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l J
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Vo
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5
,
No
.
4
,
Dec
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201
6
,
p
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3
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3
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1
I
SS
N:
2252
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8806
384
J
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JP
HS
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no
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Anti
m
i
crob
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Deb
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k
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Ethio
pia
Desa
leg
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m
a
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elellw
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a
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ellie
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De
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c
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Ba
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De
b
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p
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Art
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I
nfo
AB
ST
RAC
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A
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ticle
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to
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y:
R
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Sep
1
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2
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Irra
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th
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se
a
n
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sp
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a
d
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a
n
ti
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sista
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it
is
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g
lo
b
a
l
c
o
n
c
e
rn
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is
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f
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n
ti
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g
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l
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risis.
T
h
e
m
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ra
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ts
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im
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ial
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sista
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c
e
a
t
D
e
b
re
M
a
rk
o
s
U
n
iv
e
rsity
.
In
stit
u
ti
o
n
a
l
b
a
se
d
c
o
m
p
a
ra
ti
v
e
c
ro
ss
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se
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ti
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a
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su
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s
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o
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f
ro
m
Ju
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e
to
Ju
ly
w
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to
tal
sa
m
p
le
siz
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o
f
670.
P
a
rti
c
i
p
a
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ts
w
e
re
se
le
c
ted
u
sin
g
sim
p
le ran
d
o
m
sa
m
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m
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d
u
sin
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ra
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m
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tab
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tere
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th
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d
a
ta
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o
Ep
i
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a
ta
v
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3
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1
a
n
d
tran
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to
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in
d
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so
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.
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d
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ica
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w
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tere
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in
to
m
u
lt
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lo
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re
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ss
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e
c
u
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o
ff
p
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a
ti
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w
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-
v
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<
0
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0
5
.
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b
o
u
t
1
4
.
8
%
stu
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y
p
a
rti
c
ip
a
n
ts
h
a
d
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d
e
q
u
a
te
k
n
o
w
led
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e
to
w
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rd
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d
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g
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sista
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.
Ru
ra
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re
sid
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c
e
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o
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h
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p
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a
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iate
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sig
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m
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p
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ts
w
h
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h
a
d
p
o
siti
v
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a
tt
it
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d
e
w
e
re
p
o
siti
v
e
ly
a
s
so
c
iate
d
w
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se
lf
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m
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n
a
s
c
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m
p
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re
to
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w
h
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d
n
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g
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ti
v
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a
tt
it
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.
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h
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v
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ra
ll
k
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led
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f
p
a
rti
c
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ts
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g
a
rd
in
g
to
a
n
ti
m
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b
ial
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sista
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c
e
w
a
s
lo
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.
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th
e
o
t
h
e
r
h
a
n
d
,
m
a
jo
rit
y
o
f
p
a
rti
c
ip
a
n
ts
h
a
d
p
o
siti
v
e
a
tt
it
u
d
e
.
T
h
o
se
p
a
rti
c
ip
a
n
ts
w
h
o
h
a
d
p
o
siti
v
e
a
tt
it
u
d
e
w
e
re
sig
n
if
ic
a
n
tl
y
a
ss
o
c
i
a
ted
w
it
h
a
n
ti
m
icro
b
ial
re
sista
n
c
e
a
s co
m
p
a
re
d
to
w
h
o
h
a
d
n
e
g
a
ti
v
e
a
tt
it
u
d
e
.
K
ey
w
o
r
d
:
A
n
ti
m
icr
o
b
ia
l
A
tt
itu
d
e
D
r
u
g
r
esi
s
ta
n
ce
K
n
o
w
led
g
e
S
elf
-
m
ed
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n
Co
p
y
rig
h
t
©
2
0
1
6
In
stit
u
te o
f
A
d
v
a
n
c
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d
E
n
g
i
n
e
e
rin
g
a
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d
S
c
ien
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e
.
Al
l
rig
h
ts
re
se
rv
e
d
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Desaleg
n
e
Am
ar
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Z
e
lell
w
,
Dep
ar
t
m
en
t o
f
Nu
r
s
in
g
,
C
o
lleg
e
o
f
Me
d
ici
n
e
a
n
d
Hea
lth
Scie
n
ce
s
,
B
ah
ir
Dar
Un
iv
er
s
it
y
,
B
ah
ir
Dar
,
E
th
io
p
ia
.
E
m
ail:
d
esa2
0
0
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@
y
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o
.
co
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,
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ez
e
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w
@
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m
ai
l.c
o
m
1.
I
NT
RO
D
UCT
I
O
N
An
ti
m
icr
o
b
ial
r
esis
ta
n
ce
is
a
g
lo
b
al
co
n
ce
r
n
[
1
]
.
I
r
r
atio
n
al
u
s
e
o
f
m
ed
ici
n
es
i
s
a
k
e
y
r
ea
s
o
n
f
o
r
t
h
e
in
cr
ea
s
e
a
n
d
s
p
r
ea
d
o
f
an
ti
m
i
cr
o
b
ial
r
esis
tan
ce
[
2
-
5
]
.
Se
v
e
r
al
f
ac
to
r
s
e
n
h
a
n
ce
ir
r
atio
n
al
u
s
e
o
f
an
tib
io
tics
,
w
h
ic
h
co
u
ld
b
e
d
o
cto
r
s
’
k
n
o
wled
g
e
an
d
ex
p
er
i
e
n
ce
[
6
]
,
d
iag
n
o
s
tic
u
n
ce
r
tai
n
t
y
,
p
atien
t
s
'
e
x
p
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tatio
n
s
,
lack
o
f
p
atien
t
a
n
d
h
ea
lt
h
ca
r
e
p
r
o
f
ess
io
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al
s
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ed
u
ca
tio
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,
p
h
ar
m
a
ce
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tical
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ar
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g
,
a
n
tib
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tic
s
elli
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g
w
it
h
o
u
t
a
p
r
escr
ip
tio
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an
d
ec
o
n
o
m
ic
[
7
]
.
