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Nu
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in
[
1
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3
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,
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I
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14
,
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3
,
Sep
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20
25
:
1
3
4
7
-
1
3
5
6
1348
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n
g
s
t
wo
m
en
in
a
r
u
r
al
s
ettin
g
,
wh
er
e
s
o
cial
s
tig
m
as
p
lay
a
c
r
u
cia
l
r
o
le
in
av
ailin
g
h
ea
lth
b
e
n
ef
its
.
B
y
an
aly
zin
g
th
e
ass
o
ciatio
n
s
b
etwe
en
m
en
o
p
a
u
s
e
an
d
ab
o
v
e
m
e
n
tio
n
ed
v
ar
ia
b
les
lik
e
m
o
o
d
,
en
e
r
g
y
,
an
d
p
h
y
s
ical
r
elatio
n
s
,
we
ca
n
d
esig
n
a
m
o
r
e
co
h
esiv
e
ap
p
r
o
ac
h
f
o
r
d
esig
n
in
g
th
e
n
ec
ess
ar
y
in
ter
v
en
tio
n
s
n
ee
d
ed
to
im
p
r
o
v
e
q
u
ality
o
f
life
o
f
wo
m
e
n
b
elo
n
g
in
g
to
b
o
th
p
er
im
en
o
p
a
u
s
al
an
d
p
o
s
t
-
m
e
n
o
p
a
u
s
al
ca
teg
o
r
ies.
T
h
u
s
,
we
co
n
d
u
cte
d
th
is
s
tu
d
y
with
th
e
o
b
jectiv
e
o
f
ass
ess
in
g
th
e
ass
o
ciatio
n
o
f
m
e
n
o
p
au
s
e
o
n
ce
r
tain
attr
ib
u
tes
o
f
life
n
am
ely
s
leep
,
en
e
r
g
y
,
m
em
o
r
y
,
wo
r
k
,
leis
u
r
e,
p
h
y
s
ical
r
elatio
n
s
,
an
d
ev
er
y
d
ay
ac
tiv
ities
,
all
wh
ich
p
lay
a
s
ig
n
if
ican
t
r
o
le
in
d
eter
m
in
i
n
g
q
u
ality
o
f
life
o
f
wo
m
en
.
T
h
ese
asp
ec
ts
wer
e
ch
o
s
en
d
u
e
to
t
h
eir
r
elev
an
ce
in
in
f
lu
e
n
cin
g
o
v
er
all
well
-
b
ei
n
g
d
u
r
in
g
m
en
o
p
au
s
e.
T
h
e
ai
m
o
f
th
is
s
tu
d
y
was
to
b
etter
o
u
r
u
n
d
er
s
tan
d
i
n
g
o
f
h
o
w
m
e
n
o
p
a
u
s
e
af
f
ec
ts
d
aily
f
u
n
ctio
n
in
g
an
d
g
en
er
al
life
s
atis
f
ac
tio
n
o
f
wo
m
en
.
2.
RE
S
E
ARCH
M
E
T
H
O
D
2
.
1
.
Study
des
ig
n
A
co
m
m
u
n
ity
b
ased
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
was
co
n
d
u
cted
o
v
er
a
p
er
io
d
o
f
th
r
ee
m
o
n
th
s
.
A
li
s
t
o
f
v
illag
es
u
n
d
er
r
u
r
al
f
ield
p
r
a
ctice
ar
ea
o
f
p
r
iv
ate
m
ed
ical
co
lleg
e
in
Ma
h
ar
ash
tr
a,
I
n
d
ia
was
o
b
tain
ed
.
T
h
e
s
tu
d
y
was
ca
r
r
ied
o
u
t
b
y
o
r
g
a
n
izin
g
a
g
en
er
al
h
ea
lt
h
ch
ec
k
-
u
p
ca
m
p
at
a
r
an
d
o
m
ly
s
elec
ted
v
illag
e
f
r
o
m
th
e
lis
t.
Ad
d
itio
n
al
d
ata
was g
ath
e
r
ed
b
y
h
o
u
s
e
to
h
o
u
s
e
v
is
its
at
th
e
s
am
e
an
d
c
o
n
s
ec
u
tiv
e
v
ill
ag
es a
s
p
er
th
e
lis
t.
2
.
2
.
Set
t
ing
T
h
e
s
tu
d
y
was
co
n
d
u
cted
in
r
u
r
al
f
ield
p
r
ac
tice
a
r
ea
o
f
a
p
r
iv
ate
m
e
d
ical
co
lleg
e
i
n
th
e
s
tate
o
f
Ma
h
ar
ash
tr
a,
I
n
d
ia.
W
e
o
b
tai
n
ed
a
lis
t
o
f
1
3
v
illag
es
u
n
d
e
r
th
is
ar
ea
,
f
r
o
m
wh
ich
o
n
e
v
illag
e,
C
h
an
d
e
was
r
an
d
o
m
l
y
s
elec
ted
b
y
s
im
p
le
r
an
d
o
m
s
am
p
lin
g
.
A
team
,
w
h
ich
co
n
s
is
ted
o
f
a
p
r
in
ci
p
al
in
v
esti
g
ato
r
an
d
a
m
ed
ical
s
o
cial
wo
r
k
er
was
f
o
r
m
ed
.
C
o
o
p
er
atio
n
o
f
t
h
e
v
illag
e
h
ea
d
an
d
co
m
m
u
n
ity
m
o
b
ilizer
s
m
ain
ly
ac
cr
ed
ited
s
o
cial
h
ea
lth
ac
tiv
i
s
t
(
ASHA)
wo
r
k
er
s
was
s
o
u
g
h
t
an
d
th
e
y
wer
e
in
f
o
r
m
e
d
r
e
g
ar
d
in
g
th
e
s
tu
d
y
o
b
je
ctiv
es
an
d
th
e
b
en
ef
it
o
f
ca
r
r
y
i
n
g
o
u
t
t
h
is
s
tu
d
y
i
n
th
eir
v
illag
e.
Data
was
co
llected
b
y
o
r
g
an
izin
g
a
g
en
er
al
h
ea
lth
-
c
h
ec
k
u
p
ca
m
p
at
s
elec
ted
v
illag
e
an
d
h
o
u
s
e
to
h
o
u
s
e
v
is
its
.
T
o
f
u
lf
il
th
e
r
em
ain
in
g
s
am
p
le
s
ize,
n
ex
t
th
r
ee
c
o
n
s
ec
u
tiv
e
v
i
llag
e
f
r
o
m
th
e
lis
t
o
f
1
3
v
illag
es,
Nan
d
e,
Pira
n
g
u
t
,
an
d
Ur
a
wad
e,
wer
e
s
elec
ted
.
T
h
eir
v
illag
e
h
ea
d
an
d
co
m
m
u
n
ity
m
o
b
ilizer
s
in
clu
d
in
g
AS
HA
wo
r
k
er
s
wer
e
in
f
o
r
m
ed
,
a
n
d
f
o
r
co
n
s
ec
u
tiv
e
v
illag
es,
o
n
ly
h
o
u
s
e
-
to
-
h
o
u
s
e
v
is
its
wer
e
d
o
n
e.
