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1.
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NT
RO
D
UCT
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N
R
ab
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s
ac
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p
r
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r
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an
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m
a
l,
an
d
m
ig
r
ate
s
to
th
e
b
r
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n
[
1
,
2
]
.
R
ab
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s
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au
s
ed
b
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a
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[
3
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.
T
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cr
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it
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t
h
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m
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[
4
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.
T
h
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a
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m
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b
lo
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ca
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b
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tr
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s
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r
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b
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[
5
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.
GHP
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[
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[
8
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R
ab
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ev
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v
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y
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ted
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s
s
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[
11
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12
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.
W
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0
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w
it
h
v
ar
io
u
s
ac
ti
v
itie
s
,
m
ed
ia
o
u
tr
ea
ch
an
d
i
n
itiati
v
es
ca
r
r
ie
d
o
u
t
b
y
i
n
d
iv
id
u
als,
p
r
o
f
es
s
io
n
als,
o
r
g
a
n
izatio
n
s
an
d
g
o
v
er
n
m
e
n
t
s
f
r
o
m
lo
ca
l
t
o
i
n
ter
n
atio
n
al
lev
el
s
.
T
o
r
es
p
o
n
d
to
th
e
lack
o
f
a
w
ar
en
e
s
s
ab
o
u
t
ap
p
r
o
p
r
iate
r
ab
ies p
r
ev
en
tio
n
s
tr
ateg
ies,
d
ev
elo
p
in
g
an
d
i
n
cr
ea
s
i
n
g
ac
ce
s
s
to
b
asic a
w
ar
en
e
s
s
a
n
d
ed
u
ca
tio
n
al
r
eso
u
r
ce
s
i
s
an
i
m
p
o
r
tan
t
p
ar
t
[
13
]
.
A
n
i
m
al
b
it
es
o
f
ten
o
cc
u
r
in
e
v
e
r
y
d
a
y
li
f
e.
P
h
y
s
ical
tr
au
m
a
f
r
o
m
b
ite
s
o
f
r
ab
ies
-
tr
an
s
m
itti
n
g
an
i
m
al
s
(
GHP
R
)
is
an
i
n
itial
tr
a
u
m
a
t
h
at
r
es
u
lt
s
in
s
o
f
t
tis
s
u
e
tear
i
n
g
[
14
]
.
T
h
e
tr
au
m
a
r
esu
lti
n
g
f
r
o
m
t
h
ese
b
ite
s
in
c
lu
d
es
lac
er
atio
n
s
,
av
u
l
s
io
n
s
,
p
u
n
ct
u
r
es
,
s
cr
atch
es
a
n
d
tis
s
u
e
d
e
s
tr
u
c
tio
n
[
4
]
.
Da
m
ag
ed
tis
s
u
e
w
ill
m
a
k
e
th
e
w
o
u
n
d
v
e
r
y
v
u
ln
er
ab
le
to
in
f
ec
tio
n
[
15
]
.
C
li
n
ical
m
an
i
f
e
s
tatio
n
s
o
f
r
ab
ies
ca
n
p
r
o
g
r
es
s
to
d
an
g
er
o
u
s
s
ta
g
es
i
n
GHP
R
v
icti
m
s
[
16
]
.
R
ab
ies
af
f
ec
ts
t
h
e
ce
n
tr
al
n
er
v
o
u
s
s
y
s
te
m
w
i
th
p
r
o
d
r
o
m
a
l
s
y
m
p
to
m
s
s
u
ch
a
s
f
ev
er
,
h
ea
d
ac
h
es,
a
n
d
f
lu
,
b
u
t
i
n
f
ec
tio
n
s
ca
n
d
ev
elo
p
r
ap
id
ly
ca
u
s
i
n
g
h
all
u
cin
a
tio
n
s
,
p
ar
aly
s
is
a
n
d
u
lti
m
atel
y
d
ea
th
d
u
e
to
r
esp
ir
ato
r
y
d
is
tr
e
s
s
[
17
]
.
Ma
n
ag
e
m
e
n
t
o
f
GHP
R
w
i
th
p
o
s
t
-
ex
p
o
s
u
r
e
p
r
o
p
h
y
la
x
is
(
P
E
P
)
is
th
e
m
o
s
t
i
m
p
o
r
tan
t
s
tr
ateg
y
f
o
r
p
r
ev
e
n
ti
n
g
m
o
r
ta
lit
y
[
18
]
.
P
E
P
is
an
i
m
m
ed
iate
ac
tio
n
f
o
r
GHP
R
v
ic
ti
m
s
i
n
h
ea
lt
h
f
ac
ili
ties
.
T
h
i
s
ac
tio
n
p
r
ev
e
n
ts
t
h
e
en
tr
y
o
f
th
e
v
ir
u
s
i
n
to
th
e
ce
n
t
r
al
n
er
v
o
u
s
s
y
s
te
m
,
w
h
ic
h
th
e
n
r
esu
lts
i
n
r
a
p
id
d
ea
th
[
19
]
.
GHP
R
v
icti
m
s
n
ee
d
th
e
r
i
g
h
t
P
E
P
.
E
f
f
ec
tiv
e
ad
m
i
n
is
tr
atio
n
o
f
p
o
s
t
-
ex
p
o
s
u
r
e
p
r
o
p
h
y
lax
is
d
ep
en
d
s
o
n
g
o
o
d
in
d
iv
id
u
al
a
w
ar
en
e
s
s
ab
o
u
t
r
ab
ies,
an
d
ac
ce
s
s
to
h
e
alth
s
er
v
ice
s
[
20
]
.
Alth
o
u
g
h
P
E
P
is
w
id
el
y
a
v
ailab
le,
d
ea
t
h
s
ca
n
o
cc
u
r
d
u
e
to
lack
o
f
ad
h
er
en
ce
to
th
e
r
ec
o
m
m
en
d
ed
tr
ea
t
m
en
t
g
u
id
eli
n
e
s
[
21
]
.
On
e
o
f
t
h
e
m
ai
n
p
r
o
b
le
m
s
in
p
r
ev
en
t
in
g
r
ab
ies
at
th
e
m
o
s
t
b
asic
le
v
el
is
th
e
lac
k
o
f
k
n
o
w
led
g
e
a
m
o
n
g
p
eo
p
le
liv
i
n
g
i
n
en
d
e
m
ic
r
ab
ies
ar
ea
s
[
13
]
.
