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Ass
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w
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s
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B
an
g
lad
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Co
-
m
o
r
b
id
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Dep
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Ger
iatr
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Ma
ln
u
tr
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T
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is i
s
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p
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c
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ss
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u
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CC B
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SA
li
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C
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p
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A
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:
Mst.
R
o
k
s
h
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a
R
ab
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Dep
ar
tm
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f
Pu
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Hea
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Prim
ea
s
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Un
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s
ity
R
an
g
s
R
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Sq
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Pra
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ir
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af
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ak
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an
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m
ail:
r
o
k
s
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r
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u
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b
d
1.
I
NT
RO
D
UCT
I
O
N
T
h
e
p
r
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s
s
o
f
ag
in
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a
co
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tin
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o
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s
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io
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p
h
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o
m
en
o
n
ch
ar
ac
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ized
b
y
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in
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er
en
t
p
r
o
g
r
ess
io
n
th
at
is
lar
g
ely
b
ey
o
n
d
h
u
m
an
in
ter
v
en
tio
n
[
1
]
.
I
n
d
em
o
g
r
a
p
h
ic
ter
m
s
,
th
e
eld
er
ly
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in
d
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id
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als
6
0
y
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r
s
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f
ag
e
an
d
o
ld
er
[
2
]
.
T
h
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ag
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u
p
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p
ar
ticu
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ly
v
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ln
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k
o
f
co
n
tr
ac
tin
g
in
f
ec
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s
d
is
ea
s
es [
3
]
.
T
h
e
wo
r
l
d
g
e
r
iatr
ic
p
o
p
u
latio
n
was
1
b
illi
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,
a
n
d
it
is
p
r
ed
icted
to
d
o
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b
le
b
y
2
0
5
0
[
4
]
.
T
h
is
tr
en
d
o
f
p
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p
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latio
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ag
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g
is
a
p
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v
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lo
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p
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m
en
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,
with
B
an
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lad
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also
ex
p
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if
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t
d
em
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r
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p
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if
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r
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ar
d
[
5
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.
Am
o
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t
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1
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m
il
lio
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p
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p
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y
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s
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ld
[
6
]
.
T
h
e
p
h
e
n
o
m
en
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n
o
f
ac
ce
ler
ated
ag
in
g
in
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an
g
lad
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h
is
in
f
lu
en
ce
d
b
y
f
ac
to
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s
s
u
ch
as
wid
esp
r
ea
d
p
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ty
,
lab
o
r
-
in
ten
s
iv
e
em
p
lo
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m
en
t,
m
aln
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tr
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p
r
ev
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t
h
ea
lth
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s
u
es,
a
n
d
g
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r
a
p
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ic
co
n
d
itio
n
s
[
2
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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8
8
0
6
A
s
s
ess
men
t o
f d
ep
r
ess
io
n
,
ma
ln
u
tr
itio
n
a
n
d
c
o
-
mo
r
b
id
ities
o
f g
eria
tr
ic
…
(
Ms
t.
Umme
H
a
fs
a
B
eg
u
m
)
1621
Dep
r
ess
io
n
is
ch
ar
ac
ter
ized
b
y
a
co
m
b
in
atio
n
o
f
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eg
ativ
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f
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g
s
s
u
ch
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s
ad
n
es
s
,
l
o
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elin
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,
ir
r
itab
ilit
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,
wo
r
th
less
n
ess
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h
o
p
eless
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es
s
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itatio
n
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d
g
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ac
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p
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n
ar
r
a
y
o
f
p
h
y
s
ical
s
y
m
p
to
m
s
[
7
]
.
T
h
is
m
en
tal
h
ea
lth
co
n
d
itio
n
is
a
s
ig
n
if
ican
t
g
lo
b
al
is
s
u
e,
p
ar
ticu
lar
ly
p
r
ev
alen
t
am
o
n
g
t
h
e
eld
er
l
y
pop
u
latio
n
an
d
lin
k
ed
with
n
u
t
r
itio
n
al
co
n
d
itio
n
s
[
8
]
.
Dep
r
es
s
io
n
ca
n
lead
t
o
d
etr
im
e
n
tal
co
n
s
eq
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en
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s
s
u
ch
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ce
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o
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g
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h
ea
lth
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eter
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o
r
atio
n
,
an
d
i
n
c
r
ea
s
ed
m
ed
ical
b
u
r
d
en
[
9
]
.
Am
o
n
g
th
e
el
d
er
ly
,
d
ep
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n
ca
n
m
ar
k
ed
ly
elev
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m
o
r
b
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ity
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n
d
m
o
r
tality
r
a
tes,
ak
in
to
th
e
ef
f
ec
ts
o
f
m
al
n
u
tr
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n
[
1
0
]
.
I
n
th
is
p
h
ase
o
f
life
,
t
h
ey
h
a
v
e
in
cr
ea
s
ed
ex
p
ec
tatio
n
s
f
r
o
m
th
ei
r
f
am
ilies
,
an
d
m
an
y
o
f
th
eir
p
r
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er
r
ed
ac
tiv
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r
em
ain
u
n
m
et.
As
a
r
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lt,
th
ey
ex
p
er
ien
ce
d
a
s
en
s
e
o
f
em
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tin
ess
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d
a
d
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aily
life
en
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y
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lead
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lev
els o
f
d
ep
r
ess
io
n
[
1
1
]
.
Ma
ln
u
tr
itio
n
is
a
well
-
d
o
c
u
m
e
n
ted
y
et
o
f
te
n
u
n
d
er
r
ec
o
g
n
ize
d
d
is
o
r
d
er
c
h
ar
ac
ter
ized
b
y
a
d
ef
icien
cy
,
ex
ce
s
s
,
o
r
im
b
alan
ce
in
e
n
er
g
y
,
p
r
o
tein
,
a
n
d
o
th
er
n
u
tr
ien
t
i
n
tak
e,
af
f
ec
tin
g
th
e
b
o
d
y
'
s
s
h
ap
e,
s
ize,
co
m
p
o
s
itio
n
,
an
d
f
u
n
ctio
n
an
d
p
o
ten
tially
lead
in
g
to
clin
ical
illn
ess
[
1
2
]
.
Old
er
ad
u
lts
f
ac
e
a
h
eig
h
ten
ed
r
is
k
o
f
m
aln
u
tr
itio
n
o
win
g
to
th
eir
r
ed
u
ce
d
co
n
s
u
m
p
tio
n
o
f
f
o
o
d
an
d
in
cr
ea
s
ed
n
u
t
r
itio
n
al
d
em
a
n
d
s
s
tem
m
in
g
f
r
o
m
d
iv
er
s
e
m
ed
ical
co
n
d
it
io
n
s
[
1
3
]
.
Prio
r
r
esear
c
h
h
as sh
o
wn
th
at
m
aln
u
tr
itio
n
is
lin
k
ed
to
h
ig
h
e
r
m
o
r
b
i
d
ity
an
d
m
o
r
tality
r
ates in
d
is
ea
s
ed
s
tates
an
d
ad
v
er
s
ely
af
f
ec
ts
r
ec
o
v
er
y
o
u
tco
m
es
[
1
4
]
.
T
h
e
h
i
g
h
r
ates
o
f
lo
n
g
-
ter
m
im
p
air
m
en
ts
an
d
s
o
cial
is
o
latio
n
m
ay
s
er
v
e
as
i
n
d
ir
ec
t
f
ac
t
o
r
s
lead
i
n
g
to
p
s
y
c
h
iatr
ic
d
is
o
r
d
e
r
s
lik
e
d
ep
r
ess
i
o
n
,
w
h
ich
a
r
e
o
f
ten
ass
o
ciate
d
with
an
o
r
ex
ia
an
d
in
ad
eq
u
ate
f
o
o
d
c
o
n
s
u
m
p
tio
n
[
1
5
]
.
