I
nte
rna
t
io
na
l J
o
urna
l o
f
P
u
bli
c
H
ea
lt
h Science
(
I
J
P
H
S)
Vo
l.
10
,
No
.
3
,
Sep
tem
b
er
202
1
,
p
p
.
5
7
4
~
5
8
0
I
SS
N:
2
2
5
2
-
8
8
0
6
,
DOI
: 1
0
.
1
1
5
9
1
/i
j
p
h
s
.
v
10
i
3
.
2
0
8
5
8
574
J
o
ur
na
l ho
m
ep
a
g
e
:
h
ttp
:
//
ijp
h
s
.
ia
esco
r
e.
co
m
Risk
f
a
ctors o
f
le
ptos
piro
sis
incide
nce
in
a
g
ricul
tura
l
a
rea
M
it
o
ria
na
P
o
rus
ia
1
,
Anni
s
a
F
a
uzia
h
Dw
i A
nd
a
ri
2
,
Wind
i
Wula
nd
a
ri
3
,
Dua
ng
rue
dee
Cho
t
k
la
ng
4
1
,
2,
3
P
u
b
l
ic He
a
lt
h
De
p
a
rtm
e
n
t
,
Un
iv
e
rsitas
M
u
h
a
m
m
a
d
i
y
a
h
S
u
ra
k
a
rta,
Ka
rtas
u
ra
,
In
d
o
n
e
sia
4
Em
e
r
g
e
n
c
y
M
e
d
ica
l
De
p
a
rt
m
e
n
t
,
S
iri
n
d
h
o
rn
Co
ll
e
g
e
o
f
P
u
b
li
c
He
a
lt
h
Kh
o
n
Ka
e
n
,
Kh
o
n
Ka
e
n
,
T
h
a
il
a
n
d
Art
icle
I
nfo
AB
ST
RAC
T
A
r
ticle
his
to
r
y:
R
ec
eiv
ed
J
an
2
7
,
2
0
21
R
ev
i
s
ed
J
u
n
5
,
2
0
21
A
cc
ep
ted
J
u
n
20
,
2
0
21
T
h
e
ra
te
o
f
lep
to
sp
iro
sis
i
n
c
id
e
n
c
e
in
Bo
y
o
lali
re
g
e
n
c
y
,
In
d
o
n
e
sia
,
d
u
r
in
g
2
0
1
7
w
a
s
h
ig
h
a
n
d
sh
o
w
in
g
a
n
in
c
re
a
sin
g
tren
d
.
A
c
c
o
rd
in
g
to
Bo
y
o
lali
District
He
a
lt
h
Off
ice
th
e
n
u
m
b
e
r
o
f
lep
to
sp
ir
o
sis
c
a
se
s
in
2
0
1
7
w
a
s
3
4
c
a
se
s.
F
a
c
to
rs
re
l
a
ted
to
lep
to
s
p
iro
sis
in
t
h
e
a
g
ricu
lt
u
re
a
re
a
sh
o
u
l
d
b
e
u
n
d
e
rst
o
o
d
w
e
ll
to
tak
e
th
e
rig
h
t
m
e
a
su
re
m
e
n
ts
f
o
r
lep
to
sp
iro
sis
c
o
n
tr
o
l
in
a
ty
p
ica
l
a
g
ricu
lt
u
ra
l
a
re
a
.
S
e
v
e
ra
l
risk
f
a
c
to
rs,
su
c
h
a
s
p
e
rso
n
a
l
h
y
g
i
e
n
e
,
e
n
v
iro
n
m
e
n
tal
sa
n
it
a
ti
o
n
,
w
o
u
n
d
p
re
se
n
c
e
,
o
c
c
u
p
a
ti
o
n
,
a
re
th
e
f
a
c
to
rs
o
f
lep
to
sp
i
ro
sis
i
n
f
e
c
ti
o
n
.
T
h
is
st
u
d
y
a
i
m
e
d
to
d
e
term
in
e
th
e
risk
fa
c
to
rs
a
ss
o
c
iate
d
w
it
h
th
e
lep
to
s
p
iro
sis
in
c
id
e
n
c
e
in
Bo
y
o
lali
r
e
g
e
n
c
y
,
In
d
o
n
e
sia
.
T
h
is
re
se
a
rc
h
u
se
d
a
n
o
b
se
rv
a
ti
o
n
a
l
m
e
th
o
d
w
it
h
a
c
a
se
-
c
o
n
tro
l
d
e
sig
n
.
T
h
e
to
tal
n
u
m
b
e
r
o
f
c
a
se
s
a
m
p
le
w
a
s
3
3
p
e
o
p
le,
a
n
d
th
e
c
o
n
tr
o
l
sa
m
p
le
w
e
r
e
9
9
p
e
o
p
le
(ra
ti
o
1
:3
)
w
it
h
m
a
tch
e
d
b
y
a
li
v
in
g
a
re
a
.
Da
ta
c
o
ll
e
c
ti
o
n
w
e
re
c
a
rrie
d
o
u
t
w
it
h
in
terv
iew
s
u
sin
g
a
q
u
e
stio
n
n
a
ire
to
re
sp
o
n
d
e
n
ts
re
late
d
t
o
p
e
rso
n
a
l
h
y
g
ien
e
,
e
n
v
iro
n
m
e
n
tal
sa
n
it
a
ti
o
n
,
w
o
u
n
d
p
re
se
n
c
e
a
n
d
w
o
rk
a
s
a
fa
r
m
e
r.
T
h
e
d
a
ta
w
e
re
tes
t
e
d
u
sin
g
lo
g
ist
ic
re
g
re
s
sio
n
.
M
o
st
o
f
th
e
c
a
se
re
sp
o
n
d
e
n
ts
w
o
rk
a
s
a
f
a
r
m
e
r
a
n
d
w
o
rk
e
r.
T
h
e
re
su
lt
s
sh
o
w
e
d
th
a
t
th
e
risk
f
a
c
to
rs
a
ss
o
c
iate
d
w
it
h
lep
to
s
p
iro
sis
in
c
id
e
n
c
e
w
e
re
a
w
o
u
n
d
p
re
se
n
c
e
(OR:1
7
.
0
1
4
;9
5
%
CI:5
.
4
8
7
-
5
2
.
7
6
1
)
a
n
d
w
o
rk
e
d
a
s
a
f
a
r
m
e
r
(OR:
5,
1
8
6
;
9
5
%
CI:1
.
6
8
2
-
1
5
.
9
8
9
).
Un
re
late
d
v
a
riab
les
w
e
re
b
a
d
p
e
rso
n
a
l
h
y
g
ien
e
(9
5
%
CI:0
.
6
4
7
-
7
.
8
8
5
)
a
n
d
e
n
v
ir
o
n
m
e
n
tal
sa
n
it
a
ti
o
n
(
9
5
%
CI:0
.
7
9
3
-
8
.
7
7
3
)
.
T
h
e
d
o
m
in
a
n
t
risk
f
a
c
to
r
th
a
t
c
a
u
se
s
L
e
p
to
sp
iro
sis
w
a
s
w
o
u
n
d
p
re
se
n
c
e
s
a
n
d
o
c
c
u
p
a
ti
o
n
a
s
a
fa
r
m
e
r.
T
h
e
re
f
o
r
e
p
e
o
p
le
w
h
o
w
o
rk
m
o
stl
y
to
u
c
h
th
e
w
a
ter
li
k
e
f
a
r
m
e
rs
m
u
st
c
o
v
e
r
a
n
y
w
o
u
n
d
o
n
f
e
e
t
a
n
d
k
e
e
p
p
e
rso
n
a
l
a
n
d
e
n
v
i
ro
n
m
e
n
tal
sa
n
it
a
ti
o
n
to
p
re
v
e
n
t
i
n
f
e
c
ti
o
n
.
K
ey
w
o
r
d
s
:
Ag
r
icu
ltu
r
al
ar
ea
Far
m
er
L
ep
to
s
p
ir
o
s
is
R
is
k
f
ac
to
r
T
h
is
is
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Mito
r
ian
a
P
o
r
u
s
ia
P
u
b
lic
Hea
lth
Dep
ar
t
m
e
n
t
Facu
lt
y
o
f
Hea
l
th
Sc
ien
ce
,
U
n
iv
er
s
ita
s
Mu
h
a
m
m
ad
i
y
a
h
S
u
r
ak
ar
ta
Kar
tasu
r
a,
5
7
1
6
2
,
I
n
d
o
n
esia
E
m
ail:
m
ito
r
ian
a.
p
o
r
u
s
ia@
u
m
s
.
ac
.
id
1.
I
NT
RO
D
UCT
I
O
N
L
ep
to
s
p
ir
o
s
is
is
th
e
m
o
s
t
w
i
d
esp
r
ea
d
zo
o
n
o
s
is
in
t
h
e
w
o
r
ld
.
Ma
n
y
lep
to
s
p
ir
o
s
is
ca
s
es
h
av
e
b
ee
n
u
n
d
er
d
iag
n
o
s
ed
b
ec
au
s
e
o
f
th
e
u
n
s
p
ec
if
ic
s
y
m
p
to
m
s
o
f
th
is
s
p
ir
o
ch
etal
p
at
h
o
g
e
n
[
1
]
,
[
2
]
.
B
ased
o
n
lep
to
s
p
ir
o
s
is
B
u
r
d
en
E
p
id
e
m
i
o
lo
g
y
R
e
f
er
en
ce
Gr
o
u
p
,
t
h
e
i
n
cid
en
ce
r
ate
o
f
t
h
i
s
d
is
ea
s
e
v
er
y
lo
w
d
u
e
to
late
d
iag
n
o
s
e;
t
h
er
ef
o
r
e,
th
er
e
w
as
a
g
ap
b
etw
ee
n
th
e
r
ep
o
r
ted
ca
s
e
an
d
th
e
r
ea
l
ca
s
e.
A
h
ig
h
n
u
m
b
er
of
lep
to
s
p
ir
o
s
is
in
cid
e
n
ce
h
ap
p
en
ed
in
Af
r
ica
(
9
5
.
5
/1
0
0
.
0
0
0
)
,
W
est
P
ac
if
ic
(
6
6
.
4
/1
0
0
.
0
0
0
)
an
d
So
u
t
h
ea
s
t
A
s
i
a
(
4
.
8
/1
0
0
.
0
0
0
)
[
3
]
.
In
So
u
t
h
ea
s
t
Asi
a,
a
Dev
elo
p
in
g
co
u
n
tr
y
li
k
e
T
h
aila
n
d
,
I
n
d
o
n
esia
h
a
d
b
ee
n
s
tr
u
g
g
li
n
g
to
m
an
a
g
e
lep
to
s
p
ir
o
s
is
.
A
cc
o
r
d
in
g
to
t
h
e
lep
to
s
p
ir
o
s
is
ex
p
e
n
s
e
ep
id
e
m
io
lo
g
y
r
e
f
er
en
ce
g
r
o
u
p
(
L
E
R
G
)
,
th
e
in
cid
en
ce
o
f
lep
to
s
p
ir
o
s
i
s
in
th
e
w
o
r
ld
is
v
er
y
lo
w
d
u
e
to
d
elay
s
i
n
d
iag
n
o
s
i
s
b
y
h
ea
lth
p
r
o
f
ess
io
n
al
s
,
r
esu
lti
n
g
i
n
t
h
e
n
u
m
b
er
o
f
ca
s
es
b
ein
g
q
u
esti
o
n
ed
w
it
h
d
if
f
er
en
t
c
h
a
n
g
e
s
.
T
h
e
h
i
g
h
est
i
n
cid
en
ce
r
ate
i
s
i
n
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.
I
SS
N:
2
252
-
8806
R
is
k
f
a
cto
r
s
o
f le
p
to
s
p
ir
o
s
is
in
cid
en
ce
in
a
g
r
icu
ltu
r
a
l a
r
ea
(
Mit
o
r
ia
n
a
P
o
r
u
s
ia
)
575
Af
r
ica
(
9
5
.
5
p
er
1
0
0
,
0
0
0
p
o
p
u
latio
n
)
,
th
e
n
w
e
s
ter
n
p
ac
if
ic
(
6
6
.
4
p
e
r
1
0
0
,
0
0
0
p
o
p
u
latio
n
)
,
Am
er
ica
(
1
2
.
5
p
er
100
,
0
0
0
p
o
p
u
latio
n
)
,
So
u
th
ea
s
t
Asi
a
(
4
.
8
p
er
1
0
0
,
0
0
0
p
o
p
u
latio
n
)
an
d
th
e
lo
w
est
i
s
E
u
r
o
p
e
(
0
.
5
p
er
1
0
0
,
0
0
0
p
o
p
u
latio
n
)
[
3
]
.
I
n
T
h
aila
n
d
,
i
n
1
9
9
8
,
th
er
e
w
er
e
5
9
p
atien
t
s
r
ep
o
r
ted
lep
to
s
p
ir
o
s
is
in
Na
k
o
r
n
r
atch
a
s
r
i
m
a.
I
n
2
0
1
9
,
9
2
0
lep
to
s
p
ir
o
s
is
ca
s
es
w
er
e
r
ep
o
r
te
d
in
I
n
d
o
n
es
ia,
with
1
2
2
d
ea
th
s
ca
u
s
ed
b
y
t
h
e
d
is
ea
s
e.
T
h
e
ca
s
e
s
w
er
e
m
o
s
tl
y
r
ep
o
r
ted
f
r
o
m
n
i
n
e
p
r
o
v
in
ce
s
;
B
an
ten
,
DKI
J
ak
ar
ta,
W
est
J
av
a,
C
en
tr
al
J
av
a,
DI
Yo
g
y
a
k
ar
ta,
E
ast J
av
a,
Ma
lu
k
u
,
So
u
t
h
Su
la
w
e
s
i a
n
d
No
r
th
Kal
i
m
a
n
ta
n
[
4
]
.