Aw
ar
e
n
es
s
ab
o
u
t
r
ab
ies
a
n
d
s
ee
k
in
g
tr
ea
t
m
e
n
t
ar
e
v
er
y
i
m
p
o
r
tan
t
b
o
th
f
o
r
p
r
ev
e
n
ti
v
e
m
ea
s
u
r
es
a
n
d
d
is
ea
s
e
co
n
tr
o
l
[
22
]
.
On
e
i
m
p
o
r
ta
n
t
r
eq
u
ir
e
m
en
t
f
o
r
ac
h
ie
v
i
n
g
"
Z
er
o
h
u
m
a
n
r
ab
ies
d
ea
t
h
b
y
2
0
3
0
"
is
to
b
u
ild
a
w
ar
e
n
ess
o
f
P
E
P
an
d
ca
r
e
f
o
r
v
icti
m
s
ex
p
o
s
ed
to
GHP
R
[
23
]
.
T
h
e
p
u
r
p
o
s
e
o
f
th
is
s
y
s
t
e
m
atic
r
ev
ie
w
is
to
f
i
n
d
o
u
t
w
h
at
is
t
h
e
ef
f
o
r
ts
m
a
d
e
b
y
th
e
co
m
m
u
n
it
y
i
n
r
aisi
n
g
p
u
b
lic
a
w
ar
en
es
s
to
o
b
tain
P
E
P
b
y
co
n
d
u
cti
n
g
in
itial
h
a
n
d
lin
g
af
ter
GHP
R
ap
p
r
o
p
r
iately
?
2.
RE
S
E
ARCH
M
E
T
H
O
D
T
h
e
f
ir
s
t
p
r
ep
ar
atio
n
o
f
th
is
s
y
s
te
m
a
tic
r
ev
ie
w
w
as
d
eter
m
i
n
atio
n
o
f
ti
m
e
t
h
at
o
n
l
y
to
o
k
th
e
r
esear
ch
f
r
o
m
2
0
1
4
to
2
0
1
9
.
T
h
e
f
o
ll
o
w
i
n
g
p
r
ep
ar
atio
n
w
a
s
d
eter
m
i
n
atio
n
o
f
t
h
e
k
e
y
w
o
r
d
s
t
h
at
w
er
e
"
a
w
ar
e
n
es
s
"
A
N
D
"
an
i
m
al
b
ite"
A
ND
r
a
b
ies,
th
en
d
eter
m
in
ed
th
e
s
o
u
r
ce
d
atab
ase
th
at
w
as
P
r
o
q
u
est,
Scie
n
Dir
ec
t,
Sp
r
in
g
er
a
n
d
E
b
s
co
an
d
d
eter
m
i
n
ed
th
e
e
x
cl
u
s
io
n
an
d
i
n
cl
u
s
io
n
cr
iter
ia.
T
h
e
in
cl
u
s
io
n
cr
iter
ia
w
er
e
r
ab
ies
an
i
m
al
b
ite
w
o
u
n
d
,
an
d
P
E
P.
W
h
ile
th
e
ex
cl
u
s
io
n
cr
iter
i
a
ar
e
v
eter
in
ar
y
m
ed
icin
e,
r
a
b
ies
h
is
to
r
y
,
r
ab
ies
f
i
n
an
ci
n
g
,
d
o
g
v
ac
cin
atio
n
an
d
d
o
g
p
o
p
u
latio
n
.
Selectio
n
is
d
o
n
e
b
y
p
r
ef
er
r
ed
r
ep
o
r
tin
g
ite
m
s
f
o
r
s
y
s
te
m
atic
r
ev
ie
w
s
an
d
m
e
ta
-
a
n
al
y
s
e
s
(
P
R
I
SMA
)
f
lo
w
d
iag
r
a
m
an
d
s
elec
ted
u
s
i
n
g
th
e
J
o
an
n
a
B
r
ig
g
s
I
n
s
titu
te
(
J
B
I
)
ch
ec
k
l
is
t
f
o
r
m
at
to
o
ls
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
T
h
e
ar
ticles
s
ea
r
ch
i
n
g
co
n
d
u
cted
b
y
u
s
in
g
s
ev
er
al
k
e
y
w
o
r
d
s
,
th
en
f
o
u
n
d
t
h
e
n
u
m
b
er
o
f
s
ea
r
ch
r
esu
lt
s
u
s
i
n
g
k
e
y
w
o
r
d
s
:
a
w
ar
en
es
s
A
N
D
P
E
P
A
ND
r
ab
ies
is
1
4
1
ar
ticles
f
r
o
m
t
h
e
P
r
o
q
u
est
d
atab
ase,
2
3
ar
ticles
f
r
o
m
th
e
Sc
ien
ce
D
ir
ec
t
d
atab
ase,
o
n
e
ar
ticle
f
r
o
m
th
e
Sp
r
in
g
er
d
atab
ase
an
d
5
9
ar
ticles
f
r
o
m
t
h
e
E
b
s
co
d
atab
ase.
T
h
is
p
r
o
ce
s
s
is
p
ar
t
o
f
id
en
tif
icatio
n
th
r
o
u
g
h
t
h
e
P
R
I
SM
A
f
r
a
m
e
w
o
r
k
,
th
en
r
ea
d
s
th
e
ti
tle
an
d
ab
s
tr
ac
t
o
f
ea
c
h
ar
ticle,
t
h
e
n
u
m
b
er
o
f
ar
ticle
s
e
n
ter
ed
f
o
r
th
e
n
ex
t
p
r
o
ce
s
s
b
ased
o
n
t
h
e
tit
le
a
n
d
ab
s
tr
ac
t
is
1
1
1
f
r
o
m
t
h
e
P
r
o
q
u
est
d
ata
b
ase,
1
9
ar
ticles
f
r
o
m
t
h
e
Scie
n
ce
Dir
ec
t
d
atab
ase,
o
n
e
ar
ticl
e
f
r
o
m
t
h
e
s
p
r
i
n
g
er
d
atab
ase
an
d
1
2
a
r
ticle
f
r
o
m
t
h
e
E
b
s
co
d
atab
ase,
th
is
p
r
o
ce
s
s
is
a
s
cr
ee
n
i
n
g
o
f
th
e
P
r
ef
er
r
ed
R
ep
o
r
tin
g
I
te
m
s
f
o
r
s
y
s
te
m
atic
r
e
v
ie
w
s
an
d
m
eta
-
a
n
al
y
s
es
(
P
R
I
SM
A
)
f
r
a
m
e
w
o
r
k
.
