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[
14]
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[
15]
,
a
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l
o
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[
14]
.
2.
RE
S
E
AR
CH
M
E
T
HO
D
T
hi
s
s
t
ud
y
wa
s
a
ppr
o
v
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d
by
t
he
e
t
hi
c
a
l
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o
m
mi
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o
f
t
h
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M
e
d
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l
F
a
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l
t
y
,
S
r
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w
ij
a
y
a
U
ni
ve
r
s
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t
y
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No.
364/kepkr
s
m
hf
ku
n
s
r
i
/2016)
.
T
hi
s
r
e
s
e
a
r
c
h
w
a
s
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o
n
duc
t
e
d
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n
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ly
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h
m
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h
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s
t
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e
n
t
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d
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t
i
o
nna
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o
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ne
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f
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a
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T
h
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x
pe
c
t
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d
n
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m
be
r
o
f
s
a
m
p
l
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wa
s
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s
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s
400
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t
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ll
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w
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r
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f
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ne
d
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s
p<
0.
05.
T
h
e
s
t
a
t
i
s
t
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c
a
n
a
ly
s
i
s
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s
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e
us
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ng
I
B
M
S
P
S
S
S
t
a
t
i
s
t
i
c
s
B
a
s
e
22.
0.
3.
RE
S
UL
T
S
A
ND
DI
S
CU
S
S
I
ONS
I
n
t
hi
s
s
t
ud
y
t
h
e
r
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we
r
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1.
124
r
e
s
po
n
de
n
t
s
m
a
t
c
h
e
d
t
h
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nc
l
us
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c
r
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t
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r
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a
.
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h
e
a
n
a
ly
s
i
s
wa
s
do
n
e
b
y
uni
va
r
i
a
t
e
,
bi
va
r
i
a
t
e
a
n
d
m
u
l
t
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va
r
i
a
t
e
.
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h
e
s
t
ud
y
a
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m
e
d
t
o
de
t
e
r
m
i
ne
t
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de
t
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m
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na
n
t
s
o
f
m
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d
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c
a
l
s
t
ude
n
t
s
’
i
n
t
e
r
e
s
t
to
w
o
r
k
i
n
r
ur
a
l
a
r
e
a
s
.
3.
1.
Dis
t
r
ib
u
t
ion
of
m
e
d
ical
s
t
u
d
e
n
t
s
’
in
t
e
r
e
s
t
t
o
wor
k
in
r
u
r
al
a
r
e
a
s
T
h
e
r
e
we
r
e
748
(
66.
5%
)
o
f
s
t
ude
n
t
s
s
h
o
w
i
n
g
i
n
t
e
r
e
s
t
o
f
wo
r
k
i
n
g
i
n
r
ur
a
l
a
r
e
a
s
a
s
s
h
o
w
n
i
n
T
a
bl
e
1
.
Out
o
f
1124
r
e
s
po
n
d
e
n
t
s
,
t
h
e
r
e
we
r
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943
of
r
e
s
po
nde
n
t
s
h
a
d
t
h
e
e
x
pe
r
i
e
nc
e
o
f
vi
s
i
t
i
ng
r
ur
a
l
a
r
e
a
s
,
a
nd
68.
9%
o
f
t
h
e
m
h
a
d
t
he
i
n
t
e
r
e
s
t
of
wo
r
k
i
n
g
i
n
r
ur
a
l
a
r
e
a
s
.
R
e
s
po
n
de
n
t
s
w
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t
h
n
o
pa
s
t
e
x
pe
r
i
e
n
c
e
o
f
vi
s
i
t
i
n
g
r
ur
a
l
a
r
e
a
s
we
r
e
a
s
m
a
ny
a
s
181
a
n
d
54.
1%
o
f
t
h
e
m
we
r
e
i
n
t
e
r
e
s
t
e
d
to
w
o
r
k
i
n
r
ur
a
l
a
r
e
a
s
.
T
h
e
pe
r
c
e
n
t
a
ge
o
f
s
t
ude
n
t
s
’
pr
e
f
e
r
e
n
c
e
o
f
wo
r
ki
n
g
i
n
r
ur
a
l
a
r
e
a
s
wa
s
hi
g
he
r
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n
t
h
o
s
e
wi
t
h
pa
s
t
e
x
pe
r
i
e
n
c
e
o
f
vi
s
i
t
i
ng
r
ur
a
l
a
r
e
a
s
.