Fro
m
t
h
e
h
ea
lt
h
p
r
o
f
ile
C
e
n
t
r
al
J
av
a,
I
n
d
o
n
esia
2
0
1
8
,
it
w
as
s
h
o
w
ed
t
h
at
lep
to
s
p
ir
o
s
is
w
er
e
f
r
eq
u
en
t
o
u
tb
r
ea
k
s
h
ap
p
en
ed
in
C
en
tr
al
J
av
a
w
it
h
C
FR
2
0
.
8
4
%,
w
h
ich
is
h
i
g
h
er
t
h
a
n
t
h
e
n
at
io
n
al
C
F
R
1
6
.
6
5
%.
B
ased
o
n
d
ata
o
n
I
n
d
o
n
esia
'
s
h
ea
lt
h
p
r
o
f
ile
i
n
2
0
1
6
,
th
e
h
i
g
h
est
n
u
m
b
er
o
f
lep
to
s
p
ir
o
s
is
s
u
f
f
er
er
s
in
2
0
1
1
w
a
s
8
5
7
ca
s
es,
an
d
in
2
0
1
5
it
d
ec
r
ea
s
ed
b
y
3
6
6
ca
s
es,
in
2015
th
e
h
ig
h
C
F
R
(
1
7
.
7
6
%)
in
2
0
1
6
in
cr
ea
s
ed
by
833
ca
s
es.
T
h
e
m
o
s
t
w
id
e
s
p
r
ea
d
lep
to
s
p
ir
o
s
is
th
r
o
u
g
h
o
u
t
I
n
d
o
n
e
s
ia,
th
er
e
w
er
e
s
e
v
en
p
r
o
v
in
ce
s
r
ep
o
r
ted
in
th
e
2
0
1
4
-
2
0
1
6
p
e
r
io
d
an
d
th
e
h
i
g
h
e
s
t
i
n
Yo
g
y
ak
a
r
ta
P
r
o
v
in
ce
,
I
n
d
o
n
esia
in
2
0
1
4
(
1
5
4
ca
s
es),
DKI
J
ak
ar
ta
,
I
n
d
o
n
esia
in
2
0
1
4
(
1
0
6
ca
s
es)
an
d
C
en
tr
al
J
av
a
in
2
0
1
4
(
1
9
8
ca
s
es).
T
h
e
h
ig
h
e
s
t
m
o
r
talit
y
r
ate
in
B
an
ten
p
r
o
v
i
n
ce
in
2
0
1
6
w
as
2
1
.
8
8
%.
T
h
e
n
u
m
b
er
o
f
ca
s
e
s
w
as
o
n
l
y
3
2
ca
s
es
[
5
]
.
A
cc
o
r
d
in
g
to
d
ata
f
r
o
m
B
o
y
o
lali P
u
b
lic
Hea
lth
O
f
f
ice,
th
e
n
u
m
b
er
s
o
f
lep
to
s
p
ir
o
s
is
p
atien
ts
in
2
0
1
4
w
er
e
1
9
ca
s
e
s
w
it
h
s
e
v
e
n
d
ea
t
h
s
,
in
2
0
1
5
th
er
e
w
er
e
1
7
ca
s
es
w
it
h
f
o
u
r
d
ea
th
s
,
in
2
0
1
6
th
er
e
w
er
e
o
n
l
y
s
e
v
en
ca
s
es
w
it
h
o
u
t
d
ea
th
s
,
w
h
ile
i
n
201
7
th
er
e
w
as
a
n
i
n
cr
ea
s
e
o
f
3
4
ca
s
es
w
it
h
o
n
e
d
ea
th
[
6
]
.
I
n
2
0
1
7
,
th
e
n
u
m
b
er
o
f
l
ep
to
s
p
ir
o
s
is
in
B
o
y
o
lali
r
eg
en
c
y
,
in
J
a
w
a
T
en
g
a
h
P
r
o
v
in
ce
,
i
n
cr
ea
s
ed
d
r
am
at
icall
y
[
7
]
.
Un
til
Ma
y
2
0
1
8
,
it
w
a
s
r
ep
o
r
ted
th
at
th
er
e
w
er
e
1
3
ca
s
es
o
f
lep
to
s
p
ir
o
s
i
s
w
it
h
th
r
ee
d
ea
t
h
s
[
6
]
.
T
h
is
n
u
m
b
er
w
as
h
i
g
h
a
n
d
is
s
h
o
w
i
n
g
an
i
n
cr
ea
s
i
n
g
tr
en
d
.
Sev
er
al
f
ac
to
r
s
h
av
e
b
ee
n
r
ep
o
r
ted
to
a
r
is
k
o
f
l
ep
to
s
p
ir
o
s
is
in
f
ec
tio
n
.
Acc
o
r
d
in
g
Hi
m
an
i
et
a
l
.
[
8
]
,
p
er
s
o
n
al
h
y
g
ie
n
e
af
f
ec
t
s
th
e
i
n
cid
en
ce
o
f
l
ep
to
s
p
ir
o
s
is
(p
-
v
alu
e
0
.
0
2
4
;
O
R
=7
.
4
2
9
)
.
I
n
j
u
r
i
es
ar
e
lik
el
y
r
elate
d
to
lep
to
s
p
ir
o
s
is
tr
an
s
m
i
s
s
io
n
b
ec
au
s
e
l
ep
to
s
p
ir
a
b
ac
ter
ia
ea
s
il
y
en
ter
th
r
o
u
g
h
w
o
u
n
d
s
o
n
s
k
i
n
s
,
e
s
p
ec
iall
y
th
o
s
e
o
n
th
e
f
ee
t
an
d
h
an
d
s
.
T
h
is
is
i
n
lin
e
w
it
h
P
r
asti
w
i
'
s
s
t
u
d
y
[
9
]
;
a
h
is
to
r
y
o
f
in
j
u
r
y
h
a
s
a
1
0
ti
m
es
g
r
ea
ter
r
is
k
o
f
d
ev
elo
p
in
g
lep
to
s
p
ir
o
s
is
.
Occ
u
p
atio
n
as
a
f
ar
m
e
r
an
d
b
u
tc
h
er
is
also
r
elate
d
to
lep
to
s
p
ir
o
s
is
.
E
n
v
ir
o
n
m
e
n
tal
f
ac
to
r
s
ar
e
als
o
v
er
y
i
n
f
l
u
en
t
ial
i
n
l
ep
to
s
p
ir
o
s
is
tr
a
n
s
m
is
s
io
n
,
a
n
d
e
n
v
ir
o
n
m
e
n
tal
f
ac
to
r
s
ca
n
b
e
ass
ess
ed
f
r
o
m
t
h
e
p
r
ese
n
c
e
o
f
m
ice
ar
o
u
n
d
th
e
h
o
u
s
e,
p
o
o
r
s
ew
er
a
n
d
tr
ash
co
n
d
itio
n
s
,
an
d
th
e
p
r
esen
ce
p
u
d
d
le
[
1
0
]
,
[
1
1
]
.
T
h
e
p
r
esen
ce
o
f
m
ice
in
t
h
e
h
o
u
s
e
ca
n
t
r
an
s
m
it
lep
to
s
p
ir
o
s
is
b
ac
ter
ia
to
h
u
m
an
s
t
h
r
o
u
g
h
f
o
o
d
o
r
d
ir
ec
t
co
n
tact
w
it
h
r
at
s
t
h
at
ar
e
co
n
ta
m
i
n
ated
w
it
h
r
at
u
r
i
n
e
in
f
ec
ted
w
it
h
lep
to
s
p
ir
o
s
is
[
1
2
]
.
A
u
li
y
a
's
r
esear
ch
[
1
3
]
s
h
o
w
s
t
h
at
w
a
s
te
d
is
p
o
s
al
f
ac
ilit
ie
s
t
h
at
d
o
n
o
t
m
ee
t
t
h
e
r
eq
u
ir
e
m
en
t
s
h
av
e
a
5
.
4
ti
m
e
s
g
r
ea
ter
r
is
k
o
f
d
ev
e
lo
p
in
g
l
ep
to
s
p
ir
o
s
i
s
.
P
r
ev
io
u
s
r
esear
c
h
h
ad
s
h
o
w
n
th
e
f
ac
to
r
s
o
f
lep
to
s
p
ir
o
s
is
i
n
f
ec
tio
n
m
o
s
tl
y
i
n
u
r
b
an
ar
ea
s
;
h
o
w
ev
er
,
in
f
ec
tio
n
i
n
th
e
a
g
r
ic
u
lt
u
r
al
ar
ea
is
n
o
t
f
u
ll
y
u
n
d
er
s
to
o
d
.
I
n
I
n
d
o
n
esia,
J
a
w
a
T
en
g
ah
P
r
o
v
i
n
ce
,
th
er
e
ar
e
m
an
y
ag
r
icu
l
tu
r
e
ar
ea
s
w
h
er
e
i
t
is
m
o
s
tl
y
ir
r
i
g
ated
an
d
p
r
o
ce
s
s
ed
tr
ad
itio
n
all
y
.
I
n
d
o
n
es
ian
f
ar
m
er
s
an
d
o
t
h
er
w
o
r
k
er
s
ar
e
at
r
is
k
o
f
lep
to
s
p
ir
o
s
is
in
f
ec
tio
n
.
Facto
r
s
r
elate
d
to
lep
to
s
p
ir
o
s
is
in
a
g
r
ic
u
lt
u
r
e
ar
ea
th
at
h
ap
p
en
ed
in
B
o
y
o
lali
r
eg
en
c
y
s
h
o
u
ld
b
e
u
n
d
er
s
to
o
d
w
ell
to
ta
k
e
th
e
r
ig
h
t
m
ea
s
u
r
e
m
e
n
ts
to
co
n
tr
o
l
an
d
m
a
n
ag
e
lep
to
s
p
ir
o
s
is
in
a
t
y
p
ical
a
g
r
icu
lt
u
r
al
ar
ea
.
T
h
er
e
f
o
r
e,
t
h
is
s
t
u
d
y
ai
m
ed
to
d
eter
m
i
n
e
t
h
e
r
is
k
f
ac
to
r
s
ass
o
ciate
d
w
it
h
t
h
e
lep
to
s
p
ir
o
s
is
in
cid
e
n
ce
in
B
o
y
o
lali r
eg
e
n
c
y
.
2.
RE
S
E
ARCH
M
E
T
H
O
D
T
h
is
r
esear
ch
u
s
ed
ca
s
e
-
co
n
tr
o
l
d
esig
n
an
d
co
n
d
u
cted
o
n
p
er
io
d
J
u
n
e
2
0
1
8
.
T
h
e
ca
s
e
p
o
p
u
latio
n
w
er
e
co
llected
f
r
o
m
t
h
e
P
u
b
l
ic
Hea
lth
o
f
f
ice
in
B
o
y
o
lali
,
C
en
tr
al
J
a
v
a,
I
n
d
o
n
esia
d
u
r
in
g
Ma
y
2
0
1
7
-
Ma
y
2
0
1
8
w
it
h
a
to
tal
s
a
m
p
li
n
g
L
e
p
to
s
p
ir
o
s
is
ca
s
e
g
r
o
u
p
(
n
=3
3
)
an
d
co
n
tr
o
l
g
r
o
u
p
(
n
=9
9
)
(
r
a
tio
1
:3
)
.
I
n
cl
u
s
io
n
cr
i
ter
ia
f
o
r
t
h
e
l
ep
to
s
p
ir
o
s
i
s
g
r
o
u
p
w
er
e
p
atien
ts
w
it
h
lab
o
r
ato
r
y
p
o
s
itiv
e
l
ep
to
s
p
ir
o
s
is
p
r
o
o
f
an
d
r
ec
o
r
d
ed
b
y
th
e
lo
ca
l
p
u
b
lic
h
ea
lt
h
o
f
f
i
ce
d
u
r
in
g
2
0
1
7
.
Ho
w
e
v
er
,
t
h
e
d
ied
p
atien
t
w
as
e
x
cl
u
d
ed
.
I
n
cl
u
s
i
o
n
cr
i
ter
ia
f
o
r
th
e
co
n
tr
o
l
g
r
o
u
p
w
er
e
p
eo
p
le
w
h
o
liv
e
clo
s
ed
to
th
e
p
atien
ts
o
r
m
atc
h
ed
b
y
th
e
l
iv
i
n
g
ar
ea
,
w
h
i
c
h
co
u
l
d
b
e
f
a
m
ili
es
o
r
n
eig
h
b
o
u
r
s
,
ag
ed
b
et
w
ee
n
1
5
-
5
5
y
ea
r
s
o
ld
.
T
h
e
p
atien
ts
w
er
e
in
ter
v
ie
w
ed
r
elatin
g
s
ev
er
al
r
is
k
f
ac
to
r
s
as
v
ar
iab
les;
k
n
o
w
led
g
e
ab
o
u
t
L
ep
to
s
p
ir
o
s
i
s
,
p
er
s
o
n
al
h
y
g
ie
n
e,
e
n
v
ir
o
n
m
en
ta
l
s
a
n
itatio
n
,
o
cc
u
p
atio
n
an
d
w
o
u
n
d
p
r
ese
n
ce
(
ath
le
te’
s
f
ee
t,
a
n
i
m
al
b
ite
a
n
d
s
cr
atc
h
w
o
u
n
d
)
.
T
h
e
I
n
d
ep
en
d
en
t
v
ar
i
ab
le
m
ea
s
u
r
ed
w
a
s
k
n
o
w
led
g
e
ab
o
u
t
l
ep
to
s
p
ir
o
s
is
,
p
er
s
o
n
al
h
y
g
ie
n
e,
e
n
v
ir
o
n
m
e
n
tal
s
a
n
ita
tio
n
,
o
cc
u
p
atio
n
an
d
w
o
u
n
d
p
r
ese
n
ce
,
an
d
t
h
e
d
ep
en
d
en
t
v
ar
iab
le
m
ea
s
u
r
ed
w
as
t
h
e
p
atie
n
ts
'
lep
to
s
p
ir
o
s
is
i
n
cid
en
ce
.