Ne
x
t,
d
o
w
n
lo
ad
th
e
f
u
ll
tex
t
a
n
d
r
ea
d
ea
ch
co
m
p
lete
te
x
t
f
r
o
m
th
e
ar
ticle
to
en
ter
th
e
in
cl
u
s
io
n
an
d
e
x
clu
s
io
n
cr
iter
ia,
an
d
f
i
n
d
ar
ticles
w
ith
i
n
cl
u
s
io
n
cr
iter
ia,
n
a
m
el
y
r
ab
ies
a
n
i
m
al
b
ite
w
o
u
n
d
an
d
P
E
P
d
atab
ase
ar
ticles
P
r
o
q
u
est,
Scien
D
ir
ec
t
an
d
E
b
s
co
,
th
is
p
r
o
ce
s
s
is
a
eli
g
ib
ilit
y
p
r
o
ce
s
s
an
d
i
s
in
cl
u
d
ed
f
r
o
m
P
R
I
SM
A
an
d
is
an
an
al
y
s
in
g
p
r
o
ce
s
s
.
T
h
is
p
r
o
ce
s
s
a
ls
o
u
s
e
s
t
h
e
J
o
an
n
a
B
r
ig
g
s
I
n
s
tit
u
te
(
J
B
I
)
ch
ec
k
l
is
t
f
o
r
m
at
to
o
ls
as
th
e
ar
ticle
s
elec
tio
n
p
r
o
ce
s
s
.
F
u
r
th
er
m
o
r
e,
id
en
ti
f
y
i
n
g
d
u
p
licated
ar
ticle
s
f
o
u
n
d
1
4
ar
ticles a
n
d
n
i
n
e
ar
ti
cles i
n
clu
d
ed
i
n
t
h
e
r
ev
ie
w
.
P
R
I
SM
A
Flo
w
C
h
ar
t
f
o
r
L
iter
at
u
r
e
I
d
en
ti
f
icati
o
n
a
s
s
h
o
w
n
i
n
Fi
g
u
r
e
1
.
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
2
5
2
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8806
C
o
mmu
n
ity
effo
r
ts
in
ea
r
ly
h
a
n
d
lin
g
p
o
s
t
-
ex
p
o
s
u
r
e
p
r
o
p
h
yl
a
xis ca
s
es o
f ra
b
ies a
n
ima
l…
(
Ta
n
ti Ma
r
jia
n
a
)
129
Fig
u
r
e
1
.
P
R
I
SMA
f
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[
30
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.
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[
31
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.
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m
m
ed
iatel
y
b
ef
o
r
e
th
e
v
ic
ti
m
i
s
tak
e
n
to
a
h
ea
lt
h
ca
r
e
f
ac
ilit
y
.
A
cc
o
r
d
in
g
to
t
h
e
Mi
n
is
tr
y
o
f
Hea
lt
h
o
f
R
ep
u
b
lic
o
f
I
n
d
o
n
esia
[
6
]
th
e
tr
ea
t
m
e
n
t
is
ca
r
r
ied
o
u
t
b
y
a
p
p
ly
i
n
g
w
o
u
n
d
w
as
h
in
g
w
it
h
s
o
ap
/d
eter
g
en
t
a
n
d
r
u
n
n
i
n
g
w
a
ter
f
o
r
10
-
1
5
m
i
n
u
tes
a
n
d
p
r
o
v
id
in
g
an
t
is
ep
tic
s
s
u
ch
a
s
p
o
v
id
o
n
e
io
d
in
e,
7
0
%
alco
h
o
l
in
t
h
e
w
o
u
n
d
.
R
e
s
ea
r
ch
b
y
Har
ad
an
h
alli
et
a
l.
[
21
]
in
I
n
d
ia
s
aid
6
4
.
7
%
o
f
r
es
p
o
n
d
en
ts
d
id
w
a
s
h
i
n
g
w
o
u
n
d
s
an
d
7
3
.
7
%
o
f
r
esp
o
n
d
en
t
s
r
ea
lized
th
at
t
h
e
y
r
ec
eiv
ed
P
E
P
o
n
ti
m
e.
T
h
e
r
esear
c
h
o
f
T
i
w
ar
i,
R
o
b
er
ts
o
n
,
O'
d
ea
an
d
Van
a
k
[
25
]
in
I
n
d
ia
s
aid
th
at
7
3
%
o
f
r
esp
o
n
d
en
ts
k
n
e
w
t
h
at
r
ab
ies
co
u
ld
b
e
p
r
ev
en
ted
b
y
g
i
v
i
n
g
P
E
P
to
v
icti
m
s
o
f
GHP
R
a
n
d
8
7
%
o
f
r
esp
o
n
d
e
n
ts
w
er
e
a
w
ar
e
o
f
t
h
e
i
n
e
f
f
ec
ti
v
en
e
s
s
o
f
tr
ad
itio
n
al
m
ed
icin
e
ap
p
licatio
n
s
,
s
u
c
h
as
ch
ili/
t
u
r
m
er
ic
p
o
w
d
er
.
A
cc
o
r
d
in
g
to
L
i
u
et
a
l.
[
19
]
th
ese
ac
tio
n
s
s
er
v
e
to
p
r
ev
en
t
th
e
en
tr
y
o
f
th
e
v
ir
u
s
i
n
to
th
e
c
en
tr
al
n
er
v
o
u
s
s
y
s
te
m
,
r
esu
lti
n
g
i
n
r
ap
id
m
o
r
talit
y
in
v
i
cti
m
s
.
R
ab
ies
ca
n
b
e
p
r
ev
en
ted
b
y
g
i
v
in
g
P
E
P
i
m
m
ed
iatel
y
to
v
icti
m
s
o
f
GHP
R
[
32
]
.
