Assessment of Dietary Habits, Water, Sanitation, and Hygiene Practices Among School Aged Children and Adolescents in Zanzibar: Implications for Health and Academic Performance

Assessment of Dietary Habits, Water, Sanitation, and Hygiene Practices Among School Aged Children and Adolescents in Zanzibar: Implications for Health and Academic Performance | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Dietary Habits, Water, Sanitation, and Hygiene Practices Among School Aged Children and Adolescents in Zanzibar: Implications for Health and Academic Performance Asha Salmin, Germana Leyna, Esther Ngadaya, Anna Mosses, David Solomon, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6113106/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Consumption of healthy foods, intake of safe and clean water, use of improved toilets, and good hand-washing hygiene practices have a huge impact on academic performance, overall health and well-being among young children and adolescents. However, there is limited evidence of these habits and practices among schoolchildren and adolescents in Zanzibar. This study examined the current state of food, water, sanitation, and hygiene practices among school-going children in Zanzibar . Methods: This was a school-based cross-sectional study. Data were gathered from students aged between 5 and 19 years enrolled in primary and secondary schools during the academic year 2022. Data collection involved dietary surveys and food frequency questionnaires (Prime Diet Quality Score, PDQS). Simple descriptive analyses were conducted using Stata Version 17. Results: The consumption of unhealthy food groups was alarming with over 2 in 5 children consuming refined grains and baked goods (40.9%), and desserts and ice cream (26.0%), with a mean PDQS of 16.4±3.7 (Range 7-34). Higher PDQS scores were statistically significantly associated with male gender (uβC 1.5 (95%CI 1.2-1.8), living in Kaskazini A, Magharibi A, Kaskazini Unguja and Mjini Magharibi. Over half (50.4%) did not consume breakfast in the previous seven (7) days before the survey, and 56.6 percent eat snacks almost every day. Furthermore, most (94.2%) of the study respondents reported using improved drinking water sources, however, a third (33%) reported not treating water for drinking purposes with either boiling, clorination or letting it settle. Additionally, only about 20% of participants had unimproved toilet facilities whereas 5.6% did not have latrines at all. About 67% of the participants reported washing their hands with soap and water before eating. However, 29.8% reported using water only, and 0.2% reported not washing their hands at all. Conclusion: Majority of Children and adolescents in Zanzibar have poor dietary habits. Over half consume breakfast the most important meal of the day. A commendable number reported to drink clean water and wash their hands with soap and water. With a global commitment to improve WASH for school children, the findings indicare a need for the government, development partners and implementation researchers to develop and implement effective interventions for improving food habits, and water and hygienic practices as an entry point for improving both academic and health outcomes among school children and adolescents. Nutrition Sanitation Hygiene Malnutrition Zanzibar Anemia Figures Figure 1 Figure 2 Figure 3 Background The eating habits, water, sanitation, and hygiene practices among school-going children play a crucial role in their overall health, well-being, and academic performance at the present and in their future life (1). These aspects are interlinked and contribute significantly to the physical and cognitive development of children (2). Inappropriate eating patterns have been significant contributors to mortality and morbidity in children (3). Unhealthy eating practices, such as increased consumption of high-calorie snacks, skipping breakfast, dining out frequently, consuming soft drinks, and having lower intakes of fruits, vegetables, and dietary supplements, have been identified in several studies conducted in both developed and developing countries (4,5). Childhood is a critical period for establishing lifelong healthy habits, as such dietary habits that the child and adolescent acquires has significant impact on their life as well as their future life, and contribute to their congnnitive development and school performance. School going children required sufficient among of protein to meet their maintainance demands, and promote health growth, as such access to a good healthy breakfast and mid-day meals is very crutial not only to their nutritional stutus but also make them concentrate with their studies (6). According to the Recommended Dietary Allowances (RDAs), protein requirements per kg of body weight drop from around 1.8 g in young children to 1.2 g in late childhood. However, combining plant and animal foods, such as cereal with beans, nuts, lentils, seeds, milk, and other dairy products, can offer the correct amount of protein to meet these demands (7). Furthermore, breakfast a widely acknowledged most important meal of the day, has associated with a number of good nutrition advantages in children such as higher intake of dietary fiber, total carbohydrate and lower total fat and cholesterol (8) large contribution to daily micronutrient intake (8) maintaining a body mass index (BMI) within the normal range (9) and positively affects learning (10). Physical inactivity and low cardio respiratory fitness level has also been associated with lack of breakfast intake (11). Moreover, inadequate access to safe water and sanitation facilities can lead to numerous health issues, including diarrhoea, malnutrition, and reduced school attendance. The assessment of the worldwide WASH burden reveals that 600 million children continue to face a deficit in the provision of safely managed drinking water, 1.1 billion lack access to safely managed sanitation facilities, and 689 million do not have access to basic hygiene services (12). An evaluation by UNICEF found that in schools in low-income countries, only 51% of schools had access to adequate water sources and only 45% had adequate sanitation (13). In Tanzania, approximately four million individuals lack access to a safe water source, and an alarming 29 million people do not have adequate sanitation facilities (14). These challenges disproportionately impact vulnerable groups, with women and children being particularly affected (15,16). By investigating these aspects and understanding the factors influencing these behaviours, effective interventions and policies to promote healthy lifestyles among children can be designed. Therefore, this research paper sought to examine the current state of eating habits, water, sanitation and hygiene practices among school going children, shed light on the existing gaps and develop evidence-based recommendations to enhance the overall health and well-being of school-going children in Zanzibar. Methods Study design The study was a school-based cross-sectional study. Data were gathered from students aged between 5 and 19 years who were enrolled in primary and secondary schools during the academic year 2022. Students with serious illness or who were unwilling to participate were excluded. Study setting The study was conducted in Zanzibar. Zanzibar is an insular semi-autonomous province which united with Tanganyika in 1964 to form the United Republic of Tanzania with the total population of 1,889,773 persons in the 2022 Census(17). Over one third of the population is between 5 to 19 years. Zanzibar is an archipelago in the Indian Ocean, 25–50 km (16–31 mi) off the coast of the African mainland, and consists of many small islands and two large ones: Unguja (the main island, referred to informally as Zanzibar) and Pemba Island. The capital is Zanzibar City, located on the island of Unguja. Zanzibar has a total of 5 regions (3 in Unguja and 2 in Pemba). Almost half of the population (893,169; 47.3%) is found in only one region Mjini Magharibi which is in Unguja. Zanzibar's marine ecosystem is an important part of the economy for fishing and algaculture and contains important marine ecosystems that act as fish nurseries for Indian Ocean fish populations, and also main source of protein for its citizen including children and adolescents. Sampling technique: We utilized a stratified multi-stage sample design(18). The initial stage involved selecting a sample of schools as the primary sampling unit (PSU) using a probability proportional to size (PPS) method. In the second stage, one class level was selected using a simple random sampling approach (SRS), followed by the selection of individuals from these classes. Each selected class had 28 students evenly distributed by sex (14 girls and 14 boys), chosen using a systematic sampling technique. Sample size calculation: The sample was selected to provide a plausible estimate of anthropometric and Hemoglobin level across different domains, such as national, regional and district levels as well as urban/rural areas, and according to the sex. The sample size was estimated at the district level (domains) and aggregated to obtain the regional and national sample. The prevalence of anemia was the preferred indicator, utilizing an indicative value of 50%, with a margin error of 0.5, significance level of 5%, and design effect of 1.5. Data and Sample collection. Social-demographic and economic data collection: A pre-tested structured questionnaires were used to collect data on demographic characteristics and socioeconomic factors after obtaining written informed consent form through face-to-face interview. Questionnaire were developed in English, translated into Swahili and then back-translated to English to verify accuracy. A household level index was determined using Principal Component Analysis (PCA) by considering household assets and type of house. First, variables were coded between 0 and 1. Secondly, variables were entered and analyzed using PCA, and variables with communality values of greater than 0.5 were used to produce factor scores. Finally, factor scores were summed and ranked into tertials as poor, medium, and rich. Anthropometric measurements : The recording of age, weight, and height of the participants, and measurements were done in the school premises by using a portable weight scale and a stadio-meter with a sliding headpiece. Survey questions regarding the availability and use of sanitation facilities, disposal methods for different types of waste (organic, plastic, etc.) were used. Furthermore observational measures and self-report questionnaires on hand washing frequency and technique were used to measure hygiene level of the respondents. Dietary habits : Dietary surveys and food frequency questionnaires were used to evaluate children’s eating habits. Dietary quality is an optimal measure of nutrients for the wellbeing. Dietary quality among schoolchildren and adolescents 5-19 years was assessed using the Prime Diet Quality Score (PDQS). The Prime Diet Quality Score (PDQS) was recently developed using a modified Prime Screen questionnaire as a way to characterize diet quality globally and was associated with a lower risk of coronary heart diseases (CHD) to a large population in USA. PDQS contained 21 food groups; 13 were categorized into healthy, and 8 as unhealthy food groups. Food groups were queried on a 5- point Likert scale: 0= never, 1= once in a week, 2-4 times a week, 5-6 times a week and every day. Points were assigned for consumption of healthy food groups as follows: 0–1 serving/week= 0 points; 2–3 servings/week= 1 point; and ≥4 servings/week=2 points. Scoring for unhealthy food groups was assigned as follows: 0–1 serving/week=2 points; 2–3 servings/week= 1 point; and ≥4 servings/week= 0 points. Individual scores were aggregated to gen an overall score which ranged from 0 to 42 possible scores, the higher the score the quality of diet consumed by a respective children or adolescent. Water, sanitation and hygiene (WASH) practices The structured questionnaire facilitated the systematic collection of data. Participants were asked to identify their primary source of drinking water, practices related to water treatment and the type of toilet facilities available in households. Data management and analysis: Data were collected using a tablet-based questionnaire, programmed into the Survey Solutions software, with paper forms available as backup. A chain of supervisors approved the data, transmitted to the cloud server after every session of data entry. Data cleaning was undertaken by a trained team. Simple descriptive analyses were executed in Microsoft Excel for routine reporting. Results The sampled of 2,556 children and adolescents aged 5 to 19 years participated in the study. The study was implemented in all 11 districts of Zanzibar. The demographic and socio-economic characteristics of the survey population including age, sex, place of residence, caregiver’s schooling and household wealth status is presented in Table 1 (below). A Slightly higher proportion (51.7%; 1,322) of the study participants were girls. Almost 2 in 5 were individuals from 10-14 years, and most of them were from primary school. Slightly over 5 in 10 were residing in urban areas. Table 1: Social demographic characteristics of the study participants (5-19 years; N= 2,556) Background Characteristics Number Percentage (%) Sex Male 1,234 48.3 Female 1,322 51.7 Age 5 – 9 784 30.7 10 – 14 1,058 41.4 15 – 19 714 27.9 Level of Education Primary 1,768 69.1 Secondary 788 30.8 School ownership Public 2463 96.4 Private 93 3.6 Area Rural 1,194 46.7 Urban 1,362 53.3 Wealth quintile Lowest 530 20.7 Second 493 19.3 Middle 513 20.1 Fourth 538 21.0 Highest 482 18.9 District Kaskazini A 184 7.2 Kaskazini B 196 7.7 Kati 196 7.7 Kusini 196 7.7 Mjini 264 10.3 Magharibi A 305 11.9 Magharibi B 332 13.0 Wete 251 9.8 Micheweni 195 7.6 Chakechake 219 8.6 Mkoani 218 8.5 Region Kaskazini Unguja 380 14.9 Kusini Unguja 392 15.3 Mjini Magharibi 901 35.3 Kaskazini Pemba 446 17.4 Kusini Pemba 437 17.1 Dietary Quality Using Table 2 below describe the frequency thresholds of consumption of healthy food groups for at least >4 serving per week among study participants. Less than half of school-age children and adolescent consumed fish (48%), other vitamin A rich vegetables and fruits (69.8%) and dark leafy green vegetables (56.7%). Eggs (1.6%), Cruciferous vegetables (1.8%), and Other whole fruits (3.9%) were the least consumed. On the other hand, the frequency thresholds of consumption of 6 unhealthy food groups for at least >4 serving per week among SAC was also high, where over 2 in five school-age children and adolescents consumed refined grains and baked goods (40.9%), and desserts and ice cream (26.0%). Moreover, about 25.9 percent consumed fried foods obtained away from home for at least >4 serving per week. Processed meat (0.7%) and red meat (2.4%) consumption was low. Table 2: Frequency distribution of Prime dietary quality scores (PDQS) among SAC in Zanzibar (n= 2556) Food group 0–1 serving/wk 2–3 servings/wk ≥4 serving/wk Healthy food groups n % n % n % Dark green leafy vegetables 1,080 42.3 1,259 49.3 217 8.5 Cruciferous vegetables 2,271 88.9 239 9.4 46 1.8 Rich vegetable and fruits 594 23.2 965 37.8 997 39.0 