E
ac
h
o
f
th
e
m
w
a
s
te
s
ted
u
s
i
n
g
C
h
i
-
Sq
u
ar
e
to
tes
t
t
h
e
r
elatio
n
s
h
ip
o
r
ef
f
ec
t
o
f
i
n
d
ep
en
d
en
t
an
d
d
ep
en
d
en
t
v
ar
iab
les
an
d
th
en
te
s
ted
u
s
i
n
g
m
u
lti
v
ar
iate
lo
g
is
tic
r
eg
r
es
s
io
n
.
B
iv
ar
iate
a
n
al
y
s
is
to
d
eter
m
i
n
e
t
h
e
r
elatio
n
s
h
ip
b
et
w
ee
n
k
n
o
w
led
g
e
ab
o
u
t
l
ep
to
s
p
ir
o
s
is
,
p
er
s
o
n
al
h
y
g
ien
e,
en
v
ir
o
n
m
e
n
tal
s
an
i
tatio
n
,
o
cc
u
p
atio
n
a
n
d
w
o
u
n
d
p
r
esen
c
e
w
it
h
t
h
e
i
n
cid
en
ce
o
f
l
ep
to
s
p
ir
o
s
is
u
s
in
g
.
M
u
lti
v
ar
iate
an
al
y
s
i
s
w
a
s
u
s
ed
to
d
eter
m
i
n
e
w
h
ic
h
v
ar
iab
le
w
as
m
o
s
t
r
e
s
p
o
n
s
ib
le
f
o
r
th
e
in
c
id
en
ce
o
f
l
ep
to
s
p
ir
o
s
is
(
co
n
f
id
e
n
ce
li
m
it
α
=0
.
0
5
)
.
P
er
s
o
n
a
l
h
y
g
ien
e
co
n
s
is
ted
of
q
u
est
io
n
s
r
elati
n
g
to
s
h
o
e
wea
r
,
r
o
d
en
t
co
n
tr
o
l,
b
ath
in
t
h
e
s
tr
ea
m
,
w
ater
u
s
e.
E
n
v
ir
o
n
m
e
n
tal
Sa
n
itatio
n
co
n
s
i
s
ted
o
f
q
u
e
s
tio
n
s
r
elatin
g
to
g
ar
b
ag
e,
r
u
b
b
is
h
b
i
n
co
n
d
itio
n
,
w
a
s
te
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8806
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.,
Vo
l.
10
,
No
.
3
,
Sep
tem
b
er
2021
:
574
–
5
8
0
576
d
is
ch
ar
g
e,
s
e
w
er
a
g
e
co
n
d
itio
n
.
Occ
u
p
atio
n
as
a
f
ar
m
er
w
o
r
k
ed
in
t
h
e
r
ice
f
ie
ld
an
d
d
i
d
f
ar
m
i
n
g
(
p
lan
t
in
g
,
p
lo
w
i
n
g
,
h
ar
v
e
s
ti
n
g
)
.
T
h
o
s
e
v
ar
iab
le
w
er
e
m
ea
s
u
r
ed
u
s
i
n
g
G
u
t
m
a
n
s
ca
le
(
g
o
o
d
o
r
b
ad
)
.
W
o
u
n
d
p
r
esen
ce
co
n
s
is
ted
o
f
q
u
es
tio
n
s
r
elatin
g
to
w
o
u
n
d
p
r
ese
n
ce
,
esp
ec
ial
l
y
o
n
f
ee
t
o
r
h
a
n
d
,
in
cl
u
d
i
n
g
an
i
m
al
b
ite,
s
cr
atc
h
o
r
tin
ea
p
ed
is
(
ath
lete’
s
f
o
o
t)
.
3.
RE
SU
L
T
S
A
ND
D
I
SCU
SS
I
O
N
A
d
is
tr
ib
u
tio
n
o
f
r
esp
o
n
d
en
t
’
s
o
cc
u
p
atio
n
is
p
r
esen
ted
in
th
e
p
ie
ch
ar
ts
an
d
m
u
lti
v
ar
iate
te
s
t
(
lo
g
is
tic
r
eg
r
ess
io
n
)
r
esu
lt i
s
p
r
esen
ted
in
th
e
Fig
u
r
e
1.
Fig
u
r
e
1
.
Occ
u
p
atio
n
t
y
p
e
s
o
f
ca
s
e
an
d
co
n
tr
o
l g
r
o
u
p
Of
3
3
p
eo
p
le
i
n
t
h
e
ca
s
e
g
r
o
u
p
,
2
5
w
er
e
m
ale
(
7
5
.
8
%),
an
d
ei
g
h
t
w
er
e
f
e
m
ale
(
2
4
.
2
%).
Fig
u
r
e
1
s
h
o
w
ed
th
at
m
o
s
t
o
f
th
e
ca
s
e
-
p
atien
ts
w
o
r
k
ed
as
a
f
ar
m
er
(
5
1
.
5
2
%)
o
r
w
o
r
k
er
(
3
6
.
3
6
%).
W
h
ile
in
t
h
e
co
n
tr
o
l
g
r
o
u
p
,
m
o
s
t
p
eo
p
le
w
o
r
k
ed
as
a
w
o
r
k
er
(
4
8
%)
an
d
f
ar
m
er
(
2
4
%).
T
ab
le
1
s
h
o
w
s
t
h
at
t
h
e
v
ar
iab
le
f
ac
to
r
s
th
at
h
ad
a
s
ig
n
i
f
ican
t
r
elatio
n
s
h
ip
w
it
h
l
e
p
to
s
p
ir
o
s
is
in
cid
en
ce
w
er
e
w
o
u
n
d
p
r
ese
n
ce
.
R
e
g
ar
d
in
g
OR
v
al
u
e,
was
w
o
u
n
d
p
r
esen
ce
O
R
=1
7
.
0
1
4
,
9
5
%
C
I
:
5
.
4
8
7
-
5
2
.
7
6
1
,
th
er
ef
o
r
e
it
ca
n
b
e
ass
u
m
ed
t
h
at
w
o
u
n
d
p
r
esen
ce
is
ex
p
o
s
u
r
e
r
is
k
o
f
lep
to
s
p
ir
o
s
is
in
cid
en
ce
a
n
d
ca
n
r
is
k
lep
to
s
p
ir
o
s
is
i
n
f
ec
tio
n
1
7
ti
m
e
s
g
r
ea
ter
.
Occ
u
p
atio
n
a
s
a
f
ar
m
er
h
ad
a
r
elat
io
n
s
h
ip
w
i
t
h
lep
to
s
p
ir
o
s
is
w
it
h
a
v
alu
e
O
R
:
5
.
1
8
6
;
9
5
%
C
I
:
1
.
6
8
2
-
1
5
.
9
8
9
.
T
h
o
s
e
v
alu
e
ca
n
b
e
in
ter
p
r
e
ted
th
at
s
o
m
eo
n
e
w
h
o
w
o
r
k
s
as
a
f
ar
m
er
i
s
5
.
1
g
r
ea
ter
to
th
e
r
is
k
o
f
lep
to
s
p
ir
o
s
is
.
Ot
h
er
f
ac
to
r
s
,
b
ad
p
er
s
o
n
al
h
y
g
ien
e
an
d
en
v
ir
o
n
m
en
tal
s
an
ita
tio
n
d
id
n
o
t
s
h
o
w
a
n
y
s
ig
n
if
ican
t
r
elatio
n
s
h
ip
to
w
ar
d
s
lep
to
s
p
ir
o
s
is
in
cid
e
n
ce
.
K
n
o
w
led
g
e
w
as
tak
e
n
o
u
t f
r
o
m
t
h
e
lo
g
i
s
tic
r
eg
r
e
s
s
io
n
test
b
ec
au
s
e
th
e
n
u
m
b
er
o
f
s
ig
n
if
ican
ce
w
a
s
b
ig
g
er
th
a
n
0
.
2
5
.
T
ab
le
1
.
R
is
k
f
ac
to
r
s
a
n
d
lep
to
s
p
ir
o
s
is
in
c
id
en
ce
R
i
s
k
f
a
c
t
o
r
P
a
t
i
e
n
t
s
(
n
=
3
3
)
(
%)
C
o
n
t
r
o
l
(
n
=
9
9
)
(
%)
O
R
(
9
5
%
C
I
)
*
B
a
d
p
e
r
so
n
a
l
h
y
g
i
e
n
e
1
7
(
5
1
.
5
)
1
5
(
1
5
.
2
)
2.
2
5
8
(
0
.
6
4
7
-
7
.
8
8
5
)
P
o
o
r
e
n
v
i
r
o
n
me
n
t
al
sa
n
i
t
a
t
i
o
n
2
5
(
5
7
.
6
)
3
6
(
3
6
.
4
)
2
.
6
3
8
(
0
.
7
9
3
-
8
.
7
7
3
)
O
c
c
u
p
a
t
i
o
n
a
s
f
a
r
me
r
1
7
(
5
1
.
5
2
)
2
4
(
2
4
.
2
4
)
5
.
1
8
6
(
1
.
6
8
2
-
1
5
.
9
8
9
)
W
o
u
n
d
p
r
e
se
n
c
e
2
2
(
6
6
.
6
7
)
1
1
(
1
1
.
1
)
1
7
.
0
1
4
(
5
.
4
8
7
-
5
2
.
7
6
1
)
*
S
i
g
n
i
f
i
c
a
n
t
v
a
l
u
e
9
5
%
3
.
1
.
P
er
s
o
na
l
h
y
g
iene
a
nd
lept
o
s
piro
s
is
T
h
er
e
is
n
o
r
elatio
n
s
h
ip
b
et
w
ee
n
p
er
s
o
n
al
h
y
g
ie
n
e
an
d
l
ep
to
s
p
ir
o
s
is
in
cid
en
ce
(
OR
:2
.
2
5
8
;9
5
%
C
I
:
0
.
6
4
7
-
7
.
8
8
5
)
.
E
v
en
th
o
u
g
h
t
h
e
ca
s
e
g
r
o
u
p
s
h
o
w
ed
m
o
r
e
b
a
d
p
er
s
o
n
al
h
y
g
ie
n
e,
b
ad
p
er
s
o
n
al
h
y
g
ie
n
e
is
li
k
el
y
n
o
t
a
f
f
ec
tin
g
l
ep
to
s
p
ir
o
s
is
i
n
ci
d
en
ce
i
n
B
o
y
o
lali.
T
h
o
u
g
h
i
t
h
as
n
o
r
elatio
n
,
i
n
t
h
i
s
s
tu
d
y
,
th
er
e
w
a
s
a
m
o
t
h
er
w
h
o
p
r
ev
io
u
s
l
y
w
o
r
k
ed
as
a
n
ass
i
s
ta
n
t
i
n
f
o
o
d
s
talls
an
d
a
d
m
itted
t
h
at
s
h
e
w
as
h
ed
d
is
h
es
in
t
h
e
ir
r
ig
at
io
n
s
tr
ea
m
.
T
h
r
ee
d
a
y
s
a
f
ter
t
h
at,
s
h
e
h
ad
a
f
e
v
er
an
d
h
ea
d
ac
h
e
an
d
co
n
f
ir
m
ed
to
g
e
t
l
ep
to
s
p
ir
o
s
is
af
ter
a
b
lo
o
d
test
.
P
er
s
o
n
al
h
y
g
ie
n
e
af
f
ec
t
s
th
e
i
n
cid
en
ce
o
f
l
ep
to
s
p
ir
o
s
is
.
I
n
p
er
s
o
n
al
h
y
g
ie
n
e,
s
ev
er
al
f
ac
to
r
s
af
f
ec
t
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.
I
SS
N:
2
252
-
8806
R
is
k
f
a
cto
r
s
o
f le
p
to
s
p
ir
o
s
is
in
cid
en
ce
in
a
g
r
icu
ltu
r
a
l a
r
ea
(
Mit
o
r
ia
n
a
P
o
r
u
s
ia
)
577
in
d
iv
id
u
als
in
f
ec
ted
w
i
th
l
ep
t
o
s
p
ir
o
s
is
,
in
cl
u
d
i
n
g
b
at
h
in
g
a
n
d
w
a
s
h
in
g
h
ab
it
s
i
n
r
iv
er
s
o
r
ir
r
ig
atio
n
ch
a
n
n
els,
n
o
t
w
as
h
i
n
g
h
a
n
d
s
w
i
th
s
o
ap
af
ter
co
n
tact
w
it
h
w
ater
s
u
s
p
e
cted
o
f
b
ein
g
co
n
ta
m
i
n
ated
,
an
d
th
e
h
ab
it
o
f
n
o
t
w
ea
r
i
n
g
f
o
o
t
w
ea
r
w
h
e
n
w
o
r
k
in
g
o
r
n
o
t
w
o
r
k
i
n
g
.
I
n
an
o
th
er
ca
s
e,
co
n
s
tr
u
ctio
n
w
o
r
k
er
s
in
t
h
is
ca
s
e
g
r
o
u
p
s
aid
th
e
y
w
as
h
ed
a
f
ter
w
o
r
k
in
th
e
w
ater
s
tr
ea
m
n
e
x
t
to
th
e
r
ice
f
ield
.
T
h
e
y
th
o
u
g
h
t
th
e
wate
r
w
as
clea
n
an
d
s
af
e,
s
o
t
h
e
y
u
s
e
it
e
v
er
y
d
a
y
af
ter
.