P
E
P
is
ca
r
r
ied
o
u
t
w
h
en
GHP
R
v
icti
m
s
ar
r
iv
e
at
a
h
ea
lt
h
f
ac
il
it
y
s
o
th
at
f
u
r
t
h
er
tr
ea
t
m
e
n
t
is
ap
p
r
o
p
r
iate,
th
ese
ac
tio
n
s
co
n
s
i
s
t
o
f
:
ex
ten
s
iv
e
w
o
u
n
d
w
a
s
h
i
n
g
an
d
lo
ca
l
w
o
u
n
d
ca
r
e
i
m
m
ed
iatel
y
a
f
ter
e
x
p
o
s
u
r
e;
s
tr
o
n
g
an
d
e
f
f
ec
tiv
e
r
ab
ies
v
ac
cin
atio
n
th
at
m
ee
t
s
W
HO
s
tan
d
ar
d
s
;
a
n
d
ad
m
in
i
s
tr
atio
n
o
f
R
I
G
i
f
i
n
d
icate
d
.
P
r
o
p
er
w
o
u
n
d
h
an
d
li
n
g
a
n
d
p
o
s
t
-
e
x
p
o
s
u
r
e
r
ab
ies
v
ac
cin
a
tio
n
ar
e
ess
e
n
tial
f
o
r
r
ab
ies p
r
ev
en
ti
v
e
tr
ea
t
m
e
n
t
[
19
]
.
R
esear
ch
f
r
o
m
T
i
w
ar
i,
R
o
b
e
r
ts
o
n
,
O
'
Dea
an
d
Va
n
ak
[
25
]
also
s
aid
9
7
%
o
f
r
esp
o
n
d
e
n
ts
w
o
u
ld
r
ec
o
m
m
e
n
d
t
h
at
G
HP
R
v
icti
m
s
b
e
r
ef
er
r
ed
to
h
o
s
p
itals
.
P
r
o
p
er
w
o
u
n
d
m
a
n
a
g
e
m
en
t
af
t
er
GHP
R
i
n
a
h
ea
l
th
ca
r
e
f
ac
ilit
y
h
a
s
t
h
e
m
ai
n
p
r
in
cip
le,
w
h
ic
h
i
n
cl
u
d
es
w
o
u
n
d
ca
r
e
an
d
ap
p
r
o
p
r
iate
an
ti
m
icr
o
b
ial
p
r
o
p
h
y
la
x
i
s
i
f
in
d
icate
d
.
I
r
r
ig
atio
n
th
e
w
o
u
n
d
is
i
m
p
o
r
ta
n
t
to
r
ed
u
ce
t
h
e
r
ate
o
f
s
u
b
s
eq
u
e
n
t
i
n
f
ec
ti
o
n
s
.
W
o
u
n
d
clo
s
u
r
e
is
g
en
er
all
y
n
o
t
r
ec
o
m
m
e
n
d
ed
b
y
th
e
g
u
id
eli
n
es
e
x
ce
p
t
f
o
r
f
a
cial
in
j
u
r
ies.
A
n
ti
m
icr
o
b
ial
p
r
o
p
h
y
lax
is
is
g
i
v
e
n
f
o
r
u
p
to
f
iv
e
d
a
y
s
,
w
h
ic
h
h
as
b
ee
n
r
ec
o
m
m
e
n
d
ed
b
y
g
u
i
d
elin
es
f
o
r
th
e
r
eg
u
latio
n
o
f
an
i
m
al
b
ites
in
t
h
e
p
r
esen
ce
o
f
p
r
i
m
ar
y
w
o
u
n
d
cl
o
s
u
r
e,
m
o
d
er
ate
to
s
e
v
er
e
i
n
j
u
r
ies,
lesi
o
n
s
o
n
t
h
e
h
a
n
d
s
o
r
f
ac
e
[
4
]
.
W
HO
[
33
]
r
ec
o
m
m
e
n
d
s
t
w
o
m
a
in
v
ac
ci
n
atio
n
s
tr
ateg
ies
f
o
r
p
r
ev
en
ti
o
n
o
f
r
ab
ies
in
h
u
m
a
n
s
,
n
a
m
el
y
:
p
o
s
t
-
e
x
p
o
s
u
r
e
p
r
o
p
h
y
la
x
i
s
(
P
E
P)
w
h
ic
h
in
cl
u
d
es
ex
te
n
s
i
v
e
an
d
co
m
p
r
eh
e
n
s
i
v
e
w
as
h
i
n
g
o
f
w
o
u
n
d
s
at
t
h
e
s
ite
o
f
ex
p
o
s
u
r
e,
to
g
eth
er
w
i
th
r
ab
ies
i
m
m
u
n
o
g
lo
b
u
li
n
(
R
I
G)
i
f
i
n
d
icate
d
a
n
d
ad
m
i
n
is
tr
at
io
n
o
f
a
s
er
ies
o
f
v
ac
ci
n
e
s
r
a
b
ies
d
o
s
e.
T
h
en
p
r
e
-
e
x
p
o
s
u
r
e
(
P
r
E
P
)
is
th
e
ad
m
i
n
i
s
tr
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o
f
s
ev
e
r
al
d
o
s
e
s
o
f
r
ab
ies
v
ac
ci
n
e
b
e
f
o
r
e
ex
p
o
s
u
r
e.
I
n
d
icatio
n
s
an
d
p
r
o
ce
d
u
r
es
f
o
r
P
E
P
d
ep
en
d
o
n
th
e
t
y
p
e
o
f
co
n
tact
w
it
h
s
u
s
p
ec
ted
r
ab
ies
a
n
i
m
als
a
n
d
t
h
e
v
icti
m
's
v
ac
cin
a
tio
n
s
tat
u
s
[
33
]
.
T
h
e
co
m
m
u
n
it
y
is
n
ec
e
s
s
ar
y
to
u
n
d
er
s
ta
n
d
th
at
i
m
m
ed
iat
e
h
an
d
li
n
g
is
ta
k
e
n
af
ter
b
ein
g
ex
p
o
s
ed
to
G
HP
R
a
n
d
s
u
b
s
eq
u
e
n
t
ac
t
io
n
s
o
b
tain
ed
at
h
ea
lt
h
ca
r
e
f
ac
ili
t
ies
(
p
u
b
lic
h
ea
lt
h
ce
n
tr
e
/h
o
s
p
ita
ls
/r
ab
ies
ce
n
tr
es
)
.
