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l J
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c
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(
I
J
P
H
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Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
2
0
2
5
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The co
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mily
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he role o
f
fam
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health
tas
ks in preven
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n
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during pr
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M
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T
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Sy
lv
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li
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t
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g
a
n
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m
ia d
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g
p
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K
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w
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r
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s
:
An
em
ia
Fam
ily
em
p
o
wer
m
en
t
Fam
ily
r
o
le
Ma
ter
n
al
h
ea
lth
Pre
g
n
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cy
T
h
is i
s
a
n
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p
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c
c
e
ss
a
rticle
u
n
d
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r th
e
CC B
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SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Mir
a
T
r
ih
ar
in
i
Facu
lty
o
f
Nu
r
s
in
g
,
Un
iv
er
s
ita
s
Air
lan
g
g
a
C
am
p
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s
C
,
Mu
ly
o
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Su
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a
b
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6
0
1
1
5
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d
o
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m
ail:
m
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-
t@
f
k
p
.
u
n
air
.
ac
.
id
1.
I
NT
RO
D
UCT
I
O
N
An
em
ia
is
a
co
n
d
itio
n
ch
ar
ac
t
er
ized
b
y
d
ec
r
ea
s
ed
h
em
o
g
l
o
b
in
lev
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o
f
ten
r
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er
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ed
to
a
s
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lack
o
f
b
lo
o
d
,
with
r
ed
b
l
o
o
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ce
ll
h
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o
g
lo
b
i
n
lev
els
f
allin
g
b
elo
w
th
e
n
o
r
m
al
r
an
g
e
[
1
]
.
Pr
eg
n
an
t
wo
m
en
ar
e
d
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n
o
s
ed
with
an
e
m
ia
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n
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o
g
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in
lev
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w
1
1
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d
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to
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9
r
e
p
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t
b
y
th
e
W
o
r
ld
Hea
lth
Or
g
an
izatio
n
(
W
HO)
,
th
e
g
lo
b
al
p
r
ev
alen
ce
o
f
a
n
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ia
in
p
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an
t
wo
m
e
n
is
3
6
.
5
%.
Desp
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v
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s
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ts
,
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p
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f
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o
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g
p
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I
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d
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esia
r
em
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s
h
ig
h
an
d
h
as
in
cr
ea
s
ed
in
2
0
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7
(
4
3
.
2
%),
2
0
1
8
(
4
3
.
7
%),
an
d
2
0
1
9
(
4
4
.
2
%).
An
em
ia
is
p
r
ev
alen
t
am
o
n
g
p
r
eg
n
an
t
wo
m
en
d
u
e
to
a
d
ef
icien
c
y
in
ess
en
tial
n
u
tr
ien
ts
r
eq
u
ir
ed
f
o
r
b
lo
o
d
f
o
r
m
atio
n
,
s
u
c
h
as
ir
o
n
,
f
o
lic
ac
id
,
an
d
v
itam
in
B
1
2
.
An
em
ia
d
u
r
in
g
p
r
eg
n
an
cy
p
o
s
es
s
ig
n
if
ican
t
r
is
k
s
to
b
o
th
th
e
m
o
th
er
an
d
b
ab
y
,
n
eg
ativ
ely
im
p
ac
tin
g
m
ater
n
al
m
o
r
b
id
ity
an
d
m
o
r
t
ality
r
ates
[
2
]
.
T
h
e
n
eg
ativ
e
im
p
ac
ts
o
f
an
em
ia
o
n
m
o
th
e
r
s
in
clu
d
e
f
atig
u
e,
im
p
air
ed
im
m
u
n
e
f
u
n
ctio
n
,
s
h
o
r
tn
ess
o
f
b
r
ea
th
,
p
alp
itatio
n
s
,
s
leep
d
is
o
r
d
er
s
,
p
r
ee
clam
p
s
ia,
m
is
ca
r
r
iag
e,
an
d
an
in
cr
ea
s
ed
r
is
k
o
f
b
leed
in
g
b
ef
o
r
e
a
n
d
d
u
r
in
g
d
eliv
e
r
y
[
3
]
.
T
h
e
e
f
f
ec
ts
o
f
an
em
ia
o
n
b
ab
ies
in
clu
d
e
in
tr
au
ter
in
e
g
r
o
wth
r
etar
d
atio
n
(
I
UGR),
p
r
em
atu
r
e
b
ir
th
,
co
n
g
en
ital
d
ef
ec
ts
,
lo
w
b
ir
t
h
weig
h
t
(
L
B
W
)
,
an
d
an
in
cr
ea
s
ed
r
is
k
o
f
f
etal
d
ea
th
i
n
th
e
wo
m
b
[
4
]
.
I
f
a
n
em
ia
d
u
r
in
g
p
r
e
g
n
an
c
y
d
o
es n
o
t
g
et
s
er
io
u
s
atten
tio
n
,
it c
an
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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N
:
2
2
5
2
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6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
3
7
5
-
1
3
8
6
1376
af
f
ec
t
th
e
d
ea
th
o
f
th
e
m
o
th
er
an
d
b
ab
y
[
5
]
.
Pre
v
en
tio
n
an
d
tr
ea
tm
en
t
o
f
an
em
ia
in
p
r
eg
n
a
n
cy
r
eq
u
ir
e
co
o
r
d
in
ate
d
ac
tio
n
s
am
o
n
g
m
u
ltip
le
s
tak
eh
o
ld
er
s
an
d
p
ar
tn
er
s
,
esp
ec
ially
p
r
e
g
n
an
t
wo
m
en
an
d
th
ei
r
f
am
ily
[
3
]
.
Fam
ilies
s
h
o
u
ld
b
e
awa
r
e
o
f
p
o
ten
tial
p
r
eg
n
a
n
c
y
co
m
p
licatio
n
s
an
d
b
e
atten
t
iv
e
to
th
e
n
ee
d
s
o
f
th
eir
p
r
e
g
n
an
t
m
em
b
er
s
[
4
]
.
T
h
er
ef
o
r
e
,
b
y
c
o
m
b
in
i
n
g
f
am
ily
em
p
o
we
r
m
en
t,
th
is
r
esear
ch
c
an
h
elp
f
am
ilies
to
p
r
ev
en
t a
n
em
ia
in
p
r
eg
n
a
n
t w
o
m
en
.
T
h
e
m
ajo
r
ity
o
f
p
r
eg
n
a
n
t
wo
m
en
ar
e
n
e
v
er
ac
co
m
p
an
ied
b
y
th
eir
h
u
s
b
an
d
o
r
f
a
m
ily
d
u
r
in
g
a
n
te
-
n
atal
ca
r
e
an
d
th
is
m
ak
e
th
em
lazy
to
tak
e
ir
o
n
s
u
p
p
lem
en
t
s
r
eg
u
lar
ly
[
3
]
.
T
h
is
d
ata
s
h
o
ws
th
at
f
am
ilies
ar
e
s
till
n
o
t
ab
le
to
ca
r
r
y
o
u
t
f
a
m
ily
h
ea
lth
task
well.
T
h
e
f
a
m
ily
is
an
ef
f
ec
tiv
e
g
r
o
u
p
t
o
im
p
r
o
v
e
h
ea
lth
an
d
p
r
ev
en
t
d
is
ea
s
e,
s
o
th
e
lo
wer
th
e
f
am
ily
'
s
ab
ilit
y
to
ca
r
r
y
o
u
t
f
am
ily
h
ea
lth
task
s
,
th
e
m
o
r
e
d
if
f
icu
lt
it
is
f
o
r
th
e
f
am
ily
t
o
o
v
er
co
m
e
h
ea
lt
h
p
r
o
b
lem
s
ex
p
er
ien
ce
d
b
y
f
am
ily
m
em
b
e
r
s
[
6
]
.
Fam
ilies
m
u
s
t
s
u
p
p
o
r
t
th
eir
f
am
ily
m
em
b
e
r
s
d
u
r
i
n
g
p
r
eg
n
an
cy
an
d
en
c
o
u
r
a
g
e
th
em
t
o
co
n
s
u
m
e
ir
o
n
s
u
p
p
lem
en
ts
.
S
ev
er
al
s
tu
d
ies
h
av
e
f
o
u
n
d
th
at
f
am
ily
f
ac
to
r
s
p
lay
a
s
ig
n
if
ican
t
r
o
le
in
p
r
ev
en
ti
n
g
an
em
ia
d
u
r
i
n
g
p
r
e
g
n
an
c
y
[
4
]
.
I
n
th
is
co
n
tex
t,
th
e
f
am
ily
is
co
n
s
id
er
e
d
to
b
e
m
o
r
e
e
f
f
ec
tiv
e
in
s
u
p
er
v
is
i
n
g
p
r
e
g
n
an
t
wo
m
en
’
s
ir
o
n
s
u
p
p
lem
en
t
in
tak
e
,
as
th
ey
ar
e
th
e
im
m
ed
iate
an
d
cl
o
s
est s
u
p
p
o
r
t n
etwo
r
k
f
o
r
p
r
e
g
n
an
t w
o
m
en
[
7
]
.
An
em
ia
in
p
r
eg
n
an
t
wo
m
e
n
ca
n
b
e
attr
ib
u
ted
to
v
ar
io
u
s
f
ac
to
r
s
,
in
clu
d
in
g
s
o
ci
o
ec
o
n
o
m
ic
co
n
d
itio
n
s
,
life
s
ty
les,
an
d
h
ea
l
th
-
s
ee
k
in
g
b
eh
a
v
io
r
s
,
all
o
f
w
h
ich
v
ar
y
ac
r
o
s
s
d
if
f
er
en
t
cu
lt
u
r
es
[
8
]
.
Ho
wev
e
r
,
in
I
n
d
o
n
esia
,
th
er
e
ar
e
cu
ltu
r
al
d
if
f
er
en
ce
s
in
ea
ch
f
am
il
y
th
at
co
n
tr
ib
u
te
to
th
e
lo
w
awa
r
en
ess
o
f
th
e
im
p
o
r
tan
ce
o
f
p
r
ev
en
tin
g
an
e
m
ia
in
p
r
eg
n
an
t
wo
m
en
.
Nu
m
er
o
u
s
in
itiativ
es
h
av
e
b
ee
n
u
n
d
er
tak
en
to
p
r
e
v
en
t
an
em
ia
in
p
r
e
g
n
an
t w
o
m
e
n
.
T
h
e
f
am
ily
'
s
r
o
le
in
p
r
ev
en
tin
g
an
em
ia
ca
n
b
e
u
n
d
er
s
to
o
d
th
r
o
u
g
h
f
iv
e
k
ey
h
ea
lth
task
s
.
T
h
e
f
ir
s
t
task
in
v
o
lv
es
id
en
tify
in
g
th
e
h
ea
lth
is
s
u
es
o
f
ea
ch
f
am
ily
m
em
b
er
.
A
lack
o
f
f
am
ily
k
n
o
wled
g
e
ab
o
u
t
p
r
o
p
e
r
n
u
tr
itio
n
o
r
f
o
o
d
s
th
at
b
o
o
s
t
h
em
o
g
lo
b
in
lev
els
ca
n
co
n
tr
ib
u
te
t
o
an
em
ia
in
p
r
eg
n
an
t
wo
m
en
[
9
]
.
Seco
n
d
,
m
ak
in
g
ap
p
r
o
p
r
iate
h
ea
lth
ac
tio
n
d
ec
is
io
n
s
;
th
e
f
am
ily
m
u
s
t
b
e
ab
le
t
o
m
ak
e
d
ec
is
io
n
s
if
s
o
m
eth
in
g
h
a
p
p
en
s
to
th
e
p
r
eg
n
an
t
wo
m
a
n
,
s
u
ch
as
im
m
ed
iately
s
ee
k
in
g
th
e
n
ea
r
est
h
ea
lth
f
ac
ilit
y
[
1
0
]
.
T
h
ir
d
,
p
r
o
v
id
in
g
ca
r
e
f
o
r
s
ick
f
am
ily
m
em
b
er
s
;
wh
en
a
p
r
eg
n
an
t
wo
m
a
n
e
x
p
er
ien
ce
s
illn
e
s
s
,
th
e
f
am
ily
m
u
s
t
b
e
ab
le
t
o
ca
r
e
f
o
r
th
e
p
r
e
g
n
an
t
wo
m
a
n
s
u
ch
as
s
u
p
p
o
r
t
in
g
th
e
tr
ea
tm
en
t.
