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IJCRR - 4(11), June, 2012

Pages: 151-159

Date of Publication: 18-Jun-2012


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STUDY OF DEFAULTERS OF REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME IN THE THREE PRIMARY HEALTH CENTRES OF BELGAUM DISTRICT

Author: Shivappa Hatnoor, Hemagiri K, Sangolli H N, Mallapur M.D, VinodKumar C.S

Category: Healthcare

Abstract:The Revised National Tuberculosis Control Programme introduced in 1993 lays more emphasis on good quality diagnosis by direct sputum smear microscopy and quality drugs, through standardized short course chemotherapy regimens administered under direct observation along with systematic monitoring and evaluation. The goal of the Revised National Tuberculosis Control Programme is to cure at least 85% of new sputum smear positive patients detected and to detect at least 70% of all such patients after the goal for cure rate has been met. No studies have been done on evaluation of Revised National Tuberculosis Control Programme and reasons for default in these areas. Objective of this study to know the reasons for default of the patients put under Revised National Tuberculosis Control Programme. Materials and method: This study carried over for one year one month (November 1st 2004 to 31st December 2005). The data collected by using pre-designed and pretested proforma. The first visit was done when the patient was registered in the Primary Health Centre and
started on the treatment. Second visit i.e. First follow-up visit was done at the end of Intensive Phase and the data was collected regarding the scheduled intake of drugs, result of 1st follow-up sputum examination and about defaulters if any. Second follow-up visit was done in the middle of continuation phase and the data was collected regarding the scheduled intake of drugs, result of 2nd follow-up sputum examination and defaulters if any. Fourth visit i.e. third follow-up visit was done at the end of Continuation Phase and the data was collected regarding the scheduled intake of drugs, result of sputum examination at the end of the treatment, about defaulters if any and outcome of the treatment. Results: Out of 69 defaulter cases majority 63% of them were males, the main reason for treatment failure were illiteracy (42%), marital
status (79%), Class V family (58%), complaining of acidity and vomiting (63%). habit of smoking (31%) and smokeless tobacco(15%). These are the significant reasons for treatment failure.

Keywords: Keywords: RNTCP, tuberculosis, defaulters

Full Text:

INTRODUCTION
Tuberculosis continues to be one of the most important public health problems worldwide. It infects one third of the world‘s population at any point of time. There are approximately 9 million new cases of all form of tuberculosis occurring annually and 3 million people die from it each year. Out of these 95% tuberculosis cases and 98% tuberculosis deaths are contributed by developing countries1 . India accounts for nearly one third of the global burden of tuberculosis. Around 2.0 million people are diagnosed to be suffering from tuberculosis every year.1 Tuberculosis kills more adults in India than any other infectious diseases. More than 1000 people a day i.e one every minutes die of tuberculosis2 . Despite the National Tuberculosis Programme since 1992, the desired control of tuberculosis could not be achieved. Moreover, there has been an increase in the absolute number of tuberculosis patients because of the increase in population. The impending threat of Tuberculosis- HIV co- infection and the emergence of Multi Drug Resistance Tuberculosis have made the situation worse3 . In 1992, an expert committee reviewed the National Tuberculosis Programme and found that less than 30% treatment completion rate, undue emphasis on radiological diagnosis, poor quality of sputum microscopy, multiplicity of treatment regimens, emphasis on case detection rather than on treatment completion, inadequate budgets and shortages of drugs3 . The Revised National Tuberculosis Control Programme introduced in 1993 lays more emphasis on good quality diagnosis by direct sputum smear microscopy and quality drugs, through standardized short course chemotherapy regimens administered under direct observation along with systematic monitoring and evaluation3 . The goal of the Revised National Tuberculosis Control Programme is to cure at least 85% of new sputum smear positive patients detected and to detect at least 70% of all such patients after the goal for cure rate has been met2 . Belgaum district started implementing Revised National Tuberculosis Control Programme from 15th July 2003. K.L.E. Society‘s J.N. Medical College adopted three Primary Health Centres namely Kinaye, Vantmuri and Handignur on 7th April 2004 as such no studies have been done on evaluation of Revised National Tuberculosis Control Programme in these areas. So, this study was taken to evaluate the implementation of Revised National Tuberculosis Control Programme in these areas and also to know the reasons for default of the patients put under Revised National Tuberculosis Control Programme.

MATERIALS AND METHODS
Ethical clearance:
Ethical clearance was obtained from JN Medical College, Belgaum, Karnataka

Design:
This was a longitudinal study undertaken to evaluate the Revised National Tuberculosis Control Programme in three Primary Health Centres, attached to JN Medical College, Belgaum, Karnataka Source of Data: Total population of three Primary Health Centres were; Kinaye 47,159, Vantamuri 30,756 and Handiganoor 23,452 population.