GHP
R
ex
p
o
s
u
r
e
ca
teg
o
r
ies
ar
e
g
r
o
u
p
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in
to
th
r
ee
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teg
o
r
i
es.
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h
e
h
an
d
li
n
g
o
f
GHP
R
v
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m
s
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s
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ased
o
n
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e
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p
o
s
u
r
e
g
r
o
u
p
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w
h
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h
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as
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e
v
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r
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f
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mag
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R
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d
.
ID (
in
trad
e
rm
al
);
IM
(
in
tram
u
sc
u
lar
)
[
33
,
34
]
.
P
u
b
lic
k
n
o
w
led
g
e
ab
o
u
t
r
ab
ies
in
g
e
n
er
al
is
r
ef
lecte
d
in
co
m
m
u
n
it
y
p
r
ac
tices
an
d
h
ea
lth
s
ee
k
in
g
b
eh
av
io
r
[
12
]
.
I
t
is
i
m
p
o
r
tan
t
f
o
r
th
e
co
m
m
u
n
i
t
y
to
h
a
v
e
k
n
o
w
led
g
e,
a
w
ar
en
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s
s
a
n
d
p
r
ac
tices
r
elate
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to
GHP
R
to
u
n
d
er
s
ta
n
d
t
h
eir
p
r
ep
ar
ed
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ess
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r
l
y
h
an
d
li
n
g
.
Af
ter
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h
e
y
ca
r
r
y
o
u
t
t
h
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n
e
x
t
i
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ea
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m
e
n
t
i
n
a
h
ea
lt
h
f
ac
ili
t
y
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h
ea
lth
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o
r
k
er
s
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ill
r
esp
o
n
d
q
u
ic
k
l
y
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n
ti
n
u
e
P
E
P
w
h
ic
h
p
r
ev
en
t
s
d
ea
th
in
v
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m
s
t
h
r
o
u
g
h
th
e
p
r
o
v
is
io
n
o
f
P
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E
P
an
d
R
I
G
i
m
m
ed
iatel
y
[
35
]
.
R
ab
ies
v
ac
cin
atio
n
i
s
a
n
i
m
p
o
r
tan
t
s
te
p
to
im
p
r
o
v
e
p
u
b
lic
h
ea
lt
h
[
36
]
.
T
h
e
v
ac
cin
e
r
eg
i
m
en
g
i
v
e
n
f
o
r
r
ab
ies
P
E
P
is
al
m
o
s
t
1
0
0
%
ef
f
ec
ti
v
e
[
37
]
.
T
h
e
r
ab
ies
v
ac
cin
e
s
ti
m
u
la
tes
t
h
e
i
m
m
u
n
e
s
y
s
te
m
to
p
r
o
d
u
ce
an
tib
o
d
ies
to
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r
o
tect
th
e
b
o
d
y
f
r
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m
a
n
i
m
m
in
e
n
t
i
n
f
ec
tio
n
.
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h
er
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o
r
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m
p
leti
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g
t
h
e
v
ac
cin
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s
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h
ed
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le
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y
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m
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r
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u
f
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o
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y
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to
n
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tr
al
ize
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e
r
ab
ies
v
ir
u
s
a
n
d
p
r
ev
en
t
ac
ti
v
e
r
ab
ies
in
f
ec
t
io
n
in
GHP
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v
icti
m
s
.
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h
u
s
,
th
o
s
e
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o
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t
co
m
p
lete
t
h
e
f
u
ll
P
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P
s
c
h
e
d
u
le
w
er
e
less
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k
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y
to
p
r
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d
u
ce
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r
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titer
s
o
f
an
t
ib
o
d
ies
to
p
r
ev
en
t
in
f
ec
tio
n
[
38
]
.
I
n
ca
s
es
o
f
ca
teg
o
r
y
I
I
I
ex
p
o
s
u
r
e,
R
I
G
is
al
s
o
r
ec
o
m
m
e
n
d
ed
in
ad
d
itio
n
to
w
o
u
n
d
ca
r
e
an
d
P
E
P
v
ac
cin
atio
n
[
38
]
.
R
eg
ar
d
less
o
f
t
h
e
a
v
ailab
ilit
y
o
f
R
I
G,
all
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atien
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o
s
ed
to
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I
I
I
s
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o
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ld
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ec
eiv
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t
h
e
r
ab
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ac
c
in
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m
m
ed
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y
.
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I
G
s
h
o
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ld
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e
g
iv
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o
n
l
y
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n
ce
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p
r
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f
er
ab
l
y
to
g
e
th
er
w
h
e
n
s
tar
tin
g
P
E
P
an
d
n
o
later
t
h
a
n
7
d
a
y
s
af
ter
t
h
e
f
ir
s
t
r
ab
ies
v
ac
ci
n
e
[
36
]
.
Ver
y
f
e
w
p
eo
p
le
h
a
v
e
t
h
e
r
ig
h
t
a
w
ar
e
n
es
s
i
n
i
m
p
le
m
en
t
in
g
P
E
P
.
T
h
e
r
esu
lts
o
f
J
ain
an
d
J
ain
r
esear
c
h
[
29
]
in
I
n
d
ia
s
aid
8
0
%
o
f
GHP
R
v
icti
m
s
ap
p
lied
co
ld
p
aste
an
d
o
il
b
ef
o
r
e
co
m
in
g
to
p
r
i
m
ar
y
ca
r
e;
r
esear
ch
r
esu
lt.
Kab
eta
et
a
l.
[
22
]
in
E
th
io
p
ia
m
en
t
io
n
ed
th
at
4
3
%
o
f
v
ic
ti
m
s
o
f
GHP
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d
id
n
o
t
tak
e
in
i
tial
tr
ea
t
m
en
t
af
ter
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.
