Market Research for 7.1% Chlorhexidine Digluconate: Nigeria · Two-phase approach • Initiated in...
Transcript of Market Research for 7.1% Chlorhexidine Digluconate: Nigeria · Two-phase approach • Initiated in...
Market Research for 7.1% Chlorhexidine Digluconate: Nigeria
November 2014
Photo: PATH/Evelyn Hockstein
Page 2
Goals, Objectives, and Research Methodology
Photo: PATH/Evelyn Hockstein
Goals and Objectives
Goals
• Support the development of effective introduction plans.
• Help manufacturers create business plans.
Objectives
• Segment the market and estimate demand by segment.
• Identify the priority market segments.
• Identify effective distribution and communication strategies to reach the priority market segments.
Page 3
Two-phase approach
• Initiated in January 2014 after securing national and state-level approvals and pretesting the research tools.
• Implemented in two phases.
• Phase 1: Qualitative research
• Identified factors relevant to market segmentation.
• Phase 2: Quantitative research
• Segment the market and identify priority segments.
• Estimate the size of priority segments.
• Identify effective distribution and communication strategies to reach each segment.
Page 4
Phase I Methodology
Performed desk and qualitative research in four states.
Page 5
• Four focus group discussions (FGDs) with 30 potential users in Osun and Nasarawa states.*
• Kano, Nassarawa, Osun and Cross River
• 26 in-depth interviews with stakeholders at both the national and state levels (four states).
* Potential users include currently pregnant women (CPWs) who have at least one child and recently delivered women (RDWs) who have children < 3 months old.
Phase II Methodology
• Conducted data collection in the same four states:
• 38 key informant interviews (KII).
• 16 FGDs.
• 2 FGDs in rural areas and 2 FGDs in urban areas per state with 123 participants.
• 401 individual interviews through home visits.
States Interviews KII FGD
Kano 100 10 25
Nasarawa 100 9 30
Osun 102 9 32
Cross River 99 10 32
Total 401 38 123
Page 6
Respondent distribution
Page 7Photo: PATH/Evelyn Hockstein
Respondent distribution
Page 8
Respondent distribution
By rural vs. urban By religion
Page 9
153 166
3943
0
50
100
150
200
250
Rural Urban
CPW/RDW Relatives
146167
40
42
0
50
100
150
200
250
Christianity Islam
CPW/RDW Relatives
Nu
mb
er o
f p
arti
cip
ants
Nu
mb
er o
f p
arti
cip
ants
Respondent distribution
By age By income level
Page 10
62
171
85
13
48
21
0
50
100
150
200
250
High income Moderateincome
Low income
CPW/RDW Relatives
0
50
100
150
200
250
16 - 25 26 - 35 36 - 45 46 - 55 56+
CPW/RDW Relatives
Nu
mb
er o
f p
arti
cip
ants
Nu
mb
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arti
cip
ants
Characteristics of respondents: FGD participants
State
Characteristics of participants
# of
participantsType Rural/Urban SEC Age Education
Kano Husbands Urban H >30 Secondary school education and above 7
Women Urban M >20 Secondary school education and above 6
Women Rural M >15 Primary school education and below 6
Women Rural L >15 Primary school education and below 6
Cross
River
Husbands Urban H 20-39 Secondary school education and above 10
Women Urban M 20-39 Secondary school education and above 10
Women Rural M 20-39 Primary school education and below 10
Women Rural L 20-39 Primary school education and below 6
Osun Women Urban H 20-40 Secondary school education and above 6
Women Urban M 20-39 Secondary school education and above 10
Husbands Rural M 20-39 Primary school education and below 6
Women Rural L 20-39 Primary school education and below 10
Nasarawa Women Urban H >15 Secondary school education and above 6
Husbands Urban M >30 Secondary school education and above 8
Women Rural M >15 Primary school education and below 8
Women Rural L >15 Primary school education and below 8
SEC: Socio-economic class; H: High income; M: Moderate income; L: Low income
Page 11
Characteristics of respondents: KII participantsState Respondents type Organization Total
Kano Policymakers Primary Health Care Coordinator, Kano Municipal; Primary Health care