Other vegetables 1,346 52.7 699 27.4 511 20.0 Fruits Whole citrus 2,110 82.6 339 13.3 107 4.2 Other whole fruits 2,089 81.7 367 14.4 100 3.9 Legumes 1,437 56.2 979 38.3 140 5.5 Nuts 1,811 70.9 558 21.8 187 7.3 Poultry 2,045 80.0 444 17.4 67 2.6 Fish 401 15.7 928 36.3 1,227 48.0 Whole grains 1,959 76.6 347 13.6 250 9.8 Liquid vegetable oils 1,281 50.1 805 31.5 470 18.4 Eggs Freq. 2,186 85.5 328 12.8 42 1.6 Unhealthy food groups Red meats 2,204 86.2 291 11.4 61 2.4 Processed meat 2,478 97.0 60 2.4 18 0.7 Refined grains and baked goods 945 37.0 567 22.2 1,044 40.9 Sugar-sweetened beverages 2,007 78.5 417 16.3 132 5.2 Fried foods 1,222 47.8 672 26.3 662 25.9 Ice cream 1,065 41.7 806 31.5 685 26.8 Roots and tubers (cooked potatoes) 1,492 58.4 888 34.7 176 6.9 Low-fat dairy: Drinking milk or milk products (e.g. yoghurt) 2,036 79.7 378 14.8 142 5.6 Predictors of maximum PDQS scores using T-Test, ANOVA and linear regression model The assessment of the Prime Dietary Quality Scores (PDQS) among school-aged children in Zanzibar revealed a mean PDQS of 16.4±3.7, with scores ranging from a minimum of 7 to a maximum of 34 out of 42 possible scores. According to table 3 below, statistically significant maximum PDQS scores were associated with a male gender (uβC 1.5 (95% CI 1.2-1.8), living in Kaskazini A, Magharibi A, Kaskazini Unguja and Mjini Magharibi. In addition, children and adolescents aged 5 to 19 years from Unguja island and those with highest quintiles had the highest maximum PDQS scores than their comparison groups. In contrary, the following were statistically significant associated with decreased chances of having maximum PDQS scores; age group 5 to 9, children and adolescents studying in private schools, primary school students, those living in Kaskazini B and Kusini Unguja as well as children and adolescents from Middle and fourth quintiles Table 3: Factors associated with PDQS scores (max scores) using T-Test, ANOVA and linear regression model Variable Mean (SD) P-value uβC, 95%CI P-value Gender Male 17.2(3.9) <0.001 1.5(1.2-1.8) <0.001 Female 15.7(3.4) 1 Age in years 5 to 9 16.6(3.8) 0.109 0.4(0.02-0.8) 0.040 10 to 14 16.4(3.7) 0.14(-0.22-0.50) 0.443 15-19 16.2(3.7) 1 Ownership Government 16.4(3.7) 0.020 1 Private 17.3(4.4) 0.9(0.15-1.7) 0.02 Level Primary 16.5(3.8) 0.001 0.4(0.1-0.7) 0.01 Secondary 16.1(3.6) 1 Settings Rural 16.3(3.5) 0.057 1 Urban 16.5(3.9) 0.3(-0.01-0.6) 0.057 District Kaskazini A 16.2(3.8) <0.001 1.4(0.6-2.1) <0.001 Kaskazini B 17.6(4.4) 0.9(0.1-1.6) 0.024 Kati 17.1(3.8) -0.6(-1.4-0.12) 0.098 Kusini 15.6(3.3) 1.0(0.3-1.7) 0.006 Mjini 17.2(4.1) 0.5(-0.21-1.1) 0.176 Magharibi A 16.7(4.1) 1.0(0.4-1.7) 0.003 Magharibi B 17.2(4.1) -0.3(-1.0-0.4) 0.351 Wete 15.9(3.1) -0.7(-1.5-0.03) 0.059 Micheweni 15.5(2.9) -0.7(-1.4-0.06) 0.071 Chakechake 15.5(3.0) -0.7(-1.4-0.6) 0.073 Mkoani 15.5(2.7) 1 Region Kaskazini Unguja 16.9(4.2) <0.001 1.4(0.9-1.9) <0.001 Kusini Unguja 16.3(3.6) 0.8(0.3-1.3) 0.003 Mjini Magharibi 17.0(4.2) 1.5(1.1-1.9) <0.001 Kaskazini Pemba 15.7(3.0) 0.2(-0.3-0.7) 0.515 Kusini Pemba 15.5(2.8) 1 Island Pemba 15.6(2.9) 1 Unguja 16.8(4.1) <0.001 1.2(0.9-1.5) <0.001 Wealth quintile Lowest 15.7(3.3) <0.001 1 Second 16.0(3.6) 0.4(-0.1-0.8) 0.109 Middle 16.3(3.7) 0.6(0.15-1.04) 0.009 Fourth 16.4(3.6) 0.7(0.3-1.2) 0.001 Highest 17.8(4.1) 2.2(1.7-2.6) <0.001 Total 16.4(3.7) Unadjusted Beta Coefficient (uβC) and Confidence Interval (CI), The mean PDQS was 16.4±3.7 with min=7 and max=34 out of 42 possible scores . Dietary Habits among SAC Our study findings found that overall, in the previous seven (7) days leading up to the survey, 50.4 percent of the children and adolescents aged 5-19 years in Zanzibar never had breakfast; only two (2) percent reported to eat outside home for at least three (3) or more times a week, and 56.6 percent eat snacks almost every day (see figures 1, and 2). Table 4 below, describe dietary habits among school children and adolescents of 5-19 years by sex and age. Dietary Habits among school children and adolescents of 5-19 years by sex and age. Missing breakfast was almost similar for both genders—boys and girls; however, the proportion is slightly higher for boys (51.1%) than for girls (49.8%), who reported having missed breakfast in the last seven (7) days before the survey. Among SAC who did not have breakfast at all in the last seven (7) days before the survey, children in the early adolescence aged 10-14 years were more likely to miss breakfast (53.5%) compared to the youngest aged 5-9 years (48.3%) and the older group aged 15-19 years (48.2%). Among the SAC who did not have any breakfast, 50.8 percent were from rural settings and 49.7 percent from urban settings. Having breakfast among children is very heterogeneous across regions. The findings indicate more than half of the school age children and adolescents aged 5-19 years from Kusini Unguja (53.8 %) and Mjini Magharibi (52.1%) had not had any breakfast in the past seven days. Having breakfast among children is very heterogeneous across districts. The study findings indicate that more than half of the school-age children and adolescents 5-19 years from Kati (56.1%), Magharibi B (56.6%) and Micheweni (57.4%) had not had any breakfast in the past seven days. A high proportion of younger school age children in younger age (62.9%) reported to eat snacks at school on a daily basis compared to children in the early adolescence (56.4%) and older children (50%). Eating snacks in school was more common among SAC from urban (57.8%) than those from rural settings (55.8%). Eating snacks in school was more common among school children and adolescents 5-19 years in Kusini Pemba (78.3%), Kaskazini Pemba (57.6%) and Mjini Magharibi (54.1%). By district, eating snacks in school almost daily was observed to be higher among school children and adolescents aged 5-19 years from Chake Chake (79.9%), Mkoani (76.6%) and Mjini (59.5%) whereas the lowest was Kaskazini A (42.4%). Table 4: Dietary Habits among school children and adolescents of 5-19 years by sex and age Background characteristics Never Almost every day 2 - 4 times a week 1 - 3 times a month Breakfast Breakfast Breakfast Breakfast Sex Girls 49.8 33.3 15.5 1.4 Boys 51.1 35.6 12.5 0.9 Age group 10 - 14 53.5 30.3 14.7 1.4 15-19 48.2 31.8 18.8 1.3 5 - 9 48.3 42.2 8.8 0.6 Residence Rural 50.8 32.6 14.8 1.8 Urban 49.7 36.3 13.5 0.5 Region Kaskazini Pemba 53.6 30 13.2 3.1 Kaskazini Unguja 43.7 35.8 18.4 2.1 Kusini Pemba 46.7 42.6 10.8 0 Kusini Unguja 53.8 29.6 15.3 1.3 Mjini Magharibi 52.1 34.1 13.7 0.2 District Chake Chake 44.3 45.7 10 0 Kaskazini A 32.6 42.4 20.7 4.3 Kaskazini B 54.1 29.6 16.3 0 Kati 56.1 27.6 14.3 2 Kusini 51.5 31.6 16.3 0.5 Magharibi A 51.5 33.8 14.1 0.7 Magharibi B 56.6 31.9 11.4 0 Micheweni 57.4 29.7 10.8 2.1 Mjini 47 37.1 15.9 0 Mkoani 49.1 39.4 11.5 0 Wete 50.6 30.3 15.1 4 Water, sanitation and hygiene (WASH) practices Based on the survey findings, water sources were categorized into improved and unimproved water sources. Improved water sources were tap-water within dwellings, tap-water in the neighborhood, covered wells and bottled water. On the other hand, unimproved water sources were springs/ rivers and unprotected wells. Most (94.2%) of the study respondents reported to use improved drinking water sources, particularly tap-water for drinking purposes as compared to unimproved (5.%). Over half (67%) reported treating water for drinking purposes with either boiling, clorination or letting it to settle. Survey results indicate that, more than 70% of the respondents reported having improved toilet facilities in their respective households (flush toilet facilities 59.7%, covered pit-latrines/VIP 11.1%, and ecological toilets 0.4%). More than 20 percent had unimproved toilet facilities (14.9% uncovered pit-latrine, 8.3% covered pit-latrine but not washable) whereas 5.6 percent did not have latrines at all. The survey results further show that out of households that reported using improved toilet facilities, 73.3 percent were not shared with other households. Among those with unimproved toilet facilities, only 18.4 percent reported not sharing with other household members (see figure 3). Table 5 further presents details on the sanitation service ladder in terms of percentage distribution of de jure population by type of sanitation service, according to background characteristics. Table 5: Sanitation Service Ladder Background characteristics At least basic service 1 Limited service 2 Unimproved 3 Open defecation 3 Total Number of persons Residence Urban 71.9 11.8 14.3 2.1 100.0 1,241 Rural 52.2 16.4 21.1 10.3 100.0 1,054 Region Kaskazini Pemba 57.3 15.3 12.7 14.6 100.0 424 Kaskazini Unguja 43.5 14.3 34.6 7.6 100.0 315 Kusini Pemba 71.7 10.7 8.3 9.3 100.0 420 Kusini Unguja 49.2 25.6 23.0 2.2 100.0 313 Mjini Magharibi 73.8 10.2 15.7 0.4 100.0 823 Wealth quintile Lowest 66.3 14.0 15.6 4.1 100.0 1,893 Second 60.3 13.3 21.2 5.3 100.0 151 Middle 47.6 9.5 42.9 0.0 100.0 21 Fourth 100.0 0.0 0.0 0.0 100.0 1 Highest 37.2 14.6 26.6 21.7 100.0 226 Total 62.8 13.9 17.4 5.8 100.0 2295 1 Improved sanitation facilities include a pit-latrine with slab, a ventilated improved pit-latrine, a flush toilet, a pour-flush toilet or a composting toilet that are single-sex a usable 2 Improved sanitation facilities such as a pit-latrine with slab, a ventilated improved pit-latrine, a flush toilet, a pour-flush toilet or a composting toilet that are no single-sex or unusable 3 A pit-latrine with no slab, or a no ventilated improved pit-latrine, or no composting toilet or no sanitation facilities 3 Same as open defecation by standard definition should added together H ygiene situation and habits among the participants About 67% of the participants reported to wash their hands with soap and water before eating. Another 29.8% reported using water only, and only 0.2% reported not wash their hands with water and sand. The results further showed that 1.3% of the respondents normally did not wash hands with either water or soap. About 70.9% of participants aged 15 - 19 years and 63.7% of the respondents aged 10 - 14 years wash their hands after visiting the toilets (Table 6). Table 6: Hand-washing practice after visiting toilets among the participants by demographic characteristics: Washing hands practice after visiting toilet Never Rarely Many times, Number Percent Number Percent Number Percent SEX Boys 102 8.3 314 25.6 812 66.1 Girls 159 12.1 346 26.3 813 61.7 AGE 5 - 9 104 13.4 226 29.1 446 57.5 10 - 14 116 11 267 25.3 673 63.7 15 - 19 41 5.7 167 23.4 506 70.9 Washing hands before eating More than two-thirds (63.9%) of the pupils reported washing their hands before eating with only 0.2% who did not. Optimal washing of hands behavior before eating was also observed by age groups, such that behavior of washing hand increased with increase in age. Pupils aged 15-19 (69%) and 10-14 years (64.5%) were more likely to wash their hands after eating compared to pupils aged 5-9. Majority of boys (73.4%) reported to wash their hands before eating than girls (55.1%), and the majority reported to use water and soap 65.8 percent (n=1681). Almost 1-in-3 children reported to wash their hands with water only (Table 7). Table 7: Distribution of hand washing practices by age and sex Never Really Sometimes Many Times, Most of the time Sex Boys 0.3 0.6 9.1 16.5 73.4 Girls 0.2 1.4 13.6 29.6 55.1 Age 5 – 9 0.3 1.7 15.5 24 58.6 10 – 14 0.2 0.8 12.3 22.3 64.5 15 – 19 0.3 0.8 5.7 24.1 69 Discussion This cross-sectional study was conducted to describe the current state of eating habits, water, sanitation and hygiene practices among school-going children and adolescents in Zanzibar. The study was conducted amidst concerns about the growing burden of overweight and obesity and poor sanitation and hygienic practices among children and adolescents in Zanzibar. Because of limited studies on the topic, the findings are expected to fill the scholarly gaps and offer recommendations for improving the health and well-being of school children and adolescents in Zanzibar. Moreover, adequate nutrition has been strongly linked to better academic outcomes ( 19 – 21 ). For example, a study in Ethiopia indicated that children with poor nutrition were characterised by stunting, being underweight and wasting and had poorer academic performance than normal children ( 20 ). It is therefore expected that the findings will catalyse the investment in this age group that investments in consequently improving academic performance in Zanzibar. We used PDQS to determine the frequency thresholds of consumption of healthy food groups among school children and adolescents. The findings indicated that vitamin A-rich vegetables and fruits, dark leafy green vegetables and fish are commonly consumed, however, an alarming proportion of school children and adolescents appear to not consume these foods. For example, looking at the results, more than half (52%), a third (30.2%, and almost half 43.3%) appears to not consume fish, vitamin A rich vegetables and fruits, and green leafy vegetables respectively. Similarly, the findings indicate less consumption of Eggs, Cruciferous vegetables and Other whole fruits. Notably, half of the school children and adolescents never had breakfast in the past seven days and more than half eat snacks almost every day. While it is recommended that adolescents consume should consume healthy foods ( 21 ), our findings noted high consumption of six unhealthy food groups on the contrary. We noted that two in five school children and adolescents consumed refined grains and baked goods, desserts and ice creams although the consumption of processed and red meat was generally low. In general, our findings report poor dietary food intake among school children and adolescents with an alarming consumption of unhealthy foods. Poor dietary food intake among school children and adolescents is not uncommon ( 22 – 24 ). For example, a study examining food consumption patterns among adolescents aged 14–16 years in private, English-speaking schools in Kolkata, India using a self-administered questionnaire reported poor dietary practices ( 24 ). Over one-quarter of adolescents reported no consumption of vegetables with over 70% reported consumming three or more servings of energy-dense snacks, almost half having not consumed fruits and almost half reported drinking three or more servings of energy-dense beverages. In support, a review of the literature to characterize and assess food consumption patterns and nutrient intakes in the Eastern Mediterranean countries also reported poor dietary patterns among school-aged children (5–10 years) and adolescents (10–19 years) ( 23 ). The findings of this review indicated documentation of low intake of fruits, vegetables and fibre, inadequate consumption of water, milk and dairy products complicated with high intakes of fat, saturated fat, and sugar-sweetened beverages and frequent consumption of energy-dense, nutrient-poor foods such as sweet and savoury snacks ( 23 ). Consequently, the authors recommended a need for “a food system approach in developing and implementing national and regional policies and interventions aimed at improving the diet of children and adolescents”( 23 ). It is important to note that few previous studies in Zanzibar have reported adverse nutritional manifestations such as iron