T
h
is
b
e
h
av
io
u
r
m
a
y
i
n
cr
ea
s
e
l
ep
to
s
p
ir
o
s
is
tr
a
n
s
m
i
s
s
io
n
s
in
ce
th
e
y
u
s
e
co
n
ta
m
i
n
ated
w
ater
to
w
as
h
ed
d
is
h
es
a
n
d
t
h
e
m
s
el
v
es.
In
t
h
e
a
g
r
ic
u
lt
u
r
al
ar
ea
,
th
er
e
ar
e
u
s
u
all
y
s
tr
ea
m
n
ex
t
to
th
e
r
ice
f
ield
to
f
lo
w
th
e
w
ater
f
o
r
ir
r
ig
atio
n
.
T
h
e
w
ater
lo
o
k
s
clea
n
,
b
u
t
th
is
t
y
p
e
of
o
p
en
w
ater
i
s
ac
ce
s
s
ib
le
f
o
r
r
icef
ield
r
ats as w
ell
an
d
p
o
s
s
ib
l
y
u
r
i
n
ated
by
t
h
e
m
.
I
n
th
is
s
tu
d
y
,
b
ad
p
er
s
o
n
al
h
y
g
ie
n
e
w
a
s
n
o
t
r
elate
d
to
l
ep
to
s
p
ir
o
s
is
in
cid
e
n
ce
.
T
h
er
e
m
i
g
h
t
b
e
an
o
th
er
f
ac
to
r
th
at
s
u
p
p
o
r
ts
.
L
ep
to
s
p
ir
o
s
is
tr
an
s
m
i
s
s
io
n
th
o
u
g
h
th
e
p
eo
p
le
h
av
e
g
o
o
d
p
er
s
o
n
al
h
y
g
ie
n
e.
E
v
en
th
o
u
g
h
p
er
s
o
n
al
h
y
g
ien
e
h
as
no
r
elatio
n
s
h
ip
to
l
ep
to
s
p
ir
o
s
i
s
i
n
cid
en
ce
,
p
er
s
o
n
a
l
h
y
g
ie
n
e
is
i
m
p
o
r
tan
t
to
b
e
m
ai
n
tai
n
ed
to
p
r
ev
en
t
an
y
g
e
r
m
i
n
f
ec
tio
n
.
I
n
Sa
n
J
o
s
e,
P
er
u
,
l
ep
to
s
p
ir
o
s
is
r
is
k
f
ac
to
r
s
i
n
clu
d
e
u
n
w
ea
r
y
i
n
g
s
h
o
es
i
n
th
e
f
ield
,
an
d
m
o
s
t
i
n
h
ab
itan
t
s
s
ta
y
in
p
o
o
r
h
o
u
s
in
g
n
ea
r
to
s
m
al
l
-
s
ca
le
ag
r
ic
u
l
t
u
r
e
[
1
0
]
.
I
t
m
a
y
r
elate
to
u
n
w
ea
r
y
i
n
g
f
o
o
t
w
ea
r
in
th
e
r
icef
ield
as
w
e
ll.
Ma
n
y
I
n
d
o
n
esian
f
ar
m
er
s
ar
e
i
n
d
o
len
t
to
w
ea
r
b
o
o
ts
b
ec
au
s
e
b
o
o
ts
ar
e
ea
s
il
y
s
tu
c
k
in
t
h
e
m
u
d
an
d
s
lo
w
to
m
o
v
e.
T
o
m
ain
tain
p
er
s
o
n
al
h
y
g
ie
n
e,
th
er
e
ar
e
s
o
m
e
e
f
f
o
r
ts
t
h
at
m
u
s
t
b
e
m
ad
e
to
a
v
o
id
tr
an
s
m
is
s
io
n
o
f
l
ep
to
s
p
ir
o
s
is
.
P
er
s
o
n
al
h
y
g
ien
e
w
a
s
m
ea
s
u
r
ed
b
y
as
k
i
n
g
ab
o
u
t
t
h
eir
b
ath
in
g
h
ab
its
,
th
e
u
s
e
o
f
p
er
s
o
n
al
p
r
o
tectiv
e
eq
u
ip
m
e
n
t
w
h
en
w
o
r
k
i
n
g
,
t
h
e
u
s
ed
f
o
o
t
w
ea
r
w
h
en
g
o
in
g
o
u
t
o
f
th
e
h
o
u
s
e,
w
as
h
i
n
g
h
a
n
d
s
b
e
f
o
r
e
ea
tin
g
.
I
t
all
ca
n
a
f
f
ec
t
th
e
in
cid
e
n
ce
o
f
l
ep
to
s
p
ir
o
s
is
.
P
er
s
o
n
al
h
y
g
ie
n
e
co
u
ld
b
e
ass
ess
ed
b
y
g
ai
n
i
n
g
in
f
o
r
m
atio
n
s
o
t
h
at
b
eh
a
v
io
u
r
ca
n
ch
a
n
g
e.
R
esp
o
n
d
en
t
s
'
h
ab
i
ts
ar
e
v
er
y
d
if
f
ic
u
lt
to
ch
an
g
e,
an
d
th
er
e
f
o
r
e,
th
er
e
is
a
n
ee
d
f
o
r
co
n
t
in
u
o
u
s
co
u
n
s
elli
n
g
,
b
u
t
ch
a
n
g
es
in
b
eh
av
io
u
r
m
u
s
t
al
s
o
b
e
s
u
p
p
o
r
ted
b
y
r
eso
u
r
ce
s
to
s
u
p
p
o
r
t
th
e
m
,
s
u
c
h
as
b
o
o
ts
f
o
r
w
o
r
k
,
g
lo
v
e
s
,
eq
u
ip
m
en
t
b
ath
.
E
f
f
o
r
ts
to
m
ai
n
tai
n
p
er
s
o
n
al
h
y
g
ie
n
e
is
an
ef
f
o
r
t
to
p
r
ev
en
t
th
e
tr
an
s
m
is
s
io
n
o
f
l
ep
to
s
p
ir
o
s
is
.
Qu
i
n
a
e
t
a
l.
[
1
4
]
s
u
g
g
ested
t
h
at
in
f
o
r
m
atio
n
d
i
s
s
e
m
i
n
atio
n
th
r
o
u
g
h
m
as
s
m
ed
ia
a
n
d
in
cr
ea
s
i
n
g
a
w
ar
en
e
s
s
a
m
o
n
g
s
u
s
ce
p
ti
b
le
g
r
o
u
p
s
ca
n
be
a
p
r
ev
en
ti
v
e
s
tr
ate
g
y
to
av
o
id
l
e
p
to
s
p
ir
o
s
is
.
T
h
e
a
w
ar
en
e
s
s
s
h
ar
in
g
i
n
cl
u
d
es
m
ai
n
tai
n
i
n
g
h
y
g
ien
e
an
d
s
a
n
ita
tio
n
s
u
r
r
o
u
n
d
in
g
an
d
u
s
i
n
g
p
r
o
p
er
p
er
s
o
n
al
s
af
et
y
eq
u
ip
m
e
n
t li
k
e
s
h
o
es.
3
.
2
.
P
o
o
r
env
iro
nm
e
nta
l sa
n
it
a
t
io
n a
nd
lept
o
s
piro
s
is
B
ased
o
n
th
e
r
esu
lts
,
t
h
e
p
r
o
p
o
r
tio
n
o
f
p
eo
p
le
w
it
h
p
o
o
r
en
v
ir
o
n
m
en
tal
s
a
n
itat
io
n
i
n
t
h
e
ca
s
e
g
r
o
u
p
w
a
s
b
i
g
g
er
th
a
n
th
o
s
e
i
n
t
h
e
co
n
tr
o
l
g
r
o
u
p
(
5
7
.
6
%>3
6
4
%).
Ho
w
ev
er
,
t
h
er
e
i
s
n
o
r
elatio
n
s
h
ip
b
et
w
ee
n
en
v
ir
o
n
m
e
n
tal
s
an
itatio
n
a
n
d
th
e
i
n
cid
en
ce
of
l
ep
to
s
p
ir
o
s
i
s
in
B
o
y
o
lali
(
OR
=2
.
6
3
8
;
9
5
%C
I
:
0
.
7
9
3
-
8
.
7
7
3
)
.
Ma
n
y
r
e
s
ea
r
ch
er
s
co
n
s
id
er
en
v
ir
o
n
m
en
tal
s
a
n
itatio
n
as
a
r
i
s
k
f
ac
to
r
f
o
r
l
ep
to
s
p
ir
o
s
is
.
Ull
m
an
n
a
n
d
L
a
n
g
o
n
i
[
1
5
]
s
tated
th
at
in
a
d
e
v
elo
p
in
g
co
u
n
tr
y
,
l
ep
to
s
p
ir
o
s
is
o
u
tb
r
ea
k
s
r
elate
to
lack
o
f
s
a
n
itatio
n
,
i
n
ad
eq
u
ate
h
o
u
s
in
g
an
d
cli
m
ate
co
n
d
itio
n
.
He
s
aid
th
at
r
u
r
al
ar
ea
h
as
a
h
ig
h
er
r
is
k
,
p
ar
ticu
lar
l
y
i
n
a
tr
o
p
ical
clim
ate.
I
n
ad
d
itio
n
,
R
eis
e
t
a
l.
[
1
6
]
ex
p
lain
ed
t
h
at
b
ad
s
an
itatio
n
i
n
f
r
astru
ct
u
r
e
co
u
ld
b
e
an
en
v
ir
o
n
m
e
n
tal
s
o
u
r
ce
o
f
l
ep
to
s
p
ir
o
s
is
tr
an
s
m
i
s
s
io
n
.
H
o
w
e
v
er
,
in
t
h
is
s
t
u
d
y
,
p
o
o
r
e
n
v
ir
o
n
m
e
n
tal
s
an
itatio
n
w
a
s
n
o
t
r
elate
d
to
th
e
l
ep
to
s
p
ir
o
s
is
in
cid
en
ce
.
T
h
er
e
m
ig
h
t
b
e
an
o
th
er
f
ac
to
r
th
a
t
s
u
p
p
o
r
ts
l
ep
to
s
p
ir
o
s
is
tr
an
s
m
is
s
io
n
t
h
o
u
g
h
t
h
e
p
eo
p
le
h
av
e
g
o
o
d
en
v
ir
o
n
m
e
n
tal
s
a
n
itat
io
n
.
B
o
y
o
lali
is
a
s
e
m
i
-
u
r
b
an
ar
ea
w
h
er
e
t
h
er
e
ar
e
m
a
n
y
r
ice
-
f
ield
an
d
o
p
en
f
ield
.
T
h
is
r
eg
en
c
y
r
ar
el
y
h
as
a
f
lo
o
d
f
o
r
th
e
last
2
0
y
ea
r
s
,
an
d
it
is
clo
s
e
to
S
u
r
ak
ar
ta
cit
y
,
w
h
ich
i
s
an
u
r
b
an
cit
y
.
Ne
v
er
th
ele
s
s
,
B
o
y
o
lali
s
till
h
as
a
s
e
m
i
-
u
r
b
an
ar
ea
th
at
co
n
s
is
t
s
o
f
m
an
y
r
ic
e
f
ield
.
T
h
er
e
is
n
o
s
lu
m
s
ar
ea
a
n
d
o
v
er
cr
o
w
d
i
n
g
p
o
p
u
latio
n
i
n
B
o
y
o
lali.
P
o
o
r
en
v
ir
o
n
m
e
n
tal
s
a
n
ita
tio
n
in
t
h
e
s
e
m
i
-
u
r
b
an
ar
ea
is
lik
e
l
y
d
if
f
er
en
t
f
r
o
m
th
at
in
a
n
u
r
b
an
ar
ea
.
P
o
o
r
s
an
itatio
n
an
d
ab
u
n
d
a
n
ce
of
r
ats
u
s
u
al
l
y
h
ap
p
en
in
u
r
b
an
s
lu
m
s
w
it
h
o
v
er
cr
o
w
d
i
n
g
h
o
u
s
in
g
,
w
h
ile
in
B
o
y
o
lali i
s
m
o
s
t
l
y
an
a
g
r
icu
ltu
r
al
ar
ea
w
it
h
a
t
r
ad
itio
n
al
h
o
u
s
e.
In
B
o
y
o
lali,
m
o
s
t
r
esp
o
n
d
e
n
t
s
h
ad
an
o
p
en
s
e
w
er
w
h
er
e
r
ats
can
ea
s
il
y
ac
ce
s
s
.
E
v
en
t
h
o
u
g
h
t
h
is
co
n
d
itio
n
d
id
n
o
t
r
elate
to
t
h
e
lep
to
s
p
ir
o
s
is
i
n
f
ec
t
io
n
,
i
t
co
u
l
d
b
e
a
p
o
ten
tial
f
ac
to
r
f
o
r
lep
to
s
p
ir
o
s
is
i
n
f
ec
tio
n
.
A
r
a
u
j
o
et
a
l.
[
1
7
]
co
n
clu
d
ed
t
h
at
co
n
tact
w
it
h
o
p
en
s
e
w
er
s
,
f
lo
o
d
w
a
ter
s
,
an
d
g
ar
b
ag
e
wer
e
r
is
k
f
ac
to
r
s
f
o
r
lep
to
s
p
ir
o
s
is
.
So
m
e
i
m
p
o
r
tan
t
en
v
ir
o
n
m
en
tal
f
ac
to
r
s
ar
e
t
h
e
p
r
esen
ce
o
f
r
at
s
,
p
o
o
r
s
e
w
er
co
n
d
itio
n
s
,
p
o
o
r
tr
ash
co
n
d
itio
n
s
an
d
th
e
p
r
esen
ce
o
f
s
tan
d
i
n
g
w
ater
[
1
1
]
.
P
o
o
r
s
e
w
er
co
n
d
itio
n
s
af
f
ec
t
th
e
in
cid
en
ce
o
f
lep
to
s
p
ir
o
s
is
[
1
6
]
.