I
n
to
tal,
f
o
u
r
v
illag
es
o
u
t
o
f
th
ir
teen
v
illag
es
wer
e
co
v
er
ed
an
d
wo
m
en
,
wh
o
f
it
th
e
in
clu
s
io
n
cr
iter
ia
wer
e
ass
e
s
s
ed
f
o
r
th
eir
q
u
ality
o
f
life
u
s
in
g
th
e
m
en
o
p
a
u
s
al
q
u
ality
o
f
life
q
u
esti
o
n
n
air
e.
2
.
3
.
Sa
m
ple size
T
o
ca
lcu
late
s
am
p
le
s
ize,
p
r
ev
alen
ce
o
f
7
0
.
2
%
was
co
n
s
id
er
ed
u
s
in
g
f
i
n
d
in
g
s
p
u
b
lis
h
ed
b
y
M
.
Kalh
an
in
h
is
s
tu
d
y
o
n
p
r
e
v
al
en
ce
o
f
m
e
n
o
p
a
u
s
al
s
y
m
p
to
m
s
in
r
u
r
al
wo
m
en
b
etwe
en
th
e
ag
es
o
f
4
0
-
6
0
y
ea
r
s
[
1
1
]
.
A
p
er
m
is
s
ib
le
er
r
o
r
o
f
1
0
%
an
d
co
n
f
id
en
ce
lev
el
o
f
9
5
%,
was
u
s
ed
f
o
r
ca
lcu
la
tio
n
.
Usi
n
g
th
ese
ab
o
v
e
v
alu
es,
th
e
s
am
p
le
s
ize
was c
alcu
lated
to
b
e
1
6
2
,
r
o
u
n
d
in
g
o
f
to
1
6
5
.
2
.
4
.
Study
pa
rt
icipa
nts
W
e
s
cr
ee
n
ed
wo
m
en
b
etwe
en
th
e
ag
es
o
f
4
0
-
6
5
y
ea
r
s
f
o
r
in
clu
s
io
n
in
th
e
s
tu
d
y
.
T
h
e
in
clu
s
io
n
cr
iter
ia
o
f
t
h
is
s
tu
d
y
wer
e
w
o
m
en
wh
o
wer
e
e
ith
er
p
er
i
-
m
en
o
p
a
u
s
al
o
r
p
o
s
t
-
m
en
o
p
au
s
al
s
in
ce
10
y
ea
r
s
.
Ho
wev
er
,
af
ter
p
r
im
ar
y
s
cr
ee
n
in
g
f
o
r
ag
e,
wo
m
e
n
wh
o
h
ad
i
n
d
u
ce
d
m
e
n
o
p
a
u
s
e
eith
er
b
y
p
h
ar
m
ac
o
th
e
r
ap
y
o
r
s
u
r
g
ically
,
h
a
v
in
g
p
r
e
-
ex
is
tin
g
th
y
r
o
id
co
n
d
itio
n
,
h
y
p
er
ten
s
io
n
,
o
r
d
iab
etes
wer
e
ex
cl
u
d
ed
f
r
o
m
t
h
e
s
tu
d
y
.
Du
r
in
g
th
e
h
ea
lth
c
h
ec
k
-
u
p
ca
m
p
,
at
th
e
f
ir
s
t
v
illag
e,
C
h
ale,
6
2
wo
m
en
b
etwe
en
th
e
ag
es
o
f
4
0
-
6
5
y
ea
r
s
wer
e
s
cr
ee
n
ed
ag
ain
,
o
u
t
o
f
wh
ich
2
9
wer
e
ex
clu
d
ed
d
u
e
to
p
r
e
-
ex
is
tin
g
d
iab
etes
an
d
h
y
p
e
r
ten
s
io
n
.
Hen
ce
,
3
3
wo
m
en
wer
e
r
ec
r
u
ited
b
y
th
e
p
r
in
ci
p
al
in
v
esti
g
ato
r
f
o
r
th
e
s
tu
d
y
.
Prio
r
co
n
s
en
t
was
o
b
tain
ed
f
r
o
m
all
th
e
elig
ib
le
wo
m
en
b
ef
o
r
e
a
d
m
i
n
is
ter
in
g
th
e
q
u
esti
o
n
n
air
e
.
Ob
jectiv
es
o
f
th
e
s
tu
d
y
an
d
th
e
L
ik
e
r
t
s
ca
le
o
f
q
u
esti
o
n
n
air
e
was
ex
p
lain
ed
to
th
e
wo
m
en
.
T
h
en
th
e
q
u
esti
o
n
n
air
e
was
ad
m
in
is
ter
ed
b
y
th
e
p
r
in
cip
al
in
v
esti
g
ato
r
th
o
u
g
h
in
te
r
v
iew
m
eth
o
d
to
th
em
.
A
h
ea
lth
talk
was
g
iv
e
n
at
th
e
en
d
o
f
q
u
esti
o
n
n
air
e
to
all
wo
m
en
,
a
d
v
is
in
g
th
em
o
n
wh
at
all
ac
tiv
e
in
ter
v
e
n
tio
n
s
ca
n
b
e
tak
e
n
to
im
p
r
o
v
e
th
eir
q
u
ality
o
f
life
an
d
h
o
w
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
Qu
a
lity o
f life
a
mo
n
g
p
eri me
n
o
p
a
u
s
a
l a
n
d
p
o
s
t
-
men
o
p
a
u
s
a
l wo
men
fr
o
m
…
(
S
a
n
ja
n
a
Ma
n
ikta
lla
)
1349
to
co
m
b
at
m
en
o
p
au
s
e
ef
f
ec
tiv
ely
.
Af
ter
h
ea
lth
ch
ec
k
-
u
p
ca
m
p
,
h
o
u
s
e
v
is
its
wer
e
d
o
n
e
i
n
s
am
e
v
illag
e
d
u
r
in
g
wh
ich
3
0
wo
m
e
n
wer
e
r
ec
r
u
it
ed
af
ter
b
ein
g
s
cr
ee
n
ed
in
ac
c
o
r
d
an
ce
with
in
clu
s
io
n
an
d
ex
clu
s
io
n
cr
iter
ia
a
n
d
wer
e
ad
m
in
is
ter
ed
th
e
s
tan
d
ar
d
ized
q
u
esti
o
n
n
air
e
b
y
in
ter
v
i
ew
tech
n
iq
u
e
.
C
o
n
s
ec
u
tiv
e
v
il
lag
es
ac
co
r
d
in
g
t
o
th
e
lis
t,
Nan
d
e,
Pira
n
g
u
t
,
an
d
Ur
awa
d
e
in
o
r
d
er
,
wer
e
v
is
ited
f
r
o
m
wh
er
e
1
0
2
wo
m
e
n
wer
e
r
ec
r
u
ited
af
ter
s
cr
ee
n
in
g
to
f
u
lf
il
th
e
s
am
p
le
s
ize
an
d
th
eir
QOL
was
ass
es
s
ed
b
y
Prin
cip
al
I
n
v
esti
g
ato
r
.
