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PROJECT TOPIC AND MATERIAL ON SOCIO-DEMOGRAPHIC VARIABLES PREDICTING HIV/AIDS AWARENESS AND PREVENTIVE MEASURES AMONG SENIOR SECONDARY SCHOOL STUDENTS IN EDO STATE
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This study assessed socio-demographic variables of sex, age, school location, and school type predicting HIV/AIDS awareness and preventive measures among senior secondary school students in Edo State using correlational survey design. The research participants were 937 senior secondary school students in Edo State. These respondents were sampled from the three senatorial districts of Edo State using multi stage stratified simple random sampling. The instrument used in the study was an adopted questionnaire titled HIV/AIDS Awareness and Preventive Measures Scales Questionnaire which was validated by two experts from the Department of Community Health Medicine, Ambrose Alli University, Ekpoma. The data collated were analyzed using percentage, mean, standard deviation and logistic regression.
The findings revealed that the socio-demographic variables significantly predict HIV/AIDS awareness and preventive measures among senior secondary school students in Edo State. In addition, it was also established that socio-demographic variables of age and school location were the potent predictors of HIV/AIDS awareness and preventive measures among senior secondary school students in Edo State. It was further revealed that the odds of the students within the age bracket of 12 to 15 years having good awareness of HIV/AID was 14.020 times higher than the odds of those within the 16 and above years age bracket and that the odds of students in rural schools having good awareness of HIV/AIDS was 11.021 times higher than the odds of those in urban schools.
Based on the findings it was recommended that there should be creation of more public awareness on HIV/AIDS targeted particularly at the senior secondary school students with age and school location bias, particularly on causes, mode of transmission, sex education, management and control of HIV/AIDS. In addition, it was also recommended that more public awareness on HIV/AIDS preventive measures targeted particularly at the senior secondary school students within the lower age group and those in the rural schools should be created. Government at all levels should put policies in place to provide free HIV voluntary counselling for students. Finally, HIV/AIDS education and HIV voluntary counselling training should be intensified in the senior secondary schools curriculum to create HIV/AIDS awareness and preventive measures among the senior secondary school students in Edo State.
TABLE OF CONTENTS
Title Page: … … … … … … … … … … i
Certification: … … … … … … … … … iii
Dedication: … … … … … … … … … … iv
Acknowledgements: … … … … … … … … v
List of tables: … … … … … … … … … x
List of figures … … … … … … … … … xi
Abstract: … … … … … … … … … … xii
CHAPTER ONE: INTRODUCTION
Background to the Study: … … … … … … … … 1
Statement of the Problem: … … … … … … … … 9
Purpose of the Study: … … … … … … … … 12
Research Questions: … … … … … … … … … 13
Hypotheses: … … … … … … … … … … 13
Significance of the Study: … … … … … … … … 14
Scope of the Study: … … … … … … … … … 15
Operational Definition of Terms: … … … … … … … 16
CHAPTER TWO: REVIEW OF RELATED LITERATURE
Conceptual Framework of the Study: … … … … … … 17
Empirical research studies on Predictors of Awareness of HIV/AIDS: … 44
Empirical research studies on Predictors of Preventive Measures of HIV/AIDS: 63
Summary of Reviewed Literature: … … … … … … … 79
CHAPTER THREE: METHOD OF STUDY
Design of the Study: … … … … … … … … … 81
Population of the Study: … … … … … … … … 82
Sample and Sampling Techniques: … … … … … … 82
Instrument of the Study: … … … … … … … … 84
Method of Data Collection: … … … … … … … 86
Method of Data Analysis: … … … … … … … … 86
CHAPTER FOUR: RESULTS AND DISCUSSION
Presentation of Results: … … … … … … … … 89
Testing of Hypotheses: … … … … … … … … 94
Summary of Major Findings: … … … … … … … 107
Discussion: … … … … … … … … … … 108
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATION
Summary: … … … … … … … … … … 124
Conclusion: … … … … … … … … … … 127
Recommendations: … … … … … … … … … 128
Implications for Counselling … … … … … … … 129
Contributions to Knowledge … … … … … … … 134
Suggestions for Further Research: … … … … … … 134
References: … … … … … … … … … 135
Appendix … … … … … … … … … 148
LIST OF TABLES
Table 4.1: Demographic Characteristics of the Participants in the
study according to Sex, Age, School location and School type …….88
Table 4.2: Respondents score on HIV/AIDS Awareness …………………………..89