deficiency anaemia among school children in Zanzibar ( 25 , 26 ). Our findings therefore point to a suggestion that more efforts are needed to improve the intake of healthy foods among school children and adolescents in Zanzibar as a strategy to reduce the prevalence of nutritional-related diseases. When considering interventions for improving nutritional status among school children and adolescents, it is important to focus on the identified predictors. Our study indicated that higher PDQS scores (good food practices) were statistically significantly associated with male genders and living in some regions such as Kaskazini A, Magharibi A, Kaskazini Unguja and Mjini Magharibi, more mature children and adolescents (10–19 years) and being in a financially stable family. This suggests that girls, living in Kaskazini B and Kusini Unguja, being much younger age group (5-9years), studying in private schools and being in a family which have less income are associated with poor food intake. Comparing our findings with previous studies, while girls were found to have better food intake as compared to boys in India ( 24 ), there is a broad consensus in the literature that living in a low-income family predisposes to poor food intake ( 19 – 23 , 27 ). This points to a suggestion that girls and children from economically disadvantaged families should be prioritized in efforts to improve food intake among school children and adolescents in Zanzibar. It is evident that safe water, toilets and good hygiene have a huge impact on the life and health of children and adolescents. UNICEF has continually insisted that access to clean and safe water, basic toilets, and good hygiene practices not only keeps children thriving but also gives them a healthier start in life ( 28 ). Cognizant of this, we went ahead to assess water, sanitation and hygiene practices among school children and adolescents. It is also important to note that adequate water intake is considered to improve weight status, reduce dental caries, and improve cognition among children and adolescents ( 29 , 30 ). However, access to safe and clean water among school children and adolescents is challenging in many LMICs including Tanzania ( 30 , 31 ). Our findings indicated that the majority of participants reported using improved drinking water although almost a third quarter (33 per cent) did not report treating water for drinking purposes with either boiling, chlorination or letting it settle. This indicates that there is a need for continued efforts to improve access to safe and clean water in Schools in Zanzibar Furthermore, the 2018 Tanzania National School WASH Report ( 18 ) indicate that only a quarter of schools in Tanzania meet the minimum government standard for the number of students per toilet (20 girls and 25 boys per toilet), and only 17 per cent of schools provided changing rooms with basic amenities, such as water, waste bin, soap and emergency supplies. While the report focused on school settings, we focused on access to toilets at home. Our findings indicate that almost a third reported not having improved toilet facilities in their respective households with more than one-fifth having unimproved toilet facilities and almost 6 per cent did not have latrines at all. This calls for more efforts to ensure access to improved toilet facilities at home among school children and adolescents alongside efforts to improve access in school settings. Finally, we examined hygiene practices characterized by hand washing practices. Our findings indicated that a third of school children and adolescencts wash hands with water only (without soap) before eating with few not washing at all. Furthermore, a third of school children and adolescents aged 10–14 years, and more than a quarter of those aged 15–19 years do not wash hands after visiting the toilets. These findings are important because washing hands with soap and water has been reported to reduce diarrhoeal burden among children. This is evident in a review of literature which reported that interventions promoting hand washing contributed to a 39% reduction in diarrhoea episodes in children in high-income countries, and a 32% reduction of diarrhoeal in children in LMICs ( 18 ). This indicates a need for intensifying efforts to improve hand-washing practices among school children and adolescents in Zanzibar. Limitations This study is not without limitations. Although the findings address the research gap in Zanzibar and may be useful in policy formulation, the study did not examine the feeding habits, water intake and hygienic practices of caregivers as they may influence the habits and practices of school children and adolescents. Further studies that tap into the food habits, water consumption and hygienic practices are recommended for generating a comprehensive understanding of the persistent contributors of poor habits and practices in Zanzibar. Likewise, the study only focused on school children in Zanzibar. Future studies may seek to extend beyond schools to out-of-school children who may be at a disadvantage as compared to those attending schools. Conclusion While a commendable number of school children and adolescents have good food habits, drink clean water and wash their hands with soap and water, an alarming number of students have poor food habits and practices. Evidently, good feeding habits, and drinking safe and clean water have a positive impact on children's academic performance, health and wellbeing. A main challenge however is finding ways of encouraging families and schools to ensure access to healthy foods, access to safe and clean water and encouraging school children and adolescents themselves to wash their hands properly. With a global commitment to improve WASH for school children( 28 – 32 ) we welcome the government, development partners and implementation researchers to develop and implement effective interventions for improving food habits, and water and hygienic practices as an entry point for improving both academic and health outcomes among school children and adolescents. Abbreviations WASH: Water, Sanitation, and Hygiene BMI: Body Mass Index RDA: Recommended Dietary Allowance PSU: Primary Sampling Unit PPS: Probability Proportional to Size SRS: Simple Random Sampling Declarations Ethics approval and consent to participate This study involves human participants. This study received ethics clearances from a the Zanzibar Health Research Institute (ZAHREC/03/SEP/2021/24). The chief investigator of this project is affiliated with the National Institute for Medical Research in Tanzania. Additionally, gateway permission was obtained from the administration of local authorities and selected Schools. All study participants were informed about the study and written informed consent/ assent forms were obtained before the interviews. All study responses were kept confidential and data collection ensured privacy. Further, all data gathered were not used for purposes other than the present research. Competing interests None declared. Patient consent for publication Not applicable. Funding This study was a UNICEF consultancy award (Award Number: 56282) received by Dr. Esther Ngadaya. Author Contribution Proposal Development : EN, AM, HM, KIAnalysis:EN,KI,G, Funding acquisition: ENMethodology: EN, GK,KIand AM. Writing - original draft: EN. Writing-reviewing andediting: AS, GL,EN, AM,DS, KMK, GK,GM,FAS, KI, MK, PC, HM and JN. EN, GL, HSaccepts full responsibility for the finished work and/or the conduct of the study, haddata collection and controlled the decision to publish Acknowledgement The Ministry of Health (MoH) Zanzibar would like to express its gratitude and appreciation to all individuals, institutions, and partners who contributed to the implementation of this School Health and Nutrition Survey (SHNS) conducted in Zanzibar. In particular, the MoH acknowledges the contribution of partners from governmental agencies, the Office of the Chief Government Statistician (OCGS), the Ministry of Education and Vocational Training (MoEVT) together with the Tanzania Food and Nutrition Centre for their active participation and technical inputs toward this survey.Special thanks go to the United Nations Children’s Fund (UNICEF) for their technical and financial support, and for seeing the requirement to adopt a similar study on Tanzania Mainland. The MoH would also like to thank all individual consultants, oversight organisations and partners for their roles in organising and preparing questionnaires, training of field staff, co-ordination of fieldwork, and support in developing this report, who include individuals from the Muhimbili University of Health and Allied Sciences (MUHAS), the National Institute for Medical Research (NIMR), and the Nelson Mandela University.The MoH would also like to thank all the field supervisors, who oversaw the data collection exercise, and field data collectors who interviewed students. Moreover, the MoH would like to extend its appreciation to Data Entry Clerks, Regional and District teams (e.g., Malaria Focal Persons, laboratory technologists/technicians, School Health Programme Co-ordinators, Nutrition Officers, and drivers) for their participation during the survey. Furthermore, the MoH would like to thank all the students and school teachers for their readiness to participate in the survey. The MoH would also like to acknowledge the following teams of experts involved in the report preparation and finalization.Data analysis, Report writing and finalisation Team: Dr. Geofrey Mchau, Sauli Epimark, Shemsa Msellem, Hawa Msola, Fatma Abdallar, Dr Anna Mosses, Dr David Solomon and Asha Samini, Fatma Said, Adam Haji Ame, Heavenlight Ayubu, Stanlaus Erick Mollel, Salum Kassim Ally, Fahima Mohamed Issa, Sabina Raphael Daima, Kombo Mdachi Kombo, Hadija Hamisi Hamadi, Ahmad Hamza Mohamed, Aisha Mohamed Said, Asha Mahafodhi, and Prof. Esther Ngadaya. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Helwig NE, Hong S, Hsiao-wecksler ET. No 主観的健康感を中心とした在宅高齢者における 健康関連指標に関する共分散構造分析Title. Tofail F, Fernald LC, Das KK, Rahman M, Ahmed T, Jannat KK, et al. Effect of water quality, sanitation, hand washing, and nutritional interventions on child development in rural Bangladesh (WASH Benefits Bangladesh): a cluster-randomised controlled trial. Lancet Child Adolesc Heal [Internet]. 2018;2(4):255–68. Available from: http://dx.doi.org/10.1016/S2352-4642(18)30031-2 Mank I, Vandormael A, Traoré I, Ouédraogo WA, Sauerborn R, Danquah I. Dietary habits associated with growth development of children aged < 5 years in the Nouna Health and Demographic Surveillance System, Burkina Faso. Nutr J. 2020;19(1):1–14. Otinwa G, Jaiyesimi B, Bamitale T, Owolabi H, Owolewa M. Eating habits and nutrition status of Nigerian school children in rural and urban areas (NigeriaLINX pilot project). Heliyon [Internet]. 2023;9(7):e17564. Available from: https://doi.org/10.1016/j.heliyon.2023.e17564 Abdelaziz SB, Youssef MRL, Sedrak AS, Labib JR, Abdelaziz SB, Youssef MRL, et al. Nutritional Status and Dietary Habits of School Children in Beni-Suef Governorate, Egypt. Food Nutr Sci [Internet]. 2015 Jan 12 [cited 2023 Sep 29];6(1):54–63. Available from: http://www.scirp.org/Html/7-2701420_53087.htm Ugochukwu E, Onubogu C, Okeke K, Edokwe E. Nutritional contents of lunch packs of primary school children in Nnewi, Nigeria. Ann Med Health Sci Res. 2014;4(8):108. Nutrition [Internet]. [cited 2023 Oct 1]. Available from: https://www.who.int/health-topics/nutrition#tab=tab_1 Adolphus K, Lawton CL, Dye L. The effects of breakfast on behavior and academic performance in children and adolescents. Prenat Child Nutr Eval Neurocognitive Connect. 2015;7(August):289–319. Szajewska H, Ruszczyński M. Systematic Review Demonstrating that Breakfast Consumption Influences Body Weight Outcomes in Children and Adolescents in Europe. Crit Rev Food Sci Nutr [Internet]. 2010 Feb [cited 2023 Oct 1];50(2):113–9. Available from: https://www.tandfonline.com/doi/abs/10.1080/10408390903467514 Hoyland A, Dye L, Lawton CL. A systematic review of the effect of breakfast on the cognitive performance of children and adolescents. Nutr Res Rev. 2009;22(2):220–43. Sandercock GRH, Voss C, Dye L. Associations between habitual school-day breakfast consumption, body mass index, physical activity and cardiorespiratory fitness in English schoolchildren. Eur J Clin Nutr 2010 6410 [Internet]. 2010 Aug 4 [cited 2023 Oct 1];64(10):1086–92. Available from: https://www.nature.com/articles/ejcn2010145 Vaccaro B. Triple threat. Fire Rescue Mag. 2016;34(6). McMichael C. Water, sanitation and hygiene (WASH) in schools in low-income countries: A review of evidence of impact. Int J Environ Res Public Health. 2019;16(3):1–21. Article Text-187683-1-10-20120730. Tanzania’s Water Crisis - Tanzania’s Water | Water.org [Internet]. [cited 2023 Sep 29]. Available from: https://water.org/our-impact/where-we-work/tanzania/ Redae GA, Mengestu TK, Abdalla FM, Slim SN, Simon VT, Ali AO, et al. Towards cholera elimination in Zanzibar: analysis of evidences on what have worked. Pan Afr Med J. 2023;45(Supp 1):6. Ministry of Finance and Planning, Tanzania National Bureau of Statistics, Office of the Chief Government Statistician Zanzibar. The 2022 Population and Housing Census: Age and Sex Distribution Report Tanzania Mainland. 2022;1–23. Ejemot-Nwadiaro RI, Ehiri JE, Arikpo D, Meremikwu MM, Critchley JA. Hand-washing promotion for preventing diarrhoea. Cochrane Database Syst Rev. 2021;2021(1). Chinyoka K. Impact of Poor Nutrition on the Academic Performance of Grade Seven learners: A Case of Zimbabwe. Int J Learn Dev. 2014;4(3):73. Asmare B, Taddele M, Berihun S, Wagnew F. Nutritional status and correlation with academic performance among primary school children, northwest Ethiopia. BMC Res Notes [Internet]. 2018;11(1):1–6. Available from: https://doi.org/10.1186/s13104-018-3909-1 Tell MN, Hedin K, Nilsson M, Golsäter M, Lingfors H. Food intake in children and adolescents: a cross-sectional study from 2009/2010 to 2015/2016. J Nutr Sci. 2021;10:e51. Desbouys L, De Ridder K, Rouche M, Castetbon K. Food consumption in adolescents and young adults: Age-specific socio-economic and cultural disparities (Belgian Food Consumption Survey 2014). Nutrients. 2019;11(7). Al-Jawaldeh A, Taktouk M, Nasreddine L. Food consumption patterns and nutrient intakes of children and adolescents in the eastern mediterranean region: A call for policy action. Nutrients. 2020;12(11):1–28. Unconfirmed 793703.crdownload. Stoltzfus RJ, Chwaya HM, Tielsch JM, Schulze KJ, Albonico M, Savioli L. Epidemiology of iron deficiency anemia in Zanzibari schoolchildren: The importance of hookworms. Am J Clin Nutr [Internet]. 1997;65(1):153–9. Available from: https://doi.org/10.1093/ajcn/65.1.153 Said FA, Khamis AG, Habib A, Yang H, He Z, Luo X. Prevalence and determinants of anemia among children in zanzibar, tanzania: Analysis of cross-sectional population representative surveys. Children. 2021;8(12). Florence MD, Asbridge M, Veugelers PJ. Diet quality and academic performance: Research article. J Sch Health. 2008;78(4):209–15. Water, Sanitation and Hygiene (WASH) | UNICEF [Internet]. [cited 2023 Oct 1]. Available from: https://www.unicef.org/wash Patel AI, Hampton KE. Encouraging consumption of water in school and child care settings: Access, challenges, and strategies for improvement. Am J Public Health. 