Fo
u
r
th
,
m
o
d
if
y
in
g
a
h
ea
lth
y
en
v
ir
o
n
m
en
t;
an
u
n
h
ea
lth
y
e
n
v
ir
o
n
m
e
n
t
is
co
n
s
id
er
e
d
a
s
ig
n
if
ican
t
r
is
k
f
ac
t
o
r
th
at
ca
n
je
o
p
ar
d
ize
m
ater
n
al
h
ea
lth
d
u
r
in
g
p
r
e
g
n
an
c
y
.
Fift
h
,
u
tili
zin
g
co
m
m
u
n
ity
h
ea
lt
h
f
ac
ilit
ies;
f
am
ilies
ca
n
ca
r
r
y
o
u
t
f
am
ily
h
ea
lth
task
s
s
u
ch
as
u
s
in
g
h
ea
lth
f
ac
ilit
ies
to
p
r
o
v
id
e
an
te
-
n
atal
ca
r
e
f
o
r
p
r
eg
n
a
n
t
wo
m
e
n
,
s
o
th
at
p
r
eg
n
an
t
wo
m
en
f
ee
l th
ey
h
a
v
e
s
u
p
p
o
r
t to
liv
e
a
h
ea
lth
y
life
d
u
r
in
g
p
r
e
g
n
an
c
y
to
p
r
e
v
en
t a
n
e
m
ia
[
1
1
]
.
Fam
ily
ar
e
a
b
le
to
ch
a
n
g
e
th
ei
r
b
e
h
av
io
r
wh
en
th
e
y
u
n
d
er
s
ta
n
d
th
at
an
em
ia
is
a
s
er
io
u
s
p
r
o
b
lem
an
d
it
will
h
av
e
a
n
eg
ativ
e
im
p
ac
t
f
o
r
b
o
th
th
e
m
o
th
e
r
an
d
b
a
b
y
[
1
2
]
.
Ho
wev
er
,
f
a
m
ilies
p
lay
a
c
r
u
cial
r
o
le
i
n
en
s
u
r
in
g
m
ater
n
al
h
ea
lth
a
n
d
s
af
e
d
eliv
e
r
y
.
I
n
v
o
lv
in
g
f
am
ilies
in
p
r
eg
n
an
cy
-
r
elate
d
h
ea
lth
e
d
u
ca
tio
n
p
o
s
itiv
ely
im
p
ac
ts
th
e
h
ea
lt
h
o
f
b
o
th
m
o
th
er
s
an
d
b
ab
ies
[
1
3
]
.
T
h
e
f
am
ily
-
ce
n
ter
ed
em
p
o
wer
m
en
t
m
o
d
el
ca
n
b
e
u
s
ed
as
a
b
asic
th
eo
r
y
to
in
cr
ea
s
e
th
e
f
am
ily
r
o
le
in
h
e
alth
task
to
p
r
ev
en
t
an
em
ia
i
n
p
r
eg
n
a
n
t
wo
m
en
.
Fam
ily
em
p
o
wer
m
en
t
c
o
n
s
is
ts
o
f
m
o
tiv
atio
n
,
c
o
g
n
itiv
e,
an
d
p
er
s
o
n
al
tr
aits
.
C
u
r
r
en
tly
,
th
er
e
is
s
till
lim
ited
r
esear
ch
o
n
f
am
ily
em
p
o
wer
m
en
t
wh
ich
in
cl
u
d
es
m
o
tiv
ati
o
n
,
co
g
n
itiv
e,
a
n
d
p
er
s
o
n
al
tr
aits
to
war
d
s
th
e
r
o
le
o
f
th
e
f
am
ily
th
r
o
u
g
h
f
iv
e
f
a
m
ily
task
s
in
p
r
ev
en
tin
g
a
n
e
m
ia
d
u
r
in
g
p
r
eg
n
an
cy
.
T
h
u
s
,
th
is
s
tu
d
y
aim
ed
to
an
aly
ze
th
e
co
r
r
elatio
n
b
etwe
en
f
am
ily
em
p
o
wer
m
en
t
u
s
in
g
th
r
ee
v
a
r
iab
les
in
clu
d
es
m
o
tiv
atio
n
,
c
o
g
n
itiv
e,
p
er
s
o
n
al
tr
aits
,
an
d
f
am
ily
r
o
le
in
h
ea
lth
task
to
p
r
ev
e
n
t a
n
em
ia
d
u
r
in
g
p
r
e
g
n
an
c
y
.
2.
M
E
T
H
O
D
T
h
is
s
tu
d
y
em
p
lo
y
ed
b
o
th
a
d
escr
ip
tiv
e
co
r
r
elatio
n
al
ap
p
r
o
ac
h
an
d
an
an
aly
tical
ap
p
r
o
ac
h
.
A
d
escr
ip
tiv
e
co
r
r
elatio
n
al
r
esea
r
ch
d
esig
n
d
escr
ib
es
th
e
v
ar
ia
b
les
an
d
m
ea
s
u
r
es
th
e
ex
ten
t
o
f
th
e
r
elatio
n
s
h
ip
s
th
at
o
cc
u
r
b
etwe
en
an
d
am
o
n
g
th
e
v
ar
iab
les
[
1
4
]
.
T
h
e
s
tu
d
y
p
o
p
u
latio
n
co
n
s
is
ted
o
f
p
r
e
g
n
an
t
wo
m
en
wh
o
r
ec
eiv
ed
an
ten
atal
ca
r
e
at
th
e
Klam
p
is
Ng
asem
an
d
Paca
r
Kelin
g
Pu
b
lic
Hea
lth
C
en
ter
,
E
ast
J
av
a,
I
n
d
o
n
esia
f
r
o
m
J
u
ly
to
Au
g
u
s
t
2
0
2
4
.
T
h
is
s
tu
d
y
em
p
lo
y
e
d
th
e
co
n
s
ec
u
tiv
e
s
am
p
lin
g
m
eth
o
d
,
a
tech
n
iq
u
e
th
at
i
n
v
o
lv
es
s
elec
tin
g
s
am
p
les
f
r
o
m
th
e
p
o
p
u
latio
n
th
at
m
ee
t
th
e
r
esea
r
ch
cr
iter
ia
with
in
a
s
p
ec
if
ied
p
er
io
d
u
n
til
th
e
d
esire
d
s
am
p
le
s
ize
i
s
ac
h
iev
ed
[
1
5
]
.
T
h
e
s
am
p
le
th
at
m
et
th
e
cr
iter
ia
in
clu
d
ed
1
5
0
p
e
o
p
le.
T
h
e
in
clu
s
io
n
cr
iter
ia
u
s
ed
wer
e:
p
r
eg
n
an
t
wo
m
en
wh
o
h
ad
an
te
n
atal
ca
r
e
at
th
e
co
m
m
u
n
ity
h
ea
lth
ce
n
ter
.
T
h
is
s
tu
d
y
was
ap
p
r
o
v
ed
b
y
th
e
Hea
lth
R
es
ea
r
ch
E
th
ics
C
o
m
m
ittee
o
f
th
e
Facu
lty
o
f
Nu
r
s
in
g
,
Un
i
v
er
s
itas
Air
lan
g
g
a,
Su
r
ab
ay
a,
I
n
d
o
n
esia
,
n
u
m
b
er
3
3
2
3
-
KE
PK.
Prio
r
to
d
ata
co
llectio
n
,
wr
itt
en
au
th
o
r
izatio
n
was
s
ec
u
r
e
d
f
r
o
m
th
e
i
n
s
titu
tio
n
wh
er
e
th
e
r
esear
ch
to
o
k
p
lace
.
Par
ticip
an
ts
wer
e
in
f
o
r
m
e
d
ab
o
u
t
th
e
s
tu
d
y
th
r
o
u
g
h
th
e
f
ir
s
t
p
ag
e
o
f
th
e
s
u
r
v
ey
,
p
r
ep
ar
ed
b
y
th
e
r
esear
ch
er
s
.
Ver
b
al
co
n
s
en
t
w
as
o
b
tain
ed
f
r
o
m
p
ar
ticip
an
ts
wh
o
wer
e
b
r
ief
e
d
a
b
o
u
t
th
e
r
esear
ch
an
d
ag
r
ee
d
to
p
ar
ticip
ate.
I
n
f
o
r
m
ed
c
o
n
s
en
t
s
er
v
es
as
a
m
ea
n
s
f
o
r
p
atien
ts
to
m
ak
e
in
f
o
r
m
e
d
d
ec
is
io
n
s
ab
o
u
t
m
ed
ical
p
r
o
ce
d
u
r
es,
e
n
s
u
r
in
g
th
at
t
h
ey
ca
n
p
r
o
v
id
e
co
n
c
r
ete
ap
p
r
o
v
a
l
b
y
u
n
d
er
s
tan
d
in
g
th
e
in
f
o
r
m
atio
n
r
e
g
ar
d
in
g
th
e
ac
tio
n
s
to
b
e
u
n
d
er
tak
e
n
[
1
6
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Th
e
co
r
r
ela
tio
n
b
etw
ee
n
fa
mily
emp
o
w
ermen
t a
n
d
th
e
r
o
le
o
f fa
mily
h
ea
lth
ta
s
ks
…
(
Mir
a
Tr
ih
a
r
in
i
)
1377
T
h
e
d
em
o
g
r
a
p
h
ic
d
at
a
q
u
es
ti
o
n
n
ai
r
e
c
o
n
s
is
ts
o
f
6
p
a
r
ts
c
o
n
s
is
ti
n
g
o
f
t
h
e
a
g
e
o
f
t
h
e
p
r
e
g
n
a
n
t
m
o
t
h
er
,
ed
u
c
ati
o
n
,
em
p
lo
y
m
e
n
t
,
f
am
il
y
i
n
c
o
m
e
,
g
est
ati
o
n
al
a
g
e
,
p
a
r
it
y
,
a
n
d
f
am
il
y
t
y
p
e.
T
h
e
f
a
m
il
y
e
m
p
o
we
r
m
e
n
t
q
u
esti
o
n
n
ai
r
e
c
o
n
s
is
ts
o
f
m
o
ti
v
at
io
n
a
l,
c
o
g
n
iti
v
e
,
a
n
d
p
er
s
o
n
al
t
r
a
its
s
u
b
-
v
ar
ia
b
l
es
.
T
h
e
m
o
t
i
v
a
t
i
o
n
q
u
e
s
t
i
o
n
n
a
i
r
e
w
as
d
e
v
e
l
o
p
e
d
b
y
r
e
s
e
a
r
c
h
e
r
s
a
n
d
m
o
d
i
f
i
e
d
f
r
o
m
t
h
e
c
o
n
c
e
p
t
o
f
m
o
ti
v
a
t
i
o
n
.
T
h
i
s
q
u
es
t
i
o
n
n
a
i
r
e
u
s
e
s
a
L
i
k
e
r
t
s
ca
l
e
,
w
it
h
7
q
u
e
s
t
i
o
n
i
t
e
m
s
.
T
h
e
r
a
n
g
e
o
f
v
a
l
u
e
s
s
t
a
r
t
s
f
r
o
m
1
i
f
s
t
r
o
n
g
l
y
d
i
s
a
g
r
e
e
a
n
d
4
i
f
s
t
r
o
n
g
l
y
a
g
r
e
e
o
n
f
a
v
o
r
a
b
l
e
i
t
e
m
s
,
w
h
i
le
f
o
r
u
n
f
a
v
o
r
a
b
l
e
,
i
t
is
t
h
e
o
p
p
o
s
i
t
e
.
T
h
e
c
o
g
n
i
t
i
v
e
q
u
es
t
i
o
n
n
a
i
r
e
w
as
d
e
v
e
l
o
p
e
d
b
y
r
e
s
e
a
r
c
h
e
r
s
a
n
d
m
o
d
i
f
ie
d
f
r
o
m
t
h
e
c
o
g
n
i
t
i
v
e
q
u
e
s
t
i
o
n
n
a
i
r
e.