Table 4.3: Respondents score on HIV/AIDS Preventive measure…………………..92
Table 4.4: Case processing summary………………………………………………….95
Table 4.5: Categorical Variable codings with awareness as independent variable…..95
Table 4.6: Ominibus Tests of model coefficients, model summary and
Hosmer-LemeshowTest tables for HIV/AIDS awareness: … … 96
Table 4.7: Variables in equation with awareness as independent variable………….97
Table 4.8: Categorical Variable codings with Abstinence as
independent variable ………………………………….………….98
Table 4.9: Ominibus Tests of model coefficients, model summary and
Hosmer-Lemeshow tables for Abstinence………………..: … 99
Table4.10: Variables in equation with Abstinence as independent variable………………………………………………………..100
Table 4.11: Categorical Variable codings with Condom Use as
independent variable ..……………………………….………….101
Table 4.12: Ominibus Tests of model coefficients, model summary and
Hosmer-Lemeshow tables for Condom Use……………..: … 102
Table4.13: Variables in equation with Condom Use as independent variable…………………………………………………………..103
Table 4.14: Categorical Variable codings with Counselling/Testing as
independent variable ..……………………………….………….104
Table 4.15: Ominibus Tests of model coefficients, model summary and
Hosmer-Lemeshow tables for Counselling/Testing………..: … 105
Table4.16: Variables in equation with Counselling/Testing as independent variable……………………………………………………………..106
LIST OF FIGURES
Fig. 2.1 The Health Believe Model: … … … … … 18
Fig. 2.2 Framework of AIDS Risk Reduction Model: … … … 25
Fig. 2.3 Framework of the Stages of Change Theory: … … … 28
Fig.2.4 Framework of the theory of Reasoned Action: … … … 32
Background to the Study
Human Immune-deficiency Virus and Acquired Immune Deficiency Syndrome commonly known as HIV/AIDS has become one of the leading causes of death in the world. HIV/AIDS is one of the most challenging health problems of our era. HIV weakens the immune system, making the body susceptible to opportunistic diseases that often lead to death. The predominant mode of transmission is through heterosexual contacts followed in magnitude by perinatal, transmission, where the mother passes the virus to the child during pregnancy, delivery or breastfeeding. Other modes of transmission are through infected bloods and unsafe injections (Nambatya, 2010).
The global prevalence of HIV and AIDS shows that an estimated 39.5 million people were living with HIV at the end of 2014 with 4.3 million people newly infected with the virus. According to United Nation Programme of HIV/AIDS (UNAIDS, 2011) there are over 25 million people living with HIV in sub-Saharan Africa, and forty-five percent of new infection occurred in young people aged 15-24years. In Nigeria, an estimated 4.1million people are living with HIV (UNAIDS, 2014). Even though there is a decrease in the prevalence rate of HIV infection worldwide, the pandemic continues to pose serious challenges to individuals, families, communities and the nation, more so with new infections commonly found among young people aged 15 to 24 years. HIV/AIDS therefore remains one of the biggest social, economic and development challenges in Nigeria, particularly among young people (Falaye and Adeleke, 2012). According to Shika (2014) young people are, an important group and potential resource for prevention of HIV/AIDS, as it is the younger generation that is most infected and affected. Young people are particularly affected because many of them participate in risky activities including unprotected sex with multiple partners. The situation is more compounded in developing countries where many factors combine to contribute to their risk for sexual and health problems such as sexually transmitted infections (STIs), and early pregnancies. Young people are disproportionately affected by factors that increase vulnerability to poor sexual and reproductive health. Due to their physiological make up, adolescent girls are more susceptible to HIV infection than adolescent boys. Age and gender differences, early marriage and poverty in particular, influence sexual behaviour of young people (Dehne & Reidner, 2015).
Early marriages for girls and wide age difference between them and their male partners could increase the possibility of sexual coercion and reduce their skill of negotiation. Also, due to poverty, young girls are forced into prostitution as a means of survival (World Health Organization, 2012; Falaye & Adeleke, 2012). Other factors documented contributing to young people’s risks for sexually transmitted infections including HIV are risky sexual behaviour (UNAIDS/WHO, 2014), incorrect and incomplete information (Lynn, Walberg & Margarine, 2016), poor access to youth friendly services and low perception of risks (Faleya, 2008).