2011;101(8):1370–9. Jena S, Satpathy N, Sahoo KC, Epari V. Access to water, sanitation and hygiene in schools: A prerequisite to achieving SDGs in India. J Prev Med Hyg. 2022;63(4):E495–6. How water, sanitation and hygiene contribute to girls’ education in Tanzania | UNESCO [Internet]. [cited 2023 Oct 1]. Available from: https://www.unesco.org/en/articles/how-water-sanitation-and-hygiene-contribute-girls-education-tanzania NBS, OCGS, UNICEF. 2018 school water, sanitation and hygiene assessment: Main report. Gov Tanzania [Internet]. 2020;(February). Available from: https://www.unicef.org/tanzania/media/2356/file/National School WASH Report 2020.pdf Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6113106","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":424562454,"identity":"0a677f81-9040-4dac-a3a5-d5eba567b2b9","order_by":0,"name":"Asha Salmin","email":"","orcid":"","institution":"Ministry of Health and Social Welfare","correspondingAuthor":false,"prefix":"","firstName":"Asha","middleName":"","lastName":"Salmin","suffix":""},{"id":424562455,"identity":"060c15ef-9aa5-46b3-932b-113645a78246","order_by":1,"name":"Germana Leyna","email":"","orcid":"","institution":"Tanzania Food and Nutrition 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had snack in the previous seven days\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6113106/v1/aaf6d96b37f650c96567f2da.png"},{"id":78238808,"identity":"cdfd5de1-663a-49fc-aa96-79a2cab7e0f0","added_by":"auto","created_at":"2025-03-11 08:50:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30193,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eNumber of times SAC had snack in the previous seven days\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6113106/v1/9d8143112f1a49c1727c3d85.png"},{"id":78238807,"identity":"164468c5-db38-48f9-8e32-0908fd4385e0","added_by":"auto","created_at":"2025-03-11 08:50:22","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":5405,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eToilet facility sharing\u003c/em\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6113106/v1/aa4e635fd9c3952a06fe3970.png"},{"id":102245762,"identity":"ba42e405-6ca5-4d33-8395-042b774c8a19","added_by":"auto","created_at":"2026-02-09 17:56:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1935661,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6113106/v1/f3b602ca-6307-4c09-b35d-91e609570a32.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of Dietary Habits, Water, Sanitation, and Hygiene Practices Among School Aged Children and Adolescents in Zanzibar: Implications for Health and Academic Performance","fulltext":[{"header":"Background","content":"\u003cp\u003eThe eating habits, water, sanitation, and hygiene practices among school-going children play a crucial role in their overall health, well-being, and academic performance at the present and in their future life (1). These aspects are interlinked and contribute significantly to the physical and cognitive development of children (2). Inappropriate eating patterns have been significant contributors to mortality and morbidity in children (3). Unhealthy eating practices, such as increased consumption of high-calorie snacks, skipping breakfast, dining out frequently, consuming soft drinks, and having lower intakes of fruits, vegetables, and dietary supplements, have been identified in several studies conducted in both developed and developing countries (4,5). \u003c/p\u003e\n\n\u003cp\u003eChildhood is a critical period for establishing lifelong healthy habits, as such dietary habits that the child and adolescent acquires has significant impact on their life as well as their future life, and contribute to their congnnitive development and school performance. School going children required sufficient among of protein to meet their maintainance demands, and promote health growth, as such access to a good healthy breakfast and mid-day meals is very crutial not only to their nutritional stutus but also make them concentrate with their studies (6). According to the Recommended Dietary Allowances (RDAs), protein requirements per kg of body weight drop from around 1.8 g in young children to 1.2 g in late childhood. However, combining plant and animal foods, such as cereal with beans, nuts, lentils, seeds, milk, and other dairy products, can offer the correct amount of protein to meet these demands (7). Furthermore, breakfast a widely acknowledged most important meal of the day, has associated with a number of good nutrition advantages in children such as higher intake of dietary fiber, total carbohydrate and lower total fat and cholesterol (8) large contribution to daily micronutrient intake (8) maintaining a body mass index (BMI) within the normal range (9) and positively affects learning (10). Physical inactivity and low cardio respiratory fitness level has also been associated with lack of breakfast intake (11).\u003c/p\u003e\n\n\u003cp\u003eMoreover, inadequate access to safe water and sanitation facilities can lead to numerous health issues, including diarrhoea, malnutrition, and reduced school attendance. The assessment of the worldwide WASH burden reveals that 600 million children continue to face a deficit in the provision of safely managed drinking water, 1.1 billion lack access to safely managed sanitation facilities, and 689 million do not have access to basic hygiene services (12). An evaluation by UNICEF found that in schools in low-income countries, only 51% of schools had access to adequate water sources and only 45% had adequate sanitation (13). In Tanzania, approximately four million individuals lack access to a safe water source, and an alarming 29 million people do not have adequate sanitation facilities (14). These challenges disproportionately impact vulnerable groups, with women and children being particularly affected (15,16). By investigating these aspects and understanding the factors influencing these behaviours, effective interventions and policies to promote healthy lifestyles among children can be designed. Therefore, this research paper sought to examine the current state of eating habits, water, sanitation and hygiene practices among school going children, shed light on the existing gaps and develop evidence-based recommendations to enhance the overall health and well-being of school-going children in Zanzibar.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was a school-based cross-sectional study. Data were gathered from students aged between 5 and 19 years who were enrolled in primary and secondary schools during the academic year 2022. Students with serious illness or who were unwilling to participate were excluded. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in Zanzibar. Zanzibar is an insular semi-autonomous province which united with Tanganyika in 1964 to form the United Republic of Tanzania with the total population of 1,889,773 persons in the 2022 Census(17). Over one third of the population is between 5 to 19 years. Zanzibar is an archipelago in the Indian Ocean, 25\u0026ndash;50 km (16\u0026ndash;31 mi) off the coast of the African mainland, and consists of many small islands and two large ones: Unguja (the main island, referred to informally as Zanzibar) and Pemba Island. The capital is Zanzibar City, located on the island of Unguja. Zanzibar has a total of 5 regions (3 in Unguja and 2 in Pemba). Almost half of the population (893,169; 47.3%) is found in only one region Mjini Magharibi which is in Unguja. Zanzibar\u0026apos;s marine ecosystem is an important part of the economy for fishing and algaculture and contains important marine ecosystems that act as fish nurseries for Indian Ocean fish populations, and also main source of protein for its citizen including children and adolescents. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling technique: \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe utilized a stratified multi-stage sample design(18). The initial stage involved selecting a sample of schools as the primary sampling unit (PSU) using a probability proportional to size (PPS) method. In the second stage, one class level was selected using a simple random sampling approach (SRS), followed by the selection of individuals from these classes. Each selected class had 28 students evenly distributed by sex (14 girls and 14 boys), chosen using a systematic sampling technique.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size calculation:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample was selected to provide a plausible estimate of anthropometric and Hemoglobin level across different domains, such as national, regional and district levels as well as urban/rural areas, and according to the sex. The sample size was estimated at the district level (domains) and aggregated to obtain the regional and national sample. The prevalence of anemia was the preferred indicator, utilizing an indicative value of 50%, with a margin error of 0.5, significance level of 5%, and design effect of 1.5.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData and Sample collection.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocial-demographic and economic data collection:\u003c/strong\u003e A pre-tested structured questionnaires were used to collect data on demographic characteristics and socioeconomic factors after obtaining written informed consent form through face-to-face interview. Questionnaire were developed in English, translated into Swahili and then back-translated to English to verify accuracy. A household level index was determined using Principal Component Analysis (PCA) by considering household assets and type of house. First, variables were coded between 0 and 1. Secondly, variables were entered and analyzed using PCA, and variables with communality values of greater than 0.5 were used to produce factor scores. Finally, factor scores were summed and ranked into tertials as poor, medium, and rich.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnthropometric measurements\u003c/strong\u003e: The recording of age, weight, and height of the participants, and measurements were done in the school premises by using a portable weight scale and a stadio-meter with a sliding headpiece. Survey questions regarding the availability and use of sanitation facilities, disposal methods for different types of waste (organic, plastic, etc.) were used. Furthermore observational measures and self-report questionnaires on hand washing frequency and technique were used to measure hygiene level of the respondents.\u003c/p\u003e\n\u003cp id=\"_Toc144052185\"\u003e\u003cstrong\u003eDietary habits\u003c/strong\u003e: Dietary surveys and food frequency questionnaires were used to evaluate children\u0026rsquo;s eating habits. Dietary quality is an optimal measure of nutrients for the wellbeing. Dietary quality among schoolchildren and adolescents 5-19 years was assessed using the Prime Diet Quality Score (PDQS). The Prime Diet Quality Score (PDQS) was recently developed using a modified Prime Screen questionnaire as a way to characterize diet quality globally and was associated with a lower risk of coronary heart diseases (CHD) to a large population in USA. PDQS contained 21 food groups; 13 were categorized into healthy, and 8 as unhealthy food groups. Food groups were queried on a 5- point Likert scale: 0= never, 1= once in a week, 2-4 times a week, 5-6 times a week and every day. Points were assigned for consumption of healthy food groups as follows: 0\u0026ndash;1 serving/week= 0 points; 2\u0026ndash;3 servings/week= 1 point; and \u0026ge;4 servings/week=2 points. Scoring for unhealthy food groups was assigned as follows: 0\u0026ndash;1 serving/week=2 points; 2\u0026ndash;3 servings/week= 1 point; and \u0026ge;4 servings/week= 0 points. Individual scores were aggregated to gen an overall score which ranged from 0 to 42 possible scores, the higher the score the quality of diet consumed by a respective children or adolescent. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWater, sanitation and hygiene (WASH) practices\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe structured questionnaire facilitated the systematic collection of data. Participants were asked to identify their primary source of drinking water, practices related to water treatment and the type of toilet facilities available in households.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData management and analysis: \u003c/strong\u003eData were collected using a tablet-based questionnaire, programmed into the Survey Solutions software, with paper forms available as backup. A chain of supervisors approved the data, transmitted to the cloud server after every session of data entry. Data cleaning was undertaken by a trained team. Simple descriptive analyses were executed in Microsoft Excel for routine reporting. \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe sampled of 2,556 children and adolescents aged 5 to 19 years participated in the study. The study was implemented in all 11 districts of Zanzibar. The demographic and socio-economic characteristics of the survey population including age, sex, place of residence, caregiver\u0026rsquo;s schooling and household wealth status is presented in Table 1 (below). A Slightly higher proportion (51.7%; 1,322) of the study participants were girls. Almost 2 in 5 were individuals from 10-14 years, and most of them were from primary school. Slightly over 5 in 10 were residing in urban areas.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Social demographic characteristics of the study participants (5-19 years; N= 2,556)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBackground Characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1,234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e48.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1,322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e51.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e5 \u0026ndash; 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e784\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e30.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e10 \u0026ndash; 14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1,058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e41.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e15 \u0026ndash; 19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e27.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of Education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1,768\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e69.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;Secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e788\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e30.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool ownership\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003ePublic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e2463\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e96.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eArea\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1,194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e46.