T
h
i
s
q
u
e
s
t
i
o
n
n
a
i
r
e
u
s
e
s
a
L
i
k
e
r
t
s
c
al
e
,
f
a
v
o
r
a
b
l
e
s
t
a
te
m
e
n
t
s
w
i
t
h
a
v
a
l
u
e
o
f
4
=
a
l
w
a
y
s
,
3
=
o
f
t
e
n
,
2
=
s
o
m
et
i
m
e
s
,
a
n
d
a
v
a
l
u
e
o
f
1
=
n
e
v
e
r
.
W
h
i
l
e
f
o
r
u
n
f
a
v
o
r
a
b
l
e
v
a
l
u
e
s
,
1
=
a
l
w
a
y
s
,
2
=
o
f
t
e
n
,
3
=
s
o
m
e
t
i
m
e
s
,
a
n
d
a
v
a
l
u
e
o
f
4
=
n
e
v
e
r
.
C
o
g
n
i
t
i
v
e
s
c
o
r
e
7
6
-
1
0
0
%
=
h
i
g
h
,
56
-
7
5
%
m
e
d
i
u
m
,
a
n
d
<
5
6
%
=
l
o
w
.
T
h
e
p
e
r
s
o
n
al
t
r
ai
ts
q
u
e
s
t
i
o
n
n
a
i
r
e
w
as
d
e
v
el
o
p
e
d
b
y
r
e
s
e
a
r
c
h
e
r
s
a
n
d
m
o
d
i
f
i
e
d
f
r
o
m
t
h
e
a
tt
i
t
u
d
e
q
u
e
s
t
i
o
n
n
a
i
r
e
.
T
h
i
s
q
u
e
s
ti
o
n
n
a
i
r
e
u
s
e
s
a
L
i
k
e
r
t
s
ca
l
e
,
f
a
v
o
r
a
b
l
e
s
t
at
e
m
e
n
ts
w
it
h
a
v
a
l
u
e
o
f
4
=
s
t
r
o
n
g
l
y
a
g
r
e
e
,
3
=
a
g
r
e
e
,
2
=
d
i
s
a
g
r
e
e
,
a
n
d
1
=
s
t
r
o
n
g
l
y
d
i
s
a
g
r
e
e
.
W
h
il
e
f
o
r
u
n
f
a
v
o
r
a
b
l
e
s
t
a
te
m
e
n
t
s
w
i
t
h
v
a
l
u
es
o
f
1
=
s
t
r
o
n
g
l
y
a
g
r
e
e
,
2
=
a
g
r
e
e
,
3
=
d
i
s
a
g
r
e
e
,
a
n
d
4
=
s
t
r
o
n
g
l
y
d
i
s
a
g
r
e
e
.
T
h
e
f
am
i
ly
r
o
le
q
u
esti
o
n
n
ai
r
e
c
o
n
s
is
ts
o
f
5
s
u
b
-
v
a
r
ia
b
l
es,
n
am
el
y
r
e
c
o
g
n
i
zi
n
g
h
ea
l
th
p
r
o
b
le
m
s
,
m
a
k
i
n
g
d
e
ci
s
io
n
s
r
e
g
a
r
d
i
n
g
t
h
e
r
i
g
h
t
l
ev
el
o
f
h
ea
lt
h
,
ca
r
i
n
g
f
o
r
p
r
e
g
n
a
n
t
wo
m
e
n
in
p
r
ev
en
ti
n
g
a
n
e
m
ia
,
m
o
d
if
y
i
n
g
th
e
p
h
y
s
i
ca
l
a
n
d
p
s
y
c
h
o
lo
g
i
ca
l
e
n
v
i
r
o
n
m
e
n
t
,
an
d
u
t
ili
zi
n
g
e
x
is
ti
n
g
h
ea
lt
h
f
ac
i
liti
es.
T
h
e
f
a
m
il
y
r
o
l
e
q
u
es
ti
o
n
n
ai
r
e
was
d
e
v
e
lo
p
ed
b
y
r
ese
ar
c
h
e
r
s
a
n
d
m
o
d
i
f
i
ed
f
r
o
m
t
h
e
f
i
v
e
f
a
m
il
y
h
e
alt
h
t
ask
q
u
es
ti
o
n
n
a
i
r
e
an
d
t
h
e
a
n
e
m
i
a
p
r
e
v
e
n
ti
o
n
q
u
est
io
n
n
a
ir
e
f
o
r
p
r
e
g
n
a
n
t
wo
m
e
n
[
1
7
]
.
T
h
e
f
if
th
h
ea
l
th
tas
k
is
to
u
s
e
e
x
is
ti
n
g
h
e
alt
h
f
a
cil
iti
es
f
o
r
p
r
e
g
n
a
n
t
w
o
m
e
n
i
n
p
r
ev
e
n
ti
n
g
an
em
ia
.
R
es
p
o
n
d
e
n
ts
c
h
o
o
s
e
o
n
e
o
f
th
e
a
v
ail
ab
le
a
n
s
w
e
r
s
,
n
a
m
el
y
:
y
es
(
1
)
a
n
d
n
o
(
2
)
.
T
h
en
t
h
e
m
e
as
u
r
em
en
t
r
es
u
l
ts
a
r
e
c
ate
g
o
r
iz
ed
i
n
t
o
3
,
n
am
el
y
:
h
i
g
h
=
7
5
%
,
m
e
d
i
u
m
=
5
0
–
7
4
%
,
a
n
d
lo
w
=
<
5
0
%.
Un
iv
ar
iate
an
d
b
iv
a
r
iate
an
al
y
s
es
ar
e
u
s
ed
in
d
ata
an
aly
s
is
u
s
in
g
th
e
SP
SS
2
5
p
ac
k
ag
e
p
r
o
g
r
a
m
.
E
ac
h
v
ar
ia
b
le
id
en
tifie
d
in
th
e
r
esear
ch
was
an
aly
ze
d
u
s
in
g
u
n
iv
a
r
iate
an
aly
s
is
,
wh
ile
b
i
v
ar
iate
an
aly
s
is
was
em
p
lo
y
ed
to
ascer
tain
th
e
r
elatio
n
s
h
ip
s
b
etwe
en
th
r
ee
o
r
m
o
r
e
in
d
ep
en
d
en
t
v
ar
iab
le
s
an
d
a
d
e
p
en
d
e
n
t
v
ar
iab
le.
A
s
tatis
tical
test
to
d
eter
m
in
e
th
e
r
elatio
n
s
h
ip
b
et
wee
n
in
d
ep
e
n
d
en
t
an
d
d
ep
e
n
d
en
t
v
ar
ia
b
les
u
s
in
g
Sp
ea
r
m
an
r
an
k
co
r
r
elatio
n
an
d
C
h
i
-
s
q
u
ar
e
with
a
s
ig
n
if
ican
ce
lev
el
o
f
α
≤
0
.
0
5
.
T
h
e
Sp
e
ar
m
an
r
an
k
test
is
a
non
-
p
ar
am
etr
ic
s
tatis
tical
m
et
h
o
d
u
s
ed
to
ass
ess
th
e
s
tr
en
g
th
an
d
d
ir
ec
tio
n
o
f
th
e
ass
o
ciatio
n
b
etwe
en
two
r
an
k
ed
v
a
r
iab
les.
I
t
ev
alu
ates
wh
eth
er
th
er
e
is
a
m
o
n
o
to
n
i
c
r
elatio
n
s
h
ip
b
etwe
en
th
e
v
ar
iab
les,
m
ak
in
g
it
s
u
itab
le
f
o
r
o
r
d
in
al
d
ata
o
r
c
o
n
tin
u
o
u
s
d
ata
th
at
d
o
n
o
t
m
ee
t
th
e
ass
u
m
p
tio
n
s
o
f
n
o
r
m
alit
y
[
1
8
]
.
T
h
e
v
ar
ia
b
le
test
ed
u
s
in
g
Sp
ea
r
m
an
'
s
r
an
k
wer
e
f
am
ily
em
p
o
wer
m
en
t
(
m
o
tiv
atio
n
,
c
o
g
n
itiv
e,
a
n
d
p
er
s
o
n
al
tr
aits
)
an
d
f
am
ily
r
o
le
in
th
e
p
r
e
v
en
tio
n
an
em
ia
d
u
r
in
g
p
r
e
g
n
an
c
y
.
C
r
o
s
s
-
s
ec
tio
n
al
s
tu
d
ies
ar
e
o
b
s
er
v
atio
n
al
s
tu
d
ies
th
at
ex
am
in
e
d
ata
f
r
o
m
a
p
o
p
u
lati
o
n
at
a
s
in
g
le
m
o
m
en
t.
T
h
ey
ar
e
f
r
eq
u
e
n
tly
em
p
lo
y
e
d
to
ass
ess
th
e
p
r
ev
alen
ce
o
f
h
ea
lth
o
u
tco
m
es,
u
n
d
er
s
tan
d
h
ea
lth
d
eter
m
in
an
ts
,
an
d
d
es
cr
ib
e
p
o
p
u
latio
n
c
h
ar
ac
ter
is
tics
.
T
h
ese
s
tu
d
ies
d
o
n
o
t
tr
ac
k
in
d
iv
i
d
u
als
o
v
er
tim
e
an
d
ar
e
ty
p
ically
co
s
t
-
ef
f
ec
t
iv
e
an
d
ea
s
y
to
p
er
f
o
r
m
[
1
9
]
.
T
h
e
v
ar
iab
le
test
ed
u
s
in
g
ch
i
-
s
q
u
ar
e
is
f
a
m
ily
em
p
o
wer
m
en
t
an
d
f
am
ily
r
o
le
in
p
r
ev
e
n
tin
g
an
em
ia
(
r
ec
o
g
n
iz
e
h
ea
lth
p
r
o
b
lem
in
th
e
f
am
ily
)
,
f
a
m
ily
em
p
o
wer
m
en
t
an
d
f
a
m
ily
r
o
le
in
p
r
ev
en
tin
g
a
n
em
ia
(
ta
k
in
g
d
ec
is
io
n
s
f
o
r
a
p
p
r
o
p
r
iate
tr
ea
tm
en
t)
,
f
am
ily
em
p
o
wer
m
en
t
an
d
f
a
m
ily
r
o
le
i
n
p
r
e
v
e
n
tin
g
an
em
ia
(
tak
in
g
ca
r
e
f
o
r
p
r
eg
n
a
n
t
m
o
th
e
r
)
,
f
am
ily
em
p
o
wer
m
e
n
t
an
d
f
a
m
ily
r
o
le
in
p
r
ev
e
n
tin
g
an
e
m
ia
(
m
o
d
if
y
i
n
g
a
h
ea
lth
y
e
n
v
ir
o
n
m
en
t)
,
f
am
ily
em
p
o
wer
m
en
t a
n
d
f
am
ily
r
o
le
in
p
r
ev
e
n
tin
g
a
n
em
ia
(
u
tili
zin
g
a
h
ea
lth
s
er
v
ice
f
ac
ilit
ies).
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
T
ab
le
1
d
escr
ib
es
th
at
th
e
h
i
g
h
est
ag
e
ch
a
r
ac
ter
is
tics
o
f
p
r
eg
n
an
t
w
o
m
en
a
r
e
in
th
e
ag
e
o
f
2
0
-
3
5
y
ea
r
s
(
8
2
.
7
%),
th
e
h
ig
h
est
ch
ar
ac
ter
is
tics
o
f
ed
u
ca
tio
n
ar
e
in
h
ig
h
s
ch
o
o
l
(
6
3
.
3
%),
th
e
h
ig
h
est
em
p
lo
y
m
en
t
ch
ar
ac
ter
is
tics
ar
e
as
h
o
u
s
ewiv
es
(
4
6
.
7
%),
th
e
h
ig
h
est
f
a
m
ily
in
co
m
e
is
ab
o
v
e
r
eg
io
n
al
m
in
im
u
m
wag
e
(
5
4
.
0
%),
th
e
h
ig
h
est
g
estatio
n
al
ag
e
is
tr
im
ester
3
(
3
6
.
0
%),
p
ar
ity
lev
el
is
in
th
e
p
ar
ity
1
ca
teg
o
r
y
(
7
9
.