Ma
ln
u
tr
itio
n
ex
ac
er
b
ates
p
h
y
s
ical
d
eter
io
r
atio
n
a
n
d
m
u
s
cle
wastin
g
,
r
ed
u
cin
g
i
n
d
ep
e
n
d
en
ce
a
n
d
f
r
e
q
u
en
tly
lea
d
in
g
t
o
f
alls
a
n
d
f
r
ac
t
u
r
es
[
1
6
]
.
L
iter
atu
r
e
also
in
d
icate
s
th
at
el
d
er
ly
in
d
iv
id
u
als
in
o
u
r
s
o
ciety
f
ac
e
a
b
r
o
ad
s
p
ec
tr
u
m
o
f
s
o
cia
l,
m
en
tal,
m
ed
ical,
an
d
ec
o
n
o
m
ic
ch
allen
g
es.
I
n
B
an
g
lad
esh
,
o
ld
er
a
d
u
lts
ex
p
e
r
ien
ce
th
ese
ch
allen
g
es
m
o
r
e
ac
u
tely
d
u
e
to
th
eir
ad
v
an
ce
d
ag
e
[
1
7
]
.
W
h
ile
s
ev
er
al
s
tu
d
ies ad
d
r
ess
e
d
g
er
iatr
ic
m
aln
u
t
r
itio
n
an
d
d
e
p
r
ess
io
n
am
o
n
g
el
d
er
ly
p
o
p
u
l
atio
n
s
,
we
f
o
u
n
d
a
g
ap
in
th
e
liter
atu
r
e
r
e
g
ar
d
in
g
th
e
ass
o
ciatio
n
o
f
d
ep
r
ess
io
n
with
m
aln
u
tr
itio
n
,
i
n
clu
d
in
g
c
o
-
m
o
r
b
id
ities
in
th
e
co
n
tex
t
o
f
th
is
s
tu
d
y
s
ettin
g
.
T
h
u
s
,
th
is
s
tu
d
y
aim
ed
to
a
s
s
es
s
th
e
co
n
d
itio
n
o
f
m
e
n
tal
h
ea
lth
,
m
aln
u
tr
itio
n
,
an
d
th
e
c
o
-
m
o
r
b
id
ities
o
f
r
u
r
a
l
g
er
iatr
ic
p
eo
p
le
in
B
an
g
la
d
e
s
h
.
T
h
e
s
tu
d
y
'
s
o
u
tco
m
es
m
a
y
aid
th
e
h
ea
lth
ca
r
e
s
y
s
tem
in
cr
af
tin
g
s
tr
ateg
ies an
d
in
ter
v
e
n
tio
n
s
to
ef
f
ec
tiv
ely
p
r
ev
en
t th
ese
wid
esp
r
ea
d
co
n
d
itio
n
s
an
d
en
h
a
n
ce
th
e
h
ea
lth
s
tatu
s
o
f
r
u
r
al
eld
er
l
y
in
d
iv
id
u
als in
B
an
g
lad
esh
.
2.
M
E
T
H
O
D
2
.
1
.
Study
des
ig
n,
s
et
t
ing
,
a
nd
po
pu
la
t
io
n
T
h
is
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
was
co
n
d
u
cted
in
r
a
n
d
o
m
l
y
s
elec
ted
r
u
r
al
ar
ea
s
o
f
th
e
Gaz
ip
u
r
,
Kis
h
o
r
eg
an
j,
M
u
n
s
h
ig
an
j,
Na
r
ay
an
g
a
n
j,
C
o
x
’
s
B
az
ar
,
C
h
a
n
d
p
u
r
,
Ku
r
ig
r
am
,
R
an
g
p
u
r
,
a
n
d
B
ar
g
u
n
a
d
is
tr
ict
s
u
n
d
er
f
o
u
r
d
if
f
e
r
en
t
d
iv
is
io
n
s
in
B
an
g
lad
esh
.
T
h
e
s
tu
d
y
f
o
cu
s
ed
o
n
g
e
r
iatr
ic
in
d
iv
id
u
als
ag
ed
6
0
y
ea
r
s
an
d
ab
o
v
e
in
t
h
e
s
elec
ted
ar
ea
s
o
f
B
an
g
lad
esh
b
etwe
en
th
e
p
e
r
io
d
o
f
Ma
r
ch
2
0
2
3
a
n
d
Sep
tem
b
er
2
0
2
3
.
T
h
e
in
d
iv
id
u
als
wh
o
wer
e
u
n
willin
g
o
r
u
n
ab
le
t
o
p
a
r
ticip
ate
d
u
e
to
co
m
m
u
n
icatio
n
is
s
u
es
o
r
s
ev
er
e
illn
ess
wer
e
ex
clu
d
e
d
f
r
o
m
th
e
s
am
p
lin
g
f
r
am
e.
2
.
2
.
Sa
m
pli
ng
a
nd
s
a
m
ple size
ca
lcula
t
io
n
Data
was
o
b
tain
ed
f
r
o
m
p
ar
ti
cip
an
ts
f
o
llo
win
g
a
s
im
p
le
r
an
d
o
m
s
am
p
lin
g
m
et
h
o
d
.
T
h
e
s
am
p
le
s
ize
was
ca
lcu
lated
u
s
in
g
th
e
f
o
r
m
u
la
n
=
Z
2
p
q
/
d
2
,
wh
er
e
n
is
th
e
r
eq
u
ir
ed
s
am
p
le
s
ize,
Z
is
th
e
s
tan
d
ar
d
n
o
r
m
al
d
ev
iatio
n
(
eq
u
iv
alen
t
to
1
.
9
6
f
o
r
a
9
5
%
C
I
)
,
p
is
th
e
p
r
ev
alen
ce
o
f
d
ep
r
ess
io
n
5
5
.
5
%
o
r
0
.
5
5
[
1
8
]
,
q
is
1
-
p
an
d
d
is
th
e
allo
wab
le
er
r
o
r
(
5
%
o
r
0
.
0
5
)
.
Fin
ally
,
th
e
y
ield
ed
s
a
m
p
le
s
ize
was 3
8
0
.
2
.
3
.
M
ea
s
ures
2
.
3
.
1
.
Da
t
a
co
llect
io
n t
o
o
ls
Da
ta
was
co
llected
th
r
o
u
g
h
f
ac
e
-
to
-
f
ac
e
in
ter
v
iews
u
s
in
g
a
s
tr
u
ctu
r
ed
q
u
esti
o
n
n
air
e
d
e
v
elo
p
ed
in
E
n
g
lis
h
an
d
s
u
b
s
eq
u
e
n
tly
tr
a
n
s
lated
in
to
th
e
lo
ca
l
lan
g
u
ag
e
(
B
an
g
la)
.
I
n
f
o
r
m
ed
c
o
n
s
en
t
was
o
b
tain
ed
f
r
o
m
ea
ch
p
a
r
ticip
an
t
o
r
t
h
eir
s
u
p
p
o
r
t
b
ef
o
r
e
th
e
i
n
ter
v
iew
.
T
h
e
s
tu
d
y
'
s
p
u
r
p
o
s
e
an
d
s
ig
n
if
ica
n
c
e
wer
e
e
x
p
lain
ed
in
th
e
lo
ca
l la
n
g
u
a
g
e.
2
.
3
.
2
.
