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E ec i eness o he Tes S ip Me hod o Hemoglobin Assessmen o Iden i y Anemia
in P egnan Women a Puskesmas Ba alaiwo u, Kabupa en Muna, Sou heas Sulawesi
Wa Ode Si i Pu namasa i * and I Agus Adi Gunawan
Bachelo o Applied Medical Labo a o y Technology, Pa ama a Poly echnic Raha, 93612.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1422-1429
Publica ion his o y: Recei ed on 10 July 2025; e ised on 17 Augus 2025; accep ed on 19 Augus 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.2.2997
Abs ac
Backg ound: Anemia du ing p egnancy emains a signi ican public heal h issue wo ldwide, pa icula ly in de eloping
coun ies. I inc eases he isk o ma e nal complica ions, low bi h weigh , p e e m deli e y, and pe ina al mo ali y.
Ea ly de ec ion o hemoglobin le els is c ucial; howe e , limi ed labo a o y esou ces in p ima y heal hca e acili ies
o en hinde imely sc eening. Tes s ip hemoglobin me hods o e a p ac ical and cos -e ec i e al e na i e o such
se ings.
Objec i e: This s udy aimed o e alua e he e ec i eness o he hemoglobin es s ip in iden i ying anemia among
p egnan women a ending Puskesmas Ba alaiwo u, Kabupa en Muna, Sou heas Sulawesi, Indonesia.
Me hods: A desc ip i e-analy ic c oss-sec ional design was employed. The s udy included 60 p egnan women who
unde wen an ena al ca e (ANC) a Puskesmas Ba alaiwo u, selec ed using pu posi e sampling. The independen
a iable was hemoglobin measu emen using he es s ip, while he dependen a iable was anemia s a us (Hb <11
g/dL = anemia; ≥11 g/dL = no mal). Con ounding a iables included ma e nal age, pa i y, ges a ional age, educa ion
le el, and nu i ional s a us. Da a we e analyzed using SPSS so wa e, applying uni a ia e and bi a ia e analyses,
including Chi-squa e and Kappa es s o assess he ag eemen be ween he es s ip and s anda d hema ology analyze .
Resul s: Mos esponden s we e wi hin he heal hy ep oduc i e age g oup (20–35 yea s, 57%) and in he hi d
imes e o p egnancy (50%). Compliance wi h i on able supplemen a ion was 60%, while 40% we e non-complian .
Anemia p e alence was 43%, wi h mean hemoglobin le els highes in he i s imes e (11.53 g/dL), dec easing in he
second imes e (10.15 g/dL), and sligh ly ising in he hi d imes e (10.45 g/dL). The es s ip me hod
demons a ed good ag eemen wi h he s anda d hema ology analyze .
Conclusion: Hemoglobin es s ips a e an e ec i e and p ac ical ool o anemia sc eening in p ima y heal hca e
se ings. Regula moni o ing o hemoglobin le els and imp o ed compliance wi h i on supplemen a ion a e essen ial
s a egies o educe anemia p e alence among p egnan women, especially in la e ges a ion.
Keywo ds: P egnancy; Hemoglobin; Tes S ip; An ena al Ca e; I on Supplemen a ion
1. In oduc ion
Anemia emains one o he mos c i ical public heal h issues wo ldwide, pa icula ly among p egnan women (1). The
Wo ld Heal h O ganiza ion (WHO) epo s ha o e 40% o p egnan women globally a e a ec ed by anemia, wi h he
highes p e alence obse ed in de eloping coun ies (2). In A ica, he p e alence o anemia among p egnan women is
epo ed o each 57%, while in Sou h Asia, i anges be ween 40–50% (3). These igu es illus a e ha anemia
con inues o pose a signi ican challenge o imp o ing ma e nal and child heal h globally.
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In Indonesia, anemia in p egnancy emains a p essing public heal h conce n. Da a om he 2018 Basic Heal h Resea ch
(Riskesdas) indica e ha he p e alence o anemia among p egnan women eaches 48.9%, wi h conside able a ia ion
ac oss p o inces (4). In Sou heas Sulawesi, he p e alence o anemia among p egnan women emains ela i ely high,
a app oxima ely 40–45%, con ibu ing o an inc eased isk o p egnancy- ela ed complica ions (5). One o he dis ic s
wi h a signi ican numbe o cases is Muna, including he se ice a ea o Puskesmas Ba alaiwo u, whe e anemia is
commonly obse ed among p egnan women du ing an ena al ca e isi s.