An
ti
m
icr
o
b
ial
d
r
u
g
r
esis
tan
ce
is
a
f
ast
m
o
u
n
ti
n
g
u
n
iv
er
s
al
cr
is
is
.
Ma
n
y
f
ac
to
r
s
lik
e
i
n
ap
p
r
o
p
r
iate
u
s
e
o
f
an
tib
io
tics
,
n
o
t
f
o
llo
w
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g
u
s
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f
a
n
tib
io
tics
b
y
p
r
escr
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p
h
y
s
icia
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,
u
n
r
eg
u
lated
s
al
e
o
f
m
ed
icin
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s
an
d
s
elf
-
m
ed
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ac
cr
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ited
to
th
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ad
v
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m
e
n
t o
f
r
es
is
ta
n
ce
t
o
s
ev
er
al
an
ti
m
icr
o
b
ials
[
8
-
9
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
P
HS
I
SS
N:
2252
-
8806
K
n
o
w
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a
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d
A
ttit
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.
.
.
.
(
Desa
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A
ma
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Zelellw
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385
L
ac
k
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r
ig
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an
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f
m
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b
i
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lo
g
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tib
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ac
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itted
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h
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led
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v
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tib
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o
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[
1
0
-
1
1
]
.
Fro
m
th
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ab
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v
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f
ac
to
r
s
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f
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d
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f
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k
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liter
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s
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m
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w
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a
n
ti
m
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d
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h
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d
ev
elo
p
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w
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ld
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m
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Sev
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tr
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d
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[
1
2
-
1
3
]
.
An
tib
io
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d
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i
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as
th
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ab
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f
a
m
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s
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d
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ex
p
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to
an
ti
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r
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t
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s
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cc
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f
u
l
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.
An
tib
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r
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ta
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is
a
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p
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b
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s
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t
h
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lo
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l,
n
atio
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al
a
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d
g
lo
b
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lev
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s
.
C
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y
,
a
n
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o
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ta
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ce
is
a
co
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ce
r
n
as
it
is
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o
lo
n
g
er
a
p
r
ed
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r
o
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m
ai
n
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n
i
n
g
h
ea
l
th
w
it
h
in
p
o
p
u
latio
n
s
b
u
t
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in
cr
ea
s
i
n
g
t
h
r
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t
to
f
u
tu
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e
o
f
h
ea
lt
h
as a
n
tib
io
tic
s
ar
e
b
ein
g
m
is
u
s
ed
[
1
4
-
1
8
]
.
T
h
e
m
ai
n
ai
m
o
f
t
h
is
s
t
u
d
y
w
as
t
o
ass
ess
t
h
e
le
v
el
o
f
k
n
o
w
led
g
e
an
d
attit
u
d
e
o
f
p
ar
ticip
an
ts
to
w
ar
d
s
an
ti
m
icr
o
b
ial
r
esis
tan
ce
.
2.
M
E
T
H
O
DS A
ND
M
AT
E
RI
AL
S
2
.
1
.
Study
Set
t
i
ng
a
nd
Desig
n
T
h
e
s
tu
d
y
w
a
s
d
o
n
e
at
Deb
r
e
Ma
r
k
o
s
Un
iv
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s
it
y
f
r
o
m
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u
n
e
to
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u
l
y
2
0
1
5
.
I
t
is
2
9
9
k
m
f
a
r
f
r
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m
t
h
e
ca
p
ital
cit
y
o
f
E
th
io
p
ia,
A
d
d
is
A
b
ab
a.
A
l
l
Deb
r
e
Ma
r
k
o
s
Un
i
v
er
s
it
y
e
x
ten
s
io
n
s
t
u
d
en
ts
’
w
h
o
f
u
lf
i
ll
t
h
e
in
cl
u
s
io
n
cr
iter
ia
w
er
e
th
e
s
tu
d
y
p
o
p
u
latio
n
.
I
n
s
tit
u
tio
n
a
l
b
ased
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m
p
ar
ativ
e
cr
o
s
s
-
s
e
ctio
n
al
s
u
r
v
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y
w
a
s
co
n
d
u
cted
.
2
.
2
.
I
nclu
s
io
n a
nd
E
x
cl
ud
ed
Cr
it
er
ia
A
ll
n
o
n
-
h
ea
lth
s
cien
ce
a
n
d
h
ea
lth
s
cie
n
ce
s
t
u
d
en
t
s
w
h
o
w
er
e
r
eg
is
ter
ed
in
th
e
u
n
i
v
er
s
it
y
p
r
o
g
r
am
a
s
ex
ten
s
io
n
s
t
u
d
en
t
s
w
er
e
i
n
cl
u
d
ed
in
t
h
e
s
tu
d
y
.
Hea
lt
h
s
cien
ce
s
tu
d
e
n
ts
w
er
e
s
elec
te
d
at
least
ta
k
i
n
g
p
h
ar
m
ac
o
lo
g
y
co
u
r
s
e.
T
h
o
s
e
s
tu
d
en
t
s
w
h
o
d
is
m
i
s
s
ed
,
w
it
h
d
r
a
w
,
a
n
d
d
r
o
p
o
u
t
w
er
e
ex
cl
u
d
e
d
f
r
o
m
th
i
s
s
t
u
d
y
.
2
.
3
.
Sa
m
ple
Size
Det
er
m
i
na
t
io
n
a
nd
Sa
m
pli
ng
T
ec
hn
iqu
e
T
h
e
s
a
m
p
le
s
ize
w
as
ca
lcu
lat
ed
u
s
i
n
g
t
h
e
a
s
s
u
m
p
t
io
n
o
f
9
5
%
co
n
f
id
en
ce
in
ter
v
al,
8
0
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p
o
w
er
w
it
h
o
n
e
to
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n
e
r
atio
o
f
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ed
ical
a
n
d
n
o
n
-
m
ed
ical
s
t
u
d
en
t
s
u
s
i
n
g
t
h
e
r
esp
ec
ti
v
e
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r
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p
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tio
n
o
f
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2
.
