
n
t
r
i
b
u
t
i
n
g
f
a
c
t
o
r
is
t
h
e
e
x
p
e
r
t
i
s
e
o
f
f
r
o
n
t
l
i
n
e
h
e
al
t
h
w
o
r
k
e
r
s
i
n
r
e
a
c
ti
v
e
s
u
r
v
e
il
l
a
n
c
e
a
n
d
t
h
e
p
r
e
s
e
n
c
e
o
f
b
as
i
c
h
e
a
l
t
h
s
t
a
f
f
.
T
h
e
k
n
o
w
l
e
d
g
e
o
f
f
r
o
n
t
l
i
n
e
h
e
a
l
t
h
w
o
r
k
e
r
s
r
e
g
ar
d
i
n
g
m
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