Anemia in p egnancy has se ious consequences o bo h ma e nal and e al heal h. Clinically, anemia may cause a igue,
educed wo k capaci y, impai ed concen a ion, and weakened immune unc ion (6). Du ing p egnancy, anemia
inc eases he isk o obs e ic complica ions such as pos pa um hemo hage, p eeclampsia, and p e e m deli e y (7).
Fo he e us, anemia can esul in low bi h weigh (LBW), in au e ine g ow h e a da ion, and an ele a ed isk o
pe ina al mo ali y (8).
Se e al ac o s con ibu e o he high p e alence o anemia in p egnancy, including de iciencies in i on, olic acid, and
i amin B12, which a e essen ial componen s o hemoglobin (9). Addi ionally, socio-economic s a us, die a y pa e ns,
adhe ence o i on supplemen a ion, and he p esence o ch onic in ec ions such as mala ia and helmin hiasis u he
exace ba e anemia p e alence (10). These ac o s unde sco e ha anemia is a mul i ac o ial condi ion equi ing
comp ehensi e p omo i e, p e en i e, and cu a i e app oaches.
Ea ly de ec ion o anemia in p egnan women has adi ionally elied on hemoglobin assessmen using s anda d
labo a o y me hods, such as spec opho ome y o hema ology analyze s. Howe e , he a ailabili y o labo a o y
in as uc u e in p ima y heal hca e acili ies, pa icula ly in u al a eas, emains limi ed (11). As an al e na i e, he
use o hemoglobin es s ips has gained a en ion due o hei con enience, lowe cos , and applicabili y in esou ce-
limi ed se ings (12).
Al hough se e al s udies ha e e alua ed he e ec i eness o es s ip me hods, mos esea ch has been conduc ed in
o he coun ies o in heal hca e acili ies wi h ull labo a o y suppo (13). Da a speci ically examining he e ec i eness
o es s ips o hemoglobin assessmen among p egnan women a p ima y heal hca e cen e s, pa icula ly in
Sou heas Sulawesi, emain sca ce. This ep esen s an impo an esea ch gap, pa icula ly in egions wi h a high
p e alence o anemia.
This s udy aims o e alua e he e ec i eness o hemoglobin es s ips o iden i ying anemia among p egnan women
a Puskesmas Ba alaiwo u, Muna Dis ic , Sou heas Sulawesi. The no el y o his esea ch lies in i s applied ocus a he
p ima y heal hca e le el, wi h he expec a ion o p o iding scien i ic e idence suppo ing he use o a simple ye
e ec i e me hod o anemia sc eening. The indings a e an icipa ed o in o m he de elopmen o mo e p ac ical and
a o dable anemia sc eening policies in a eas wi h limi ed labo a o y esou ces.
2. Ma e ial and me hods
2.1. S udy Design
This s udy employed a desc ip i e-analy ic design wi h a c oss-sec ional app oach. This app oach was chosen because
i allows esea che s o e alua e he e ec i eness o hemoglobin es s ip me hods among p egnan women wi hin a
speci ic ime ame, wi hou ongoing in e en ions. The design is sui able o iden i ying he ela ionship be ween es
s ip esul s and he s anda d labo a o y me hod as a e e ence.
2.2. S udy Sample
The s udy popula ion consis ed o all p egnan women a ending an ena al ca e (ANC) a Puskesmas Ba alaiwo u, Muna
Dis ic , Sou heas Sulawesi. Pa icipan s we e selec ed using pu posi e sampling, wi h he ollowing inclusion c i e ia:
p egnan women willing o pa icipa e, wi hou ch onic diseases (e.g., halassemia o kidney disease), and p esen
du ing he s udy pe iod. A o al o 60 esponden s we e ec ui ed based on he Slo in o mula. The s udy was conduc ed
om May o July 2025.
2.3. S udy Va iables
The a iables in his s udy included:
• Independen a iable: hemoglobin assessmen using es s ip me hod.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1422-1429
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• Dependen a iable: anemia s a us among p egnan women (ca ego ized as hemoglobin <11 g/dL = anemia,
≥11 g/dL = no mal).
