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8806
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P
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w
d
iag
n
o
s
ed
o
f
T
B
b
ec
o
m
e
es
s
en
tial.
th
e
lack
o
f
k
n
o
w
led
g
e
a
m
o
n
g
co
m
m
u
n
it
y
a
n
d
T
B
p
atien
t
s
m
ig
h
t
i
n
cr
ea
s
e
t
h
e
p
r
o
g
r
ess
io
n
o
f
MD
R
-
T
B
in
f
u
t
u
r
e
[
7
]
.
Du
e
to
th
i
s
co
n
d
itio
n
,
th
e
p
atie
n
t
s
n
ee
d
t
o
b
e
em
p
o
w
er
ed
ea
r
l
ier
o
f
th
is
r
is
k
f
o
r
h
a
v
i
n
g
MD
R
-
T
B
in
th
e
f
u
t
u
r
e
if
th
e
y
ca
n
n
o
t
ad
h
er
e
th
e
m
ed
icatio
n
s
in
ce
t
h
e
b
eg
in
n
i
n
g
o
f
th
e
tr
e
at
m
e
n
t
o
f
T
B
[
8
,
9
]
.
T
h
u
s
,
it
i
s
a
n
ee
d
to
en
g
ag
e
h
ea
lt
h
p
r
o
f
ess
io
n
als
in
p
r
o
v
id
i
n
g
tr
ain
i
n
g
an
d
ed
u
ca
t
io
n
to
t
h
e
p
atien
ts
.
I
n
o
r
d
er
to
im
p
r
o
v
e
an
d
k
n
o
w
led
g
e
o
f
T
B
p
atien
ts
,
t
h
is
s
t
u
d
y
p
r
o
p
o
s
ed
to
m
o
d
if
y
th
e
u
s
e
o
f
m
ed
i
a
an
d
m
e
th
o
d
s
i
n
d
eli
v
er
in
g
h
ea
lth
ed
u
ca
tio
n
b
y
th
e
h
ea
l
th
p
r
o
f
es
s
io
n
al
s
.
T
h
e
p
u
r
p
o
s
e
o
f
th
is
s
t
u
d
y
w
a
s
t
o
in
v
es
tig
a
te
th
e
e
f
f
ec
t
o
f
h
ea
lth
ed
u
ca
tio
n
o
n
p
r
ev
en
tio
n
b
e
h
av
io
r
s
o
f
M
D
R
-
T
B
in
p
atien
ts
w
it
h
p
u
l
m
o
n
ar
y
tu
b
er
cu
lo
s
is
i
n
P
u
b
lic
Hea
lt
h
C
e
n
ter
,
P
ad
an
g
.
2.
RE
S
E
ARCH
M
E
T
H
O
D
T
h
is
s
t
u
d
y
u
s
ed
a
q
u
asi
-
e
x
p
er
i
m
en
tal
d
esi
g
n
w
i
th
p
r
e
-
p
o
s
t
test
w
i
th
o
u
t
co
n
tr
o
l
g
r
o
u
p
,
d
u
e
to
s
o
m
e
co
n
s
id
er
atio
n
s
u
c
h
as
li
m
ited
n
u
m
b
er
o
f
p
atien
ts
w
h
o
m
et
th
e
c
r
iter
ia,
an
d
also
n
o
t
all
th
e
p
atien
t
s
w
er
e
ac
co
m
p
a
n
ied
b
y
th
e
f
a
m
il
y
a
n
d
w
il
lin
g
to
in
v
o
lv
e
in
t
h
is
s
tu
d
y
.
W
e
m
a
n
ag
ed
to
co
n
tr
o
l
th
e
co
n
f
o
u
n
d
in
g
f
ac
to
r
s
b
y
li
m
ited
t
h
e
p
r
o
g
r
a
m
to
o
n
l
y
n
e
w
p
atie
n
t
s
t
h
at
n
e
v
er
atten
d
ed
an
y
ed
u
c
atio
n
a
l
p
r
o
g
r
a
m
ab
o
u
t
T
B
o
r
MD
R
-
T
B
.
2
.
1
.
P
o
pu
la
t
io
n a
nd
s
a
m
ple
T
h
e
s
a
m
p
lin
g
tec
h
n
iq
u
e
is
a
n
o
n
-
p
r
o
b
ab
ilit
y
w
it
h
p
u
r
p
o
s
iv
e
s
a
m
p
li
n
g
m
et
h
o
d
.
T
h
e
p
o
p
u
latio
n
o
f
th
is
s
t
u
d
y
w
as
6
1
n
e
w
l
y
d
iag
n
o
s
ed
w
it
h
T
B
B
T
A
(
+)
in
t
h
e
la
s
t
t
h
r
ee
m
o
n
th
s
.
Us
in
g
p
u
r
p
o
s
iv
e
s
a
m
p
li
n
g
eq
u
atio
n
,
t
h
er
e
w
er
e
2
9
r
es
p
o
n
d
en
ts
f
o
r
t
h
is
s
t
u
d
y
[
1
0
]
.
R
esp
o
n
d
e
n
ts
w
er
e
s
elec
ted
b
y
i
n
cl
u
s
io
n
a
n
d
ex
clu
s
io
n
cr
iter
ia.
