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co
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Ev
a
lua
tion
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h
mo
nitoring
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pro
mo
tion
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a
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se s
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y
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2
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Th
e
imp
lem
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n
tati
o
n
o
f
g
ro
wt
h
m
o
n
it
o
r
in
g
a
n
d
p
ro
m
o
t
io
n
(G
M
P
),
wh
ic
h
fu
n
c
ti
o
n
s
to
m
o
n
it
o
r
t
h
e
g
ro
wt
h
a
n
d
d
e
v
e
l
o
p
m
e
n
t
o
f
to
d
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lers
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is
c
a
rried
o
u
t
b
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n
teg
ra
ted
se
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ice
p
o
st
c
o
m
m
u
n
it
y
h
e
a
lt
h
v
o
lu
n
tee
rs
(
CHV
s
)
(in
In
d
o
n
e
sia
c
a
ll
e
d
Po
sy
a
n
d
u
),
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ll
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e
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l
y
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a
s
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t
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e
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ted
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y
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is
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se
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im
e
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to
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v
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lu
a
te
th
e
imp
lem
e
n
t
a
ti
o
n
o
f
G
M
P
,
it
s
b
a
rriers
,
a
n
d
s
u
p
p
o
rti
n
g
fa
c
to
rs.
Th
e
re
se
a
rc
h
d
e
sig
n
is
c
o
n
c
u
rre
n
t
m
i
x
e
d
m
e
th
o
d
s.
Qu
a
n
t
it
a
ti
v
e
d
a
ta
c
o
ll
e
c
ti
o
n
wa
s
c
a
rried
o
u
t
u
si
n
g
G
M
P
p
ra
c
ti
c
e
o
b
se
rv
a
ti
o
n
s
h
e
e
ts
with
a
sa
m
p
le
o
f
3
0
CHV
s.
G
M
P
p
ra
c
ti
c
e
o
b
se
rv
a
ti
o
n
s
we
r
e
c
a
rried
o
u
t
b
y
th
re
e
o
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se
rv
e
rs
a
n
d
t
h
e
re
su
lt
s
we
re
a
n
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ly
z
e
d
u
sin
g
m
u
lt
i
fa
c
e
t
Ra
sc
h
m
e
a
su
re
m
e
n
t
(
M
F
RM
).
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a
li
tativ
e
d
a
ta
wa
s
c
o
ll
e
c
ted
th
ro
u
g
h
in
-
d
e
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t
h
in
terv
iew
s
a
n
d
fo
c
u
s g
ro
u
p
d
isc
u
ss
io
n
(
F
G
D
)
wit
h
2
7
in
fo
rm
a
n
ts.
Th
e
re
se
a
rc
h
re
su
lt
s
s
h
o
w
th
a
t
G
M
P
p
r
a
c
ti
c
e
s
in
th
e
c
o
m
p
o
n
e
n
ts
o
f
g
r
o
wth
m
e
a
su
re
m
e
n
t,
p
lo
tt
in
g
m
e
a
su
re
m
e
n
t
re
su
lt
s,
i
n
terp
re
tatio
n
o
f
g
ro
wt
h
in
d
ica
to
rs,
a
n
d
c
o
u
n
se
li
n
g
stil
l
n
e
e
d
to
b
e
imp
ro
v
e
d
.
Ba
rriers
to
imp
lem
e
n
ti
n
g
G
M
P
a
re
h
u
m
a
n
re
so
u
rc
e
s,
fa
c
il
it
ies
,
a
n
d
i
n
fra
stru
c
tu
re
,
lac
k
o
f
m
o
t
iv
a
ti
o
n
,
a
tt
it
u
d
e
o
f
m
o
th
e
rs
o
f
to
d
d
lers
,
i
n
a
d
e
q
u
a
te
c
a
p
a
c
it
y
o
f
CHV
Po
sy
a
n
d
u
,
a
n
d
lac
k
o
f
v
il
la
g
e
g
o
v
e
r
n
m
e
n
t
s
u
p
p
o
rt
.
S
u
p
p
o
r
ti
n
g
t
h
e
imp
lem
e
n
tati
o
n
o
f
G
M
P
is
th
e
p
a
rti
c
ip
a
ti
o
n
,
m
o
n
it
o
rin
g
,
a
n
d
ro
le
o
f
CHV
s
in
h
u
m
a
n
d
e
v
e
lo
p
m
e
n
t.
Th
e
re
se
a
rc
h
c
o
n
c
lu
d
e
s
t
h
a
t
t
h
e
p
ra
c
ti
c
e
o
f
imp
lem
e
n
ti
n
g
G
M
P
in
t
h
e
se
fo
u
r
c
o
m
p
o
n
e
n
ts
is
c
o
n
si
d
e
re
d
n
o
t
o
p
ti
m
a
l.
It
is
re
c
o
m
m
e
n
d
e
d
t
h
a
t
Po
sy
a
n
d
u
CHV
s
n
e
e
d
to
in
c
re
a
se
th
e
ir
c
a
p
a
c
it
y
i
n
imp
lem
e
n
ti
n
g
G
M
P
so
th
a
t
t
h
e
g
r
o
wth
a
n
d
d
e
v
e
lo
p
m
e
n
t
o
f
c
h
i
ld
re
n
u
n
d
e
r
fiv
e
c
a
n
b
e
p
ro
p
e
rly
m
o
n
it
o
re
d
to
p
re
v
e
n
t
e
a
rly
m
a
ln
u
tri
t
io
n
a
n
d
stu
n
ti
n
g
.
K
ey
w
o
r
d
s
:
C
h
ild
r
en
u
n
d
er
f
iv
e
C
o
m
m
u
n
ity
h
ea
lth
v
o
lu
n
teer
s
Gr
o
wth
m
o
n
ito
r
in
g
a
n
d
p
r
o
m
o
tio
n
I
m
p
lem
en
tatio
n
Ma
ln
u
tr
itio
n
M
u
lti f
ac
et
R
asch
m
ea
s
u
r
em
en
t
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
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-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
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A
uth
o
r
:
Dew
i M
ar
h
ae
n
i D
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Her
awa
ti
Dep
ar
tm
en
t o
f
Pu
b
lic
Hea
lth
,
Div
is
io
n
o
f
Me
d
ical
Nu
tr
itio
n
,
Facu
lty
o
f
Me
d
icin
e
,
Un
iv
er
s
itas
Pad
jad
jar
an
E
y
ck
m
an
Stre
et
No
.
3
8
,
B
an
d
u
n
g
4
0
1
6
1
,
I
n
d
o
n
esia
E
m
ail: m
ar
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ae
n
i@
u
n
p
a
d
.
ac
.
id
1.
I
NT
RO
D
UCT
I
O
N
Sev
er
e
m
aln
u
tr
itio
n
is
wid
esp
r
ea
d
in
ch
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r
en
a
n
d
h
as
a
h
ig
h
d
is
ea
s
e
b
u
r
d
en
co
n
ce
n
tr
ated
i
n
lo
w
an
d
m
id
d
le
-
in
co
m
e
c
o
u
n
tr
ies.
Alm
o
s
t
h
alf
o
f
th
e
d
ea
th
s
wo
r
ld
wid
e
in
ch
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r
en
u
n
d
er
th
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ag
e
o
f
f
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ar
e
r
elate
d
to
u
n
d
er
n
u
tr
itio
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,
d
u
r
i
n
g
th
is
cr
it
ical
p
er
io
d
g
o
o
d
n
u
tr
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n
al
c
o
n
d
itio
n
s
af
f
ec
t a
c
h
ild
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s
h
ea
lth
,
d
ev
el
o
p
m
en
t,
an
d
p
h
y
s
ical
an
d
co
g
n
itiv
e
f
u
n
ctio
n
in
g
[
1
]
–
[
4
]
.
B
ased
o
n
W
HO
d
ata
in
2
0
2
0
,
1
4
9
.
2
m
illi
o
n
ch
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r
en
in
th
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wo
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ld
ar
e
s
tu
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ted
,
4
5
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5
m
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ar
e
wastin
g
an
d
3
8
.
9
m
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o
n
a
r
e
o
v
er
weig
h
t
[
5
]
.
I
n
I
n
d
o
n
esia,
th
e
B
asic
Hea
lth
R
esear
ch
(
R
is
k
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as)
s
h
o
wed
a
d
ec
r
ea
s
e
in
th
e
p
r
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alen
ce
o
f
s
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g
,
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n
d
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h
t,
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f
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m
3
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2
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% in
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to
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7
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7
%,
an
d
1
0
.
2
% in
R
is
k
esd
as 2
0
1
8
[
6
]
.
Sev
er
e
ch
ild
h
o
o
d
m
aln
u
tr
itio
n
is
co
m
m
o
n
an
d
p
r
im
a
r
ily
af
f
e
cts
lo
w
an
d
m
id
d
le
-
in
co
m
e
co
m
m
u
n
ities
,
with
a
s
ig
n
if
ican
t
d
is
ea
s
e
b
u
r
d
en
.
T
h
e
m
aj
o
r
ity
o
f
m
al
n
u
t
r
i
tio
n
tr
ea
tm
en
t
an
d
p
o
licy
in
iti
ativ
es
to
d
ate
h
av
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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b
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Hea
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Sci
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N:
2252
-
8
8
0
6
E
va
lu
a
tio
n
imp
leme
n
ta
tio
n
g
r
o
w
th
mo
n
ito
r
in
g
a
n
d
p
r
o
mo
ti
o
n
:
a
ca
s
e
s
tu
d
y
…
(
K
iki
K
a
mila
h
)
623
co
n
ce
n
tr
ated
o
n
im
m
ed
iate
h
a
za
r
d
s
,
s
u
ch
as
illn
ess
es
an
d
f
at
alities
.
No
n
eth
eless
,
th
er
e
is
m
o
u
n
tin
g
p
r
o
o
f
th
at
th
o
s
e
wh
o
s
u
r
v
iv
e
s
tar
v
atio
n
h
av
e
lo
n
g
-
ter
m
d
is
ad
v
an
ta
g
es,
s
u
ch
as
an
in
cr
ea
s
ed
r
is
k
o
f
n
o
n
-
c
o
m
m
u
n
icab
le
d
is
ea
s
es
in
later
life
.
As
a
r
esu
lt
o
f
co
o
r
d
in
ated
in
ter
n
atio
n
al
in
itiativ
es,
th
e
p
r
ev
ale
n
ce
o
f
m
al
n
u
tr
itio
n
h
as
d
ec
lin
ed
r
ec
e
n
tly
.
Ho
we
v
er
,
f
o
o
d
i
n
s
ec
u
r
ity
,
c
o
n
f
lict,
a
n
d
c
lim
ate
ch
an
g
e
p
o
s
e
a
th
r
ea
t
to
th
e
p
e
r
s
is
ten
ce
o
f
ch
ild
h
o
o
d
m
aln
u
tr
iti
o
n
in
m
an
y
ar
ea
s
with
u
n
s
tab
le
f
o
o
d
s
u
p
p
ly
n
etwo
r
k
s
[
7
]
–
[
1
0
]
.
Fu
r
t
h
er
m
o
r
e,
m
aln
u
tr
itio
n
ca
n
h
av
e
a
n
im
p
ac
t
o
n
f
u
tu
r
e
g
en
er
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n
s
b
y
r
e
d
u
cin
g
p
h
y
s
ical
s
tr
en
g
th
,
d
ec
r
ea
s
in
g
p
r
o
d
u
ctiv
ity
at
wo
r
k
,
in
cr
ea
s
in
g
th
e
lik
elih
o
o
d
o
f
u
n
em
p
lo
y
m
en
t,
an
d
r
aisi
n
g
th
e
ch
an
ce
o
f
p
o
v
er
ty
.
T
h
e
g
r
o
w
th
m
o
n
ito
r
in
g
an
d
p
r
o
m
o
tio
n
(
GM
P)
p
r
o
g
r
am
h
as
b
ee
n
s
u
g
g
ested
b
y
th
e
Un
i
ted
Natio
n
s
C
h
ild
r
en
’
s
Fu
n
d
(
W
HO)
as
a
way
to
r
ed
u
ce
ch
ild
h
o
o
d
m
aln
u
tr
itio
n
to
ad
d
r
ess
th
is
p
r
o
b
lem
[
1
1
]
–
[
1
3
]
.
GM
P
is
u
s
ed
in
m
an
y
lo
w
-
an
d
m
id
d
le
-
i
n
co
m
e
co
u
n
tr
ies
to
tr
ac
k
g
r
o
wth
f
ailu
r
e
ea
r
ly
t
o
im
p
r
o
v
e
c
h
ild
g
r
o
wth
ch
ar
ts
th
r
o
u
g
h
n
u
tr
itio
n
co
u
n
s
elin
g
an
d
o
th
er
h
e
alth
p
r
o
m
o
tio
n
m
ea
s
u
r
es.
Acc
o
r
d
in
g
to
W
HO
g
u
id
elin
es,
GM
P
in
clu
d
es
:
i
)
r
o
u
tin
e
m
ea
s
u
r
em
e
n
t
o
f
c
h
ild
weig
h
t
a
n
d
le
n
g
th
/h
ei
g
h
t;
ii
)
p
lo
ttin
g
ch
ild
m
ea
s
u
r
em
en
ts
an
d
co
m
p
ar
in
g
th
e
ch
ild
’
s
n
u
tr
itio
n
al
s
tatu
s
with
g
r
o
wth
ch
ar
t
s
tan
d
ar
d
s
t
o
ass
es
s
th
e
ch
ild
’
s
g
r
o
wth
p
atter
n
;
iii
)
co
u
n
s
elin
g
a
cc
o
r
d
in
g
to
th
e
g
r
o
wth
ch
a
r
t;
an
d
,
if
n
ec
ess
ar
y
;
iv
)
tak
in
g
co
r
r
ec
tiv
e
an
d
h
ea
lth
p
r
o
m
o
tio
n
m
ea
s
u
r
es
[
1
]
.
T
o
i
m
p
r
o
v
e
th
e
n
u
tr
itio
n
al
co
n
d
itio
n
o
f
ch
ild
r
e
n
,
GM
P
s
er
v
ices
ar
e
d
eliv
er
ed
th
r
o
u
g
h
th
e
p
r
im
a
r
y
h
ea
lth
ca
r
e
s
y
s
tem
at
th
e
co
m
m
u
n
ity
an
d
h
ea
lt
h
f
ac
ilit
y
lev
els.
GM
P
is
a
p
r
ev
en
tativ
e
in
itiativ
e
m
ad
e
u
p
o
f
c
h
ild
G
M
ass
o
ciate
d
with
a
p
r
o
m
o
tio
n
th
at
r
aises
awa
r
en
ess
o
f
ch
ild
d
ev
elo
p
m
en
t,
en
h
a
n
ce
s
p
ar
en
tin
g
tech
n
iq
u
es,
an
d
b
o
o
s
ts
th
e
n
ee
d
f
o
r
a
d
d
itio
n
al
s
er
v
ices
[
1
4
]
,
[
1
5
]
.
