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- Volume 89, Issue 1_Suppl, July 2013
The American Journal of Tropical Medicine and Hygiene - Volume 89, Issue 1_Suppl, July 2013

Volume 89, Issue 1_Suppl, July 2013
- Acknowledgments
- Cover Photo Attributions
- Preface
- Articles
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Health care seeking for Childhood Diarrhea in Developing Countries: Evidence from Seven Sites in Africa and Asia
Pages: 3–12More LessAbstract.We performed serial Health Care Utilization and Attitudes Surveys (HUASs) among caretakers of children ages 0–59 months randomly selected from demographically defined populations participating in the Global Enteric Multicenter Study (GEMS), a case-control study of moderate-to-severe diarrhea (MSD) in seven developing countries. The surveys aimed to estimate the proportion of children with MSD who would present to sentinel health centers (SHCs) where GEMS case recruitment would occur and provide a basis for adjusting disease incidence rates to include cases not seen at the SHCs. The proportion of children at each site reported to have had an incident episode of MSD during the 7 days preceding the survey ranged from 0.7% to 4.4% for infants (0–11 months of age), from 0.4% to 4.7% for toddlers (12–23 months of age), and from 0.3% to 2.4% for preschoolers (24–59 months of age). The proportion of MSD episodes at each site taken to an SHC within 7 days of diarrhea onset was 15–56%, 17–64%, and 7–33% in the three age strata, respectively. High cost of care and insufficient knowledge about danger signs were associated with lack of any care-seeking outside the home. Most children were not offered recommended fluids and continuing feeds at home. We have shown the utility of serial HUASs as a tool for optimizing operational and methodological issues related to the performance of a large case-control study and deriving population-based incidence rates of MSD. Moreover, the surveys suggest key targets for educational interventions that might improve the outcome of diarrheal diseases in low-resource settings.
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Health Care Utilization and Attitudes Survey: Understanding Diarrheal Disease in Rural Gambia
Pages: 13–20More LessAbstract.Diarrheal disease causes ∼1.34 million deaths per year among children under 5 years of age globally. We conducted a Health Care Utilization and Attitudes Survey of 1,012 primary caregivers of children aged 0–11, 12–23, and 24–59 months randomly selected from a Demographic Surveillance population in rural Gambia. Point prevalence of diarrhea was 7.7% (95% confidence interval [CI] = 6.1–9.8); 23.3% had diarrhea within the previous 2 weeks. Caregivers of 81.5% of children with diarrhea sought healthcare outside their home, but only 48.4% of them visited a health center. Only 17.0% (95% CI = 12.1–23.2) of children with diarrhea received oral rehydration solution (ORS) at home. Abbreviated surveys conducted on six occasions over the subsequent 2 years showed no change in prevalence or treatment-seeking behavior. Diarrhea remains a significant problem in rural young Gambian children. Encouraging care-seeking behavior at health centers and promoting ORS use can reduce mortality and morbidity in this population.
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Seeking Care for Pediatric Diarrheal Illness from Traditional Healers in Bamako, Mali
Pages: 21–28More LessAbstract.Diarrhea is a leading cause of child mortality worldwide. Early recognition of symptoms and referral to medical treatment are essential. In 2007, we conducted a Healthcare Utilization and Attitudes Survey (HUAS) of 1,000 children randomly selected from a population census to define care-seeking patterns for diarrheal disease in Bamako, Mali, in preparation for the Global Enteric Multicenter Study (GEMS). We found that 57% of caretakers sought care for their child's diarrheal illness from traditional healers, and 27% of caretakers sought care from the government health center (GHC). Weighted logistic regression showed that seeking care from a traditional healer was associated with more severe reported diarrheal disease, like decreased urination (odds ratio [OR] = 3.35, 95% confidence interval [95% CI] = 1.19–9.41) and mucus or pus in stool (OR = 4.42, 95% CI = 1.35–14.51), along with other indicators of perceived susceptibility. A locally designed traditional healer referral system was, therefore, created that emphasized more severe disease. This system may serve as a model for health systems in West Africa.
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Health Care-Seeking Behavior During Childhood Diarrheal Illness: Results of Health Care Utilization and Attitudes Surveys of Caretakers in Western Kenya, 2007–2010
Pages: 29–40More LessAbstract.We interviewed caretakers of 1,043 children < 5 years old in a baseline cross-sectional survey (April to May 2007) and > 20,000 children on five separate subsequent occasions (May of 2009 to December 31, 2010) to assess healthcare seeking patterns for diarrhea. Diarrhea prevalence during the preceding 2 weeks ranged from 26% at baseline to 4–11% during 2009–2010. Caretakers were less likely to seek healthcare outside the home for infants (versus older children) with diarrhea (adjusted odds ratio [aOR] = 0.33, confidence interval [CI] = 0.12–0.87). Caretakers of children with reduced food intake (aOR = 3.42, CI = 1.37–8.53) and sunken eyes during their diarrheal episode were more likely to seek care outside home (aOR = 4.76, CI = 1.13–8.89). Caretakers with formal education were more likely to provide oral rehydration solution (aOR = 3.01, CI = 1.41–6.42) and visit a healthcare facility (aOR = 3.32, CI = 1.56–7.07). Studies calculating diarrheal incidence and healthcare seeking should account for seasonal trends. Improving caretakers' knowledge of home management could prevent severe diarrhea.