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;Urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1,362\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e53.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWealth quintile\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eLowest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;530 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e20.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eSecond\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e493\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e19.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e20.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eFourth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eHighest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e482\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e18.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDistrict\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eKaskazini A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eKaskazini B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eKati\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eKusini\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eMjini\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eMagharibi A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eMagharibi B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eWete\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eMicheweni\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eChakechake\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eMkoani\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eKaskazini Unguja\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e380\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eKusini Unguja\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eMjini Magharibi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e901\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e35.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eKaskazini Pemba\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e446\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 44px;\"\u003e\n \u003cp\u003eKusini Pemba\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 27px;\"\u003e\n \u003cp\u003e17.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc142100454\"\u003e\u003cstrong\u003eDietary Quality Using\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 below describe the frequency thresholds of consumption of healthy food groups for at least \u0026gt;4 serving per week among study participants. Less than half of school-age children and adolescent consumed fish (48%), other vitamin A rich vegetables and fruits (69.8%) and dark leafy green vegetables (56.7%). Eggs (1.6%), Cruciferous vegetables (1.8%), and\u0026nbsp;Other whole fruits\u0026nbsp;(3.9%) were the least consumed. On the other hand, the frequency thresholds of consumption of 6 unhealthy food groups for at least \u0026gt;4 serving per week among SAC was also high, where over 2 in five school-age children and adolescents consumed refined grains and baked goods (40.9%), and desserts and ice cream (26.0%). Moreover, about 25.9 percent consumed fried foods obtained away from home for at least \u0026gt;4 serving per week. Processed meat (0.7%) and red meat (2.4%) consumption was low.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc112872829\"\u003e\u003cstrong\u003eTable 2: Frequency distribution of Prime dietary quality scores (PDQS) among SAC in Zanzibar (n=\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2556)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"651\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFood group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u0026ndash;1 serving/wk\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u0026ndash;3 servings/wk\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;4\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eserving/wk\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eHealthy food groups\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eDark green leafy vegetables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1,080\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e42.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e1,259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e49.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eCruciferous vegetables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e2,271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e88.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eRich vegetable and fruits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e594\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e23.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e965\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e37.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e997\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e39.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;Other vegetables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1,346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e52.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e699\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e511\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eFruits Whole citrus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e2,110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e82.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e339\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eOther whole fruits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e2,089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e81.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eLegumes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1,437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e56.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e979\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e38.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eNuts\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1,811\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e70.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e558\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e21.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003ePoultry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e2,045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e80.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eFish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e928\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e36.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1,227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e48.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eWhole grains\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1,959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e76.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eLiquid vegetable oils\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1,281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e50.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e805\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e31.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e470\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eEggs Freq.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e2,186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e85.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eUnhealthy food groups\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eRed meats\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e2,204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e86.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eProcessed meat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e2,478\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e97.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eRefined grains\u003cbr\u003e\u0026nbsp;and baked goods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e945\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e37.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e22.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1,044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e40.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eSugar-sweetened beverages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e2,007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e78.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e16.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eFried foods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1,222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e47.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e672\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e662\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e25.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eIce cream\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1,065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e806\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e31.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e685\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e26.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;Roots and tubers (cooked potatoes) \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e1,492\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e58.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e888\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e34.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003eLow-fat dairy: Drinking milk or milk products (e.g. yoghurt)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e2,036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e79.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePredictors of maximum PDQS scores using T-Test, ANOVA and linear regression model\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe assessment of the Prime Dietary Quality Scores (PDQS) among school-aged children in Zanzibar revealed a mean PDQS of 16.4\u0026plusmn;3.7, with scores ranging from a minimum of 7 to a maximum of 34 out of 42 possible scores. According to table 3 below, statistically significant maximum PDQS scores were associated with a male gender (u\u0026beta;C 1.5 (95% CI 1.2-1.8), living in Kaskazini A, Magharibi A, Kaskazini Unguja and Mjini Magharibi. In addition, children and adolescents aged 5 to 19 years from Unguja island and those with highest quintiles had the highest maximum PDQS scores than their comparison groups. In contrary, the following were statistically significant associated with decreased chances of having maximum PDQS scores; age group 5 to 9, children and adolescents studying in private schools, primary school students, those living in Kaskazini B and Kusini Unguja as well as children and adolescents from Middle and fourth quintiles\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Factors associated with PDQS scores (max scores) using T-Test, ANOVA and linear regression model\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"662\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003eu\u0026beta;C, 95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e17.2(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.5(1.2-1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e15.7(3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAge in years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003e5 to 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.6(3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.4(0.02-0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003e10 to 14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.4(3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.14(-0.22-0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.443\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003e15-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.2(3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eOwnership\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eGovernment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.4(3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e17.3(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.9(0.15-1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLevel\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.5(3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.4(0.1-0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.1(3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSettings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.3(3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.5(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.3(-0.01-0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDistrict\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eKaskazini A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.2(3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.4(0.6-2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eKaskazini B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e17.6(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.9(0.1-1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eKati\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e17.1(3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e-0.6(-1.4-0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eKusini\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e15.6(3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.0(0.3-1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eMjini\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e17.2(4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.5(-0.21-1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.176\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eMagharibi A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.7(4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.0(0.4-1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eMagharibi B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e17.2(4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e-0.3(-1.0-0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.351\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eWete\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e15.9(3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e-0.7(-1.5-0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eMicheweni\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e15.5(2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e-0.7(-1.4-0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eChakechake\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e15.5(3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e-0.7(-1.4-0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eMkoani\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e15.5(2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eRegion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eKaskazini Unguja\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.9(4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.4(0.9-1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eKusini Unguja\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.3(3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.8(0.3-1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eMjini