Dem
o
g
ra
ph
ic
info
rm
a
t
io
n
Dem
o
g
r
ap
h
ic
an
d
s
o
cio
-
ec
o
n
o
m
ic
in
f
o
r
m
atio
n
was
co
ll
ec
ted
d
u
r
i
n
g
th
e
h
o
m
e
in
ter
v
iew.
T
h
e
d
em
o
g
r
a
p
h
ic
v
a
r
iab
les
in
clu
d
ed
th
e
ag
e
a
n
d
s
ex
o
f
th
e
r
esp
o
n
d
e
n
t.
T
h
e
r
esp
o
n
d
en
t’
s
s
o
cio
ec
o
n
o
m
ic
s
tatu
s
(
SES)
was
in
d
icate
d
b
y
ed
u
ca
tio
n
an
d
m
o
n
th
ly
f
am
ily
in
co
m
e
in
B
an
g
lad
esh
i
T
ak
a
(
B
DT
)
.
I
n
co
m
e
was
f
u
r
th
e
r
ca
teg
o
r
ized
i
n
to
th
r
ee
ca
teg
o
r
i
es
to
d
eter
m
in
e
th
e
lo
w
(
less
th
an
1
0
,
0
0
0
B
DT
)
,
m
i
d
d
le
(
1
0
,
0
0
0
to
4
0
,
0
0
0
B
DT
)
,
an
d
h
ig
h
e
r
in
co
m
e
(
m
o
r
e
th
a
n
4
0
,
0
0
0
B
DT
)
ca
teg
o
r
ies
f
o
llo
win
g
th
e
W
o
r
ld
B
an
k
Atl
as
m
eth
o
d
in
co
m
e
class
if
icatio
n
[
1
9
]
.
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
.
3
,
Sep
tem
b
er
20
25
:
1
6
2
0
-
1
62
8
1622
2
.
3
.
3
.
Depre
s
s
io
n a
s
s
e
s
s
m
ent
Dep
r
ess
io
n
was
ass
e
s
s
ed
u
s
in
g
th
e
g
er
iatr
ic
d
e
p
r
ess
io
n
s
ca
le
(
GDS)
1
5
-
s
h
o
r
t
f
o
r
m
,
a
v
ali
d
ated
to
o
l
ef
f
ec
tiv
e
in
d
etec
tin
g
d
ep
r
ess
io
n
in
o
ld
er
ad
u
lts
.
T
h
is
s
ca
le
co
n
s
is
ts
o
f
1
5
y
es/n
o
q
u
esti
o
n
s
r
ef
lectin
g
th
e
p
ar
ticip
an
ts
'
f
ee
lin
g
s
o
v
er
th
e
p
ast
wee
k
o
n
s
atis
f
ac
tio
n
with
life
in
v
ar
io
u
s
asp
ec
ts
,
in
cl
u
d
in
g
h
o
p
eless
n
ess
,
an
d
h
elp
less
n
ess
,
with
s
co
r
es
r
an
g
in
g
f
r
o
m
0
-
4
in
d
icatin
g
n
o
d
e
p
r
ess
io
n
,
5
-
8
m
ild
d
ep
r
ess
io
n
,
9
-
1
1
m
o
d
er
ate
d
ep
r
ess
io
n
,
a
n
d
1
2
-
1
5
s
ev
er
e
d
ep
r
ess
io
n
[
2
0
]
.
Fu
r
th
er
m
o
r
e,
GDS
was
ca
teg
o
r
ized
as
d
ep
r
e
s
s
io
n
p
r
esen
t
(
Sco
r
e
5
-
1
5
)
a
n
d
d
ep
r
ess
io
n
a
b
s
en
t (
s
co
r
e
0
-
4
)
.
2
.
3
.
4
.
Nut
rit
io
na
l st
a
t
us
a
s
s
ess
m
ent
Nu
tr
itio
n
al
s
tatu
s
was
ev
alu
ate
d
u
s
in
g
th
e
m
in
i
n
u
t
r
itio
n
al
ass
ess
m
en
t
(
MN
A)
,
a
v
alid
ated
to
o
l
wid
ely
u
s
ed
to
m
ea
s
u
r
e
th
e
n
u
tr
itio
n
al
s
tatu
s
o
f
th
e
g
e
r
iatr
ic
p
o
p
u
lati
o
n
g
r
o
u
p
.
T
h
e
MN
A
c
o
n
s
is
ts
o
f
1
8
q
u
esti
o
n
s
an
d
a
to
tal
s
co
r
e
o
f
3
0
aim
ed
at
id
en
tify
in
g
th
e
lev
el
o
f
n
u
tr
itio
n
al
s
tatu
s
.
T
h
e
f
o
u
r
q
u
esti
o
n
s
in
MN
A
wer
e
ab
o
u
t
an
th
r
o
p
o
m
etr
ic
ass
ess
m
en
t,
wh
ich
in
clu
d
es
b
o
d
y
m
ass
in
d
e
x
(
B
MI
)
,
m
id
-
u
p
p
er
ar
m
cir
cu
m
f
er
en
ce
(
MU
AC
)
,
ca
lf
cir
cu
m
f
er
e
n
ce
(
CC
)
,
an
d
weig
h
t
lo
s
s
d
u
r
in
g
th
e
last
th
r
ee
m
o
n
th
s
.
A
s
tad
io
m
eter
was
u
s
ed
to
r
ec
o
r
d
h
ei
g
h
t
,
m
ea
s
u
r
ed
with
o
u
t
s
h
o
es
to
th
e
n
ea
r
est
0
.
1
cm
,
an
d
a
d
ig
ital
s
ca
le
was
u
s
ed
to
m
ea
s
u
r
e
t
h
e
b
o
d
y
weig
h
t.
T
h
e
Asi
an
B
MI
cu
t
-
o
f
f
p
o
in
ts
wer
e
ap
p
lied
to
ca
teg
o
r
ize
p
ar
ticip
a
n
ts
'
n
u
tr
itio
n
al
s
tatu
s
[
2
1
]
.
T
h
e
r
e
wer
e
s
ix
g
e
n
er
al
ass
es
s
m
en
t
q
u
esti
o
n
s
u
n
d
er
MN
A
r
elate
d
to
life
s
ty
le,
m
ed
icatio
n
,
m
o
b
ilit
y
,
p
s
y
ch
o
l
o
g
i
ca
l
o
r
ac
u
te
d
is
ea
s
e,
n
eu
r
o
lo
g
ical
p
r
o
b
lem
s
,
p
r
es
s
u
r
e
s
o
r
es,
o
r
s
k
i
n
d
is
ea
s
e
in
th
e
p
ast
th
r
ee
m
o
n
t
h
s
.
T
h
e
d
ietar
y
a
s
s
es
s
m
en
t
o
f
MN
A
in
clu
d
es
s
ix
q
u
esti
o
n
s
r
elate
d
to
th
e
n
u
m
b
er
o
f
m
ea
ls
,
f
o
o
d
an
d
f
l
u
id
in
tak
e,
a
n
d
m
o
d
e
o
f
f
ee
d
in
g
.
Self
-
ass
es
s
m
en
t
was
d
o
n
e
b
y
ask
i
n
g
two
q
u
esti
o
n
s
,
in
clu
d
in
g
s
elf
-
p
er
ce
p
ti
o
n
o
f
h
ea
lth
an
d
n
u
tr
itio
n
.
Fin
ally
,
th
e
MN
A
s
co
r
e
was
d
iv
id
ed
in
to
th
r
ee
ca
teg
o
r
ies:
an
MN
A
s
co
r
e
b
elo
w
1
7
in
d
icate
s
m
aln
u
tr
itio
n
,
b
etwe
en
1
7
-
2
3
.