Coordinator, Makoda Local Government; Deputy Director Public Health, Kano
State Ministry of Health
2
Influential
stakeholders
Chairman, National Association of Community Health Practitioners of Nigeria;
Chairman, Association of Patent Proprietary Medicine Vendors Makoda
3
Providers TBA PPMV/Environmental Health Officer; Pharmacist; Community Health
Extension Worker; Chief, Matron Maternity Ward Muritala Mohammed Hospital
5
Total 10
Osun Policymakers Maternal and Child Health Coordinator; Deputy Director Community Health
Officer
2
Influential
stakeholders
President, PPMV/Ilesha West Zone; Chairman, National Association of Nigeria
Nurses and Midwives Ilesha West Zone
2
Providers TBA; PPMV; medical doctor; Assistant Community Health Extension Worker;
Registered Nurse
5
Total 9
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TBA: trained birth attendant; PPMV: proprietary patent medicine vendors
Characteristics of respondents: KII participants (cont.)State Respondents type Organization Total
Nasarawa Policymakers Head of Health, Primary Healthcare Department, Obi local government Area;
Clinical Department Ministry of Health
2
Influential
stakeholders
State Chairman, MHWUN; Chairperson, Traditional Birth Attendant Association
Obi Local Government Area
2
Providers TBA; PPMV; Pharmacist; Nurse; Doctor 5
Total 9
Cross
River
Policymakers Maternal and Child Health Focal Person, RSPHCMB Rivers State; Medical Officer,
Health, Emuoha Local Government Area
2
Influential
stakeholders
Secretary NAPMED; Chairperson NACHP Obiakpor Local Government Area 2
Providers TBA; PPMV; pharmacist; medical doctor, Primary Health Center Rumueme;
Community Health Extension Worker, Primary Health Center, Rumueme;
Midwife, Primary Health Center, Rumueme
6
Total 10
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MHWUN: Medical Health Workers Union of NigeriaTBA: trained birth attendantPPMV: proprietary patent medicine vendorsRSPHCMB: Rivers State Primary Health Care Management BoardNAPMED: Nation Association of Patent Medicine DealersNACHP: National Association of Community Health Practitioners
Page 14
Key findings
Photo: PATH/Mike Wang
Antenatal care (ANC): % of women receiving ANC and timing of first visit
Receiving ANC By timing of first visit
Page 15
Trimester Trimester Trimester
Per
cen
t o
f p
arti
cip
ants
Antenatal care (ANC):Place of ANC
Page 16
Antenatal care (ANC):Place by rural vs. urban and socioeconomic status
By rural vs. urban By income level
Page 17
Per
cen
t o
f p
arti
cip
ants
Per
cen
t o
f p
arti
cip
ants
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Public hospital Privatehospital
Missionhouse/church
TBA home Within thecommunity
Rural Urban
Place of delivery
Page 18
Place of delivery
By rural vs. urban By income level
Page 19
Per
cen
t o
f p
arti
cip
ants
Per
cen
t o
f p
arti
cip
ants
ANC vs. delivery: Place
Where did you receive
antenatal care?
Where did you
deliver the baby?
Public
hospital
Private
hospital
Mission
house/
church
TBA home Within the
community
Total
Home (assisted by a
caregiver)
12 1 0 0 2 15
Home (assisted by a TBA) 23 0 0 6 0 29
Home (self-delivery) 33 0 0 0 0 33
Church facility/premises 15 0 3 0 0 18
TBA facility/premises 13 2 1 10 1 27
Health facility (public) 132 4 0 0 1 137
Health facility (private) 17 28 0 0 0 45
Others (specify) 5 0 0 0 1 6
Total 250 35 4 16 5 310
Page 20
Number = number of respondents
ANC vs. delivery: Personnel
Personnel assisting delivery Personnel providing ANC
Page 21
12%
48%
1% 3%
21%
5% 7%3% 1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Per
cen
t o
f p
arti
cip
ants
Per
cen
t o
f p
arti
cip
ants
Substances currently purchased for cord care
Percent procurement
Page 22
Procurement by state
Purchased88%
Did not purchase
9%
Missing3%
Per
cen
t o
f p
arti
cip
ants
Substances currently purchased for cord care
Page 23
Nu
mb
er o
f p
arti
cip
ants
Substance
Substances currently purchased for cord care
By rural vs. urban By income level
Page 24
Per
cen
t o
f p
arti
cip
ants
Per
cen
t o
f p
arti
cip
ants
Substances currently used for cord care:Who influenced what cord care substances should be used?