3
%),
f
am
ily
ty
p
e
is
in
e
x
ten
d
ed
f
am
ily
(
5
0
.
7
%).
3
.
1
.
C
o
r
re
l
a
t
i
o
n b
e
t
we
en
f
a
m
i
ly
e
m
p
o
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ment
a
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f
a
m
i
ly
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le
t
o
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re
v
en
t
a
n
e
m
i
a
du
rin
g
t
he
pr
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na
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c
y
T
ab
le
2
d
escr
ib
es
th
at
t
h
er
e
is
co
r
r
elatio
n
b
etwe
en
f
am
ily
em
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o
wer
m
e
n
t
an
d
f
am
il
y
r
o
le
in
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r
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ia
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r
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r
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g
n
an
cy
(
p
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0
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0
;
r
=
0
.
5
7
8
)
.
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h
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a
r
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ip
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f
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ily
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o
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e
n
t
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d
f
am
ily
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o
le.
Mo
tiv
atio
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(
p
=
0
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0
0
0
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r
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0
.
5
6
7
)
,
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o
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itiv
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p
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0
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r
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4
4
8
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d
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6
5
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c
o
r
r
elate
d
with
f
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ily
r
o
le
in
p
r
ev
en
tin
g
an
em
ia
d
u
r
in
g
p
r
eg
n
an
c
y
.
T
h
e
f
am
ily
r
o
le
will
in
cr
ea
s
e
wh
en
f
am
ily
em
p
o
we
r
m
en
t
is
ca
r
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ied
o
u
t
p
r
o
p
e
r
ly
d
u
r
in
g
p
r
eg
n
an
c
y
.
Pre
v
en
tio
n
an
d
tr
ea
tm
e
n
t
o
f
a
n
em
ia
in
p
r
eg
n
a
n
cy
r
e
q
u
ir
e
c
o
o
r
d
in
ate
d
ac
tio
n
s
am
o
n
g
m
u
ltip
le
s
tak
eh
o
ld
er
s
an
d
p
a
r
tn
er
s
,
s
u
ch
as
f
am
ily
[
2
0
]
.
T
h
e
f
am
ily
is
th
e
p
r
im
a
r
y
an
d
clo
s
est
u
n
it
to
p
r
eg
n
a
n
t
wo
m
en
,
f
am
iliar
with
th
eir
c
o
n
d
itio
n
a
n
d
e
n
g
ag
in
g
i
n
f
r
eq
u
e
n
t
c
o
m
m
u
n
icatio
n
.
Op
e
n
,
two
-
way
c
o
m
m
u
n
icatio
n
with
in
th
e
f
am
ily
g
r
ea
tly
s
u
p
p
o
r
ts
p
r
eg
n
an
t
wo
m
en
,
r
em
i
n
d
in
g
an
d
m
o
tiv
atin
g
th
e
m
to
atten
d
an
ten
atal
ca
r
e,
c
o
n
s
u
m
e
n
u
tr
itio
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s
f
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o
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s
,
an
d
tak
e
s
u
p
p
lem
en
ts
to
p
r
ev
en
t
an
em
ia.
T
h
e
f
am
ily
'
s
ab
ilit
y
to
m
a
n
a
g
e
h
ea
lth
ca
r
e
task
s
Evaluation Warning : The document was created with Spire.PDF for Python.
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I
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Hea
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14
,
No
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3
,
Sep
tem
b
er
20
25
:
1
3
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5
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1378
r
ef
lects
th
eir
r
o
le
a
n
d
ca
p
ab
ilit
y
in
ad
d
r
ess
in
g
h
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lth
p
r
o
b
lem
s
am
o
n
g
f
a
m
ily
m
em
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er
s
.
Fam
ilies
th
at
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f
ec
tiv
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ca
r
r
y
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u
t h
ea
lth
tas
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lv
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alth
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in
th
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[
2
1
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T
ab
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1
.
C
h
ar
ac
ter
is
tics
o
f
p
r
e
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t w
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r
s
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r
s
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Ed
u
c
a
t
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El
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t
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n
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G
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r
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F
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2
.
T
h
e
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s
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ip
b
etwe
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f
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ily
em
p
o
wer
m
e
n
t a
n
d
f
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ily
r
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le
V
a
r
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a
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M
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a
n
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8
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7
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8
8
5
)
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C
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S
i
g
n
i
f
i
c
a
n
t
w
i
t
h
p
-
v
a
l
u
e
<
0
.
0
5
;
S
p
e
a
r
man
t
e
s
t
r
e
su
l
t
s
T
h
e
f
am
ily
'
s
in
v
o
lv
em
en
t
in
th
e
ca
r
e
o
f
p
r
e
g
n
an
t
wo
m
en
ca
n
p
r
o
v
i
d
e
v
alu
ab
le
s
o
cial
s
u
p
p
o
r
t
f
o
r
all
f
am
ily
m
em
b
e
r
s
[
2
2
]
.
R
esear
ch
in
d
icate
s
th
at
s
ev
e
r
al
f
ac
to
r
s
co
n
tr
i
b
u
te
to
p
o
o
r
ad
h
er
en
ce
to
ir
o
n
s
u
p
p
lem
en
ts
d
u
r
in
g
p
r
e
g
n
an
c
y
.
T
h
ese
i
n
clu
d
e
in
s
u
f
f
icien
t
k
n
o
wled
g
e
an
d
awa
r
en
ess
ab
o
u
t
an
e
m
ia,
lim
ited
ac
ce
s
s
to
ir
o
n
s
u
p
p
le
m
en
ts
,
f
e
ar
o
f
s
id
e
e
f
f
ec
ts
,
u
n
d
er
u
tili
za
tio
n
o
f
an
te
n
atal
ca
r
e
s
er
v
ices,
in
ad
eq
u
ate
s
u
p
p
ly
o
f
ir
o
n
s
u
p
p
lem
en
ts
,
p
o
o
r
c
o
u
n
s
elin
g
,
an
d
a
lack
o
f
s
u
p
p
o
r
t.
T
h
ese
b
ar
r
ier
s
co
llectiv
ely
h
in
d
er
p
r
eg
n
an
t
wo
m
en
f
r
o
m
f
o
llo
win
g
th
e
r
ec
o
m
m
en
d
e
d
ir
o
n
s
u
p
p
lem
e
n
tatio
n
g
u
id
elin
es
[
2
3
]
.
T
h
e
h
ea
lth
b
eh
av
io
r
s
o
f
p
r
eg
n
a
n
t
wo
m
en
in
p
r
ev
e
n
tin
g
an
em
ia
ar
e
in
f
lu
en
ce
d
b
y
v
ar
io
u
s
f
ac
to
r
s
.
A
k
ey
f
ac
to
r
is
th
e
r
o
le
o
f
th
e
f
am
ily
,
wh
ich
ca
n
b
e
ass
es
s
ed
th
r
o
u
g
h
th
e
ex
ec
u
tio
n
o
f
f
am
ily
h
ea
lth
r
esp
o
n
s
ib
il
ities
[
2
4
]
.
Fam
ily
em
p
o
wer
m
en
t
p
la
y
s
a
cr
u
cial
r
o
le
in
p
r
ev
en
tin
g
an
e
m
i
a
d
u
r
in
g
p
r
eg
n
a
n
cy
.
B
y
co
n
s
is
ten
tly
r
em
in
d
in
g
p
r
eg
n
a
n
t
wo
m
en
to
tak
e
ir
o
n
s
u
p
p
lem
en
ts
r
eg
u
la
r
ly
,
p
r
o
v
i
d
in
g
n
u
tr
itio
u
s
f
o
o
d
,
o
f
f
er
in
g
u
n
d
er
s
tan
d
i
n
g
an
d
m
o
tiv
atio
n
,
an
d
en
co
u
r
ag
in
g
ad
h
er
en
ce
to
an
te
n
atal
ca
r
e,
f
am
ilies
s
ig
n
if
ican
tly
s
u
p
p
o
r
t
th
is
ef
f
o
r
t.
T
h
e
in
v
o
lv
em
e
n
t
o
f
f
am
ily
h
ea
lth
d
u
ties
an
d
r
esp
o
n
s
ib
ilit
ies
p
o
s
itiv
ely
in
f
lu
e
n
ce
s
p
r
e
g
n
an
t
wo
m
en
'
s
co
m
p
lian
ce
th
r
o
u
g
h
o
u
t t
h
e
p
r
e
g
n
an
c
y
p
r
o
ce
s
s
.
Mo
tiv
atio
n
is
im
p
o
r
tan
t
f
o
r
p
r
ev
en
tin
g
an
em
ia
in
p
r
eg
n
a
n
cy
,
as
it
ca
n
h
elp
en
s
u
r
e
t
h
at
p
r
eg
n
an
t
wo
m
en
r
eg
is
ter
ea
r
ly
a
n
d
tak
e
ir
o
n
s
u
p
p
le
m
en
ts
,
an
d
ea
t
a
b
alan
ce
d
d
iet.
W
h
en
p
r
eg
n
an
t
wo
m
en
h
a
v
e
a
s
tr
o
n
g
u
n
d
er
s
tan
d
in
g
o
f
p
r
eg
n
an
cy
,
it
em
p
o
wer
s
th
em
to
b
e
m
o
tiv
ated
to
en
g
a
g
e
in
p
o
s
itiv
e
an
d
b
en
ef
icial
ac
tiv
ities
,
lead
in
g
to
th
e
d
ev
elo
p
m
en
t
o
f
p
o
s
itiv
e
b
eh
av
io
r
s
as
a
r
esu
lt
o
f
atten
d
in
g
p
r
en
at
al
class
e
s
[
2
5
]
.
On
e
o
f
th
e
f
ac
to
r
s
th
at
a
p
er
s
o
n
c
an
b
e
m
o
tiv
ated
b
y
is
in
f
lu
e
n
ce
d
b
y
e
x
ter
n
al
f
ac
to
r
s
,
n
a
m
ely
s
o
cial
s
u
p
p
o
r
t,
b
ec
au
s
e
th
e
s
u
p
p
o
r
t
p
r
o
v
id
ed
b
y
f
am
ily
o
r
h
u
s
b
an
d
ca
n
m
o
tiv
ate
p
r
eg
n
an
t
wo
m
en
to
m
ain
tain
th
eir
h
ea
lt
h
d
u
r
in
g
p
r
eg
n
a
n
cy
,
wh
ich
is
s
h
o
wn
b
y
em
p
ath
y
,
atten
tio
n
,
an
d
ca
r
e
[
2
6
]
.
Hig
h
e
r
m
o
tiv
a
tio
n
lev
els
lead
to
g
r
ea
ter
co
m
p
lian
ce
am
o
n
g
p
r
eg
n
an
t
wo
m
en
in
tak
in
g
ir
o
n
(
Fe)
tab
lets
.
T
h
er
ef
o
r
e,
i
t's
v
ital
f
o
r
f
am
ily
m
em
b
er
s
to
ass
is
t
b
y
m
o
n
ito
r
i
n
g
,
r
ec
o
r
d
in
g
,
r
em
in
d
in
g
,
an
d
s
u
p
p
o
r
tin
g
p
r
eg
n
an
t
w
o
m
en
in
th
eir
m
ed
icatio
n
r
eg
im
en
.
C
o
u
n
s
elin
g
an
d
m
o
t
iv
atio
n
p
r
o
v
i
d
ed
b
y
h
ea
lth
w
o
r
k
er
s
also
p
lay
a
s
ig
n
if
ican
t
r
o
le
in
en
h
an
cin
g
k
n
o
wled
g
e.
E
d
u
ca
tio
n
an
d
m
o
tiv
atio
n
b
ec
o
m
e
ef
f
ec
tiv
e
wh
e
n
p
atien
ts
u
n
d
e
r
s
tan
d
th
e
im
p
o
r
tan
ce
o
f
ad
o
p
tin
g
n
ew
h
ea
lth
y
b
eh
av
i
o
r
s
.