T
a
bl
e
1.
C
h
a
r
a
c
t
e
r
i
s
t
i
c
s
o
f
m
e
d
i
c
a
l
s
t
ude
n
t
s
’
i
n
t
e
r
e
s
t
to
w
o
r
k
i
n
r
ur
a
l
a
r
e
a
s
M
e
di
c
a
l
s
tu
de
n
ts
’
i
nt
e
r
e
s
t
to
w
o
r
k i
n
r
ur
a
l
a
r
e
a
s
N
%
I
nt
e
r
e
s
t
e
d
748
66.5
U
ni
nt
e
r
e
s
te
d
376
33.5
T
ot
a
l
1,124
100
3.
2.
De
t
e
r
m
in
an
t
s
of
m
e
d
ica
l
s
t
u
d
e
n
t
s
’
in
t
e
r
e
s
t
t
o
wor
k
in
r
u
r
a
l
a
r
e
as
De
t
e
r
m
i
na
n
t
s
whi
c
h
i
nf
l
ue
n
c
e
d
m
e
d
i
c
a
l
s
t
ude
n
ts
’
i
n
t
e
r
e
s
t
o
f
wo
r
ki
n
g
i
n
r
ur
a
l
a
r
e
a
s
we
r
e
pa
s
t
e
x
pe
r
i
e
n
c
e
o
f
vi
s
i
t
i
ng
r
ur
a
l
a
r
e
a
s
(
p
<
0.
001)
,
c
a
r
e
e
r
o
pp
o
r
t
uni
t
i
e
s
(
p
<
0.
001)
,
f
a
mi
ly
e
c
o
n
o
m
i
c
s
t
a
t
us
(p
=
0.
001)
,
pr
o
xi
mi
t
y
o
f
l
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c
a
t
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o
n
to
f
a
mi
ly
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p=
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.
001)
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a
l
a
r
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a
’
s
f
a
c
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li
t
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s
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a
l
c
o
mm
u
ni
t
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c
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l
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ur
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005
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s
t
ude
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t
s
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l
if
e
s
t
y
l
e
(
p=
0.
005)
,
c
u
r
r
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c
u
l
u
m
a
b
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r
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a
l
a
r
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a
(
p=
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007)
,
pr
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mi
t
y
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f
l
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c
a
t
i
o
n
to
s
po
us
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p=
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031)
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a
n
d
u
ni
ve
r
s
i
t
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l
o
c
a
t
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o
n
(
p=
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049)
.
A
s
c
a
n
b
e
s
e
e
n
i
n
T
a
bl
e
2
, p
a
s
t
e
x
pe
r
i
e
n
c
e
o
f
vi
s
i
t
i
ng
r
ur
a
l
a
r
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a
wa
s
t
h
e
m
o
s
t
d
o
m
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na
n
t
f
a
c
t
o
r
i
n
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n
f
l
ue
nc
i
n
g
s
t
ude
n
t
i
n
t
e
r
e
s
t
to
w
or
k
i
n
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a
l
a
r
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s
w
i
t
h
t
he
hi
g
h
e
s
t
o
dd
r
a
t
i
o
o
f
2
.
281.
T
a
bl
e
2.
De
t
e
r
m
i
na
n
t
s
o
f
m
e
d
i
c
a
l
s
t
ude
n
t
s
’
i
n
t
e
r
e
s
t
to
w
o
r
k
i
n
r
ur
a
l
a
r
e
a
s
V
a
r
ia
bl
e
s
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R
(
95%
C
I
)
P
P
a
s
t
e
x
p
e
r
ie
n
c
e
of
v
is
it
in
g
r
ur
a
l
a
r
e
a
2.281
(
1.689
-
3.082)
<
0.001
C
a
r
e
e
r
o
pp
o
r
tu
ni
t
y
2.157 (
1.425
-
3.265)
<
0.001
F
a
mi
l
y
e
c
o
n
o
mi
c
s
ta
tu
s
0.567 (
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a
s
c
a
r
e
e
r
l
o
c
a
t
i
o
n
[
14,
28]
.