Substances applied
Reasons
Methylated spirit
Hot compress
Mentholatum ToothpasteNative
substanceOthers Total
Used in the family 31 30 4 18 11 2 96
Used in the village 8 9 1 9 4 1 32
Told by the TBA 24 13 7 14 4 6 68
Told by CHEW/CHW 67 12 3 1 0 2 85
On the hospital list 26 10 8 1 0 0 45
Told by health care providers
79 23 18 2 1 12 135
Available 4 3 0 1 0 0 8
Others 3 2 0 2 0 2 9
Missing 9 6 2 1 0 0 18
Total 251 108 43 49 20 25 496
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Number = number of respondents
Substances currently purchased for cord care
Timing of purchase Place of purchase
Page 26
24.8%
44.2%
21.3%
6.9%2.8%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Beforedelivery
(notduringANC)
Beforedelivery(duringANC)
At thetime ofdelivery
Others MissingP
erce
nt
of
par
tici
pan
ts
Per
cen
t o
f p
arti
cip
ants
Substances currently purchased for cord care:Place of purchase
By rural vs. urban By income level
Page 27
Per
cen
t o
f p
arti
cip
ants
Per
cen
t o
f p
arti
cip
ants
Substances currently purchased for cord care: Price
Page 28
Average price of methylated spirits = NGN200/bottle
Price (in NGN)
Nu
mb
er o
f re
spo
nd
ents
Source of information for ante- and post-natal care
Respondents stated that personnel who assist with delivery are the best positioned to determine cord care practices.
Page 29
Clean delivery kits (CDK):Knowledge and use
Page 30
Knew about and used CDK9%
Knew about, but did not use CDK24%
Did not know about CDK67%
7.1% chlorhexidine digluconate: Preferred dosage form
Page 31
Liquid46%
Gel54%
7.1% chlorhexidine digluconate:Preferred dosage form
By state By rural vs. urban
Page 32
By socioeconomic class
46%49% 49%
37%
54%51% 51%
63%
0%
10%
20%
30%
40%
50%
60%
70%
Kano Nasarawa Osun River
Liquid Gel
46% 46%
54% 54%
40%
45%
50%
55%
60%
Rural UrbanLiquid Gel
60%
42% 42%40%
58% 58%
0%
20%
40%
60%
80%
High income Middle income Low income
Liquid Gel
Per
cen
t o
f p
arti
cip
ants
Per
cen
t o
f p
arti
cip
ants
Per
cen
t o
f p
arti
cip
ants
Cross
7.1% chlorhexidine digluconate:Perceptions about gel and liquid
Page 33
Gel Liquid
Stays on the cord • Covers the cord well.• No need for reapplication; requires
small amount.• Easy to see how much is applied.
Afraid of spillage • Doesn’t cover the cord.• May require reapplication; requires
larger amount due to wastage.• Cannot determine how much
remains on the cord.
Covers the cord well, thereby protecting the cord.
Cannot cover the cord.
Can apply with finger. Requires an applicator (i.e., cotton balls).
Similar to toothpaste (the substance the respondents currently use for cord care).
Similar to methylated spirits (the substance that the respondents currently use for cord care).