5
%
an
d
6
1
.
5
%
f
r
o
m
p
r
ev
io
u
s
s
tu
d
y
[
1
9
]
E
p
i
I
n
f
o
v
er
s
io
n
3
.
5
.
1
w
as
u
s
ed
to
ca
lcu
late
th
e
r
eq
u
ir
ed
s
a
m
p
le
s
ize
u
s
i
n
g
t
h
e
f
o
llo
w
in
g
f
o
r
m
u
la
[
2
0
]
.
I
n
clu
d
i
n
g
1
0
%,
n
o
n
e
r
esp
o
n
s
e
r
ate
t
h
e
f
i
n
al
s
a
m
p
le
w
as
6
7
0
.
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h
e
lis
t
o
f
s
t
u
d
en
t
s
w
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s
ta
k
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n
f
r
o
m
th
e
u
n
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v
er
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t
y
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is
tr
ar
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d
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h
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s
a
m
p
lin
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f
r
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m
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f
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r
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ed
ical
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d
n
o
n
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m
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s
tu
d
e
n
ts
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er
e
p
r
ep
ar
ed
f
r
o
m
th
eir
lis
t.
Selectio
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o
f
p
ar
ticip
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t
s
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r
r
ied
o
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t b
y
ap
p
l
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n
g
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m
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le
r
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n
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o
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s
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m
p
l
in
g
m
et
h
o
d
u
s
in
g
r
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n
d
o
m
tab
le.
I
n
o
r
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er
to
g
et
s
elec
t p
ar
ticip
a
n
ts
,
th
e
lear
n
i
n
g
clas
s
r
o
o
m
n
u
m
b
e
r
w
as id
e
n
ti
f
ied
f
r
o
m
ea
c
h
d
ep
ar
t
m
en
t.
2
.
4
.
Da
t
a
Co
llect
io
n
To
o
ls
T
h
e
d
ata
w
er
e
co
llected
u
s
i
n
g
s
e
lf
-
ad
m
in
i
s
ter
ed
q
u
esti
o
n
n
air
e.
Fo
u
r
d
ip
lo
m
a
an
d
t
w
o
-
b
ac
h
elo
r
d
eg
r
ee
g
r
ad
u
ated
n
u
r
s
es
w
er
e
d
ata
co
llecto
r
s
an
d
s
u
p
er
v
is
o
r
s
,
r
esp
ec
tiv
el
y
.
2
.
5
.
Da
t
a
Q
ua
lity
Co
ntr
o
l
A
p
r
e
-
te
s
ted
an
d
s
tan
d
ar
d
ized
q
u
esti
o
n
n
air
e
w
as
u
s
ed
.
I
t
w
a
s
ad
ap
ted
an
d
m
o
d
if
ied
i
n
to
lo
ca
l
co
n
tex
t.
T
r
ain
in
g
w
as
g
iv
e
n
f
o
r
b
o
th
d
ata
co
llecto
r
s
an
d
s
u
p
er
v
i
s
o
r
s
.
Dail
y
s
u
p
er
v
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s
io
n
w
as
ca
r
r
ied
o
u
t
d
u
r
in
g
d
ata
co
llectio
n
p
er
io
d
.
T
h
en
,
d
ata
clea
n
in
g
w
as
d
o
n
e
u
s
in
g
f
r
eq
u
en
c
y
,
lis
ti
n
g
,
s
o
r
tin
g
an
d
to
id
en
tify
o
u
tlier
s
an
d
a
n
y
m
i
s
s
ed
v
al
u
es
.
2
.
6
.
Da
t
a
P
ro
ce
s
s
ing
a
nd
Ana
ly
s
is
Data
cler
k
d
o
u
b
le
en
ter
ed
t
h
e
d
ata
in
to
E
p
i
d
ata
v
er
s
io
n
3
.
1
an
d
tr
an
s
f
er
r
ed
to
SP
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v
er
s
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n
2
1
.
0
.
T
h
e
d
escr
ip
tiv
e
o
u
tp
u
t
o
f
t
h
e
s
tu
d
y
w
as
p
r
ese
n
ted
o
n
t
h
e
tab
les.
T
h
e
ass
o
ciatio
n
b
et
wee
n
d
ep
en
d
en
t
a
n
d
in
d
ep
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d
en
t
v
ar
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le
s
w
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s
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a
m
i
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ed
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in
ar
y
a
n
d
m
u
lt
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g
r
ess
io
n
s
.
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h
o
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ar
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w
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k
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t.
3.
RE
SU
L
T
S
3
.
1
.
P
a
rt
icipa
nts’
Cha
ra
ct
er
is
t
ics
:
Fiv
e
h
u
n
d
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ed
s
ix
t
y
o
n
e
p
ar
ticip
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ts
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e
p
ar
ticip
ated
in
t
h
e
s
tu
d
y
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Half
o
f
t
h
e
282
(
5
0
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3
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f
th
e
m
w
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lth
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ity
(
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ab
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1
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T
ab
le
1
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o
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ac
ter
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t
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mal
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3
3
6
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2
2
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c
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t
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t
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9
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s
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t
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≤ 2
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.
2
.
P
a
rt
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nts’
B
eha
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r
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o
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Use A
ntib
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t
ics
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o
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t
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3
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f
p
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ts
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s
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t
ib
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tics
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er
th
a
n
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r
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u
r
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n
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j
o
r
ity
,
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9
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f
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ticip
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ts
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ir
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at
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ed
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e
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e
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g
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d
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s
ed
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u
r
h
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n
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r
ed
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ev
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n
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er
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n
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l
ted
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I
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DIS
CU
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T
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[
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4
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a
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d
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in
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ts
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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N:
2252
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8806
K
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timicr
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.
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.
(
Desa
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389
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an
tib
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[
2
5
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Mo
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in
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[
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d
e
v
el
o
p
m
e
n
t
o
f
b
ac
ter
ial
r
esis
ta
n
ce
[
3
9
]
.