M
e
d
i
c
a
l
s
t
ude
n
t
s
a
l
s
o
a
s
s
u
m
e
d
t
h
a
t
c
ul
t
ur
e
s
o
f
r
ur
a
l
a
r
e
a
s
c
o
u
l
d
a
l
s
o
b
e
i
n
c
o
n
s
i
de
r
a
t
i
o
n
i
n
c
h
o
o
s
i
n
g
r
ur
a
l
a
r
e
a
s
a
s
c
a
r
e
e
r
l
o
c
a
t
i
o
n
.
W
hi
l
e
l
a
c
k
o
f
i
nf
r
a
s
t
r
uc
t
ur
e
a
n
d
f
a
c
il
i
t
i
e
s
i
n
r
ur
a
l
a
r
e
a
s
de
m
o
t
i
va
t
e
d
m
e
d
i
c
a
l
s
t
ude
n
t
s
to
w
o
r
k
t
h
e
r
e
[
1,
29
-
30
]
.
F
a
r
m
o
r
e
a
dv
a
n
c
e
d
f
a
c
il
i
t
i
e
s
i
n
ur
ba
n
a
r
e
a
s
c
a
us
e
d
t
h
e
m
e
d
i
c
a
l
s
t
ude
n
t
s
to
b
e
m
o
r
e
i
n
t
e
r
e
s
t
e
d
to
w
or
k
i
n
ur
b
a
n
a
r
e
a
s
[
14]
.
C
a
r
e
e
r
o
pp
o
r
tuni
t
i
e
s
i
n
r
ur
a
l
a
r
e
a
s
a
l
s
o
a
f
f
e
c
t
e
d
s
t
ude
n
t
s
'
i
n
t
e
r
e
s
t
to
r
ur
a
l
pr
a
c
t
i
c
e
s
[
14]
.
C
o
n
s
i
de
r
e
d
m
o
ne
t
a
r
y
c
o
m
pe
ns
a
t
i
o
n
a
l
s
o
e
n
t
i
c
e
d
m
e
d
i
c
a
l
s
t
ud
e
n
t
to
w
o
r
k
i
n
r
ur
a
l
a
r
e
a
s
[
28]
.
W
il
li
ng
n
e
s
s
o
f
wo
r
k
i
n
g
i
n
c
e
r
t
a
i
n
a
r
e
a
s
i
s
a
l
s
o
i
n
f
l
ue
n
c
e
d
by
t
h
e
s
t
ude
n
t
s
’
n
o
r
m
s
[
31]
.
Ge
ne
r
a
l
pr
a
c
t
i
t
i
o
n
e
r
e
s
pe
c
i
a
ll
y
i
n
r
ur
a
l
a
r
e
a
s
,
i
s
s
t
i
ll
t
h
e
l
e
a
s
t
pr
e
f
e
r
r
e
d
c
a
r
e
e
r
pr
o
s
pe
c
t,
w
i
t
h
pe
r
s
o
na
l
i
n
t
e
r
e
s
t
a
n
d
s
o
c
i
a
l
f
a
c
to
r
s
a
s
m
a
i
n
de
t
e
r
m
i
na
n
t
s
.
C
a
r
e
e
r
c
h
o
i
c
e
s
s
h
o
u
l
d
b
e
e
a
r
ly
i
n
t
r
o
duc
e
d
to
s
t
ude
n
t
s
s
o
t
h
e
y
c
a
n
s
t
a
r
t
e
x
p
l
o
r
i
n
g
a
n
d
de
t
e
r
m
i
ne
t
h
e
r
i
g
h
t
c
h
o
i
c
e
s
f
o
r
i
t
[
32]
.
Al
l
pa
r
t
i
e
s
i
n
c
l
ud
i
ng
a
c
a
d
e
m
i
c
i
ns
t
i
t
u
t
i
o
ns
a
n
d
po
l
i
c
ym
a
ke
r
s
s
h
o
u
l
d
c
o
n
s
i
de
r
t
hi
s
w
h
e
n
p
l
a
nni
ng
a
t
t
r
a
c
t
i
o
n
a
n
d
r
e
t
e
n
t
i
o
n
s
t
r
a
t
e
gi
e
s
t
o
de
c
e
n
t
r
a
l
i
z
e
do
c
to
r
s
d
i
s
t
r
i
b
ut
i
o
n
f
r
o
m
ur
b
a
n
to
r
ur
a
l
a
r
e
a
s
[
33]
.
4.