T
h
e
in
cl
u
s
i
o
n
cr
iter
ia
o
f
th
i
s
s
t
u
d
y
w
er
e;
T
B
n
e
w
ca
s
e
w
ith
B
T
A
(
+)
,
th
e
p
ar
ticip
an
t
is
s
til
l
in
t
h
e
p
h
ase
o
f
tr
ea
t
m
e
n
t
(
ca
te
g
o
r
y
I
a
n
d
I
I
)
,
p
atien
t
s
w
h
o
f
a
ile
d
f
ir
s
t
-
lin
e
tr
ea
t
m
en
t
ea
r
lier
,
p
atien
ts
h
ad
g
o
o
d
co
m
m
u
n
icatio
n
an
d
co
o
p
er
ativ
e,
an
d
p
atie
n
t
s
w
h
o
h
a
v
e
n
e
v
er
r
ec
eiv
ed
h
ea
l
th
ed
u
ca
tio
n
a
b
o
u
t
T
B
g
en
er
all
y
.
W
h
ile
t
h
e
e
x
cl
u
s
io
n
cr
iter
ia
i
n
t
h
i
s
s
tu
d
y
w
er
e;
th
e
p
atien
t
w
h
o
h
ad
a
p
r
o
b
lem
i
n
h
ea
r
i
n
g
an
d
v
i
s
io
n
an
d
p
atien
ts
w
er
e
ab
s
e
n
t in
.
2
.
2
.
I
nte
rv
ent
io
n
T
h
e
s
tu
d
y
w
a
s
co
n
d
u
cted
f
o
r
f
o
u
r
m
o
n
t
h
s
w
h
ic
h
t
h
e
h
ea
l
th
ed
u
ca
tio
n
is
g
i
v
en
a
s
m
u
c
h
as
t
wo
s
ess
io
n
s
co
n
d
u
c
ted
in
o
n
e
m
o
n
th
.
Hea
lt
h
ed
u
ca
tio
n
ac
ti
v
itie
s
ca
r
r
ied
o
u
t
4
5
m
in
u
te
s
/s
e
s
s
i
o
n
.
W
e
in
v
o
lv
ed
th
e
h
ea
lt
h
p
r
o
f
ess
io
n
als
’
tea
m
in
d
eliv
er
i
n
g
i
n
f
o
r
m
atio
n
p
r
o
g
r
a
m
to
th
e
p
atien
ts
.
I
n
t
h
e
f
ir
s
t
s
es
s
io
n
,
b
e
f
o
r
e
h
ea
lth
ed
u
ca
tio
n
w
as
g
i
v
e
n
,
th
e
r
esp
o
n
d
en
ts
w
er
e
f
illi
n
g
o
u
t
q
u
e
s
tio
n
n
air
e
k
n
o
w
led
g
e
an
d
att
itu
d
e
s
ab
o
u
t
t
h
e
p
r
ev
e
n
tio
n
b
e
h
av
io
r
o
f
MD
R
-
T
B
(
p
r
etest).
I
n
th
i
s
s
ess
io
n
,
r
esp
o
n
d
e
n
t
s
w
er
e
g
iv
e
n
h
ea
lt
h
ed
u
ca
t
io
n
o
n
b
eh
av
io
r
p
r
ev
en
tio
n
o
f
MD
R
-
T
B
in
a
co
m
b
in
atio
n
l
ec
tu
r
e
m
e
th
o
d
an
d
d
is
cu
s
s
io
n
.
I
t
w
as
also
u
s
ed
th
e
elec
tr
o
n
ic
m
ed
ia
t
h
at
co
n
s
i
s
ts
o
f
s
l
id
e
an
d
v
id
eo
s
an
d
p
r
in
t
m
ed
ia
co
n
s
is
ti
n
g
o
f
f
lip
c
h
ar
t a
n
d
b
o
o
k
let
s
.
Af
ter
o
n
e
w
ee
k
,
th
e
h
ea
lth
ed
u
ca
tio
n
s
e
s
s
io
n
s
t
w
o
w
a
s
co
n
d
u
cted
in
th
e
s
a
m
e
to
p
ic.
I
n
t
h
is
s
e
s
s
io
n
,
b
ef
o
r
e
d
eliv
er
in
g
h
ea
lt
h
ed
u
ca
tio
n
,
r
esp
o
n
d
en
ts
w
er
e
ev
al
u
ated
ab
o
u
t
th
e
p
r
ev
en
tio
n
b
eh
av
io
r
o
f
MD
R
-
T
B
th
at
w
as
e
x
p
lain
ed
in
t
h
e
last
s
ess
io
n
.
T
h
e
to
p
ic
an
d
m
et
h
o
d
s
in
d
eliv
er
in
g
h
ea
lt
h
ed
u
c
atio
n
w
er
e
s
t
ill
th
e
s
a
m
e
as t
h
e
la
s
t ses
s
io
n
.
I
n
th
e
e
n
d
,
th
e
r
esp
o
n
d
en
t
s
wer
e
f
illi
n
g
o
u
t
q
u
est
io
n
n
air
es
k
n
o
w
led
g
e
an
d
attit
u
d
es
o
n
p
r
ev
en
tio
n
b
eh
av
io
r
MD
R
-
T
B
(
p
o
s
t
-
tes
t)
.