W
h
en
h
ea
lth
wo
r
k
er
s
ac
tiv
ely
en
co
u
r
ag
e
p
r
e
g
n
an
t
wo
m
e
n
to
co
n
s
u
m
e
ir
o
n
tab
lets
,
it
b
ec
o
m
es e
asier
f
o
r
t
h
em
to
a
d
h
er
e
to
th
is
p
r
ac
tice
[
2
7
]
.
E
d
u
ca
tio
n
is
cr
u
cial
in
p
r
ev
en
tin
g
p
r
e
g
n
an
c
y
-
r
elate
d
an
e
m
ia.
E
d
u
ca
ted
in
d
iv
id
u
als
h
av
e
b
etter
n
u
tr
itio
n
k
n
o
wled
g
e
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n
d
a
d
e
ep
er
u
n
d
er
s
tan
d
i
n
g
o
f
p
r
eg
n
a
n
cy
f
ac
t
o
r
s
co
m
p
ar
ed
to
th
o
s
e
with
o
u
t
ac
ce
s
s
to
Evaluation Warning : The document was created with Spire.PDF for Python.
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8
8
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6
Th
e
co
r
r
ela
tio
n
b
etw
ee
n
fa
mily
emp
o
w
ermen
t a
n
d
th
e
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o
le
o
f fa
mily
h
ea
lth
ta
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ks
…
(
Mir
a
Tr
ih
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r
in
i
)
1379
ed
u
ca
tio
n
.
W
ith
th
is
awa
r
en
ess
an
d
k
n
o
wled
g
e,
ed
u
ca
ted
p
eo
p
le
ca
n
tak
e
b
etter
ca
r
e
o
f
th
em
s
elv
es
an
d
s
u
p
p
o
r
t
o
th
er
wo
m
en
d
u
r
i
n
g
p
r
eg
n
an
c
y
,
th
er
eb
y
r
ed
u
cin
g
th
e
r
is
k
o
f
an
em
ia
[
8
]
.
W
o
m
en
'
s
liter
ac
y
r
ates
ar
e
a
k
ey
d
eter
m
in
an
t
in
th
e
p
r
e
v
alen
ce
o
f
a
n
em
ia.
E
d
u
ca
ted
w
o
m
en
g
en
er
ally
h
a
v
e
b
etter
a
cc
ess
to
h
ea
lth
ca
r
e
s
er
v
ices
an
d
f
ac
ilit
ies,
wh
ich
h
elp
s
lo
wer
th
eir
r
is
k
o
f
d
e
v
elo
p
in
g
a
n
em
ia
[
2
8
]
.
As
ed
u
ca
tio
n
lev
els
r
is
e,
wo
m
en
g
ain
a
d
ee
p
er
u
n
d
er
s
tan
d
in
g
o
f
th
e
h
ea
lth
r
is
k
s
ass
o
ciate
d
with
an
em
ia.
C
o
n
s
eq
u
en
tly
,
th
e
m
o
r
e
ed
u
ca
ted
wo
m
en
a
r
e,
th
e
b
e
tter
eq
u
ip
p
ed
t
h
ey
ar
e
to
p
r
ev
en
t
o
r
m
a
n
ag
e
an
em
ia,
th
er
eb
y
r
ed
u
cin
g
its
in
cid
en
ce
[
2
9
]
.
E
d
u
ca
ted
wo
m
en
ten
d
to
b
e
m
o
r
e
awa
r
e
o
f
th
eir
h
ea
lth
s
tatu
s
an
d
ar
e
p
r
o
ac
tiv
e
in
s
ee
k
in
g
h
ea
lth
in
f
o
r
m
atio
n
.
L
iter
ac
y
e
n
h
an
ce
s
wo
m
en
'
s
in
d
ep
en
d
e
n
ce
,
s
elf
-
esteem
,
an
d
th
eir
ab
ili
ty
to
m
ak
e
in
f
o
r
m
ed
d
ec
is
io
n
s
r
eg
ar
d
in
g
th
ei
r
o
w
n
h
ea
lth
an
d
th
at
o
f
th
eir
ch
i
ld
r
en
.
C
o
n
s
eq
u
en
tly
,
ed
u
ca
te
d
wo
m
en
ar
e
m
o
r
e
lik
ely
to
p
u
r
s
u
e
q
u
ality
h
ea
lth
ca
r
e
s
er
v
ices
an
d
ef
f
ec
ti
v
ely
u
tili
ze
p
r
o
v
id
er
s
t
h
at
o
f
f
er
s
u
p
er
io
r
ca
r
e
[
3
0
]
.
T
h
er
ef
o
r
e,
in
f
o
r
m
atio
n
s
u
p
p
o
r
t
f
r
o
m
v
ar
i
o
u
s
ty
p
es
o
f
m
ed
ia
an
d
f
ac
ilit
ies
m
u
s
t
b
e
ca
r
r
ied
o
u
t
t
o
in
cr
ea
s
e
k
n
o
wled
g
e
i
n
p
r
e
v
en
tin
g
an
e
m
ia
in
p
r
eg
n
an
t w
o
m
e
n
.
T
h
e
f
am
ily
p
lay
s
a
cr
u
cial
r
o
le
in
h
ea
lth
p
r
o
m
o
tio
n
.
On
e
o
f
th
e
k
ey
f
ac
to
r
s
co
n
t
r
ib
u
tin
g
to
h
ig
h
an
em
ia
r
ates
in
p
r
eg
n
an
t
wo
m
en
is
th
e
lack
o
f
f
a
m
ily
awa
r
e
n
ess
r
eg
ar
d
in
g
t
h
e
im
p
o
r
tan
ce
o
f
n
u
t
r
itio
n
d
u
r
in
g
p
r
eg
n
a
n
cy
[
3
1
]
.
T
h
er
ef
o
r
e,
p
r
eg
n
an
t
wo
m
en
ten
d
t
o
h
av
e
b
etter
f
am
ily
s
u
p
p
o
r
t
an
d
b
etter
f
am
ily
tr
aits
,
en
h
an
cin
g
th
eir
ab
ilit
y
to
ac
c
ess
h
ea
lth
ca
r
e
s
er
v
ices
f
o
r
p
r
eg
n
an
t
wo
m
e
n
[
3
2
]
.
T
h
is
is
in
ac
co
r
d
a
n
ce
with
r
esear
ch
[
1
1
]
,
p
r
eg
n
an
t
wo
m
en
ca
n
f
ee
l
m
o
tiv
ated
to
h
av
e
g
o
o
d
b
eh
a
v
io
r
to
p
r
e
v
en
t
an
em
ia
b
y
th
e
in
v
o
lv
em
e
n
t
o
f
th
eir
h
u
s
b
a
n
d
o
r
f
am
ily
.
Go
o
d
p
e
r
s
o
n
al
tr
a
its
f
r
o
m
th
e
f
am
ily
o
r
h
u
s
b
an
d
ca
n
b
e
d
o
n
e
b
y
ac
ce
s
s
in
g
in
f
o
r
m
atio
n
f
r
o
m
v
ar
io
u
s
s
o
u
r
ce
s
,
s
u
ch
as
s
o
cial
m
ed
ia.
Me
d
ia
ex
p
o
s
u
r
e
ca
n
in
d
ir
ec
tly
d
ec
r
ea
s
e
d
th
e
lik
elih
o
o
d
o
f
a
n
em
ic
wo
m
en
b
y
in
cr
ea
s
in
g
th
e
f
am
ily
’
s
k
n
o
wled
g
e
a
n
d
awa
r
e
n
ess
o
f
th
e
im
p
o
r
tan
ce
o
f
p
r
o
p
er
n
u
tr
itio
n
d
u
r
in
g
p
r
eg
n
an
cy
[
3
3
]
.
Acc
o
r
d
in
g
to
m
an
y
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als,
f
am
ily
m
u
s
t
s
u
p
p
o
r
t
p
r
eg
n
a
n
t
wo
m
en
d
u
r
in
g
p
r
eg
n
an
cy
an
d
e
n
co
u
r
ag
e
th
em
to
c
o
n
s
u
m
e
ir
o
n
s
u
p
p
lem
en
ts
.
T
h
ey
also
em
p
h
asized
th
at
b
o
th
f
am
ilies
an
d
p
r
eg
n
a
n
t
wo
m
en
n
ee
d
to
s
ea
r
ch
f
o
r
in
f
o
r
m
atio
n
ab
o
u
t
a
n
em
ia
d
u
r
in
g
p
r
eg
n
a
n
cy
an
d
lear
n
h
o
w
to
p
r
ev
en
t
an
em
ia
.
C
o
n
tem
p
o
r
ar
y
h
ea
lth
-
p
r
o
m
o
tin
g
f
am
ily
m
o
d
els
ca
n
estab
lis
h
s
ca
f
f
o
ld
s
f
o
r
s
h
ap
in
g
h
ea
lth
b
eh
a
v
io
r
s
an
d
ca
n
b
e
u
s
ef
u
l
to
o
ls
f
o
r
ed
u
ca
ti
o
n
an
d
h
ea
lth
p
r
o
m
o
ti
o
n
to
p
r
ev
en
t
an
em
ia
[
3
4
]
.
T
o
im
p
r
o
v
e
an
e
m
ia
p
r
ev
en
ti
o
n
a
m
o
n
g
p
r
eg
n
a
n
t
wo
m
en
,
in
itiativ
es
s
h
o
u
ld
f
o
cu
s
o
n
s
tr
en
g
th
en
i
n
g
f
am
ily
em
p
o
wer
m
en
t
t
h
r
o
u
g
h
tar
g
et
ed
ed
u
ca
tio
n
al
p
r
o
g
r
am
s
.
T
h
ese
p
r
o
g
r
am
s
co
u
ld
p
r
o
v
id
e
in
f
o
r
m
atio
n
o
n
t
h
e
im
p
o
r
tan
ce
o
f
n
u
tr
itio
n
,
th
e
r
o
le
o
f
ir
o
n
s
u
p
p
lem
en
ts
,
an
d
t
h
e
n
ec
ess
ity
o
f
an
ten
atal
ca
r
e.
E
n
g
ag
in
g
f
am
ilies
in
d
is
cu
s
s
io
n
s
ab
o
u
t
h
ea
lth
is
s
u
es
an
d
f
o
s
ter
in
g
o
p
e
n
co
m
m
u
n
icatio
n
ca
n
f
u
r
t
h
er
en
h
an
ce
s
u
p
p
o
r
t
s
y
s
tem
s
f
o
r
p
r
eg
n
a
n
t
wo
m
en
.
C
o
m
m
u
n
ity
h
ea
lth
wo
r
k
er
s
ca
n
f
ac
ili
tate
wo
r
k
s
h
o
p
s
th
at
em
p
h
asize
th
e
co
llectiv
e
r
esp
o
n
s
ib
ilit
y
o
f
f
am
ilies
in
m
an
ag
in
g
h
ea
lth
,
th
u
s
r
ein
f
o
r
cin
g
th
e
im
p
o
r
tan
ce
o
f
b
o
th
e
d
u
ca
tio
n
an
d
s
o
cial
s
u
p
p
o
r
t in
p
r
o
m
o
tin
g
h
ea
lth
ier
b
eh
av
io
r
s
d
u
r
in
g
p
r
e
g
n
an
cy
.
3
.
2
.
C
o
r
re
l
a
t
i
o
n b
e
t
we
en
f
a
m
i
ly
e
m
p
o
w
er
ment
a
nd
f
a
m
i
ly
r
o
le
:
r
ec
o
g
niz
e
h
ea
lt
h
p
ro
ble
m
s
in
t
he
f
a
mil
y
T
a
b
l
e
3
e
x
p
l
a
i
n
s
t
h
a
t
t
h
e
m
a
j
o
r
i
t
y
o
f
r
e
s
p
o
n
d
e
n
t
s
h
a
v
e
s
t
r
o
n
g
m
o
t
i
v
a
t
i
o
n
w
i
t
h
r
e
c
o
g
n
i
z
e
h
e
a
l
t
h
p
r
o
b
l
e
m
s
i
n
f
a
m
il
y
i
n
t
h
e
m
e
d
iu
m
c
a
t
e
g
o
r
y
(
6
6
.
4
%
)
.