I
n
th
is
s
t
u
d
y
,
m
o
s
t
o
f
t
h
e
en
v
ir
o
n
m
e
n
ta
l
s
an
itat
io
n
co
n
d
itio
n
s
in
t
h
e
r
esp
o
n
d
en
t
'
s
h
o
u
s
e
h
av
e
o
p
en
s
e
w
er
o
r
s
e
w
er
a
g
e
co
n
d
itio
n
s
.
So
m
e
o
f
th
e
r
i
s
k
f
ac
to
r
s
ca
n
b
e
p
r
ev
e
n
ted
b
y
clo
s
in
g
t
h
e
s
e
w
a
g
e
d
r
ain
ag
e,
co
n
tr
o
lli
n
g
t
h
e
r
o
d
en
t
p
o
p
u
latio
n
s
i
n
p
er
i
-
d
o
m
ici
l
ar
y
e
n
v
ir
o
n
m
en
t
s
.
3
.
3
.
O
cc
up
a
t
io
n a
s
f
a
r
m
er
a
nd
le
pto
s
piro
s
is
T
h
er
e
is
an
a
s
s
o
ciatio
n
b
et
w
e
en
o
cc
u
p
atio
n
as
f
ar
m
er
an
d
l
ep
to
s
p
ir
o
s
is
(
OR
:5
.
1
8
6
;
9
5
%
C
I
:1
.
6
8
2
-
1
5
.
9
8
9
)
.
I
t
is
lik
el
y
t
h
at
o
cc
u
p
atio
n
as
a
f
ar
m
er
h
as
a
f
i
v
e
ti
m
e
s
g
r
ea
ter
r
is
k
to
g
et
l
ep
to
s
p
ir
o
s
is
t
h
an
o
t
h
er
o
cc
u
p
atio
n
.
I
t
i
s
r
elate
d
to
f
ar
m
er
w
o
r
k
p
lace
an
d
ac
t
iv
i
ties
.
Far
m
er
w
o
r
k
i
n
t
h
e
r
ice
f
ield
w
h
er
e
it
is
u
s
u
all
y
w
et
an
d
s
u
b
m
er
g
ed
w
i
th
w
ate
r
f
o
r
a
co
u
p
le
o
f
w
ee
k
s
.
M
w
a
ch
u
i
et
a
l.
[
1
8
]
f
o
u
n
d
t
h
at
i
n
B
r
az
il,
f
ar
m
er
s
w
h
o
cu
lti
v
ate
r
ice
o
r
en
g
ag
e
i
n
s
m
all
s
ca
le
li
v
es
to
ck
p
r
o
d
u
ctio
n
w
er
e
h
i
g
h
l
y
s
u
s
ce
p
tib
le
to
lep
to
s
p
ir
o
s
is
.
So
m
e
ac
tiv
itie
s
p
r
io
r
l
ep
to
s
p
ir
o
s
is
il
ln
es
s
ar
e
w
al
k
in
g
t
h
r
o
u
g
h
w
a
ter
,
ap
p
ly
in
g
f
er
tili
ze
r
,
p
lo
w
i
n
g
in
,
p
la
n
ti
n
g
a
n
d
p
u
llin
g
o
u
t
r
ice
p
lan
ts
s
p
r
o
u
t
s
in
w
et
f
ield
s
f
o
r
m
o
r
e
th
an
s
ix
h
o
u
r
s
a
d
ay
.
Ho
w
ev
er
,
ac
ti
v
itie
s
w
i
th
d
r
y
f
iled
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8806
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.,
Vo
l.
10
,
No
.
3
,
Sep
tem
b
er
2021
:
574
–
5
8
0
578
lik
e
h
ar
v
est
in
g
an
d
p
r
ep
ar
in
g
s
talk
b
u
n
d
les
w
er
e
n
o
t
r
is
k
s
.
R
ice
f
ie
ld
s
ar
e
n
o
r
m
all
y
h
ab
it
ed
b
y
s
o
m
e
r
o
d
en
t
s
s
u
c
h
a
s
R
a
ttu
s
a
r
g
en
tiven
ter
.
T
h
ey
b
u
r
y
u
n
d
er
g
r
o
u
n
d
a
n
d
l
o
o
k
f
o
r
f
o
o
d
,
p
ar
ticu
lar
l
y
w
h
e
n
h
ar
v
e
s
t ti
m
e.
R
at
s
ar
e
a
r
eser
v
o
ir
f
o
r
l
ep
to
s
p
ir
o
s
i
s
b
ac
ter
ia,
an
d
w
ater
i
s
it
s
m
e
d
ia.
T
h
er
ef
o
r
e
th
e
r
ice
f
ie
ld
b
ec
o
m
e
s
a
r
i
s
k
y
p
lace
f
o
r
l
ep
to
s
p
ir
o
s
is
.
T
h
e
b
ac
ter
i
a
ca
n
s
u
r
v
i
v
e
in
t
h
e
w
ater
an
d
en
ter
h
u
m
an
b
lo
o
d
ca
p
illar
y
t
h
r
o
u
g
h
w
o
u
n
d
s
.
T
h
o
u
g
h
it
is
a
r
is
k
y
p
lace
f
o
r
l
ep
to
s
p
ir
o
s
is
,
f
a
r
m
er
s
ca
n
b
e
p
r
o
tecte
d
b
y
u
s
i
n
g
b
o
o
ts
o
r
r
u
b
b
er
g
lo
v
es,
esp
ec
iall
y
w
h
e
n
t
h
e
y
h
av
e
w
o
u
n
d
o
n
f
ee
t
an
d
h
an
d
s
.
Ho
w
e
v
er
,
m
o
s
t
I
n
d
o
n
e
s
ia
n
f
ar
m
er
s
ig
n
o
r
e
w
o
u
n
d
s
on
th
eir
s
k
i
n
a
n
d
r
ar
el
y
u
s
e
b
o
o
ts
an
d
g
lo
v
e
s
w
h
e
n
t
h
e
y
w
o
r
k
.
M
w
ac
h
u
i
et
a
l
.
[
1
9
]
ass
u
m
e
d
th
at
a
g
r
icu
l
tu
r
al
p
r
ac
tices
o
f
r
ice
an
d
cr
o
p
cu
ltiv
atio
n
w
er
e
co
n
n
ec
ted
w
it
h
l
ep
to
s
p
ir
o
s
is
r
is
k
.
P
ets,
r
o
d
en
ts
a
n
d
liv
e
s
to
ck
ex
h
ib
ited
a
h
i
g
h
v
ar
iatio
n
a
m
o
n
g
s
tu
d
ies.
T
h
er
ef
o
r
e,
th
e
n
u
m
b
er
o
f
f
ar
m
er
s
w
h
o
in
f
ec
ted
with
l
ep
to
s
p
ir
o
s
is
is
al
w
a
y
s
ab
o
v
e
a
v
er
ag
e
i
n
a
n
a
g
r
icu
lt
u
r
al
co
u
n
tr
y
.
I
n
th
i
s
s
tu
d
y
,
m
a
n
y
ca
s
e
-
p
atie
n
ts
l
iv
e
n
ea
r
t
h
e
r
ice
f
ield
.
So
m
e
ca
s
e
s
i
n
t
h
is
s
tu
d
y
w
er
e
c
o
n
s
tr
u
ct
io
n
w
o
r
k
er
w
h
o
ex
p
er
ie
n
ce
d
w
a
s
h
i
n
g
af
ter
w
o
r
k
on
t
h
e
ir
r
i
g
atio
n
w
ater
s
tr
ea
m
n
e
x
t
to
th
e
r
ice
f
ield
.
I
t
is
co
h
er
en
t
w
it
h
Ul
l
m
a
n
n
an
d
L
a
n
g
o
n
i
[
1
5
]
,
s
a
y
in
g
t
h
at
l
ep
to
s
p
ir
o
s
is
ca
n
h
ap
p
en
in
co
n
s
tr
u
ctio
n
w
o
r
k
er
in
C
alic
u
t,
I
n
d
ia.
L
ep
to
s
p
ir
o
s
is
i
s
n
o
t
o
n
l
y
r
elate
d
to
th
e
o
cc
u
p
atio
n
b
u
t
also
r
elate
d
to
th
e
d
is
aster
(
f
lo
o
d
)
o
r
ev
en
t
s
s
u
c
h
as
tr
iat
h
lo
n
(
s
w
i
m
m
in
g
)
.
P
lan
k
a
n
d
Dea
n
[
2
]
b
eliev
ed
th
at
f
ar
m
er
s
,
m
i
n
er
s
,
s
e
w
er
w
o
r
k
er
s
,
m
ea
t
w
o
r
k
er
s
a
n
d
f
is
h
er
m
a
n
ar
e
th
e
o
cc
u
p
atio
n
w
it
h
h
i
g
h
r
is
k
to
l
ep
to
s
p
ir
o
s
is
in
cid
en
ce
.
E
s
p
ec
iall
y
in
t
h
e
u
r
b
a
n
p
o
p
u
latio
n
,
u
r
b
an
d
ec
a
y
a
n
d
f
lo
o
d
in
g
.
L
ep
to
s
p
ir
o
s
i
s
is
as
s
o
ciate
d
w
it
h
ir
r
ig
atio
n
in
d
r
y
lan
d
o
r
f
ar
m
.
T
h
e
w
ater
f
r
o
m
t
h
e
ir
r
ig
a
tio
n
was
s
tr
ea
m
ed
f
r
o
m
t
h
e
o
p
en
w
ater
s
u
c
h
as
r
i
v
er
an
d
l
ak
e.
W
h
er
e
h
u
m
an
h
ab
itatio
n
b
ec
o
m
e
s
h
ig
h
er
,
t
h
e
d
o
m
esti
c
r
o
d
en
t
a
n
d
an
i
m
al
b
ec
o
m
es
h
i
g
h
er
an
d
i
n
cr
ea
s
es
th
e
r
i
s
k
o
f
l
ep
to
s
p
ir
o
s
is
to
h
u
m
a
n
.
I
n
th
i
s
s
tu
d
y
,
a
s
t
u
d
en
t
ad
m
i
tted
th
at
h
e
g
o
t
lep
to
s
p
ir
o
s
i
s
af
ter
g
e
ttin
g
b
itte
n
b
y
h
i
s
p
et
h
a
m
s
ter
.
Ha
m
s
ter
is
o
n
e
an
i
m
al
t
h
at
ca
n
b
r
in
g
l
ep
to
s
p
ir
a
s
tr
ain
s
.
S
y
r
ia
n
h
a
m
s
ter
ca
n
b
e
in
f
ec
t
ed
b
y
s
er
o
v
ar
s
o
f
L
ep
to
s
p
ir
a
in
ter
r
o
g
a
n
s
,
w
it
h
b
ac
ter
ia
tr
av
elin
g
r
ap
id
ly
to
t
h
e
b
lo
o
d
s
tr
ea
m
v
ia
th
e
l
y
m
p
h
atics
[
2
0
]
.
A
n
o
t
h
er
o
cc
u
p
atio
n
in
t
h
e
ca
s
e
g
r
o
u
p
w
a
s
a
co
n
s
tr
u
c
tio
n
w
o
r
k
er
.
N
o
t
o
n
l
y
a
f
ar
m
er
,
o
th
er
o
cc
u
p
a
tio
n
th
at
w
o
r
k
i
n
an
o
u
td
o
o
r
en
v
ir
o
n
m
en
t
an
d
w
o
r
k
p
lace
th
at
e
x
p
o
s
e
to
f
lo
o
d
w
ater
,
b
u
t
s
e
w
a
g
e
an
d
m
u
d
ar
e
also
lik
el
y
to
ass
o
ciate
w
it
h
l
ep
to
s
p
ir
o
s
is
.
Fo
r
ex
a
m
p
le,
l
ep
to
s
p
ir
o
s
is
ar
e
p
r
ev
alen
t
a
m
o
n
g
s
la
u
g
h
ter
h
o
u
s
e
w
o
r
k
er
s
an
d
b
u
tch
er
s
[
2
1
]
,
[
2
2
]
.
P
lan
k
an
d
Dea
n
[
2
]
b
eliev
e
d
th
at
f
ar
m
er
s
,
m
i
n
er
s
,
s
e
w
er
w
o
r
k
er
s
,
m
ea
t
w
o
r
k
er
s
an
d
f
is
h
er
m
an
ar
e
th
e
o
cc
u
p
atio
n
w
it
h
h
ig
h
r
is
k
to
l
ep
to
s
p
ir
o
s
is
in
cid
en
ce
.
I
n
th
i
s
s
t
u
d
y
,
m
en
w
er
e
o
b
s
er
v
ed
as
7
5
.
8
%
o
f
th
e
ca
s
e
-
p
atien
t
s
w
h
ile
w
o
m
e
n
w
er
e
o
n
l
y
2
4
.
2
%.
Me
n
ar
e
li
k
el
y
to
h
a
v
e
a
h
i
g
h
er
r
is
k
th
a
n
w
o
m
e
n
[
2
]
.
B
ased
o
n
in
ter
v
ie
w
s
w
it
h
ca
s
e
r
esp
o
n
d
en
ts
,
t
h
e
y
s
aid
t
h
e
y
d
id
n
o
t
k
n
o
w
w
h
at
l
ep
to
s
p
ir
o
s
is
is
,
b
u
t
th
e
y
k
n
e
w
t
h
at
r
at
u
r
in
e
w
as
o
n
e
o
f
t
h
e
l
ep
to
s
p
ir
o
s
i
s
s
o
u
r
ce
s
.
T
h
e
y
d
id
n
o
t
k
n
o
w
t
h
at
th
e
d
is
e
ase
w
a
s
co
n
ta
g
io
u
s
an
d
co
u
ld
b
e
in
f
ec
ted
t
h
r
o
u
g
h
a
w
o
u
n
d
o
n
t
h
e
h
a
n
d
s
an
d
f
ee
t
.