Alth
o
u
g
h
G
MP
s
er
v
ices
ar
e
s
till
u
s
ed
in
m
o
s
t
l
ow
-
an
d
m
id
d
l
e
-
in
co
m
e
co
u
n
tr
ies,
im
p
lem
e
n
tatio
n
s
till
h
as
m
an
y
ch
allen
g
es
in
clu
d
in
g
l
o
w
s
er
v
ice
co
v
er
ag
e
,
in
ad
eq
u
ate
tr
ain
in
g
o
r
ca
p
ac
ity
b
u
ild
in
g
o
f
h
ea
lth
wo
r
k
er
s
an
d
r
esu
ltin
g
m
ea
s
u
r
em
en
t
er
r
o
r
s
,
in
co
r
r
ec
t
i
n
ter
p
r
etatio
n
o
f
g
r
o
wth
ch
ar
ts
,
an
d
p
o
o
r
o
r
n
o
c
o
u
n
s
elin
g
[
1
]
,
[
1
2
]
,
[
1
6
]
.
I
d
ea
lly
,
h
ea
lth
w
o
r
k
er
s
s
h
o
u
ld
p
r
o
v
id
e
i
n
f
o
r
m
atio
n
th
r
o
u
g
h
p
r
o
m
o
tiv
e
c
o
u
n
s
elin
g
,
f
ac
ilit
ate
co
m
m
u
n
icatio
n
,
an
d
in
ter
ac
t
with
m
o
th
er
s
/car
eg
iv
e
r
s
b
ased
o
n
t
h
e
ch
ild
’
s
s
tatu
s
o
n
th
e
g
r
o
wth
ch
ar
t c
o
n
tain
ed
in
th
e
Ma
ter
n
al
an
d
C
h
ild
Hea
lth
book
[
1
7
]
.
T
h
is
s
tu
d
y
’
s
o
b
ject
iv
e
is
to
ev
alu
ate
h
o
w
GM
P i
m
p
lem
en
tatio
n
p
r
ac
tices,
b
ar
r
i
er
s
,
a
n
d
s
u
p
p
o
r
ter
s
.
2.
M
E
T
H
O
D
T
h
is
r
esear
ch
m
eth
o
d
u
s
es
a
m
ix
ed
m
eth
o
d
r
esear
ch
m
eth
o
d
with
a
co
n
cu
r
r
en
t
m
ix
e
d
m
eth
o
d
s
tr
ateg
y
,
wh
er
e
q
u
an
titativ
e
d
ata
an
d
q
u
alitativ
e
d
ata
ar
e
co
llected
at
o
n
e
tim
e,
an
d
th
en
c
o
m
p
a
r
ed
to
d
eter
m
in
e
wh
eth
er
th
er
e
ar
e
d
if
f
er
e
n
ce
s
,
co
n
v
er
g
en
ce
,
o
r
c
o
m
b
in
at
io
n
s
[
1
8
]
.
T
h
is
s
tu
d
y
was
a
p
p
r
o
v
ed
b
y
th
e
Hea
lth
E
th
ics
C
o
m
m
ittee
o
f
th
e
Facu
lty
o
f
Me
d
icin
e,
Pad
jad
jar
an
Un
iv
er
s
ity
with
eth
ical
n
u
m
b
er
3
5
0
/
UN6
.
KE
P/EC
/2
0
2
3
an
d
p
e
r
m
is
s
io
n
f
r
o
m
th
e
E
ast
L
am
p
u
n
g
Dis
t
r
ict
Hea
lth
Of
f
i
ce
.
T
h
e
s
tu
d
y
was
co
n
d
u
cted
i
n
th
e
wo
r
k
in
g
ar
ea
o
f
th
e
Ma
r
g
o
to
to
Hea
lth
C
en
ter
wh
ich
in
clu
d
es
Kib
an
g
Villag
e,
Ma
r
g
o
to
t
o
Villag
e,
Ma
r
g
ajay
a
Villag
e,
Pu
r
b
o
s
em
b
o
d
o
Villag
e,
Su
m
b
er
Ag
u
n
g
Villag
e,
Ma
r
g
o
s
ar
i
Villag
e
an
d
J
ay
a
Asri
Villag
e.
T
h
is
r
e
s
ea
r
ch
was
co
n
d
u
cte
d
f
r
o
m
Ma
r
ch
to
J
u
n
e
2
0
2
3
.
T
h
e
q
u
an
titativ
e
ap
p
r
o
ac
h
is
cr
o
s
s
-
s
ec
tio
n
al
with
a
p
o
s
t
-
p
o
s
itiv
is
m
p
ar
ad
ig
m
.
T
h
e
ai
m
o
f
th
e
q
u
an
titativ
e
ap
p
r
o
ac
h
is
to
ev
alu
ate
th
e
im
p
lem
en
tatio
n
o
f
G
MP
ca
r
r
ied
o
u
t
b
y
C
o
m
m
u
n
ity
Hea
lth
Vo
lu
n
teer
s
(
C
HVs
)
u
s
in
g
th
e
GM
P
o
b
s
er
v
atio
n
in
s
tr
u
m
e
n
t
f
r
o
m
Su
n
j
ay
a
et
a
l
.
[
1
9
]
.
W
h
ich
h
as
b
e
en
m
o
d
if
ie
d
b
y
th
e
r
esear
ch
team
.
Dev
elo
p
m
e
n
t o
r
m
o
d
if
icatio
n
o
f
i
n
s
tr
u
m
en
ts
,
esp
ec
ially
in
th
e
h
ea
lth
p
r
o
m
o
tio
n
asp
ec
t
,
ca
r
r
ied
o
u
t
b
y
C
HVs
r
ef
er
r
in
g
to
GM
P
th
eo
r
y
.
T
h
e
n
u
m
b
er
o
f
item
s
o
b
s
er
v
e
d
is
2
6
item
s
f
o
r
to
d
d
l
er
s
an
d
2
5
item
s
f
o
r
ch
ild
r
en
>
2
-
5
y
ea
r
s
.
T
h
e
p
o
p
u
l
atio
n
o
f
th
is
s
tu
d
y
was
P
o
s
ya
n
d
u
C
HVs.
T
h
e
s
am
p
le
s
ize
in
R
asch
m
o
d
elin
g
f
o
r
a
s
am
p
le
o
f
N
wh
o
wo
r
k
ed
o
n
th
e
in
s
tr
u
m
en
t
ac
co
r
d
in
g
to
th
e
co
r
r
esp
o
n
d
i
n
g
n
u
m
b
er
o
f
item
s
,
th
e
m
ea
n
c
h
an
ce
v
alu
e
is
b
etwe
en
0
-
5
an
d
0
.
8
7
s
o
th
at
th
e
s
tan
d
ar
d
e
r
r
o
r
m
o
d
el
is
o
b
tain
ed
in
th
e
r
an
g
e
o
f
:
2
/√
(
N)
<SE
<3
/√
N
o
r
4
/SE^2
<
N<
9
/SE^2
W
ith
a
co
n
f
id
en
ce
lev
el
o
f
9
9
%,
it
is
in
th
e
r
an
g
e
o
f
±
2
.
6
S
E
.
Fo
r
a
r
an
g
e
o
f
±
1
lo
g
it,
th
e
SE
v
alu
e
is
in
th
e
r
an
g
e
o
f
±
1
/
2
.
6
lo
g
it,
s
o
th
e
n
u
m
b
er
o
f
s
am
p
les ca
n
b
e
d
eter
m
in
ed
as:
4
/(
(
2
.
6
)
^2
)
<N
<9
/(
(
2
.
6
)
^2
)
T
h
at
is
2
7
<N
<
6
1
(
ca
n
b
e
s
ee
n
in
T
a
b
le
1
wh
ich
is
a
tab
le
cr
ea
ted
b
y
L
in
ac
r
e
)
.
A
s
am
p
le
s
ize
o
f
3
0
C
HVs
is
ap
p
r
o
p
r
iate
f
o
r
a
p
ilo
t
s
tu
d
y
,
wh
ich
is
a
r
an
g
e
o
f
±
1
lo
g
it
with
a
9
5
%
co
n
f
id
e
n
ce
lev
el.
S
am
p
lin
g
was
ca
r
r
ied
o
u
t u
s
in
g
s
im
p
le
r
a
n
d
o
m
s
am
p
lin
g
[
2
0
]
.
A
r
ev
iew
o
f
th
e
GM
P
o
b
s
er
v
atio
n
s
h
ee
t
was
ca
r
r
ied
o
u
t
b
y
an
ex
p
er
ts
to
test
th
e
f
ea
s
ib
ilit
y
o
f
th
e
in
s
tr
u
m
en
t
b
o
t
h
in
ter
m
s
o
f
g
r
am
m
ar
a
n
d
m
ater
ial
co
n
te
n
t.
Prio
r
to
th
e
ass
ess
m
en
t,
th
e
o
b
s
er
v
er
s
will
b
e
ex
p
lain
ed
th
e
ass
ess
m
en
t
asp
ec
ts
co
n
tain
ed
in
th
e
o
b
s
er
v
at
io
n
s
h
ee
t.
B
ef
o
r
e
co
llec
tin
g
d
ata,
th
e
r
esear
ch
er
s
test
ed
th
e
r
eliab
ilit
y
an
d
v
alid
ity
o
f
th
e
GM
P
p
r
ac
tice
o
b
s
er
v
atio
n
s
h
ee
t
in
Ap
r
il
2
0
2
3
o
n
3
0
C
HVs
at
3
0
Hea
lth
C
en
ter
in
E
ast
L
am
p
u
n
g
d
is
tr
ict.
T
esti
n
g
th
e
r
eliab
ilit
y
a
n
d
v
alid
ity
o
f
th
e
o
b
s
er
v
atio
n
s
h
ee
t
u
s
in
g
Min
is
tep
s
o
f
twar
e.
T
h
e
r
esu
lts
o
b
tain
e
d
f
r
o
m
th
e
item
r
eliab
ilit
y
v
alu
e
o
f
0
.
9
1
in
d
icate
th
at
th
e
co
n
s
is
ten
cy
o
f
th
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
2
,
J
u
n
e
20
25
:
62
2
-
63
3
624
r
esp
o
n
d
en
ts
’
an
s
wer
s
is
v
er
y
g
o
o
d
a
n
d
th
e
p
er
s
o
n
r
eliab
ilit
y
is
0
.
8
7
,
with
a
v
alu
e
ab
o
v
e
0
.
8
in
d
icatin
g
th
at
th
e
item
s
in
th
e
in
s
tr
u
m
en
t
ar
e
g
o
o
d
.
C
r
o
n
b
ac
h
’
s
alp
h
a
v
alu
e
o
f
0
.
9
1
in
d
icate
s
r
eliab
ilit
y
,
wh
ich
ar
e
th
e
in
ter
ac
tio
n
b
etwe
en
p
er
s
o
n
an
d
item
as
a
wh
o
le
is
v
er
y
g
o
o
d
.
T
h
e
r
esu
lt
o
f
m
ea
s
u
r
in
g
th
e
r
aw
v
a
r
ian
ce
o
f
th
e
d
ata
is
6
3
.
4
%,
in
d
icatin
g
th
at
th
e
m
in
im
u
m
u
n
id
im
en
s
io
n
ality
r
e
q
u
ir
em
e
n
t
o
f
2
0
%
ca
n
b
e
m
et,
with
a
v
alu
e
ab
o
v
e
6
0
%,
wh
ich
m
ea
n
s
s
p
ec
ial.
T
h
e
v
a
r
ian
ce
t
h
at
ca
n
n
o
t
b
e
ex
p
lain
ed
b
y
th
e
in
s
tr
u
m
en
t
s
h
o
ws
a
v
alu
e
o
f
8
.
4
%,
5
.
2
%,
3
.
8
%,
3
.
2
%,
an
d
3
.
1
% wh
ic
h
d
o
es n
o
t e
x
ce
ed
1
5
%,
wh
ich
m
ea
n
s
i
t is id
ea
l.
An
d
r
ich
T
r
esh
o
ld
v
a
lu
es (
NONE
,
-
0
.
1
9
,
0
.
1
9
)
wh
ic
h
m
o
v
e
f
r
o
m
NONE
th
en
n
eg
ativ
e
an
d
co
n
tin
u
e
to
lead
to
p
o
s
itiv
e
in
s
eq
u
en
ce
in
d
icate
th
at
th
e
o
p
tio
n
s
ar
e
v
alid
f
o
r
th
e
r
esp
o
n
d
en
ts
.
I
n
c
o
n
clu
s
io
n
,
th
e
r
es
u
lts
o
f
th
e
r
eliab
ilit
y
an
d
v
alid
ity
test
o
f
th
e
GM
P
p
r
ac
tic
e
o
b
s
er
v
atio
n
s
h
ee
t c
an
b
e
s
aid
to
b
e
g
o
o
d
[
2
0
]
.
T
ab
le
1
.
Sam
p
le
s
ize
in
R
asch
m
o
d
elin
g
S
t
a
b
l
e
a
i
t
e
m c
a
l
i
b
r
a
t
i
o
n
C
o
n
f
i
d
e
n
c
e
l
e
v
e
l
S
a
mp
l
e
r
a
n
g
e
A
p
p
r
o
p
r
i
a
t
e
s
a
mp
l
e
si
z
e
±
1
l
o
g
i
t
9
5
%
16
-
36
30
±
1
l
o
g
i
t
9
9
%
27
-
61
50
±0
.
5
l
o
g
i
t
9
5
%
64
-
1
4
4
1
0
0
±0
.
5
l
o
g
i
t
9
9
%
1
0
8
-
243
1
5
0
Qu
an
titativ
e
d
ata
an
aly
s
is
was
o
b
tain
ed
f
r
o
m
o
b
s
er
v
atio
n
s
wer
e
ca
r
r
ied
o
u
t
at
P
o
s
ya
n
d
u
ac
tiv
ities
,
wh
en
C
HVs
ca
r
r
ied
o
u
t
GM
P,
th
ey
wo
u
ld
b
e
ass
ess
ed
b
y
t
h
r
ee
o
b
s
er
v
er
s
,
b
ased
o
n
th
e
ass
es
s
m
en
t
asp
ec
ts
co
n
tain
ed
in
th
e
o
b
s
er
v
atio
n
s
h
ee
t.
T
h
e
d
ata
co
llected
was
an
aly
ze
d
with
m
u
lti
-
f
ac
eted
R
asch
m
ea
s
u
r
em
en
t
(
MFR
M
)
,
wh
ich
is
a
d
ev
elo
p
m
en
t
o
f
th
e
R
asch
m
ea
s
u
r
em
en
t
m
o
d
el
th
at
aim
s
to
an
aly
s
e
m
u
lti
r
ater
s
.