Af
ter
h
ea
lt
h
ed
u
ca
tio
n
w
as
f
in
is
h
ed
,
th
e
r
e
s
p
o
n
d
e
n
ts
w
er
e
ask
ed
to
f
ill
f
o
r
m
d
o
cu
m
en
tatio
n
o
f
b
eh
a
v
io
r
o
f
tak
i
n
g
T
B
d
r
u
g
s
f
o
r
t
w
o
w
ee
k
s
.
I
t
w
a
s
an
ev
al
u
atio
n
o
f
p
er
f
o
r
m
i
n
g
r
esp
o
n
d
en
t
s
in
tak
in
g
m
ed
icatio
n
o
f
T
B
d
r
u
g
s
.
2
.
3
.
Da
t
a
a
na
ly
s
is
T
h
e
q
u
esti
o
n
n
air
e
o
f
k
n
o
w
led
g
e
an
d
attitu
d
es
o
n
t
h
e
p
r
ev
en
t
io
n
b
eh
a
v
io
r
o
f
MD
R
-
T
B
u
s
ed
in
th
e
s
tu
d
y
w
as
d
er
iv
ed
f
r
o
m
t
h
e
s
t
u
d
y
o
f
t
h
e
k
n
o
w
led
g
e
q
u
e
s
tio
n
n
air
e
co
n
s
i
s
ted
o
f
1
5
q
u
e
s
tio
n
s
w
ith
t
h
e
s
co
r
es
r
an
g
e
f
r
o
m
0
-
1
5
u
s
i
n
g
G
u
t
m
an
Scale.
Fo
r
t
h
e
k
n
o
w
led
g
e,
t
h
is
s
t
u
d
y
as
s
ess
ed
th
e
k
n
o
w
led
g
e
r
e
g
ar
d
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
2
5
2
-
8806
Hea
lth
ed
u
ca
tio
n
o
n
mu
ltid
r
u
g
-
r
esis
ta
n
t tu
b
ercu
lo
s
is
p
r
ev
e
n
tio
n
o
f tu
b
ercu
lo
s
is
… (
Hem
a
Ma
lin
i
)
29
d
ef
in
i
tio
n
o
f
T
B
an
d
MD
R
-
T
B
,
s
y
m
p
to
m
s
,
ca
u
s
es,
an
d
p
r
ev
en
t
io
n
to
MD
R
T
B
[
8
]
.
A
tt
itu
d
e
q
u
esti
o
n
n
a
ir
e
co
n
s
is
ts
o
f
1
1
q
u
esti
o
n
s
w
it
h
L
ik
er
t
s
ca
le
o
f
1
-
4
w
it
h
an
1
1
-
4
4
s
co
r
e
r
an
g
e,
w
h
ic
h
m
e
asu
r
ed
th
e
clo
s
ed
attitu
d
e
o
f
r
elate
d
to
p
ics
as
m
en
tio
n
i
n
k
n
o
w
led
g
e
[1
1
]
.
Me
an
w
h
i
le,
d
o
cu
m
e
n
tatio
n
b
eh
av
io
r
in
tak
in
g
me
d
icatio
n
d
ev
elo
p
ed
b
y
th
e
r
esear
ch
er
to
b
e
f
illed
o
u
t
b
y
r
esp
o
n
d
en
ts
co
m
p
r
is
i
n
g
o
f
d
ay
/d
ate/ti
m
e,
t
y
p
e
o
f
m
ed
icatio
n
,
t
h
e
r
u
les
o
f
tak
i
n
g
th
e
m
ed
icatio
n
,
ta
k
in
g
m
ed
i
ca
tio
n
in
f
o
r
m
at
io
n
(
tak
i
n
g
m
e
d
icatio
n
/f
o
r
g
e
t
tak
e
m
ed
icatio
n
)
a
n
d
t
h
e
r
ea
s
o
n
f
o
r
n
o
t
tak
i
n
g
t
h
e
d
r
u
g
s
.
T
h
e
co
llected
d
ata
w
a
s
an
a
l
y
ze
d
u
s
i
n
g
b
y
s
tati
s
tical
p
ac
k
ag
e
f
o
r
t
h
e
s
o
cial
s
cie
n
c
e
(
SP
SS
)
v
er
s
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n
.
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h
e
d
ata
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y
s
i
s
w
as
p
er
f
o
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m
ed
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t
h
e
d
escr
ip
tiv
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tati
s
tic
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p
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ed
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-
test
.
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h
e
lev
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o
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ig
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f
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ce
in
t
h
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w
a
s
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et
at
p
<
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.
0
5
f
o
r
s
ta
tis
tical
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y
s
i
s
.
2
.
4
.
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t
hica
l
a
pp
ro
v
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l
T
h
is
s
t
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y
w
a
s
ap
p
r
o
v
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b
y
E
th
ics
C
o
m
m
ittee
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f
Fac
u
lt
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f
Me
d
icin
e,
U
n
i
v
er
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ita
s
An
d
al
as.
A
ll
t
h
e
r
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p
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to
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s
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th
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3.
RE
SU
L
T
S
A
ND
D
I
SCU
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O
N
T
h
e
r
esu
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ter
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ca
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o
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k
ill
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f
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ts
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ter
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s
h
o
w
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f
2
9
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esp
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n
v
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th
is
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t
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y
w
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e
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al
f
o
f
th
e
m
w
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u
lts
(
5
5
.
2
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f
e
m
ale
(
6
9
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w
ith
th
e
s
en
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h
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ch
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(
6
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as
lev
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le
1
.