5
r
is
k
o
f
m
al
n
u
tr
itio
n
,
an
d
2
4
an
d
ab
o
v
e
in
d
icate
s
well
-
n
o
u
r
is
h
ed
[
2
2
]
.
2
.
3
.
5
.
F
un
ct
io
na
l st
a
t
us
a
s
s
es
s
m
ent
T
h
e
f
u
n
ctio
n
al
s
tatu
s
o
f
p
a
r
ticip
an
ts
was
ass
es
s
ed
with
th
e
Katz
I
n
d
ex
o
f
in
d
e
p
en
d
e
n
ce
i
n
ac
tiv
ities
o
f
d
aily
liv
in
g
(
Katz
ADL
)
.
T
h
is
to
o
l
was
u
s
ed
t
o
ass
ess
th
e
f
u
n
ctio
n
al
s
tatu
s
o
f
th
e
r
esp
o
n
d
en
ts
as
a
m
ea
s
u
r
em
en
t
o
f
th
eir
a
b
ilit
y
t
o
p
er
f
o
r
m
th
eir
d
aily
liv
in
g
ac
tiv
ities
in
d
ep
en
d
en
tly
.
T
h
e
i
n
d
ex
r
a
n
k
s
ad
eq
u
ac
y
o
f
p
er
f
o
r
m
an
ce
in
th
e
s
ix
f
u
n
ct
io
n
s
,
in
clu
d
in
g
b
ath
i
n
g
,
d
r
ess
in
g
,
to
iletin
g
,
tr
an
s
f
er
r
i
n
g
,
co
n
tin
en
ce
,
an
d
f
ee
d
i
n
g
.
T
h
e
s
co
r
in
g
was
d
eter
m
in
ed
b
y
tak
in
g
r
esp
o
n
d
en
ts
'
an
s
we
r
s
b
y
y
es/n
o
f
o
r
in
d
e
p
en
d
e
n
c
e
in
ea
ch
o
f
th
e
s
ix
f
u
n
ctio
n
s
.
Sco
r
es
r
a
n
g
in
g
f
r
o
m
0
-
4
in
d
icate
s
ev
er
e
im
p
air
m
en
t,
4
-
5
in
d
icate
m
o
d
er
ate
im
p
air
m
en
t,
an
d
6
in
d
icate
s
in
d
ep
en
d
e
n
ce
[
2
3
]
.
2
.
3
.
6
.
Co
mo
rbidi
t
ies a
s
s
es
s
m
ent
T
h
e
r
esp
o
n
d
en
ts
wer
e
ask
ed
wh
eth
er
th
ey
h
a
v
e
co
m
o
r
b
i
d
ities
s
u
ch
as
d
iab
etes,
as
th
m
a/
ch
r
o
n
ic
o
b
s
tr
u
ctiv
e
p
u
lm
o
n
ar
y
d
is
ea
s
e
(
C
OPD)
,
h
y
p
er
ten
s
io
n
,
ca
r
d
io
v
ascu
lar
d
is
ea
s
es
(
C
VD)
,
an
d
k
id
n
ey
d
is
ea
s
e
.
T
h
e
p
r
esen
ce
o
f
d
is
ea
s
e
was
v
er
if
ied
th
r
o
u
g
h
p
r
e
v
io
u
s
m
ed
ical
r
ec
o
r
d
s
,
v
alid
ated
test
r
ep
o
r
ts
,
o
r
d
is
cu
s
s
io
n
s
with
f
am
ily
m
em
b
e
r
s
.
T
h
e
an
s
wer
s
to
ea
ch
q
u
esti
o
n
wer
e
o
b
tain
e
d
u
s
in
g
y
es a
n
d
n
o
r
esp
o
n
s
es.
2
.
4
.
Da
t
a
m
a
na
g
e
m
ent
,
qu
a
l
it
y
co
ntr
o
l,
a
nd
a
na
ly
s
is
pla
n
A
tr
ain
ed
g
r
o
u
p
o
f
n
u
tr
itio
n
g
r
ad
u
ate
s
tu
d
en
ts
was
r
e
s
p
o
n
s
ib
le
f
o
r
d
ata
co
llectio
n
.
A
d
r
a
f
t
q
u
esti
o
n
n
air
e
was
d
e
v
elo
p
ed
ac
co
r
d
in
g
to
th
e
s
tu
d
y
o
b
jectiv
es,
p
r
e
-
test
ed
f
o
r
d
ata
q
u
ali
ty
,
an
d
r
ev
is
ed
as
n
ec
ess
ar
y
.
Data
q
u
ality
was
en
s
u
r
ed
th
r
o
u
g
h
c
o
n
s
is
ten
t
ch
ec
k
in
g
an
d
s
u
p
er
v
is
io
n
f
o
r
co
m
p
leten
ess
an
d
co
n
s
is
ten
cy
.
All
d
ata
wer
e
ed
it
ed
,
co
d
ed
,
an
d
an
aly
ze
d
u
s
in
g
Statis
t
ical
Pack
ag
e
f
o
r
t
h
e
So
cial
Scien
ce
s
(
S
PS
S
)
v
er
s
io
n
2
2
.
I
n
c
o
m
p
lete
d
ata
was
ex
clu
d
ed
f
r
o
m
th
e
d
at
aset
b
ef
o
r
e
a
n
aly
s
is
.
Descr
ip
tiv
e
s
tatis
tics
wer
e
p
er
f
o
r
m
ed
t
o
ev
al
u
ate
th
e
v
ar
i
ab
les
th
r
o
u
g
h
t
h
e
ca
lcu
latio
n
o
f
f
r
eq
u
e
n
cies
an
d
p
r
o
p
o
r
tio
n
s
.
T
h
e
ass
o
ciatio
n
s
b
etwe
en
v
ar
iab
les
wer
e
ev
alu
ated
u
s
in
g
th
e
C
h
i
-
s
q
u
ar
e
test
,
an
d
o
n
ly
s
ig
n
if
ica
n
t
v
ar
iab
les
wer
e
in
co
r
p
o
r
ated
i
n
to
th
e
lo
g
is
tic
r
eg
r
ess
io
n
m
o
d
el
(
p
<
0
.
0
5
)
.
T
h
e
s
tr
en
g
th
o
f
ass
o
ciatio
n
s
was
ex
p
r
ess
ed
th
r
o
u
g
h
ad
ju
s
ted
o
d
d
s
r
atio
s
(
AOR)
an
d
th
eir
9
5
%
co
n
f
id
en
ce
in
ter
v
als
(
C
I
)
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
So
cio
-
dem
o
g
ra
ph
ic
a
nd
depress
io
n a
m
o
ng
elderly
p
eo
ple
A
to
tal
o
f
3
8
4
p
ar
ticip
an
ts
wer
e
in
v
o
lv
ed
in
th
is
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
.
T
h
e
m
ajo
r
ity
o
f
r
e
s
p
o
n
d
en
ts
wer
e
b
etwe
en
6
0
an
d
7
5
y
ea
r
s
o
ld
(
8
5
.
7
%),
with
a
m
ea
n
ag
e
o
f
6
7
.
9
5
y
ea
r
s
(
SD±
8
.
0
2
6
)
.
T
h
e
g
en
d
er
d
is
tr
ib
u
tio
n
was
r
elativ
ely
b
alan
ce
d
,
with
5
8
.
3
%
f
em
ales
an
d
4
1
.
7
%
m
ale
s
.
J
o
in
t
f
am
ily
liv
i
n
g
ar
r
an
g
e
m
en
ts
wer
e
p
r
e
v
alen
t
am
o
n
g
5
8
.
9
%
o
f
p
a
r
ticip
an
ts
.