First,
th
e
r
aw
s
co
r
e
d
ata
o
f
GM
P p
r
ac
tice
o
b
s
er
v
atio
n
s
wer
e
co
llected
f
r
o
m
3
o
b
s
er
v
er
s
,
th
en
th
e
d
at
a
wer
e
en
ter
ed
in
to
th
e
Mic
r
o
s
o
f
t
E
x
ce
l
p
r
o
g
r
am
,
t
h
en
th
e
f
ile
was
s
av
ed
in
t
h
e
f
o
r
m
o
f
a
C
SV
f
ile,
th
en
g
en
er
ic
co
d
in
g
was
ca
r
r
ie
d
o
u
t
to
an
al
y
ze
th
e
d
ata
t
o
b
e
c
alcu
lated
with
Min
if
ac
s
o
f
twa
r
e
[
2
1
]
.
T
h
e
d
ata
d
is
p
lay
af
te
r
p
r
o
ce
s
s
in
g
will
b
e
in
th
e
f
o
r
m
o
f
in
ter
v
al
d
ata
wh
i
ch
h
as
a
l
o
g
it
v
al
u
e.
T
h
en
t
h
e
m
ea
s
u
r
em
en
t
r
esu
lts
ca
n
b
e
ca
teg
o
r
ized
.
Fo
r
GM
P
p
r
ac
tices
at
C
HVs,
r
esear
ch
er
s
d
iv
id
e
th
em
in
to
th
r
ee
in
ter
v
al
s
ca
le
ca
teg
o
r
ies,
g
o
o
d
(
lo
g
it
v
alu
e>
+1
)
,
ad
eq
u
ate
(
lo
g
it v
alu
e
b
etwe
en
+1
an
d
-
1
)
an
d
less
(
lo
g
it v
al
u
e
<
-
1
)
.
T
h
e
q
u
alitativ
e
r
esear
ch
ap
p
r
o
ac
h
is
p
h
en
o
m
eo
l
o
g
y
,
with
an
in
te
r
p
r
etiv
is
m
p
ar
ad
ig
m
.
Data
co
llectio
n
was c
ar
r
ied
o
u
t th
r
o
u
g
h
in
-
d
ep
th
in
ter
v
iews with
th
e
h
ea
d
o
f
th
e
Ma
r
g
o
to
to
Hea
lth
C
en
ter
a
n
d
7
C
HVs.
Ap
ar
t
f
r
o
m
th
at,
a
f
o
cu
s
g
r
o
u
p
d
is
c
u
s
s
io
n
(
FGD)
was
also
ca
r
r
ie
d
o
u
t
in
3
g
r
o
u
p
s
.
T
h
e
f
ir
s
t
g
r
o
u
p
is
th
e
v
illag
e
m
id
wi
f
e
g
r
o
u
p
co
n
s
is
tin
g
o
f
s
ev
en
v
illag
e
m
id
wiv
es,
th
e
s
ec
o
n
d
g
r
o
u
p
co
n
s
is
ts
o
f
th
r
ee
p
eo
p
le
ea
ch
p
r
o
g
r
am
m
an
ag
er
co
n
s
is
tin
g
o
f
one
n
u
tr
itio
n
im
p
lem
en
ter
,
one
h
ea
lth
p
r
o
m
o
tio
n
p
r
o
g
r
am
,
an
d
one
m
id
wif
e
co
o
r
d
in
ato
r
,
an
d
th
e
last
g
r
o
u
p
co
n
s
is
ts
o
f
n
in
e
m
o
th
er
s
o
f
to
d
d
ler
s
,
s
o
th
e
n
u
m
b
er
o
f
in
f
o
r
m
a
n
ts
f
o
r
q
u
alitativ
e
r
esear
ch
is
2
7
p
eo
p
le.
Dete
r
m
in
atio
n
o
f
s
u
b
jects in
C
HV
s
in
f
o
r
m
an
ts
an
d
m
o
th
er
s
o
f
to
d
d
ler
s
is
b
y
n
o
n
-
p
r
o
b
ab
ilit
y
u
s
in
g
p
u
r
p
o
s
iv
e
s
am
p
lin
g
wh
ich
is
a
tech
n
iq
u
e
o
f
d
eter
m
in
in
g
s
u
b
jects
b
ased
o
n
ce
r
tain
c
o
n
s
id
e
r
atio
n
s
an
d
r
ea
s
o
n
s
[
2
2
]
.
T
h
e
h
ea
d
o
f
t
h
e
h
ea
lth
c
en
ter
,
th
e
v
illag
e
m
id
wif
e,
th
e
h
ea
lth
ce
n
te
r
n
u
tr
itio
n
o
f
f
icer
an
d
t
h
e
p
er
s
o
n
in
ch
ar
g
e
o
f
t
h
e
h
ea
lth
p
r
o
m
o
tio
n
p
r
o
g
r
am
at
th
e
h
ea
lth
ce
n
ter
,
an
d
t
h
e
co
o
r
d
in
ato
r
m
id
wif
e
at
th
e
h
ea
lth
ce
n
ter
u
s
ed
to
tal
s
am
p
lin
g
,
wh
er
e
th
e
h
ea
d
o
f
Pu
b
lic
h
ea
lth
ce
n
ter
,
h
ea
lth
p
r
o
m
o
tio
n
p
r
o
g
r
am
,
m
id
wif
e
co
o
r
d
in
at
o
r
,
n
u
tr
itio
n
im
p
lem
e
n
tatio
n
,
an
d
s
ev
en
v
illag
e
m
id
wif
e
in
Ma
r
g
o
to
to
Pu
b
lic
h
ea
lth
ce
n
ter
wer
e
all
s
am
p
led
i
n
th
is
s
tu
d
y
.
T
h
e
r
esear
ch
o
b
jects u
s
ed
in
th
is
r
esear
ch
ar
e
th
e
r
esu
lts
o
f
o
b
s
er
v
atio
n
s
at
th
e
P
o
s
ya
n
d
u
in
th
e
f
o
r
m
o
f
f
ield
n
o
tes
an
d
d
o
cu
m
en
t
s
tu
d
ies.
Do
cu
m
en
t
s
tu
d
ies
a
r
e
co
n
d
u
cted
th
r
o
u
g
h
d
ata
co
ll
ec
tio
n
b
y
s
tu
d
y
in
g
d
o
cu
m
e
n
ts
th
at
ar
e
alr
ea
d
y
av
ailab
l
e
to
o
b
tain
d
ata
o
r
i
n
f
o
r
m
atio
n
r
elate
d
to
th
e
to
p
ic
t
o
b
e
r
esear
ch
ed
[
2
3
]
.
Q
u
alitativ
e
d
ata
an
aly
s
is
tech
n
iq
u
es u
s
ed
th
r
o
u
g
h
s
ev
er
al
s
tag
es in
clu
d
in
g
tr
an
s
cr
ip
tio
n
,
d
a
ta
s
o
r
tin
g
,
co
d
in
g
,
d
ata
ca
teg
o
r
is
atio
n
,
d
escr
ib
in
g
th
em
es,
d
ata
v
er
if
icatio
n
th
r
o
u
g
h
tr
u
s
two
r
th
in
ess
,
an
d
d
ata
r
ep
r
esen
tatio
n
.
T
r
u
s
two
r
th
in
ess
is
ca
r
r
ied
o
u
t
th
r
o
u
g
h
s
ev
er
al
s
tag
es,
th
e
f
ir
s
t
i
s
c
r
ed
ib
ilit
y
wh
ich
is
ca
r
r
ied
o
u
t
th
r
o
u
g
h
s
ev
er
al
s
tag
es,
in
clu
d
in
g
tr
ia
n
g
u
latio
n
o
n
d
ata,
i
n
clu
d
in
g
tr
ian
g
u
latio
n
o
n
d
at
a
s
o
u
r
ce
s
wh
ic
h
is
im
p
lem
en
ted
with
in
f
o
r
m
an
ts
in
r
esear
ch
th
at
ar
e
d
iv
er
s
e
an
d
r
elate
d
to
r
esear
ch
to
p
i
c
s
.
C
o
n
tin
u
ed
with
tr
ian
g
u
latio
n
o
n
r
esear
c
h
m
et
h
o
d
s
b
y
co
llectin
g
d
ata
th
r
o
u
g
h
FGD
ac
tiv
ities
alo
n
g
with
f
ield
n
o
tes,
th
e
n
ex
t
s
tep
is
a
tr
ian
g
u
latio
n
o
f
th
eo
r
y
b
y
k
n
o
win
g
th
e
p
er
s
p
ec
tiv
e
s
o
f
p
r
o
f
ess
io
n
als,
in
th
is
ca
s
e
th
r
o
u
g
h
d
is
cu
s
s
io
n
ac
tiv
ities
with
s
u
p
er
v
is
o
r
s
a
n
d
d
eb
r
ief
in
g
th
r
o
u
g
h
d
is
cu
s
s
io
n
o
f
r
esear
c
h
r
esu
lts
with
s
u
p
er
v
is
o
r
s
.
T
h
e
n
ex
t
s
tep
is
tr
ian
g
u
latio
n
o
f
th
eo
r
y
b
y
k
n
o
win
g
th
e
p
er
s
p
ec
tiv
es
o
f
p
r
o
f
ess
io
n
als,
in
th
is
ca
s
e
th
r
o
u
g
h
d
is
cu
s
s
io
n
ac
tiv
ities
with
s
u
p
er
v
is
o
r
s
an
d
d
eb
r
ief
in
g
th
r
o
u
g
h
d
is
cu
s
s
io
n
o
f
r
e
s
ea
r
ch
r
esu
lts
with
s
u
p
er
v
is
o
r
s
,
th
e
s
ec
o
n
d
is
tr
an
s
f
er
ab
ilit
y
wh
er
e
r
esear
ch
er
s
m
ak
e
r
esear
c
h
r
esu
lts
in
d
e
tail,
clea
r
ly
an
d
s
y
s
tem
atica
lly
s
o
th
at
th
e
y
ca
n
b
e
u
n
d
er
s
to
o
d
an
d
a
clea
r
p
ictu
r
e
i
s
o
b
tain
ed
th
r
o
u
g
h
t
h
ick
d
escr
i
p
tio
n
,
th
e
th
ir
d
is
d
ep
en
d
ab
ilit
y
wh
er
e
r
esear
c
h
er
s
m
ak
e
r
ep
o
r
ts
o
n
th
e
r
esear
c
h
p
r
o
ce
s
s
s
tar
tin
g
f
r
o
m
d
eter
m
i
n
in
g
th
e
p
r
o
b
lem
,
s
ea
r
c
h
in
g
f
o
r
d
ata
i
n
th
e
f
ield
,
d
eter
m
in
in
g
d
ata
s
o
u
r
ce
s
,
an
aly
zin
g
an
d
test
in
g
th
e
v
alid
ity
o
f
th
e
d
ata
an
d
m
ak
in
g
co
n
clu
s
i
o
n
s
,
an
d
th
e
f
o
u
r
t
h
is
co
n
f
ir
m
ab
ilit
y
wh
er
e
th
e
r
esear
ch
r
esu
lts
ca
n
b
e
p
r
o
v
en
co
r
r
ec
t,
b
ec
a
u
s
e
th
e
r
esear
ch
r
esu
lts
ar
e
b
y
th
e
d
at
a
th
at
h
as
b
ee
n
co
llected
an
d
an
aly
ze
d
an
d
th
en
in
clu
d
ed
in
th
e
r
esear
ch
r
esu
lts
.
Data
r
ep
r
esen
tatio
n
,
p
r
esen
ts
th
e
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
E
va
lu
a
tio
n
imp
leme
n
ta
tio
n
g
r
o
w
th
mo
n
ito
r
in
g
a
n
d
p
r
o
mo
ti
o
n
:
a
ca
s
e
s
tu
d
y
…
(
K
iki
K
a
mila
h
)
625
r
esu
lts
o
f
r
esear
c
h
d
ata
an
al
y
s
is
th
at
is
in
ter
esti
n
g
an
d
r
ep
r
e
s
en
tativ
e
s
o
th
at
it
is
ea
s
ily
u
n
d
er
s
to
o
d
b
y
r
ea
d
er
s
[
1
8
]
.
T
h
is
r
esear
ch
u
s
es
a
p
h
en
o
m
en
o
lo
g
ical
ap
p
r
o
ac
h
,
wh
ich
ten
d
s
to
s
ee
k
th
e
m
ea
n
in
g
o
f
th
e
p
h
en
o
m
en
a
ex
p
er
ien
ce
d
b
y
t
h
e
p
ar
ticip
a
n
ts
[
2
2
]
.
Qu
alitativ
e
d
ata
p
r
o
ce
s
s
in
g
is
ca
r
r
ied
o
u
t
u
s
in
g
co
n
ten
t a
n
aly
s
is
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
Q
ua
ntit
a
t
iv
e
re
s
ult
C
h
ar
ac
ter
is
tics
o
f
r
esp
o
n
d
en
ts
b
ased
o
n
th
e
ag
e
o
f
C
HVs
i
n
th
e
Ma
r
g
o
to
to
Hea
lth
C
en
te
r
wo
r
k
in
g
ar
ea
ar
e
m
o
r
e
ag
ed
3
0
to
4
0
y
e
ar
s
.
B
ased
o
n
th
e
lev
el
o
f
ed
u
c
atio
n
,
C
HVs
in
th
e
Ma
r
g
o
to
to
Hea
lth
C
en
ter
wo
r
k
ar
ea
ar
e
m
o
r
e
with
ju
n
io
r
h
i
g
h
s
ch
o
o
l
ed
u
ca
tio
n
,
wh
ile
b
as
ed
o
n
th
e
len
g
th
o
f
tim
e
b
ein
g
C
HVs
m
o
r
e
in
th
e
r
an
g
e
o
f
1
1
to
1
5
y
ea
r
s
,
as sh
o
wn
in
T
ab
le
2
.
T
ab
le
2
.
C
h
ar
ac
ter
is
tics
o
f
r
es
p
o
n
d
e
n
ts
V
a
r
i
a
b
l
e
C
H
V
s (n
=
3
0
)
%
A
g
e
g
r
o
u
p
<
3
0
y
e
a
r
s
2
6
.
6
6
30
-
4
0
y
e
a
r
s
14
4
.
6
7
40
-
5
0
y
e
a
r
s
12
40
>
5
0
y
e
a
r
2
6
.
6
6
Le
v
e
l
e
d
u
c
a
t
i
o
n
El
e
m
e
n
t
a
r
y
s
c
h
o
o
l
3
10
Ju
n
i
o
r
h
i
g
h
sc
h
o
o
l
16
5
3
.
3
3
S
e
n
i
o
r
h
i
g
h
s
c
h
o
o
l
10
3
3
.
3
3
C
o
l
l
e
g
e
1
3
.
3
3
Le
n
g
t
h
o
f
t
i
m
e
b
e
i
n
g
C
H
V
s
0
-
5
y
e
a
r
s
12
40
6
-
1
0
y
e
a
r
s
5
1
6
.
6
7
11
-
1
5
y
e
a
r
s
13
4
3
.