Magharibi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e17.0(4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.5(1.1-1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eKaskazini Pemba\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e15.7(3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.2(-0.3-0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eKusini Pemba\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e15.5(2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eIsland\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003ePemba\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e15.6(2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eUnguja\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.8(4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.2(0.9-1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eWealth quintile\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eLowest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e15.7(3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eSecond\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.0(3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.4(-0.1-0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.3(3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.6(0.15-1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eFourth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.4(3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.7(0.3-1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eHighest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e17.8(4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e2.2(1.7-2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 150px;\"\u003e\n \u003cp\u003e16.4(3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eUnadjusted Beta Coefficient (u\u0026beta;C) and Confidence Interval (CI),\u0026nbsp;\u003c/em\u003e\u003cem\u003eThe mean PDQS was 16.4\u0026plusmn;3.7 with min=7 and max=34 out of 42 possible scores\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDietary Habits among SAC\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study findings found that overall, in the previous seven (7) days leading up to the survey, 50.4 percent of the children and adolescents aged 5-19 years in Zanzibar never had breakfast; only two (2) percent reported to eat outside home for at least three (3) or more times a week, and 56.6 percent eat snacks almost every day (see figures 1, and 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4 below, describe dietary habits among school children and adolescents of 5-19 years by sex and age. Dietary Habits among school children and adolescents of 5-19 years by sex and age. Missing breakfast was almost similar for both genders\u0026mdash;boys and girls; however, the proportion is slightly higher for boys (51.1%) than for girls (49.8%), who reported \u0026nbsp;having missed breakfast in the last seven (7) days before the survey. Among SAC who did not have breakfast at all in the last seven (7) days before the survey, children in the early adolescence aged 10-14 years were more likely to miss breakfast (53.5%) compared to the youngest aged 5-9 years (48.3%) and the older group aged 15-19 years (48.2%). Among the SAC who did not have any breakfast, 50.8 percent were from rural settings and 49.7 percent from urban settings. Having breakfast among children is very heterogeneous across regions. The findings indicate more than half of the school age children and adolescents aged 5-19 years from Kusini Unguja (53.8 %) and Mjini Magharibi (52.1%) had not had any breakfast in the past seven days. Having breakfast among children is very heterogeneous across districts. The study findings indicate that more than half of the school-age children and adolescents 5-19 years from Kati (56.1%), Magharibi B (56.6%) and Micheweni (57.4%) had not had any breakfast in the past seven days. A high proportion of younger school age children in younger age (62.9%) reported to eat snacks at school on a daily basis compared to children in the early adolescence (56.4%) and older children (50%). Eating snacks in school was more common among SAC from urban (57.8%) than those from rural settings (55.8%). Eating snacks in school was more common among school children and adolescents 5-19 years in Kusini Pemba (78.3%), Kaskazini Pemba (57.6%) and Mjini Magharibi (54.1%). By district, eating snacks in school almost daily was observed to be higher among school children and adolescents aged 5-19 years from Chake Chake (79.9%), Mkoani (76.6%) and Mjini (59.5%) whereas the lowest was Kaskazini A (42.4%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Dietary Habits among school children and adolescents of 5-19 years by sex and age\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"105%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 18px;\"\u003e\n \u003cp\u003eBackground characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003eAlmost every day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e2 - 4 times a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1 - 3 times a month\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eBreakfast\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eBreakfast\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eBreakfast\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eBreakfast\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Girls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e49.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Boys\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e51.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e35.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 10 - 14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e53.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e30.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 15-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e48.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e18.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 5 - 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e48.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e42.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Rural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e50.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e32.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e49.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e36.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Kaskazini Pemba\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e53.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Kaskazini Unguja\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e43.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e35.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eKusini Pemba\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e46.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e42.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eKusini Unguja\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e53.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e29.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eMjini Magharibi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e52.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e34.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDistrict\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eChake Chake\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e44.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e45.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eKaskazini A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e32.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e42.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e20.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eKaskazini B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e54.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e29.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e16.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eKati\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e56.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e27.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eKusini\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e51.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e31.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e16.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eMagharibi A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e51.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e33.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eMagharibi B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e56.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e31.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eMicheweni\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e57.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e29.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eMjini\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e37.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eMkoani\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e49.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e39.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eWete\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e50.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e30.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e15.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eWater, sanitation and hygiene (WASH) practices\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc104393221\"\u003eBased on the survey findings, water sources were categorized into improved and unimproved water sources. Improved water sources were tap-water within dwellings, tap-water in the neighborhood, covered wells and bottled water. On the other hand, unimproved water sources were springs/ rivers and unprotected wells. Most (94.2%) \u0026nbsp;of the study respondents reported to use improved drinking water sources, particularly tap-water for drinking purposes as compared to unimproved (5.%). Over half (67%) reported treating water for drinking purposes with either boiling, clorination or letting it to settle. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSurvey results indicate that, more than 70% of the respondents reported having improved toilet facilities in their respective households (flush toilet facilities 59.7%, covered pit-latrines/VIP 11.1%, and ecological toilets 0.4%). More than 20 percent had unimproved toilet facilities (14.9% uncovered pit-latrine, 8.3% covered pit-latrine but not washable) whereas 5.6 percent did not have latrines at all. The survey results further show that out of households that reported using improved toilet facilities, 73.3 percent were not shared with other households. Among those with unimproved toilet facilities, only 18.4 percent reported not sharing with other household members (see figure 3).\u003c/p\u003e\n\u003cp\u003eTable 5 further presents details on the sanitation service ladder in terms of percentage distribution of \u003cem\u003ede jure\u003c/em\u003e population by type of sanitation service, according to background characteristics.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Sanitation Service Ladder\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBackground characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt least basic service\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLimited service\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnimproved\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpen defecation\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of persons\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e71.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1,241\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e52.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003e16.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e21.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1,054\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eKaskazini Pemba\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e57.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003e15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e424\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eKaskazini Unguja\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e43.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e34.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e315\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eKusini Pemba\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e71.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003e10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e420\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eKusini Unguja\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e49.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003e25.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e23.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e313\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eMjini Magharibi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e73.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003e10.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e823\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003eWealth quintile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003eLowest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e66.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e15.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1,893\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003eSecond\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e60.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e21.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e47.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e42.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003eFourth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\n \u003cp\u003eHighest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e37.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e26.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e21.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e226\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 126px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e62.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2295\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003e1\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e\u003cem\u003eImproved sanitation facilities include a pit-latrine with slab, a ventilated improved pit-latrine, a flush toilet, a pour-flush toilet or a composting toilet that are single-sex a usable\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e\u0026nbsp;Improved sanitation facilities such as a pit-latrine with slab, a ventilated improved pit-latrine, a flush toilet, a pour-flush toilet or a composting toilet that are no single-sex or unusable\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003e3\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e\u0026nbsp;A pit-latrine with no slab, or a no ventilated improved pit-latrine, or no composting toilet or no sanitation facilities\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003e3\u003c/sup\u003e\u003c/em\u003e\u003cem\u003eSame as open defecation by standard definition should added together\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc142100475\"\u003e\u003cstrong\u003eH\u003c/strong\u003e\u003cstrong\u003eygiene situation and habits among the participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbout 67% of the participants reported to wash their hands with soap and water before eating. Another 29.8% reported using water only, and only 0.2% reported not wash their hands with water and sand. The results further showed that 1.3% of the respondents normally did not wash hands with either water or soap. About 70.9% of participants aged 15 - 19 years and 63.7% of the respondents aged 10 - 14 years wash their hands after visiting the toilets (Table 6). