Three health centers and two hospitals were included in the study. All patient flow less than five years of age children in the last two consecutive years of the same period of data collection was taken from the monthly registration book of each health institution and these two years patient flow data average was used as a baseline to proportionally allocate the study participants. Then, the number of actual study participants for each health institution was calculated and taken proportionally. Then participants were selected by using a systematic random sampling technique to ensure representativeness.

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