3
3
F
i
g
u
r
e
1
d
e
s
c
r
i
b
es
t
h
e
d
is
t
r
i
b
u
ti
o
n
o
f
t
h
e
w
r
i
g
h
t
m
a
p
o
f
t
h
e
a
s
s
e
s
s
m
e
n
t
r
es
u
l
ts
c
a
r
r
ie
d
o
u
t
b
y
C
H
Vs
o
n
t
h
e
p
r
a
c
t
ic
e
o
f
w
e
i
g
h
t m
e
as
u
r
em
e
n
t
o
f
i
n
f
a
n
ts
0
-
2
y
e
a
r
s
.
C
o
l
u
m
n
C
HV
s
a
n
d
as
p
e
c
ts
a
s
s
es
s
ed
:
t
h
e
r
e
a
r
e
8
C
H
Vs
w
i
t
h
c
o
d
e
n
u
m
b
e
r
s
“
1
3
,
2
4
,
2
6
,
2
9
,
5
,
7
,
1
,
1
1
”
w
h
o
m
a
s
t
e
r
e
d
t
h
e
4
a
s
p
e
c
t
s
a
s
s
es
s
e
d
,
w
h
i
c
h
a
r
e
i
d
e
n
t
i
f
i
c
at
i
o
n
o
f
w
e
i
g
h
i
n
g
d
i
s
t
u
r
b
a
n
c
e
s
,
d
et
e
r
m
in
a
t
i
o
n
o
f
t
h
e
s
t
a
r
t
i
n
g
n
u
m
b
e
r
s
o
f
s
c
a
l
es
,
d
e
te
r
m
i
n
a
t
i
o
n
o
f
m
e
asu
r
e
m
e
n
t
r
e
s
u
l
ts
a
n
d
r
e
c
o
r
d
i
n
g
o
f
m
e
a
s
u
r
e
m
e
n
t
r
es
u
l
t
s
.
C
H
Vs
wi
t
h
c
o
d
e
n
u
m
b
e
r
s
“
1
5
,
3
,
1
4
,
1
9
,
2
0
,
2
3
,
3
0
,
4
,
6
,
9
,
1
2
,
2
,
8
”
m
as
t
e
r
ed
t
h
e
3
a
s
p
e
c
t
s
as
s
e
s
s
e
d
,
w
h
i
c
h
ar
e
d
e
t
e
r
m
i
n
i
n
g
t
h
e
s
t
a
r
ti
n
g
n
u
m
b
e
r
o
f
s
c
a
l
es
,
d
e
t
e
r
m
i
n
i
n
g
t
h
e
m
e
a
s
u
r
e
m
e
n
t
r
es
u
l
ts
a
n
d
r
e
c
o
r
d
i
n
g
t
h
e
m
e
as
u
r
e
m
e
n
t
r
e
s
u
lt
s
.
C
H
Vs
wi
t
h
c
o
d
e
n
u
m
b
e
r
s
“
1
8
,
2
2
,
2
5
,
2
7
”
m
as
t
e
r
e
d
2
a
s
p
e
c
ts
ass
e
s
s
e
d
,
w
h
i
c
h
a
r
e
d
e
te
r
m
i
n
i
n
g
t
h
e
m
ea
s
u
r
e
m
e
n
t
r
es
u
l
ts
a
n
d
r
e
c
o
r
d
i
n
g
t
h
e
m
e
as
u
r
e
m
e
n
t
r
es
u
l
ts
.
W
h
i
le
C
HV
s
w
it
h
c
o
d
e
n
u
m
b
e
r
s
“
2
1
,
1
0
,
1
6
,
1
7
,
2
8
”
c
o
u
l
d
n
o
t
m
a
s
t
e
r
t
h
e
4
a
s
p
e
c
ts
a
s
s
es
s
e
d
.
T
h
e
a
s
p
e
c
t
o
f
i
d
e
n
t
if
i
c
a
t
i
o
n
o
f
w
e
i
g
h
i
n
g
d
i
s
t
u
r
b
a
n
c
es
i
s
t
h
e
m
o
s
t
d
i
f
f
ic
u
l
t
a
s
p
e
ct
p
r
a
c
t
is
e
d
b
y
C
HV
s
,
wh
i
l
e
t
h
e
a
s
p
ec
t
o
f
r
e
c
o
r
d
i
n
g
t
h
e
m
e
a
s
u
r
e
m
e
n
t
r
es
u
l
ts
i
s
t
h
e
e
as
i
es
t
a
s
p
e
ct
p
r
a
c
ti
s
e
d
b
y
C
HV
s
.
O
b
s
e
r
v
e
r
s
w
i
t
h
t
h
e
co
d
e
“
IM
”
t
e
n
d
t
o
b
e
s
t
r
ic
t
i
n
a
s
s
e
s
s
i
n
g
t
h
e
p
r
a
c
ti
ce
o
f
w
e
i
g
h
t
m
e
a
s
u
r
e
m
e
n
t
o
f
i
n
f
a
n
t
s
0
-
2
y
e
a
r
s
,
w
h
i
l
e
o
b
s
e
r
v
e
r
s
w
i
t
h
t
h
e
c
o
d
e
“
ER
”
t
e
n
d
t
o
b
e
e
a
s
y
i
n
a
s
s
ess
i
n
g
t
h
e
p
r
a
c
t
i
c
e
o
f
w
ei
g
t
m
e
as
u
r
e
m
e
n
t
o
f
i
n
f
a
n
t
s
0
-
2
y
e
a
r
s
.
B
ased
o
n
T
ab
le
3
,
GM
P
p
r
ac
tices
ca
n
b
e
ass
ess
ed
f
r
o
m
4
co
m
p
o
n
en
ts
s
ep
ar
ated
in
to
2
ca
teg
o
r
ies,
wh
ich
ar
e
in
f
a
n
ts
0
-
2
y
ea
r
s
an
d
to
d
d
ler
s
2
-
5
y
ea
r
s
,
b
ec
a
u
s
e
th
er
e
ar
e
d
if
f
er
e
n
ce
s
in
m
ea
s
u
r
i
n
g
b
o
d
y
le
n
g
th
a
n
d
h
eig
h
t.
Mo
s
t o
f
th
e
lev
els o
f
C
HVs p
r
ac
tices in
weig
h
t m
ea
s
u
r
em
en
t o
f
in
f
an
ts
0
-
2
y
ea
r
s
w
er
e
in
th
e
ad
eq
u
ate
ca
teg
o
r
y
,
an
d
in
to
d
d
ler
s
2
-
5
y
ea
r
s
m
o
s
t
wer
e
in
th
e
ad
e
q
u
a
te
ca
teg
o
r
y
.
T
h
e
p
r
ac
tice
o
f
C
HVs
in
b
o
d
y
len
g
th
m
ea
s
u
r
em
en
t o
f
in
f
an
ts
0
-
2
y
e
ar
s
,
m
o
s
t
ly
in
th
e
a
d
eq
u
ate
ca
t
eg
o
r
y
an
d
p
r
ac
tice
o
f
C
HVs
h
eig
h
t
m
ea
s
u
r
em
e
n
t
o
f
to
d
d
ler
s
2
-
5
y
ea
r
s
,
m
o
s
tly
in
th
e
a
d
eq
u
ate
ca
teg
o
r
y
.
I
n
t
h
e
p
r
ac
tice
o
f
C
HVs
o
n
p
lo
ttin
g
th
e
m
ea
s
u
r
em
en
t
r
esu
lts
o
f
in
f
a
n
ts
0
-
2
y
ea
r
s
,
m
o
s
t
wer
e
in
th
e
ad
e
q
u
ate
ca
teg
o
r
y
,
w
h
ile
in
t
o
d
d
l
er
s
2
-
5
y
ea
r
s
,
m
o
s
t
wer
e
in
th
e
less
ca
teg
o
r
y
.
T
h
e
p
r
ac
tice
o
f
C
HV
s
in
th
e
in
ter
p
r
etatio
n
o
f
g
r
o
wth
in
d
icato
r
s
f
o
r
in
f
an
ts
0
-
2
y
ea
r
s
,
m
o
s
t
o
f
th
em
wer
e
in
t
h
e
m
o
d
er
ate
ca
t
eg
o
r
y
,
an
d
in
to
d
d
ler
s
2
-
5
y
ea
r
s
,
m
o
s
t
o
f
th
em
wer
e
in
less
ca
teg
o
r
y
.
T
h
e
p
r
ac
tice
of
C
HVs
in
co
u
n
s
elin
g
f
o
r
in
f
an
ts
0
-
2
y
ea
r
s
,
m
o
s
t
o
f
th
em
w
er
e
in
th
e
ad
eq
u
ate
ca
teg
o
r
y
,
i
n
to
d
d
le
r
s
2
-
5
y
ea
r
s
,
m
o
s
t o
f
th
em
wer
e
in
th
e
a
d
eq
u
ate
ca
teg
o
r
y
.
3
.
2
.
Q
ua
lit
a
t
iv
e
re
s
ult
T
h
e
n
u
m
b
er
o
f
q
u
alitativ
e
p
a
r
ticip
an
ts
in
th
is
s
tu
d
y
was
2
7
r
esp
o
n
d
en
ts
.
Mo
s
t
r
esp
o
n
d
en
ts
wer
e
b
etwe
en
2
2
-
5
5
y
ea
r
s
o
ld
,
with
an
ass
o
ciate
d
eg
r
ee
ed
u
ca
tio
n
l
ev
el
(
3
7
.
1
%),
an
d
m
o
th
er
s
o
f
to
d
d
ler
s
b
ac
k
g
r
o
u
n
d
(
3
3
.
3
%),
d
etails
ca
n
b
e
s
ee
n
in
T
ab
le
4
.
T
h
e
an
aly
s
is
T
h
is
an
aly
s
is
r
ev
ea
ls
a
co
m
p
o
s
ite
p
ict
u
r
e
o
f
th
e
r
esu
lts
o
f
in
-
d
ep
th
i
n
t
er
v
iews,
FGDs
,
an
d
f
ield
o
b
s
er
v
atio
n
s
.
T
h
is
s
t
u
d
y
f
o
u
n
d
th
r
ee
th
e
m
es:
GM
P
p
r
ac
tices,
GM
P
b
ar
r
ier
s
,
an
d
GM
P su
p
p
o
r
ter
s
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
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d
2
-
5
y
ea
r
s
s
h
o
ws
th
at
th
e
s
k
ills
of
C
H
Vs
s
til
l
n
ee
d
to
be
im
p
r
o
v
ed
.
“
Mea
s
u
r
in
g
h
eig
h
t,
th
e
h
ea
d
mu
s
t
lo
o
k
fo
r
w
a
r
d
,
th
e
n
u
m
b
ers
mu
s
t
be
at
eye
leve
l,
th
o
s
e
w
h
o
mea
s
u
r
e
a
r
e
u
s
u
a
lly
one
p
ers
o
n
,
t
h
ere
is
no
o
ne
to
h
o
ld
if
yo
u
mea
s
u
r
e
h
eig
h
t
if
th
e
len
g
t
h
of
th
e
b
o
d
y
,
s
o
meo
n
e
mu
s
t
h
elp
h
o
ld
it,
c
a
d
r
es
w
h
o
h
elp
h
o
l
d
it
.
”
(IW
-
4)
C
HVs
in
f
o
r
m
an
ts
co
n
v
ey
e
d
h
o
w
h
eig
h
t
m
ea
s
u
r
em
en
ts
of
ch
ild
r
en
ag
ed
2
-
5
y
ea
r
s
wer
e
u
s
u
ally
ca
r
r
ied
out
at
th
e
P
o
s
ya
n
d
u
wh
ich
lack
ed
d
etail,
C
HVs
in
f
o
r
m
a
n
ts
d
id
not
e
n
s
u
r
e
th
at
s
h
o
e
s
/
f
o
o
twea
r
,
s
o
ck
s
,
h
air
p
iece
s
,
an
d
h
ea
d
g
ea
r
wer
e
r
em
o
v
ed
b
ef
o
r
e
h
eig
h
t
m
ea
s
u
r
em
en
ts
wer
e
tak
en
.
C
HVs
in
f
o
r
m
an
ts
on
ly
e
n
s
u
r
e
th
e
ac
cu
r
ac
y
of
th
e
h
ea
d
p
o
s
itio
n
,
not
e
n
s
u
r
in
g
th
at
th
e
f
iv
e
p
ar
ts
of
th
e
c
h
ild
'
s
body
(
b
ac
k
of
th
e
h
ea
d
,
b
ac
k
,
b
u
tto
ck
s
,
ca
lv
es
,
an
d
h
ee
ls
)
a
r
e
attac
h
ed
to
th
e
m
ea
s
u
r
in
g
i
n
s
tr
u
m
en
t.
T
h
e
r
esu
lts
of
th
e
im
p
lem
en
tatio
n
of
p
lo
ttin
g
th
e
r
esu
lts
of
g
r
o
wth
m
ea
s
u
r
em
en
ts
in
th
e
Ma
r
g
o
to
t
o
Hea
lth
C
en
ter
wo
r
k
i
n
g
ar
ea
s
h
o
w
th
at
th
e
s
k
ills
of
C
HVs
in
p
lo
ttin
g
th
e
r
esu
lt
s
of
g
r
o
wth
m
ea
s
u
r
em
en
ts
s
till
n
ee
d
to
be
im
p
r
o
v
ed
.
“
A
ctu
a
lly,
in
th
e
ma
tern
a
l
a
n
d
ch
ild
h
ea
lth
b
o
o
k,
th
ere
is
a
lr
ea
d
y
a
w
eig
h
t
fo
r
len
g
th
ch
a
r
t,
w
eig
h
t
fo
r
age
ch
a
r
t,
len
g
th
fo
r
a
g
ec
h
a
r
t,
but
th
a
t
’
s
b
ec
a
u
s
e
th
e
c
h
a
r
t
has
n
ev
er
b
ee
n
fill
ed
in
,
a
ctu
a
lly
we
h
a
ve
b
ee
n
ta
u
g
h
t
h
o
w
to
fill
it
in
,
but
not
p
r
a
ctice
d
.
”
(I
-
F9
)
“
Yes
,
th
e
h
eig
h
t
and
a
g
e,
if
th
e
w
eig
h
t
and
h
eig
h
t
h
a
ve
n
o
t
b
ee
n
p
lo
tted
.
”
(I
-
W
2
)
“
Yes
,
th
e
ch
a
r
ts
a
r
e
a
ll
fill
ed
in
by
th
e
mid
w
ife
.