7.1% chlorhexidine digluconate:Preferred places to obtain
Place for obtaining chlorhexidine
Current place for obtaining substances for cord care
Page 34
29.8%
17.0%
3.3%
14.1%17.8% 18.5%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Per
cen
t o
f p
arti
cip
ants
Per
cen
t o
f p
arti
cip
ants
7.1% chlorhexidine digluconate:Timing for obtaining
Timing of obtaining chlorhexidine
Timing for obtaining current cord care substances
Page 35
18.2%
73.1%
2.5%5.8%
0.4%0%
10%
20%
30%
40%
50%
60%
70%
80%
Beforedelivery
(notduringANC)
Beforedelivery(duringANC)
At thetime ofdelivery
Afterdelivery
Anytime
Per
cen
t o
f p
arti
cip
ants
Per
cen
t o
f p
arti
cip
ants
7.1% chlorhexidine digluconate:Price for single dose
7.1% chlorhexidine digluconate Substance currently used
Page 36
Nu
mb
er o
f p
arti
cip
ants
Nu
mb
er o
f p
arti
cip
ants
7.1% chlorhexidine digluconate:Difference in price for single dose
By rural vs urban By income level
Page 37
0%
5%
10%
15%
20%
25%
30%
35%
<100 100-150 150-200 200-250 >250
Rural Urban
0%
5%
10%
15%
20%
25%
30%
35%
<100 100-150 150-200 200-250 >250
High income Moderate income
Low income
Segmentation
Page 38Photo: PATH/Evelyn Hockstein
Segmentation factors
• Respondents’ locations of residence (rural or urban) and socioeconomic status.
• These factors affect:
• Place where they deliver babies, which therefore affects providers who assisted births.
• Substances purchased for cord care.
• Place where substances for cord care are purchased.
Page 39
Segmentation factors
• Places where the respondents currently buy/obtain cord care substances.
• Current behaviors are good indicators of future behaviors:
• Places and times where respondents currently obtain cord care substances are similar to places and times where respondents could obtain chlorhexidine.
Page 40
Factors considered but not utilized for segmentation
• Location of ANC and location of deliveries:
• Virtually all respondents (97.2%) receive ANC.
• Cannot segment respondents based on whether they did or did not receive ANC.
• Locations where respondents receive ANC and locations where they deliver their babies are, in turn, influenced by the location of their residences and their socioeconomic status.
• The majority of respondents currently obtain cord care substances at locations different from where they receive ANC or from where they deliver their babies.
Page 41
SegmentationRDW and CPW
Rural (153)
High income (0)Moderate
income (70)
Chemist/PPMV
(33)
Pharmacy
(3)
HC Facility
(1)
Market/shop
(17)
TBA
(7)
Other Traditional
(7)
Family/friend
(1)
Don’t know
(1)
Low income (83)
Chemist/PPMV
(37)
Pharmacy
(3)
HC Facility
(5)
Market/shop
(27)
TBA
(5)
Family/friend
(1)
Other
(3)
Don’t know
(2)
Urban (166)
High income (62)
Chemist/PPMV
(20)
Pharmacy
(20)
HC Facility
(6)
Market/shop
(13)
TBA
(1)
Other
(1)
Missing (1)
Moderate income (101)
Chemist/PPMV
(34)
Pharmacy
(23)
HC facility
(19)
Market/shop
(16)
TBA
(1)
Family/friend
(2)
Other
(1)
Don’t know
(2)
Missing (3)
Low income (2)
Pharmacy
(1)
HC Facility
(1)
Target:
Overall, these segments represent an 63.3%of CPW/RDW women enrolled in this survey.