5.
CO
NCLU
SI
O
N
T
h
e
o
v
er
all
k
n
o
w
led
g
e
o
f
p
ar
ticip
an
ts
r
eg
ar
d
i
n
g
to
an
ti
m
ic
r
o
b
ial
r
esis
tan
ce
w
a
s
i
n
ad
eq
u
ate.
I
n
th
e
o
th
er
h
a
n
d
,
m
aj
o
r
it
y
o
f
p
ar
ticip
an
ts
h
ad
p
o
s
iti
v
e
attit
u
d
e.
T
h
o
s
e
p
ar
ticip
an
t
s
w
h
o
h
ad
p
o
s
iti
v
e
attit
u
d
e
w
er
e
s
ig
n
i
f
ica
n
tl
y
as
s
o
ciate
d
w
ith
an
ti
m
icr
o
b
ial
r
esis
ta
n
ce
a
s
co
m
p
ar
ed
to
w
h
o
h
ad
n
e
g
at
iv
e
attit
u
d
e.
R
u
r
al
r
esid
en
ce
s
o
f
th
e
p
ar
tici
p
an
t
s
w
er
e
s
i
g
n
i
f
ica
n
tl
y
a
s
s
o
ciat
ed
w
i
th
d
r
u
g
r
esi
s
ta
n
ce
as
co
m
p
ar
ed
to
u
r
b
an
r
esid
en
ce
.
P
ar
ticip
an
ts
w
h
o
h
ad
ad
eq
u
ate
k
n
o
w
led
g
e
w
er
e
p
r
o
tectiv
e
f
o
r
s
elf
-
m
ed
icat
io
n
an
d
d
r
u
g
r
esis
ta
n
ce
as c
o
m
p
ar
e
to
th
o
s
e
w
h
o
h
ad
i
n
ad
eq
u
ate
k
n
o
w
led
g
e.
CO
M
P
E
T
I
NG
I
NT
E
R
E
S
T
A
ll
a
u
t
h
o
r
s
h
av
e
co
n
f
ir
m
e
d
th
at
th
e
y
h
av
e
n
o
co
m
p
etin
g
i
n
ter
est.
W
e
h
av
e
n
o
r
ec
eiv
ed
r
ei
m
b
u
r
s
e
m
e
n
ts
,
f
ee
s
,
f
u
n
d
in
g
,
o
r
s
alar
y
,
s
h
ar
e,
g
ai
n
o
r
lo
s
e
f
r
o
m
an
o
r
g
a
n
izatio
n
th
a
t
m
a
y
in
a
n
y
w
a
y
g
ai
n
o
r
lo
s
e
f
in
an
cial
l
y
f
r
o
m
th
e
p
u
b
licatio
n
o
f
t
h
is
m
an
u
s
cr
ip
t,
eith
er
in
th
e
p
ast
f
i
v
e,
n
o
w
o
r
in
th
e
f
u
t
u
r
e.
I
n
ad
d
itio
n
,
th
er
e
i
s
n
o
f
i
n
a
n
cial
an
d
n
o
n
-
f
i
n
a
n
cial
co
m
p
e
tin
g
in
ter
es
t
i
n
r
elatio
n
to
th
is
p
a
p
er
.
C
u
r
r
en
tl
y
,
a
n
y
co
n
ten
t
o
f
th
i
s
m
a
n
u
s
cr
ip
t
d
o
n
o
t
ap
p
l
y
i
n
g
f
o
r
an
y
p
ate
n
ts
.
I
n
f
o
r
m
ed
co
n
s
en
t
w
as
o
b
tain
ed
f
r
o
m
ea
c
h
p
ar
ticip
an
t to
p
ar
ticip
ate
in
th
i
s
s
t
u
d
y
an
d
t
h
e
in
f
o
r
m
ed
co
n
s
en
t o
b
tain
ed
f
r
o
m
ea
c
h
s
u
b
j
ec
t f
o
r
p
u
b
licatio
n
.
ACK
NO
WL
E
D
G
E
M
E
NT
W
e
ar
e
g
r
atef
u
l
t
h
an
k
s
to
Deb
r
e
Ma
r
k
o
s
Un
iv
er
s
it
y
f
o
r
tec
h
n
ical
a
n
d
f
i
n
a
n
cial
s
u
p
p
o
r
t.
Ou
r
d
ee
p
est
g
r
atit
u
d
e
g
o
es to
th
a
n
k
s
f
o
r
t
h
e
d
ata
co
llecto
r
s
an
d
s
tu
d
y
p
ar
ticip
an
ts
.
RE
F
E
R
E
NC
E
S
[1
]
D.
M
.
S
h
lae
s,
e
t
a
l.
,
―
S
HEA
p
o
siti
o
n
p
a
p
e
r:
S
o
c
iety
f
o
r
h
e
a
lt
h
c
a
re
e
p
id
e
m
io
lo
g
y
o
f
Am
e
rica
a
n
d
in
f
e
c
ti
o
u
s
d
ise
a
se
s
so
c
iet
y
o
f
Am
e
rica
jo
in
t
c
o
m
m
it
tee
o
n
th
e
p
re
v
e
n
ti
o
n
o
f
a
n
ti
m
icro
b
ial
re
sista
n
c
e
:
G
u
id
e
li
n
e
s
f
o
r
th
e
p
re
v
e
n
ti
o
n
o
f
a
n
ti
m
icro
b
ial
re
sis
tan
c
e
in
h
o
s
p
it
a
ls,
‖
In
fec
t.
Co
n
tr
o
l
Ho
s
p
.
E
p
id
e
mi
o
l
,
v
o
l
.
1
8
,
p
p
.
2
7
5
-
9
1
,
1
9
9
7
.
[2
]
I.
C.