• Con ounding a iables: ma e nal age, pa i y, ges a ional age, educa ion le el, and nu i ional s a us.
2.4. Resea ch Ins umen s
The ins umen s used in his s udy we e:
• Hemoglobin es s ips o apid assessmen o hemoglobin le els om capilla y blood samples o p egnan
women.
• Hema ology analyze as he e e ence (gold s anda d) o alida e es esul s.
• Obse a ion shee s and ques ionnai es o eco d demog aphic da a, obs e ic s a us, and o he suppo ing
ac o s po en ially in luencing he ou comes.
2.5. Da a Analysis
Da a we e analyzed using he la es e sion o SPSS s a is ical so wa e. Uni a ia e analysis was pe o med o desc ibe
esponden s’ cha ac e is ics, anemia p e alence, and he dis ibu ion o hemoglobin es esul s. Bi a ia e analysis was
conduc ed using he Chi-squa e es o Kappa es o e alua e he ag eemen be ween he es s ip and s anda d
labo a o y me hods. A p- alue <0.05 was conside ed s a is ically signi ican , and he le el o ag eemen was assessed
using he Kappa coe icien (κ).
2.6. Resea ch E hics
E hical app o al was ob ained om he Heal h Resea ch E hics Commi ee o Uni e si as Ka ya Pe sada Muna. All
pa icipan s we e p o ided wi h de ailed in o ma ion ega ding he s udy objec i es, p ocedu es, and bene i s, and
signed w i en in o med consen p io o pa icipa ion. Con iden iali y o pa icipan s’ pe sonal da a was s ic ly
main ained and used solely o esea ch pu poses.
3. Resul s
3.1. Ma e nal Age
Ma e nal age is an impo an ac o in luencing a woman’s heal h du ing p egnancy, including he isk o complica ions.
The dis ibu ion o ma e nal age among he s udy esponden s is p esen ed in he ollowing able.
Table 1 Dis ibu ion o Ma e nal Age
Age
F equency
Pe cen age (%)
< 20 yea s
12
20
20–35 yea s
34
57
> 35 yea s
14
23
To al
60
100
The esul s indica e ha he majo i y o p egnan women we e in he 20–35 yea s age g oup, wi h 34 esponden s
(57%), ollowed by he >35 yea s g oup wi h 14 esponden s (23%), and he <20 yea s g oup wi h 12 esponden s
(20%). This dis ibu ion sugges s ha mos pa icipan s all wi hin he heal hy ep oduc i e age ange o 20–35 yea s,
which is physiologically conside ed he op imal pe iod o p egnancy and childbi h.
P egnan women unde 20 yea s a e ca ego ized as high- isk due o incomple e ep oduc i e o gan ma u a ion, which
inc eases he likelihood o complica ions such as anemia, p eeclampsia, p e e m deli e y, and low bi h weigh .
Simila ly, he >35 yea s age g oup is also conside ed high- isk, as i is o en associa ed wi h educed ep oduc i e
unc ion, inc eased incidence o ges a ional hype ension, ges a ional diabe es, and a highe likelihood o assis ed
deli e ies (14).
The obse ed dis ibu ion aligns wi h he heo y ha he heal hy ep oduc i e age ange (20–35 yea s) ep esen s he
op imal pe iod o p egnancy. The high p opo ion o women wi hin his age g oup indica es ha mos esponden s
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1422-1429
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we e in a ela i ely low- isk ca ego y. Ne e heless, he p esence o p egnan women in he <20 yea s and >35 yea s
g oups wa an s special a en ion, including close moni o ing du ing
3.2. Ges a ional Age
Ges a ional age plays a c i ical ole in de e mining ma e nal physiological needs and e al de elopmen , including he
isk o anemia. The dis ibu ion o ges a ional age among esponden s in his s udy is p esen ed in he ollowing able.
Table 2 Dis ibu ion o Ges a ional Age (T imes e )
Ges a ional Age
F equency
Pe cen age (%)
Fi s imes e
18
30
Second imes e
12
20
Thi d imes e
30
50
To al
60
100
The esul s indica e ha mos esponden s we e in he hi d imes e (n = 30, 50%), ollowed by he i s imes e (n
= 18, 30%) and second imes e (n = 12, 20%). These indings sugges ha he majo i y o p egnan women
pa icipa ing in his s udy we e in he la e s ages o p egnancy.
