July 11th is World Population Day. This year’s UNFPA theme, Putting the brakes on COVID-19, is focused on safeguarding the health of women and girls during the pandemic. World Population Day is an opportunity to pause and reflect on how women are uniquely affected by the COVID-19 crisis:
Women make up the largest share of frontline health workers, so they are disproportionately exposed to the novel coronavirus.
Disrupted supply chains impact women’s access to modern contraceptives, which can result in unintended pregnancies.
Staying home to prevent the spread of COVID-19 puts already vulnerable women at a heightened risk of violence. In addition, gender-based violence prevention and protection efforts, social services, and care have been reduced during the pandemic.
The pandemic creates additional barriers to people who are pregnant to access antenatal care and safe-delivery services.
With the disruption of schools and community-based services, adolescents and young people may struggle to access information and services related to sexual and reproductive health.
A population pyramid is a great visualization of a country’s distribution of age groups by sex. Take The DHS Program’s #PopPyramid Quiz to test your knowledge of population pyramids from recently published Demographic and Health Surveys (DHS) and learn more about DHS indicators related to COVID-19 prevention.
As health systems and programs are increasingly managed at subnational levels (regions, states, or counties), DHS data are frequently available at smaller geographic units. For instance, the 2018 Nigeria DHS provides estimates at the national level, by urban-rural residence, and for 6 zones and 36 states and the Federal Capital Territory (FCT). There is an increased demand for subnational dissemination activities to present DHS survey findings to local stakeholders to encourage data use in program design, evaluation, and research at the local level. To train communicators on survey dissemination to local program managers, The DHS Program developed a ‘Communicating DHS Data at the National and State Levels’ workshop.
The capacity strengthening training was piloted with the 2016 Kenya DHS, the first Kenya DHS survey to collect data at the county level. The workshop was then formalized into a five-day training, different versions of which have now been implemented in Tanzania, Malawi, Myanmar, Mali, Philippines, Uganda, and Haiti.
On November 5, 2019, more than 300 people attended the official launch of the 2018 Nigeria Demographic and Health Survey (NDHS) in Abuja. Following the national seminar, The DHS Program Dissemination team trained teams from the survey implementing agencies, the National Population Commission (NPC) and National Malaria Elimination Programme (NMEP). Participants learned about dissemination, data use, and data visualization best practices and developed data use activities and presentations with state-level data.
From November to December 2019, the NPC and NMEP teams facilitated state-level data use workshops in each of Nigeria’s 36 states and the FCT. The audience included government officials (Governors’ representatives, Deputy Governors, State Public Health Directors), state-level representatives from UNICEF and WHO, traditional leaders, academia, and others. NPC and NMEP officials trained state-level data users on how to read the tables in the 2018 NDHS final report, demonstrated STATcompiler and The DHS Program mobile app, and facilitated locally relevant discussions about using the 2018 NDHS state-level findings to inform evidence-based programs and policies.
During the Jigawa state dissemination workshop, Governor Mohammed Badaru Abubakar of Jigawa state called for action, “this report can also be used for planning purposes in our ministries, departments, boards and parastatals as well as other relevant agencies in Jigawa state.” The Federal Commissioner for NPC in Anambra state, where 53% of ever-married women age 15-49 have experienced physical, sexual, or emotional spousal violence, said that the 2018 NDHS would be used for “proper planning for sustainable development.”
Thanks to the hard work of the NPC and NMEP dissemination teams, more than 5,000 people attended dissemination workshops in their states and learned the 2018 NDHS findings first-hand.
See here for the latest update on The DHS Program fieldwork activities during COVID-19.
In October 2019, The DHS Program welcomed visitors from Cameroon who came to the office to finalize the report for the 2018 Cameroon DHS. This post is one in a series of interviews with visitors to DHS headquarters.
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Nom, titre et
organisation : Anaclet
Désiré DZOSSA, Chef de Division des Statistiques Démographiques à l’Institut
National de la Statistique (INS) ; Paul Roger LIBITE, Chef de Département
des Statistiques Démographiques et Sociales, INS
peu de la première fois que vous avez travaillé sur des données du « The
DHS Program » :
DZOSSA : C’était en 2004 lorsque j’ai participé pour
la première fois à l’analyse des données de l’Enquête Démographique et de Santé
du Cameroun (l’EDSC-III). J’ai été émerveillé, par curiosité lors de ces
travaux en 2004, de voir les données et rapports des autres pays aussi.