Gy
ss
e
n
s,
―
Qu
a
li
t
y
m
e
a
su
re
s o
f
a
n
ti
m
icro
b
ial
d
ru
g
u
se
,
‖
I
n
t.
J
.
An
ti
mic
ro
b
.
A
g
e
n
ts
,
v
o
l.
1
7
,
p
p
.
9
-
1
9
,
2
0
0
1
.
[3
]
P.
No
r
d
b
e
rg
,
e
t
a
l.
,
―
A
n
ti
b
a
c
teria
l
Dru
g
Re
sista
n
c
e
.
Ba
c
k
g
ro
u
n
d
d
o
c
u
m
e
n
t
P
rio
r
it
y
M
e
d
icin
e
s
f
o
r
Eu
ro
p
e
a
n
d
th
e
W
o
rld
.
A
P
u
b
l
ic He
a
lt
h
A
p
p
ro
a
c
h
to
In
n
o
v
a
ti
o
n
,
‖
W
HO
,
G
e
n
e
v
a
,
2
0
0
4
.
[4
]
A
.
S
rin
iv
a
sa
n
,
e
t
a
l.
,
―
A
su
rv
e
y
o
f
k
n
o
w
led
g
e
,
a
tt
it
u
d
e
s,
a
n
d
b
e
li
e
f
s
o
f
h
o
u
se
sta
ff
p
h
y
sic
ian
s
f
ro
m
v
a
rio
u
s
sp
e
c
ialti
e
s co
n
c
e
rn
in
g
a
n
ti
m
icro
b
ial
u
se
a
n
d
re
sista
n
c
e
,
‖
Arc
h
.
In
t
.
M
e
d
,
v
o
l.
1
6
4
,
p
p
.
1
4
5
1
-
1
4
5
6
,
2
0
0
4
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8806
I
J
P
HS
Vo
l.
5
,
No
.
4
,
Dec
em
b
er
2
0
1
6
:
384
–
3
9
1
390
[5
]
D.
J.
M
o
rg
a
n
,
e
t
a
l.
,
―
No
n
-
p
re
sc
rip
ti
o
n
a
n
ti
m
icro
b
ial
u
se
w
o
rld
w
i
d
e
:
a
s
y
ste
m
a
ti
c
re
v
ie
w
,
‖
L
a
n
c
e
t
In
fec
t
Dis
,
v
o
l.
1
1
,
p
p
.
6
9
2
-
7
0
1
,
2
0
1
1
.
[6
]
S
.
Ce
ti
n
k
a
y
a
,
e
t
a
l.
,
―
Kn
o
w
led
g
e
a
n
d
b
e
h
a
v
io
r
o
f
th
e
p
e
d
iatricia
n
s
o
n
ra
ti
o
n
a
l
u
se
o
f
a
n
ti
b
i
o
ti
c
s,‖
Af
r.
J
.
Ph
a
rm
.
Ph
a
ra
c
o
l
, v
o
l.
4
,
p
p
.
7
8
3
-
7
9
,
2
0
1
0
.
[7
]
Orto
n
P
.
,
―
P
re
ss
u
re
t
o
p
re
sc
rib
e
,‖
i
n
S
o
u
ls
b
y
S
wa
f
f
h
a
m
P
W
R,
―
A
n
ti
m
icro
b
ial
Re
sista
n
c
e
,
‖
p
p
.
1
3
9
-
1
4
3
,
2
0
0
1.
[8
]
R.
T
.
V
a
rg
h
e
se
a
n
d
R.
Da
s,
―
A
n
ti
m
icro
b
ial
d
ru
g
re
sista
n
c
e
in
In
d
ia,
P
o
ss
ib
le
c
a
u
se
s,‖
Asia
n
S
tu
d
M
e
d
,
v
ol
.
1
,
p
p
.
151
-
5
4
,
2
0
1
0
.
[9
]
N.
A
.
A
le
y
k
u
tt
y
,
e
t
a
l.
,
―
Ef
fe
c
t
o
f
re
g
u
latio
n
s
o
n
t
h
e
a
p
p
r
o
p
riate
u
se
o
f
a
n
ti
b
io
ti
c
s,‖
In
t
J
Ph
a
rm
a
Bi
o
S
c
i
,
v
o
l.
2
,
p
p
.
3
2
-
3
5
,
2
0
1
1
.
[1
0
]
G
lo
b
a
l
A
n
ti
b
io
ti
c
Re
sista
n
c
e
P
a
rt
n
e
rsh
ip
-
I
n
d
ia
(G
A
RP
-
In
d
ia),
―
S
it
u
a
ti
o
n
a
n
a
ly
sis
-
A
n
ti
b
io
ti
c
Us
e
a
n
d
Re
sista
n
c
e
in
In
d
ia,‖
G
lo
b
a
l
A
n
ti
b
io
ti
c
Re
sista
n
c
e
P
a
rt
n
e
rsh
i
p
-
In
d
ia Na
ti
o
n
a
l
W
o
rk
in
g
G
ro
u
p
,
p
p
.
9
-
1
2
,
2
0
1
1
-
2
0
1
3
.
[1
1
]
J.
K.
T
h
o
m
a
s,
e
t
a
l
.
,
―
P
h
a
rm
a
c
o
d
y
n
a
m
ic
e
v
a
lu
a
ti
o
n
o
f
f
a
c
to
rs
a
ss
o
c
iate
d
w
it
h
th
e
d
e
v
e
lo
p
m
e
n
t
o
f
b
a
c
teria
l
re
sista
n
c
e
in
a
c
u
tely
il
l
p
a
ti
e
n
ts
d
u
rin
g
t
h
e
ra
p
y
,
‖
An
ti
mic
ro
b
A
g
e
n
t
s Ch
e
mo
th
e
r
,
v
o
l
.
4
2
,
p
p
.
5
2
1
,
1
9
9
8
.
[1
2
]
P
.
B.
R
ich
m
a
n
,
e
t
a
l.