Physiologically, ges a ional age de e mines ma e nal nu i ional equi emen s and he isk o heal h complica ions o
bo h mo he and e us. Du ing he i s imes e , p egnan women o en expe ience nausea and omi ing, which may
a ec nu i ional in ake and impac hemoglobin le els. The second imes e is cha ac e ized by inc eased nu ien
equi emen s due o apid e al g ow h. In he hi d imes e , i on equi emen s ise signi ican ly owing o inc eased
plasma olume, he eby ele a ing he isk o anemia. This aligns wi h p e ious s udies indica ing ha physiological
changes, pa icula ly in he la e s ages o p egnancy, con ibu e o highe hemoglobin demands (15)
The p edominance o esponden s in he hi d imes e highligh s he need o ca e ul a en ion o anemia isk du ing
his pe iod. P e en i e measu es, including nu i ional moni o ing and egula i on supplemen a ion, a e essen ial
s a egies o minimize complica ions as deli e y app oaches.
3.3. Compliance wi h I on Supplemen a ion
Compliance wi h i on able (i on- olic acid) supplemen a ion is a c ucial ac o in p e en ing anemia du ing
p egnancy. The compliance le els o esponden s in his s udy a e p esen ed in Table 3.
Table 3 Dis ibu ion o Compliance wi h I on Table Consump ion
Compliance
F equency
Pe cen age (%)
Complian
36
60
Non-complian
24
40
To al
60
100
Ma e nal compliance wi h i on supplemen a ion is a key indica o in he p e en ion and managemen o ges a ional
anemia. The indings indica e ha he majo i y o esponden s (60%) adhe ed o he ecommended i on able egimen,
whe eas 40% we e non-complian .
The ela i ely high compliance a e e lec s an awa eness among mos pa icipan s ega ding he impo ance o i on
supplemen a ion o main ain adequa e hemoglobin le els du ing p egnancy. None heless, a no able p opo ion o non-
complian women may be in luenced by ac o s such as side e ec s (e.g., nausea, cons ipa ion), lack o knowledge abou
he bene i s o supplemen a ion, and limi ed suppo om amily o heal hca e p o ide s.
These indings align wi h p e ious esea ch demons a ing a signi ican associa ion be ween i on able compliance and
educed isk o anemia in p egnan women. Non-compliance inc eases ulne abili y o i on de iciency, which may
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1422-1429
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ad e sely a ec ma e nal and e al heal h, including p e e m deli e y, low bi h weigh , and ele a ed ma e nal and
neona al mo bidi y.
3.4. Hemoglobin Le els
Hemoglobin concen a ion is he p ima y indica o o de e mining anemia s a us in p egnan women. The dis ibu ion
o hemoglobin le els among esponden s is shown in Table 4.
Table 4 Dis ibu ion o Hemoglobin Le els
Hemoglobin S a us
F equency
Pe cen age (%)
Anemia
26
43
Non-anemia
34
57
To al
60
100
Hemoglobin concen a ion di ec ly e lec s he blood’s oxygen-ca ying capaci y o bo h ma e nal and e al issues.
Among he 60 esponden s, 26 (43%) we e classi ied as anemic, while 34 (57%) we e wi hin he no mal ange. This
indica es ha he p e alence o anemia among p egnan women in he Puskesmas Ba alaiwo u ca chmen a ea emains
conside able, e en hough mos esponden s had no mal hemoglobin le els.
The high p opo ion o anemia is consis en wi h he Indonesian Minis y o Heal h (2021), which epo ed a na ional
p e alence o 48.9% among p egnan women (16). Anemia du ing p egnancy equi es a en ion due o i s po en ial o
inc ease obs e ic complica ions, including p e e m bi h, low bi h weigh , and ele a ed ma e nal and neona al
mo bidi y and mo ali y.
Fac o s in luencing anemia p e alence include compliance wi h i on supplemen a ion, nu i ional s a us, ges a ional
age, and socio-economic condi ions. In his s udy, he 43% p e alence o anemia may be associa ed wi h subop imal
i on able compliance, as 40% o esponden s we e non-complian . These indings suppo he hypo hesis ha i on
supplemen a ion in e en ions mus be accompanied by in ensi e nu i ional counseling and moni o ing o
signi ican ly educe anemia incidence.