3
.
4
.
Rela
t
io
ns
hip
bet
w
ee
n t
he
pr
esence
o
f
w
o
un
d a
nd
lept
o
s
piro
s
is
B
ased
o
n
th
e
s
tatis
tical
te
s
ts
r
esu
lts
,
it
ca
n
b
e
co
n
clu
d
ed
th
at
th
er
e
is
a
s
ig
n
i
f
ica
n
t
r
elatio
n
s
h
ip
b
et
w
ee
n
w
o
u
n
d
p
r
esen
ce
an
d
l
ep
to
s
p
ir
o
s
is
in
cid
en
ce
(
OR
=1
7
.
0
1
4
,
9
5
%
C
I
:5
.
4
8
7
-
5
2
.
7
6
1
)
.
T
h
er
ef
o
r
e,
it
is
b
eliev
ed
t
h
at
s
o
m
eo
n
e
w
i
th
a
w
o
u
n
d
ca
n
r
is
k
g
e
tti
n
g
l
ep
to
s
p
ir
o
s
is
5
,
4
ti
m
es
g
r
ea
ter
t
h
an
t
h
o
s
e
w
h
o
d
o
n
o
t
h
av
e
it.
T
h
is
s
t
u
d
y
i
s
in
li
n
e
w
it
h
t
h
e
s
t
u
d
y
o
f
Ma
n
iiah
[
2
3
]
w
h
er
e
a
h
is
to
r
y
o
f
in
j
u
r
y
i
s
a
r
is
k
f
ac
to
r
f
o
r
l
ep
to
s
p
ir
o
s
is
(
OR
=
8
,
1
9
6
;
9
5
%
C
I
=2
,
3
1
1
-
2
9
,
0
7
3
)
.
In
ad
d
i
tio
n
,
P
r
asti
w
i
's
s
t
u
d
y
[
9
]
an
d
C
ah
y
ati
et
a
l.
[
8
]
b
eliev
e
th
at
w
o
u
n
d
h
as
a
r
elatio
n
s
h
ip
w
it
h
t
h
e
in
cid
en
ce
o
f
l
ep
to
s
p
ir
o
s
is
.
I
t
is
ea
s
ier
f
o
r
l
ep
to
s
p
ir
o
s
is
b
ac
ter
ia
to
en
ter
th
e
body
t
h
r
o
u
g
h
a
wo
u
n
d
s
k
i
n
[
2
4
]
.
T
an
g
k
an
a
k
u
l
et
a
l.
[
1
8
]
an
d
Ka
m
ath
et
a
l.
[
2
5
]
co
n
clu
d
es
t
h
at
cu
ts
o
r
w
o
u
n
d
s
is
ass
o
ciate
d
w
it
h
th
e
d
is
ea
s
e.
L
ep
to
s
p
ir
o
s
i
s
o
u
tb
r
ea
k
s
h
a
v
e
b
ee
n
r
ep
o
r
ted
f
o
llo
w
i
n
g
d
r
in
k
in
g
an
d
s
w
i
m
m
i
n
g
in
co
n
ta
m
i
n
at
ed
w
ater
.
Ka
m
ath
e
t
a
l.
[
2
5
]
b
eliev
ed
th
at
t
h
e
s
tr
o
n
g
est
r
is
k
f
ac
to
r
r
elate
d
w
it
h
l
ep
to
s
p
ir
o
s
is
in
f
ec
tio
n
is
t
h
e
p
r
esen
ce
o
f
t
h
e
w
o
u
n
d
o
r
cu
t
i
n
th
e
s
k
i
n
d
u
r
in
g
t
h
e
w
o
r
k
.
P
h
r
aisu
w
a
n
et
a
l.
[
2
6
]
in
d
icate
d
th
at
w
ea
r
i
n
g
lo
n
g
p
an
ts
ca
n
r
ed
u
ce
th
e
l
ep
to
s
p
ir
o
s
is
i
n
f
ec
tio
n
a
n
d
th
e
p
r
ese
n
ce
o
f
m
o
r
e
th
an
t
w
o
w
o
u
n
d
s
a
s
s
o
ciate
d
w
it
h
th
e
i
n
f
ec
tio
n
(
O
R
3
.
9
7
)
.
I
n
th
i
s
s
tu
d
y
,
m
o
s
t f
ar
m
er
s
h
a
d
w
o
u
n
d
s
u
ch
as ti
n
ea
p
ed
is
(
a
th
lete
’
s
f
o
o
t)
,
an
i
m
al
/
r
at
b
ites
,
s
cr
atch
es.
T
h
e
w
o
u
n
d
s
in
t
h
e
ca
s
e
g
r
o
u
p
w
er
e
m
o
s
t
l
y
ca
u
s
ed
b
y
a
n
a
n
i
m
al
b
ite
o
r
h
ig
h
h
u
m
id
it
y
(
tin
ea
p
ed
is
)
,
an
d
s
p
i
k
y
p
lan
ts
.
Far
m
er
s
ad
m
i
tted
t
h
at
t
h
e
y
r
ar
el
y
u
s
ed
s
h
o
es
w
h
e
n
wo
r
k
in
g
,
t
h
e
y
d
id
n
o
t
co
v
er
o
r
h
ea
l
a
n
y
w
o
u
n
d
s
i
n
th
eir
f
ee
t,
an
d
t
h
e
y
w
as
h
ed
t
h
eir
f
ee
t
an
d
h
a
n
d
s
o
n
th
e
wate
r
s
tr
ea
m
n
ex
t
to
th
e
r
ice
f
ield
w
er
e
p
o
s
s
ib
l
y
co
n
ta
m
i
n
ated
.
aE
it
h
er
i
n
u
r
b
an
o
r
r
u
r
al
ar
ea
s
,
an
t
h
r
o
p
o
g
en
ic
ac
ti
v
itie
s
r
elate
d
to
o
p
en
w
ater
a
n
d
p
o
o
r
co
n
d
itio
n
m
a
y
i
n
f
l
u
e
n
ce
lep
t
o
s
p
ir
al
tr
an
s
m
is
s
io
n
to
h
u
m
a
n
s
[
1
7
]
,
[
2
7
]
.
I
t
w
a
s
r
ep
o
r
ted
th
at
lep
to
s
p
ir
al
b
ac
ter
ia
w
er
e
f
o
u
n
d
m
o
r
e
in
th
e
s
tr
ea
m
t
h
an
i
n
t
h
e
u
n
d
er
g
r
o
u
n
d
s
o
u
r
ce
s
,
w
ell
a
n
d
r
ai
n
wate
r
co
llectio
n
.
O
n
e
o
f
th
e
co
m
m
o
n
w
o
u
n
d
in
f
ar
m
er
s
is
ti
n
ea
p
ed
is
o
r
A
th
lete
’
s
f
o
o
t.
I
t
o
cc
u
r
s
w
h
e
n
th
e
tin
ea
s
p
.
f
u
n
g
u
s
g
r
o
w
s
o
n
th
e
f
ee
t.
T
h
e
f
u
n
g
u
s
ca
n
b
e
ex
p
o
s
ed
th
r
o
u
g
h
d
ir
ec
t
c
o
n
tact
w
it
h
an
i
n
f
ec
ted
p
er
s
o
n
or
by
to
u
c
h
i
n
g
s
u
r
f
ac
es
co
n
ta
m
i
n
ated
w
it
h
t
h
e
f
u
n
g
u
s
.
T
h
e
f
u
n
g
u
s
t
h
r
iv
e
s
i
n
m
o
is
t
an
d
w
ar
m
e
n
v
ir
o
n
m
e
n
ts
.
I
t
is
co
m
m
o
n
l
y
f
o
u
n
d
in
s
w
i
m
m
i
n
g
p
o
o
ls
,
s
h
o
w
er
s
,
o
p
en
w
ater
o
r
s
tr
ea
m
s
.
W
o
u
n
d
ca
r
e
i
s
n
ee
d
ed
to
av
o
id
th
e
tr
an
s
m
is
s
io
n
o
f
l
ep
to
s
p
ir
o
s
is
t
h
r
o
u
g
h
i
n
j
u
r
e
d
s
k
i
n
a
n
d
also
u
s
e
s
h
o
es
w
h
en
w
o
r
k
i
n
g
,
esp
ec
ial
l
y
f
o
r
f
ar
m
er
s
.
P
r
ev
en
tio
n
e
f
f
o
r
ts
ca
n
b
e
m
ad
e
b
y
co
v
er
i
n
g
w
o
u
n
d
s
,
p
r
o
v
id
in
g
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.
I
SS
N:
2
252
-
8806
R
is
k
f
a
cto
r
s
o
f le
p
to
s
p
ir
o
s
is
in
cid
en
ce
in
a
g
r
icu
ltu
r
a
l a
r
ea
(
Mit
o
r
ia
n
a
P
o
r
u
s
ia
)
579
an
tis
ep
tic
f
l
u
id
s
,
m
ai
n
tai
n
i
n
g
p
er
s
o
n
al
h
y
g
ien
e
an
d
th
e
en
v
i
r
o
n
m
e
n
t,
esp
ec
iall
y
w
h
e
n
t
h
er
e
ar
e
in
j
u
r
ies
to
t
h
e
b
o
d
y
,
an
d
u
s
i
n
g
s
h
o
e
s
w
h
en
w
o
r
k
i
n
g
,
esp
ec
iall
y
f
o
r
w
o
r
k
e
r
s
w
h
o
ar
e
o
f
te
n
i
n
co
n
tact
w
i
th
w
ater
.
Far
m
er
s
o
r
an
y
o
n
e
s
h
o
u
ld
n
o
t
w
a
s
h
h
a
n
d
s
o
r
f
ee
t
i
n
ir
r
i
g
ated
r
ice
f
ield
s
,
p
ar
ticu
lar
l
y
w
h
e
n
t
h
er
e
ar
e
in
j
u
r
ies.
W
as
h
i
n
g
th
e
m
u
s
in
g
clo
s
ed
-
s
o
u
r
ce
w
at
er
w
it
h
s
o
ap
is
r
ec
o
m
m
e
n
d
ed
[
2
8
]
.
3.
5.
Do
m
i
na
nt
ris
k
f
a
ct
o
r
o
f
lept
o
s
piro
s
is
In
th
i
s
s
t
u
d
y
,
all
t
h
e
v
ar
iab
le
s
w
er
e
tes
ted
w
i
th
r
e
g
r
ess
io
n
lo
g
is
t
ic
e
x
ce
p
t
k
n
o
w
led
g
e,
a
n
d
th
e
r
es
u
lt
s
h
o
w
ed
b
ad
p
er
s
o
n
al
h
y
g
ien
e
an
d
p
o
o
r
en
v
ir
o
n
m
en
ta
l
s
a
n
i
tatio
n
s
h
o
w
ed
no
as
s
o
ciatio
n
to
l
ep
to
s
p
ir
o
s
is
.
On
th
e
o
th
er
h
an
d
,
o
cc
u
p
atio
n
,
as f
ar
m
er
is
a
r
is
k
to
g
et
l
ep
to
s
p
ir
o
s
is
in
f
ec
tio
n
(
O
R
:5
.
1
8
6
)
a
n
d
w
o
u
n
d
p
r
ese
n
ce
,
ten
d
s
to
b
e
th
e
m
o
s
t
in
f
l
u
en
t
ial
f
ac
to
r
(
OR
:1
7
.
0
1
4
)
in
B
o
y
o
la
li.
I
t
in
d
icate
d
th
at
l
ep
to
s
p
ir
o
s
is
w
as
ea
s
i
l
y
tr
an
s
m
itted
t
h
r
o
u
g
h
th
e
s
k
in
w
o
u
n
d
.
T
h
er
ef
o
r
e,
p
eo
p
le
w
h
o
w
o
r
k
p
r
i
m
ar
il
y
in
w
ater
n
ee
d
to
tr
ea
t
th
e
ir
s
k
i
n
w
o
u
n
d
o
r
co
v
er
t
h
e
m
w
h
e
n
w
o
r
k
i
n
g
.
T
h
is
i
s
in
li
n
e
w
it
h
Han
d
a
y
a
n
i
'
s
r
esear
ch
[
2
9
]
th
at
w
o
u
n
d
ca
r
e
is
a
p
r
o
tectiv
e
f
ac
to
r
of
l
ep
to
s
p
ir
o
s
is
(
OR
=0
.
2
4
9
;9
5
%
C
I
=0
.
0
9
5
-
0
.
6
6
4
)
.
Far
m
er
s
ar
e
u
s
u
al
l
y
u
n
a
w
ar
e
o
f
t
h
eir
s
af
et
y
-
r
e
lated
to
p
esti
cid
e
to
x
ic,
h
y
g
ien
e
a
n
d
in
f
e
ctio
n
.
Ma
h
y
u
n
i
et
a
l.
[
3
0
]
s
tated
th
at
s
u
p
p
o
r
t
f
r
o
m
g
o
v
er
n
m
e
n
t e
n
d
o
r
s
e
m
e
n
t is
n
e
ed
ed
to
d
ev
elo
p
k
n
o
w
led
g
e
a
n
d
a
w
ar
en
e
s
s
a
m
o
n
g
f
ar
m
er
s
.
T
h
is
r
esear
ch
g
i
v
es
a
b
etter
u
n
d
er
s
ta
n
d
in
g
o
f
lep
to
s
p
ir
o
s
i
s
in
f
ec
tio
n
i
n
a
n
a
g
r
ic
u
lt
u
r
al
ar
ea
.
T
h
is
r
esear
ch
'
s
li
m
itat
io
n
w
as
t
h
at
th
e
au
t
h
o
r
h
ad
n
o
t
test
ed
t
h
e
v
alu
e
ad
j
u
s
ted
ad
d
r
atio
n
(
aOR).