,
―
Ora
l
a
n
ti
b
io
ti
c
u
se
w
it
h
o
u
t
c
o
n
su
lt
in
g
a
p
h
y
sic
ian
:
a
su
rv
e
y
o
f
ED
p
a
ti
e
n
ts,
‖
Am
J
Eme
r
g
M
e
d
,
v
o
l.
1
9
,
p
p
.
5
7
-
6
0
,
2
0
0
1
.
[1
3
]
E.
J.
V
a
n
d
e
n
,
e
t
a
l
.,
―
Co
n
su
m
e
r
a
tt
it
u
d
e
s
a
n
d
u
se
o
f
a
n
ti
m
i
c
ro
b
ial
d
ru
g
s,‖
Eme
rg
In
fec
t
Dis
,
v
o
l.
9
,
p
p
.
1
1
2
8
-
3
5
,
2
0
0
3
.
[1
4
]
W
o
rld
He
a
lt
h
Org
a
n
iza
ti
o
n
(
W
HO
),
―
T
h
e
a
n
ti
m
icro
b
ial
re
s
istan
c
e
:
g
lo
b
a
l
re
p
o
rt
o
n
su
rv
e
il
lan
c
e
,
‖
2
0
1
4
.
h
tt
p
:
//
ww
w
.
w
h
o
.
in
t
/d
r
u
g
re
sista
n
c
e
/d
o
c
u
m
e
n
ts/su
rv
e
il
lan
c
e
re
p
o
rt/
e
n
/.
[1
5
]
W
o
rld
He
a
lt
h
Org
a
n
iza
ti
o
n
(W
HO
),
―
T
h
e
e
v
o
lv
in
g
th
re
a
t
o
f
a
n
ti
m
icro
b
ial
re
sista
n
c
e
o
p
ti
o
n
s
f
o
r
a
c
ti
o
n
,
‖
2
0
1
2
.
h
tt
p
:
//
ww
w
.
w
h
o
.
in
t
/p
a
ti
e
n
tsa
f
e
t
y
/
im
p
le
m
e
n
tatio
n
/am
r/p
u
b
li
c
a
ti
o
n
/
e
n
/.
ERS
S
IS
BN
-
Nu
m
b
e
r:
9
0
-
6
9
6
0
-
1
3
1
-
1.
[1
6
]
―
T
h
e
Eu
ro
p
e
a
n
a
n
ti
m
icro
b
ial
re
sista
n
c
e
su
rv
e
il
lan
c
e
sy
ste
m
(E
A
RS
S
)
a
n
n
u
a
l
re
p
o
rt,
‖
2
0
0
4
.
h
tt
p
:
//
ww
w
.
e
c
d
c
.
e
u
ro
p
a
.
e
u
/en
/ac
t
iv
it
ies
/su
rv
e
il
lan
c
e
/E
A
RS
N
e
t/
Do
c
u
m
e
n
ts/2
0
0
4
_
EA
RS
S
_
A
n
n
u
a
l_
Re
p
o
rt
.
[1
7
]
W
o
rld
He
a
lt
h
Org
a
n
iza
ti
o
n
(W
HO
),
―
A
n
ti
b
io
ti
c
re
sista
n
c
e
,
‖
h
tt
p
:/
/w
ww
.
e
u
ro
.
w
h
o
.
in
t/
e
n
/w
h
a
t
-
we
-
d
o
/h
e
a
lt
h
-
to
p
ics
/d
ise
a
se
-
p
re
v
e
n
ti
o
n
/an
ti
b
i
o
t
ic
-
re
sista
n
c
e
.
[1
8
]
P.
No
r
d
b
e
rg
,
e
t
a
l.
,
―
A
n
ti
b
a
c
teria
l
re
sista
n
c
e
.
Ba
c
k
g
ro
u
n
d
d
o
c
u
m
e
n
t
f
o
r
th
e
W
HO
p
ro
jec
t:
p
ri
o
rit
y
m
e
d
icin
e
s
f
o
r
Eu
ro
p
e
a
n
d
th
e
W
o
rl
d
—
a
p
u
b
li
c
h
e
a
lt
h
a
p
p
ro
a
c
h
to
i
n
n
o
v
a
ti
o
n
,
‖
Ge
n
e
v
a
,
W
H
O,
2
0
0
4
.
[1
9
]
A
.
R.
G
h
a
d
e
e
r,
e
t
a
l.
,
―
A
c
ro
ss
-
s
e
c
ti
o
n
a
l
stu
d
y
o
n
k
n
o
w
led
g
e
,
a
tt
it
u
d
e
a
n
d
b
e
h
a
v
io
r
re
late
d
t
o
a
n
t
ib
io
t
ic
u
se
a
n
d
re
sista
n
c
e
a
m
o
n
g
m
e
d
ica
l
a
n
d
n
o
n
-
m
e
d
ica
l
u
n
iv
e
rsit
y
stu
d
e
n
ts
in
Jo
rd
a
n
,
‖
Af
ric
a
n
J
o
u
rn
a
l
o
f
Ph
a
rm
a
c
y
a
n
d
Ph
a
rm
a
c
o
lo
g
y
,
v
o
l
/i
ss
u
e
:
6
(
10
)
,
p
p
.
7
6
3
-
7
7
0
,
2
0
1
2
.
[2
0
]
V
.
Ka
siu
lev
ičiu
s,
e
t
a
l.
,
―
S
a
m
p
le
siz
e
c
a
lcu
latio
n
i
n
e
p
id
e
m
io
lo
g
ica
l
stu
d
ies
,
‖
Ge
ro
n
t
o
lo
g
ij
a
,
v
o
l
/i
ss
u
e
:
7
(
4
)
,
p
p
.
225
–
2
3
1
,
2
0
0
6
.
[2
1
]
K.
Ke
tev
a
n
,
e
t
a
l.