”
(I
-
W
2
)
B
ased
on
o
b
s
er
v
atio
n
s
,
len
g
t
h
f
o
r
ag
e
or
weig
h
t
f
o
r
ag
e
ch
a
r
t
s
ar
e
p
lo
tted
o
n
ly
e
v
er
y
Feb
r
u
ar
y
a
n
d
Au
g
u
s
t,
wh
ile
w
e
ig
h
t
f
o
r
h
eig
h
t
or
weig
h
t
f
o
r
h
eig
h
t
ch
ar
t
s
a
r
e
alm
o
s
t
m
o
s
tly
not
p
lo
tted
e
v
er
y
m
o
n
th
,
if
t
h
ese
ch
ar
ts
ar
e
not
p
lo
tted
,
th
ey
ca
n
n
o
t
be
in
ter
p
r
eted
wh
eth
e
r
th
e
to
d
d
ler
is
n
o
r
m
al
or
ex
p
e
r
ien
c
in
g
g
r
o
wth
f
ailu
r
e.
C
o
u
n
s
elin
g
is
a
f
o
llo
w
-
up
to
g
r
o
wth
m
o
n
ito
r
in
g
co
n
d
u
cted
at
th
e
P
o
s
ya
n
d
u
,
th
e
r
esu
lts
s
h
o
w
th
at
th
er
e
is
s
till
a
n
ee
d
f
o
r
in
cr
ea
s
ed
co
u
n
s
elin
g
f
o
r
C
HVs
in
th
e
Ma
r
g
o
to
to
Hea
lth
C
en
ter
.
“
..........
if
I
ta
lk
to
o
mu
ch
d
eta
il,
I
d
o
n
't
d
a
r
e,
at
mo
s
t
,
I
g
ive
it
to
th
e
mid
w
ife
.
”
(
I
-
W6
)
“
E
ve
n
th
o
u
g
h
ma
n
y
ca
d
r
es
a
r
e
s
ma
r
t,
th
ey
h
a
ve
r
ea
d
a
lo
t
,
but
th
ey
d
o
n
’
t
h
a
ve
co
n
fid
en
ce
.
”
(
I
-
F1
7
)
T
h
e
C
HVs
in
f
o
r
m
an
ts
s
tated
t
h
at
th
ey
d
id
n
o
t
f
ee
l
ab
le
to
c
ar
r
y
out
co
u
n
s
elin
g
,
a
n
d
th
e
C
HVs
h
ad
lo
w
s
elf
-
co
n
f
id
en
ce
,
so
th
e
C
HVs
ad
v
is
ed
m
o
th
er
s
u
n
d
er
f
i
v
e
to
do
co
u
n
s
elin
g
with
th
e
v
illag
e
m
id
wif
e,
th
is
is
by
wh
at
was
ex
p
r
ess
ed
by
t
h
e
v
illag
e
m
id
wif
e
i
n
f
o
r
m
an
t
wh
o
s
tated
th
at
th
e
C
HVs
f
elt
less
co
n
f
id
e
n
t
an
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
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:
2
2
5
2
-
8
8
0
6
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n
t J Pu
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Hea
lth
Sci
,
Vo
l.
14
,
No
.
2
,
J
u
n
e
20
25
:
62
2
-
63
3
628
n
er
v
o
u
s
if
th
ey
h
ad
to
do
co
u
n
s
elin
g
to
m
o
th
er
s
u
n
d
er
f
iv
e.
I
n
f
o
r
m
a
n
ts
of
m
o
th
er
s
of
to
d
d
ler
s
s
tated
th
at
th
e
im
p
lem
en
tatio
n
of
g
r
o
wth
m
o
n
ito
r
in
g
ca
r
r
ied
o
u
t
at
th
e
P
o
s
ya
n
d
u
in
clu
d
es
weig
h
in
g
th
e
weig
h
t
of
ch
ild
r
e
n
u
n
d
er
f
iv
e
an
d
m
ea
s
u
r
in
g
t
h
e
weig
h
t
f
o
r
len
g
th
of
c
h
ild
r
en
u
n
d
er
f
iv
e
o
n
l
y
,
in
f
o
r
m
an
ts
d
i
d
not
g
et
co
u
n
s
elin
g
s
er
v
ices
f
r
o
m
eith
er
C
HVs
or
v
illag
e
m
id
wiv
es,
b
ec
au
s
e
af
ter
m
ea
s
u
r
in
g
weig
h
t
f
o
r
le
n
g
th
th
e
in
f
o
r
m
an
t
co
n
ce
r
n
e
d
im
m
ed
iately
lef
t
t
h
e
P
o
s
ya
n
d
u
.
“
I
don
’
t
g
et
e
n
o
u
g
h
ex
p
la
n
a
ti
o
n
,
u
s
u
a
lly
at
th
e
P
o
s
ya
n
d
u
if
yo
u
co
me,
o
n
ly
w
eig
h
,
mea
s
u
r
e,
th
en
go
h
o
me
.
”
(I
-
F1
9
)
T
h
e
r
esu
lts
of
o
b
s
er
v
atio
n
s
in
th
e
f
ield
wer
e
co
n
d
u
cted
co
u
n
s
elin
g
ac
tiv
ities
at
th
e
P
o
s
ya
n
d
u
co
n
d
u
cte
d
b
o
th
by
C
HVs,
as
well
as
by
h
ea
lth
wo
r
k
er
s
f
r
o
m
th
e
Ma
r
g
o
to
to
Hea
lth
C
en
ter
.
In
s
o
m
e
P
o
s
ya
n
d
u
,
m
ass
co
u
n
s
elin
g
is
co
n
d
u
cte
d
at
th
e
P
o
s
ya
n
d
u
ev
er
y
m
o
n
th
with
m
ater
ial
ac
co
r
d
in
g
to
a
p
r
e
d
eter
m
in
ed
s
ch
ed
u
le.
Ma
s
s
co
u
n
s
elin
g
is
co
n
s
id
er
ed
to
r
ea
ch
more
tar
g
ets
wh
en
co
m
p
a
r
ed
to
p
er
s
o
n
a
l
co
u
n
s
elin
g
,
but
th
e
k
n
o
wled
g
e
p
r
o
v
id
e
d
is
g
en
er
al
,
an
d
n
o
t
s
p
ec
if
ic
ac
co
r
d
i
n
g
to
th
e
r
esu
lts
of
m
o
n
ito
r
in
g
th
e
g
r
o
wth
of
each
ch
ild
u
n
d
er
f
iv
e.
T
h
em
atic
d
is
tr
ib
u
ti
o
n
ca
n
b
e
s
ee
n
in
T
a
b
le
5
.
T
ab
le
5.
T
h
em
atic
d
is
tr
ib
u
tio
n
Th
e
m
e
C
a
t
e
g
o
r
y
C
o
d
e
G
M
P
p
r
a
c
t
i
c
e
s
G
r
o
w
t
h
me
a
su
r
e
me
n
t
W
e
i
g
h
t
m
e
a
s
u
r
e
m
e
n
t
Le
n
g
t
h
mea
s
u
r
e
me
n
t
H
e
i
g
h
t
me
a
s
u
r
e
me
n
t
P
l
o
t
t
i
n
g
m
e
a
s
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r
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l
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D
e
t
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h
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g
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h
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l
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r
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t
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t
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o
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n
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t
o
r
i
n
g
H
e
a
l
t
h
f
u
n
d
C
r
o
ss
-
se
c
t
o
r
m
o
n
i
t
o
r
i
n
g
H
u
ma
n
d
e
v
e
l
o
p
m
e
n
t
C
H
V
s
M
o
n
i
t
o
r
i
n
g
f
r
o
m
t
h
e
c
o
m
mu
n
i
t
y
h
e
a
l
t
h
c
e
n
t
e
r
Th
e
r
o
l
e
o
f
h
u
ma
n
d
e
v
e
l
o
p
m
e
n
t
C
H
V
s
3
.
2
.
2
.
T
hem
e
2:
G
M
P
ba
rr
ie
rs
T
h
e
m
ain
h
u
m
an
r
eso
u
r
ce
s
in
v
o
lv
ed
in
th
e
GM
P
p
r
o
g
r
am
a
r
e
P
o
s
ya
n
d
u
C
HVs,
C
H
Vs
ar
e
th
e
m
ain
d
r
iv
er
s
of
GM
P,
wh
e
r
e
th
e
s
u
c
ce
s
s
of
th
e
GM
P
p
r
o
g
r
am
is
h
i
g
h
ly
d
ep
en
d
en
t
on
th
e
q
u
ality
of
P
o
s
ya
n
d
u
C
HVs,
th
e
r
esu
lts
of
th
e
r
esear
ch
f
o
u
n
d
th
at
m
o
s
t
C
HVs
h
av
e
a
ju
n
io
r
h
ig
h
s
ch
o
o
l
ed
u
ca
tio
n
al
b
a
ck
g
r
o
u
n
d
,
a
n
d
th
er
e
ar
e
ev
en
C
HVs
wh
o
h
av
e
a
p
r
im
ar
y
s
ch
o
o
l
ed
u
c
atio
n
al
b
ac
k
g
r
o
u
n
d
,
th
e
l
o
w
lev
el
of
e
d
u
ca
tio
n
of
C
HVs
can
af
f
ec
t
th
e
ca
p
ac
ity
of
C
HVs
in
im
p
lem
en
tin
g
t
h
e
GM
P
p
r
o
g
r
am
at
th
e
P
o
s
ya
n
d
u
.
“
……
w
e
a
r
e
a
w
a
r
e
of
o
u
r
s
elv
es;
my
ed
u
ca
tio
n
is
th
e
lo
w
est
co
mp
a
r
ed
to
o
th
ers
.
”
(I
-
W
6
)
“B
e
c
a
u
s
e
t
h
e
e
d
u
c
a
t
i
o
n
is
a
ls
o
d
i
f
f
er
e
n
t
,
t
h
e
c
a
p
a
c
i
t
y
is
a
ls
o
d
i
f
f
er
e
n
t
,
so
t
h
er
e
a
r
e
t
h
o
s
e
w
h
o
we
te
a
c
h
,
t
h
e
y
s
e
em
to
u
n
d
e
r
s
t
a
n
d
but
t
h
e
i
m
p
l
e
me
n
t
a
t
i
o
n
is
s
t
i
ll
w
r
o
n
g
,
t
h
a
t
’
s
j
u
s
t
t
h
e
r
es
o
u
r
c
e
.
”
(I
-
F9
)
T
h
e
r
esu
lts
of
o
b
s
er
v
atio
n
s
in
th
e
f
ield
,
lim
ited
f
ac
ilit
ies
th
at
m
ak
e
it
d
if
f
icu
lt
to
r
ec
o
r
d
th
e
r
esu
lts
of
g
r
o
wth
m
ea
s
u
r
em
e
n
ts
an
d
p
lo
t
tin
g
g
r
o
wth
in
d
icato
r
s
,
not
ev
e
n
leav
in
g
a
p
lace
to
be
ab
le
to
co
n
d
u
ct
co
u
n
s
elin
g
to
m
o
th
er
s
of
to
d
d
ler
s
,
in
P
o
s
y
a
n
d
u
.
B
ased
on
t
h
e
r
esu
lts
of
f
ield
n
o
tes,
co
u
n
s
elin
g
an
d
co
u
n
s
elin
g
f
ac
ilit
ies
at
th
e
P
o
s
ya
n
d
u
ar
e
s
till
in
ad
eq
u
ate,
th
e
P
o
s
ya
n
d
u
d
o
es
not
h
av
e
co
m
m
u
n
icatio
n
m
ed
ia.
T
h
e
s
u
cc
ess
of
GM
P
im
p
lem
en
tatio
n
d
ep
en
d
s
on
th
e
p
ar
ticip
atio
n
of
C
HVs
an
d
th
e
c
o
m
m
u
n
ity
wh
ich
is
in
f
lu
en
ce
d
by
th
e
m
o
tiv
atio
n
al
f
ac
to
r
s
th
ey
h
a
v
e
;
th
e
r
esu
lts
s
h
o
w
th
at
th
e
ac
tiv
en
ess
of
P
o
s
ya
n
d
u
C
HVs
is
l
ac
k
in
g
.
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
E
va
lu
a
tio
n
imp
leme
n
ta
tio
n
g
r
o
w
th
mo
n
ito
r
in
g
a
n
d
p
r
o
mo
ti
o
n
:
a
ca
s
e
s
tu
d
y
…
(
K
iki
K
a
mila
h
)
629
“
S
o
m
e
t
im
e
s
d
u
r
i
n
g
t
h
e
h
a
r
v
e
s
t
s
e
a
s
o
n
,
m
a
n
y
p
e
o
p
l
e
h
a
v
e
p
e
r
m
is
s
i
o
n
to
go
to
t
h
e
P
o
s
y
a
n
d
u
,
out
of
7
c
a
d
r
e
s
o
n
l
y
3
c
o
m
e
,
i
t
's
a
b
i
t
o
v
e
r
w
h
e
l
mi
n
g
f
o
r
t
h
e
v
i
ll
a
g
e
m
id
w
i
f
e
d
u
r
i
n
g
t
h
e
h
a
r
ve
s
t
s
e
a
s
o
n
.
”
(I
-
F
1
6
)
T
h
e
C
HVs
in
f
o
r
m
an
ts
in
d
icate
d
th
at
th
er
e
ar
e
C
HVs
wh
o
a
r
e
not
ac
tiv
ely
co
m
in
g
to
t
h
e
P
o
s
ya
n
d
u
,
th
e
r
ea
s
o
n
f
o
r
t
h
e
C
HVs
in
ac
ti
v
ity
is
due
to
m
an
y
t
h
in
g
s
,
f
o
r
ex
am
p
le
C
HVs
ar
e
not
ac
tiv
e
due
to
m
an
y
th
in
g
s
,
b
ec
au
s
e
th
e
C
HVs
ar
e
o
u
ts
id
e
th
e
P
o
s
ya
n
d
u
,
b
esid
es
th
e
P
o
s
ya
n
d
u
C
HVs
o
f
ten
ch
a
n
g
e,
so
th
e
im
p
lem
en
tatio
n
of
GM
P
is
less
th
an
o
p
tim
al
b
ec
au
s
e
wi
th
th
e
c
h
an
g
e
of
C
HVs,
n
ew
C
HVs
m
u
s
t
be
r
ep
lace
d
wh
o
h
av
e
not
m
aster
ed
GM
P
p
r
ac
tices.
Vill
ag
e
m
id
wiv
es
f
in
d
it
d
if
f
icu
lt
to
f
in
d
r
e
p
lace
m
en
t
C
HVs
b
ec
au
s
e
not
ev
er
y
o
n
e
is
willin
g
to
be
ap
p
o
in
ted
as
P
o
s
ya
n
d
u
C
HVs.
“
B
ec
a
u
s
e
th
e
ca
d
r
es
keep
c
h
a
n
g
i
n
g
,
a
ctu
a
lly
th
ey
h
a
ve
b
ee
n
tr
a
in
ed
,
th
ey
u
n
d
ers
ta
n
d
,
th
en
th
ey
ch
a
n
g
e
ca
d
r
es,
th
ey
h
a
ve
to
te
a
ch
th
em
a
g
a
in
.”