Agitation for a change in the risky sexual behaviour among active population of Nigerian society has led to series of conferences and seminars’ some of these are the initiative taken by the Association of Commonwealth Universities (ACU) and Association of African Universities (AAU) with a view to providing leadership and developing policy papers for fighting the HIV/AIDS pandemic in Africa. The conferences identified ways in which HIV/AIDS pandemic could be reduced if not completely eradicated. One of such ways is awareness which specifically was identified as the key to prevention of the dreaded HIV/AIDS scourge (Ngarari, 2010). Unfortunately, most young people who are basically worst hit, by the HIV/AIDS scourge are unaware that, a healthy looking person can be living with HIV/AIDS, and that their exposure to unprotected sex and other risky behaviour are dangerous (Akisolu, 2014).
Demographic is the study of a population based on factors such as age, race and sex among others. The term socio demographic therefore, refers to a group defined by its sociological and demographic characteristics. Socio-demographic variables then, are seen as personal statistics that describe a specific population, income, level, gender, educational level, age, location, race, ethnicity and family size.
Awareness is the ability to integrate sensations to social environment in order to guide behaviour. It includes the public or common knowledge or understanding about a social, scientific or political issue. It is the ability to generate emotions for the purpose of understanding relevant issues in one’s environment. It follows that since awareness is the product of the cognitive process, it has a relationship with human behaviour (Akinyemi & Okpechi, 2011). The awareness possessed by a community refers to the understanding of that topic or issue. In this case awareness is the ability of the secondary school students to know the mode of transmission, prevention, control and management of HIV/AIDS.
The way human beings respond to the events in their social environments is a function of their awareness of the events. Thus, awareness of HIV/AIDS can be high, moderate or low. A high awareness signifies that one has a good understanding of the HIV/AIDS issue. With such high level of awareness he can have a well informed opinion about it as well as respond appropriately to effective measures. Average awareness means moderate knowledge of HIV/AIDS, while low awareness implies that the individual finds it difficult to have a good understanding of the issues relating to HIV/AIDS – the mode of transmission, prevention, and therefore cannot respond to them appropriately by taking the right steps. The concern to eradicate HIV/AIDS and the fact that there is no cure yet for the disease has made prevention of HIV/AIDS infections a cherished strategy. Awareness of HIV/AIDS is critical in the preventive measures and treatment of HIV/AIDS because it helps the individual, to make an informed decision about carrying out any of the preventive measures, assess personal risk for HIV and further develop a risk reduction strategy which will lead to behaviour change, subsequent contribution to the reduction of HIV transmission.
Preventive measures of HIV/AIDS are simply steps taken by anyone to checkmate the spread of HIV/AIDS. It may be done by individuals to protect their own health and the health of those in their community or may be instituted by government or other organizations as public health policies. Preventive measures can either seek to control or aim to empower. Awareness is necessary to enable an individual assume responsibility to stop transmission of HIV/AIDS. There is no cure for HIV/AIDS as at now, it is therefore possible to protect oneself and others from being infected through self-education and behaviour that does not put an individual at risk of infection and its attendance consequences (Centre for Disease Control (CDC) 2011). The unabated spread of HIV/AIDS led to the introduction of different preventive measures to mitigate the spread of HIV/AIDS. Some of these preventive measures introduced by government and non-governmental organizations are HIV voluntary counselling and testing, condom use, and sex education (Centre for Disease Control, 2012).
HIV voluntary counselling and testing is the process by which individuals or a group of persons undergo counselling to enable them to make informed choices about being tested for HIV, adopting healthy sexual behaviour and improving quality of life if they test positive for HIV/AIDS (UNAIDS, 2012). One to one preventive counselling has a particular contribution in that it enables frank discussion of sensitive aspects of a client’s life style, causes, symptoms, prevention and control of HIV/AIDS. The aims of counselling in HIV infection are determining whether the life style of an individual places him or her at risk; working with an individual so that he or she understands the risk; helping to identify the meanings of high risk behaviour; helping to define the potential for behaviour change; working with the individual to adhere and sustain behaviour change and preparing the individual, couple or group for HIV test through pre and post test counselling (CDC, 2013).