LIBITE : Il y a presque 27 ans en 1992, j’avais eu
la charge d’analyser les résultats de l’Enquête Démographique et de Santé du
Cameroun de 1991. J’avais reçu les tableaux de 7 chapitres et c’est moi qui
étais chargé de préparer les drafts qui devraient être par la suite enrichis
par mes supérieurs hiérarchiques. Moi je n’étais que jeune cadre.
Quel est votre
chapitre ou indicateur préféré, et pourquoi ?
DZOSSA : L’indicateur de niveau de bien-être
économique parce qu’il résume plusieurs aspects des caractéristiques
sociodémographiques et des conditions de vie des populations.
Quel est le
problème de population ou de santé qui vous intéresse le plus, et
LIBITE : De ma part, ma formation et mes
fonctions, c’est difficile de faire un choix. Tous les problèmes sont politiquement
préoccupants et comportent chacun un intérêt scientifique pertinent. Je suis
prêt à travailler sur n’importe quelle thématique.
espérez-vous que les données de l’EDS sur votre pays soient utilisées ?
DZOSSA : J’espère que cela sera effectivement utilisé
pour évaluer les politiques et stratégies mises en œuvre, et réorienter au
besoin celles qui devraient l’être pour le bien-être des populations.
appris en travaillant avec « The DHS Program » ?
LIBITE : Au-delà de la formation universitaire,
c’est en travaillant avec le programme DHS que j’ai compris comment mettre en
pratique les connaissances académiques. C’est une valeur ajoutée très
importante. Dans les universités et les écoles de formation, les cours sont
généralement très théoriques, et après la fin des études supérieures, il peut
arriver que l’on soit affecté à des tâches purement administratives qui ne
donnent pas l’opportunité de mettre en pratique les connaissances accumulées.
De plus, avec le programme DHS, il faut rester éveillé sur les évolutions
méthodologiques et scientifiques.
L’Enquête Démographique et de Santé 2018 de la République du Cameroun a été publiée le 10 juin 2020. Téléchargez le rapport final, la base de données et autres documents ici.
Are facilities prepared to face infectious disease pandemics like COVID-19? A new fact sheet explores infection control and readiness in health facilities from seven Service Provision Assessments (SPA) conducted in Afghanistan, Bangladesh, the Democratic Republic of Congo, Haiti, Nepal, Senegal, and Tanzania. The SPA collects information on the availability of different health services in a country and facilities’ readiness to provide those services.
In six out of seven countries, fewer than 75% of facilities have soap and running water or alcohol-based disinfectant for handwashing. Senegal is the exception, where 95% of health facilities in Senegal have these resources for handwashing.
Availability of personal protective equipment (PPE) such as latex gloves, medical masks, and gowns varies. In Nepal, latex gloves are available in 80% of facilities, while only 19% have medical masks and 9% have gowns. In the Democratic Republic of Congo, gowns (83%) and latex gloves (75%) are more common than medical masks (14%).
In Haiti, only 17% of facilities have appropriate storage of infectious waste, and fewer than half of facilities have safe final disposal of infectious waste. In Tanzania, 44% of facilities have appropriate storage of infectious waste, while 36% have safe final disposal of infectious waste.
Fewer than 1 in 4 facilities in five countries offer in-patient care. Few facilities have oxygen.
Most facilities have a thermometer and stethoscope. In Bangladesh, 86% of facilities have a thermometer and 94% have a stethoscope.
Explore indicators on infection prevention, PPE, diagnostic capacity, and newly tabulated indicators on therapeutic readiness in the new fact sheet.
The DHS Program has been a leading source of anthropometric (height and weight) data for more than 30 years. Measurements are collected from children, women, and men in some surveys. This information enables countries to make data-driven decisions and to monitor their progress in improving nutritional status and achieving the Sustainable Development Goals.
The DHS Program continually improves anthropometric data collection processes. In 2018, The DHS Program undertook a qualitative study to identify how to further enhance the quality of anthropometry data. The findings prompted several tools and processes to be tested in the field in Nigeria, including biomarker checklists and anthropometry remeasurement, which have now become standard practice.