Page 42
Characteristics of target segment: Rural
Characteristics
Rural women, moderate income,
purchasing from
chemists/PPMVs
(N=33, 10.3%)
Rural women, low income,
purchasing from
chemists/PPMVs
(N=37, 11.6%)
Rural women, low income,
purchasing from markets/shops
(N=27, 8.5%)
Age range
16-25 years
26-35 years
36-45 years
46-55 years
30.3%
42.4%
27%
--
43.2%
43.2%
8.2%
5.4%
48.1%
48.1%
3.7%
--
Occupation
Artisans
Traders
Housewives
Civil servants
Teachers
Farmers
36.4%
36.4%
18.2%
6.1%
6.1%
--
18.9%
27.0%
32.4%
--
--
18.9%
22.2%
48.1%
14.8%
--
--
11.1%
Number Of children
1 child
2 children
3 children
4 children
> 4 children
9.1%
33.3%
30.3%
3%
24.2%
10.8%
35.1%
8.1%
32.4%
13.5%
22.2%
29.6%
22.2%
7.4%
18.5%
Page 43
Characteristics of target segment: Rural
Characteristics
Rural women, moderate
income, purchasing from
chemists/PPMVs
(N=33, 10.3%)
Rural women, low income,
purchasing from
chemists/PPMVs
(N=37, 11.6%)
Rural women, low income,
purchasing from
markets/shops
(N=27, 8.5%)
Place of ANC
Public Hospital
Private Hospital
Mission house/church
TBA
Community help
Missing
78.8%
9.1%
6.1%
--
--
6.1%
86.5%
2.70%
--
5.4%
--
5.4%
74.1%
--
3.7%
18.5%
3.7%
--
Place of delivery
Home - assisted by caregivers
Home - assisted by TBAs
Home - self-delivery
Church facility/premises
TBA facility/premises
Health facility - public
Health facility - private
Others - specify
0.0%
12.1%
18.2%
9.1%
9.1%
36.4%
15.2%
0.0%
5.4%
29.7%
21.6%
5.4%
8.1%
21.6%
5.4%
2.7%
7.4%
14.8%
14.8%
11.1%
22.2%
29.6%
0.0%
0.0%
Cord care practices
Methylated spirits
Traditional substances
72.7%
27.3%
62.2%
37.8%
3.7%
96.3%
Page 44
Characteristics of target segment: Rural
Characteristics
Rural women, moderate
income, purchasing from
chemists/PPMVs
(N=33, 10.3%)
Rural women, low income,
purchasing from
chemists/PPMVs
(N=37, 11.6%)
Rural women, low income,
purchasing from
markets/shops
(N=27, 8.5%)
Formulation preference
Liquid
Gel
45.5%
54.5%
35.1%
64.9%
51.9%
48.1%
Sources of information
Radio
TV
Health workers (during ANC)
Health workers (outside of ANC)
TBAs
Market place
Friends
Female relatives
Trade groups
Wife of religious leader
72%
59%
54%
51%
29%
18.9%
13.5%
5.4%
5.4%
5.4%
75.6%
32.4%
54%
56.7%
45.9%
16.2%
8.1%
10.8%
--
21.6%
88%
62.9%
33.3%
59.2%
48.1%
--
25.9%
44.4%
14.8%
--
Page 45
Characteristics of target segment: Urban
Characteristics
Urban women, high
income, purchasing from
chemists/ PPMVs
(N=20, 6.3%)
Urban women, high
income, purchasing from
pharmacy
(N=20, 6.3%)
Urban women, moderate
income, purchasing from
chemists/PPMVs
(N=34, 10.7%)
Urban women, moderate
income, purchasing from
pharmacy
(N=23, 7.2%)
Age range
16-25 years
26-35 years
36-45 years
45-55 years
45%
40%
15%
--
30%
55%
15%
--
35.3%
52.9%
11.8%
--
30.4%
52.2%
17.4%
--
Occupation
Artisans
Traders
Housewives
Civil servants
Teachers
Clerical work
Health workers
Professionals
Bankers
Businesswomen
Student
--
25%
10%
35%
15%
--
--
--
--
--
--
--
25%
5%
20%
5%
15%
15%
10%
5%
--
--
23.5%
35.3%
14.7%
5.9%
5.9%
2.9%
5.9%
2.9%
2.9%
--
--
----
43.5%
21.7%
8.7%
4.3%
--
--
4.3%
--
4.3%
4.3%
Number of children
1 child
2 children
3 children
4 children
> 4 children
15%
45%
2%
15%
15%
25%
30%
20%
15%
10%
9%
47%
29%
6%
9%
9%
61%
13%
4%
13%
Page 46
Characteristics of target segment: Urban
Characteristics
Urban women, high
income level,
purchasing from
chemists/ PPMVs
(N=20, 6.3%)
Urban women, high
income level,
purchasing from
pharmacy
(N=20, 6.3%)
Urban women,
moderate income
level, purchasing from
chemists/PPMVs
(N=34, 10.7%)
Urban women,
moderate income
level, purchasing
from pharmacy
(N=23, 7.2%)
Place of ANC
Public Hospital
Private Hospital
TBA
Community help
90%
10%
--
--
85%
15%
--
--
70.6%
23.5%
2.9%
2.9%
82.6%
17.4%
--
--
Place of delivery
Home - assisted by caregivers
Home - assisted by TBAs
Home - self-delivery
Church facility/premises
TBA facility/premises
Health facility - public
Health facility - private
Others - specify
10.0%
0.0%
5.0%
10.0%
0.0%