3.5. Mean Hemoglobin Le els by T imes e
Mean hemoglobin le els a y ac oss di e en imes e s o p egnancy. Table 5 p esen s he mean hemoglobin alues
pe imes e .
Table 5 Mean Hemoglobin Le els by T imes e
T imes e
N
Min
Max
Mean
Fi s imes e
18
9.2
14.3
11.53
Second imes e
12
9.3
12.8
10.15
Thi d imes e
30
9.4
12.9
10.45
To al
60
-
-
-
Analysis shows a ia ions in mean hemoglobin le els ac oss ges a ional age. In he i s imes e , he mean hemoglobin
was 11.53 g/dL ( ange 9.2–14.3), which is highe han in subsequen imes e s, likely due o minimal physiological
hemodilu ion. Du ing he second imes e , mean hemoglobin dec eased o 10.15 g/dL ( ange 9.3–12.8), e lec ing he
physiological expansion o plasma olume ou pacing ed blood cell mass, esul ing in physiological anemia.
In he hi d imes e , mean hemoglobin sligh ly inc eased o 10.45 g/dL ( ange 9.4–12.9), possibly due o adap i e
e y h opoiesis and egula i on supplemen a ion. Ne e heless, mean le els in he second and hi d imes e s
emained below i s - imes e le els, indica ing ha mid- o-la e p egnancy emains a ulne able pe iod o anemia.
These indings a e consis en wi h p e ious li e a u e epo ing a decline in hemoglobin du ing mid-p egnancy due o
physiological changes, wi h po en ial imp o emen in la e p egnancy i nu i ional in ake is adequa e and i on
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supplemen a ion is main ained. This unde sco es he impo ance o moni o ing hemoglobin le els ac oss all imes e s
as pa o ea ly de ec ion and p e en ion s a egies o anemia in p egnan women.
4. Discussion
This s udy e ealed ha he majo i y o p egnan women we e wi hin he heal hy ep oduc i e age ange (20–35 yea s),
accoun ing o 57% o esponden s, whe eas women aged <20 yea s and >35 yea s comp ised 20% and 23%,
espec i ely. Rega ding ges a ional age, mos esponden s we e in he hi d imes e (50%), ollowed by he i s
imes e (30%) and second imes e (20%). Compliance wi h i on able (i on- olic acid) supplemen a ion was
ela i ely good, wi h 60% o esponden s adhe ing o he ecommended egimen. Ne e heless, he p e alence o
anemia emained subs an ial, a ec ing 43% o p egnan women, while 57% we e classi ied as non-anemic. Analysis o
mean hemoglobin le els showed he highes alues in he i s imes e (11.53 g/dL), a dec ease in he second imes e
(10.15 g/dL), and a sligh inc ease in he hi d imes e (10.45 g/dL).
The age dis ibu ion indica es ha mos p egnan women we e wi hin he heal hy ep oduc i e pe iod, conside ed he
op imal phase o p egnancy. Howe e , he p esence o esponden s aged <20 yea s and >35 yea s emains signi ican ,
as hese age g oups a e physiologically a highe isk o obs e ic complica ions, including anemia. This inding aligns
wi h a s udy in Nige ia epo ing highe anemia p e alence among p egnan women <20 yea s and >35 yea s compa ed
o hose wi hin he heal hy ep oduc i e age, highligh ing ma e nal age as an impo an de e minan o hemoglobin
s a us (17).
Analysis o ges a ional age shows ha esponden s in he hi d imes e end o ha e an inc eased isk o anemia. This
is consis en wi h he concep o physiological hemodilu ion, whe e plasma olume expands mo e apidly han ed
blood cell mass du ing mid- o-la e p egnancy. These indings suppo p e ious s udies epo ing ha anemia
p e alence is highes in he la e s ages o p egnancy due o inc eased i on equi emen s ha may no be me by die a y
in ake, indica ing ha he hi d imes e is a c i ical pe iod o anemia p e en ion (18).
Compliance wi h i on supplemen a ion signi ican ly in luenced hemoglobin s a us. In his s udy, 60% o esponden s
we e complian , highe han he 40% who we e non-complian . This is consis en wi h p io esea ch demons a ing
ha p egnan women wi h high adhe ence o i on supplemen a ion exhibi signi ican ly highe hemoglobin le els
compa ed o non-complian indi iduals (19). Fac o s con ibu ing o non-compliance include gas oin es inal side
e ec s, low knowledge abou supplemen a ion bene i s, and limi ed suppo om amily o heal hca e p o ide s (20).