C
o
u
n
s
ellin
g
o
n
th
e
im
p
l
icatio
n
s
an
d
in
ter
v
en
tio
n
s
n
ee
d
ed
to
im
p
r
o
v
e
QOL
in
m
en
o
p
au
s
e
was
d
o
n
e
at
th
e
en
d
o
f
s
tu
d
y
to
al
l
wo
m
en
ir
r
esp
ec
tiv
e
o
f
wh
eth
e
r
th
ey
wer
e
i
n
clu
d
ed
in
th
e
s
tu
d
y
o
r
n
o
t.
2
.
5
.
Va
ri
a
bles
Var
iab
les
wer
e
ass
e
s
s
ed
u
n
d
er
th
r
ee
h
ea
d
in
g
s
o
f
s
o
cio
-
d
em
o
g
r
ap
h
ic
ch
a
r
ac
ter
is
tics
,
s
tatu
s
o
f
m
en
o
p
a
u
s
e
an
d
q
u
ality
o
f
lif
e.
Un
d
er
s
o
cio
-
d
em
o
g
r
a
p
h
ic
ch
ar
ac
ter
is
tics
,
th
e
v
ar
iab
les
u
s
ed
wer
e
r
elig
io
n
,
ty
p
e
o
f
f
am
ily
,
ed
u
ca
tio
n
an
d
o
cc
u
p
atio
n
o
f
th
e
wo
m
an
a
s
well
as
h
er
h
u
s
b
an
d
an
d
th
eir
s
o
cio
-
ec
o
n
o
m
ic
s
ta
tu
s
.
T
h
ese
v
ar
iab
les
in
d
icate
d
to
war
d
s
th
eir
s
tatu
s
in
s
o
ci
ety
an
d
ab
ilit
y
to
av
ail
r
eso
u
r
ce
s
f
o
r
b
etter
m
en
t o
f
th
eir
q
u
ality
o
f
life
.
Statu
s
o
f
m
en
o
p
a
u
s
e
was
d
eter
m
in
ed
b
y
d
iv
id
in
g
s
tu
d
y
p
ar
ticip
a
n
ts
p
er
i
-
m
en
o
p
au
s
al
an
d
p
o
s
t
-
m
en
o
p
au
s
al
s
tatu
s
f
o
r
b
etter
u
n
d
er
s
tan
d
in
g
o
f
th
eir
s
ig
n
s
an
d
s
y
m
p
to
m
s
an
d
f
o
r
h
ea
lth
ed
u
ca
tio
n
p
u
r
p
o
s
es.
Fo
r
q
u
ality
o
f
life
,
eig
h
t
v
ar
iab
les
wer
e
ass
es
s
ed
n
am
ely
s
leep
,
en
er
g
y
,
m
em
o
r
y
,
f
ee
lin
g
s
,
p
h
y
s
ical
r
elatio
n
s
,
h
o
m
e
an
d
d
aily
lif
e
ac
tiv
ities
,
wo
r
k
,
s
o
cial
life
an
d
leis
u
r
e
ac
tiv
it
ies
an
d
th
eir
ass
o
ciatio
n
with
s
tatu
s
o
f
m
en
o
p
a
u
s
e
was d
eter
m
in
ed
.
2
.
6
.
Da
t
a
s
o
urce
s
a
nd
m
ea
s
urem
ent
W
e
d
esig
n
ed
an
d
v
alid
ated
a
r
esear
ch
to
o
l
co
n
s
is
tin
g
o
f
q
u
e
s
tio
n
s
o
n
th
r
ee
s
ec
tio
n
s
.
First,
to
co
llect
th
e
s
o
cio
-
d
em
o
g
r
ap
h
ic
d
ata.
Seco
n
d
,
to
ass
ess
th
e
m
en
o
p
au
s
al
s
tatu
s
o
f
th
e
wo
m
an
.
T
h
ir
d
,
m
en
o
p
au
s
al
q
u
ality
o
f
life
q
u
esti
o
n
n
air
e
h
av
in
g
eig
h
t
co
m
p
o
n
en
ts
n
am
ely
s
leep
,
m
em
o
r
y
,
en
e
r
g
y
,
f
ee
lin
g
s
,
p
h
y
s
ical
r
elatio
n
s
,
h
o
m
e
an
d
d
aily
life
ac
tiv
ities
,
wo
r
k
,
s
o
cial
life
a
n
d
d
aily
ac
tiv
ities
,
with
4
5
q
u
esti
o
n
s
in
to
tal,
to
ass
es
s
q
u
ality
o
f
life
i
n
m
e
n
o
p
au
s
e
wo
m
en
.
E
ac
h
d
o
m
ain
h
ad
a
lis
t
o
f
q
u
esti
o
n
s
u
n
d
er
it,
wh
ich
wer
e
s
co
r
e
d
b
etwe
en
1
-
6
o
n
a
L
ik
er
t
s
ca
l
e,
wh
er
e
“1
”
s
tan
d
s
f
o
r
“
I
a
m
n
ev
er
li
k
e
th
is
”
to
“6
”
w
h
ich
s
tan
d
s
f
o
r
“
I
am
alwa
y
s
lik
e
th
is
”.
R
ev
er
s
e
s
c
o
r
in
g
o
f
n
i
n
etee
n
q
u
esti
o
n
s
was
d
o
n
e.
Ma
x
im
u
m
s
co
r
e
was
4
5
an
d
m
in
im
u
m
s
co
r
e
was
2
7
0
.
T
h
e
to
o
l
was
f
i
r
s
t
tr
an
s
lated
to
th
e
lo
ca
l
lan
g
u
ag
e
an
d
th
e
n
b
ac
k
tr
a
n
s
lated
to
E
n
g
lis
h
to
ch
ec
k
f
o
r
ac
cu
r
ac
y
an
d
wh
et
h
er
t
h
e
tech
n
ical
ter
m
s
u
s
ed
in
d
icate
d
th
e
s
am
e
in
f
o
r
m
at
io
n
th
at
th
e
p
r
in
cip
al
in
v
esti
g
ato
r
was
tr
y
in
g
to
co
n
v
ey
to
th
e
s
u
b
ject
s
u
b
jects.
I
t
was
f
u
r
th
er
ce
r
tifie
d
b
y
th
e
s
u
b
ject
ex
p
er
t.
A
wr
itten
co
p
y
o
f
b
o
th
th
e
tr
an
s
lated
as
well
as
E
n
g
lis
h
v
er
s
io
n
o
f
th
is
q
u
esti
o
n
n
air
e
wa
s
with
th
e
p
r
in
cip
al
in
v
esti
g
ato
r
d
u
r
in
g
th
e
p
r
o
ce
s
s
o
f
d
ata
c
o
llectio
n
.
I
n
th
e
en
d
,
s
co
r
in
g
o
f
ea
ch
d
o
m
ai
n
wa
s
d
o
n
e.