(I
-
F9
)
Villag
e
m
id
wif
e
in
f
o
r
m
a
n
ts
a
ls
o
s
tated
th
at
th
er
e
wer
e
co
m
p
lain
ts
f
r
o
m
P
o
s
ya
n
d
u
C
HVs
ab
o
u
t
th
e
am
o
u
n
t
of
in
ce
n
tiv
es
f
o
r
P
o
s
ya
n
d
u
C
HVs
th
at
h
ad
not
s
h
o
w
n
an
y
im
p
r
o
v
em
e
n
t,
by
t
h
e
s
tatem
en
ts
of
P
o
s
ya
n
d
u
C
HVs
in
f
o
r
m
an
ts
wh
o
s
tated
th
at
th
e
C
HVs
in
ce
n
tiv
es
th
ey
r
ec
eiv
ed
wer
e
in
a
d
eq
u
ate,
not
p
r
o
p
o
r
tio
n
al
to
th
e
r
o
le
of
P
o
s
ya
n
d
u
C
HVs
in
th
e
GM
P
p
r
o
g
r
am
.
T
h
e
GM
P
p
r
o
g
r
am
in
th
e
Ma
r
g
o
to
to
Hea
lth
C
en
ter
wo
r
k
in
g
ar
ea
is
v
er
y
d
ep
en
d
en
t
on
th
e
attitu
d
e
of
m
o
th
er
s
of
to
d
d
ler
s
in
u
tili
zin
g
th
e
GM
P
p
r
o
g
r
am
.
T
h
e
r
esear
ch
r
esu
lts
s
h
o
w
th
e
attitu
d
e
of
m
o
th
er
s
wh
o
do
not
tak
e
ad
v
a
n
tag
e
of
th
e
GM
P
p
r
o
g
r
a
m
by
not
atten
d
in
g
th
e
P
o
s
ya
n
d
u
.
“
S
o
metime
s
th
ere
a
r
e
th
o
s
e
w
h
o
if
t
h
eir
ch
ild
r
en
a
r
e
to
ld
th
a
t
th
ey
a
r
e
s
tu
n
ted
,
th
e
n
ex
t
mo
n
th
th
ey
d
o
n
't
w
a
n
t
to
go
to
th
e
P
o
s
ya
n
d
u
.
”
(I
-
F1
6
)
“
F
r
o
m
th
e
fa
cto
r
of
th
e
to
d
d
ler
’
s
mo
th
er,
we
h
a
ve
b
ee
n
to
ld
th
a
t
s
o
metime
s
th
ey
a
r
e
s
tu
b
b
o
r
n
,
we
h
a
ve
g
iven
a
d
vice
,
but
th
ey
d
o
n
't
do
it,
so
t
h
ere
is
no
ch
a
n
g
e
.
”
(I
-
F1
3
)
P
o
s
y
a
n
d
u
C
H
Vs
w
h
o
h
a
v
e
b
e
en
g
i
v
e
n
k
n
o
w
l
e
d
g
e
a
b
o
u
t
G
M
P
t
h
r
o
u
g
h
t
r
a
i
n
i
n
g
or
r
e
f
r
e
s
h
i
n
g
C
H
Vs
a
r
e
e
x
p
e
c
t
e
d
to
p
r
a
c
t
i
c
e
t
h
e
k
n
o
w
le
d
g
e
t
h
a
t
h
a
s
b
e
e
n
o
b
t
a
i
n
e
d
,
b
u
t
due
to
a
l
o
w
l
e
v
e
l
of
u
n
d
e
r
s
t
a
n
d
i
n
g
,
r
e
s
u
l
ti
n
g
in
G
M
P
p
r
a
c
t
i
ce
s
t
h
a
t
a
r
e
not
e
x
ac
t
l
y
as
e
x
p
e
c
t
e
d
.
E
f
f
o
r
ts
by
h
ea
l
t
h
w
o
r
k
e
r
s
a
n
d
v
i
l
l
a
g
e
m
i
d
wi
v
e
s
to
i
m
p
r
o
v
e
t
h
e
a
b
i
l
i
t
y
of
C
H
Vs
to
p
r
a
c
ti
c
e
G
MP
h
a
v
e
b
ee
n
m
a
d
e
,
but
f
r
o
m
t
h
e
r
e
s
u
lt
s
of
f
i
el
d
n
o
t
es
,
C
H
Vs
d
id
not
p
r
a
c
t
ic
e
GM
P
a
p
p
r
o
p
r
i
a
t
e
l
y
,
w
h
e
n
c
o
n
f
i
r
m
ed
C
HV
s
s
t
at
e
d
t
h
at
t
h
e
y
h
a
d
f
o
r
g
o
t
t
e
n
.
To
i
m
p
r
o
v
e
t
h
e
q
u
a
l
i
t
y
of
b
as
i
c
h
ea
l
t
h
s
e
r
v
i
c
es
in
P
o
s
y
a
n
d
u
,
it
is
n
e
c
e
s
s
a
r
y
to
d
e
v
e
l
o
p
a
p
p
r
o
p
r
ia
t
e
a
n
d
e
f
f
e
c
t
i
v
e
h
u
m
a
n
r
es
o
u
r
c
e
s
.
T
r
ai
n
i
n
g
a
n
d
d
e
v
e
l
o
p
m
e
n
t
of
P
o
s
y
a
n
d
u
C
HV
s
is
n
e
e
d
e
d
to
i
m
p
r
o
v
e
t
h
e
i
r
u
n
d
e
r
s
t
a
n
d
i
n
g
a
n
d
s
k
il
ls
in
p
r
o
v
id
i
n
g
G
M
P
s
e
r
v
i
c
es
.
P
o
s
ya
n
d
u
as
a
p
lace
to
o
r
g
an
i
ze
th
e
GM
P
p
r
o
g
r
am
n
ee
d
s
s
u
p
p
o
r
t
f
r
o
m
th
e
v
illag
e
g
o
v
er
n
m
en
t.
T
h
e
v
illag
e
g
o
v
e
r
n
m
e
n
t
in
th
e
wo
r
k
in
g
ar
ea
of
P
u
s
ke
s
ma
s
Ma
r
g
o
to
to
h
as
tr
ied
to
s
u
p
p
o
r
t
th
e
ac
tiv
ities
o
r
g
an
ized
at
th
e
P
o
s
ya
n
d
u
,
but
it
h
as
n
o
t
b
ee
n
o
p
tim
al
e
n
o
u
g
h
.
In
ter
m
s
of
th
e
welf
a
r
e
of
P
o
s
ya
n
d
u
C
HV
s,
th
e
p
r
o
p
o
s
ed
in
cr
ea
s
e
in
in
ce
n
tiv
es
f
o
r
P
o
s
ya
n
d
u
C
HVs
h
as
also
b
ee
n
r
ep
ea
ted
ly
p
r
o
p
o
s
ed
by
P
o
s
ya
n
d
u
C
HVs
an
d
v
illag
e
m
id
wiv
es
but
h
as
not
r
ec
eiv
e
d
a
p
o
s
itiv
e
r
esp
o
n
s
e.
In
ter
m
s
of
g
u
id
an
ce
to
P
o
s
ya
n
d
u
,
P
o
s
ya
n
d
u
C
HVs
f
ee
l
th
at
th
e
r
o
le
of
th
e
v
illag
e
is
less
th
an
o
p
tim
al.
“
S
u
p
ervis
io
n
at
th
e
P
o
s
ya
n
d
u
leve
l
is
a
ls
o
la
ck
in
g
,
th
e
villa
g
e
a
p
p
a
r
a
tu
s
has
n
ev
er
c
o
me
d
o
w
n
,
o
n
ly
r
elyin
g
on
th
e
villa
g
e
mid
w
ife,
th
e
villa
g
e
mid
w
ife
has
ta
ke
n
ca
r
e
of
o
th
ers
,
so
th
e
ca
d
r
es
to
fill
it
in
a
ls
o
s
till
h
a
ve
mis
ta
ke
s
so
s
o
m
etimes
it
is
not
mo
n
ito
r
ed
.”
(I
-
F9
)
3
.
2
.
3
.
T
hem
e
3:
G
M
P
s
up
po
rt
er
s
P
a
r
t
i
ci
p
a
t
i
o
n
is
t
h
e
i
n
v
o
l
v
e
m
e
n
t
of
g
r
o
u
p
s
or
c
o
m
m
u
n
i
t
i
e
s
to
r
e
a
l
i
z
e
t
h
e
i
m
p
l
e
m
e
n
t
at
i
o
n
of
t
h
e
G
M
P
p
r
o
g
r
a
m
.
T
h
e
r
e
s
u
l
ts
of
p
a
r
ti
c
ip
a
t
i
o
n
f
o
u
n
d
in
t
h
e
Ma
r
g
o
t
o
t
o
H
e
a
l
t
h
C
e
n
te
r
w
o
r
k
i
n
g
a
r
e
a
i
n
cl
u
d
e
c
o
r
p
o
r
a
t
e
s
o
ci
a
l
r
e
s
p
o
n
s
i
b
il
i
t
y
(
C
SR
)
a
n
d
h
e
a
l
t
h
y
f
u
n
d
s
.
T
h
e
p
a
r
t
i
c
i
p
a
t
i
o
n
of
t
h
e
b
u
s
i
n
e
s
s
w
o
r
l
d
in
t
h
e
i
m
p
l
e
m
e
n
t
a
t
i
o
n
of
G
M
P
in
t
h
e
w
o
r
k
i
n
g
a
r
e
a
of
t
h
e
M
a
r
g
o
to
t
o
H
e
a
l
t
h
C
e
n
t
e
r
is
t
h
r
o
u
g
h
C
S
R
f
r
o
m
a
c
h
ic
k
e
n
f
a
r
m
in
one
of
t
h
e
v
i
l
l
a
g
es
.
“
Th
ere
is
a
ls
o
co
o
p
era
tio
n
w
ith
C
S
R
,
th
ere
is
a
c
h
icke
n
fa
r
m
in
th
e
villa
g
e
th
a
t
p
r
o
vid
es
eg
g
s
,
so
o
n
ce
a
m
o
n
th
th
e
to
d
d
lers
a
r
e
g
iven
eg
g
s
.”
(I
-
F9
)
Mo
n
ito
r
in
g
is
th
e
p
r
o
ce
s
s
of
s
u
p
er
v
is
in
g
an
ac
tiv
ity
,
m
o
n
ito
r
in
g
t
h
e
GM
P
p
r
o
g
r
am
in
th
e
Ma
r
g
o
t
o
to
Hea
lt
h
C
en
ter
wo
r
k
in
g
a
r
ea
is
ca
r
r
ie
d
out
by
cr
o
s
s
-
s
ec
to
r
s
an
d
P
u
s
ke
s
ma
s
.
B
a
s
ed
on
th
e
FGD
r
esu
lts
,
cr
o
s
s
-
s
ec
to
r
m
o
n
ito
r
in
g
is
ca
r
r
ied
out
t
h
r
o
u
g
h
cr
o
s
s
-
s
ec
to
r
m
in
i
-
wo
r
k
s
h
o
p
s
(
in
I
n
d
o
n
esia
ca
lled
Lo
kmin
)
an
d
g
r
o
wth
m
o
n
ito
r
in
g
an
aly
s
is
is
ca
r
r
ied
out
ev
e
r
y
q
u
ar
ter
.
T
h
e
c
r
o
s
s
-
s
ec
to
r
al
L
o
kmin
in
v
o
l
v
es
th
e
s
u
b
-
d
is
tr
ict
h
ea
d
,
v
illag
e
h
ea
d
,
Fam
ily
Hea
lth
E
m
p
o
wer
m
en
t,
ag
r
ic
u
ltu
r
al
e
x
ten
s
io
n
wo
r
k
er
s
,
an
d
th
e
h
ea
d
of
th
e
h
ea
lth
ce
n
ter
.
Gr
o
wth
m
o
n
ito
r
i
n
g
an
al
y
s
is
i
n
v
o
lv
es
th
e
Fam
ily
Hea
lth
E
m
p
o
wer
m
en
t
a
n
d
v
illag
e
m
id
wif
e
to
d
is
cu
s
s
th
e
r
esu
lts
of
m
ea
s
u
r
em
en
ts
at
th
e
P
o
s
ya
n
d
u
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
2
,
J
u
n
e
20
25
:
62
2
-
63
3
630
“
If
th
ere
is
a
q
u
a
r
terl
y
g
r
o
w
th
mo
n
ito
r
in
g
a
n
a
lysi
s
,
we
in
vo
lve
th
e
F
a
mily
Hea
lth
E
mp
o
w
ermen
t
mo
b
iliz
in
g
tea
m
a
n
d
th
e
villa
g
e
mid
w
ife,
so
a
fter
we
h
a
ve
a
w
eig
h
in
g
mo
n
th
,
we
d
is
cu
s
s
w
h
a
t
th
e
r
esu
lts
of
th
e
mea
s
u
r
eme
n
ts
a
r
e,
it
is
co
n
ve
ye
d
th
ere.
”
(I
-
F9
)
Mo
n
ito
r
in
g
co
n
d
u
cte
d
by
t
h
e
Pu
b
lic
Hea
lth
C
en
ter
is
t
h
r
o
u
g
h
m
o
n
th
ly
L
o
kmin
an
d
s
u
p
er
v
is
io
n
o
f
th
e
P
o
s
ya
n
d
u
.
Mo
n
th
ly
Lo
kmin
in
v
o
lv
es
cr
o
s
s
-
p
r
o
g
r
am
s
.
Su
p
e
r
v
is
io
n
th
e
P
o
s
ya
n
d
u
by
co
n
d
u
ct
in
g
co
ac
h
in
g
to
th
e
P
o
s
ya
n
d
u
.
C
o
ac
h
in
g
to
P
o
s
y
a
n
d
u
in
v
o
lv
es
p
r
o
g
r
am
s
r
ela
ted
to
P
o
s
ya
n
d
u
.
C
o
ac
h
in
g
r
elate
d
to
GM
P
is
s
p
ec
if
ically
ca
r
r
ied
o
u
t
by
N
u
tr
itio
n
E
x
ec
u
tiv
es
an
d
Hea
lth
P
r
o
m
o
tio
n
Pro
g
r
a
m
Ma
n
ag
e
r
s
.
Hu
m
an
d
e
v
elo
p
m
e
n
t
C
HVs
ar
e
v
illag
e
c
o
m
m
u
n
ity
m
em
b
er
s
wh
o
a
r
e
elec
ted
th
r
o
u
g
h
v
illag
e
d
elib
er
atio
n
s
as
ass
is
tan
ts
to
th
e
v
illag
e
g
o
v
er
n
m
en
t
an
d
v
il
lag
e
co
m
m
u
n
ities
,
to
f
ac
ilit
at
e
th
e
p
r
e
v
en
tio
n
of
s
tu
n
tin
g
co
n
v
er
g
e
n
ce
.