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6: Hand-washing practice after visiting toilets among the participants by demographic characteristics:\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWashing hands practice after visiting toilet\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNever\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRarely\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMany times,\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSEX\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eBoys\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e25.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e812\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e66.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eGirls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e813\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e61.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAGE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e5 - 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e29.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e446\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e57.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e10 - 14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e25.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e673\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e63.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e15 - 19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e23.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e70.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc142100477\"\u003e\u003cstrong\u003eWashing hands before eating\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMore than two-thirds (63.9%) of the pupils reported washing their hands before eating with only 0.2% who did not. Optimal washing of hands behavior before eating was also observed by age groups, such that behavior of washing hand increased with increase in age. Pupils aged 15-19 (69%) and 10-14 years (64.5%) were more likely to wash their hands after eating compared to pupils aged 5-9. Majority of boys (73.4%) reported to wash their hands before eating than girls (55.1%), and the majority reported to use water and soap 65.8 percent (n=1681). Almost 1-in-3 children reported to wash their hands with water only (Table 7).\u003c/p\u003e\n\u003cp id=\"_Toc122609831\"\u003e\u003cstrong\u003eTable 7: Distribution of hand washing practices by age and sex\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eReally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eMany Times,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eMost of the time\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eBoys\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e73.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eGirls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e29.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e55.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e5 \u0026ndash; 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e58.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e10 \u0026ndash; 14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e22.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e64.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e15 \u0026ndash; 19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e24.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis cross-sectional study was conducted to describe the current state of eating habits, water, sanitation and hygiene practices among school-going children and adolescents in Zanzibar. The study was conducted amidst concerns about the growing burden of overweight and obesity and poor sanitation and hygienic practices among children and adolescents in Zanzibar. Because of limited studies on the topic, the findings are expected to fill the scholarly gaps and offer recommendations for improving the health and well-being of school children and adolescents in Zanzibar. Moreover, adequate nutrition has been strongly linked to better academic outcomes (\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). For example, a study in Ethiopia indicated that children with poor nutrition were characterised by stunting, being underweight and wasting and had poorer academic performance than normal children (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). It is therefore expected that the findings will catalyse the investment in this age group that investments in consequently improving academic performance in Zanzibar.\u003c/p\u003e \u003cp\u003eWe used PDQS to determine the frequency thresholds of consumption of healthy food groups among school children and adolescents. The findings indicated that vitamin A-rich vegetables and fruits, dark leafy green vegetables and fish are commonly consumed, however, an alarming proportion of school children and adolescents appear to not consume these foods. For example, looking at the results, more than half (52%), a third (30.2%, and almost half 43.3%) appears to not consume fish, vitamin A rich vegetables and fruits, and green leafy vegetables respectively. Similarly, the findings indicate less consumption of Eggs, Cruciferous vegetables and Other whole fruits. Notably, half of the school children and adolescents never had breakfast in the past seven days and more than half eat snacks almost every day. While it is recommended that adolescents consume should consume healthy foods (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), our findings noted high consumption of six unhealthy food groups on the contrary. We noted that two in five school children and adolescents consumed refined grains and baked goods, desserts and ice creams although the consumption of processed and red meat was generally low. In general, our findings report poor dietary food intake among school children and adolescents with an alarming consumption of unhealthy foods. Poor dietary food intake among school children and adolescents is not uncommon (\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). For example, a study examining food consumption patterns among adolescents aged 14\u0026ndash;16 years in private, English-speaking schools in Kolkata, India using a self-administered questionnaire reported poor dietary practices (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Over one-quarter of adolescents reported no consumption of vegetables with over 70% reported consumming three or more servings of energy-dense snacks, almost half having not consumed fruits and almost half reported drinking three or more servings of energy-dense beverages. In support, a review of the literature to characterize and assess food consumption patterns and nutrient intakes in the Eastern Mediterranean countries also reported poor dietary patterns among school-aged children (5\u0026ndash;10 years) and adolescents (10\u0026ndash;19 years) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The findings of this review indicated documentation of low intake of fruits, vegetables and fibre, inadequate consumption of water, milk and dairy products complicated with high intakes of fat, saturated fat, and sugar-sweetened beverages and frequent consumption of energy-dense, nutrient-poor foods such as sweet and savoury snacks (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Consequently, the authors recommended a need for \u0026ldquo;a food system approach in developing and implementing national and regional policies and interventions aimed at improving the diet of children and adolescents\u0026rdquo;(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). It is important to note that few previous studies in Zanzibar have reported adverse nutritional manifestations such as iron deficiency anaemia among school children in Zanzibar (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Our findings therefore point to a suggestion that more efforts are needed to improve the intake of healthy foods among school children and adolescents in Zanzibar as a strategy to reduce the prevalence of nutritional-related diseases.\u003c/p\u003e \u003cp\u003eWhen considering interventions for improving nutritional status among school children and adolescents, it is important to focus on the identified predictors. Our study indicated that higher PDQS scores (good food practices) were statistically significantly associated with male genders and living in some regions such as Kaskazini A, Magharibi A, Kaskazini Unguja and Mjini Magharibi, more mature children and adolescents (10\u0026ndash;19 years) and being in a financially stable family. This suggests that girls, living in Kaskazini B and Kusini Unguja, being much younger age group (5-9years), studying in private schools and being in a family which have less income are associated with poor food intake. Comparing our findings with previous studies, while girls were found to have better food intake as compared to boys in India (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), there is a broad consensus in the literature that living in a low-income family predisposes to poor food intake (\u003cspan additionalcitationids=\"CR20 CR21 CR22\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). This points to a suggestion that girls and children from economically disadvantaged families should be prioritized in efforts to improve food intake among school children and adolescents in Zanzibar.\u003c/p\u003e \u003cp\u003eIt is evident that safe water, toilets and good hygiene have a huge impact on the life and health of children and adolescents. UNICEF has continually insisted that access to clean and safe water, basic toilets, and good hygiene practices not only keeps children thriving but also gives them a healthier start in life (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Cognizant of this, we went ahead to assess water, sanitation and hygiene practices among school children and adolescents. It is also important to note that adequate water intake is considered to improve weight status, reduce dental caries, and improve cognition among children and adolescents (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). However, access to safe and clean water among school children and adolescents is challenging in many LMICs including Tanzania (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Our findings indicated that the majority of participants reported using improved drinking water although almost a third quarter (33 per cent) did not report treating water for drinking purposes with either boiling, chlorination or letting it settle. This indicates that there is a need for continued efforts to improve access to safe and clean water in Schools in Zanzibar\u003c/p\u003e \u003cp\u003eFurthermore, the 2018 Tanzania National School WASH Report (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) indicate that only a quarter of schools in Tanzania meet the minimum government standard for the number of students per toilet (20 girls and 25 boys per toilet), and only 17 per cent of schools provided changing rooms with basic amenities, such as water, waste bin, soap and emergency supplies. While the report focused on school settings, we focused on access to toilets at home. Our findings indicate that almost a third reported not having improved toilet facilities in their respective households with more than one-fifth having unimproved toilet facilities and almost 6 per cent did not have latrines at all. This calls for more efforts to ensure access to improved toilet facilities at home among school children and adolescents alongside efforts to improve access in school settings.\u003c/p\u003e \u003cp\u003eFinally, we examined hygiene practices characterized by hand washing practices. Our findings indicated that a third of school children and adolescencts wash hands with water only (without soap) before eating with few not washing at all. Furthermore, a third of school children and adolescents aged 10\u0026ndash;14 years, and more than a quarter of those aged 15\u0026ndash;19 years do not wash hands after visiting the toilets. These findings are important because washing hands with soap and water has been reported to reduce diarrhoeal burden among children. This is evident in a review of literature which reported that interventions promoting hand washing contributed to a 39% reduction in diarrhoea episodes in children in high-income countries, and a 32% reduction of diarrhoeal in children in LMICs (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). This indicates a need for intensifying efforts to improve hand-washing practices among school children and adolescents in Zanzibar.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study is not without limitations. Although the findings address the research gap in Zanzibar and may be useful in policy formulation, the study did not examine the feeding habits, water intake and hygienic practices of caregivers as they may influence the habits and practices of school children and adolescents. Further studies that tap into the food habits, water consumption and hygienic practices are recommended for generating a comprehensive understanding of the persistent contributors of poor habits and practices in Zanzibar. Likewise, the study only focused on school children in Zanzibar. Future studies may seek to extend beyond schools to out-of-school children who may be at a disadvantage as compared to those attending schools.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWhile a commendable number of school children and adolescents have good food habits, drink clean water and wash their hands with soap and water, an alarming number of students have poor food habits and practices. Evidently, good feeding habits, and drinking safe and clean water have a positive impact on children's academic performance, health and wellbeing. A main challenge however is finding ways of encouraging families and schools to ensure access to healthy foods, access to safe and clean water and encouraging school children and adolescents themselves to wash their hands properly. With a global commitment to improve WASH for school children(\u003cspan additionalcitationids=\"CR29 CR30 CR31\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) we welcome the government, development partners and implementation researchers to develop and implement effective interventions for improving food habits, and water and hygienic practices as an entry point for improving both academic and health outcomes among school children and adolescents.