Par
ticip
an
ts
wh
o
s
co
r
e
d
less
th
an
o
r
e
q
u
al
to
h
alf
th
e
m
ea
n
o
f
to
ta
l
s
co
r
e
wer
e
s
aid
t
o
h
av
e
“
Po
o
r
QOL
”,
wh
ile
p
ar
ticip
an
ts
wh
o
s
co
r
e
d
m
o
r
e
th
an
h
alf
o
f
m
ea
n
o
f
t
o
tal
s
co
r
e,
w
er
e
s
aid
to
h
a
v
e
“Go
o
d
QOL
”.
2
.
7
.
St
a
t
is
t
ica
l
a
na
ly
s
is
S
t
a
ti
s
t
i
c
al
a
n
a
l
y
s
i
s
w
as
d
o
n
e
u
s
i
n
g
SP
SS
s
o
f
tw
a
r
e
(
v
e
r
s
i
o
n
2
8
.
0
)
.
C
o
n
t
i
n
u
o
u
s
v
a
r
i
a
b
l
es
r
e
s
u
l
ts
w
e
r
e
s
h
o
w
n
b
y
d
e
s
c
r
i
p
t
i
v
e
s
ta
t
is
ti
cs
.
C
ateg
o
r
ical
v
ar
iab
les
r
esu
lts
wer
e
s
h
o
wn
b
y
f
r
eq
u
en
c
y
an
d
p
er
ce
n
tag
es.
I
n
d
ep
e
n
d
en
t
t
-
test
was
u
s
ed
to
f
in
d
ass
o
ciatio
n
b
etw
ee
n
d
o
m
ain
s
o
f
QOL
an
d
m
en
o
p
a
u
s
e.
C
h
i
-
s
q
u
ar
e
test
was
u
s
ed
to
f
in
d
th
e
ass
o
ciatio
n
b
etwe
en
s
o
cio
-
d
em
o
g
r
a
p
h
i
c
v
ar
iab
les
an
d
d
o
m
ain
s
o
f
QOL
.
T
h
r
o
u
g
h
o
u
t
th
e
r
esu
lts
,
a
5
%
lev
el
o
f
s
ig
n
if
ica
n
ce
was
m
ain
tain
ed
.
All
r
esu
lt
s
wer
e
s
h
o
wn
with
9
5
%
co
n
f
id
en
ce
in
ter
v
a
l,
an
d
p
-
v
alu
e
o
f
<0
.
0
5
was c
o
n
s
id
er
ed
as si
g
n
if
ican
t.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
T
h
e
p
r
in
cip
al
in
v
esti
g
ato
r
an
d
m
ed
ical
s
o
cial
wo
r
k
er
v
is
ited
f
o
u
r
v
illag
es,
o
u
t
o
f
t
h
ir
teen
an
d
th
e
p
r
in
cip
al
in
v
esti
g
ato
r
ass
ess
e
d
1
6
5
wo
m
e
n
f
o
r
th
eir
q
u
alit
y
o
f
life
an
d
its
ass
o
ciatio
n
with
m
en
o
p
au
s
e.
T
h
e
m
ap
in
Fig
u
r
e
1
s
h
o
ws
th
e
Pu
n
e
d
is
tr
ict
in
Ma
h
ar
ash
tr
a,
I
n
d
ia.
T
h
e
s
ec
o
n
d
,
Fig
u
r
e
2
s
h
o
w
s
a
d
etailed
m
a
p
o
f
Pu
n
e,
with
th
e
r
u
r
al
f
ield
p
r
a
ctice
ar
ea
wh
er
e
th
e
s
tu
d
y
was
co
n
d
u
cted
.
T
h
e
m
a
p
s
h
o
w
s
a
co
m
p
lete
lis
t
o
f
v
illag
e
s
u
n
d
er
t
h
e
f
ield
p
r
ac
tice
ar
ea
,
with
f
o
u
r
s
p
ec
if
ic
v
illa
g
es m
ar
k
ed
wh
e
r
e
th
e
s
tu
d
y
w
as c
ar
r
ied
o
u
t.
3
.
1
.
So
cio
-
dem
o
g
ra
ph
ic
cha
ra
ct
er
is
t
ics
T
ab
le
1
s
h
o
ws
th
e
d
is
tr
ib
u
ti
o
n
o
f
wo
m
en
ac
co
r
d
in
g
to
s
o
cio
-
d
em
o
g
r
ap
h
ic
v
ar
iab
les
an
d
th
eir
p
er
ce
n
tag
es.
I
n
th
e
c
u
r
r
en
t
s
t
u
d
y
,
m
ea
n
ag
e
was
ca
lcu
lated
to
b
e
4
8
.
1
6
y
ea
r
s
±
8
.
4
SD,
with
m
ajo
r
ity
o
f
wo
m
en
,
2
7
.
8
7
%
h
a
v
in
g
attain
ed
ed
u
ca
tio
n
u
p
to
h
ig
h
e
r
s
ec
o
n
d
ar
y
lev
el.
Sev
er
al
n
atio
n
al
an
d
in
ter
n
atio
n
al
co
m
m
u
n
ity
b
ased
s
tu
d
ies
[
4
]
–
[
7
]
s
h
o
wca
s
ed
a
s
im
ilar
m
e
an
ag
e
an
d
attain
m
en
t
o
f
e
d
u
ca
tio
n
at
least
u
p
to
s
ec
o
n
d
ar
y
lev
el
[
1
2
]
–
[
1
4
]
.
T
h
is
s
h
o
wca
s
es
a
b
o
o
s
t
to
war
d
s
ed
u
ca
tio
n
am
o
n
g
s
t
wo
m
en
in
o
u
r
s
tu
d
y
.
Ho
wev
er
,
in
co
n
tr
ast to
th
e
lev
el
o
f
ed
u
ca
tio
n
,
m
aj
o
r
ity
o
f
wo
m
en
,
5
8
.
1
8
% in
o
u
r
s
tu
d
y
wer
e
h
o
u
s
ewiv
es a
n
d
n
o
t
ea
r
n
i
n
g
,
i
n
s
im
ilar
ity
with
o
th
er
s
tu
d
ies
[
1
5
]
–
[
1
8
]
.
T
h
is
ca
n
b
e
o
wed
to
t
h
e
r
u
r
al
s
ettin
g
wh
er
e
s
tig
m
a
o
f
wo
m
en
b
ein
g
em
p
lo
y
ed
an
d
ea
r
n
in
g
,
p
r
ev
ails
till
n
o
w.
I
r
r
esp
ec
tiv
e
o
f
wo
m
e
n
h
av
in
g
ac
h
iev
ed
a
h
ig
h
e
r
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
3
4
7
-
1
3
5
6
1350
ed
u
ca
tio
n
,
c
o
m
p
ar
e
d
to
o
th
e
r
s
tu
d
ies,
o
u
r
s
tu
d
y
h
i
g
h
lig
h
ts
t
h
e
n
ee
d
to
c
r
ea
te
m
o
r
e
wo
r
k
p
l
ac
e
o
p
p
o
r
tu
n
ities
to
en
r
o
ll
wo
m
en
an
d
in
cr
ea
s
e
th
eir
s
elf
-
r
elian
ce
.