Si
m
ilar
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s
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at
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Sah
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s
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v
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[1
2
]
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T
ab
le
1
.
C
h
ar
ac
ter
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tics
o
f
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p
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d
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ter
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llo
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w
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h
as
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ter
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F
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1
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aid
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h
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p
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r
in
ta
k
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m
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les
s
ac
ti
v
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b
ec
au
s
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th
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f
a
m
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l
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n
o
t
r
e
m
i
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d
in
g
th
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m
to
ta
k
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m
ed
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o
r
s
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p
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v
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s
e
t
h
e
r
esp
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d
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t
to
tak
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m
ed
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.
A
s
t
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d
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d
u
cted
in
U
g
an
d
a,
m
o
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if
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t
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p
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m
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m
in
d
er
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ev
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also
tex
t
m
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s
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,
f
o
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d
th
at
p
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ts
f
e
lt
t
h
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t
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tech
n
o
lo
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en
ab
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th
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m
f
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r
f
o
llo
w
i
n
g
t
h
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tr
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t
m
e
n
t
w
ell
[1
3
]
.
Si
m
i
lar
to
t
h
is
s
t
u
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y
,
L
ester
,
et
a
l.
[1
4
]
r
ec
o
m
m
en
d
ed
th
at
in
o
r
d
er
to
im
p
r
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v
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g
s
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p
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g
lo
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f
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r
T
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p
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,
t
h
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f
m
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b
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p
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es
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n
d
SMS
a
s
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m
in
d
er
i
n
m
ed
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.
T
h
u
s
,
in
f
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t
u
r
e,
in
o
r
d
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to
en
h
a
n
ce
th
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m
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h
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en
ce
a
m
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g
T
B
p
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,
h
ea
l
th
p
r
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f
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s
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s
co
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ld
u
s
e
th
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ti
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d
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d
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d
also
tex
ti
n
g
th
e
p
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s
as c
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t r
e
m
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d
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th
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m
.
Fu
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f
tak
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h
as
s
h
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w
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th
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ca
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r
p
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ev
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ti
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n
MD
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o
n
T
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p
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.
Hea
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ca
tio
n
s
h
o
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ld
i
n
v
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l
v
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t
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s
u
p
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v
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o
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o
r
f
a
m
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to
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m
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p
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t
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m
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r
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lar
l
y
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f
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d
r
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s
.
A
s
t
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d
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a
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atic
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ev
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w
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ce
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p
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ta
k
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m
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.
B
ar
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s
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u
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as
lo
w
m
o
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v
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,
lack
o
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p
p
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d
also
t
h
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ef
f
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ts
o
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p
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s
to
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p
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.
I
t
i
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o
m
m
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n
d
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at
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ts
-
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tr
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ap
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in
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th
e
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en
c
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a
m
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g
T
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p
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[1
5
]
.
Mo
r
eo
v
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,
B
o
r
u
,
et
a
l.
[1
6
]
in
th
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s
t
u
d
y
f
o
u
n
d
th
er
e
w
as
s
e
v
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f
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to
r
s
t
h
at
co
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tr
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to
th
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co
m
p
lian
ce
o
f
m
e
d
icatio
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a
m
o
n
g
T
B
p
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s
u
ch
a
s
:
lac
k
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eq
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f
o
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d
,
p
o
o
r
c
o
m
m
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icatio
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b
et
w
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p
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s
a
n
d
h
ea
l
th
p
r
o
f
ess
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n
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ls
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s
id
e
Evaluation Warning : The document was created with Spire.PDF for Python.
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30
ef
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t
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a
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d
also
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cr
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m
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a
tio
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[1
6
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.
A
s
tu
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al
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a
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[1
7
]
.
T
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y
h
as
a
n
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ti
n
g
MD
R
-
T
B
to
th
e
n
e
w
l
y
d
ia
g
n
o
s
is
T
B
p
a
tien
ts
.
T
h
e
in
v
o
l
v
e
m
e
n
t
o
f
h
ea
lt
h
p
r
o
f
ess
io
n
als
a
s
a
tea
m
w
o
u
ld
b
ec
o
m
e
a
s
i
g
n
if
ic
an
t
s
u
p
p
o
r
t
f
o
r
th
e
T
B
p
atien
ts
.
A
co
m
p
ar
ati
v
e
s
y
s
te
m
atic
r
ev
ie
w
ab
o
u
t
th
e
T
B
C
o
n
s
o
lia
w
o
r
k
in
g
a
tea
m
ap
p
r
o
ac
h
w
as
e
f
f
ec
ti
v
e
i
n
i
m
p
r
o
v
in
g
t
h
e
T
B
/MDR
-
T
B
m
a
n
ag
e
m
e
n
t
i
n
s
ev
er
al
c
o
u
n
tr
ies
[1
8
]
.
Gar
f
ein
a
n
d
D
o
s
h
i
[
1
9
]
an
d
C
h
e
n
,
et
a
l.
[
20
]
s
tated
th
at
t
h
e
u
s
e
o
f
v
id
eo
o
b
s
er
v
ed
th
er
ap
y
w
a
s
v
is
ib
le
a
n
d
ac
ce
p
tab
le
f
o
r
h
ea
lth
p
r
o
f
es
s
io
n
al
to
u
s
e
a
s
th
e
ac
ti
v
e
s
u
p
p
o
r
t
to
th
e
T
B
p
atien
ts
i
n
th
e
ir
m
ed
icatio
n
tr
ea
t
m
e
n
t.
