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All volunteers were provided with consent forms to fill before the study began. Consent forms were translated to local language (Kiswahili). Ethical approval for the study was obtained from Ifakara Health Institute Institutional Review Board (IHI\/IRB\/No: 35-2015) and from the Medical Research Coordinating Committee (MRCC) at the National Institutes of Medical Research (NIMR), Ref: NIMR\/HQ\/R.8a\/Vol.IX\/2162). Permission to publish this work was also obtained from NIMR (Ref: NIMR\/HQ\/P.12 VOL XXVII\/38). The research team conducted meetings with local government administration officers and village leaders before the study was initiated in all villages. 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