HIV voluntary counselling and testing as core intervention and preventive measures against the spread of HIV consists of three key segments; pre-test counselling, post-test counselling and follow up counselling. Pre-test counselling aims at assessing the client’s motivation for finding out his or her sero-status. Once the result of the test has been obtained, the presenting client will enter into post-test counselling session with his or her consent to receive the result of the test. Follow up counselling is the continual counselling of people whether sero positive or sero-negative.
Condom use is another HIV preventive measure aimed at preventing the spread of HIV/AIDS particularly among the sexually active men, women, boys and girls. There are both male and female condoms. Condom is over 90% effective if it is used correctly. Another form of HIV preventive measure is abstinence. This is the process of abstaining from sex. It is particularly good for those that are not married but engage in sex for pleasure and conquest purposes. This HIV preventive measure is 100% effective. Also very important in HIV preventive measures, are sex and health education. Health and sex education are prevention practices aimed at implementing a scale up of these HIV preventive measures at schools, community, local and national levels. Health and sex education at schools are meant to expose students to the causes, symptoms, preventive measures, control and management of HIV/AIDS.
Nigeria’s journey in addressing HIV/AIDS began when the first case was identified in 1986. There was however, an initial denial about the infection for four years, that is, from 1986-1990. HIV infection spread unabated among the “at risk population or vulnerable group” including uniformed men, women, girls, long distance trucks drivers, youths and workers during the said period. The denial of HIV/AIDs fueled the spread of the epidemic. The stigma and discrimination faced by the few known HIV positive individual also drove the infection underground, slowly and steadily, the number of HIV positive case grew (NACA, 2012).
Nigeria as a country is making efforts into the world imperatives at ensuring that these measures are taken into full consideration and implemented accordingly. These, in addition to ensuring sexuality education is infused into the school curriculum or at least given attention in schools, as imperative is a way of creating HIV sense of awareness and preventive measures among students irrespective of their sex, age, school location and school type. A cross-sectional study of HIV/ AIDS awareness and preventive measures showed that male students were more likely to have high awareness of HIV/AIDS but were less likely to have good preventive measures than the female students. Students who are 35years old were also more likely to have high awareness of HIV/AIDS preventive measures than students between 12-17 years old. Since male seems to dominate sexual practices, it is not unlikely therefore, that the females are always at the receiving end in terms of number of those infected with the HIV/AIDS disease (Federal Republic of Nigeria, 2009). Oyo-Ita, Ikpeme, Etokidem, Okokon and Etuk (2005) reported high awareness of HIV/AIDS among secondary school adolescents in Calabar-Nigeria. Murtala (2009) carried out studies on HIV/AIDS knowledge and awareness among young senior secondary students in Katsina, Nigeria. Several studies carried out to evaluate the knowledge of adolescents mostly under the school based setting in Nigeria have identified gaps in awareness (Harding, Anadu, Gray and Champeau 1999, Nwokocha & Nwakoby,2002; Odusanya & Bankole, 2006). Alika (2013) also carried out studies on HIV/AIDS awareness level of urban and rural adolescents in Edo State, Nigeria with emphasis on implication for counselling. Ibrahim, Padeola, Adebayo and Fatuse (2015) carried out HIV/AIDS awareness among secondary schools’ adolescents in South Western Nigeria so as to strengthen advocacy and strategic sexuality education programmes. Oladipo, Malomo and Ishmael (2014) considered demographic factors of age, gender, religion and institution as a tool for predicting knowledge of HIV/AIDS among undergraduates in a university in Nigeria
Several efforts have been made by government and Non- governmental Organizations (NGOs) towards making young people and adults aware of HIV with a view to preventing the spread of the dreaded HIV/AIDS, yet it remains unabated as there is a consistent problem with having an HIV/AIDS free society especially among the youths who are mainly students in the secondary schools who are more vulnerable because of their exploratory and experimentation tendencies. Apart from the fact that the lives of these youths are jeopardized by their risky behaviours, the economic, social and political life of the countries in which they operate is also jeopardized. It is against this backdrop that this study seek to assess, the socio-demographic variables (sex, age, school location and school type) predicting HIV/AIDS awareness and preventive measures among the senior secondary school students in Edo state.