Here are some examples of how The DHS Program supports countries to collect quality anthropometric data.
Designing surveys that incorporate best practices for collecting anthropometric data
To increase knowledge and enhance capacity of countries to implement DHS surveys, The DHS Program provides technical assistance on anthropometric data collection. An anthropometry brochure summarizes the key inputs needed to collect quality anthropometric data. It is based on the recently released WHO-UNICEF guidelines for anthropometric data collection.
Training fieldworkers to take precise and accurate measurements
DHS anthropometry trainings are interactive, including standardization exercises. Trainees take two separate measurements of multiple children which are compared to those of a gold standard measurer. Staff at The DHS Program, consultants, and in-country trainers have been certified as gold standard measurers. These data are entered into the DHS Anthropometry Standardization Tool to identify trainees who need re-training and re-standardization.
and improving anthropometric data in real-time
During data collection, field check tables are run, summarizing recently collected data that reflect team performance. If problems are discovered, feedback is provided to data collection supervisors. The DHS Anthropometry Field Check Tables are based on years of experience and analytical studies.
The DHS Program has also implemented new height and weight re-measurement procedures, in which repeat measurements are taken for a random set of children and from children with an unusual first measurement. During field work, the Computer-Assisted Personal Interviewing (CAPI) system produces a report on children selected for remeasurement. This provides information on overall anthropometry data quality and reduces the number of incorrect measurements.
quality of anthropometric data to users
Information on anthropometric data collection and quality helps users have confidence in the results and make correct inferences when comparing estimates over time and across countries. Recent DHS survey final reports provide a summary of anthropometric data quality in addition to documentation on survey implementation. For more in-depth information on data quality, DHS datasets can be inputted into the WHO Anthro Survey Analyser.
Data quality procedures lead to high quality anthropometry data for children in Nigeria
97% of trainees passed the standardization exercise
Nearly all trainees passed the standardization accuracy and precision criteria.
Only 2% of random remeasurement cases had a height difference > 1 cm
Data collectors’ precision for height measurements was high.
< 1% of data were implausible for each anthropometric index
This meets the WHO-UNICEF data quality criteria of < 1% implausible values based on WHO Growth Standards.
< 1% missing data for month and year of birth
Completeness of date of birth data was high.
< 3% missing data for height and weight measurements
There does not appear to be selection bias in height and weight data collection.
Data quality is an iterative process. As The DHS Program continues to learn, further enhancements and innovations will be implemented to ensure quality anthropometric data.
World Immunization Week is observed annually in the last week of April (April 24-30, 2020), to promote the use of vaccines to protect people of all ages against disease. Already, nearly 20 million children in the world are unvaccinated and under-vaccinated. Now, COVID-19 is disrupting the delivery of routine vaccines in low- and middle-income countries. This year’s theme for World Immunization Week, #VaccinesWork for All, highlights the heroes who develop, deliver, and receive vaccines to protect the health of everyone, everywhere.
The DHS Program has collected immunization data for over 30 years and has dozens of vaccination indicators available for 90+ countries on STATcompiler. Use STATcompiler to explore a map of basic vaccination coverage among children age 12-23 months in 47 countries. Or explore vaccination rates by background characteristics, such as wealth quintile.
Sustainable Development Goal (SDG) 3 aims to ensure healthy lives and promote well-being for all at all ages. Coverage of the diphtheria-pertussis-tetanus vaccine (the percent of children age 12-23 months who have received the third dose of the vaccine) is one DHS survey indicator that tracks countries’ progress towards achieving SDG 3. Learn about coverage of the DPT 3 vaccination and all eight basic vaccinations from five recent DHS surveys in the infographic below.
Share this infographic on Facebook and Twitter, and don’t forget to tag #VaccinesWork to engage with others in this global conversation!
Based on an in-person Malaria Indicator Trends Workshop developed by The DHS Program in 2017, this free, self-guided course takes 2-3 hours to complete. This course is designed for malaria data users, such as professionals from National Malarial Control Programs, Ministries of Health, implementing and collaborating agencies, donor agencies, and anyone who works in malaria programming or is interested in malaria data.
The purpose of this course is to increase the capacity of participants to understand and interpret trends in malaria indicators from population-based household surveys to answer key malaria programmatic questions.