T
h
e
r
e
is
n
o
r
e
l
a
t
i
o
n
s
h
i
p
b
et
w
e
e
n
m
o
ti
v
a
t
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o
n
a
n
d
t
h
e
r
o
l
e
o
f
t
h
e
f
a
m
i
l
y
i
n
r
ec
o
g
n
i
z
i
n
g
h
ea
l
t
h
p
r
o
b
l
e
m
s
i
n
f
a
m
i
l
y
(
p
=
0
.
7
7
7
)
.
M
a
j
o
r
i
t
y
o
f
r
e
s
p
o
n
d
e
n
t
s
h
a
v
e
m
e
d
i
u
m
c
o
g
n
i
t
i
v
e
w
i
t
h
r
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c
o
g
n
i
z
e
h
e
a
lth
p
r
o
b
l
e
m
s
i
n
f
a
m
i
l
y
i
n
t
h
e
m
e
d
i
u
m
c
a
t
e
g
o
r
y
(
7
5
.
2
%
)
.
T
h
e
r
e
i
s
a
r
e
l
a
ti
o
n
s
h
i
p
b
e
t
w
e
e
n
c
o
g
n
i
t
i
v
e
a
n
d
t
h
e
r
o
l
e
o
f
t
h
e
f
a
m
i
l
y
i
n
r
e
c
o
g
n
i
z
i
n
g
h
e
a
l
t
h
p
r
o
b
l
e
m
s
i
n
f
a
m
i
l
y
(
p
=
0
.
0
0
4
)
.
M
a
j
o
r
i
t
y
o
f
r
e
s
p
o
n
d
e
n
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.
T
h
e
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ip
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etwe
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o
wer
m
e
n
t a
n
d
f
am
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in
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r
ev
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tin
g
a
n
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m
ia:
r
ec
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ize
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ea
lth
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r
o
b
lem
in
th
e
f
am
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F
a
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R
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S
i
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f
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t
w
i
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su
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Acc
o
r
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in
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t
o
r
esear
ch
[
6
]
,
r
ec
o
g
n
izin
g
f
am
ily
h
ea
lt
h
is
s
u
es
is
cr
u
cial,
as
th
e
f
am
ily
is
o
f
te
n
th
e
f
ir
s
t
to
id
en
tif
y
h
ea
lth
p
r
o
b
lem
s
in
o
n
e
o
f
its
m
em
b
er
s
.
E
m
p
o
we
r
in
g
f
am
ilies
is
clo
s
ely
lin
k
ed
to
e
n
h
an
cin
g
th
eir
ab
ilit
y
to
id
en
tify
h
ea
lth
is
s
u
es,
wh
ich
in
tu
r
n
is
r
elate
d
t
o
o
v
er
all
f
am
ily
h
ea
lth
s
tatu
s
.
I
n
th
is
co
n
tex
t,
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
I
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t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
3
7
5
-
1
3
8
6
1380
f
am
ilies
also
p
lay
a
s
ig
n
if
ican
t
r
o
le
in
p
r
o
v
id
i
n
g
p
s
y
ch
o
l
o
g
i
ca
l
s
u
p
p
o
r
t
to
m
o
tiv
ate
p
r
eg
n
an
t
wo
m
en
to
ad
o
p
t
h
ea
lth
y
h
a
b
its
to
p
r
ev
e
n
t a
n
em
ia.
T
h
e
f
am
il
y
'
s
ab
ilit
y
to
id
e
n
tify
h
ea
lth
p
r
o
b
lem
s
ex
te
n
d
s
b
e
y
o
n
d
r
ec
o
g
n
izin
g
illn
ess
es;
th
ey
m
u
s
t
also
u
n
d
er
s
tan
d
th
e
tr
ea
tm
en
t
p
r
o
c
ess
,
p
o
ten
tial
is
s
u
e
s
d
u
r
in
g
tr
e
atm
en
t
an
d
p
r
e
v
en
tio
n
,
an
d
th
e
co
n
s
eq
u
en
ce
s
o
f
p
r
eg
n
a
n
t
wo
m
en
n
o
t
tak
in
g
i
r
o
n
s
u
p
p
lem
en
ts
o
r
r
ec
eiv
i
n
g
r
eg
u
lar
an
ten
atal
ca
r
e
[
1
1
]
.
Fam
ilies
s
h
o
u
ld
b
e
awa
r
e
th
at
an
em
ia
ca
n
b
e
d
an
g
er
o
u
s
f
o
r
p
r
eg
n
an
t
wo
m
en
,
s
o
f
am
ilies
h
av
e
an
im
p
o
r
tan
t
r
o
le
in
p
r
o
v
id
i
n
g
s
o
cial
s
u
p
p
o
r
t to
p
r
eg
n
an
t w
o
m
en
to
p
r
ev
en
t a
n
em
ia
in
ea
r
l
y
s
tag
e
o
f
p
r
eg
n
a
n
cy
[
9
]
.
T
h
e
f
am
ily
'
s
ca
p
ac
ity
to
i
d
en
t
if
y
h
ea
lth
p
r
o
b
lem
s
is
p
ar
t
o
f
th
e
k
n
o
wled
g
e
ac
q
u
is
itio
n
p
r
o
ce
s
s
.
T
h
is
k
n
o
wled
g
e
ca
n
b
e
g
ain
ed
th
r
o
u
g
h
ed
u
ca
tio
n
,
an
d
a
p
er
s
o
n
'
s
ed
u
ca
tio
n
al
lev
el
s
ig
n
i
f
ican
tly
im
p
ac
ts
th
eir
u
n
d
er
s
tan
d
i
n
g
o
f
is
s
u
es
lik
e
h
ea
lth
p
r
o
b
lem
s
.
I
f
s
o
m
eo
n
e
h
a
s
a
h
ig
h
er
e
d
u
ca
tio
n
,
it
will
m
ak
e
th
em
ea
s
ier
t
o
k
n
o
w
an
d
u
n
d
er
s
tan
d
.
T
h
e
s
tu
d
y
co
n
d
u
cted
b
y
Saee
d
[
3
5
]
r
e
p
o
r
ted
a
s
ig
n
i
f
ican
t
r
e
latio
n
s
h
ip
b
etwe
en
ed
u
ca
tio
n
lev
el
a
n
d
th
e
lev
el
o
f
k
n
o
wled
g
e
o
n
ir
o
n
d
ef
icien
cy
an
em
ia
in
p
r
eg
n
a
n
cy
.
I
m
p
r
o
v
ed
ed
u
ca
tio
n
f
o
r
p
r
eg
n
a
n
t
wo
m
e
n
,
t
h
eir
f
am
ilies
,
an
d
co
m
m
u
n
ities
o
n
an
e
m
ia
,
in
clu
d
i
n
g
its
im
p
o
r
ta
n
ce
,
ca
u
s
es,
tr
ea
tm
en
t
an
d
p
r
ev
en
tio
n
,
m
ay
s
u
p
p
o
r
t
b
ett
er
u
p
tak
e
o
f
an
e
m
ia
p
r
e
v
en
ti
o
n
an
d
tr
ea
tm
en
t
s
tr
ateg
ies.
E
m
p
o
wer
in
g
f
am
ily
m
em
b
er
s
to
id
en
tif
y
h
ea
lth
is
s
u
es
is
cr
u
cial
in
d
eter
m
in
in
g
th
e
n
ec
ess
ar
y
s
tep
s
to
ad
d
r
e
s
s
th
ese
p
r
o
b
lem
s
.
W
h
en
f
am
ilies
ar
e
f
am
iliar
w
i
th
h
ea
lth
co
n
ce
r
n
s
,
p
ar
ticu
lar
l
y
r
eg
ar
d
in
g
p
r
eg
n
an
t
wo
m
en
,
th
ey
ca
n
an
ticip
ate
p
o
ten
tial c
o
m
p
licatio
n
s
d
u
r
in
g
p
r
eg
n
a
n
cy
a
n
d
tak
e
p
r
o
ac
tiv
e
m
ea
s
u
r
es to
p
r
ev
e
n
t a
n
em
ia.
T
o
en
h
a
n
ce
f
am
il
y
r
ec
o
g
n
itio
n
o
f
h
ea
lth
p
r
o
b
lem
s
,
c
o
m
m
u
n
ity
-
b
ased
ed
u
ca
tio
n
al
p
r
o
g
r
a
m
s
s
h
o
u
ld
b
e
d
ev
elo
p
e
d
th
at
f
o
cu
s
o
n
an
em
ia
awa
r
en
ess
an
d
p
r
ev
en
t
io
n
.
T
h
ese
p
r
o
g
r
am
s
ca
n
p
r
o
v
id
e
r
eso
u
r
ce
s
an
d
tr
ain
in
g
f
o
r
f
am
ilies
,
em
p
h
asizin
g
th
e
im
p
o
r
ta
n
ce
o
f
p
s
y
ch
o
lo
g
ical
s
u
p
p
o
r
t
f
o
r
p
r
eg
n
a
n
t
wo
m
en
.
W
o
r
k
s
h
o
p
s
co
u
ld
in
cl
u
d
e
p
r
ac
tical
in
f
o
r
m
atio
n
o
n
n
u
tr
itio
n
,
ir
o
n
s
u
p
p
lem
en
tatio
n
,
an
d
th
e
s
ig
n
i
f
ican
ce
o
f
r
eg
u
lar
an
ten
atal
ca
r
e.
I
n
v
o
lv
in
g
lo
ca
l
h
ea
lth
p
r
o
f
ess
io
n
als
to
d
eliv
er
th
ese
s
ess
io
n
s
ca
n
h
elp
b
u
i
ld
tr
u
s
t
an
d
en
s
u
r
e
th
e
in
f
o
r
m
atio
n
is
r
elev
an
t
an
d
ac
ce
s
s
ib
le.
E
m
p
o
wer
in
g
f
a
m
ilies
th
r
o
u
g
h
ed
u
ca
tio
n
will
en
ab
le
th
em
to
tak
e
p
r
o
ac
tiv
e
s
tep
s
in
m
an
ag
in
g
h
ea
lth
is
s
u
es,
u
ltima
tely
im
p
r
o
v
in
g
o
u
tco
m
es
f
o
r
p
r
eg
n
an
t
wo
m
en
an
d
th
eir
f
am
ilies
.
3
.
3
.
C
o
r
r
e
l
a
t
i
o
n
b
e
t
w
e
e
n
f
a
mi
l
y
e
mp
o
w
e
r
m
e
n
t
a
n
d
f
a
m
i
l
y
r
o
l
e
:
t
a
ki
n
g
d
e
c
i
s
i
o
n
s
f
o
r
a
p
p
r
o
p
r
i
a
t
e
t
r
e
a
t
m
e
n
t
T
ab
le
4
ex
p
lain
s
th
at
th
e
m
ajo
r
ity
o
f
r
esp
o
n
d
e
n
ts
h
av
e
s
tr
o
n
g
m
o
tiv
atio
n
with
tak
in
g
d
e
cisi
o
n
s
f
o
r
ap
p
r
o
p
r
iate
tr
ea
tm
en
t
in
t
h
e
m
ed
iu
m
ca
teg
o
r
y
(
5
1
.
7
%).
T
h
er
e
is
n
o
r
elatio
n
s
h
ip
b
etwe
en
m
o
tiv
atio
n
a
n
d
th
e
r
o
le
o
f
th
e
f
am
ily
in
tak
in
g
d
ec
is
io
n
s
f
o
r
ap
p
r
o
p
r
iate
tr
ea
tm
en
t
(
p
=
0
.
6
2
8
)
.
Ma
jo
r
ity
o
f
r
esp
o
n
d
en
ts
h
av
e
m
ed
iu
m
co
g
n
itiv
e
with
tak
in
g
d
ec
is
io
n
s
f
o
r
ap
p
r
o
p
r
iate
tr
ea
t
m
en
t in
th
e
m
ed
iu
m
ca
te
g
o
r
y
(
6
2
.
4
%).
T
h
er
e
is
a
r
elatio
n
s
h
ip
b
etwe
en
co
g
n
iti
v
e
an
d
th
e
r
o
le
o
f
th
e
f
am
il
y
in
tak
in
g
d
ec
is
io
n
s
f
o
r
ap
p
r
o
p
r
iate
tr
ea
tm
en
t
(
p
=
0
.