CONC
L
USI
ON
De
t
e
r
m
i
na
n
t
s
o
f
i
n
t
e
r
e
s
t
o
f
m
e
d
i
c
a
l
s
t
ude
n
t
s
’
to
wo
r
k
i
n
r
ur
a
l
a
r
e
a
s
we
r
e
p
a
s
t
e
x
p
e
r
i
e
nc
e
o
f
vi
s
i
t
i
ng
r
ur
a
l
a
r
e
a
,
c
a
r
e
e
r
o
ppor
t
uni
t
y
,
f
a
mi
ly
e
c
o
n
o
m
i
c
s
t
a
t
us
,
pr
o
x
i
mi
t
y
o
f
l
o
c
a
t
i
o
n
t
o
f
a
mi
ly
,
r
ur
a
l
a
r
e
a
’
s
f
a
c
il
i
t
i
e
s
,
Evaluation Warning : The document was created with Spire.PDF for Python.
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M
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tudents
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(
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r
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nf
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s
t
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n
t
s
’
i
n
t
e
r
e
s
t
o
n
r
ur
a
l
pr
a
c
t
i
c
e
s
.
AC
K
NOWL
E
DGE
M
E
NT
S
T
h
e
a
ut
h
o
r
s
wo
u
l
d
li
ke
t
o
de
l
i
ve
r
gr
a
t
i
t
ude
to
S
r
i
w
i
j
a
y
a
U
ni
ve
r
s
i
t
y
f
o
r
m
a
k
i
ng
t
hi
s
s
t
ud
y
po
s
s
i
b
l
e
a
n
d
a
ll
pa
r
t
i
e
s
t
h
a
t
s
uppo
r
t
e
d
t
hi
s
s
t
ud
y
.
RE
F
E
R
E
NC
E
S
[1
]
Bu
d
h
at
h
o
k
i
SS
,
Z
w
a
n
i
k
k
en
PA
C
,
P
o
k
h
ar
e
l
PK
,
S
c
h
e
rp
b
i
e
r
A
J
.
Fa
c
t
o
rs
i
n
f
l
u
en
c
i
n
g
med
i
c
a
l
s
t
u
d
e
n
t
s
'
mo
t
i
v
at
i
o
n
t
o
p
rac
t
i
s
e
i
n
r
u
ral
ar
e
as
i
n
l
o
w
-
i
n
c
o
me
a
n
d
mi
d
d
l
e
-
i
n
co
me
co
u
n
t
ri
e
s
:
a
s
y
s
t
em
at
i
c
r
e
v
i
ew
.
B
M
J
O
p
en
2
0
1
7
;
7
(2
):
e
0
1
3
5
0
1
. (
h
t
t
p
s
:
/
/
w
w
w
.
n
c
b
i
.
n
l
m
.
n
i
h
.
g
o
v
/
p
u
b
med
/
2
8
2
3
2
4
6
5
)
[2
]
So
u
s
a
A
,
D
al
P
o
z
MR
,
Bo
s
c
h
i
-
Pi
n
t
o
C
.
R
e
d
u
c
i
n
g
i
n
e
q
u
i
t
i
e
s
i
n
n
e
o
n
at
al
mo
rt
al
i
t
y
t
h
r
o
u
g
h
ad
e
q
u
at
e
s
u
p
p
l
y
o
f
h
eal
t
h
w
o
rk
e
rs
:
e
v
i
d
en
ce
fro
m
N
ew
b
o
rn
H
e
a
l
t
h
i
n
Brazi
l
.
P
Lo
S
O
NE
2013;
8
:
e
7
4
7
7
2
.
(
h
t
t
p
:
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/
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o
u
rn
a
l
s
.
p
l
o
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i
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d
=
1
0
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j
o
u
r
n
al
.
p
o
n
e
.
0
0
7
4
7
7
2
)
[3
]
Sri
n
i
v
as
an
CS,
Z
an
el
l
o
G
,
Sh
an
k
ar
B.
Ru
ra
l
-
u
rb
an
d
i
s
p
ari
t
i
e
s
i
n
ch
i
l
d
n
u
t
ri
t
i
o
n
i
n
Ba
n
g
l
ad
e
s
h
an
d
N
e
p
al
.