T
ab
le
2
p
r
esen
ts
th
e
i
m
p
ac
t
o
f
h
ea
lt
h
ed
u
ca
tio
n
i
n
T
B
p
at
ien
ts
.
T
h
e
e
f
f
ec
t
o
f
h
ea
lt
h
ed
u
ca
tio
n
o
n
p
r
ev
en
tio
n
b
eh
a
v
io
u
r
o
f
MD
R
-
TB
in
co
m
m
u
n
it
y
h
ea
lt
h
ce
n
ter
in
P
ad
an
g
w
a
s
s
h
o
w
ed
th
at
t
h
er
e
ar
e
s
ig
n
i
f
ica
n
t
in
f
l
u
e
n
ce
s
o
f
h
ea
l
th
ed
u
ca
tio
n
o
n
k
n
o
w
led
g
e
(
p
=
0
.
0
0
0
)
.
M
o
r
eo
v
er
,
th
e
tab
le
s
h
o
w
ed
th
er
e
is
s
ig
n
i
f
ica
n
t in
f
l
u
e
n
ce
o
n
attit
u
d
es b
ef
o
r
e
an
d
af
ter
h
ea
l
th
ed
u
c
atio
n
(
p
=
0
.
0
0
0
)
.
T
ab
le
2
.
T
h
e
ef
f
ec
t o
f
h
ea
lt
h
ed
u
ca
tio
n
o
n
p
r
ev
e
n
tio
n
b
e
h
av
i
o
u
r
o
f
MD
R
-
T
B
in
co
m
m
u
n
it
y
h
ea
lt
h
ce
n
ter
s
i
n
P
ad
an
g
V
a
r
i
a
b
l
e
s
M
e
a
n
SD
M
e
a
n
D
i
f
f
e
r
e
n
c
e
t
p
-
v
a
l
u
e
K
n
o
w
l
e
d
g
e
Pre
-
t
e
st
7
.
9
0
3
.
6
1
9
2
.
8
3
6
.
3
7
0
.
0
0
0
P
o
st
-
t
e
st
1
0
.
7
2
2
.
8
9
A
t
t
i
t
u
d
e
Pre
-
t
e
st
2
6
.
7
9
5
.
7
5
4
.
0
7
6
.
2
6
0
.
0
0
0
T
h
er
e
is
s
ig
n
i
f
ica
n
t
in
f
l
u
en
ce
o
f
h
ea
lth
ed
u
ca
tio
n
in
i
m
p
r
o
v
in
g
r
esp
o
n
d
en
ts
’
k
n
o
w
led
g
e.
B
ef
o
r
e
f
o
llo
w
in
g
t
h
e
h
ea
lt
h
ed
u
ca
t
i
o
n
p
r
o
g
r
a
m
,
it
w
a
s
k
n
o
w
n
o
n
l
y
a
s
m
all
p
r
o
p
o
r
tio
n
o
f
r
e
s
p
o
n
d
en
ts
f
r
o
m
2
9
r
esp
o
n
d
en
ts
an
s
w
er
ed
co
r
r
ec
tly
,
w
ith
t
h
e
av
er
a
g
e
v
al
u
e
o
f
k
n
o
w
led
g
e
ar
e
7
.
9
0
.
T
h
e
an
aly
s
is
ite
m
s
a
n
s
w
er
ed
co
r
r
ec
tly
ar
e;
4
8
.
3
%
o
f
r
esp
o
n
d
en
t
s
a
w
ar
e
o
f
M
DR
-
T
B
tr
ea
t
m
e
n
t
f
o
r
1
8
-
2
4
m
o
n
t
h
s
;
4
8
.
3
%
k
n
o
w
h
o
w
to
av
o
id
tr
an
s
m
is
s
io
n
o
f
T
B
to
o
th
er
s
w
i
th
clo
s
i
n
g
n
o
s
e
a
n
d
m
o
u
t
h
w
h
en
co
u
g
h
in
g
o
r
s
n
ee
zi
n
g
u
s
i
n
g
a
h
an
d
k
er
ch
ie
f
,
an
d
4
4
.
8
%
aw
ar
e
o
f
MD
R
-
T
B
tr
ea
tm
e
n
t
l
o
n
g
er
th
a
n
r
eg
u
lar
T
B
.
Fu
r
th
er
m
o
r
e,
4
4
.
8
%
ar
e
a
w
ar
e
o
f
d
r
u
g
-
r
esi
s
ta
n
t
T
B
t
r
a
n
s
m
i
s
s
io
n
t
h
r
o
u
g
h
co
u
g
h
in
g
a
n
d
d
r
o
p
lets
o
f
p
atien
ts
;
4
1
.
4
%
k
n
o
w
t
h
at
T
B
is
n
o
t
ca
u
s
ed
b
y
s
m
o
k
i
n
g
,
a
n
d
3
7
.
9
%
k
n
o
w
t
h
e
m
ea
n
in
g
o
f
M
DR
-
T
B
.
A
f
ter
g
i
v
en
h
ea
lt
h
ed
u
ca
tio
n
,
t
h
er
e
i
s
a
s
ig
n
i
f
ica
n
t
i
n
cr
ea
s
e
i
n
k
n
o
w
l
ed
g
e;
ap
p
r
o
x
i
m
atel
y
7
2
.