,
―
A
n
ti
b
io
ti
c
u
se
a
n
d
re
sista
n
c
e
:
a
c
ro
ss
-
se
c
ti
o
n
a
l
stu
d
y
e
x
p
lo
rin
g
k
n
o
w
led
g
e
a
n
d
a
tt
it
u
d
e
s
a
m
o
n
g
sc
h
o
o
l
a
n
d
in
stit
u
ti
o
n
p
e
rs
o
n
n
e
l
in
T
b
il
isi,
Re
p
u
b
l
ic o
f
G
e
o
r
g
ia,‖
BM
C
Res
No
tes
,
v
o
l.
8
,
p
p
.
4
9
5
,
2
0
1
5
.
[2
2
]
―
V
a
li
d
a
ti
o
n
o
f
th
e
p
a
re
n
tal
k
n
o
w
led
g
e
a
n
d
a
tt
it
u
d
e
t
o
w
a
rd
s
a
n
ti
b
io
t
ic
u
sa
g
e
a
n
d
re
sista
n
c
e
a
m
o
n
g
c
h
il
d
re
n
i
n
T
e
to
v
o
,
th
e
Re
p
u
b
li
c
o
f
M
a
c
e
d
o
n
ia E
d
it
a
A
L
I
L
I
-
IDRIZI,
M
e
rit
a
DA
U
T
I,
Led
jan
M
A
LAJ,‖ 2
0
1
4
.
[2
3
]
M
.
M
.
A
z
e
v
e
d
o
,
e
t
a
l.
,
―
P
o
rt
u
g
u
e
se
stu
d
e
n
ts’
k
n
o
w
led
g
e
o
f
a
n
ti
b
io
ti
c
s:
a
c
ro
ss
-
se
c
ti
o
n
a
l
stu
d
y
o
f
s
e
c
o
n
d
a
ry
sc
h
o
o
l
a
n
d
u
n
iv
e
rsity
stu
d
e
n
ts
in
Bra
g
a
,
‖
BM
C
Pu
b
li
c
He
a
lt
h
,
v
o
l.
9
,
p
p
.
3
5
9
,
2
0
0
9
.
[2
4
]
M.
V
a
ll
i
n
,
e
t
a
l.
,
―
Kn
o
w
led
g
e
a
n
d
A
tt
it
u
d
e
s
to
w
a
rd
s
A
n
ti
b
io
ti
c
Us
e
a
n
d
Re
sista
n
c
e
-
A
L
a
ten
t
Cla
ss
A
n
a
l
y
sis
o
f
a
S
w
e
d
ish
P
o
p
u
lati
o
n
-
Ba
se
d
S
a
m
p
le,‖
PL
o
S
ONE
,
v
o
l
/
issu
e
:
11
(
4
)
,
2
0
1
6
.
[2
5
]
A
.
K.
A
.
Kh
a
n
,
e
t
a
l.
,
―
A
n
ti
b
io
ti
c
Re
sista
n
c
e
a
n
d
Us
a
g
e
-
A
S
u
rv
e
y
o
n
t
h
e
Kn
o
w
led
g
e
,
A
tt
it
u
d
e
,
P
e
rc
e
p
ti
o
n
s
a
n
d
P
ra
c
ti
c
e
s
a
m
o
n
g
th
e
M
e
d
ica
l
S
t
u
d
e
n
ts
o
f
a
S
o
u
t
h
e
rn
I
n
d
ia
n
T
e
a
c
h
in
g
Ho
sp
it
a
l,
‖
J
o
u
rn
a
l
o
f
Cl
in
ic
a
l
a
n
d
Dia
g
n
o
stic
Res
e
a
rc
h
,
v
o
l
/i
ss
u
e
:
7
(
8
)
,
p
p
.
1
6
1
3
-
1
6
1
6
,
2
0
1
3
.
[2
6
]
A
.
B
a
y
e
h
,
e
t
a
l.
,
―
Kn
o
w
led
g
e
a
n
d
b
e
li
e
f
s
o
n
a
n
ti
m
icro
b
ial
re
sista
n
c
e
a
m
o
n
g
p
h
y
sic
ian
s
a
n
d
n
u
rse
s
in
h
o
sp
i
tals
in
Am
h
a
r
a
Re
g
io
n
,
Et
h
i
o
p
ia
,‖
BM
C
Ph
a
rm
a
c
o
lo
g
y
a
n
d
T
o
x
ico
lo
g
y
,
v
o
l.
15
,
p
p
.
26
,
2
0
1
5
.
h
tt
p
:
//
ww
w
.
b
io
m
e
d
c
e
n
tral.
c
o
m
/2
0
5
0
-
6
5
1
1
/1
5
/2
6
.
[2
7
]
B.
L
.
S
tu
a
rt
a
n
d
M
.
Bo
n
n
ie,
―
A
n
ti
b
a
c
teria
l
re
sista
n
c
e
w
o
rld
w
id
e
:
c
a
u
se
s,
c
h
a
ll
e
n
g
e
s
a
n
d
re
sp
o
n
se
s,‖
Na
t
u
re
me
d
icin
e
su
p
p
lem
e
n
t
,
v
o
l
/i
ss
u
e
:
10
(
12
)
,
2
0
0
4
.
h
tt
p
:/
/w
ww
.
n
a
tu
re
.
c
o
m
/n
a
tu
re
m
e
d
icin
e
.
[2
8
]
N.
P
a
u
l
in
e
,
e
t
a
l.
,
―
P
u
b
li
c
Be
li
e
fs
a
b
o
u
t
A
n
ti
b
io
t
ics
,
In
f
e
c
ti
o
n
a
n
d
Re
sista
n
c
e
:
A
Qu
a
li
tativ
e
S
tu
d
y
,‖
An
ti
b
io
t
ics
,
v
o
l.
2
,
p
p
.
4
6
5
-
4
7
6
,
2
0
1
3
.
w
ww
.
m
d
p
i.
c
o
m
/j
o
u
rn
a
l/
a
n
ti
b
io
ti
c
s
.
[2
9
]
V
.
E.
Jo
d
i,
e
t
a
l.