This new course on malaria trends complements existing malaria resources offered by The DHS Program, including another free, self-guided course, Measuring Malaria through Household Surveys, available on the Global Health eLearning Center platform in English and French. Measuring Malaria takes 2-3 hours to complete and provides an overview of key malaria indicators collected through household surveys. Since Measuring Malaria covers data collection, calculation, and interpretation of key malaria indicators, taking it first can lay a strong foundation before taking Interpreting Trends in Malaria Indicators.
As the world responds to the COVID-19 outbreak, The DHS Program remains committed to promoting the use of DHS data. As many DHS data users transition to distance teaching and learning, do not forget about existing capacity strengthening resources available through The DHS Program to close statistical skills gaps.
The DHS Program is pleased to announce The DHS Program Learning Hub, a virtual learning and collaboration space, at learning.dhsprogram.com. The Learning Hub offers a solution to make learning opportunities more widely available with online courses, either standalone or as part of The DHS Program workshops.
What types of courses are found on the Learning Hub?
All courses on the Learning Hub are asynchronous, meaning learners engage on their own time, from any time zone. Course formats vary.
Self-guided: Anyone can enroll in these open-access online courses, which can be taken any time, at your own pace. Currently, The DHS Program is offering Interpreting Trends in Malaria Indicatorsas a self-guided course. Learn about Malaria Indicator Surveys, key malaria indicators, and how to interpret trends in data to answer malaria programmatic questions. This course takes 2-3 hours to complete. Just create an account on the Learning Hub, enroll in the course, and start learning!
Blended: All DHS Program regional workshops (such as Data Mapping and Data Processing Procedures) have both online and in-person components in tailored combinations. Participants complete pre-work assignments online before meeting in-person for a capacity strengthening workshop. This helps ensure that all participants have the same foundation and are equally ready to maximize their time together in-person. The DHS Fellows Program is another example of a blended course. For all DHS Program workshops, participants go through a rigorous application process.
Instructor-led: These courses are 100% online, time-bound, and led by an instructor, usually a staff member of The DHS Program, who is available to assist participants and answer their questions. Learners must apply to instructor-led courses, as space is limited. Applications are reviewed by The DHS Program staff to ensure course participants have the required knowledge and skills. A proportion of applicants are formally accepted to the course. The Survey Sampling Training Course, for instance, equips participants with the knowledge, tools, skills, and abilities to design samples for population surveys, such as DHS surveys. Participants in the Survey Sampling course spend an average of 5-10 hours a week for 8 weeks engaging with modules, completing coursework, and interacting with their peers and instructor(s) in a discussion forum. The call for applications for the first Survey Sampling Training Course to be offered en français will be available soon.
All courses on The DHS Program Learning Hub include interactive modules, videos, and links to further reading and useful resources. Courses and associated resources remain available to participants even after they complete the course or the course ends.
More courses on different topics related to household surveys are in development now. Check The DHS Program’s capacity strengthening page and the Learning Hub for announcements regarding upcoming courses and calls for applications.
Follow The DHS Program on Facebook, Twitter, or LinkedIn for updates on capacity strengthening opportunities and more!
The current World Health Organization’s guidelines call for the public focus on handwashing, social distancing, communication with medical providers, and staying informed to help mitigate the spread of COVID-19. However, such guidance may be more aspirational than actionable for millions at risk of exposure to the virus in lower- and middle-income countries (LMICs) as revealed by recent Demographic and Health Surveys (DHS). DHS data from 2014 onward from more than 50 countries in Africa, Asia, and Latin America highlight the very different contexts for daily living in LMICs. These realities must be considered when developing country or context-specific strategies for reducing COVID-19 transmission.
The basics required for handwashing (soap and water) are taken for granted by many but are not readily available for millions of people. In Burundi (2016-17 DHS), only 5% of households were observed to have soap and water for handwashing (among those where handwashing places were observed). Soap and water were present in fewer than 20% of households in Malawi, Ethiopia, Benin, and Mali (see chart). A location for handwashing with soap and water was found in fewer than half of households in 21 out of 36 recent surveys for which The DHS Program has this information.
Household Size and Sleeping Arrangements:
Messaging about social distancing in the current pandemic focuses on staying home and reducing contact with people. In LMICs, self-quarantining to individual households and nuclear families may not be a particularly useful concept.