0
0
0
)
.
Ma
j
o
r
ity
o
f
r
es
p
o
n
d
e
n
ts
h
av
e
p
o
s
itiv
e
p
er
s
o
n
al
tr
aits
with
ta
k
in
g
d
ec
is
io
n
s
f
o
r
ap
p
r
o
p
r
iate
tr
ea
tm
en
t
in
t
h
e
m
e
d
iu
m
ca
te
g
o
r
y
(
5
1
%).
T
h
er
e
is
a
r
elatio
n
s
h
ip
b
etwe
en
c
o
g
n
itiv
e
an
d
th
e
r
o
le
o
f
t
h
e
f
a
m
ily
in
tak
in
g
d
ec
is
io
n
s
f
o
r
a
p
p
r
o
p
r
iate
tr
ea
tm
en
t (
p
=
0
.
0
0
0
)
.
T
ab
le
4
.
T
h
e
r
elatio
n
s
h
ip
b
etwe
en
f
am
ily
em
p
o
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ap
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p
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at
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a
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m
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er
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o
lv
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t
er
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ct
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b
et
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w
o
m
en
,
p
ar
t
n
er
s
,
an
d
o
th
e
r
f
a
m
i
ly
m
em
b
e
r
s
[
3
6
]
.
P
r
ev
io
u
s
r
es
e
ar
ch
h
a
s
s
h
o
wn
t
h
at
wo
m
en
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eiv
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th
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p
ar
t
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er
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a
s
i
m
p
o
r
t
an
t
d
ec
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s
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n
al
p
ar
t
n
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s
an
d
in
v
o
lv
in
g
th
em
c
an
en
h
an
c
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th
e
q
u
a
li
ty
o
f
th
e
d
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i
s
io
n
-
m
ak
in
g
p
r
o
ce
s
s
r
eg
ar
d
in
g
p
r
eg
n
an
cy
-
r
e
la
te
d
d
ec
is
io
n
s
[
3
7
]
.
Fu
r
th
er
m
o
r
e
,
d
ec
i
s
io
n
s
r
el
at
e
d
to
p
r
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cy
in
f
lu
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n
o
t
j
u
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th
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ex
p
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ct
an
t
m
o
th
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u
t
al
s
o
h
e
r
p
ar
tn
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in
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ci
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-
m
ak
in
g
.
A
t
p
r
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en
t
,
th
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la
ck
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ig
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p
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r
p
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p
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p
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s
[
3
8
]
.
A
h
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c
o
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m
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ty
w
ea
lth
in
d
ex
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s
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s
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r
Evaluation Warning : The document was created with Spire.PDF for Python.
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8
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6
Th
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co
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tio
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fa
mily
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t a
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…
(
Mir
a
Tr
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r
in
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)
1381
o
d
d
s
o
f
an
em
i
a.
P
r
ev
io
u
s
s
tu
d
i
e
s
h
av
e
a
l
s
o
h
ig
h
li
g
h
t
ed
th
e
p
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tiv
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co
r
r
ela
t
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co
m
m
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n
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ty
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o
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o
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ic
s
t
at
u
s
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d
wo
m
en
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h
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lth
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n
o
t
in
g
th
at
e
co
n
o
m
ic
al
ly
d
i
s
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v
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tag
ed
co
m
m
u
n
i
ti
es
o
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la
ck
ad
eq
u
a
te
h
e
al
th
i
n
f
o
r
m
at
io
n
a
n
d
s
er
v
i
ce
s
[
3
9
]
.
W
o
m
en
's
au
to
n
o
m
y
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s
e
s
s
en
t
ia
l
in
i
t
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w
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r
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h
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d
p
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ay
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cr
u
c
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l
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le
i
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th
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ir
h
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lt
h
a
n
d
h
e
al
th
-
r
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la
te
d
m
at
ter
s
[
4
0
]
.
E
v
id
e
n
ce
i
n
d
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ca
te
s
th
a
t
m
er
el
y
in
cr
e
as
in
g
a
cc
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s
s
to
e
co
n
o
m
ic
r
e
s
o
u
r
c
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s
i
s
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n
s
u
f
f
ic
ien
t
;
en
h
an
c
in
g
wo
m
en
's
d
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ci
s
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-
m
ak
in
g
p
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co
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tr
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s
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ld
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u
r
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q
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s
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Fo
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lth
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s
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k
in
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av
io
r
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,
th
e
ir
p
ar
t
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ip
a
ti
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s
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m
ak
in
g
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cr
it
ic
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s
(
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k
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m
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r
h
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a
s
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r
p
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s
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n
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l
h
e
al
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ar
e
)
is
cr
u
ci
al.
Po
o
r
wo
m
en
's
w
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e
h
in
d
e
r
s
th
e
g
o
a
l
o
f
ac
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iev
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g
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h
ea
lth
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T
h
u
s
,
s
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g
n
if
i
ca
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t
e
f
f
o
r
ts
ar
e
n
ee
d
ed
to
r
ed
u
ce
an
em
ia
am
o
n
g
m
ar
r
i
ed
wo
m
en
,
a
s
it
ad
v
e
r
s
e
ly
af
f
ec
t
s
th
e
we
ll
-
b
e
in
g
o
f
m
o
th
er
s
,
ch
i
ld
r
en
,
an
d
th
e
en
t
ir
e
f
am
i
ly
[
3
9
]
.
T
o
im
p
r
o
v
e
h
ea
lth
o
u
tco
m
es,
in
ter
v
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tio
n
s
s
h
o
u
l
d
f
o
c
u
s
o
n
f
o
s
ter
in
g
co
llab
o
r
ativ
e
d
ec
is
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n
-
m
ak
in
g
am
o
n
g
co
u
p
les.
T
h
is
co
u
l
d
in
clu
d
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co
u
p
le
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ce
n
ter
e
d
ed
u
ca
tio
n
p
r
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g
r
am
s
t
h
at
em
p
h
asize
s
h
ar
e
d
r
esp
o
n
s
ib
ilit
ies
in
h
ea
lth
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r
elat
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d
ec
is
io
n
s
an
d
em
p
o
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wo
m
en
to
ass
er
t
th
eir
n
ee
d
s
.
C
o
m
m
u
n
ity
in
itiativ
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co
u
ld
also
aim
to
p
r
o
v
id
e
ec
o
n
o
m
ic
r
eso
u
r
ce
s
alo
n
g
s
id
e
t
r
ain
in
g
in
f
in
a
n
cial
liter
ac
y
a
n
d
d
ec
is
io
n
-
m
ak
in
g
s
k
ills
,
en
s
u
r
in
g
wo
m
en
ca
n
ac
tiv
ely
p
ar
ticip
ate
in
h
o
u
s
eh
o
ld
d
is
cu
s
s
io
n
s
.
Fu
r
th
er
m
o
r
e,
r
aisi
n
g
awa
r
en
ess
ab
o
u
t
t
h
e
im
p
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t
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f
a
n
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ia
a
n
d
o
th
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h
ea
lth
is
s
u
es
o
n
f
am
ily
well
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b
ein
g
ca
n
m
o
tiv
ate
c
o
u
p
les
to
p
r
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o
r
itize
h
ea
lth
s
er
v
ices.
Ad
d
r
ess
in
g
t
h
ese
f
ac
to
r
s
h
o
lis
tically
will
b
e
ess
en
tial
in
r
ed
u
cin
g
a
n
e
m
ia
p
r
e
v
alen
ce
a
n
d
im
p
r
o
v
in
g
o
v
er
all
f
am
ily
h
ea
lth
.
3
.
4
.
Co
rr
el
a
t
io
n bet
wee
n f
a
m
ily
em
po
wer
m
ent
a
nd
f
a
mil
y
ro
le:
t
a
k
ing
ca
re
f
o
r
s
ick
f
a
m
ily
m
e
m
ber
T
ab
le
5
ex
p
lain
s
th
at
th
e
m
ajo
r
ity
o
f
r
esp
o
n
d
en
ts
h
av
e
s
tr
o
n
g
m
o
tiv
atio
n
with
T
ak
i
n
g
ca
r
e
f
o
r
p
r
eg
n
a
n
t
m
o
t
h
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i
n
th
e
m
ed
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m
ca
teg
o
r
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(
5
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%).
T
h
er
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n
o
r
elatio
n
s
h
ip
b
etwe
en
m
o
tiv
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tio
n
an
d
th
e
r
o
le
o
f
th
e
f
am
ily
in
tak
in
g
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r
e
f
o
r
p
r
eg
n
a
n
t
m
o
th
er
(
p
=
0
.
6
8
8
)
.
Ma
jo
r
ity
o
f
r
esp
o
n
d
e
n
ts
h
av
e
m
ed
iu
m
c
o
g
n
itiv
e
with
tak
in
g
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r
e
f
o
r
p
r
e
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n
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t
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m
e
d
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m
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te
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r
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(
6
2
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T
h
er
e
is
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r
el
atio
n
s
h
ip
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le
o
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th
e
f
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ily
in
tak
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g
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r
e
f
o
r
p
r
eg
n
an
t
m
o
th
er
(
p
=
0
.
0
0
0
)
.
Ma
jo
r
ity
o
f
r
esp
o
n
d
e
n
ts
h
av
e
p
o
s
itiv
e
p
er
s
o
n
al
tr
aits
with
tak
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g
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f
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r
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t m
o
th
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e
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m
ca
teg
o
r
y
(
5
5
.
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%).
T
h
e
r
e
is
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r
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n
s
h
ip
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en
c
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le
o
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f
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ily
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t
ak
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g
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r
e
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o
r
p
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eg
n
an
t m
o
th
e
r
(
p
=
0
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0
0
0
)
.
T
ab
le
5
.
T
h
e
r
elatio
n
s
h
ip
b
etwe
en
f
am
ily
em
p
o
wer
m
e
n
t a
n
d
f
am
ily
r
o
le
in
p
r
ev
e
n
tin
g
a
n
e
m
ia:
tak
in
g
ca
r
e
f
o
r
p
r
eg
n
an
t m
o
t
h
er
F
a
mi
l
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e
m
p
o
w
e
r
me
n
t
Ta
k
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n
g
c
a
r
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f
o
r
p
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e
g
n
a
n
t
mo
t
h
e
r
p
H
i
g
h
n
(
%)
M
e
d
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[
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s
h
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am
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'
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m
ater
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d
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etal
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[
4
2
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.
Ad
eq
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ir
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weig
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[
2
5
]
.
T
h
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f
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u
n
d
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tan
d
in
g
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im
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f
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p
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m
ater
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Fam
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p
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id
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Fe)
tab
lets
[
4
3
]
.
E
m
p
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m
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t
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ter
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ab
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h
ig
h
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an
cies
[
4
4
]
.
I
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ter
v
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Fam
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p
o
wer
m
en
t
is
an
ef
f
o
r
t
to
cr
ea
te
a
f
am
ily
th
at
h
as
a
q
u
ality
o
f
life
in
a
h
ea
lth
y
en
v
ir
o
n
m
en
t
[
4
5
]
.
E
n
h
an
cin
g
an
d
m
ain
tain
in
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h
ea
lth
is
v
ital,
p
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ly
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A
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[
4
6
]
r
e
v
ea
led
th
at
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en
wh
o
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ailed
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tak
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ir
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s
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am
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ee
d
t
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ess
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o
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k
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cr
ea
ti
n
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ir
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m
en
t
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t
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e
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ted
o
n
p
r
ac
tical
way
s
to
cr
ea
te
s
u
p
p
o
r
tiv
e
en
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ir
o
n
m
en
ts
,
s
u
ch
as
m
ea
l
p
lan
n
in
g
,
o
r
g
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izin
g
g
r
o
u
p
ex
er
cises
,
an
d
f
o
s
ter
in
g
o
p
en
co
m
m
u
n
icatio
n
ab
o
u
t
h
ea
lth
n
ee
d
s
.
Ad
d
itio
n
ally
,
c
o
m
m
u
n
ity
p
r
o
g
r
am
s
co
u
l
d
p
r
o
v
id
e
r
eso
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r
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es
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d
wo
r
k
s
h
o
p
s
to
en
h
a
n
c
e
f
am
ilies
'
s
k
ill
s
in
p
r
o
m
o
tin
g
m
ater
n
al
h
ea
lth
.