H
u
m
a
n
d
ev
el
o
p
m
en
t
C
HVs
p
lay
a
r
o
le
in
ass
is
tin
g
P
o
s
ya
n
d
u
C
HVs,
esp
ec
ially
in
m
ea
s
u
r
in
g
th
e
len
g
th
an
d
h
ei
g
h
t
of
to
d
d
ler
s
.
Hu
m
an
d
ev
e
lo
p
m
en
t
C
HVs
h
av
e
an
im
p
o
r
tan
t
r
o
le
in
GM
P
im
p
lem
en
tatio
n
b
ec
a
u
s
e
th
ey
co
llab
o
r
ate
with
P
o
s
ya
n
d
u
C
HVs
in
GM
P
ac
tiv
itie
s
at
th
e
P
o
s
ya
n
d
u
.
“
We
n
ee
d
a
s
s
is
ta
n
ts
to
mea
s
u
r
e
body
le
n
g
th
and
h
eig
h
t,
so
we
ca
n
’
t
mea
s
u
r
e
it
o
u
r
s
elve
s
,
so
we
emp
o
w
er
Hu
ma
n
Dev
elo
p
men
t
ca
d
r
es
to
h
elp
P
o
s
ya
n
d
u
ca
d
r
es
.
”
(I
-
F1
0
)
3
.
3
.
Dis
cus
s
io
n
T
h
e
r
esu
lts
s
h
o
w
th
at
GM
P
p
r
ac
tices
in
th
e
Ma
r
g
o
to
to
H
ea
lth
C
en
ter
wo
r
k
in
g
ar
ea
f
r
o
m
th
e
f
o
u
r
asp
ec
ts
ass
e
s
s
ed
ar
e
s
till
not
o
p
tim
al.
T
h
e
p
r
ac
tice
of
g
r
o
wth
m
ea
s
u
r
em
en
t
of
C
HVs
in
th
e
asp
ec
t
of
weig
h
t
m
ea
s
u
r
em
en
t
is
not
o
p
tim
al,
with
th
e
m
o
s
t
d
if
f
icu
lt
asp
ec
ts
p
r
ac
tice
by
C
HVs
b
ein
g
d
eter
m
in
in
g
th
e
i
n
itial
n
u
m
b
er
of
s
ca
les
an
d
i
d
en
tify
in
g
weig
h
in
g
d
is
tu
r
b
a
n
ce
s
,
th
is
s
h
o
ws
th
at
C
HV
s
s
til
l
m
is
s
s
o
m
e
of
th
e
r
ig
h
t
weig
h
in
g
s
tep
s
th
e
p
r
ac
tice
of
weig
h
t
m
ea
s
u
r
em
e
n
t,
th
is
is
in
lin
e
with
r
esear
ch
co
n
d
u
cted
by
E
s
lin
,
wh
e
r
e
s
taf
f
weig
h
s
ch
ild
r
en
in
f
u
ll
clo
th
es
an
d
th
e
weig
h
t
is
not
ad
ju
s
ted
to
th
eir
clo
th
es.
If
weig
h
in
g
tech
n
iq
u
es
ar
e
in
co
n
s
is
ten
t,
in
co
r
r
ec
t
s
ca
le
r
ea
d
in
g
s
m
ay
be
r
ec
o
r
d
ed
[
2
4
]
,
[
2
5
]
.
E
s
lin
’s
r
esear
ch
u
s
ed
q
u
alitativ
e
m
eth
o
d
s
,
wh
ile
th
is
r
esear
ch
u
s
es
a
co
n
cu
r
r
e
n
t
m
ix
e
d
m
eth
o
d
s
tr
ateg
y
wh
e
r
e
r
esear
ch
e
r
s
co
llect
b
o
th
q
u
alitativ
e
an
d
q
u
an
titativ
e
d
ata,
wh
er
e
q
u
an
ti
tativ
e
d
ata
is
te
s
ted
with
m
u
lti
-
f
ac
et
R
asch
m
ea
s
u
r
em
en
t,
to
g
et
th
e
r
esu
lts
of
an
ac
cu
r
ate
an
aly
s
is
u
s
ed
to
ev
al
u
ate
C
HVs
GM
P
p
r
ac
tices
[
2
1
]
.
T
h
e
p
r
ac
tice
o
f
C
HVs in
th
e
a
s
p
ec
t o
f
p
lo
ttin
g
th
e
m
ea
s
u
r
e
m
en
t r
esu
lts
is
co
n
s
id
er
e
d
n
o
t
o
p
tim
al,
th
e
m
o
s
t
d
if
f
icu
lt
asp
ec
ts
in
p
r
ac
ti
ce
b
y
P
o
s
ya
n
d
u
C
HVs
ar
e
asp
ec
ts
o
f
p
lo
ttin
g
b
o
d
y
len
g
th
m
ea
s
u
r
em
en
t
r
esu
lts
o
n
weig
h
t
f
o
r
len
g
th
g
r
ap
h
a
n
d
p
lo
ttin
g
m
ea
s
u
r
em
en
t
r
esu
lts
o
n
weig
h
t
f
o
r
h
ei
g
h
t
g
r
a
p
h
,
th
is
in
d
icate
s
th
at
p
lo
ttin
g
g
r
o
wth
r
esu
lts
h
as
n
o
t
b
ee
n
in
clu
d
e
d
in
all
g
r
o
wth
in
d
icato
r
s
,
th
is
is
in
lin
e
with
Me
lk
am
u
’
s
r
esear
ch
wh
ich
s
tates
wh
o
s
ta
ted
th
at
wo
r
k
er
s
d
id
n
o
t
p
l
o
t
th
e
r
esu
lts
o
f
th
e
ch
ild
'
s
weig
h
in
g
an
d
m
ea
s
u
r
em
en
t
in
th
e
r
eg
is
tr
atio
n
b
o
o
k
[
2
6
]
.
T
h
e
p
r
a
ctice
of
C
HVs
in
th
e
asp
ec
t
in
t
er
p
r
etatio
n
of
g
r
o
wth
in
d
icato
r
s
is
co
n
s
id
er
ed
not
o
p
tim
al,
with
th
e
m
o
s
t
d
if
f
icu
l
t
asp
ec
ts
p
r
ac
ticed
by
C
HVs
b
ein
g
asp
ec
ts
of
in
te
r
p
r
etatio
n
of
n
o
r
m
al
or
f
ailu
r
e
to
g
r
o
w
on
th
e
weig
h
t
f
o
r
len
g
th
ch
ar
t
an
d
in
ter
p
r
etatio
n
of
n
o
r
m
al
or
f
ailu
r
e
to
g
r
o
w
on
th
e
weig
h
t
f
o
r
h
eig
h
t
ch
ar
t.
T
h
is
s
h
o
ws
th
at
C
HVs
h
av
e
not
in
ter
p
r
eted
all
g
r
o
wth
in
d
icato
r
s
,
o
n
ly
th
e
weig
h
t
f
o
r
th
e
ag
e
in
d
icato
r
.
In
d
eter
m
in
in
g
th
e
n
u
tr
itio
n
al
s
tatu
s
of
ch
ild
r
en
,
f
o
u
r
an
th
r
o
p
o
m
etr
ic
i
n
d
icato
r
s
m
u
s
t
be
c
o
n
s
id
er
ed
to
i
d
en
tify
g
r
o
wth
p
r
o
b
lem
s
an
d
tak
e
f
u
r
t
h
er
p
r
ev
e
n
tiv
e
an
d
m
a
n
ag
em
e
n
t
ac
tio
n
s
[
2
7
]
,
[
2
8
]
.
T
h
e
r
esu
lts
of
th
is
r
esear
ch
ar
e
in
lin
e
with
r
esear
ch
co
n
d
u
cted
by
Ma
b
esa
wh
er
e
g
r
o
wth
ch
ar
ts
wer
e
not
in
ter
p
r
eted
co
r
r
ec
tly
on
th
e
ch
ild
h
ea
lth
ca
r
d
s
[
2
8
]
.
T
h
e
p
r
ac
tice
of
C
VHs
in
th
e
co
u
n
s
elin
g
asp
ec
t
is
co
n
s
id
er
e
d
not
o
p
tim
al,
th
e
m
o
s
t
d
if
f
ic
u
lt
asp
ec
ts
ar
e
th
e
co
u
n
s
elin
g
asp
ec
ts
of
b
alan
ce
d
n
u
tr
itio
n
f
o
r
in
f
an
ts
6
-
12
m
o
n
th
s
an
d
th
e
co
u
n
s
elin
g
asp
ec
ts
of
b
alan
ce
d
n
u
tr
itio
n
f
o
r
to
d
d
ler
s
2
-
5
y
ea
r
s
.
T
h
e
r
esu
lts
of
th
is
r
esear
ch
ar
e
in
lin
e
with
r
esear
ch
co
n
d
u
cted
by
E
s
lin
an
d
Ad
itian
tiIf
ad
v
ice
on
GM
P
ac
tiv
ities
d
o
es
not
go
well,
s
taf
f
will
not
p
r
o
v
i
d
e
in
d
iv
i
d
u
al
co
u
n
s
elin
g
to
m
o
th
er
s
an
d
ca
r
eg
iv
e
r
s
of
ch
ild
r
en
,
nor
will
th
ey
p
r
o
v
i
d
e
ap
p
r
o
p
r
iate
n
u
tr
itio
n
al
ad
v
ice,
co
u
n
s
elin
g
will
o
n
ly
be
g
iv
e
n
in
ca
s
es
of
m
aln
u
tr
itio
n
[
2
4
]
,
[
2
6
]
.
C
o
u
n
s
elin
g
p
r
o
v
i
d
ed
to
c
ar
eg
iv
er
s
d
u
r
in
g
r
o
u
tin
e
GM
P
ac
tiv
ities
was
s
ee
n
as
weak
C
HVs
s
ee
m
ed
to
p
lace
more
e
m
p
h
asis
on
ch
ild
we
ig
h
in
g
as
th
e
r
e
was
no
co
u
n
s
elin
g
b
ased
on
c
h
ild
g
r
o
wth
cu
r
v
es
[
2
7
]
.
C
o
u
n
s
elin
g
is
a
h
ig
h
ly
p
r
o
f
ess
io
n
al
f
o
r
m
of
ca
r
e
th
at
r
eq
u
ir
es
s
k
ills
,
ex
p
er
ien
ce
,
an
d
tim
e,
an
d
th
e
im
p
lem
en
tatio
n
of
G
MP
in
th
e
Ma
r
g
o
to
to
Hea
lth
C
en
ter
wo
r
k
in
g
ar
ea
is
d
if
f
icu
lt
b
ec
au
s
e
m
o
s
t
C
VHs
h
av
e
l
o
w
ed
u
ca
tio
n
,
lo
w
s
elf
-
co
n
f
id
en
ce
,
a
n
d
do
n
o
t
r
ec
ei
v
e
ad
eq
u
ate
tr
ain
i
n
g
in
co
u
n
s
e
lin
g
[
2
4
]
.
T
h
r
o
u
g
h
co
u
n
s
elin
g
,
m
o
th
e
r
s
of
to
d
d
ler
s
will
r
ec
eiv
e
s
er
v
ices
on
h
ea
lt
h
y
p
ar
en
tin
g
a
n
d
f
ee
d
in
g
,
as
p
ar
t
of
m
aln
u
tr
itio
n
p
r
ev
en
tio
n
,
th
er
ef
o
r
e
n
u
tr
itio
n
in
ter
v
en
tio
n
s
s
h
o
u
ld
em
p
h
asiz
e
n
u
tr
itio
n
co
u
n
s
elin
g
an
d
t
h
e
av
ailab
ilit
y
of
GM
P
s
er
v
ices
[
2
9
]
,
[
3
0
]
.
3.
3
.
1
.
G
M
P
ba
rr
iers
T
h
e
o
b
s
tacle
s
to
GM
P
th
at
r
esear
ch
er
s
en
co
u
n
ter
ed
in
th
e
Ma
r
g
o
to
to
Hea
lth
C
en
ter
wo
r
k
in
g
a
r
ea
in
clu
d
ed
h
u
m
an
r
eso
u
r
ce
s
,
f
a
cilities
an
d
in
f
r
astru
ctu
r
e,
m
o
t
iv
atio
n
,
attitu
d
es
of
m
o
th
e
r
s
of
to
d
d
ler
s
,
ca
p
ac
ity
b
u
ild
in
g
,
a
n
d
s
u
p
p
o
r
t
f
r
o
m
th
e
v
illag
e
g
o
v
e
r
n
m
en
t.
In
th
i
s
r
esear
ch
,
GM
P
b
ar
r
ier
s
we
r
e
f
o
u
n
d
in
h
u
m
a
n
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
E
va
lu
a
tio
n
imp
leme
n
ta
tio
n
g
r
o
w
th
mo
n
ito
r
in
g
a
n
d
p
r
o
mo
ti
o
n
:
a
ca
s
e
s
tu
d
y
…
(
K
iki
K
a
mila
h
)
631
r
eso
u
r
ce
s
at
th
e
P
o
s
ya
n
d
u
C
HVs,
wh
ich
wer
e
th
e
i
n
h
ib
it
in
g
f
ac
to
r
s
in
ter
m
s
of
C
HVs
’
ed
u
ca
tio
n
a
n
d
u
n
d
er
s
tan
d
i
n
g
of
C
HVs.
So
m
e
C
HVs
h
av
e
lo
wer
ed
u
ca
tio
n
al
b
ac
k
g
r
o
u
n
d
s
.
C
HV
’
s
ed
u
ca
tio
n
lev
el
af
f
ec
ts
C
HV
’
s
s
k
il
l
in
in
ter
p
r
etin
g
we
ig
h
in
g
r
esu
lts
in
y
o
u
n
g
ch
ild
r
en
’
s
h
ea
lth
ca
r
d
s
.
T
h
e
h
ig
h
er
t
h
e
ed
u
ca
tio
n
lev
el,
th
e
b
etter
e
q
u
ip
p
e
d
th
e
C
HV
is
to
in
ter
p
r
et
th
e
c
h
ild
h
ea
lth
c
ar
d
weig
h
in
g
r
esu
lts
.
Facilities
an
d
in
f
r
astru
ctu
r
e
ar
e
th
e
s
u
p
p
o
r
tin
g
f
ac
t
o
r
s
in
th
e
im
p
lem
en
tatio
n
of
an
ac
tiv
it
y
or
p
r
o
g
r
am
.
T
h
e
r
esear
ch
f
o
u
n
d
th
at
t
h
e
f
ac
ilit
ies
an
d
in
f
r
astru
ct
u
r
e
of
P
o
s
ya
n
d
u
in
th
e
wo
r
k
i
n
g
ar
ea
of
Ma
r
g
o
to
to
Hea
lth
C
en
ter
ar
e
s
till
in
ad
eq
u
ate,
p
h
y
s
ical
f
ac
ilit
ies
in
th
e
f
o
r
m
of
f
u
r
n
itu
r
e
ar
e
s
till
lim
ited
in
n
u
m
b
er
a
n
d
th
e
P
o
s
ya
n
d
u
d
o
es
n
o
t
y
et
h
av
e
a
b
u
ild
in
g
.