A
s
ig
n
if
ican
t
p
o
r
tio
n
o
f
th
e
r
e
s
p
o
n
d
en
ts
h
a
d
n
o
f
o
r
m
al
ed
u
c
atio
n
(
7
9
.
4
%),
an
d
6
4
.
3
%
wer
e
u
n
em
p
lo
y
ed
.
Mo
s
t
h
o
u
s
eh
o
ld
s
we
r
e
in
th
e
m
id
d
le
-
in
co
m
e
lev
el
(
6
0
.
3
%).
Ad
d
itio
n
ally
,
2
1
.
1
%
o
f
th
e
p
ar
ticip
an
ts
r
e
p
o
r
te
d
b
ein
g
s
m
o
k
er
s
,
as
s
h
o
w
n
in
T
ab
le
1
.
T
h
e
p
r
ev
alen
c
e
o
f
d
e
p
r
ess
io
n
was
n
o
tab
l
y
h
ig
h
at
ap
p
r
o
x
im
ately
6
2
.
8
%.
T
h
e
in
cid
en
ce
o
f
d
ep
r
ess
io
n
was
h
ig
h
er
am
o
n
g
f
em
ales
(
7
2
.
3
%)
co
m
p
ar
ed
t
o
m
ales
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
A
s
s
ess
men
t o
f d
ep
r
ess
io
n
,
ma
ln
u
tr
itio
n
a
n
d
c
o
-
mo
r
b
id
ities
o
f g
eria
tr
ic
…
(
Ms
t.
Umme
H
a
fs
a
B
eg
u
m
)
1623
(
4
9
.
4
%).
C
o
n
v
er
s
ely
,
3
7
.
2
%
o
f
th
e
r
esp
o
n
d
e
n
ts
s
h
o
wed
n
o
s
ig
n
s
o
f
d
ep
r
ess
io
n
s
h
o
wn
in
T
a
b
le
1
.
T
h
e
p
r
ev
io
u
s
s
tu
d
y
in
d
if
f
er
e
n
t
r
eg
i
o
n
s
o
f
B
an
g
lad
esh
f
o
u
n
d
5
5
.
5
%
o
f
GD
am
o
n
g
r
u
r
al
in
d
i
v
id
u
als,
wh
ic
h
is
lo
wer
th
a
n
th
at
o
f
th
is
s
tu
d
y
[
1
8
]
.
So
m
e
r
ec
en
t
s
tu
d
ies
in
d
if
f
er
en
t
r
eg
io
n
s
o
f
B
an
g
lad
esh
in
d
icate
d
b
etwe
en
8
1
.
5
%
an
d
8
3
.
7
5
%
o
f
o
ld
er
a
d
u
lts
ex
p
er
ien
ce
d
v
a
r
y
in
g
lev
els o
f
d
ep
r
ess
iv
e
s
y
m
p
to
m
s
,
wh
ich
is
s
lig
h
tly
h
ig
h
e
r
th
an
th
at
f
o
u
n
d
i
n
th
is
s
tu
d
y
[
5
]
,
[
2
4
]
.
T
h
ese
v
ar
i
atio
n
s
in
d
ep
r
ess
io
n
p
r
ev
ale
n
c
e
am
o
n
g
th
e
eld
e
r
ly
p
o
p
u
latio
n
m
ay
b
e
attr
ib
u
ted
to
d
if
f
e
r
en
ce
s
in
t
h
e
s
o
cio
d
e
m
o
g
r
a
p
h
ic
ch
a
r
ac
ter
is
tics
o
f
th
e
s
tu
d
y
p
ar
ticip
an
ts
[
8
]
.
T
h
e
s
tu
d
y
s
h
o
wed
a
s
ig
n
if
ican
t
ass
o
ciatio
n
b
etwe
en
d
ep
r
ess
io
n
an
d
f
em
ale
g
e
n
d
er
,
liv
in
g
in
a
n
u
clea
r
f
a
m
ily
,
u
n
em
p
lo
y
m
en
t,
lo
w
h
o
u
s
eh
o
ld
in
c
o
m
e,
an
d
s
m
o
k
in
g
h
ab
its
.
T
h
e
p
r
ev
ale
n
ce
o
f
d
ep
r
ess
io
n
was
h
ig
h
er
am
o
n
g
f
em
ales
in
o
u
r
s
tu
d
y
,
alig
n
in
g
wit
h
f
in
d
in
g
s
f
r
o
m
p
r
io
r
r
esear
ch
[
2
5
]
.
T
ab
le
1
.
Descr
ip
tiv
e
s
tatis
tics
o
f
d
em
o
g
r
a
p
h
ic
v
ar
ia
b
les an
d
ass
o
ciatio
n
with
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er
iatr
ic
d
ep
r
ess
io
n
V
a
r
i
a
b
l
e
s
C
a
t
e
g
o
r
y
A
l
l
p
a
r
t
i
c
i
p
a
n
t
s
n
=
3
8
4
(
1
0
0
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e
p
r
e
ss
i
o
n
p
r
e
s
e
n
t
n
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4
1
(
6
2
.
8
%)
D
e
p
r
e
ss
i
o
n
a
b
s
e
n
t
n
=
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4
3
(
3
7
.
2
%)
p
-
v
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l
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e
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g
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g
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p
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n
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d
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6
0
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7
5
y
e
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r
s)
3
2
9
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5
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r
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6
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i
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p
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r
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45
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i
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6
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8
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Ed
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9
4
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U
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Lo
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me
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S
mo
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No
3
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3
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1
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3
.
2
.
M
o
rbidi
t
y
cha
ra
ct
er
is
t
i
cs o
f
t
he
pa
rt
icipa
nts
T
h
e
s
elf
-
r
e
p
o
r
ted
g
e
n
d
er
-
b
ased
co
m
o
r
b
i
d
ities
am
o
n
g
eld
er
ly
in
d
iv
id
u
als
a
r
e
s
h
o
w
n
T
ab
le
2
.
Hy
p
er
ten
s
io
n
was
f
o
u
n
d
in
4
7
.
1
%
o
f
th
e
p
ar
ticip
an
ts
,
with
a
n
o
tab
ly
h
ig
h
er
p
er
ce
n
ta
g
e
am
o
n
g
f
em
ales
co
m
p
ar
ed
t
o
m
ales
(
5
1
.
8
%
v
s
.
4
0
.
6
%),
wh
ich
is
s
tatis
ticall
y
s
ig
n
if
ican
t
(
p
=
0
.
0
3
1
)
.
T
h
i
s
p
er
ce
n
tag
e
alig
n
s
clo
s
ely
with
f
in
d
in
g
s
f
r
o
m
a
s
tu
d
y
co
n
d
u
cted
in
Z
am
b
ia
[
2
6
]
.
Ad
d
itio
n
ally
,
a
g
r
ea
ter
p
r
o
p
o
r
tio
n
o
f
f
em
ales
(
5
5
.
4
%)
r
ep
o
r
ted
ar
t
h
r
itis
in
co
n
tr
ast
to
m
ales
(
3
3
.
8
%).
Fu
r
th
er
m
o
r
e
,
an
o
r
ex
ia,
d
em
e
n
tia,
an
d
c
h
ewin
g
d
if
f
icu
lty
wer
e
s
ig
n
if
ican
tly
h
ig
h
er
am
o
n
g
m
ales
co
m
p
a
r
ed
to
f
e
m
ales.
Diab
etes
an
d
C
V
D
p
r
ev
alen
ce
in
th
is
s
tu
d
y
was
f
o
u
n
d
to
b
e
alm
o
s
t
s
im
ilar
to
a
s
tu
d
y
co
n
d
u
cted
i
n
No
r
th
Am
er
ica’
s
co
u
n
tr
y
[
2
7
]
.