Fu
r
t
h
er
r
esear
ch
r
elate
d
l
ep
to
s
p
ir
o
s
is
in
f
ec
tio
n
in
o
th
er
o
cc
u
p
atio
n
an
d
t
h
e
b
ig
g
er
ar
ea
s
h
o
u
ld
b
e
co
n
d
u
cted
f
o
r
b
etter
u
n
d
er
s
ta
n
d
in
g
.
4.
CO
NCLU
SI
O
N
T
h
er
e
w
as
a
n
as
s
o
ciatio
n
b
et
w
ee
n
w
o
u
n
d
p
r
esen
ce
(
OR
:1
7
.
0
1
4
;9
5
%
C
I
:5
.
4
8
7
-
5
2
.
7
6
1
)
an
d
o
cc
u
p
atio
n
as
a
f
ar
m
er
(
OR
:5
.
1
8
6
;9
5
%
C
I
:1
.
6
8
2
-
1
5
.
9
8
9
)
to
w
ar
d
s
lep
to
s
p
ir
o
s
i
s
i
n
cid
en
ce
.
Oth
er
f
ac
to
r
s
s
u
c
h
as
b
ad
p
er
s
o
n
al
h
y
g
ie
n
e
an
d
poor
en
v
ir
o
n
m
e
n
tal
s
a
n
itat
io
n
s
h
o
w
ed
no
s
i
g
n
i
f
ican
t
a
s
s
o
ciatio
n
to
w
ar
d
s
lep
to
s
p
ir
o
s
is
in
cid
e
n
ce
.
W
o
u
n
d
p
r
esen
ce
o
n
f
ee
t
co
u
ld
in
cr
e
ase
th
e
r
i
s
k
to
g
et
lep
to
s
p
ir
o
s
i
s
p
ar
ticu
lar
l
y
t
h
o
s
e
w
h
o
w
o
r
k
as
a
f
ar
m
er
.
T
h
er
ef
o
r
e,
a
f
ar
m
er
w
h
o
h
a
s
w
o
u
n
d
s
o
n
t
h
eir
f
ee
t
(
at
h
lete
’
s
f
o
o
t,
an
i
m
al
b
ite
or
s
cr
atch
w
o
u
n
d
)
s
h
o
u
ld
co
v
er
th
e
m
or
w
ea
r
s
u
itab
le
p
er
s
o
n
al
p
r
o
tectiv
e
eq
u
ip
m
e
n
t.
Su
p
p
o
r
t
to
in
cr
ea
s
e
th
e
a
w
ar
e
n
ess
o
f
p
eo
p
le
w
h
o
w
o
r
k
i
n
t
h
e
a
g
r
ic
u
lt
u
r
al
ar
ea
i
s
r
eq
u
ir
ed
.
I
t
is
s
u
g
g
ested
f
u
r
t
h
er
r
esear
ch
r
elate
d
lep
to
s
p
ir
o
s
is
in
f
ec
tio
n
i
n
o
th
er
o
cc
u
p
atio
n
.
ACK
NO
WL
E
D
G
E
M
E
NT
S
T
h
e
au
th
o
r
s
w
o
u
ld
li
k
e
to
th
a
n
k
to
Un
i
v
er
s
i
tas
M
u
h
a
m
m
ad
i
y
ah
S
u
r
ak
ar
ta
a
n
d
B
o
y
o
lal
i
r
ice
f
ar
m
er
w
h
o
p
ar
ticip
ated
in
th
i
s
s
t
u
d
y
.
RE
F
E
R
E
NC
E
S
[
1
]
S
.
V
e
li
n
e
n
i,
S
.
A
su
th
k
a
r,
P
.
Um
a
b
a
la,
V.
L
a
k
sh
m
i,
a
n
d
M
.
S
r
it
h
a
ra
n
,
“
S
e
ro
lo
g
ica
l
e
v
a
lu
a
ti
o
n
o
f
lep
to
sp
i
ro
sis
i
n
H
y
d
e
ra
b
a
d
,
A
n
d
h
ra
P
ra
d
e
sh
:
A
re
tro
sp
e
c
ti
v
e
h
o
sp
i
tal
-
b
a
se
d
stu
d
y
,
”
I
n
d
i
a
n
.
J
.
M
e
d
.
M
i
c
r
o
b
i
o
l
.
,
v
o
l.
2
5
,
n
o
.
1
,
p
p
.
24
-
2
7
,
2
0
0
7
,
d
o
i:
1
0
.
4
1
0
3
/0
2
5
5
-
0
8
5
7
.
3
1
0
5
7
.
P
M
ID:
1
7
3
7
7
3
4
8
.
[
2
]
M
.
P
ica
rd
e
a
u
,
"
Dia
g
n
o
sis
a
n
d
Ep
i
d
e
m
io
lo
g
y
o
f
lep
to
sp
iro
sis
,"
M
e
d
e
c
in
e
e
t
M
a
la
d
ies
In
fec
ti
e
u
se
s
,
v
o
l
4
3
,
n
o
.
1
,
pp
.
1
-
9
,
Ja
n
u
a
ry
2
0
1
3
,
d
o
i:
1
0
.
1
0
1
6
/j
.
m
e
d
m
a
l.
2
0
1
2
.
1
1
.
0
0
5
.
[
3
]
W
HO
,
“
Re
p
o
rt
o
f
th
e
S
e
c
o
n
d
M
e
e
ti
n
g
o
f
th
e
L
e
p
to
sp
iro
sis
B
u
rd
e
n
Ep
i
d
e
m
io
lo
g
y
Re
fe
re
n
c
e
G
ro
u
p
,
”
Re
p
o
r
t
,
G
e
n
e
v
a
,
2
0
1
1
.
[
On
l
in
e
]
.
A
v
a
il
a
b
le:
h
tt
p
s://
a
p
p
s.w
h
o
.
in
t/
iri
s/
h
a
n
d
le
/1
0
6
6
5
/4
4
5
8
8
o
n
Ja
n
u
a
ry
2
0
2
1
[
4
]
W
HO
S
o
u
th
-
Eas
t
A
sia
In
d
o
n
e
si
a
,
"
L
e
p
to
sp
iro
sis
p
re
v
e
n
ti
o
n
a
n
d
c
o
n
tro
l
i
n
In
d
o
n
e
sia
,
"
Ja
k
a
r
ta,
2
0
2
0
.
[O
n
li
n
e
A
v
a
il
a
b
le
:
h
tt
p
s://
w
ww
.
w
h
o
.
in
t/
i
n
d
o
n
e
sia
/n
e
w
s/d
e
tail/
2
4
-
08
-
2
0
2
0
-
lep
to
sp
iro
sis
-
p
re
v
e
n
ti
o
n
-
a
n
d
-
c
o
n
tro
l
-
in
-
in
d
o
n
e
sia
o
n
Ja
n
u
a
ry
2
0
2
1
[
5
]
I.
H.
M
in
ister,
“
In
d
o
n
e
sia
n
He
a
lt
h
P
ro
f
il
e
2
0
1
7
/
P
ro
f
il
e
Ke
se
h
a
tan
In
d
o
n
e
sia
2
0
1
7
,”
Ja
k
a
rta,
2
0
1
8
.
[
6
]
B.
D.
H.
Off
ice
,
“
P
ro
f
il
e
o
f
P
u
b
li
c
He
a
lt
h
Off
ice
Bo
y
o
lali
Cit
y
2
0
1
7
(I
n
In
d
o
n
e
sia
:
P
ro
f
il
Ke
se
h
a
tan
Ka
b
u
p
a
te
n
Bo
y
o
lali
T
a
h
u
n
2
0
1
7
),
”
2
0
1
7
.
[On
li
n
e
]
.
A
v
a
il
a
b
le:
h
tt
p
s:/
/p
p
id
.
b
o
y
o
lali.
g
o
.
id
/f
t_
in
f
o
p
u
b
li
k
/sh
o
w
d
o
c
/
P
ROFIL
%
2
0
2
0
1
7
%
2
0
BOY
OLA
L
I
%
2
0
CET
A
K.p
d
f
o
n
Ja
n
u
a
ry
2
0
2
1
[
7
]
H.
O.
of
J.
T.
P
r
o
v
in
c
e
,
“
He
a
lt
h
p
ro
f
il
e
of
Ja
wa
T
e
n
g
a
h
P
ro
v
i
n
c
e
In
d
o
n
e
sia
y
e
a
r
2017
(In
In
d
o
n
e
sia
:
Pro
fi
l
Ke
se
h
a
ta
n
Pro
v
i
n
si
J
a
wa
T
e
n
g
a
h
T
a
h
u
n
2
0
1
7
)
,”
S
e
m
a
ra
n
g
,
2
0
1
8
.
[
O
n
li
n
e
].
h
tt
p
:
//
d
i
n
k
e
sja
ten
g
p
ro
v
.
g
o
.
id
/v
2
0
1
8
/
d
o
k
u
m
e
n
/P
r
o
f
il
2
0
1
7
/m
o
b
il
e
/i
n
d
e
x
.
h
tm
l#
p
=
4
o
n
Ja
n
u
a
ry
2
0
2
1
[
8
]
D.
Him
a
n
i,
M
.
K.
S
u
m
a
n
,
a
n
d
B.
G
.
M
a
n
e
,
"
Ep
id
e
m
io
lo
g
y
o
f
l
e
p
to
sp
ir
o
sis:
a
n
I
n
d
ian
p
e
rsp
e
c
ti
v
e
,
"
J
o
u
rn
a
l
o
f
Fo
o
d
b
o
rn
e
a
n
d
Z
o
o
n
o
ti
c
Dise
a
se
,
v
o
l.
1
,
n
o
.
1
,
p
p
6
-
1
3
,
2
0
1
3
.
[
9
]
B.
P
ra
stiw
i,
“
F
a
c
to
rs
Re
late
d
to
L
e
p
to
sp
iro
sis
in
Ba
n
tu
l
Distr
ict
(In
In
d
o
n
e
sia
:
F
a
k
to
r
-
f
a
k
to
r
y
a
n
g
Ber
h
u
b
u
n
g
a
n
d
e
n
g
a
n
Ke
j
a
d
i
a
n
L
e
p
t
o
sp
ir
o
sis
di
Ka
b
u
p
a
te
n
B
a
n
t
u
l
)
,
”
J
.
Ke
se
h
a
t.
M
a
sy
,
v
o
l.
1
,
n
o
.
2
,
p
p
.
8
8
1
-
8
9
5
,
2
0
1
2
.
[
1
0
]
S
.
N.
F
a
jri
y
a
h
,
A
.
Ud
iy
o
n
o
,
a
n
d
L
.
D.
S
a
ra
s
wa
ti
,
"
En
v
iro
n
m
e
n
tal
a
n
d
Risk
F
a
c
to
rs
o
f
lep
to
sp
ir
o
sis:
A
sp
a
ti
a
l
a
n
a
ly
sis in
S
e
m
a
ra
n
g
c
it
y
,
"
IOP
Co
n
f.
S
e
r; E
a
rth
E
n
v
iro
n
S
c
i
.
,
2
0
1
7
,
v
o
l.
5
5
,
n
o
.
1
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8806
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.,
Vo
l.
10
,
No
.
3
,
Sep
tem
b
er
2021
:
574
–
5
8
0
580
[
1
1
]
R.
A
u
li
y
a
,
“
Re
latio
n
sh
ip
b
e
tw
e
e
n
Clea
n
He
a
lt
h
y
L
i
f
e
st
y
le,
Ho
u
se
h
o
ld
str
u
c
tu
re
a
n
d
Ho
u
se
S
a
n
i
tatio
n
to
w
a
rd
s
L
e
p
to
sp
iro
sis
I
n
c
id
e
n
c
e
(I
n
I
n
d
o
n
e
sia
:
Hu
b
u
n
g
a
n
An
t
a
ra
S
tr
a
t
a
PHB
S
T
a
ta
n
a
n
R
u
ma
h
T
a
n
g
g
a
d
a
n
S
a
n
it
a
si
Ru
ma
h
d
e
n
g
a
n
Ke
j
a
d
i
a
n
L
e
p
t
o
sp
iro
sis
)
,
”
Un
n
e
s
J
.
Pu
b
li
c
He
a
l.
,
v
o
l.
3
,
n
o
.
3
,
p
p
.
1
-
1
0
,
2
0
1
4
,
d
o
i:
1
0
.
1
5
2
9
4
/u
jp
h
.
v
3
i3
.
3
5
4
3
.
[
1
2
]
J.
Ch
i
n
,
C
o
n
tr
o
l
o
f
C
o
mm
u
n
ica
b
le
Dise
a
se
M
a
n
u
a
l
1
7
th
Ed
it
io
n
.
W
a
sh
in
g
to
n
DC:
Am
e
rica
n
P
u
b
li
c
He
a
l
t
h
A
s
so
c
iatio
n
,
2
0
0
0
.
[
1
3
]
R.
A
u
li
y
a
,
“
Re
latio
n
sh
i
p
b
e
tw
e
e
n
Clea
n
He
a
lt
h
y
L
i
f
e
st
y
l
e
,
Ho
u
se
h
o
ld
str
u
c
tu
re
a
n
d
H
o
u
se
S
a
n
it
a
ti
o
n
to
w
a
rd
s
L
e
p
to
sp
iro
sis
I
n
c
id
e
n
c
e
(I
n
I
n
d
o
n
e
sia
:
Hu
b
u
n
g
a
n
An
t
a
ra
S
tr
a
t
a
PHB
S
T
a
ta
n
a
n
R
u
ma
h
T
a
n
g
g
a
d
a
n
S
a
n
it
a
si
Ru
ma
h
d
e
n
g
a
n
Ke
ja
d
ia
n
L
e
p
to
s
p
i
ro
sis
)
,
”
J
.
Pu
b
li
c
He
a
lt
h
(
Ba
n
g
k
o
k
)
,
v
o
l.
3
,
n
o
.