4
%
a
w
ar
e
o
f
MD
R
-
T
B
tr
ea
tm
e
n
t
l
o
n
g
er
t
h
a
n
r
eg
u
lar
T
B
.
I
n
ad
d
itio
n
,
6
9
.
0
%
ar
e
aw
ar
e
o
f
MD
R
-
T
B
tr
ea
t
m
en
t
f
o
r
1
8
-
2
4
m
o
n
t
h
s
,
6
5
.
5
%
k
n
o
w
t
h
e
m
ea
n
in
g
o
f
MD
R
-
T
B
,
an
d
6
5
.
5
%
k
n
o
w
t
h
at
MD
R
-
T
B
is
n
o
t
ca
u
s
ed
b
y
s
m
o
k
i
n
g
.
F
u
r
th
er
m
o
r
e,
6
2
.
1
%
ar
e
aw
ar
e
th
a
t
MD
R
-
T
B
is
cu
r
ab
le.
Fu
r
th
er
m
o
r
e,
6
2
.
1
%
ar
e
aw
ar
e
o
f
th
e
tr
an
s
m
i
s
s
io
n
o
f
MD
R
-
T
B
b
y
co
u
g
h
i
n
g
an
d
d
r
o
p
let
o
f
p
atie
n
ts
.
Ho
w
e
v
er
,
o
n
l
y
5
8
.
6
%
w
er
e
a
w
ar
e
o
f
h
o
w
to
a
v
o
id
T
B
to
o
th
er
s
.
T
h
e
i
m
p
r
o
v
e
m
en
t
i
n
k
n
o
w
led
g
e
e
s
p
ec
iall
y
i
n
th
e
asp
ec
t
h
o
w
MD
R
-
T
B
co
u
ld
b
e
p
r
ev
en
ted
th
r
o
u
g
h
ed
u
ca
tio
n
p
r
o
g
r
a
m
.
T
h
e
en
g
a
g
e
m
e
n
t
p
r
o
g
r
am
b
et
w
ee
n
h
ea
lt
h
p
r
o
f
e
s
s
io
n
a
ls
a
n
d
p
atien
t
s
w
as
r
ec
o
m
m
en
d
ed
n
o
t
o
n
l
y
in
i
m
p
r
o
v
i
n
g
k
n
o
w
led
g
e
b
u
t
also
in
co
n
tr
o
lli
n
g
t
h
e
n
e
w
ca
s
es o
f
T
B
esp
ec
ially
i
n
u
r
b
an
ar
ea
[
6
,
2
1
]
.
I
n
cr
ea
s
ed
k
n
o
w
led
g
e
ab
o
u
t
t
h
e
p
r
ev
en
t
io
n
o
f
MD
R
-
T
B
is
also
in
f
lu
e
n
ce
d
b
y
t
h
e
f
ac
to
r
o
f
m
ed
ia
u
s
ed
in
h
ea
lt
h
ed
u
ca
tio
n
.
I
n
t
h
is
s
tu
d
y
,
th
e
m
et
h
o
d
u
s
ed
was
lectu
r
es
a
n
d
d
is
cu
s
s
io
n
g
r
o
u
p
s
w
it
h
s
lid
e
a
n
d
v
id
eo
.
T
h
e
lectu
r
e
m
eth
o
d
i
s
s
i
m
p
le
i
n
d
is
s
e
m
i
n
ati
n
g
i
n
f
o
r
m
atio
n
q
u
ick
l
y
.
Als
o
,
t
h
e
lectu
r
e
m
et
h
o
d
i
s
a
w
a
y
to
b
u
ild
a
r
elatio
n
s
h
ip
w
ith
t
h
e
r
esp
o
n
d
en
t
d
u
r
in
g
h
ea
lt
h
ed
u
ca
tio
n
.
T
h
e
u
s
e
o
f
elec
tr
o
n
ic
m
ed
ia
th
at
co
n
s
i
s
t
s
o
f
s
lid
es
a
n
d
v
id
eo
s
;
it
is
i
n
te
n
d
ed
th
at
th
e
r
esp
o
n
d
e
n
t
s
ta
y
f
o
cu
s
ed
s
o
t
h
at
th
e
m
ater
ial
w
a
s
p
r
esen
ted
w
ell
r
ec
eiv
ed
.
T
h
e
co
m
b
in
at
io
n
o
f
m
ed
ia
(
au
d
io
-
v
is
u
al)
an
d
ef
f
ec
tiv
e
co
m
m
u
n
icatio
n
d
u
r
i
n
g
d
eliv
er
in
g
h
ea
lt
h
ed
u
ca
tio
n
p
r
o
g
r
a
m
co
u
ld
b
e
e
f
f
ec
ti
v
e
i
n
i
m
p
r
o
v
i
n
g
k
n
o
w
le
d
g
e
a
n
d
b
eh
a
v
io
r
f
o
r
T
B
co
n
tr
o
l
[
4
,
2
2
, 2
3
]
.
A
c
h
a
-
An
y
i,
et
a
l.
[2
4
]
s
u
g
g
e
s
ted
th
at
in
p
r
o
v
id
in
g
h
ea
lt
h
ed
u
ca
ti
o
n
o
r
h
ea
lth
p
r
o
m
o
tio
n
p
r
o
g
r
am
,
th
e
u
s
e
o
f
s
o
cial
m
ed
ia
h
ad
i
m
p
o
r
tan
t
r
o
le
i
n
p
r
o
v
id
in
g
h
ea
lt
h
i
n
f
o
r
m
atio
n
.