T
h
is
f
i
n
d
i
n
g
h
i
g
h
l
ig
h
t
s
t
h
e
lack
o
f
u
n
d
er
s
ta
n
d
in
g
o
f
ea
r
l
y
tr
ea
t
m
en
t
t
h
at
is
i
m
p
o
r
tan
t
f
o
r
p
r
ev
en
ti
n
g
in
f
ec
tio
n
.
T
h
e
av
a
ilab
i
lit
y
o
f
P
E
P
at
th
e
C
en
ter
,
b
u
t
t
h
e
lac
k
o
f
a
w
ar
e
n
es
s
b
y
t
h
e
p
u
b
lic
ab
o
u
t
p
r
ev
en
ti
v
e
m
ea
s
u
r
es
t
h
at
h
a
m
p
er
s
ee
k
i
n
g
i
m
m
ed
iate
m
ed
ical
ass
is
ta
n
ce
[
39
,
40
]
.
So
m
e
p
eo
p
le
ar
e
s
till
lo
o
k
in
g
f
o
r
h
elp
o
r
tr
ea
tm
e
n
t
o
u
t
s
id
e
h
ea
lt
h
s
er
v
ice
f
ac
ilit
ies.
I
n
li
n
e
w
it
h
th
e
r
esear
ch
co
n
d
u
c
ted
b
y
C
o
s
t
a
et
a
l.
[
28
]
in
C
a
m
er
o
o
n
s
tated
th
a
t
9
.
7
%
o
f
r
esp
o
n
d
en
ts
w
o
u
ld
co
n
s
u
lt
tr
a
d
itio
n
al
h
ea
ler
s
i
n
h
a
n
d
li
n
g
th
e
GHP
R
ca
s
e.
Ma
s
t
h
i,
San
j
ay
,
P
r
ad
ee
p
an
d
An
w
it
h
[
24
]
in
I
n
d
ia
s
aid
t
h
at
5
.
7
%
o
f
r
esp
o
n
d
en
ts
w
o
u
ld
a
p
p
ly
tr
ad
itio
n
al
m
ed
ici
n
e
a
f
te
r
GHP
R
e
x
p
o
s
u
r
e.
T
h
ese
f
i
n
d
in
g
s
i
n
d
icate
t
h
a
t
in
cr
ea
s
ed
k
n
o
w
led
g
e
ab
o
u
t
p
r
ev
en
ti
v
e
m
ea
s
u
r
es
in
r
ab
ies
th
at
m
a
y
n
o
t
h
a
v
e
an
i
m
p
ac
t
o
n
th
e
s
ea
r
ch
f
o
r
h
ea
lt
h
s
er
v
ices
i
f
t
h
e
co
s
t
o
f
m
ed
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ca
r
e
is
a
n
o
b
s
tacle
f
o
r
th
e
co
m
m
u
n
it
y
to
g
et
f
u
r
t
h
er
tr
ea
t
m
e
n
t
[
28
]
.
P
h
y
s
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tr
au
m
a
f
r
o
m
G
HP
R
i
s
a
n
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n
itia
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r
esu
lti
n
g
i
n
s
o
f
t
tis
s
u
e
tear
i
n
g
[
14
]
.
T
h
e
p
r
esen
ce
o
f
d
a
m
a
g
ed
tis
s
u
e
m
a
k
es
t
h
e
w
o
u
n
d
v
er
y
v
u
l
n
er
ab
le
to
in
f
ec
t
io
n
[
15
]
.
T
h
e
r
a
b
ies
v
ir
u
s
t
h
at
i
s
ex
p
o
s
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f
r
o
m
an
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s
en
ter
s
t
h
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b
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a
f
ter
a
b
ite
c
a
n
t
h
en
m
i
g
r
ate
to
t
h
e
b
r
ain
[
1
]
.
I
f
t
h
e
in
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ea
t
m
e
n
t
h
as b
ee
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d
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[
16
]
.
T
h
e
m
ai
n
f
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s
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u
f
f
i
cien
t
s
u
p
p
l
y
o
f
v
ac
cin
e
s
a
n
d
R
I
G
to
g
o
v
er
n
m
e
n
t
h
o
s
p
itals
,
t
h
e
d
is
ta
n
ce
f
r
o
m
wh
er
e
GHP
R
v
icti
m
s
l
iv
e
to
g
o
v
er
n
m
e
n
t
h
o
s
p
ital
s
m
a
y
b
e
ca
u
s
e
s
o
f
lo
w
v
ac
ci
n
e
co
v
er
ag
e
a
m
o
n
g
GHP
R
v
icti
m
s
[
41
,
42
]
.
A
s
tu
d
y
b
y
L
i
u
et
a
l.
[
19
]
in
C
h
in
a
m
en
t
io
n
ed
th
at
3
5
.
3
%
o
f
GHP
R
v
icti
m
s
d
ela
y
ed
th
e
in
i
tiatio
n
o
f
P
E
P
.
T
h
e
m
ai
n
r
ea
s
o
n
f
o
r
n
o
n
-
co
m
p
lia
n
ce
to
r
eso
lv
e
an
t
i
-
r
ab
ies
v
ac
ci
n
atio
n
ac
co
r
d
in
g
to
Sh
i
v
asa
k
t
h
i
m
an
i
,
R
av
i
v
ar
m
a
n
,
an
d
Mu
r
ali
[
43
]
is
s
o
cio
-
ec
o
n
o
m
ic
f
ac
to
r
s
;
s
u
ch
as
lo
s
t
w
a
g
e
s
,
u
n
r
ea
c
h
ab
le
d
is
ta
n
ce
to
h
ea
l
th
f
ac
ili
ties
,
h
i
g
h
co
s
t
s
,
co
i
n
cid
in
g
w
it
h
s
c
h
o
o
l
ti
m
e,
f
o
r
g
o
tten
d
ates
a
n
d
u
n
a
v
ailab
ili
t
y
o
f
v
ac
ci
n
e
s
in
h
ea
lt
h
ca
r
e
f
ac
il
ities
.
T
h
e
ec
o
n
o
m
ic
b
u
r
d
en
as
s
o
ciate
d
w
it
h
f
in
a
n
ci
n
g
ca
n
b
e
r
ed
u
ce
d
th
r
o
u
g
h
m
o
r
e
p
r
u
d
en
t
an
d
co
s
t
-
e
f
f
ec
t
iv
e
ad
m
i
n
is
tr
atio
n
.