I
n
c
o
n
tr
ast
with
th
is
s
tu
d
y
,
v
is
u
al
an
d
h
ea
r
in
g
p
r
o
b
lem
s
wer
e
h
ig
h
er
in
m
ale
s
in
an
o
th
er
B
an
g
la
d
esh
i stu
d
y
[
6
]
.
3
.
3
.
Nut
rit
io
na
l st
a
t
us
o
f
pa
rt
icipa
nts
B
ased
o
n
th
e
Min
i
Nu
tr
itio
n
al
Ass
e
s
s
m
en
t,
th
e
m
ajo
r
ity
o
f
r
esp
o
n
d
en
ts
(
5
1
.
8
%)
wer
e
at
r
is
k
o
f
m
aln
u
tr
itio
n
.
Ad
d
itio
n
a
lly
,
1
3
.
0
%
o
f
th
e
r
esp
o
n
d
en
ts
wer
e
m
aln
o
u
r
is
h
ed
,
wh
ile
th
e
r
em
ain
in
g
3
5
.
2
%
wer
e
well
-
n
o
u
r
is
h
ed
in
T
ab
le
3
.
S
im
ilar
ly
,
an
o
th
er
s
tu
d
y
in
B
a
n
g
lad
esh
in
d
if
f
er
en
t
r
eg
i
o
n
s
o
b
s
er
v
e
d
a
h
ig
h
er
p
r
ev
alen
ce
o
f
m
aln
u
tr
itio
n
r
is
k
th
an
o
f
m
aln
u
tr
itio
n
[
6
]
.
I
n
li
n
e
with
th
ese
f
in
d
in
g
s
,
a
s
tu
d
y
co
n
d
u
cte
d
in
Nep
al
r
ep
o
r
ted
t
h
at
th
e
r
is
k
o
f
m
aln
u
tr
itio
n
was n
ea
r
ly
d
o
u
b
le
th
at
o
f
th
e
ac
tu
al
o
c
cu
r
r
e
n
ce
o
f
m
a
ln
u
tr
itio
n
[
2
8
]
.
Ou
r
s
tu
d
y
also
id
en
tifie
d
t
h
at
th
e
p
r
ev
alen
ce
o
f
d
ep
r
ess
io
n
was
h
ig
h
er
in
i
n
d
iv
id
u
als
wh
o
wer
e
m
aln
o
u
r
is
h
e
d
an
d
h
ad
s
ev
er
e
im
p
air
m
en
t.
R
esear
ch
in
Me
x
ic
o
f
o
u
n
d
an
in
v
er
s
e
co
r
r
elatio
n
b
etwe
en
MN
A
ev
alu
atio
n
s
an
d
d
ep
r
ess
io
n
s
co
r
es; r
esid
en
ts
with
a
b
etter
n
u
t
r
itio
n
al
s
tatu
s
h
ad
lo
wer
d
e
p
r
ess
io
n
s
co
r
es
[
2
7
]
.
3
.
4
.
F
un
ct
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na
l st
a
t
us
o
f
t
he
rura
l e
lderly
peo
ple
B
ased
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n
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Katz
I
n
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ex
o
f
a
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f
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ADL
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,
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4
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h
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m
o
d
er
ate
im
p
ai
r
m
en
t,
as sh
o
w
n
in
T
ab
le
3
.
Evaluation Warning : The document was created with Spire.PDF for Python.
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(
1
0
0
%)
A
r
t
h
r
i
t
i
s
M
a
l
e
5
4
(
3
3
.
8
%)
1
0
6
(
6
6
.
3
%)
1
6
0
(
1
0
0
%)
0
.
0
0
0
F
e
mal
e
1
2
4
(
5
5
.
4
%)
1
0
0
(
4
4
.
6
%)
2
2
4
(
1
0
0
%)
To
t
a
l
1
7
8
(
4
6
.
4
%)
2
0
6
(
5
3
.
6
%)
3
8
4
(
1
0
0
%)
V
i
su
a
l
p
r
o
b
l
e
m
M
a
l
e
6
7
(
4
1
.
9
%)
9
3
(
5
8
.
1
%)
1
6
0
(
1
0
0
%)
0
.
1
6
1
F
e
mal
e
1
1
0
(
4
9
.
1
%)
1
1
4
(
5
0
.
9
%)
2
2
4
(
1
0
0
%)
To
t
a
l
1
7
7
(
4
6
.
1
%)
2
0
7
(
5
3
.
9
%)
3
8
4
(
1
0
0
%)
H
e
a
r
i
n
g
p
r
o
b
l
e
m
M
a
l
e
5
1
(
3
1
.
9
%)
1
0
9
(
6
8
.
1
%)
1
6
0
(
1
0
0
%)
0
.
4
3
4
F
e
mal
e
8
0
(
3
5
.
7
%)
1
4
4
(
6
4
.
3
%)
2
2
4
(
1
0
0
%)
To
t
a
l
1
3
1
(
3
4
.
1
%)
2
5
3
(
6
5
.
9
%)
3
8
4
(
1
0
0
%)
D
e
n
t
a
l
p
r
o
b
l
e
m
M
a
l
e
5
6
(
3
5
.
0
%)
1
0
4
(
6
5
.
0
%)
1
6
0
(
1
0
0
%)
0
.
0
0
5
F
e
mal
e
1
1
1
(
4
9
.
6
%)
1
1
3
(
5
0
.
4
%)
2
2
4
(
1
0
0
%)
To
t
a
l
1
6
7
(
4
3
.
5
%)
2
1
7
(
5
6
.
5
%)
3
8
4
(
1
0
0
%)
A
n
o
r
e
x
i
a
M
a
l
e
4
3
(
2
6
.
9
%)
1
1
7
(
7
3
.
1
%)
1
6
0
(
1
0
0
%)
0
.
0
0
2
F
e
mal
e
9
5
(
4
2
.
4
%)
1
2
9
(
5
7
.
6
%)
2
2
4
(
1
0
0
%)
To
t
a
l
1
3
8
(
3
5
.
9
%)
2
4
6
(
6
4
.
1
%)
3
8
4
(
1
0
0
%)
D
e
men
t
i
a
M
a
l
e
2
5
(
1
5
.
6
%)
1
3
5
(
8
4
.
4
%)
1
6
0
(
1
0
0
%)
0
.
0
0
3
F
e
mal
e
6
5
(
2
9
.
0
%)
1
5
9
(
7
1
.
0
%)
2
2
4
(
1
0
0
%)
To
t
a
l
9
0
(
2
3
.
4
%)
2
9
4
(
7
6
.
6
%)
3
8
4
(
1
0
0
%)
C
h
e
w
i
n
g
d
i
f
f
i
c
u
l
t
y
M
a
l
e
3
1
(
1
9
.
4
%)
1
2
9
(
8
0
.
6
%)
1
6
0
(
1
0
0
%)
0
.
0
1
6
F
e
mal
e
6
8
(
3
0
.
4
%)
1
5
6
(
6
9
.
6
%)
2
2
4
(
1
0
0
%)
To
t
a
l
9
9
(
2
5
.
8
%)
2
8
5
(
7
4
.
2
%)
3
8
4
(
1
0
0
%)
I
n
so
mn
i
a
M
a
l
e
5
3
(
3
3
.
1
%)
1
0
7
(
6
6
.
9
%)
1
6
0
(
1
0
0
%)
0
.
1
8
7
F
e
mal
e
8
9
(
3
9
.
7
%)
1
3
5
(
6
0
.
3
%)
2
2
4
(
1
0
0
%)
To
t
a
l
1
4
2
(
3
7
.