3
,
2
0
1
4
.
[
1
4
]
C.
R.
Qu
in
a
,
J.
U.
A
lma
z
a
n
,
a
n
d
J.
B.
T
a
g
a
rin
o
,
“
Kn
o
w
led
g
e
,
A
tt
it
u
d
e
s,
a
n
d
P
ra
c
ti
c
e
s
of
Lep
to
sp
ir
o
sis
i
n
Ca
tb
a
lo
g
a
n
Cit
y
,
S
a
m
a
r,
P
h
il
i
p
p
i
n
e
s,”
Am.
J
.
Pu
b
li
c
He
a
l.
Res
,
v
o
l.
2
,
no.
3
,
p
p
.
9
1
-
9
8
,
2
0
1
4
,
d
o
i:
1
0
.
1
2
6
9
1
/ajp
h
r
-
2
-
3
-
5.
[
1
5
]
L
.
S
.
Ullma
n
n
a
n
d
H.
L
a
n
g
o
n
i,
“
In
tera
c
ti
o
n
s
b
e
tw
e
e
n
e
n
v
iro
n
m
e
n
t,
w
il
d
a
n
im
a
ls
a
n
d
h
u
m
a
n
le
p
to
sp
iro
sis
,
”
J
.
Ven
o
m.
A
n
im.
T
o
x
i
n
s In
c
l.
T
ro
p
.
Dis
,
v
o
l.
1
7
,
n
o
.
2
,
p
p
.
1
1
9
-
1
2
9
,
2
0
1
1
,
d
o
i:
1
0
.
1
5
9
0
/S
1
6
7
8
-
9
1
9
9
2
0
1
1
0
0
0
2
0
0
0
0
2
.
[
1
6
]
R.
B.
Re
is
e
t
a
l
.
,
“
Im
p
a
c
t
o
f
e
n
v
i
ro
n
m
e
n
t
a
n
d
so
c
ial
g
ra
d
ien
t
o
n
L
e
p
to
sp
ira
i
n
f
e
c
ti
o
n
in
u
rb
a
n
slu
m
s,”
PL
o
S
Ne
g
l
.
T
ro
p
.
Dis
,
v
o
l.
2
,
n
o
.
4
,
p
p
.
1
1
-
1
8
,
2
0
0
8
,
d
o
i:
1
0
.
1
3
7
1
/j
o
u
rn
a
l.
p
n
t
d
.
0
0
0
0
2
2
8
.
[
1
7
]
N.
d
e
A
r
a
ú
jo
e
t
a
l.
,
"
Kn
o
w
led
g
e
,
A
tt
it
u
d
e
s,
a
n
d
P
ra
c
ti
c
e
s
Re
late
d
t
o
L
e
p
to
sp
iro
sis
a
m
o
n
g
U
rb
a
n
S
lu
m
Re
sid
e
n
ts
in
Bra
z
il
,
"
T
h
e
Ame
ric
a
n
S
o
c
iety
o
f
T
ro
p
ica
l
M
e
d
icin
e
a
n
d
Hy
g
ien
e
,
v
o
l.
8
8
,
n
o
.
2
,
p
p
.
3
5
9
-
3
6
3
,
2
0
1
3
.
[
1
8
]
M
.
A
.
M
wa
c
h
u
i,
L
.
Cru
m
p
,
R.
Ha
rtsk
e
e
rl,
J.
Zi
n
ss
tag
,
a
n
d
J.
Ha
tt
e
n
d
o
rf
,
"
En
v
iro
n
m
e
n
tal
a
n
d
Be
h
a
v
io
u
ra
l
De
ter
m
in
a
n
ts
o
f
L
e
p
to
sp
iro
sis
T
ra
n
sm
is
sio
n
:
A
S
y
st
e
m
a
ti
c
Re
v
ie
w
,
"
P
L
o
S
Ne
g
l
T
ro
p
Dis
.
,
v
o
l.
9
,
n
o
.
9
,
2
0
1
5
,
d
o
i
:
1
0
.
1
3
7
1
/
jo
u
rn
a
l.
p
n
t
d
.
0
0
0
3
8
4
3
.
[
1
9
]
M.
A.
M
w
a
c
h
u
i,
L
.
Cru
m
p
,
R.
Ha
rtsk
e
e
rl,
J.
Zi
n
ss
tag
,
a
n
d
J.
Ha
tt
e
n
d
o
rf
,
“
En
v
iro
n
m
e
n
tal
a
n
d
Be
h
a
v
io
u
ra
l
De
ter
m
in
a
n
ts
o
f
L
e
p
to
sp
iro
sis
T
r
a
n
sm
is
sio
n
:
A
S
y
st
e
m
a
ti
c
Re
v
ie
w
,
”
PL
o
S
Ne
g
l.
T
ro
p
.
Dis.
,
v
o
l
.
9
,
n
o
.
9
,
p
p
.
1
-
1
5
,
2
0
1
5
,
d
o
i:
1
0
.
1
3
7
1
/
jo
u
rn
a
l.
p
n
t
d
.
0
0
0
3
8
4
3
.
[
2
0
]
G
.
L
.
M
u
rra
y
,
A
.
S
rik
ra
m
,
R.
He
n
ry
,
R.
A
.
Ha
rts
k
e
e
rl,
R.
W
.
S
e
r
m
s
w
a
n
,
a
n
d
B.
A
d
ler.
"
M
u
tatio
n
s
a
ff
e
c
ti
n
g
L
e
p
to
sp
ira
in
terro
g
a
n
s
li
p
o
p
o
ly
s
a
c
c
h
a
rid
e
a
tt
e
n
u
a
te
v
iru
len
c
e
,
"
M
o
l
M
icr
o
b
io
l.
,
v
o
l.
7
8
,
p
p
.
7
0
1
-
9
,
2
0
1
0
,
d
o
i
:
1
0
.
1
1
1
1
/
j.
1
3
6
5
-
2
9
5
8
.
2
0
1
0
.
0
7
3
6
0
.
x
[
2
1
]
E.
A.
J.
Co
o
k
,
W.
A.
De
G
lan
v
i
ll
e
,
L.
F.
T
h
o
m
a
s,
S
.
Ka
riu
k
i,
B.
M.
D.
C.
Bro
n
sv
o
o
rt
,
a
n
d
E.
M.
F
è
v
re
,
“
Risk
f
a
c
to
rs
f
o
r
lep
to
sp
iro
sis
se
ro
p
o
sit
i
v
it
y
in
sla
u
g
h
terh
o
u
se
w
o
rk
e
rs
in
w
e
ste
rn
Ke
n
y
a
,
”
Oc
c
u
p
.
En
v
iro
n
.
M
e
d
.
,
v
o
l.
7
4
,
n
o
.
5
,
p
p
.
3
5
7
-
3
6
5
,
2
0
1
7
,
d
o
i:
1
0
.
1
1
3
6
/
o
e
m
e
d
-
2016
-
1
0
3
8
9
5
.
[
2
2
]
P
.
Bro
w
n
,
M
.
M
c
Ke
n
z
ie,
M
.
P
in
n
o
c
k
,
a
n
d
D.
M
c
G
ro
w
d
e
r
,
“
En
v
iro
n
m
e
n
tal
risk
f
a
c
to
rs
a
ss
o
c
iate
d
w
it
h
lep
to
sp
i
ro
sis
a
m
o
n
g
b
u
tc
h
e
rs
a
n
d
th
e
ir
a
ss
o
c
iate
s
in
Ja
m
a
ica
,
”
In
t
J
Oc
c
u
p
En
v
.
M
e
d
,
v
o
l.
2
,
n
o
.
1
,
p
p
.
4
5
-
5
7
,
2
0
1
1
.
[
2
3
]
G.
M
a
n
ii
a
h
,
“
En
v
iro
n
m
e
n
tal
F
a
c
to
rs
re
late
d
t
o
L
e
p
to
sp
ir
o
sis
i
n
S
e
m
a
ra
n
g
c
it
y
In
d
o
n
e
sia
(In
I
n
d
o
n
e
sia
:
Fa
k
t
o
r
L
in
g
k
u
n
g
a
n
y
a
n
g
Ber
h
u
b
u
n
g
a
n
d
e
n
g
a
n
Ke
ja
d
i
a
n
L
e
p
t
o
sp
ir
o
sis
di
Ko
ta
S
e
ma
ra
n
g
)
,
”
J
.
Ke
se
h
a
t
.
M
a
sy
,
v
o
l.
4
,
n
o
.
3
,
p
p
.
7
2
9
-
7
9
8
,
2
0
1
6
.
[
2
4
]
W
id
o
y
o
n
o
,
T
ro
p
ica
l
Dise
a
se
:
Ep
i
d
e
mio
lo
g
y
,
T
ra
n
sm
issio
n
,
Pre
v
e
n
ti
o
n
a
n
d
Co
n
tr
o
l
(In
In
d
o
n
e
sia
:
Pen
y
a
k
it
T
ro
p
is
:
Ep
id
e
mi
o
lo
g
i
,
Pen
u
l
a
ra
n
,
Pe
n
c
e
g
a
h
a
n
d
a
n
Pem
b
e
ra
n
t
a
sa
n
n
y
a
)
.
Ja
k
a
rta:
Erl
a
n
g
g
a
P
u
b
li
sh
e
r,
2
0
1
1
.
[
2
5
]
R.
Ka
m
a
th
,
S.
S
w
a
in
,
S.
P
a
tt
a
n
s
h
e
tt
y
,
a
n
d
N.
S.
Na
ir,
“
S
tu
d
y
in
g
risk
fa
c
to
rs
a
ss
o
c
iate
d
w
it
h
h
u
m
a
n
lep
to
sp
iro
sis
,
”
J
.
Glo
b
.
In
fec
t.
Dis.
,
v
o
l
.
6
,
n
o
.
1
,
p
p
.
3
-
9
,
2
0
1
4
.
[
2
6
]
P.
P
h
ra
isu
w
a
n
et
a
l.
,
“
L
e
p
to
sp
iro
sis
:
S
k
in
w
o
u
n
d
s
a
n
d
c
o
n
tro
l
stra
teg
ies
,
T
h
a
il
a
n
d
,
1
9
9
9
,
”
Eme
rg
.
I
n
fec
t.
Dis
,
v
o
l
.
8
,
n
o
.
1
2
,
p
p
.
1
4
5
5
-
1
4
5
9
,
2
0
0
2
,
d
o
i:
1
0
.
3
2
0
1
/ei
d
0
8
1
2
.
0
2
0
1
8
0
.
[
2
7
]
S
.
M
.
A
la
v
i
S
M
,
M
.
M
.
Kh
o
s
h
k
h
o
.
"
S
e
ro
p
re
v
a
len
c
e
stu
d
y
o
f
lep
to
sp
ir
o
sis
a
m
o
n
g
rice
fa
r
m
e
rs
in
k
h
u
z
e
sta
n
p
ro
v
in
c
e
,
S
o
u
th
w
e
st I
ra
n
,
2
0
1
2
,
"
J
u
n
d
ish
a
p
u
r J M
icr
o
b
io
l.
,
v
o
l
.
7
,
n
o
.
7
,
2
0
1
4
,
d
o
i
:1
0
.
5
8
1
2
/j
jm
.
1
1
5
3
6
.
[
2
8
]
Ru
sm
in
i,
Da
n
g
e
r
of
L
e
p
to
sp
iro
sis
(
U
rin
e
Ra
t
Dise
a
se
)
and
T
h
e
Co
n
tr
o
l
/
Ba
h
a
y
a
Lep
to
sp
ir
o
sis
(
In
In
d
o
n
e
sia
:
Pen
y
a
k
it
Ke
n
c
in
g
T
iku
s d
a
n
Ca
ra
Pen
c
e
g
a
h
a
n
n
y
a
)
.
Y
o
g
y
a
k
a
rta:
Go
sy
e
n
P
u
b
l
ish
i
n
g
,
2
0
1
1
.
[
2
9
]
F
.
Ha
n
d
a
y
a
n
i,
“
Re
latio
n
s
h
ip
b
e
tw
e
e
n
Be
h
a
v
io
u
r
F
a
c
to
r
a
n
d
P
h
y
s
ica
l
En
v
iro
n
m
e
n
t
to
w
a
rd
s
L
e
p
to
s
p
iro
sis
I
n
c
id
e
n
c
e
(In
I
n
d
o
n
e
sia
:
Hu
b
u
n
g
a
n
a
n
t
a
ra
F
a
k
to
r
Per
il
a
k
u
d
a
n
L
in
g
k
u
n
g
a
n
Fi
sik
d
e
n
g
a
n
Ke
ja
d
ia
n
L
e
p
to
sp
ir
o
sis
di
Ka
b
u
p
a
ten
Kl
a
ten
,
”
T
h
e
sis,
Un
iv
e
rsitas
M
u
h
a
m
m
a
d
i
y
a
h
S
u
ra
k
a
rta
,
2
0
1
4
.
[
3
0
]
E.
L
.
M
a
h
y
u
n
i,
I.
Yu
sti
n
a
,
a
n
d
E.
S
u
d
a
ry
a
ti
,
“
S
a
f
e
t
y
T
a
lk
a
n
d
Ch
e
c
k
to
P
re
v
e
n
t
P
e
stici
d
e
T
o
x
icit
y
a
m
o
n
g
F
a
r
m
e
r,
”
In
t
e
rn
a
t
io
n
a
l
J
o
u
rn
a
l
Pu
b
li
c
He
a
l
th
S
c
i
e
n
c
e
.
,
v
o
l.
6
,
n
o
.
4
,
p
p
.
2
9
3
-
2
9
8
,
2
0
1
7
,
d
o
i:
1
0
.
1
1
5
9
1
/i
j
p
h
s.v
6
i4
.
9
1
1
3
.
Evaluation Warning : The document was created with Spire.PDF for Python.