T
h
e
m
et
h
o
d
d
ev
elo
p
ed
d
escr
ib
es
an
i
m
p
o
r
tan
t
g
ap
i
n
k
n
o
w
led
g
e,
p
r
o
v
id
in
g
a
n
i
n
itia
l
p
ictu
r
e
o
f
th
e
d
is
tr
ib
u
tio
n
o
f
t
h
e
r
ab
ies
b
u
r
d
en
ac
co
r
d
in
g
to
lo
ca
l
co
u
n
tr
y
p
o
licies
o
n
r
ab
ies
co
n
tr
o
l
an
d
p
r
ev
en
tio
n
m
ea
s
u
r
es.
I
m
p
r
o
v
ed
s
u
r
v
eil
l
an
c
e
an
d
r
ep
o
r
tin
g
o
f
GHP
R
ca
s
es
i
s
n
ee
d
ed
,
b
o
th
f
o
r
b
etter
co
s
t
esti
m
ates,
to
m
o
n
ito
r
th
e
i
m
p
ac
t
o
f
co
n
tr
o
l
ef
f
o
r
ts
[
11
]
.
T
h
r
o
u
g
h
th
e
i
n
v
e
s
t
m
en
t
o
f
G
A
VI
(
a
n
o
t
-
f
o
r
-
p
r
o
f
it
o
r
g
an
izatio
n
a
n
d
v
ac
cin
e
al
lian
ce
)
P
E
P
ca
n
b
e
m
ad
e
f
r
ee
d
u
r
i
n
g
tr
ea
t
m
e
n
t,
th
is
w
il
l
av
o
id
f
in
an
cial
co
n
s
tr
ain
ts
o
n
in
d
i
v
id
u
als
an
d
g
o
v
er
n
m
e
n
ts
,
a
n
d
als
o
co
n
v
i
n
ce
v
ac
ci
n
e
s
u
p
p
lier
s
o
p
er
atin
g
i
n
lo
w
-
a
n
d
m
id
d
le
-
in
co
m
e
co
u
n
tr
ies.
I
n
ad
d
itio
n
,
Gav
i
'
s
i
n
v
est
m
e
n
t
co
u
ld
b
r
in
g
h
ea
l
th
s
y
s
te
m
b
e
n
ef
its
s
u
c
h
as
i
n
cr
ea
s
ed
ca
p
ac
it
y
f
o
r
m
o
n
ito
r
in
g
G
HP
R
ex
p
o
s
u
r
e,
m
o
r
talit
y
,
an
d
r
esp
o
n
s
ib
le
u
s
e
o
f
P
E
P
[
44
]
.
I
t
is
also
h
o
p
ed
th
at
a
s
u
s
tain
ab
le
an
d
s
tr
ate
g
ic
h
ea
lt
h
p
r
o
g
r
a
m
f
r
o
m
h
e
alth
p
r
o
f
e
s
s
io
n
als,
g
o
v
er
n
m
e
n
t
a
n
d
n
o
n
-
g
o
v
er
n
m
en
t
o
r
g
a
n
izatio
n
s
to
co
n
tr
o
l
an
d
p
r
ev
en
t
d
is
ea
s
e
an
d
s
ec
u
r
e
a
r
ab
ies
-
f
r
ee
zo
n
e
[
45
]
.
E
d
u
ca
tio
n
ab
o
u
t
t
h
e
d
an
g
er
o
f
r
ab
ies
is
i
m
p
o
r
tan
t
to
b
e
ca
r
r
ied
o
u
t
in
th
e
lo
ca
l
co
m
m
u
n
it
y
as
an
ef
f
o
r
t
to
o
v
er
co
m
e
it.
C
o
m
m
u
n
it
y
ed
u
ca
tio
n
is
an
i
m
p
o
r
tan
t
s
tr
ate
g
y
i
n
p
r
ev
e
n
ti
n
g
r
ab
ies
i
n
h
u
m
a
n
s
.
A
cc
o
r
d
in
g
t
o
Dilag
o
an
d
Na
s
h
[
46
,
47
]
m
ater
ial
t
h
at
ca
n
b
e
d
eliv
er
ed
in
co
m
m
u
n
it
y
ac
tiv
itie
s
in
c
lu
d
es:
tr
an
s
m
is
s
io
n
o
f
r
ab
ies,
in
it
ial
h
elp
af
ter
GHP
R
,
an
d
e
f
f
o
r
ts
t
o
p
r
ev
en
t
r
ab
ies.
T
o
m
a
k
e
it
ea
s
ier
f
o
r
th
e
p
u
b
lic
to
u
n
d
er
s
tan
d
th
e
m
ater
ial
p
r
esen
ted
in
th
e
o
u
tr
ea
ch
ac
tiv
ities
,
h
ea
lth
ed
u
ca
tio
n
m
ater
ia
ls
ca
n
b
e
co
m
p
le
m
e
n
ted
b
y
v
id
eo
p
la
y
b
ac
k
,
an
d
u
s
e
o
f
i
m
a
g
e
m
ed
ia
to
m
a
k
e
it
m
o
r
e
in
ter
es
tin
g
an
d
to
r
ep
o
r
t
t
o
g
o
v
er
n
m
e
n
t
ag
e
n
cie
s
w
h
e
n
th
e
y
s
ee
a
d
o
g
s
u
s
p
ec
ted
o
f
r
ab
ies
in
th
e
co
m
m
u
n
it
y
.
T
h
i
s
ac
tiv
it
y
w
ill
h
elp
i
m
p
r
o
v
e
t
h
e
s
ea
r
ch
f
o
r
P
E
P
an
d
th
e
co
m
p
lia
n
ce
b
eh
a
v
i
o
r
o
f
p
eo
p
le
ex
p
o
s
ed
to
r
ab
ies
in
f
ec
tio
n
f
r
o
m
an
i
m
als
[
48
]
.
Sch
o
o
l
h
ea
lt
h
p
r
o
g
r
a
m
s
th
a
t i
n
clu
d
e
p
r
i
m
ar
y
-
l
ev
el
s
tu
d
e
n
ts
e
n
s
u
r
e
t
h
at
t
h
e
s
e
ef
f
o
r
ts
r
ea
ch
th
e
m
.