T
h
e
p
o
o
r
attitu
d
e
of
m
o
th
e
r
s
of
ch
ild
r
e
n
u
n
d
er
f
iv
e
in
u
tili
zin
g
th
e
GM
P
p
r
o
g
r
a
m
is
o
n
e
of
t
h
e
f
ac
to
r
s
th
at
can
h
in
d
e
r
th
e
GM
P
p
r
o
g
r
am
[
4
]
.
T
h
e
r
esu
lts
s
h
o
we
d
th
a
t
m
o
th
er
s
of
ch
ild
r
en
u
n
d
er
f
iv
e
wer
e
r
el
u
ctan
t
to
b
r
in
g
th
eir
ch
ild
r
e
n
to
ca
r
r
y
o
u
t
GM
P
at
th
e
P
o
s
ya
n
d
u
,
lik
e
th
e
r
esear
ch
co
n
d
u
cted
by
Kir
o
s
,
wh
er
e
m
o
th
er
s
of
to
d
d
ler
s
do
not
tak
e
a
d
v
an
ta
g
e
of
r
ed
u
cin
g
m
o
r
b
id
ity
an
d
m
o
r
tality
r
ates
of
in
f
an
ts
s
an
d
ch
ild
r
e
n
ca
u
s
ed
by
m
aln
u
tr
itio
n
[
1
1
]
,
[
1
4
]
.
T
h
e
k
e
y
to
in
f
lu
e
n
cin
g
b
eh
av
i
o
r
is
attitu
d
e
[
3
1
]
,
[
2
7
]
.
W
h
en
th
ey
f
e
el
co
m
f
o
r
ta
b
le
with
th
e
GM
P
p
r
o
g
r
am
or
h
av
e
a
p
o
s
itiv
e
attitu
d
e
to
war
d
th
e
p
r
o
g
r
am
,
ca
r
e
g
iv
er
s
of
c
h
ild
r
en
u
n
d
er
f
iv
e
ar
e
m
o
r
e
lik
ely
to
atten
d
GM
P
s
ess
io
n
s
[
3
2
]
.
C
ap
ac
ity
b
u
ild
in
g
of
C
HVs
r
e
lated
to
GM
P
th
at
h
as
b
ee
n
im
p
lem
en
ted
by
th
e
E
ast
L
am
p
u
n
g
d
is
tr
ict
Hea
lth
Of
f
ice
an
d
Ma
r
g
o
to
to
Hea
lth
C
en
ter
is
not
s
u
f
f
icien
t,
b
ec
au
s
e
not
all
C
HVs
h
av
e
r
ec
eiv
ed
tr
ain
in
g
or
r
ef
r
esh
in
g
C
HVs
r
elate
d
to
GM
P,
th
e
n
u
m
b
er
of
tr
ain
ed
C
HVs
is
d
ec
r
ea
s
in
g
alo
n
g
with
th
e
f
in
d
in
g
s
of
C
HVs
tu
r
n
o
v
e
r
in
each
P
o
s
ya
n
d
u
.
T
h
e
lo
w
ab
ilit
y
of
C
HV
s
in
G
MP
p
r
ac
tices
can
lead
to
er
r
o
r
s
in
th
e
id
en
tific
atio
n
an
d
class
if
icatio
n
of
n
u
tr
itio
n
a
l
s
tatu
s
.
T
h
er
ef
o
r
e,
th
e
ca
p
ac
it
y
of
C
HVs
m
u
s
t
be
in
cr
ea
s
ed
in
th
e
ap
p
licatio
n
of
GM
P,
esp
ec
ially
r
eg
ar
d
in
g
p
r
o
m
o
tiv
e
n
u
tr
itio
n
co
u
n
s
elin
g
a
n
d
its
f
o
llo
w
-
up
so
t
h
at
th
e
G
MP
p
r
o
g
r
am
ca
n
r
u
n
b
etter
[
1
]
,
[
3
3
]
.
T
h
e
r
e
s
u
l
t
s
s
h
o
w
e
d
a
l
a
c
k
of
v
i
l
l
a
g
e
g
o
v
e
r
n
m
e
n
t
s
u
p
p
o
r
t
f
o
r
P
o
s
y
a
n
d
u
in
t
h
e
M
a
r
g
o
t
o
t
o
H
e
a
l
t
h
C
e
n
t
e
r
w
o
r
k
i
n
g
a
r
e
a
.
I
n
s
t
it
u
t
i
o
n
a
l
l
y
t
h
e
P
o
s
y
a
n
d
u
is
not
p
a
r
t
of
t
h
e
v
i
l
l
a
g
e
g
o
v
e
r
n
m
e
n
t
,
so
it
d
o
e
s
not
h
a
v
e
a
c
l
e
ar
l
i
n
e
of
c
o
o
r
d
i
n
a
t
i
o
n
wi
t
h
t
h
e
v
i
l
l
a
g
e
g
o
v
e
r
n
m
e
n
t
,
t
h
e
r
el
a
t
io
n
s
h
i
p
t
h
a
t
b
i
n
d
s
t
h
e
tw
o
h
a
s
b
e
e
n
l
i
m
i
te
d
to
t
h
e
r
e
l
a
t
i
o
n
s
h
i
p
of
t
h
e
as
s
is
ta
n
c
e
p
r
o
g
r
a
m
,
e
v
e
n
t
h
o
u
g
h
in
p
r
a
c
ti
c
e
t
h
e
P
o
s
y
a
n
d
u
h
a
s
c
a
r
r
i
e
d
out
ac
t
i
v
i
ti
e
s
by
t
h
e
r
o
l
e
t
h
a
t
s
h
o
u
l
d
be
c
a
r
r
i
e
d
out
by
t
h
e
v
i
l
l
a
g
e
g
o
v
e
r
n
m
e
n
t
to
c
a
r
r
y
i
n
g
out
b
a
s
i
c
p
u
b
l
i
c
s
e
r
v
i
c
es.
T
h
i
s
i
s
s
u
e
,
if
not
r
e
s
o
l
v
e
d
i
m
m
e
d
i
at
e
l
y
,
wi
l
l
t
h
r
ea
t
e
n
t
h
e
s
u
s
t
ai
n
a
b
i
l
it
y
of
t
h
e
P
o
s
y
a
n
d
u
as
an
i
m
p
l
e
m
e
n
t
e
r
of
th
e
G
M
P
p
r
o
g
r
a
m
.
3.
3
.
2
.
G
M
P
s
up
po
rt
er
s
Su
p
p
o
r
ter
s
of
GM
P
th
at
r
esear
ch
er
s
en
co
u
n
ter
e
d
in
th
e
Ma
r
g
o
to
to
Hea
lth
C
en
ter
wo
r
k
in
g
a
r
ea
in
clu
d
e
p
ar
ticip
atio
n
,
m
o
n
ito
r
in
g
,
a
n
d
th
e
r
o
le
of
h
u
m
an
d
e
v
elo
p
m
e
n
t
C
HV
s
.
Par
ticip
atio
n
is
v
o
lu
n
tar
y
in
v
o
lv
em
en
t
in
th
e
p
r
o
g
r
am
,
eith
er
f
r
o
m
a
g
r
o
u
p
or
co
m
m
u
n
ity
.
Par
tici
p
atio
n
in
th
e
GM
P
p
r
o
g
r
am
in
Ma
r
g
o
t
o
to
Hea
lth
C
en
ter
wo
r
k
in
g
ar
ea
f
r
o
m
th
e
b
u
s
in
ess
wo
r
ld
is
C
SR
as
a
co
r
p
o
r
ate
s
o
cial
r
esp
o
n
s
ib
ilit
y
to
war
d
s
asp
ec
ts
of
co
m
m
u
n
ity
em
p
o
wer
m
en
t.
N
o
t
o
n
ly
lar
g
e
co
m
p
an
ies
b
u
t
also
s
m
all
an
d
m
e
d
iu
m
-
s
ized
c
o
m
p
an
ies
h
av
e
s
im
ilar
r
esp
o
n
s
ib
ilit
ies.
T
h
e
p
r
ac
tice
of
C
SR
is
a
f
o
r
m
of
co
n
ce
r
n
f
o
r
th
e
b
u
s
in
ess
wo
r
ld
in
co
n
tr
ib
u
tin
g
to
th
e
allev
iatio
n
of
s
o
cial
p
r
o
b
lem
s
in
I
n
d
o
n
esia
[
3
4
]
.
C
SR
o
b
tain
ed
f
r
o
m
ch
ick
e
n
f
a
r
m
s
in
Kib
an
g
V
illag
e,
in
th
e
f
o
r
m
of
co
r
p
o
r
ate
p
h
ilan
th
r
o
p
y
,
is
th
e
p
r
o
v
is
io
n
of
d
o
n
atio
n
s
as
ch
ar
itab
le
ac
tiv
ities
in
t
h
e
f
o
r
m
of
g
r
an
ts
of
goods
f
o
r
th
e
p
r
o
v
is
io
n
of
a
d
d
itio
n
al
f
o
o
d
in
P
o
s
ya
n
d
u
.
Mo
n
ito
r
in
g
is
an
ac
tiv
ity
to
o
b
s
er
v
e
th
e
p
r
o
g
r
ess
of
p
r
o
g
r
am
im
p
lem
en
tatio
n
,
m
o
n
ito
r
i
n
g
of
th
e
GM
P
p
r
o
g
r
a
m
in
th
e
Ma
r
g
o
t
o
to
Hea
lth
C
en
ter
wo
r
k
in
g
ar
ea
h
as
b
ee
n
r
eg
u
la
r
ly
ca
r
r
ie
d
o
u
t,
b
o
th
by
cr
o
s
s
-
p
r
o
g
r
a
m
s
an
d
h
ea
lth
ce
n
ter
s
.
A
r
eg
u
lar
m
o
n
ito
r
in
g
s
y
s
tem
is
v
er
y
im
p
o
r
tan
t
due
to
th
e
h
ig
h
tu
r
n
o
v
er
of
C
HVs
an
d
th
e
lo
w
ed
u
ca
tio
n
lev
el
of
C
HVs.
Hu
m
an
d
ev
el
o
p
m
en
t
C
HVs
in
th
e
wo
r
k
in
g
ar
ea
of
Ma
r
g
o
to
to
Hea
lth
C
en
ter
h
av
e
a
r
o
le
in
th
e
GM
P
p
r
o
g
r
am
to
r
aise
p
u
b
lic
awa
r
en
ess
of
s
tu
n
tin
g
by
m
ea
s
u
r
in
g
th
e
l
en
g
th
an
d
h
eig
h
t
of
to
d
d
ler
s
.
Hu
m
a
n
d
ev
el
o
p
m
en
t
C
HVs
wa
s
ch
o
s
en
as
a
p
ar
tn
er
b
ec
au
s
e
th
ey
wer
e
s
elec
ted
f
r
o
m
v
illag
e
m
ee
tin
g
s
,
an
d
th
e
n
ap
p
o
in
ted
by
th
e
v
illag
e
h
ea
d
ac
co
r
d
in
g
to
th
e
ter
m
s
an
d
c
o
n
d
itio
n
s
t
h
at
h
av
e
b
ee
n
ap
p
lied
.
C
HW
in
v
o
lv
em
e
n
t
h
as
r
esu
lted
i
n
m
ajo
r
im
p
r
o
v
em
en
ts
in
h
ea
lt
h
p
r
io
r
ity
ar
ea
s
,
in
cl
u
d
in
g
r
ed
u
cin
g
ch
ild
h
o
o
d
m
aln
u
tr
itio
n
s
u
ch
as
wastin
g
an
d
s
tu
n
tin
g
[
3
5
]
.
L
im
itatio
n
s
of
th
is
r
esear
ch
on
GM
P
im
p
lem
en
tatio
n
is
a
lim
ited
im
p
lem
en
tatio
n
f
o
r
th
e
Ma
r
g
o
to
to
Hea
lth
C
en
ter
wo
r
k
ar
ea
o
n
ly
,
so
it
ca
n
n
o
t
be
g
en
er
aliz
ed
to
an
o
th
er
h
ea
lth
ce
n
ter
.
In
c
o
n
d
u
ctin
g
FGDs
with
m
o
th
er
s
of
to
d
d
le
r
s
,
in
f
o
r
m
an
ts
also
b
r
o
u
g
h
t
th
eir
to
d
d
ler
s
so
th
at
t
he
im
p
lem
en
tatio
n
of
FGDs
was
not
o
p
tim
al.
4.
CO
NCLU
SI
O
N
GM
P
im
p
lem
en
tatio
n
p
r
ac
tices
in
th
e
co
m
p
o
n
en
ts
of
g
r
o
wth
m
ea
s
u
r
em
en
t,
p
lo
ttin
g
m
ea
s
u
r
em
en
t
r
esu
lts
,
in
ter
p
r
etatio
n
of
g
r
o
wth
in
d
icato
r
s
,
an
d
co
u
n
s
elin
g
in
th
e
wo
r
k
in
g
ar
ea
of
th
e
Ma
r
g
o
to
to
Hea
lth
C
en
ter
ar
e
not
o
p
tim
al,
esp
ec
ially
in
th
e
co
m
p
o
n
en
ts
of
p
lo
ttin
g
m
ea
s
u
r
em
en
t
r
esu
lts
an
d
in
ter
p
r
etatio
n
of
g
r
o
wth
in
d
icato
r
s
.
Ob
s
tacle
s
to
GM
P
im
p
lem
en
tatio
n
in
th
e
wo
r
k
i
n
g
ar
ea
of
Ma
r
g
o
to
to
h
ea
lth
ce
n
ter
ar
e
h
u
m
an
r
eso
u
r
ce
s
,
f
ac
ilit
ies
an
d
i
n
f
r
ast
r
u
ctu
r
e,
lack
of
m
o
tiv
atio
n
,
attitu
d
es
of
m
o
th
er
s
of
to
d
d
ler
s
,
i
n
ad
eq
u
ate
ca
p
ac
ity
b
u
ild
in
g
of
C
HVs,
an
d
lack
of
v
illag
e
g
o
v
e
r
n
m
en
t
s
u
p
p
o
r
t.
Su
p
p
o
r
ter
s
of
GM
P
im
p
lem
en
ta
tio
n
in
th
e
wo
r
k
in
g
ar
ea
of
Ma
r
g
o
to
to
H
ea
lth
C
en
t
er
ar
e
p
ar
ticip
atio
n
,
m
o
n
ito
r
i
n
g
an
d
th
e
r
o
le
of
h
u
m
an
d
e
v
elo
p
m
en
t
C
HVs.
T
h
e
wea
k
n
ess
of
th
is
s
tu
d
y
is
th
e
i
m
p
lem
en
tatio
n
of
FGDs
on
in
f
o
r
m
an
ts
of
m
o
t
h
er
s
of
to
d
d
ler
s
,
in
f
o
r
m
an
ts
also
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