Per
tain
in
g
to
ed
u
ca
tio
n
a
n
d
o
cc
u
p
atio
n
o
f
h
u
s
b
an
d
,
3
8
.
7
9
%
m
en
h
ad
attain
ed
ed
u
ca
tio
n
till
h
ig
h
er
s
ec
o
n
d
ar
y
an
d
3
5
.
7
5
%
wer
e
en
g
ag
ed
in
s
er
v
ice
jo
b
s
in
eith
er
p
u
b
lic
o
r
p
r
iv
ate
s
ec
to
r
.
T
h
is
h
ig
h
er
p
r
o
p
o
r
tio
n
o
f
m
e
n
en
g
ag
ed
i
n
s
er
v
ice
s
ec
to
r
f
u
r
t
h
er
h
i
g
h
lig
h
ts
t
h
e
g
en
d
er
d
is
p
ar
ity
in
ter
m
s
o
f
em
p
lo
y
m
en
t.
So
cio
-
ec
o
n
o
m
ic
s
tatu
s
was
m
ea
s
u
r
ed
b
y
Mo
d
if
ied
B
G
Pra
s
ad
Scale,
2
0
2
4
,
wh
ic
h
s
h
o
wed
m
ajo
r
ity
o
f
wo
m
e
n
b
elo
n
g
e
d
to
th
e
l
o
wer
m
id
d
le
class
,
as
also
s
ee
n
in
s
tu
d
ies
d
o
n
e
in
a
s
im
ilar
s
ettin
g
p
er
tain
in
g
to
m
en
o
p
au
s
e
[
1
6
]
,
[
1
8
]
.
Fig
u
r
e
1
.
Ma
p
o
f
Ma
h
ar
ash
tr
a,
I
n
d
ia
with
Pu
n
e
d
is
tr
ict
h
ig
h
li
g
h
ted
T
ab
le
1
.
Dis
tr
ib
u
tio
n
o
f
wo
m
e
n
p
er
tain
in
g
to
s
o
cio
-
d
em
o
g
r
a
p
h
ic
v
ar
iab
les (
n
=
1
6
5
)
V
a
r
i
a
b
l
e
C
a
t
e
g
o
r
y
F
r
e
q
u
e
n
c
y
R
e
l
i
g
i
o
n
H
i
n
d
u
1
5
9
(
9
6
.
3
6
)
B
u
d
d
h
i
sm
3
(
1
.
8
1
)
M
u
s
l
i
m
3
(
1
.
8
1
)
Ty
p
e
o
f
f
a
m
i
l
y
Ex
t
e
n
d
e
d
6
(
3
.
6
3
)
Jo
i
n
t
4
0
(
2
4
.
2
4
)
N
u
c
l
e
a
r
1
1
8
(
7
1
.
5
1
)
Ed
u
c
a
t
i
o
n
o
f
w
o
m
e
n
N
o
f
o
r
m
a
l
e
d
u
c
a
t
i
o
n
3
9
(
2
3
.
6
3
)
P
r
i
mary
1
9
(
1
1
.
5
1
)
S
e
c
o
n
d
a
r
y
4
1
(
2
4
.
8
4
)
H
i
g
h
e
r
s
e
c
o
n
d
a
r
y
4
6
(
2
7
.
8
7
)
G
r
a
d
u
a
t
e
2
0
(
1
2
.
1
2
)
O
c
c
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p
a
t
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o
n
o
f
w
o
m
e
n
H
o
u
s
e
w
i
f
e
9
6
(
5
8
.
1
8
)
P
e
t
t
y
b
u
si
n
e
ss
8
(
4
.
8
4
)
S
e
r
v
i
c
e
3
2
(
1
9
.
3
9
)
A
g
r
i
c
u
l
t
u
r
e
f
a
r
m
i
n
g
2
9
(
1
7
.
5
7
)
Ed
u
c
a
t
i
o
n
o
f
h
u
s
b
a
n
d
N
o
f
o
r
m
a
l
e
d
u
c
a
t
i
o
n
3
9
(
2
3
.
6
3
)
P
r
i
mary
6
(
3
.
6
4
)
S
e
c
o
n
d
a
r
y
3
0
(
1
8
.
1
8
)
H
i
g
h
e
r
s
e
c
o
n
d
a
r
y
6
4
(
3
8
.
7
9
)
G
r
a
d
u
a
t
e
2
6
(
1
5
.
7
6
)
O
c
c
u
p
a
t
i
o
n
o
f
h
u
s
b
a
n
d
R
e
t
i
r
e
d
1
4
(
8
.
4
8
)
P
e
t
t
y
b
u
si
n
e
ss
1
4
(
8
.
4
8
)
S
e
r
v
i
c
e
5
9
(
3
5
.
7
5
)
A
g
r
i
c
u
l
t
u
r
e
f
a
r
m
i
n
g
5
3
(
3
2
.
1
2
)
D
e
c
e
a
se
d
2
5
(
1
5
.
2
)
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
Qu
a
lity o
f life
a
mo
n
g
p
eri me
n
o
p
a
u
s
a
l a
n
d
p
o
s
t
-
men
o
p
a
u
s
a
l wo
men
fr
o
m
…
(
S
a
n
ja
n
a
Ma
n
ikta
lla
)
1351
Fig
u
r
e
2
.
Ma
p
o
f
Pu
n
e
d
is
tr
ict,
wh
ich
s
h
o
ws th
e
r
u
r
al
f
ield
p
r
ac
tice
ar
ea
,
with
s
p
ec
if
ic
v
illa
g
es m
ar
k
ed
wh
e
r
e
s
tu
d
y
was c
o
n
d
u
cte
d
3
.
2
.
Q
ua
lit
y
o
f
life
a
m
o
ng
s
t
peri
-
m
eno
pa
us
a
l a
nd
po
s
t
-
m
eno
pa
us
a
l w
o
m
en
I
n
o
u
r
s
tu
d
y
,
5
7
% wo
m
en
m
et
th
e
cr
iter
ia
o
f
attain
in
g
co
m
p
l
ete
m
en
o
p
au
s
e,
wh
ile
4
3
% we
r
e
in
p
er
i
-
m
en
o
p
a
u
s
al
s
tag
e.
T
h
ese
r
esu
lts
we
r
e
alm
o
s
t
co
n
cu
r
r
en
t
with
p
er
ce
n
tag
e
o
f
f
em
al
es
h
av
in
g
attain
e
d
m
en
o
p
a
u
s
e
in
o
th
er
s
tu
d
ies
[
1
2
]
,
[
1
7
]
,
[
1
9
]
i
n
a
s
im
ilar
s
etti
n
g
.
I
n
to
tal
eig
h
t
d
o
m
ain
s
wer
e
test
ed
,
an
d
a
to
tal
s
co
r
e
was c
alcu
lated
.
W
o
m
en
s
co
r
in
g
less
th
an
o
r
eq
u
al
to
h
alf
o
f
m
ea
n
o
f
to
tal
s
co
r
e
wer
e
s
aid
to
h
av
e
“Po
o
r
QOL
”,
wh
ile
wo
m
en
w
h
o
s
co
r
ed
m
o
r
e
th
a
n
h
alf
o
f
m
ea
n
o
f
to
tal
s
co
r
e
wer
e
s
aid
to
h
a
v
e
“Go
o
d
QOL
”.