E
v
en
th
o
u
g
h
in
th
is
s
t
u
d
y
,
t
h
e
r
esear
ch
e
r
s
u
s
ed
th
e
W
h
ats
A
p
p
g
r
o
u
p
as
t
h
e
r
e
m
i
n
d
er
f
o
r
p
atien
ts
to
atten
d
th
e
p
r
o
g
r
a
m
,
th
e
h
ea
lt
h
ed
u
ca
tio
n
w
a
s
s
till
u
s
e
f
ac
e
to
f
ac
e
in
ter
ac
tio
n
.
T
h
e
u
s
e
o
f
s
o
cial
m
ed
ia
co
u
ld
b
ec
o
m
e
a
r
ec
o
m
m
e
n
d
atio
n
i
n
f
u
r
t
h
er
s
tu
d
y
to
i
n
v
e
s
ti
g
ate
th
e
i
m
p
ac
t o
f
s
o
cial
m
ed
ia
to
th
e
h
ea
lt
h
b
eh
av
io
r
s
.
B
esid
es
i
m
p
r
o
v
in
g
k
n
o
w
led
g
e
o
f
r
esp
o
n
d
e
n
ts
,
h
ea
l
th
ed
u
ca
tio
n
h
as
an
i
m
p
ac
t
o
n
i
m
p
r
o
v
in
g
t
h
e
attitu
d
es
o
n
t
h
e
p
r
ev
en
tio
n
b
e
h
av
io
r
o
f
MD
R
-
T
B
.
B
ef
o
r
e
g
iv
en
h
ea
lt
h
ed
u
ca
tio
n
,
o
n
l
y
a
s
m
all
p
er
ce
n
ta
g
e
o
f
r
esp
o
n
d
en
ts
an
s
w
er
ed
ap
p
r
o
p
r
iatel
y
.
I
t
w
as
k
n
o
w
n
4
8
.
2
%
d
is
ag
r
ee
d
s
p
u
t
u
m
o
f
T
B
p
atien
ts
to
b
e
t
h
r
o
w
n
a
w
a
y
ca
r
ele
s
s
l
y
,
4
1
.
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31
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ea
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T
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lar
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(
6
4
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5
%).
E
v
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g
h
t
h
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w
a
s
s
t
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m
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p
atie
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ts
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d
to
tak
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lar
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I
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n
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ce
a
m
o
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g
T
B
p
atien
ts
in
th
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,
it
i
s
s
u
g
g
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ted
to
u
s
e
tech
n
o
lo
g
y
s
u
c
h
as
SMS
tex
t
as
r
em
i
n
d
er
s
an
d
also
to
h
elp
th
e
p
atien
t
s
in
m
a
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p
licate
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(
m
an
y
p
ill
s
to
co
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u
m
e
i
n
a
d
a
y
)
[1
3
,
2
3
,
2
5
,
2
6
]
.
Fu
r
t
h
er
m
o
r
e,
s
o
m
e
ap
p
r
o
ac
h
in
in
v
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lv
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x
p
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p
atien
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m
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v
ate
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ir
p
ee
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s
in
co
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s
u
m
in
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a
n
d
s
tr
ict
to
t
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al
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t i
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ce
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o
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iti
v
e
at
tit
u
d
es
a
m
o
n
g
T
B
p
atien
ts
[2
7
]
.
Si
m
ilar
to
th
i
s
s
tu
d
y
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h
ea
l
th
ed
u
ca
tio
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p
r
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m
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ter
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s
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ci
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g
p
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s
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T
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r
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.
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i
m
p
r
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m
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t
in
attit
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es
w
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e
p
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u
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tio
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i
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f
l
u
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ce
th
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d
en
t’
s
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h
e
k
n
o
w
led
g
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o
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T
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is
b
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g
p
r
ed
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r
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b
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attitu
d
e
an
d
g
o
o
d
p
r
ev
en
tio
n
o
f
T
B
[2
8
-
30
]
.
T
h
is
s
tu
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y
h
a
s
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li
m
itatio
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.
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th
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w
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ld
lead
to
MD
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T
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a
m
o
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g
p
atie
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ts
.
I
t
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s
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m
m
en
d
ed
t
h
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p
r
ev
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n
ti
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f
o
r
T
B
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b
ec
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m
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MD
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T
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in
t
h
e
f
u
tu
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u
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m
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tr
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en
t a
m
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n
g
T
B
p
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ts
[1
7
, 3
1
]
.
4.
CO
NCLU
SI
O
N
B
ased
o
n
th
e
r
esear
ch
t
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b
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o
f
th
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p
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ev
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t
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f
M
DR
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T
B
in
T
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p
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i
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Hea
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C
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ter
P
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cit
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b
y
d
eliv
er
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n
g
h
ea
l
th
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u
ca
t
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n
,
it
ca
n
b
e
co
n
c
lu
d
ed
,
th
er
e
is
th
e
in
f
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ce
o
f
h
ea
lt
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u
ca
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in
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cr
ea
s
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k
n
o
w
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f
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ti
v
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av
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s
o
f
MD
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-
T
B
.