Households in Sierra Leone, Tajikistan, Guinea, Pakistan, Afghanistan, and Senegal are the largest, with six or more members on average. The ability to distance from sick or vulnerable family members within the household is crucial, but in many households sleeping quarters are crowded. Households in Pakistan, Madagascar, Ethiopia, and Cambodia have the highest average of people per sleeping room, at three or more.
Household Age Structure:
A recent article in the Hindustan Times pointed out that multi-generational households in India might be a risk factor for coronavirus transmission to the elderly. The 2015-16 India National Family Health Survey (India’s DHS) reported that 4 in 10 Indian households are non-nuclear families, many of which are multi-generational. This type of family structure makes social distancing, especially for the elderly, very challenging. When younger children go to school, or working-age adults go to work, they return home to multi-generational families in which the elderly are particularly vulnerable to coronavirus. While the proportion of population age 65+ in DHS countries is not large, there are some key things to note, particularly within the context of multigenerational households. In recent surveys, on average, about 5% of the population is 65+, but in countries like India (6.6%) and Indonesia (6.2%), these seemingly small percentages correspond to many millions of people due to population size.
The DHS Program’s STATcompiler allows users to create custom
tables, charts, and maps from 1000s of indicators across 90 countries.
Just this week, the STATcompiler has been updated to include new indicators to help contextualize the COVID-19 crisis in DHS countries, and two “COVID19” tags have been added to help users identify these indicators. Explore data on handwashing, sanitation, household size, sleeping arrangements, access to media, spousal violence, and more. Other relevant DHS indicators on household age structure, access to internet and cell phones, and tobacco use will be added in the coming weeks.
Health emergencies necessitate that urgent information be shared with the public in a timely manner. And yet large portions of the global population live without regular access to mass media. More than half of women age 15-49 in Liberia, Nigeria, Sierra Leone, Guinea, Benin, Timor-Leste, Niger, Malawi, Mozambique, the Democratic Republic of the Congo, Burundi, Papua New Guinea, Ethiopia, and Chad report that they do not have weekly access to information via radio, television, or newspaper.
In 30 out of 47 recent DHS surveys, at least 75% of households owned at least one mobile telephone. Still, ownership is lower in rural areas, and still uncommon in some countries; in Madagascar, for example, only one-third of households owned a mobile phone in 2016. Internet access, however, is very low across DHS countries. In Nigeria, only 16% of women and 35% of men age 15-49 used the internet in the past year (2018 NDHS). In Zambia, use was even lower, at 12% of women and 26% of men (2018 ZDHS).
Additional Considerations: Domestic Violence, Tobacco Use, and Access to Basic Health Services
And then there are potential secondary risk factors. How does cigarette smoking affect vulnerability? How will families cope with the stresses of a pandemic and the interpersonal conflicts exacerbated in quarantine settings? Will women and children continue to get the general health services they need, such as vaccinations, antenatal and delivery care, family planning, and nutritional support? These questions are important in all settings, but especially in those that are still in the process of building systems to support accessible, quality health care services. In Nigeria, for example, fewer than one-third of children age 12-23 months have received all 8 basic vaccinations, only about 40% of births are delivered in a health facility, and 19% of women have an unmet need for family planning.
Averaging across countries with data on spousal violence shows that 1 out of 4 women report physical, sexual, or emotional violence committed by their husband or partner within the last 12 months, and 36% report ever having faced such violence in their lifetime. These data suggest that social distancing may expose a significant proportion of already vulnerable women to a heightened risk of violence as women are forced to spend even more time with their abusers than usual and their access to sources of help is further limited by the pandemic.
There are countless other factors that are likely affecting COVID-19 transmission throughout the world. Urbanization, and slum environments in particular, are breeding grounds for contagion. In LMICs, millions of people migrate to city-centers for employment and are now migrating home to rural areas seeking safe-haven. These and myriad other factors can be explored in DHS datasets and final reports.
Pandemics require data-driven decisions. While it is one unique virus that has spanned the globe, individual nations, communities, cultures, and families all face it within their own contexts. We can’t collect DHS household data during a pandemic. But we owe it to families in DHS countries to use the information already collected to better inform decisions to provide recommendations that resonate in their settings and to safeguard their already fragile health infrastructure.