,
―
Co
n
su
m
e
r
A
tt
it
u
d
e
s an
d
Us
e
o
f
A
n
ti
b
io
ti
c
s E
m
e
rg
in
g
In
f
e
c
ti
o
u
s Dise
a
se
s,‖
v
o
l
/i
ss
u
e
:
9
(
9
)
,
2
0
0
3
.
[3
0
]
H.
Ja
m
e
s,
e
t
a
l.
,
―
Ev
a
lu
a
ti
o
n
o
f
th
e
k
n
o
w
led
g
e
,
a
t
ti
tu
d
e
a
n
d
p
ra
c
t
ice
o
f
se
lf
-
m
e
d
ica
ti
o
n
a
m
o
n
g
f
irs
t
-
y
e
a
r
m
e
d
ica
l
stu
d
e
n
ts,
‖
M
e
d
.
Prin
c
.
Pra
c
t
,
v
o
l
.
1
5
,
p
p
.
2
7
0
-
2
7
5
,
2
0
0
6
.
[3
1
]
A
.
B.
Njo
o
d
,
e
t
a
l.
,
―
T
h
e
a
ss
e
ss
m
e
n
t
o
f
k
n
o
w
l
e
d
g
e
,
a
tt
it
u
d
e
a
n
d
p
ra
c
ti
c
e
o
f
a
n
ti
b
io
ti
c
s
u
sa
g
e
a
m
o
n
g
sa
u
d
i
f
e
m
a
l
e
stu
d
e
n
ts
in
p
r
in
c
e
ss
n
o
u
ra
h
u
n
iv
e
rsity
,
‖
In
ter
n
a
ti
o
n
a
l
J
o
u
rn
a
l
o
f
He
a
lt
h
a
n
d
L
if
e
S
c
ien
c
e
s
,
v
o
l
/i
ss
u
e
:
2
(
1
)
,
p
p
.
2
4
-
4
0
,
2
0
1
6
.
[3
2
]
W
o
rld
He
a
lt
h
Org
a
n
iza
ti
o
n
,
―
G
lo
b
a
l
S
trate
g
y
f
o
r
Co
n
tain
m
e
n
t
o
f
A
n
ti
m
icro
b
a
l
Re
sista
n
c
e
:
W
o
rld
He
a
lt
h
Org
a
n
iza
ti
o
n
,
‖
Co
m
m
u
n
ica
b
le
Dise
a
se
s
S
u
rv
e
il
lan
c
e
a
n
d
Re
sp
o
n
se
,
(CRS
)
,
2
0
0
1
.
W
HO
/CDS
/CRS
/DRS
/2
0
0
1
.
2
.
2
0
0
1
.
[3
3
]
J.
O.
F
a
d
a
ra
a
n
d
I.
T
a
m
u
n
o
,
―
An
ti
b
i
o
ti
c
S
e
lf
-
m
e
d
ica
ti
o
n
a
m
o
n
g
u
n
iv
e
rsity
m
e
d
ica
l
u
n
d
e
rg
ra
d
u
a
tes
in
No
rth
e
r
n
Nig
e
ria,‖
J
.
Pu
b
He
a
lt
h
E
p
id
e
mi
o
l
,
v
o
l
/i
ss
u
e
:
3
(
5
)
,
p
p
.
2
1
7
-
2
2
0
,
2
0
1
1
.
[3
4
]
N.
A
s
wa
p
o
k
e
e
,
e
t
a
l.
,
―
P
a
tt
e
r
n
o
f
a
n
ti
b
i
o
ti
c
u
se
in
m
e
d
ica
l
wa
rd
s
o
f
a
u
n
iv
e
rsit
y
h
o
sp
it
a
l,
Ba
n
k
o
k
,
T
h
a
il
a
n
d
,
‖
Rev
In
fec
t
Dis
,
v
o
l
/i
ss
u
e
:
12
(
1
)
,
p
p
.
1
3
6
-
1
4
1
,
1
9
9
0
.
[3
5
]
N.
I.
Ok
e
k
e
,
e
t
a
l.
,
―
S
o
c
io
-
e
c
o
n
o
m
ic
a
n
d
Be
h
a
v
io
ra
l
F
a
c
to
rs
L
e
a
d
in
g
to
A
c
q
u
ired
Ba
c
teria
l
Re
sista
n
c
e
to
A
n
ti
b
io
t
ics
i
n
De
v
e
lo
p
in
g
C
o
u
n
tr
ies
,
‖
Eme
rg
In
fec
t
Dis
,
v
o
l
/i
ss
u
e
:
5
(
1
)
,
p
p
.
1
8
-
2
7
,
1
9
9
9
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
P
HS
I
SS
N:
2252
-
8806
K
n
o
w
led
g
e
a
n
d
A
ttit
u
d
e
o
f S
tu
d
en
ts
o
n
A
n
timicr
o
b
ia
l R
esis
ta
n
ce
.
.
.
.
(
Desa
leg
n
e
A
ma
r
e
Zelellw
)
391
[3
6
]
H.
Ba
u
c
h
n
e
r,
e
t
a
l.
,
―
P
a
re
n
ts,
p
h
y
sic
ian
s,
a
n
d
a
n
ti
b
i
o
ti
c
u
se
,
‖
Ped
i
a
trics
,
v
o
l.
1
0
3
,
p
p
.
3
9
5
–
4
0
1
,
1
9
9
9
.
[3
7
]
S
.
L
.
Bro
n
z
wa
e
r,
e
t
a
l.
,
―
A
Eu
ro
p
e
a
n
stu
d
y
o
n
th
e
re
latio
n
sh
i
p
b
e
tw
e
e
n
a
n
ti
m
icro
b
ial
u
se
a
n
d
a
n
ti
m
icro
b
ial
re
sista
n
c
e
,
‖
Eme
rg
In
fec
t
Dis
,
v
o
l
.
8
,
p
p
.
2
7
8
–
8
2
,
2
0
0
2
.
[3
8
]
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