Statement of the Problem
HIV/AIDS has caused immense human suffering in the world over. The first case of AIDS in Nigeria was reported in 1986. The number of persons infected with the virus has risen markedly ever since. In Nigeria, the HIV seropositive is 4.2 percent (Federal Ministry of Health, 2015). Also UNAIDS (2011) had it that about 3.8 million Nigerians are living with HIV/AIDS; Adults aged 15-49 prevalence rate is 4 percent; adults aged 15 and above living with HIV is 3.3million; women aged 15 and above living with HIV is 1.9 million; children aged 0 to 14 living with HIV is 510, 000; deaths due to AIDS is 240,000 and orphans due to AIDS aged 0-17 is 2.5million. The spread of the epidemic in Nigeria has been unprecedented with 1.8 percent sero-prevalence rate in 1991 to 4.5 percent in 1996. In 2001, the sero-prevalence was 5.8 percent and at the end of 2003, it was 5.0 percent. The HIV/AIDS epidemic in Nigeria shows a lot of variation. According to the National AIDS Control Agency (2016) HIV/AIDS still remain the biggest social economic and development challenges in Nigeria.
The impact of the disease has been mainly through the scattering morbidity and mortality that disproportionately affects women during the prime of their productive life. The consequences of the epidemy span across all spheres of life (individuals and communities nationwide). It has imposed a severe and unsustainable burden on the meagre health sector resources; as funds are diverted from other areas to HIV prevention and AIDS care and treatment services (Nambatya, 2010). The obvious effects of HIV/AIDS have been illness and death. Unfortunately, the impact has not been confined to the health sector alone; households, schools, workplace and economies have also been badly affected. In sub-Saharan Africa, people with HIV-related diseases occupy more than half of the hospital beds. Large number of young people is being directly affected. The effects of HIV/AIDS on household can be very severe. In most cases, HIV/AIDS causes the household to dissolve, as parents die and children are sent to relatives for care and for their upbringing. It is hard to over emphasize the trauma and hardship young people are forced to bear.
The spread of Human Immuno -deficiency Virus (HIV), HIV/AIDS awareness and preventive measure has generated a lot of concern among parents, teachers, counsellors, psychologists, social workers, behaviour modifiers and government at all levels Akinsolu (2014). Alemu, Abseno, Degu, Wandmilcum and Amasulu (2004) and Yazazhew and Geland (2008) attributed the high level of HIV/AIDS prevalence among students and youth to lack of knowledge of mode of transmission, symptoms, causes and preventive measures of HIV/AIDS. Despite enlightment campaigns to create HIV/AIDS awareness, attention on abstinence, sex education and HIV voluntary counselling and testing, there seems to be no appreciable success in Nigeria. Many factors have been attributed to the continuous increase; these include poor circumcision practices, practice of concurrent sexual relationship, in consistent use and poor practices of HIV voluntary counselling. Interestingly these same factors are the major drivers of the HIV/AIDS pandemic in Africa.
According to NACA (2016) in its update on HIV/AIDS programme in Nigeria, HIV/AIDS is the greatest disease found among certain high burden states which have high prevalence of infections of which Edo State with prevalence of 5.3% is listed among the states. Furthermore, the Vanguard newspaper of May 16 2016, sixteen thousand persons were said to be living with HIV in Edo state. This was an official report given by Dr. Marietu Binkola, Project Manager Edo State Agency for the Control of HIV/AIDS (EDO-SACA) at the forum to mark 2016 international AIDS candle light memorial held in Auchi Etsako West Local Government Area of Edo State.
Although many studies on HIV/AIDS have been carried out in Nigeria, the studies had focused on such issues as: acceptability of HIV VCT among medical students; socio-demographic variable as predictors of knowledge, attitude and behaviour of undergraduates in reproductive health and HIV prevention; personal risk assessment of HIV/AIDS infections among Nigeria adolescent girls in secondary schools and attitude towards people living with HIV/AIDS among others. In the light of the above, since young people have been identified as most vulnerable to HIV infection, it is, therefore, pertinent to investigate and document, the awareness and preventive measures of senior secondary school students in Edo State and also to identify the socio demographic variables that would predict the HIV/AIDs awareness and preventive measures. The present study therefore focuses on the socio-demographic variables predicting HIV awareness and preventive measures among the senior secondary school students in Edo State?