50.0%
25.0%
0.0%
--
5.0%
--
--
--
75.0%
20.0%
--
9%
12%
0%
6%
3%
56%
15%
0%
4%
4%
--
--
--
74%
17%
--
Cord care practices
Methylated spirits
Traditional substances
60%
40%
70%
30%
55.9%
44.1%
69.6%
30.4%
Page 47
Characteristics of target segment: Urban
Characteristics
Urban women, high
income level,
purchasing from
chemists/ PPMVs
(N=20, 6.3%)
Urban women, high
income level,
purchasing from
pharmacy
(N=20, 6.3%)
Urban women,
moderate income
level, purchasing from
chemists/PPMVs
(N=34, 10.7%)
Urban women,
moderate income
level, purchasing
from pharmacy
(N=23, 7.2%)
Formulation preference
Liquid
Gel
Missing
60%
40%
--
75%
25%
--
41.2%
55.9%
2.9%
39.1%
56.5%
4.3%
Sources of information
Radio
TV
Health workers (during ANC)
Health workers (outside of ANC)
TBAs
Market place
Friends
Female relatives
Trade groups
Wife of religious leader
85%
80%
45%
80%
15%
--
--
--
--
--
80%
80%
45%
60%
5%
--
--
--
--
10%
79.4%
79.4%
76.5%
26.5%
5.9%
20.6%
5.9%
0.0
--
6.6%
78.3%
73.9%
65.2%
26.1%
4.3%
--
4.3%
8.7%
--
4.3%
Page 48
Page 49
Recommendations for 7.1% chlorhexidine digluconate
Photo: PATH/Amy McIver
Recommendations: General
• Introduce the liquid form of 7.1% chlorhexidine gluconate if the demand size for the chlorhexidine products becomes large enough to accommodate two product forms (splitting small demand into two product forms will lead to a low production quantity and high production cost for each product form).
• Overall, the gel form is slightly preferred over the liquid form, but a few target segments prefer the liquid form over the gel form.
• Respondents are willing to pay more for the liquid form, so potential for a secondary market is present.
Page 50
Recommendations: Distribution
• Sell 7.1% chlorhexidine digluconate product at PPMVs and pharmacies to increase availability and usage.
• The vast majority of the respondents are already buying cord care substances at these outlets.
• They are willing to pay for 7.1% chlorhexidine digluconate.
• Drugfield Pharmaceuticals has sufficient distribution channels to gain market access to all 36 states and the Federal Capital Territory at Abuja.
• Augment with social marketing to reach women/families in rural areas and with low income level.
• Markets/shops are also popular places to obtain cord care products but they are not allowed to sell drugs. Supporting distribution of product at market/shops would not be appropriate.
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Recommendations: Distribution (cont.)
• Continue to use the public-sector channels to maximize opportunity for women to access the product and to raise awareness about product use among families.
• Integration into national government programs such as the SURE-P MCH, the Midwives Service Scheme, etc.
• Use the Drug Revolving Fund.
• Putting the product into clean delivery kits (CDKs) is not an effective way to distribute the product.
• Current low awareness and low usage rates of CDKs make it an unattractive distribution channel for chlorhexidine.
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Recommendations: Awareness raising
• Use ANC as an educational avenue for women, including community-based ANC outreach programs conducted by CHEWs.
• Almost everyone accesses ANC.
• Those who provide delivery care are the ones most influential in determining which cord care products to use and which practices to employ.
• Personnel who provide delivery care are currently providing ANC.
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Recommendations: Mass media/demand generation
• Use mass media (TV and radio) as an avenue for communication
• Convey different messaging to those who use methylated spirits and those who use traditional substances.
• For those currently using methylated spirits, emphasize proven efficacy and ease of application
• For those currently using traditional substances, focus on dispelling myths.
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