B
M
C
P
u
b
H
ea
l
t
h
2
0
1
3
;
1
3
:
5
8
1
. (
h
t
t
p
s
:
/
/
b
m
c
p
u
b
l
i
c
h
e
a
l
t
h
.
b
i
o
me
d
cen
t
ral
.
c
o
m
/
art
i
c
l
e
s
/
1
0
.
1
1
8
6
/
1
4
7
1
-
2
4
5
8
-
13
-
5
8
1
)
[4
]
Ce
n
t
ral
B
u
r
e
au
o
f
St
at
i
s
t
i
c
s
Re
p
u
b
l
i
c
o
f
In
d
o
n
e
s
i
a.
T
h
e
N
u
m
b
e
r
o
f
Sp
eci
al
i
s
t
D
o
c
t
o
rs
,
G
en
e
ral
Ph
y
s
i
c
i
a
n
s
,
an
d
D
en
t
i
s
t
i
n
H
e
al
t
h
Car
e
Faci
l
i
t
i
e
s
i
n
N
i
as
Reg
e
n
cy
.
(
i
n
Bah
as
a:
B
a
n
ya
kn
ya
D
o
k
t
er
S
p
e
s
i
a
l
i
s
,
D
o
kt
e
r
U
m
u
m
,
d
a
n
D
o
kt
er
G
i
g
i
d
i
S
a
r
a
n
a
P
el
a
ya
n
a
n
Ke
s
eh
a
t
a
n
d
i
Ka
b
u
p
a
t
en
N
i
a
s
2
0
1
3
,
2
0
1
3
.
(
h
t
t
p
s
:
/
/
n
i
as
b
ara
t
k
ab
.
b
p
s
.
g
o
.
i
d
/
l
i
n
k
T
ab
el
St
at
i
s
/
v
i
ew
/
i
d
/
3
2
)
[5
]
Mi
n
i
s
t
ry
o
f
H
e
a
l
t
h
R
e
p
u
b
l
i
c
o
f
I
n
d
o
n
e
s
i
a.
“
St
rat
e
g
i
c
Pl
an
o
f
t
h
e
Mi
n
i
s
t
r
y
o
f
H
e
al
t
h
f
o
r
2
0
1
5
-
2
0
1
9
”
(i
n
Bah
as
a:
“
R
en
c
a
n
a
S
t
r
a
t
eg
i
s
Kem
en
t
r
i
a
n
Ke
s
eh
a
t
a
n
Ta
h
u
n
2
0
1
5
-
2
0
1
9
”)
.
J
ak
art
a:
Mi
n
i
s
t
ry
o
f
H
e
a
l
t
h
Re
p
u
b
l
i
c
o
f
I
n
d
o
n
es
i
a
,
2
0
1
5
.
(
w
w
w
.
d
e
p
k
e
s
.
g
o
.
i
d
/
re
s
o
u
r
ce
s
/
d
o
w
n
l
o
ad
/
i
n
fo
-
p
u
b
l
i
k
/
Ren
s
t
ra
-
2
0
1
5
.
p
d
f
)
[6
]
N
k
o
m
aza
n
a
O
,
Mas
h
R,
Sh
a
i
b
u
S,
Ph
a
l
ad
z
e
N
.
St
ak
eh
o
l
d
e
rs
’
p
e
r
ce
p
t
i
o
n
s
o
n
s
h
o
rt
ag
e
o
f
h
e
al
t
h
c
ar
e
w
o
r
k
e
r
s
i
n
p
ri
m
ar
y
h
e
a
l
t
h
c
ar
e
i
n
B
o
t
s
w
a
n
a:
fo
c
u
s
g
ro
u
p
d
i
s
cu
s
s
i
o
n
s
.
P
Lo
S
O
n
e
2
0
1
5
;
1
0
(8
):
e
0
1
3
5
8
4
6
.
(
h
t
t
p
:
/
/
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o
u
rn
al
s
.
p
l
o
s
.
o
rg
/
p
l
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c
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e
?
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d
=
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0
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1
/
j
o
u
rn
al
.
p
o
n
e
.
0
1
3
5
8
4
6
)
[7
]
A
l
i
O
,
N
o
o
r
MT
M.
R
u
r
a
l
M
ed
i
ca
l
E
d
u
ca
t
i
o
n
i
n
S
a
b
a
h
,
M
a
l
a
ys
i
a
.
Ban
g
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