Fo
r
th
e
d
o
m
ain
o
f
p
h
y
s
ical
r
elatio
n
s
,
o
n
ly
6
3
wo
m
en
an
s
wer
e
d
“y
es”.
Fo
r
th
ese
6
3
wo
m
en
,
6
8
.
2
%
h
ad
“
g
o
o
d
QOL
”
in
clu
d
in
g
all
ei
g
h
t
d
o
m
ain
s
.
On
e
x
clu
d
in
g
p
h
y
s
ical
r
elatio
n
s
d
o
m
ain
,
6
2
.
2
7
%
wo
m
en
o
u
t
o
f
1
6
5
h
a
d
“g
o
o
d
QOL
”
an
d
3
2
.
7
2
%
h
a
d
“p
o
o
r
QOL
”.
T
h
ese
f
in
d
i
n
g
s
ar
e
s
im
ilar
to
co
m
m
u
n
ity
-
b
ased
f
ield
s
tu
d
y
in
r
u
r
al
s
ettin
g
in
So
u
th
er
n
I
n
d
ia
[
1
2
]
,
[
2
0
]
–
[
2
2
]
.
T
h
is
ca
n
b
e
o
wed
to
s
im
ilar
s
tu
d
y
s
ettin
g
,
a
g
e
g
r
o
u
p
.
W
o
m
en
,
s
p
ec
ially
in
r
u
r
al
s
ettin
g
ac
ti
v
ely
p
ar
ticip
ate
in
all
r
elig
i
o
u
s
ev
en
ts
an
d
h
av
e
in
cr
ea
s
ed
s
o
cial
in
ter
ac
tio
n
s
,
wh
ich
co
u
ld
h
av
e
also
co
n
tr
i
b
u
ted
to
th
is
f
in
d
in
g
.
H
o
wev
e
r
,
th
is
is
in
co
n
tr
ast
to
f
ew
s
tu
d
ies,
d
o
n
e
i
n
I
n
d
ia
an
d
ab
r
o
a
d
,
[
1
1
]
,
[
2
3
]
,
[
2
4
]
wh
er
e
a
s
ig
n
if
ican
tly
h
ig
h
er
n
u
m
b
er
o
f
wo
m
en
h
a
d
“p
o
o
r
QOL
”.
T
h
is
s
tar
k
d
if
f
er
en
ce
ca
n
b
e
attr
ib
u
ted
to
im
p
r
o
v
e
d
ac
ce
s
s
to
h
ea
lth
ca
r
e
r
eso
u
r
ce
s
an
d
f
ac
ilit
ies
b
y
wo
m
en
in
o
u
r
s
tu
d
y
alo
n
g
with
b
etter
o
u
tr
ea
c
h
p
r
o
g
r
am
s
to
g
e
n
er
ate
awa
r
e
n
ess
o
n
wo
m
e
n
’
s
h
ea
lt
h
b
y
p
r
im
a
r
y
ca
r
e
f
ac
ilit
ies
in
r
u
r
al
p
ar
t
o
f
W
ester
n
I
n
d
ia.
3
.
3
.
Ass
o
cia
t
io
n bet
wee
n so
cio
-
ec
o
no
m
ic
cha
r
a
ct
er
is
t
ics a
nd
m
eno
pa
us
a
l
QOL
I
n
o
u
r
s
tu
d
y
,
two
s
ep
ar
ate
a
n
aly
s
is
f
o
r
ass
o
ciatio
n
wer
e
co
m
p
u
ted
f
o
r
QOL
,
o
n
e
in
cl
u
d
in
g
all
d
o
m
ain
s
an
d
th
e
o
th
er
,
ex
cl
u
d
in
g
th
e
p
h
y
s
ical
r
elatio
n
d
o
m
ain
,
as
o
n
ly
6
3
wo
m
en
o
u
t
o
f
1
6
5
wo
m
en
,
an
s
wer
ed
y
es
t
o
th
e
d
o
m
ain
o
f
p
h
y
s
ical
r
elatio
n
s
.
T
ab
le
s
2
an
d
3
d
e
p
ict
ass
o
ciatio
n
o
f
s
o
cio
-
d
em
o
g
r
a
p
h
ic
v
ar
iab
les
with
q
u
ality
o
f
life
,
with
ex
clu
s
io
n
a
n
d
i
n
clu
s
io
n
o
f
p
h
y
s
ical
r
elat
io
n
s
d
o
m
ain
.
No
s
ig
n
if
ican
t
ass
o
ciatio
n
was
f
o
u
n
d
b
etwe
en
s
o
cio
-
d
em
o
g
r
ap
h
ic
ch
ar
ac
ter
is
tics
an
d
q
u
ality
o
f
life
,
s
im
ilar
to
th
e
s
tu
d
y
d
o
n
e
o
n
m
id
d
le
a
g
ed
wo
m
e
n
in
r
u
r
al
No
r
th
en
I
n
d
ia
[
1
1
]
.
Ho
wev
er
,
t
h
e
s
tu
d
y
co
n
d
u
cted
in
an
u
r
b
a
n
s
ettin
g
[
1
8
]
s
h
o
wed
th
at
r
elig
io
n
an
d
f
am
ily
s
ize
h
ad
a
s
ig
n
if
ican
t
r
o
le
to
p
lay
with
d
ec
r
e
ased
QOL
in
s
am
e
ag
e
g
r
o
u
p
.
Oth
e
r
s
tu
d
ies
o
f
n
atio
n
al
an
d
in
ter
n
atio
n
al
o
r
ig
i
n
,
[
2
3
]
,
[
2
5
]
,
[
2
6
]
s
h
o
wed
th
a
t
wo
m
en
wh
o
wer
e
em
p
lo
y
ed
h
ad
a
b
etter
QOL
b
u
t
th
o
s
e
wh
o
wer
e
liter
ate
h
ad
p
o
o
r
QOL
c
o
m
p
ar
e
d
to
th
o
s
e
wh
o
wer
e
less
liter
ate.
T
h
is
ca
n
b
e
attr
ib
u
t
ed
to
a
d
if
f
er
en
t
to
o
l
to
ass
ess
QOL
,
as
th
ey
h
ad
u
s
ed
Hild
itch
ME
NQOL
q
u
esti
o
n
n
air
e
t
o
ass
ess
QOL
,
in
co
n
tr
ast
to
o
u
r
s
tu
d
y
,
i
n
wh
ich
m
en
o
p
au
s
al
q
u
ality
o
f
life
q
u
es
tio
n
n
air
e
d
ev
elo
p
e
d
b
y
Hy
lan
d
o
f
Ply
m
o
u
th
Un
iv
e
r
s
ity
was u
s
ed
,
alo
n
g
with
d
if
f
er
en
t stu
d
y
s
ettin
g
.
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
3
4
7
-
1
3
5
6
1352
T
ab
le
2
.