The 43% anemia p e alence obse ed in his s udy indica es ha anemia emains a signi ican public heal h conce n
wi hin he Puskesmas Ba alaiwo u ca chmen a ea. Al hough sligh ly lowe han he na ional p e alence in Indonesia
(48.9%), i s ill wa an s a ge ed in e en ion (21). These indings a e consis en wi h p e ious esea ch epo ing a
40.9% p e alence o anemia in p egnan women, which is associa ed wi h se ious ou comes such as low bi h weigh
and p e e m bi h (22). This sugges s ha , despi e a ia ions in p e alence, anemia among p egnan women emains a
global heal h issue.
Analysis o mean hemoglobin le els by imes e e lec s cha ac e is ic physiological pa e ns. The decline in
hemoglobin du ing he second imes e ollowed by a sligh inc ease in he hi d imes e co esponds o he body’s
adap i e mechanisms du ing p egnancy. These indings co obo a e p e ious s udies showing ha hemoglobin le els
end o dec ease in mid-p egnancy due o hemodilu ion and ise again app oaching deli e y, pa icula ly when
adhe ence o i on supplemen a ion is main ained (23). The e o e, moni o ing hemoglobin le els ac oss all imes e s
is c ucial o ea ly de ec ion and p e en ion o anemia.
This s udy’s s eng hs include a comp ehensi e analysis conside ing ma e nal age, ges a ional age, adhe ence o i on
supplemen a ion, and hemoglobin measu emen . Howe e , limi a ions include a ela i ely small sample size (n = 60)
and es ic ion o a single Puskesmas ca chmen a ea, limi ing gene alizabili y. Addi ionally, o he ac o s such as
nu i ional s a us, in ec ious diseases, and die a y pa e ns we e no explo ed in de ail. Fu u e esea ch is ecommended
o in ol e la ge sample sizes, assess nu i ional and socio-economic a iables, and compa e he e ec i eness o
hemoglobin assessmen me hods, he eby suppo ing mo e a ge ed in e en ions o anemia p e en ion among
p egnan women.
5. Conclusion
This s udy demons a es ha he majo i y o p egnan women esponden s we e wi hin he heal hy ep oduc i e age
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ange, wi h adhe ence o i on able (i on- olic acid) supplemen a ion a a mode a e le el (60% complian and 40%
non-complian ). Hemoglobin analysis e ealed ha 43% o esponden s we e anemic, while 57% we e non-anemic.
Mean hemoglobin le els a ied ac oss imes e s, wi h he highes alues obse ed in he i s imes e (11.53 g/dL),
ollowed by a dec ease in he second imes e (10.15 g/dL) and a sligh inc ease in he hi d imes e (10.45 g/dL).
These indings highligh he u gency o egula hemoglobin moni o ing and he ein o cemen o nu i ional
in e en ions, pa icula ly s a egies o imp o e compliance wi h i on supplemen a ion, as p e en i e measu es o
educe he p e alence o anemia among p egnan women.
Compliance wi h e hical s anda ds
Acknowledgemen s
The au ho s exp ess hei g a i ude o Puskesmas Ba alaiwo u, Kabupa en Muna, Sou heas Sulawesi, o g an ing
pe mission and p o iding suppo du ing he s udy. App ecia ion is also ex ended o all esponden s who pa icipa ed
in he esea ch and o all pa ies who assis ed in da a collec ion and he p epa a ion o his esea ch epo .
Disclosu e o Con lic o in e es
The au ho s decla e ha he e a e no po en ial con lic s o in e es o compe ing in e es s ela ed o he publica ion o
his manusc ip , ei he wi h ins i u ions o wi h p oduc s men ioned in he s udy.
S a emen o e hical app o al
This s udy ecei ed e hical app o al om he Heal h Resea ch E hics Commi ee o Uni e si as Ka ya Pe sada Muna.
S a emen o in o med consen
All pa icipan s we e p o ided wi h comp ehensi e in o ma ion ega ding he s udy’s objec i es, bene i s, and
p ocedu es. W i en in o med consen was ob ained om all esponden s p io o hei pa icipa ion in he s udy.
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