Inclusion Criteria:
All cases diagnosed for tuberculosis by the Medical Officers of three Primary Health Centers from November 1st 2004 to April 30th 2005.

Study Period:
From November 1st 2004 to 31st December 2005 (One year One month)

Methods of Data Collection:
Using pre-designed and pre-tested proforma the data is collected. The first visit was done when the patient was registered in the Primary Health Centre and started on the treatment. The following data was collected in the first visit Name, Age, Sex, Religion, Occupation, Address, Educational Status, Marital Status, Type of Family, Socio-economic status, DOT provider, Category of Treatment, Disease Classification, Type of patient, result of 1st sputum (at the start of the treatment) examination and if there are any reasons for initial default.

Second visit i.e. First follow-up visit was done at the end of Intensive Phase and the following data was collected regarding the scheduled intake of drugs, result of 1st follow-up sputum examination and about defaulters if any. Third visit i.e. second follow-up visit was done in the middle of Continuation Phase and the following data was collected regarding the scheduled intake of drugs, result of 2nd follow-up sputum examination and defaulters if any. Fourth visit i.e. third follow-up visit was done at the end of Continuation Phase and the data was collected regarding the scheduled intake of drugs, result of sputum examination at the end of the treatment, about defaulters if any and outcome of the treatment.




The present study was a longitudinal study undertaken to evaluate the Revised National Tuberculosis Control Programme in three Primary Health Centers of Belgaum which are adopted by K.L.E. Society‘s J.N. Medical College under Public Private Partnership. The total study population covered was Kinaye47,159, Vantmuri-30,756 and Handignur23,452 out of this 69 patients were put on antitubercular treatment under Revised National Tuberculosis Programme, by Medical Officers of respective Primary Health Centers from November 1st 2004 to April 30th 2005 were included in the study. All the three Primary Health Centers are located within the radius of 25 kilometers from J.N. Medical College. Our study showed that among defaulters 63% of patients had acidity and vomiting, 16% patients were alcoholics, 10.5% left the place, 5.3% had taken treatment previously and 5.3% not willing to disclose the identity. A study done in Bangalore city showed that alcoholics were more among the defaulted i.e. in category I 56.7% and in category II 68.7%.4 In another study done at Tiruvallur, District in Tamil Nadu showed that 17.1% of defaulters were alcoholics5 . In a similar study conducted in West Bengal, Jharkand and Arunachal Pradesh showed that intolerance to drugs among defaulters ranged from 5.6 % to 20%.6 In our study maximum defaulted cased were in Primary Health Center Handignur i.e. 36.4%, followed by 32% in Primary Health Center Vantamuri and 21% in Primary Health Center Kinaye. Overall in all Primary Health Centers defaulted cases were 27.5%. In a similar study conducted in West Bengal, Jharkand and Arunachal Pradesh showed that defaulted patients ranged from 10.78% to 38.13% in four centers where the study was conducted.6 In our study majority of defaulted patients were males i.e. 63% and 37% were females. In a study done in Bangalore city among category I 89.6% of defaulter were males and 90.9% males in category II.4 In our study maximum number of defaulters were seen among housewives i.e. 31.6%, followed by 26.3% each among farmers and labours, 5.3% each among business persons, drivers and children under seven years of age. In our study maximum number of defaulted patients were illiterates i.e 42%, followed by 37% Primary level education, 16% Secondary level education and 5.3% children under seven years of age. In a study conducted in Tiruvallur District in Tamil Nadu revealed that among all defaults 12.7% were illiterates6 . In a similar study conducted in the states of West Bengal, Jharkand and Arunachal Pradesh showed that 48% to 64.9% of defaulters were illiterates, Primary school level raged from 19.1% to 40%, High school level ranged from 15.9% to 40% and college level ranged from 5.6 % to 20%.7 In our study maximum numbers of defaulted patients were married i.e 79% and 21% were unmarried. In a similar study conducted in Bangalore city revealed that 73% in category I and 69.7% in category II were married.5 In our study majority of defaulted patients were from Joint family i.e 47.3%, followed by 37% three generation family, 10.5% nuclear family and 5.3% problem family. In our study maximum percentage of defaulted cases were in class V i.e 58%, 26.3% were in class IV, 10.5% were in class III and 5.3% were in class II. In a similar study conducted in states of West Bengal, Jharkand and Arunachal Pradesh revealed that in class V and IV the defaulted patient ranged from 24.5% to 63%, in class III and II it ranged from 24.5% to 45.5% and in class I it ranged from 12.5% to 30%.7 In our study maximum number of defaulted cases were having the habit of smoking and alcohol i.e. 31.6%, 15.9% were having the habit of using smokeless tobacco, 15.9% were having the habit of smoking, alcohol and use of smokeless tobacco, 5.3% were having the habit of smoking and 5.3% were having the habit of smoking and use of smokeless tobacco. 26.3% of the defaulted cases were not having any habits. In another study conducted at Tiruvallur district in Tamil Nadu showed that in overall defaulted cases 14.6% were smokers and 17.1% were alcoholics.6 In our study majority of the defaulted cases were in category I i.e. 55%, 35% were in category II and 10% were in category III. In a study conducted in Bangalore city showed that the defaulted cases in category I were 25.4% and in category II were 45.2%. 4 In our study maximum percentage of defaulted cases i.e. 68% had Anganwadi workers as DOTS providers and 32% had Health workers as DOTS providers. In our study the defaulters among males were 36% and non defaulters were 64%. Among Females 19% were defaulters and 81% were non defaulters. Which did not show any statistical significance where P = 0.116. In the study the defaulters among illiterates were 40% and non defaulters were 60%. Among literates 21% were defaulters and 79% were non defaulters. We found that their is no statistical significance between illiterate and literate defaulters. Where P=0.114. In a similar study conducted in the states of West Bengal, Jharkand and Arunachal Pradesh showed that 48% to 64.9% of defaulters were illiterates. 7 In our study defaulters among class II and III were 23% and non-defaulters were 77%. Defaulters among class IV were 20% and nondefaulters were 80%. Defaulters among class V were 35% and non-defaulters were 65%. It did not show any statistical significance where P=0.402. In a study done in West Bengal, Jharkand and Arunachal Pradesh the defaulted patients among class II and III ranged from 24.5% to 45.5% and in class IV and V it ranged from 24.5% to 63%. 7 In our study among category I 37% were defaulters and 63% were non-defaulters, among category II 21% were defaulters and 79% were non-defaulters and in category III 27% were defaulters and 73% were non-defaulters. It showed a statistical significance where P= 0.013. In a study done at Bangalore revealed that defaulters among category I were 25.4% and in category II were 45.2%. 4 In our study among Anganwadi workers 31% were defaulters and 69% were non-defaulters. Among Health workers and others 22.2% were defaulters and 77.8% were non- defaulters. It showed no statistical significance where P= 0.428. Reasons for default during the course of treatment being 12(63% ) due to toxicity of drugs (Acidity and Vomiting), 31(16%) due to addiction to Alcohol and 2(10.5%) left the place. Numbers of defaulters in category I were 11(37%), Category II were 6(46%) and category III were 2(8%). Which was statistically significant.