Ass
o
ciatio
n
b
etwe
en
s
o
cio
-
d
em
o
g
r
ap
h
ic
v
ar
iab
les
with
q
u
alit
y
-
of
-
life
with
ex
clu
s
io
n
o
f
p
h
y
s
ical
r
elatio
n
s
d
o
m
ain
(
n
=
1
6
5
)
V
a
r
i
a
b
l
e
C
a
t
e
g
o
r
y
Q
O
L
e
x
c
l
u
d
i
n
g
P
R
To
t
a
l
C
h
i
-
s
q
u
a
r
e
v
a
l
u
e
p
-
v
a
l
u
e
P
o
o
r
G
o
o
d
R
e
l
i
g
i
o
n
B
u
d
d
h
i
sm
1
(
3
3
.
3
)
2
(
6
6
.
7
)
3
(
1
0
0
)
3
.
5
1
0
.
3
1
H
i
n
d
u
5
3
(
3
3
.
3
)
1
0
6
(
6
6
.
7
)
1
5
9
(
1
0
0
)
M
u
s
l
i
m
0
(
0
)
3
(
1
0
0
)
3
(
1
0
0
)
Ty
p
e
o
f
f
a
m
i
l
y
e
x
t
e
n
d
e
d
4
(
6
6
.
7
)
2
(
3
3
.
3
)
6
(
1
0
0
)
3
.
7
2
0
.
2
9
j
o
i
n
t
1
4
(
3
4
.
1
)
2
8
(
6
8
.
2
9
)
41
(
1
0
0
)
n
u
c
l
e
a
r
3
7
(
3
1
.
3
)
8
1
(
6
8
.
6
)
1
1
8
(
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n
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3
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4
.
H
ea
lt
h do
ma
ins
a
nd
m
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pa
us
e
Qu
ality
o
f
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was
ass
ess
ed
u
n
d
er
ei
g
h
t
d
o
m
ain
s
ac
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d
in
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t
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m
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o
p
au
s
al
q
u
al
ity
o
f
life
q
u
esti
o
n
n
air
e.
T
ab
le
4
s
h
o
wca
s
es
r
elatio
n
o
f
v
ar
io
u
s
d
o
m
ai
n
s
o
f
q
u
ality
o
f
life
with
m
en
o
p
au
s
e.
Ass
o
ciatio
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b
etwe
en
th
ese
d
o
m
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s
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d
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[
1
1
]
,
[
1
2
]
,
[
2
4
]
,
[
2
7
]
to
ass
ess
QOL
in
p
e
r
i
-
m
en
o
p
au
s
al
a
n
d
p
o
s
t
-
m
en
o
p
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s
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wo
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en
.
Do
m
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f
p
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s
ical
r
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n
s
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x
h
ib
it
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u
n
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tain
in
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wo
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p
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m
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p
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ca
teg
o
r
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,
h
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d
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r
ea
s
ed
p
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y
s
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r
elatio
n
s
c
o
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p
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m
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in
p
o
s
t
-
m
en
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p
au
s
al
ca
teg
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[
2
3
]
.
T
h
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ca
n
b
e
attr
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tab
le
to
th
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lack
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f
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r
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d
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tag
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th
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s
im
p
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p
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m
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p
au
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s
tag
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d
b
ef
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r
e.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Hea
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Sci
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N:
2252
-
8
8
0
6
Qu
a
lity o
f life
a
mo
n
g
p
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n
o
p
a
u
s
a
l a
n
d
p
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men
fr
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m
…
(
S
a
n
ja
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a
Ma
n
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3
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Are
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o
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re
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idence
Ou
r
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th
at
3
2
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7
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%
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en
r
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in
r
u
r
al
ar
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ad
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atis
f
ac
to
r
y
QOL
,
ex
clu
d
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g
th
e
p
h
y
s
ical
r
elatio
n
s
(
PR
)
co
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p
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n
t.
T
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is
f
in
d
in
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is
in
ac
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r
d
an
ce
with
s
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er
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o
t
h
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ies,
[
1
1
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,
[
1
2
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[
2
8
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–
[
3
1
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.
A
h
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h
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r
o
p
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tio
n
o
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x
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ce
d
p
o
o
r
QOL
in
r
u
r
al
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g
.
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h
is
wa
s
p
r
im
ar
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d
u
e
to
a
d
if
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s
s
in
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d
af
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r
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T
h
e
s
itu
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n
w
as
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u
r
th
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wo
r
s
en
ed
b
y
lim
ited
r
eso
u
r
ce
s
av
ailab
le
in
r
u
r
al
ar
ea
s
.
T
ab
le
4
.
R
elatio
n
o
f
v
ar
io
u
s
d
o
m
ain
s
o
f
QOL
with
m
e
n
o
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u
s
e
(n
=
1
6
5
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,
(
p
h
y
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r
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n
s
n
=
6
3
)
D
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A
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*
P
o
-
M:
-
p
o
st
-
m
e
n
o
p
a
u
sa
l
,
P
e
r
i
-
M:
-
p
e
r
i
-
me
n
o
p
a
u
s
a
l
3
.
6
.
Str
eng
t
hs
a
nd
wea
k
nes
s
es
T
h
is
s
tu
d
y
co
n
tr
ib
u
ted
s
u
b
s
tan
tially
in
f
o
cu
s
in
g
o
n
d
o
m
ain
s
o
th
er
th
a
n
p
h
y
s
ical
h
ea
lth
wh
ich
also
g
et
im
p
ac
ted
d
u
r
in
g
m
e
n
o
p
a
u
s
e.
Seco
n
d
ly
,
th
is
s
tu
d
y
was
d
o
n
e
in
a
r
u
r
al
s
ettin
g
,
wh
er
e
ef
f
ec
t
o
f
s
o
cio
-
ec
o
n
o
m
ic
s
tatu
s
,
ed
u
ca
tio
n
,
lack
o
f
r
eso
u
r
ce
s
an
d
m
e
n
t
al
s
tr
ain
ca
u
s
ed
b
y
th
em
in
ass
o
ciatio
n
with
m
en
o
p
a
u
s
e
co
u
ld
b
e
s
tu
d
ied
i
n
d
ep
th
.
Ho
wev
e
r
,
in
s
u
ch
a
s
ettin
g
it
is
co
m
m
o
n
to
s
ee
w
o
m
en
p
ar
ticip
atin
g
ea
g
er
ly
i
n
c
u
ltu
r
al
e
v
en
ts
,
r
eli
g
io
u
s
p
r
ac
tices
,
an
d
p
r
ay
er
s
,
wh
ich
attr
ib
u
te
d
to
in
cr
ea
s
ed
p
r
o
p
o
r
tio
n
o
f
wo
m
e
n
h
av
in
g
a
g
o
o
d
q
u
ality
o
f
life
in
o
u
r
s
tu
d
y
.