I
t
is
also
im
p
o
r
tan
t
to
em
p
h
as
ize
av
o
id
in
g
e
x
p
o
s
u
r
e
an
d
p
r
o
m
o
ti
n
g
w
o
u
n
d
clea
n
in
g
an
d
v
is
i
tin
g
h
ea
l
th
ca
r
e
af
ter
ex
p
o
s
u
r
e
[
49
]
.
R
ab
ies
r
elate
d
tr
ain
in
g
is
i
m
p
o
r
tan
t
to
b
e
ca
r
r
ied
o
u
t
b
y
n
u
r
s
i
n
g
s
ta
f
f
.
T
h
e
tr
ea
tm
e
n
t
o
f
in
j
u
r
ies
to
v
icti
m
s
o
f
GHP
R
i
s
t
h
e
tr
ea
t
m
e
n
t
o
f
i
n
j
u
r
ies
t
h
a
t
ar
e
d
if
f
er
e
n
t
f
r
o
m
o
th
er
in
j
u
r
ies.
A
cc
o
r
d
in
g
to
Nash
[
47
]
n
u
r
s
es
a
tten
d
i
n
g
tr
ain
i
n
g
h
a
v
e
th
e
ai
m
to
in
cr
e
ase
t
h
e
k
n
o
w
led
g
e
a
n
d
s
k
i
lls
n
ee
d
ed
b
y
n
u
r
s
e
s
w
o
r
k
i
n
g
i
n
th
e
co
m
m
u
n
it
y
.
T
h
u
s
,
n
u
r
s
es
as
h
ea
l
th
w
o
r
k
er
s
ar
e
e
x
p
ec
ted
to
h
a
v
e
s
p
ec
ial
s
k
ill
s
.
T
h
e
g
o
v
er
n
m
e
n
t
is
a
h
ig
h
er
a
u
t
h
o
r
it
y
t
h
at
h
a
s
a
n
i
m
p
o
r
tan
t
r
o
le
in
p
r
o
v
id
in
g
s
u
p
p
o
r
t
to
f
ac
i
litate
f
ac
ilit
ies
a
n
d
in
f
r
astru
ct
u
r
e
as
w
ell
a
s
co
o
r
d
in
atin
g
t
h
e
i
n
s
t
itu
tio
n
s
.
Ac
co
r
d
in
g
to
Ki
a
n
d
Ma
r
ia
[
50
]
th
e
p
r
o
v
is
io
n
o
f
ad
eq
u
ate
r
eso
u
r
ce
s
a
n
d
th
e
p
r
o
v
is
io
n
o
f
f
ac
ilit
ie
s
a
n
d
in
f
r
a
s
tr
u
ct
u
r
e
is
t
h
e
m
ai
n
r
esp
o
n
s
i
b
ilit
y
o
f
th
e
h
ea
lt
h
in
s
t
itu
tio
n
.
C
o
o
r
d
in
atio
n
is
i
m
p
o
r
tan
t
to
d
o
w
ith
th
e
lo
ca
l
An
i
m
al
H
u
s
b
an
d
r
y
Ser
v
ice
a
s
a
r
ab
ies
-
tr
an
s
m
itted
an
i
m
al
m
a
n
ag
e
m
e
n
t
s
y
s
te
m
b
y
v
ac
cin
at
in
g
,
eli
m
in
at
in
g
,
an
d
lim
iti
n
g
t
h
e
tr
a
f
f
ic
o
f
r
ab
ies
-
tr
an
s
m
it
tin
g
an
i
m
als.
A
g
r
ea
ter
f
o
cu
s
o
n
m
as
s
d
o
g
v
ac
cin
a
tio
n
s
co
u
ld
eli
m
i
n
ate
d
is
ea
s
e
at
i
ts
s
o
u
r
ce
,
r
ed
u
ce
th
e
n
ee
d
f
o
r
co
s
tl
y
P
E
P
an
d
p
r
ev
en
t
m
aj
o
r
d
ea
th
s
i
n
co
m
m
u
n
it
ies at
r
is
k
[
11
]
.
4.
CO
NCLU
SI
O
N
P
u
b
lic
a
w
ar
en
e
s
s
ab
o
u
t
r
ab
ies
an
d
tr
ea
t
m
e
n
t
-
s
ee
k
i
n
g
b
eh
a
v
io
u
r
ar
e
h
i
g
h
l
y
p
r
io
r
itized
in
d
is
ea
s
e
p
r
ev
en
tio
n
a
n
d
c
o
n
tr
o
l.
I
n
i
tia
l
h
a
n
d
lin
g
o
f
GHP
R
is
a
n
i
m
p
o
r
ta
n
t
ac
tio
n
to
b
e
tak
e
n
i
m
m
ed
iatel
y
in
th
e
co
m
m
u
n
it
y
.
B
u
t
it
i
s
s
till
f
o
u
n
d
in
th
e
co
m
m
u
n
it
y
t
h
at
t
h
e
w
o
u
n
d
w
as
w
as
h
ed
i
m
p
r
o
p
er
ly
,
u
s
i
n
g
tr
ad
itio
n
al
m
ed
icin
e
s
o
n
GHP
R
w
o
u
n
d
s
an
d
v
is
i
tin
g
tr
ad
itio
n
al
h
e
aler
s
.
T
h
e
co
m
m
u
n
it
y
n
ee
d
s
to
g
et
i
m
p
o
r
tan
t
in
f
o
r
m
atio
n
o
n
ap
p
r
o
p
r
iate
h
an
d
lin
g
p
r
ac
tices
i
n
GHP
R
w
o
u
n
d
m
a
n
a
g
e
m
e
n
t.
P
E
P
is
a
n
i
m
m
ed
iate
ac
tio
n
f
o
r
ea
r
l
y
r
elief
w
h
e
n
v
icti
m
s
ar
e
ex
p
o
s
ed
to
GHP
R
.
P
E
P
is
c
o
n
d
u
cted
as
an
e
f
f
o
r
t
to
p
r
ev
en
t
th
e
v
ir
u
s
f
r
o
m
d
ev
elo
p
in
g
in
to
d
an
g
er
o
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[4
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9
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