0
%)
2
4
2
(
6
3
.
0
%)
3
8
4
(
1
0
0
%)
T
ab
le
3
.
Ass
o
ciatio
n
b
etwe
en
co
-
m
o
r
b
id
ities
an
d
g
e
r
iatr
ic
d
ep
r
ess
io
n
V
a
r
i
a
b
l
e
s
C
a
t
e
g
o
r
y
To
t
a
l
n
(
%)
D
e
p
r
e
ss
i
o
n
p
r
e
s
e
n
t
n
(
%)
D
e
p
r
e
ss
i
o
n
a
b
s
e
n
t
n
(
%)
p
-
v
a
l
u
e
H
y
p
e
r
t
e
n
si
o
n
Y
e
s
1
8
1
(
4
7
.
1
%)
1
1
7
(
6
4
.
6
%)
6
4
(
3
5
.
4
%)
0
.
4
7
2
No
2
0
3
(
5
2
.
9
%)
1
2
4
(
6
1
.
1
%)
7
9
(
3
8
.
9
%)
A
n
o
r
e
x
i
a
Y
e
s
1
3
8
(
3
5
.
9
%)
9
2
(
6
6
.
7
%)
4
6
(
3
3
.
3
%)
0
.
2
3
6
No
2
4
6
(
6
4
.
1
%)
1
4
9
(
6
0
.
6
%)
9
7
(
3
9
.
4
%)
D
e
men
t
i
a
Y
e
s
9
0
(
2
3
.
4
%)
7
0
(
7
7
.
8
%)
2
0
(
2
2
.
2
%)
0
.
0
0
1
No
2
9
4
(
7
6
.
6
%)
1
7
1
(
5
8
.
2
%)
1
2
3
(
4
1
.
8
%)
I
n
so
mn
i
a
Y
e
s
1
4
2
(
3
7
.
0
%)
1
0
1
(
7
1
.
1
%)
4
1
(
2
8
.
9
%)
0
.
0
0
9
No
2
4
2
(
6
3
.
0
%)
1
4
0
(
5
7
.
9
%)
1
0
2
(
4
2
.
1
%)
F
u
n
c
t
i
o
n
a
l
s
t
a
t
u
s
S
e
v
e
r
e
i
mp
a
i
r
me
n
t
1
1
(
2
.
9
%)
1
0
(
9
0
.
9
%)
1
(
9
.
1
%)
0
.
0
1
6
M
o
d
e
r
a
t
e
i
m
p
a
i
r
me
n
t
6
7
(
1
7
.
4
5
)
4
9
(
7
3
.
1
%)
1
8
(
2
6
.
9
%)
I
n
d
e
p
e
n
d
e
n
t
3
0
6
(
7
9
.
7
)
1
8
2
(
5
9
.
5
%)
1
2
4
(
4
0
.
5
%)
N
u
t
r
i
t
i
o
n
a
l
st
a
t
u
s
M
a
l
n
o
u
r
i
s
h
e
d
5
0
(
1
3
%)
4
1
(
8
2
.
0
%)
9
(
1
8
.
0
%)
0
.
0
0
9
A
t
r
i
s
k
o
f
ma
l
n
u
t
r
i
t
i
o
n
1
9
9
(
5
1
.
8
%)
1
2
2
(
6
1
.
3
%)
7
7
(
3
8
.
7
%)
W
e
l
l
N
o
u
r
i
s
h
e
d
1
3
5
(
3
5
.
2
%)
7
8
(
5
7
.
8
%)
5
7
(
4
2
.
2
%)
3
.
5
.
Ass
o
cia
t
io
n bet
wee
n c
o
-
m
o
rbidi
t
ies a
nd
g
er
ia
t
ric
depress
io
n
T
ab
le
3
s
h
o
ws
th
e
ass
o
ciatio
n
b
etwe
en
co
-
m
o
r
b
id
ities
,
n
u
tr
itio
n
al
s
tatu
s
,
an
d
g
er
iatr
ic
d
ep
r
ess
io
n
th
r
o
u
g
h
th
e
C
h
i
-
s
q
u
ar
e
test
.
T
h
e
p
r
esen
ce
o
f
co
m
o
r
b
id
iti
es
s
u
ch
as
d
em
en
tia
(
p
=
0
.
0
0
1
)
an
d
in
s
o
m
n
ia
(
p
=
0
.
0
0
9
)
wer
e
s
ig
n
if
ican
tly
ass
o
ciate
d
with
GD,
wh
ic
h
is
c
o
n
s
is
ten
t
with
a
p
r
e
v
io
u
s
s
tu
d
y
[
2
9
]
.
O
u
r
an
al
y
s
is
also
r
ev
ea
led
s
ig
n
if
ica
n
t
v
ar
ia
tio
n
s
in
GD
co
n
ce
r
n
in
g
th
e
f
u
n
ctio
n
al
an
d
n
u
t
r
itio
n
al
s
tatu
s
o
f
th
e
p
ar
ticip
an
ts
.
Sp
ec
if
ically
,
in
d
iv
id
u
als
with
s
ev
er
e
im
p
air
m
en
t
s
h
o
wed
a
s
ig
n
if
ican
tly
h
ig
h
er
p
r
ev
al
en
ce
o
f
d
ep
r
ess
io
n
co
m
p
ar
ed
to
th
o
s
e
with
n
o
r
m
al
f
u
n
ctio
n
al
s
tatu
s
(
in
d
ep
e
n
d
en
t)
(
p
=
0
.
0
1
6
)
.
Fu
r
th
er
m
o
r
e,
m
aln
o
u
r
is
h
ed
in
d
iv
id
u
als ex
h
i
b
ited
a
h
ig
h
er
p
r
ev
alen
ce
o
f
d
e
p
r
ess
io
n
co
m
p
ar
ed
to
well
-
n
o
u
r
is
h
e
d
in
d
iv
i
d
u
als (
p
=
0
.
0
0
9
).
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
A
s
s
ess
men
t o
f d
ep
r
ess
io
n
,
ma
ln
u
tr
itio
n
a
n
d
c
o
-
mo
r
b
id
ities
o
f g
eria
tr
ic
…
(
Ms
t.
Umme
H
a
fs
a
B
eg
u
m
)
1625
3
.
6
.
Det
er
m
ina
t
io
n o
f
ind
ependent
predict
o
rs o
f
g
er
ia
t
ric
depress
io
n
T
h
e
r
is
k
f
ac
to
r
s
ass
o
ciate
d
with
d
ep
r
ess
io
n
wer
e
d
eter
m
in
ed
th
r
o
u
g
h
r
eg
r
ess
io
n
an
aly
s
is
an
d
ar
e
p
r
esen
ted
in
T
a
b
le
4
.
T
h
e
an
a
ly
s
is
r
ev
ea
led
th
at
in
d
iv
id
u
als
r
esid
in
g
in
n
u
clea
r
f
am
ilies
wer
e
at
2
.
1
1
4
tim
es
h
ig
h
er
r
is
k
o
f
ex
p
er
ien
cin
g
d
e
p
r
ess
io
n
(
AOR
=
2
.
1
1
4
,
9
5
%
C
I
:
1
.
3
2
8
-
3
.
3
6
5
,
p
=
0
.
0
0
2
)
.
Ad
d
itio
n
ally
,
b
ein
g
u
n
em
p
lo
y
ed
was id
en
tifie
d
as
an
in
d
e
p
en
d
e
n
t p
r
ed
icto
r
o
f
g
e
r
iatr
ic
d
ep
r
ess
io
n
(
AOR =
1
.
9
9
2
,
9
5
% C
I
: 1
.
0
7
0
-
3
.