T
h
is
s
tu
d
y
u
s
ed
a
co
m
b
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m
et
h
o
d
in
d
eliv
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r
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t
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u
ca
t
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s
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s
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s
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s
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a
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v
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u
al
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d
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s
o
p
r
o
v
id
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w
r
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tten
in
f
o
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m
at
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n
,
w
h
ic
h
w
as
ac
ce
p
tab
le
b
y
t
h
e
p
atie
n
ts
.
T
h
e
h
ea
lt
h
ed
u
ca
tio
n
ab
o
u
t
MD
R
-
T
B
p
r
ev
en
tio
n
b
eh
av
io
r
s
ca
n
i
m
p
r
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v
e
th
e
k
n
o
w
led
g
e
o
f
p
u
l
m
o
n
ar
y
T
B
p
atien
ts
.
Hea
lth
ed
u
ca
tio
n
i
n
f
lu
e
n
ce
s
r
esp
o
n
d
en
ts
'
at
tit
u
d
es
to
w
ar
d
th
e
i
n
c
r
ea
s
e
in
MD
R
-
T
B
p
r
ev
en
tiv
e
b
eh
av
io
r
.
Hea
lt
h
ed
u
ca
tio
n
ab
o
u
t
M
DR
-
T
B
p
r
ev
en
t
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n
b
eh
a
v
io
r
s
ca
n
i
m
p
r
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v
e
th
e
a
ttit
u
d
e
o
f
p
u
l
m
o
n
ar
y
T
B
p
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ts
.
T
h
e
r
esu
lt
i
s
ex
p
ec
ted
to
i
m
p
r
o
v
e
th
eir
ab
ilit
y
,
s
k
ill
s
,
an
d
ex
p
er
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ce
.
A
s
w
e
ll
as
b
r
o
ad
en
its
r
esear
c
h
er
s
in
co
n
d
u
cti
n
g
s
cie
n
ti
f
ic
r
esear
c
h
,
p
ar
ticu
lar
l
y
i
n
t
h
e
p
r
o
v
i
s
io
n
o
f
h
ea
lth
ed
u
ca
tio
n
o
n
p
r
ev
e
n
tio
n
b
e
h
av
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r
s
o
f
MD
R
-
T
B
.
ACK
NO
WL
E
D
G
E
M
E
NT
S
T
h
e
au
th
o
r
s
ar
e
g
r
atef
u
l
to
all
th
e
r
esp
o
n
d
en
ts
a
n
d
h
ea
lt
h
p
r
o
f
ess
io
n
al
s
in
v
o
lv
ed
i
n
th
i
s
s
tu
d
y
f
o
r
th
eir
co
o
p
er
atio
n
d
u
r
in
g
d
ata
c
o
llectio
n
an
d
th
e
ed
u
ca
tio
n
al
p
r
o
g
r
a
m
.
RE
F
E
R
E
NC
E
S
[1
]
Po
c
k
e
t
Bo
o
k
o
f
T
B
M
DR
Pa
ti
e
n
ts
.
M
in
istry
o
f
He
a
lt
h
,
RI
,
2
0
1
5
.
[2
]
T
h
e
Da
t
a
o
f
T
B
Pa
t
ien
ts
i
n
P
u
sk
e
sm
a
s L
u
b
u
k
Beg
a
lu
n
g
.
P
a
d
a
n
g
Ci
ty
H
e
a
lt
h
Off
ice
,
2
0
1
8
.
[3
]
G
.
J.
F
o
x
,
H.
S
.
S
c
h
a
a
f
,
A
.
M
a
n
d
a
lak
a
s,
E.
Ch
ia
p
p
i
n
i,
A
.
Zu
m
l
a
,
a
n
d
B.
J.
M
a
ra
is,
"
P
re
v
e
n
ti
n
g
th
e
sp
re
a
d
o
f
m
u
lt
id
ru
g
-
re
sista
n
t
tu
b
e
rc
u
lo
sis
a
n
d
p
r
o
tec
ti
n
g
c
o
n
tac
ts
o
f
in
f
e
c
ti
o
u
s
c
a
se
s,
"
Cli
n
ica
l
M
icr
o
b
io
lo
g
y
a
n
d
I
n
fec
ti
o
n
,
v
o
l.
2
3
,
n
o
.
3
,
p
p
.
1
4
7
-
1
5
3
,
2
0
1
7
,
d
o
i:
h
tt
p
s://
d
o
i
.
o
rg
/1
0
.
1
0
1
6
/j
.
c
m
i.
2
0
1
6
.
0
8
.
0
2
4
.
[4
]
S
.
A
ru
lch
e
lv
a
n
a
n
d
R
.
El
a
n
g
o
v
a
n
,
"
Ef
fe
c
ti
v
e
c
o
m
m
u
n
ica
ti
o
n
a
p
p
ro
a
c
h
e
s
in
t
u
b
e
rc
u
l
o
sis
c
o
n
tro
l:
He
a
lt
h
w
o
rk
e
rs’
p
e
rc
e
p
ti
o
n
s
a
n
d
e
x
p
e
rien
c
e
s,"
In
d
ia
n
J
o
u
rn
a
l
o
f
T
u
b
e
rc
u
lo
sis,
v
o
l
.
6
4
,
n
o
.
4
,
p
p
.
3
1
8
-
3
2
2
,
2
0
1
7
.
[5
]
G
.
B.
M
ig
li
o
ri
,
e
t
a
l.
,
"
M
DR/X
D
R
-
T
B
m
a
n
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