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eWASH: Water, Sanitation, and Hygiene\u003c/p\u003e\n\u003cp\u003eBMI: Body Mass Index\u003c/p\u003e\n\u003cp\u003eRDA: Recommended Dietary Allowance\u003c/p\u003e\n\u003cp\u003ePSU: Primary Sampling Unit\u003c/p\u003e\n\u003cp\u003ePPS: Probability Proportional to Size\u003c/p\u003e\n\u003cp\u003eSRS: Simple Random Sampling\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThis study involves human participants. This study received ethics clearances from a the Zanzibar Health Research Institute (ZAHREC/03/SEP/2021/24). The chief investigator of this project is affiliated with the National Institute for Medical Research in Tanzania. Additionally, gateway permission was obtained from the administration of local authorities and selected Schools. All study participants were informed about the study and written informed consent/ assent forms were obtained before the interviews. All study responses were kept confidential and data collection ensured privacy. Further, all data gathered were not used for purposes other than the present research.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eNone declared.\u003c/p\u003e\n\u003ch2\u003ePatient consent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis study was a UNICEF consultancy award (Award Number: 56282) received by Dr. Esther Ngadaya.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eProposal Development : EN, AM, HM, KIAnalysis:EN,KI,G, Funding acquisition: ENMethodology: EN, GK,KIand AM. Writing - original draft: EN. Writing-reviewing andediting: AS, GL,EN, AM,DS, KMK, GK,GM,FAS, KI, MK, PC, HM and JN. EN, GL, HSaccepts full responsibility for the finished work and/or the conduct of the study, haddata collection and controlled the decision to publish\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eThe Ministry of Health (MoH) Zanzibar would like to express its gratitude and appreciation to all individuals, institutions, and partners who contributed to the implementation of this School Health and Nutrition Survey (SHNS) conducted in Zanzibar. In particular, the MoH acknowledges the contribution of partners from governmental agencies, the Office of the Chief Government Statistician (OCGS), the Ministry of Education and Vocational Training (MoEVT) together with the Tanzania Food and Nutrition Centre for their active participation and technical inputs toward this survey.Special thanks go to the United Nations Children\u0026rsquo;s Fund (UNICEF) for their technical and financial support, and for seeing the requirement to adopt a similar study on Tanzania Mainland. The MoH would also like to thank all individual consultants, oversight organisations and partners for their roles in organising and preparing questionnaires, training of field staff, co-ordination of fieldwork, and support in developing this report, who include individuals from the Muhimbili University of Health and Allied Sciences (MUHAS), the National Institute for Medical Research (NIMR), and the Nelson Mandela University.The MoH would also like to thank all the field supervisors, who oversaw the data collection exercise, and field data collectors who interviewed students. Moreover, the MoH would like to extend its appreciation to Data Entry Clerks, Regional and District teams (e.g., Malaria Focal Persons, laboratory technologists/technicians, School Health Programme Co-ordinators, Nutrition Officers, and drivers) for their participation during the survey. Furthermore, the MoH would like to thank all the students and school teachers for their readiness to participate in the survey. The MoH would also like to acknowledge the following teams of experts involved in the report preparation and finalization.Data analysis, Report writing and finalisation Team: Dr. Geofrey Mchau, Sauli Epimark, Shemsa Msellem, Hawa Msola, Fatma Abdallar, Dr Anna Mosses, Dr David Solomon and Asha Samini, Fatma Said, Adam Haji Ame, Heavenlight Ayubu, Stanlaus Erick Mollel, Salum Kassim Ally, Fahima Mohamed Issa, Sabina Raphael Daima, Kombo Mdachi Kombo, Hadija Hamisi Hamadi, Ahmad Hamza Mohamed, Aisha Mohamed Said, Asha Mahafodhi, and Prof. Esther Ngadaya.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHelwig NE, Hong S, Hsiao-wecksler ET. No 主観的健康感を中心とした在宅高齢者における 健康関連指標に関する共分散構造分析Title. \u003c/li\u003e\n\u003cli\u003eTofail F, Fernald LC, Das KK, Rahman M, Ahmed T, Jannat KK, et al. Effect of water quality, sanitation, hand washing, and nutritional interventions on child development in rural Bangladesh (WASH Benefits Bangladesh): a cluster-randomised controlled trial. Lancet Child Adolesc Heal [Internet]. 2018;2(4):255\u0026ndash;68. Available from: http://dx.doi.org/10.1016/S2352-4642(18)30031-2\u003c/li\u003e\n\u003cli\u003eMank I, Vandormael A, Traor\u0026eacute; I, Ou\u0026eacute;draogo WA, Sauerborn R, Danquah I. Dietary habits associated with growth development of children aged \u0026lt; 5 years in the Nouna Health and Demographic Surveillance System, Burkina Faso. Nutr J. 2020;19(1):1\u0026ndash;14. \u003c/li\u003e\n\u003cli\u003eOtinwa G, Jaiyesimi B, Bamitale T, Owolabi H, Owolewa M. Eating habits and nutrition status of Nigerian school children in rural and urban areas (NigeriaLINX pilot project). Heliyon [Internet]. 2023;9(7):e17564. Available from: https://doi.org/10.1016/j.heliyon.2023.e17564\u003c/li\u003e\n\u003cli\u003eAbdelaziz SB, Youssef MRL, Sedrak AS, Labib JR, Abdelaziz SB, Youssef MRL, et al. Nutritional Status and Dietary Habits of School Children in Beni-Suef Governorate, Egypt. Food Nutr Sci [Internet]. 2015 Jan 12 [cited 2023 Sep 29];6(1):54\u0026ndash;63. Available from: http://www.scirp.org/Html/7-2701420_53087.htm\u003c/li\u003e\n\u003cli\u003eUgochukwu E, Onubogu C, Okeke K, Edokwe E. Nutritional contents of lunch packs of primary school children in Nnewi, Nigeria. Ann Med Health Sci Res. 2014;4(8):108. \u003c/li\u003e\n\u003cli\u003eNutrition [Internet]. [cited 2023 Oct 1]. Available from: https://www.who.int/health-topics/nutrition#tab=tab_1\u003c/li\u003e\n\u003cli\u003eAdolphus K, Lawton CL, Dye L. The effects of breakfast on behavior and academic performance in children and adolescents. Prenat Child Nutr Eval Neurocognitive Connect. 2015;7(August):289\u0026ndash;319. \u003c/li\u003e\n\u003cli\u003eSzajewska H, Ruszczyński M. Systematic Review Demonstrating that Breakfast Consumption Influences Body Weight Outcomes in Children and Adolescents in Europe. Crit Rev Food Sci Nutr [Internet]. 2010 Feb [cited 2023 Oct 1];50(2):113\u0026ndash;9. Available from: https://www.tandfonline.com/doi/abs/10.1080/10408390903467514\u003c/li\u003e\n\u003cli\u003eHoyland A, Dye L, Lawton CL. A systematic review of the effect of breakfast on the cognitive performance of children and adolescents. Nutr Res Rev. 2009;22(2):220\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003eSandercock GRH, Voss C, Dye L. Associations between habitual school-day breakfast consumption, body mass index, physical activity and cardiorespiratory fitness in English schoolchildren. Eur J Clin Nutr 2010 6410 [Internet]. 2010 Aug 4 [cited 2023 Oct 1];64(10):1086\u0026ndash;92. Available from: https://www.nature.com/articles/ejcn2010145\u003c/li\u003e\n\u003cli\u003eVaccaro B. Triple threat. Fire Rescue Mag. 2016;34(6). \u003c/li\u003e\n\u003cli\u003eMcMichael C. Water, sanitation and hygiene (WASH) in schools in low-income countries: A review of evidence of impact. Int J Environ Res Public Health. 2019;16(3):1\u0026ndash;21. \u003c/li\u003e\n\u003cli\u003eArticle Text-187683-1-10-20120730. \u003c/li\u003e\n\u003cli\u003eTanzania\u0026rsquo;s Water Crisis - Tanzania\u0026rsquo;s Water | Water.org [Internet]. [cited 2023 Sep 29]. Available from: https://water.org/our-impact/where-we-work/tanzania/\u003c/li\u003e\n\u003cli\u003eRedae GA, Mengestu TK, Abdalla FM, Slim SN, Simon VT, Ali AO, et al. Towards cholera elimination in Zanzibar: analysis of evidences on what have worked. Pan Afr Med J. 2023;45(Supp 1):6. \u003c/li\u003e\n\u003cli\u003eMinistry of Finance and Planning, Tanzania National Bureau of Statistics, Office of the Chief Government Statistician Zanzibar. The 2022 Population and Housing Census: Age and Sex Distribution Report Tanzania Mainland. 2022;1\u0026ndash;23. \u003c/li\u003e\n\u003cli\u003eEjemot-Nwadiaro RI, Ehiri JE, Arikpo D, Meremikwu MM, Critchley JA. Hand-washing promotion for preventing diarrhoea. Cochrane Database Syst Rev. 2021;2021(1). \u003c/li\u003e\n\u003cli\u003eChinyoka K. Impact of Poor Nutrition on the Academic Performance of Grade Seven learners: A Case of Zimbabwe. Int J Learn Dev. 2014;4(3):73. \u003c/li\u003e\n\u003cli\u003eAsmare B, Taddele M, Berihun S, Wagnew F. Nutritional status and correlation with academic performance among primary school children, northwest Ethiopia. BMC Res Notes [Internet]. 2018;11(1):1\u0026ndash;6. Available from: https://doi.org/10.1186/s13104-018-3909-1\u003c/li\u003e\n\u003cli\u003eTell MN, Hedin K, Nilsson M, Gols\u0026auml;ter M, Lingfors H. Food intake in children and adolescents: a cross-sectional study from 2009/2010 to 2015/2016. J Nutr Sci. 2021;10:e51. \u003c/li\u003e\n\u003cli\u003eDesbouys L, De Ridder K, Rouche M, Castetbon K. Food consumption in adolescents and young adults: Age-specific socio-economic and cultural disparities (Belgian Food Consumption Survey 2014). Nutrients. 2019;11(7). \u003c/li\u003e\n\u003cli\u003eAl-Jawaldeh A, Taktouk M, Nasreddine L. Food consumption patterns and nutrient intakes of children and adolescents in the eastern mediterranean region: A call for policy action. Nutrients. 2020;12(11):1\u0026ndash;28. \u003c/li\u003e\n\u003cli\u003eUnconfirmed 793703.crdownload. \u003c/li\u003e\n\u003cli\u003eStoltzfus RJ, Chwaya HM, Tielsch JM, Schulze KJ, Albonico M, Savioli L. Epidemiology of iron deficiency anemia in Zanzibari schoolchildren: The importance of hookworms. Am J Clin Nutr [Internet]. 1997;65(1):153\u0026ndash;9. Available from: https://doi.org/10.1093/ajcn/65.1.153\u003c/li\u003e\n\u003cli\u003eSaid FA, Khamis AG, Habib A, Yang H, He Z, Luo X. Prevalence and determinants of anemia among children in zanzibar, tanzania: Analysis of cross-sectional population representative surveys. Children. 2021;8(12). \u003c/li\u003e\n\u003cli\u003eFlorence MD, Asbridge M, Veugelers PJ. Diet quality and academic performance: Research article. J Sch Health. 2008;78(4):209\u0026ndash;15. \u003c/li\u003e\n\u003cli\u003eWater, Sanitation and Hygiene (WASH) | UNICEF [Internet]. [cited 2023 Oct 1]. Available from: https://www.unicef.org/wash\u003c/li\u003e\n\u003cli\u003ePatel AI, Hampton KE. Encouraging consumption of water in school and child care settings: Access, challenges, and strategies for improvement. Am J Public Health. 2011;101(8):1370\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eJena S, Satpathy N, Sahoo KC, Epari V. Access to water, sanitation and hygiene in schools: A prerequisite to achieving SDGs in India. J Prev Med Hyg. 2022;63(4):E495\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eHow water, sanitation and hygiene contribute to girls\u0026rsquo; education in Tanzania | UNESCO [Internet]. [cited 2023 Oct 1]. Available from: https://www.unesco.org/en/articles/how-water-sanitation-and-hygiene-contribute-girls-education-tanzania\u003c/li\u003e\n\u003cli\u003eNBS, OCGS, UNICEF. 2018 school water, sanitation and hygiene assessment: Main report. Gov Tanzania [Internet]. 2020;(February). Available from: https://www.unicef.org/tanzania/media/2356/file/National School WASH Report 2020.pdf\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Nutrition, Sanitation, Hygiene, Malnutrition, Zanzibar, Anemia","lastPublishedDoi":"10.21203/rs.3.rs-6113106/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6113106/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eConsumption of healthy foods, intake of safe and clean water, use of improved toilets, and good hand-washing hygiene practices have a huge impact on academic performance, overall health and well-being among young children and adolescents. However, there is limited evidence of these habits and practices among schoolchildren and adolescents in Zanzibar. This study examined the current state of food, water, sanitation, and hygiene practices among school-going children in Zanzibar\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This was a school-based cross-sectional study. Data were gathered from students aged between 5 and 19 years enrolled in primary and secondary schools during the academic year 2022. Data collection involved dietary surveys and food frequency questionnaires (Prime Diet Quality Score, PDQS). Simple descriptive analyses were conducted using Stata Version 17.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The consumption of unhealthy food groups was alarming with over 2 in 5 children consuming refined grains and baked goods (40.9%), and desserts and ice cream (26.0%), with a mean PDQS of 16.4±3.7 (Range 7-34). Higher PDQS scores were statistically significantly associated with male gender (uβC 1.5 (95%CI 1.2-1.8), living in Kaskazini A, Magharibi A, Kaskazini Unguja and Mjini Magharibi. Over half (50.4%) did not consume breakfast in the previous seven (7) days before the survey, and \u0026nbsp;56.6 percent eat snacks almost every day. Furthermore, most (94.2%) of the study respondents reported using improved drinking water sources, however, a third (33%) reported not treating water for drinking purposes with either boiling, clorination or letting it settle. Additionally, only about 20% of participants had unimproved toilet facilities whereas 5.6% did not have latrines at all. About 67% of the participants reported washing their hands with soap and water before eating. However, 29.8% reported using water only, and 0.2% reported not washing their hands at all.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eMajority of Children and adolescents in Zanzibar have poor dietary habits. Over half consume breakfast the most important meal of the day. A commendable number reported to drink clean water and wash their hands with soap and water. With a global commitment to improve WASH for school children, the findings indicare a need for the government, development partners and implementation researchers to develop and implement effective interventions for improving food habits, and water and hygienic practices as an entry point for improving both academic and health outcomes among school children and adolescents.\u003c/p\u003e","manuscriptTitle":"Assessment of Dietary Habits, Water, Sanitation, and Hygiene Practices Among School Aged Children and Adolescents in Zanzibar: Implications for Health and Academic Performance","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-11 08:50:17","doi":"10.21203/rs.3.rs-6113106/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"37db27a5-bda6-4972-90e7-5185f42d8737","owner":[],"postedDate":"March 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T17:55:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-11 08:50:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6113106","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6113106","identity":"rs-6113106","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}