7
0
9
,
p
=
0
.
0
3
0
)
.
Ou
r
s
tu
d
y
h
as
also
id
en
tifie
d
th
at
r
esp
o
n
d
en
ts
r
esid
in
g
in
th
e
n
u
clea
r
f
a
m
ily
wer
e
2
.
1
1
tim
es
m
o
r
e
lik
el
y
to
b
e
d
e
p
r
ess
ed
th
an
th
o
s
e
liv
in
g
in
jo
in
t
f
am
ili
es,
a
s
im
ilar
f
in
d
in
g
h
as
b
ee
n
r
ep
o
r
ted
in
an
o
th
er
r
esear
ch
in
Pak
is
tan
[
3
0
]
.
I
n
th
is
s
tu
d
y
,
th
e
p
r
ev
alen
ce
o
f
d
e
p
r
ess
io
n
was
h
i
g
h
i
n
u
n
em
p
lo
y
ed
in
d
i
v
id
u
als.
A
r
ec
e
n
t
s
tu
d
y
in
Ko
r
ea
r
ev
ea
led
th
at
d
ep
r
ess
iv
e
s
y
m
p
to
m
s
ar
e
m
o
r
e
lik
el
y
am
o
n
g
u
n
em
p
lo
y
ed
s
en
i
o
r
citizen
th
an
th
eir
co
u
n
ter
p
a
r
t
[
3
1
]
.
T
h
e
r
is
k
o
f
d
ep
r
ess
io
n
was
two
tim
es
h
ig
h
er
am
o
n
g
u
n
em
p
l
o
y
ed
eld
er
l
y
th
an
a
m
o
n
g
th
eir
co
u
n
ter
p
a
r
ts
in
t
h
is
s
tu
d
y
.
T
h
a
t
was
alm
o
s
t
h
alf
o
f
a
s
tu
d
y
in
B
an
g
lad
esh
th
at
r
ep
o
r
ted
th
e
r
is
k
o
f
d
ep
r
ess
io
n
is
4
.
9
6
tim
es
h
ig
h
er
i
n
u
n
em
p
lo
y
ed
eld
e
r
ly
[
8
]
.
I
n
th
e
r
u
r
al
ar
ea
s
o
f
B
an
g
lad
esh
,
o
ld
er
a
d
u
lts
ar
e
f
r
eq
u
e
n
tly
u
n
em
p
lo
y
ed
an
d
d
ep
e
n
d
en
t
o
n
f
am
ily
m
em
b
e
r
s
,
ca
u
s
in
g
f
in
an
cial
in
s
ec
u
r
ity
,
lim
ited
av
ailab
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d
in
ad
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q
u
ate
ac
ce
s
s
to
ess
en
tial h
ea
lth
s
er
v
ices
[
8
]
.
T
ab
le
4
.
Facto
r
s
ass
o
ciate
d
with
g
er
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A
O
R
:
a
d
j
u
s
t
e
d
o
d
d
s
r
a
t
i
o
4.
CO
NCLU
SI
O
N
T
h
is
s
tu
d
y
r
ev
ea
led
a
h
ig
h
p
r
e
v
alen
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f
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am
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ly
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n
B
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g
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esh
,
wit
h
o
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h
alf
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r
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k
o
f
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aln
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tr
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.
L
iv
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in
a
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clea
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ily
,
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ei
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n
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p
lo
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,
in
s
o
m
n
ia,
an
d
d
em
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atr
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H
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ates
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ate
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r
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T
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r
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b
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s
t
h
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lth
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f
r
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ewo
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eq
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ate
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th
p
h
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tal
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c
ar
e,
in
clu
d
in
g
en
h
an
ce
d
m
en
tal
h
ea
lth
s
er
v
ices,
n
u
tr
itio
n
al
s
u
p
p
o
r
t
p
r
o
g
r
a
m
s
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an
d
im
p
r
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v
ed
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s
e
m
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is
im
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ativ
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T
h
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o
s
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tu
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B
an
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d
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tili
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p
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ed
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r
d
s
alo
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f
a
m
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te
r
v
iews
to
id
e
n
tify
p
ar
ticip
an
ts
'
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m
o
r
b
id
ities
.
I
n
th
e
f
u
t
u
r
e,
a
lo
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g
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in
al
s
tu
d
y
with
ap
p
r
o
p
r
iate
s
am
p
lin
g
,
in
co
r
p
o
r
atin
g
d
ir
ec
t
o
b
s
er
v
atio
n
o
f
eld
e
r
ly
in
d
iv
id
u
als'
f
o
o
d
q
u
ality
an
d
q
u
a
n
tity
,
co
n
tin
u
o
u
s
ass
es
s
m
en
t
o
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m
en
tal
h
ea
lth
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tatu
s
,
an
d
co
m
p
r
eh
en
s
iv
e
m
ed
ical
an
d
b
io
ch
e
m
ical
ex
am
in
atio
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s
to
co
n
f
ir
m
c
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m
o
r
b
id
ities
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co
u
ld
p
r
o
v
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ee
p
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in
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ts
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n
h
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er
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ACK
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e
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r
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atitu
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to
th
e
el
d
er
ly
p
ar
ticip
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ts
wh
o
s
e
in
v
o
lv
em
en
t
was
cr
u
c
ial
to
th
e
s
u
cc
ess
f
u
l c
o
m
p
letio
n
o
f
th
is
s
tu
d
y
.
F
UNDING
I
NF
O
R
M
A
T
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N
T
h
is
r
esear
ch
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an
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m
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o
r
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o
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p
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f
it
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r
g
an
izatio
n
s
.
AUTHO
R
CO
NT
RI
B
UT
I
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NS ST
A
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M
E
N
T
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h
is
jo
u
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C
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to
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les
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C
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tio
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r
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au
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s
h
ip
d
is
p
u
tes,
an
d
f
ac
ilit
ate
co
llab
o
r
atio
n
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
2
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6
I
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Hea
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14
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Sep
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b
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20
25
:
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1626
Na
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Un
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.
DATA AV
AI
L
AB
I
L
I
T
Y
Data
an
d
m
ater
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ay
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e
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a
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.
RE
F
E
R
E
NC
E
S
[
1
]
R
.
F
.
W
a
l
k
e
r
,
“
A
m
e
c
h
a
n
i
s
t
i
c
t
h
e
o
r
y
o
f
d
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v
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p
me
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n
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u
ma
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s
a
n
d
o
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h
e
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mam
m
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l
s
,
”
C
e
l
l
s
,
v
o
l
.
1
1
,
n
o
.
5
,
p
.
9
1
7
,
M
a
r
.
2
0
2
2
,
d
o
i
:
1
0
.
3
3
9
0
/
c
e
l
l
s
1
1
0
5
0
9
1
7
.
[
2
]
K
.
M
.
M
.
R
a
h
m
a
n
,
U
n
n
a
y
a
n
O
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n
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s
h
a
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P
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y
Br
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e
f
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n
Pr
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a
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Po
p
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.
U
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n
O
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–
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h
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o
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a
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o
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s
,
D
h
a
k
a
,
B
a
n
g
l
a
d
e
s
h
,
2
0
2
3
.
[
3
]
M
.
K
a
r
t
h
i
k
a
,
J.
A
b
r
a
h
a
m,
P
.
B
.
K
o
d
a
l
i
,
a
n
d
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a
t
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w
s
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n
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a
n
d
b
o
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k
o
f
Ag
i
n
g
,
H
e
a
l
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Pu
b
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y
,
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p
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:
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p
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a
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0
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3
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p
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1
–
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4
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1
0
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7
8
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981
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1
9
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1.
[
4
]
W
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l
d
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