This study became imperative because in spite of the high prevalence of HIV/AIDS in Edo State, there have been paucity of indigenous studies that have examined socio-demographic variables of sex, age, school location and school type predicting HIV awareness and preventive measures among the senior secondary schools students in Edo State. There is, therefore, a gap in knowledge. It was this gap in knowledge that this study sought to fill.
Purpose of the Study
The broad purpose of this study was to assess socio-demographic variables predicting HIV/AIDS awareness and preventive measures among the senior secondary school students in Edo State. Specifically the study helped to:
- ascertain if socio-demographic variables (sex, age, school location and school type) predict HIV/AIDS awareness among the senior secondary school students in Edo State;
- find out whether socio-demographic variables (sex, age, school location and school type) predict HIV/AIDS preventive measures among the senior secondary school students in Edo State.
The following research questions guided the study;
- Do socio-demographic variables (sex, age, school location and school type) predict HIV/AIDS awareness among the senior secondary school students in Edo State?
- Do socio-demographic variables (sex, age, school location and school type) predict HIV/AIDS preventive measures among the senior secondary school students in Edo State?
The following hypotheses were tested in the study.
- Socio-demographic variables (sex, age, school location and school-type) do not significantly predict HIV/AIDS awareness among the senior secondary school students in Edo State.
- Socio-demographic variables (sex, age, school location and school-type) do not significantly predict HIV/AIDS preventive measures among the senior secondary students in Edo State.
Significance of the Study
The findings of this study is of immense importance to students, school administrators, counsellors, social workers, psychologists and other behaviour change agents as it would contribute to the body of knowledge and increase information in the area of HIV awareness and preventive measures. The findings will therefore help in planning effective counselling programmes for secondary school students in Edo State.
It is envisaged that the findings of this study will help health programme planners, health policy makers, Ministry of Education and Ministry of Health as it would help them to review services so as to provide student-friendly services and environment whereby students in senior secondary schools could comfortably be at ease to undergo HIV voluntary counselling.
Health Training Institutions will benefit greatly from the findings of this study as they would incorporate the findings of the study in their training curriculum, so that better pre-test, post-test and follow-up counselling approaches could be adopted by the counsellors and nurses who are the majority of para-counsellors in Nigeria.
The findings of this study are most likely to be of great importance to different stakeholders (counsellors, social workers, psychologists and educators) as it would highlight the difference in HIV awareness and preventive measures in senior secondary schools in Edo State along the line of demographic variables of sex, age, school location and school-type. This will bring to bear areas of concentration in advocacy programmes aimed at increasing knowledge, positive attitude and practice of HIV voluntary counselling among senior secondary school students in Edo State.
The findings of this study is also of benefit to health educators, counsellors and researchers as they would be provoked by the findings of the study to engage in more research work on HIV awareness and preventive measures. This will help to produce more empirical studies in the area of HIV awareness and preventive measures.
Scope of the Study
The study covers socio-demographic variables predicting HIV/AIDS awareness and preventive measures among senior secondary school students in Edo State. The aspects of awareness covered include mode of transmission of HIV/AIDS, symptoms, causes, management and control. The aspects of preventive measures covered include: HIV voluntary counselling and testing, condom use and abstinence.
Operational Definition of Terms
The following terms are operationally defined:
Pre-Test Counselling – This is counselling carried out to prepare
clients for HIV test.
Post-Test Counselling – This is counselling carried out to prepare
client for HIV test result
Follow – Test Counselling – This is ongoing or continual counselling
aimed at following up HIV negative or positive clients.
HIV/AIDS Awareness – Knowledge of mode of transmission,
symptoms, causes, prevention of
HIV/AIDS and health and sex education.
Preventive Measures – HIV voluntary counselling and testing,
condom use and abstinence.
Socio-demographic – This is a group defined by its
sociological and demographic characteristics.
Variables – A thing, person, or phenomenon that is being
Rural Senior Secondary
School Students – These are student in senior secondary whose
schools are located outside towns or outside
the local government headquarters
Urban Senior Secondary
School Students – These are students in senior secondary
schools that are located in cities or at the
local government headquarters.
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