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Si vous êtes intéressé à être présenté dans la série de blogs ‘DHS Data Users’, faites-le nous savoir ici en nous soumettant votre exemple d’utilisation des données du programme DHS.
Comment êtes-vous impliqué
dans les enquêtes de The DHS Program ?
J’ai travaillé pendant trois années comme superviseur national du volet ménage des Enquêtes Démographiques et de Santé (EDS)-Continue au Sénégal. Durant cette expérience, en plus du suivi de la collecte, j’ai participé activement dans le traitement des données (éditions secondaires) et dans l’analyse des données. Lors de l’EDS-Continue, j’ai bénéficié de formations en matière de :
L’échantillonnage de l’EDS ;
Les procédures de traitement des données de
Les méthodes dynamiques de formation pour adultes.
Cette dernière a changé ma façon d’animer les ateliers. En toute modestie, si aujourd’hui la qualité de mon enseignement ou d’animation est appréciée, c’est en grande partie grâce à la formation sur les méthodes dynamiques de formation pour adultes que j’ai suivi.
Et les ateliers de l’utilisation et de l’analyse de données des enquêtes de
The DHS Program ?
2019, The DHS Program m’a engagé pour animer un atelier, Tendances des
Indicateurs du Paludisme au Bénin.
L’atelier portait sur l’analyse des tendances temporelles des indicateurs du paludisme au Bénin. La finalité était de contribuer à l’amélioration des capacités des 18 acteurs opérationnels de la mise en œuvre du programme paludisme par :
une formation sur la méthodologie de la collecte, le calcul des indicateurs clés du paludisme, notamment l’identification de numérateur et du dénominateur de chaque indicateur;
un examen des intervalles de confiances et leur interprétation
Comment utilisez-vous les données des enquêtes de The DHS Program lors de votre travail actuel ?
Depuis 2018, je
suis Data Manager de l’Evaluation prospective des programmes du Fonds Mondial
(Tuberculose, VIH, Paludisme) où je suis chargé de la gestion et de l’analyse
des données de l’évaluation.
Les données de l’EDS nous permettent de vérifier l’exactitude des données des programmes de santé mais aussi d’estimer les connaissances, attitudes et pratiques de la population sur les maladies telles que la tuberculose, le VIH ou encore le paludisme.
Quel est le problème de
population ou de santé qui vous intéresse le plus, et pourquoi ?
particulièrement intéressé par la planification familiale. La plupart des décès
maternels restent liés aux grossesses rapprochées, trop nombreuses, précoces ou
tardives. C’est pourquoi la planification familiale constitue une méthode des
plus efficaces et peu couteuse pour améliorer la santé des femmes et des
enfants et lutter contre la mortalité maternelle et infantile.
En effet, en dépit des progrès réalisés dans le secteur de la santé au Sénégal, les taux de mortalité maternelle et infantile n’ont pas connu l’évolution espérée ces dix dernières années. Le pourcentage de décès de femmes liés à la grossesse est l’un des plus élevés de la sous-région (29%). Par ailleurs, la mortalité infantile (42 décès pour 1 000 naissances vivantes, EDS-C 2017) reste au même niveau depuis quelques années et ce à cause, notamment, du nombre important de décès néonataux (28 décès pour 1 000 naissances vivantes, EDS-C 2017) qui représentent la moitié des décès infantiles.
Ingénieur statisticien de formation avec
une spécialisation en informatique décisionnelle, Ibrahima GAYE est aussi
titulaire d’un Master en management de projets et d’un Master en santé publique
spécialité Méthode Quantitatives et Économétriques pour la Recherche en santé,
pour lequel il a utilisé les données de l’EDS dans le cadre de son mémoire de
Master en santé publique sur : « Analyse multiniveau de l’utilisation
de la contraception au Sénégal ». Il est maintenant en train d’écrire sa
thèse de Doctorat en santé publique : « Contribution du modèle
Age-Période-Cohorte (APC) à l’étude de la prévalence contraceptive au
Sénégal », pour lequel il utilisera également les données de l’EDS.
Anthropometry measurement (height and weight) is a core component of DHS surveys that is used to generate indicators on nutritional status. The Biomarker Questionnaire now includes questions on clothing and hairstyle interference on measurements for both women and children for improved interpretation.