T
h
ir
d
ly
,
t
h
is
s
tu
d
y
n
o
t
o
n
ly
ed
u
ca
te
d
th
e
b
en
ef
i
ciar
ies
b
u
t
also
th
e
ASHA
wo
r
k
er
s
,
wh
o
d
ea
l
with
th
e
co
m
m
u
n
ity
o
n
d
aily
b
asis
,
th
u
s
p
r
o
v
id
in
g
in
d
ir
ec
t
t
r
ain
in
g
f
o
r
t
h
em
to
s
en
s
itize
th
e
p
u
b
lic
to
th
is
is
s
u
e.
Fo
u
r
th
ly
,
th
is
s
tu
d
y
n
o
t
o
n
ly
i
n
clu
d
e
d
th
e
wo
m
e
n
h
av
in
g
ac
h
ie
v
ed
m
en
o
p
a
u
s
e,
b
u
t
p
er
i
-
m
en
o
p
a
u
s
al
wo
m
en
as
well,
wh
o
ar
e
ap
p
r
o
ac
h
in
g
th
is
s
ig
n
if
ican
t
p
h
ase
o
f
th
eir
life
.
T
h
is
h
elp
ed
th
em
d
ev
el
o
p
a
b
etter
u
n
d
er
s
tan
d
in
g
o
f
th
e
p
h
y
s
ical,
m
en
tal
an
d
s
o
cial
ch
an
g
es
ass
o
ciate
d
wi
th
m
en
o
p
a
u
s
e,
alo
n
g
with
a
b
ett
er
ap
p
r
o
ac
h
to
d
ea
l
with
th
e
m
in
a
tim
ely
m
an
n
er
.
L
astl
y
,
h
u
s
b
an
d
s
’
e
d
u
ca
tio
n
an
d
o
cc
u
p
atio
n
was
also
tak
en
in
to
ac
co
u
n
t
as
it
p
la
y
s
a
k
ey
r
o
le
in
th
e
m
en
tal
well
-
b
ei
n
g
an
d
h
ea
lth
-
s
ee
k
in
g
b
eh
av
io
r
o
f
th
eir
p
ar
tn
er
s
.
Ou
r
s
tu
d
y
em
p
h
asizes
th
e
n
ee
d
to
c
o
n
ce
n
tr
ate
o
n
m
en
o
p
au
s
al
wo
m
en
,
as
th
is
p
h
ase
is
as
s
o
ciate
d
with
in
cr
ea
s
ed
r
is
k
o
f
d
ev
elo
p
in
g
co
m
o
r
b
id
ities
.
T
h
u
s
,
r
eg
u
lar
h
ea
lth
ch
ec
k
-
u
p
s
ca
n
b
e
o
r
g
an
ized
u
n
d
er
s
ec
o
n
d
ar
y
o
r
ter
tiar
y
ca
r
e
ce
n
ter
s
.
T
h
is
was
a
s
m
a
ll
s
tu
d
y
in
v
o
lv
in
g
o
n
ly
1
6
5
b
en
ef
iciar
ies in
lieu
o
f
wh
ich
m
o
r
e
s
tu
d
ies
with
lar
g
er
s
am
p
le
s
ize
n
ee
d
to
b
e
ca
r
r
ied
o
u
t
in
wo
m
e
n
in
v
ar
y
in
g
s
tag
es
o
f
r
ep
r
o
d
u
ctiv
ity
,
to
af
f
i
r
m
an
d
in
cr
ea
s
e
o
u
r
u
n
d
er
s
tan
d
in
g
o
f
th
e
f
in
d
in
g
s
o
f
o
u
r
s
tu
d
y
.
T
h
e
r
em
ain
in
g
n
in
e
v
illag
es
u
n
d
er
th
e
r
u
r
al
f
ield
p
r
ac
tice
ar
ea
,
ca
n
b
e
co
v
e
r
ed
as
well,
as
o
n
ly
f
o
u
r
wer
e
c
o
v
er
ed
b
y
o
u
r
s
tu
d
y
.
I
t
is
v
ital
to
s
h
if
t
th
e
f
o
cu
s
f
r
o
m
p
h
y
s
ical
s
y
m
p
to
m
s
o
f
m
e
n
o
p
au
s
e
to
a
co
h
esiv
e
ap
p
r
o
ac
h
in
v
o
lv
in
g
o
th
er
d
o
m
ain
s
,
all
o
f
wh
ich
in
f
l
u
en
c
e
q
u
ality
o
f
life
in
a
wo
m
an
.
4.
CO
NCLU
SI
O
N
Alm
o
s
t
two
-
th
ir
d
s
o
f
th
e
r
u
r
al
p
er
im
en
o
p
au
s
al
an
d
p
o
s
t
m
en
o
p
a
u
s
al
wo
m
en
in
r
u
r
al
ar
ea
h
ad
s
atis
f
ac
to
r
y
q
u
ality
o
f
life
.
Ho
wev
er
,
th
is
p
er
i
o
d
o
f
life
is
ass
o
ciate
d
with
s
ig
n
if
ican
t
ch
an
g
es
in
s
leep
,
m
em
o
r
y
,
en
e
r
g
y
an
d
p
h
y
s
ical
r
elatio
n
s
.
Me
n
o
p
a
u
s
e
in
f
lu
e
n
ce
s
m
o
r
e
th
an
o
n
e
-
th
ir
d
o
f
a
wo
m
an
’
s
life
s
p
an
an
d
lack
o
f
k
n
o
wled
g
e
p
er
ta
in
in
g
to
it
b
o
th
in
h
ea
lth
ca
r
e
g
iv
er
s
an
d
r
ec
eiv
er
s
p
o
s
e
a
m
ajo
r
h
u
r
d
le
in
im
p
r
o
v
in
g
t
h
eir
QOL
.
Hen
ce
,
m
o
r
e
s
tu
d
ies
n
ee
d
t
o
b
e
d
o
n
e
to
ev
al
u
ate
th
e
f
ac
to
r
s
af
f
ec
tin
g
t
h
e
QOL
am
o
n
g
s
t
p
e
r
i
an
d
p
o
s
tm
en
o
p
au
s
al
wo
m
en
a
n
d
m
ea
s
u
r
es
t
o
tack
le
th
e
s
am
e.
Ap
a
r
t
f
r
o
m
r
esear
ch
-
r
elate
d
ac
tiv
ities
,
h
ea
lth
ca
r
e
s
y
s
tem
n
ee
d
s
to
b
e
m
o
r
e
in
v
o
lv
e
d
in
teac
h
in
g
th
e
p
o
s
tm
en
o
p
a
u
s
al
wo
m
en
ab
o
u
t
th
e
p
o
s
s
ib
le
h
ea
lth
is
s
u
es
d
u
r
in
g
m
en
o
p
a
u
s
e
an
d
d
ev
elo
p
in
g
a
m
o
r
e
ac
ce
p
tab
le
b
eh
a
v
io
r
r
e
g
ar
d
in
g
it
alo
n
g
with
p
r
ac
ticin
g
th
e
n
ec
ess
ar
y
life
s
ty
le
m
o
d
if
icatio
n
s
n
ee
d
ed
t
o
i
m
p
r
o
v
e
th
eir
q
u
ality
o
f
life
.
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
3
4
7
-
1
3
5
6
1354
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F
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