RECOMMENDATION

  • Training newly recruited staff of Primary Health Centers.
  • Regular re-orientation of all the staff and also DOTs providers.
  • Sputum examination should be made mandatory for all the patients (Pulmonary as well as extra pulmonary).
  • IEC activities for the public regarding Tuberculosis and its treatment and also to increase the cure rate, decrease the default and failure rate amongst the patients.

ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed

References:

1. A. Jaiswal, V. Singh, J. A. Ogden, J. D. H. Porter, P. P. Sharma, R. Sarin, V. K. Arora, R. C. Jain. Adherence to tuberculosis treatment: lessons from the urban setting of Delhi, India. Tropical Medicine and International Health. 2003;8:625-633

2. Sengupta S, Pungrassami P, Balthip Q, Strauss R, Kasetjaroen Y. Social impact of tuberculosis in southern Thailand: views from patients, care providers and the community .Int. J. Tuberc. Lung. Dis. 2006; 10(9):1008-12.

3. Srivastava S.K., Ratan R.K. Srivastava P, and Prasad R: report on Revised National Tuberculosis Control Programme: urban pilot project in Lucknow, Ind J. Tub, 2000;47:159-162.

4. Sophia Vijay, Balasangameshwara .V.H, Jagannatha. P.S, Saroja V.N and Kumar P; Defaults among tuberculosis patients treated under DOTs in Bangalore city: A search for solution: Ind. J.Tub, 2003,50,185-195

5. Chandrasekaran V, Gopi P.G, Subramani R, Thomas A, Jaggarajamma K, and Narayanan. P.R; Default during the Intensive phase of Treatment under DOTs Programme. Ind. J. Tub, 2005, 52,197-202.

6. Chatterjee P, Brutoti Banerjee, Debashis Dutt,Rama Ranjan Pati and Ashok kumar Mullick. A comparative evaluation of factors and Reasons for defaulting in tuberculosis treatment in Ind. J. Tub, 2003, 50,17-22.

7. Revised National Tuberculosis Control Programme at Glance, central Tuberculosis division Directorate General of Health Services Ministry of Health and Family welfare Nirman Bhavan, New Delhi.

Announcements

Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

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Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

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A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
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A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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Disclaimer: International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.



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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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