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Health Care Utilization and Attitudes Survey in Cases of Moderate-to-Severe Diarrhea among Children Ages 0–59 Months in the District of Manhiça, Southern Mozambique
Pages: 41–48More LessAbstract.In the predominantly rural Manhiça district, in southern Mozambique, diarrhea is one of the leading causes of death among children under 5 years. Caretakers randomly selected from the Demographic Surveillance Database were invited to participate in a community-based survey on use of healthcare services for gastroenteritis. Of those caretakers reporting an episode of diarrhea during the recall period, 65.2% in the first survey and 43.8% in the second survey reported seeking care at a health facility. Independent risk factors for seeking care in health facilities in the first survey included the presence of diarrhea with fever and not knowing any sign of dehydration; having a television at home was related with an independent decreased use of the health facilities. In the second survey, the use of health services was significantly associated with diarrhea with fever and vomiting. Establishment of continuous prospective monitoring allows accounting for changes in healthcare use that may occur because of seasonality or secular events.
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Health Care Use Patterns for Diarrhea in Children in Low-Income Periurban Communities of Karachi, Pakistan
Pages: 49–55More LessAbstract.Diarrhea causes 16% of all child deaths in Pakistan. We assessed patterns of healthcare use among caretakers of a randomly selected sample of 959 children ages 0–59 months in low-income periurban settlements of Karachi through a cross-sectional survey. A diarrheal episode was reported to have occurred in the previous 2 weeks among 298 (31.1%) children. Overall, 280 (80.3%) children sought care. Oral rehydration solution and zinc were used by 40.8% and 2%, respectively; 11% were admitted or received intravenous rehydration, and 29% sought care at health centers identified as sentinel centers for recruiting cases of diarrhea for a planned multicenter diarrheal etiology case-control study. Odds ratios for independent predictors of care-seeking behavior were lethargy, 4.14 (95% confidence interval = 1.45–11.77); fever, 2.67 (1.27–5.59); and stool frequency more than six per day, 2.29 (1.03–5.09). Perception of high cost of care and use of home antibiotics were associated with reduced care seeking: odds ratio = 0.28 (0.1–0.78) and 0.29 (0.11–0.82), respectively. There is a need for standardized, affordable, and accessible treatment of diarrhea as well as community education regarding appropriate care in areas with high diarrheal burden.
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Determinants of Health Care Seeking for Diarrheal Illness in Young Children in Urban Slums of Kolkata, India
Pages: 56–61More LessAbstract.Maternal practices regarding children's health care have been recognized as an important factor associated with mortality rates among children < 5 years of age. We focused on health care-seeking practices of primary caretakers of children < 5 years of age with diarrheal disease in Kolkata. We interviewed caretakers of 1,058 children in a baseline survey and 6,077 children on six subsequent surveys. The prevalence of diarrhea during the preceding 2 weeks was 7.9% in the baseline survey and 5.7% (lowest 3.5% to highest 7.8%) in subsequent surveys. Multivariate logistic regression showed that formal education of primary caretakers was associated with seeking care outside the home (odds ratio [OR] = 15.5; 95% confidence interval [CI] [2.5–85.7]; P = 0.002). Multinomial logistic regression showed that formal education of the primary caretaker (OR = 21.4; 95% CI [3.2–139.0]; P = 0.002) and presence of dry mouth during diarrhea (OR = 17.3; 95% CI [2.7–110.9]; P = 0.003) were associated with seeking care from licensed providers compared with the children for whom care was not sought outside of the home. This health care utilization and attitudes survey (HUAS) can serve as a tool to identify the factors that influence a better health care-seeking pattern in urban slums of Kolkata.