T
ab
le
6
.
T
h
e
r
elatio
n
s
h
ip
b
etwe
en
f
am
ily
em
p
o
wer
m
e
n
t a
n
d
f
am
ily
r
o
le
in
p
r
ev
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tin
g
a
n
e
m
ia:
m
o
d
if
y
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g
a
h
ea
lth
y
en
v
ir
o
n
m
en
t
F
a
mi
l
y
e
m
p
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w
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r
me
n
t
M
o
d
i
f
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n
g
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h
e
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l
t
h
y
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v
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r
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n
m
e
n
t
p
H
i
g
h
n
(
%)
M
e
d
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u
m
n
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%)
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t
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S
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g
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c
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n
t
w
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t
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p
-
v
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l
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e
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0
.
0
5
;
C
hi
-
sq
u
a
r
e
r
e
su
l
t
s
3
.
6
.
Co
rr
el
a
t
io
n bet
wee
n f
a
m
ily
em
po
wer
m
ent
a
nd
f
a
mil
y
ro
le:
utilizing
hea
lt
h serv
ice
f
a
cilit
ies
T
ab
le
7
ex
p
lain
s
th
at
th
e
m
ajo
r
ity
o
f
r
esp
o
n
d
en
ts
h
av
e
s
tr
o
n
g
m
o
tiv
atio
n
f
o
r
u
tili
zin
g
a
h
ea
lth
s
er
v
ice
f
ac
ilit
y
in
th
e
m
ed
iu
m
ca
teg
o
r
y
(
5
5
%).
T
h
er
e
is
a
r
e
latio
n
s
h
ip
b
etwe
en
m
o
tiv
atio
n
an
d
th
e
r
o
le
o
f
th
e
f
am
ily
in
u
tili
zin
g
a
h
ea
lth
s
e
r
v
ice
f
ac
ilit
y
(
p
=
0
.
0
0
0
)
.
T
h
e
m
ajo
r
ity
o
f
r
esp
o
n
d
e
n
ts
h
av
e
m
ed
iu
m
co
g
n
itiv
e
with
u
tili
zin
g
a
h
ea
lth
s
er
v
ic
e
f
ac
ilit
y
in
th
e
m
ed
iu
m
ca
t
eg
o
r
y
(
7
3
.
4
%).
T
h
er
e
is
a
r
e
latio
n
s
h
ip
b
etwe
en
co
g
n
itiv
e
an
d
th
e
r
o
le
o
f
th
e
f
am
ily
in
u
tili
zin
g
a
h
ea
lth
s
er
v
ice
f
ac
ilit
y
(
p
=
0
.
0
0
0
)
.
T
h
e
m
ajo
r
ity
o
f
r
esp
o
n
d
en
ts
h
a
v
e
p
o
s
itiv
e
p
e
r
s
o
n
al
tr
aits
with
u
tili
zin
g
a
h
ea
lth
s
er
v
ice
f
ac
ilit
y
in
th
e
m
ed
iu
m
ca
te
g
o
r
y
(
5
3
.
8
%).
T
h
er
e
is
a
r
elatio
n
s
h
ip
b
etwe
en
co
g
n
itiv
e
an
d
th
e
r
o
le
o
f
th
e
f
am
ily
in
u
tili
zin
g
a
h
ea
lth
s
er
v
ice
f
ac
ilit
y
(
p
=
0
.
0
0
0
)
.
E
m
p
o
wer
in
g
f
am
ilies
is
a
k
ey
f
ac
to
r
in
s
h
ap
i
n
g
life
s
ty
le
h
a
b
its
an
d
h
ea
lth
b
e
h
av
io
r
s
th
at
p
o
s
itiv
ely
in
f
lu
en
ce
p
r
e
g
n
an
c
y
o
u
tco
m
es.
W
o
m
en
wh
o
h
ad
h
ig
h
lev
els o
f
f
am
ily
em
p
o
we
r
m
en
t w
er
e
also
f
o
u
n
d
to
h
a
v
e
h
ig
h
er
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els
o
f
ac
ce
s
s
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u
tili
za
tio
n
o
f
at
least
f
o
u
r
a
n
ten
atal
v
is
its
[
4
7
]
.
A
s
im
ilar
s
tu
d
y
s
h
o
wed
th
at
ec
o
n
o
m
ic
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d
em
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g
r
ap
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m
ater
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s
er
v
ices
in
b
o
th
u
r
b
an
an
d
r
u
r
al
ar
ea
s
[
4
8
]
.
As
a
r
esu
lt,
in
d
iv
id
u
als
liv
in
g
i
n
p
o
v
er
ty
a
r
e
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a
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ig
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r
r
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8
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Th
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tio
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mily
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mily
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lth
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(
Mir
a
Tr
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r
in
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)
1383
u
n
d
er
u
tili
zin
g
m
ater
n
al
h
ea
lt
h
s
er
v
ices.
T
o
en
h
an
ce
th
e
u
s
ag
e
o
f
t
h
ese
s
er
v
ices,
it
is
ess
en
tial
f
o
r
h
ea
lth
p
r
o
f
ess
io
n
als to
r
ea
ch
o
u
t to
a
n
d
s
u
p
p
o
r
t m
o
t
h
er
s
in
im
p
o
v
e
r
is
h
ed
co
n
d
itio
n
s
.
I
n
th
is
s
tu
d
y
,
it
was
f
o
u
n
d
th
at
th
e
m
ajo
r
ity
o
f
f
am
ily
e
d
u
ca
tio
n
an
d
m
ater
n
al
ed
u
ca
tio
n
h
av
e
co
m
p
leted
th
e
m
an
d
ato
r
y
1
2
y
ea
r
s
o
f
ed
u
ca
tio
n
in
ac
co
r
d
an
ce
with
th
e
ed
u
ca
tio
n
p
r
o
g
r
am
in
I
n
d
o
n
esia
.
E
d
u
ca
tio
n
al
b
ac
k
g
r
o
u
n
d
is
well
k
n
o
wn
to
in
f
lu
en
ce
h
ea
lth
-
s
ee
k
in
g
b
eh
av
i
o
r
[
4
9
]
.
Similar
to
o
th
er
s
tu
d
ies
[
5
0
]
f
in
d
th
at
h
ig
h
er
ed
u
ca
tio
n
al
attain
m
en
t
o
f
b
o
th
wo
m
en
an
d
th
eir
h
u
s
b
a
n
d
s
,
ex
p
o
s
u
r
e
to
m
ass
m
ed
ia,
an
d
h
o
u
s
eh
o
ld
wea
lth
wer
e
p
o
s
itiv
ely
ass
o
ciate
d
with
u
tili
za
tio
n
o
f
m
ater
n
al
h
ea
lth
ca
r
e
s
er
v
ices.
Du
r
in
g
p
r
eg
n
an
cy
,
wo
m
e
n
r
e
q
u
ir
e
f
am
ily
s
u
p
p
o
r
t
to
ac
h
iev
e
o
p
tim
al
m
ate
r
n
al
a
n
d
f
etal
h
e
alth
o
u
tco
m
es.
T
h
e
co
n
s
is
ten
t
u
s
e
o
f
m
ater
n
al
h
ea
lth
ca
r
e
s
er
v
ices
b
y
ex
p
ec
tan
t
m
o
th
er
s
r
em
ai
n
s
a
s
ig
n
if
ican
t
ch
allen
g
e
f
o
r
h
ea
lth
ca
r
e
s
y
s
tem
s
wo
r
ld
wid
e.
E
n
s
u
r
in
g
a
d
eq
u
ate
u
tili
za
tio
n
o
f
th
ese
s
er
v
ices
is
ess
e
n
tial
f
o
r
r
ed
u
cin
g
m
ater
n
al
m
o
r
tality
a
n
d
en
h
an
cin
g
th
e
well
-
b
ein
g
o
f
p
r
eg
n
an
t
wo
m
en
[
5
0
]
.
Giv
en
th
at
wo
m
en
'
s
h
ea
lth
ca
r
e
u
tili
za
tio
n
is
s
ig
n
if
ican
tly
in
f
lu
en
ce
d
b
y
th
ei
r
h
u
s
b
an
d
s
o
r
f
am
ily
m
em
b
er
s
,
it'
s
cr
u
cial
to
in
v
o
lv
e
m
en
in
th
ese
ef
f
o
r
ts
to
ed
u
ca
te
th
em
ab
o
u
t
th
e
i
m
p
o
r
ta
n
ce
o
f
h
ea
lth
s
er
v
ices,
th
u
s
f
o
s
ter
in
g
a
n
d
m
ain
tain
in
g
th
e
f
am
ily
'
s
o
v
er
all
well
-
b
ein
g
[
5
1
]
.
Hen
ce
,
we
r
ec
o
m
m
en
d
th
at
h
ea
lth
ed
u
ca
tio
n
in
ter
v
en
tio
n
s
s
h
o
u
ld
b
e
d
ir
ec
ted
at
b
o
th
m
en
an
d
wo
m
en
s
im
u
ltan
eo
u
s
ly
to
e
n
h
an
ce
th
eir
u
n
d
er
s
tan
d
i
n
g
an
d
awa
r
en
ess
.
I
n
ter
v
e
n
tio
n
s
s
h
o
u
ld
f
o
cu
s
o
n
co
m
m
u
n
ity
-
b
ased
p
r
o
g
r
am
s
t
h
at
en
g
a
g
e
b
o
th
m
e
n
an
d
wo
m
en
in
h
ea
lth
ed
u
ca
tio
n
.
Stra
teg
ies
co
u
ld
in
cl
u
d
e
wo
r
k
s
h
o
p
s
th
at
ed
u
ca
te
f
am
ili
es
ab
o
u
t
th
e
im
p
o
r
tan
ce
o
f
m
a
ter
n
al
h
ea
lth
ca
r
e,
th
e
r
o
le
o
f
s
u
p
p
o
r
tiv
e
p
ar
tn
er
s
,
an
d
p
r
ac
tical
way
s
to
o
v
er
co
m
e
b
ar
r
ier
s
to
ac
ce
s
s
.
Ad
d
itio
n
ally
,
in
v
o
lv
in
g
lo
ca
l
h
ea
lth
wo
r
k
er
s
to
p
r
o
v
id
e
tar
g
eted
o
u
tr
ea
ch
in
im
p
o
v
e
r
is
h
ed
ar
ea
s
c
an
h
elp
im
p
r
o
v
e
s
e
r
v
ice
u
tili
za
tio
n
an
d
p
r
o
m
o
te
h
ea
lth
ier
b
e
h
av
io
r
s
am
o
n
g
e
x
p
ec
tan
t m
o
th
er
s
.
T
ab
le
7
.
T
h
e
r
elatio
n
s
h
ip
b
etwe
en
f
am
ily
em
p
o
wer
m
e
n
t a
n
d
f
am
ily
r
o
le
in
p
r
ev
e
n
tin
g
a
n
e
m
ia:
u
tili
zin
g
a
h
ea
lth
s
er
v
ice
f
ac
ilit
y
F
a
mi
l
y
e
m
p
o
w
e
r
me
n
t
U
t
i
l
i
z
i
n
g
a
h
e
a
l
t
h
serv
i
c
e
f
a
c
i
l
i
t
y
p
H
i
g
h
n
(
%)
M
e
d
i
u
m
n
(
%)
Lo
w
n
(
%)
M
o
t
i
v
a
t
i
o
n
W
e
a
k
0
(
0
%)
0
(
0
%)
1
(
1
0
0
%)
0
.
0
0
0
*
S
t
r
o
n
g
6
6
(
4
3
.
3
%)
8
2
(
5
5
%)
1
(
0
.
7
%)
C
o
g
n
i
t
i
v
e
H
i
g
h
3
2
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8
6
.
5
%)
5
(
1
3
.
5
%)
0
(
0
%)
0
.
0
0
0
*
M
e
d
i
u
m
2
9
(
2
6
.
6
%)
8
0
(
7
3
.
4
%)
0
(
0
%)
Lo
w
2
(
5
0
%)
1
(
2
5
%)
1
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