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Health Care-Seeking Behavior for Childhood Diarrhea in Mirzapur, Rural Bangladesh
Pages: 62–68More LessAbstract.We evaluated patterns of health care use for diarrhea among children 0–59 months of age residing in Mirzapur, Bangladesh, using a baseline survey conducted during May–June 2007 to inform the design of a planned diarrheal etiology case/control study. Caretakers of 7.4% of 1,128 children reported a diarrheal illness in the preceding 14 days; among 95 children with diarrhea, 24.2% had blood in the stool, 12.2% received oral rehydration solution, 27.6% received homemade fluids, and none received zinc at home. Caretakers of 87.9% sought care outside the home; 49.9% from a pharmacy, and 22.1% from a hospital or health center. The primary reasons for not seeking care were maternal perception that the illness was not serious enough (74.0%) and the high cost of treatment (21.9%). To improve management of childhood diarrhea in Mirzapur, Bangladesh, it will be important to address knowledge gaps in caretakers' assessment of illness severity, appropriate home management, and when to seek care in the formal sector. In addition, consideration should be given to inclusion of the diverse care-giving settings in clinical training activities for diarrheal disease management.
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Volumes & issues
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Volume 104 (2021)
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Volume 103 (2020)
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Volume 102 (2020)
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Volume 101 (2019)
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Volume 100 (2019)
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Volume 99 (2018)
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Volume 98 (2018)
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Volume 97 (2017)
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Volume 96 (2017)
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Volume 95 ([2016, 2017])
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Volume 94 (2016)
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Volume 93 (2015)
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Volume 92 (2015)
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Volume 91 (2014)
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Volume 90 (2014)
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Volume 89 (2013)
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Volume 88 (2013)
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Volume 87 (2012)
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Volume 86 (2012)
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Volume 85 (2011)
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Volume 84 (2011)
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Volume 83 (2010)
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Volume 82 (2010)
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Volume 81 (2009)
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Volume 80 (2009)
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Volume 79 (2008)
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Volume 78 (2008)
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Volume 77 (2007)
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Volume 76 (2007)
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Volume 75 (2006)
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Volume 73 (2005)
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Volume 72 (2005)
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Volume 71 (2004)
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Volume 70 (2004)
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Volume 69 (2003)
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Volume 68 (2003)
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Volume 67 (2002)
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Volume 66 (2002)
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Volume 65 (2001)
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Volume 64 (2001)
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Volume 63 (2000)
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Volume 62 (2000)
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Volume 61 (1999)
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Volume 60 (1999)
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Volume 59 (1998)
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Volume 56 (1997)
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Volume 55 (1996)
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Volume 54 (1996)
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Volume 53 (1995)
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Volume 52 (1995)
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Volume 51 (1994)
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Volume 50 (1994)
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Volume 49 (1993)
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Volume 48 (1993)
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Volume 47 (1992)
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Volume 46 (1992)
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Volume 45 (1991)
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Volume 44 (1991)
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Volume 43 (1990)
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Volume 42 (1990)
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Volume 41 (1989)
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Volume 40 (1989)
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Volume 39 (1988)
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Volume 38 (1988)
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Volume 37 (1987)
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Volume 36 (1987)
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Volume 35 (1986)
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Volume 34 (1985)
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Volume 33 (1984)
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Volume 32 (1983)
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Volume 31 (1982)
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Volume 30 (1981)
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Volume 29 (1980)
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Volume 28 (1979)
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Volume 27 (1978)
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Volume 26 (1977)
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Volume 25 (1976)
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Volume 24 (1975)
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Volume 23 (1974)
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Volume 22 (1973)
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Volume 21 (1972)
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Volume 20 (1971)
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Volume 19 (1970)
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Volume 18 (1969)
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Volume 17 (1968)
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Volume 16 (1967)
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Volume 15 (1966)
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Volume 14 (1965)
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Volume 13 (1964)
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Volume 12 (1963)
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Volume 11 (1962)
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Volume 10 (1961)
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Volume 9 (1960)
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Volume 8 (1959)
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Volume 7 (1958)
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Volume 6 (1957)
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Volume 5 (1956)
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Volume 4 (1955)
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Volume 3 (1954)
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Volume 2 (1953)
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Volume 1 (1952)
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Volume s1-31 (1951)
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Volume s1-30 (1950)
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Volume s1-29 (1949)
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Volume s1-28 (1948)
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Volume s1-27 (1947)
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Volume s1-26 (1946)
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Volume s1-25 (1945)
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Volume s1-24 (1944)
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Volume s1-23 (1943)
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Volume s1-22 (1942)
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Volume s1-21 (1941)
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Volume s1-20 (1940)
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Volume s1-19 (1939)
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Volume s1-18 (1938)
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Volume s1-17 (1937)
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Volume s1-16 (1936)
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Volume s1-15 (1935)
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Volume s1-14 (1934)
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Volume s1-13 (1933)
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Volume s1-12 (1932)
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Volume s1-11 (1931)
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Volume s1-10 (1930)
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Volume s1-9 (1929)
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Volume s1-8 (1928)
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Volume s1-7 (1927)
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Volume s1-6 (1926)
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Volume s1-5 (1925)
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Volume s1-4 (1924)
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Volume s1-3 (1923)
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Volume s1-2 (1922)
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Volume s1-1 (1921)