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l J
o
urna
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ea
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(
I
J
P
H
S)
Vo
l.
1
3
,
No
.
4
,
Dec
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b
er
20
24
,
p
p
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1
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I
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2
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ev
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Ap
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Acc
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Ap
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2
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4
M
u
lt
i
d
ru
g
re
sista
n
t
t
u
b
e
rc
u
l
o
sis
(M
DR
-
TB)
is
a
sig
n
if
ica
n
t
p
u
b
li
c
h
e
a
lt
h
c
o
n
c
e
rn
i
n
I
n
d
o
n
e
sia
,
re
su
lt
i
n
g
i
n
su
b
sta
n
ti
a
l
m
o
rb
id
it
y
a
n
d
m
o
rt
a
li
ty
ra
tes
.
Th
is
stu
d
y
a
im
ed
to
q
u
a
n
ti
f
y
th
e
imp
a
c
t
o
f
risk
fa
c
to
rs
o
f
M
DR
-
T
B.
A
c
a
se
-
c
o
n
tro
l
stu
d
y
wa
s
c
o
n
d
u
c
ted
a
t
M
a
k
a
ss
a
r
Co
m
m
u
n
it
y
Lu
n
g
He
a
lt
h
Ce
n
te
r
(BBKPM
)
in
M
a
k
a
ss
a
r
Cit
y
.
A
t
o
tal
o
f
1
3
2
re
sp
o
n
d
e
n
ts,
6
6
c
a
se
s,
a
n
d
6
6
c
o
n
tro
ls
h
a
v
e
p
a
rti
c
i
p
a
ted
in
th
e
stu
d
y
.
Da
ta
wa
s
a
n
a
ly
z
e
d
u
sin
g
th
e
S
tata
v
e
rsio
n
1
4
to
o
l,
o
d
d
s
ra
ti
o
(OR)
,
a
n
d
m
u
lt
ip
le
l
o
g
ist
ic
re
g
re
ss
io
n
.
M
u
lt
i
p
l
e
lo
g
isti
c
re
g
re
ss
io
n
a
n
a
ly
sis
i
d
e
n
ti
fied
si
g
n
ifi
c
a
n
t
risk
fa
c
to
r
s
fo
r
t
h
e
o
c
c
u
rre
n
c
e
o
f
M
DR
-
TB
in
c
lu
d
e
p
re
v
io
u
s
TB
trea
tme
n
t
(OR=
8
.
4
6
,
9
5
%
CI
:
3
.
2
7
8
-
21
.
8
5
8
),
p
o
siti
v
e
a
c
id
-
fa
st
b
a
c
il
li
(
AFB
)
sp
u
t
u
m
(OR=
6
.
4
0
,
9
5
%
CI:
2
.
5
2
5
-
16
.
2
6
0
),
a
n
d
a
d
v
e
rse
d
ru
g
e
v
e
n
t
(OR=
3
.
4
5
,
9
5
%
CI:
1
.
0
0
8
-
11
.
8
6
7
)
.
Th
e
p
r
o
b
a
b
i
li
ty
o
f
d
e
v
e
lo
p
in
g
M
DR
-
TB
is
9
5
.
9
%
if
t
h
e
re
is
p
re
v
io
u
s
TB
trea
tme
n
t
with
c
a
se
s
o
f
re
lap
se
/l
o
ss
to
fo
l
lo
w
-
up
/failed
trea
tme
n
t
,
p
o
siti
v
e
AFB
sp
u
t
u
m
,
a
n
d
a
d
v
e
rse
d
r
u
g
e
v
e
n
t.
T
h
e
m
o
st
d
o
m
in
a
n
t
risk
fa
c
to
r
fo
r
th
e
o
c
c
u
rre
n
c
e
o
f
M
DR
-
TB
is
a
p
r
e
v
io
u
s
TB
trea
tme
n
t.
We
su
g
g
e
st
th
a
t
a
n
e
fficie
n
t
d
irec
tl
y
o
b
se
rv
e
d
tr
e
a
tme
n
t
sh
o
rtco
u
rse
(
DO
TS
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stra
teg
y
,
p
a
rti
c
u
larly
in
th
e
m
a
n
a
g
e
m
e
n
t
o
f
a
d
v
e
rse
d
ru
g
e
v
e
n
t
,
o
v
e
rse
e
in
g
a
n
d
su
p
p
o
rti
n
g
p
a
ti
e
n
ts
wh
o
h
a
v
e
re
c
o
v
e
re
d
fro
m
M
DR
-
TB,
in
v
o
lv
e
s
th
e
c
o
ll
a
b
o
ra
ti
o
n
o
f
M
DR
-
TB
h
e
a
lt
h
c
a
re
p
ro
fe
ss
io
n
a
ls
a
n
d
p
a
ti
e
n
t
s
u
p
p
o
rters
in
th
e
Ya
m
a
li
TB
c
o
m
m
u
n
it
y
,
m
o
v
i
n
g
sy
n
e
rg
isti
c
a
ll
y
a
s
a
n
e
ffo
rt
t
o
M
DR
-
TB
c
o
n
tro
l
a
n
d
p
re
v
e
n
ti
o
n
.
K
ey
w
o
r
d
s
:
Acid
-
f
ast b
ac
illi
s
p
u
tu
m
Ad
v
er
s
e
d
r
u
g
ev
e
n
t
Mu
ltid
r
u
g
r
esis
tan
t
Pre
v
io
u
s
tu
b
er
c
u
lo
s
is
tr
ea
tm
en
t
T
u
b
er
cu
l
o
s
is
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
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n
se
.
C
o
r
r
e
s
p
o
nd
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A
uth
o
r
:
Sit
i L
atif
ah
B
u
r
h
an
Dep
ar
tm
en
t o
f
E
p
id
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Facu
lty
o
f
Pu
b
lic
Hea
lth
,
Has
an
u
d
d
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KM
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am
alan
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Ma
k
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u
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I
n
d
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E
m
ail:
m
ad
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@
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co
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1.
I
NT
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D
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O
N
Mu
ltid
r
u
g
r
esis
tan
t
tu
b
er
cu
l
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s
is
(
MD
R
-
T
B
)
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em
ain
s
a
s
ig
n
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ican
t
ch
allen
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in
T
B
m
an
a
g
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en
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an
d
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a
m
ajo
r
p
u
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h
ea
lth
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s
s
u
e
in
n
u
m
er
o
u
s
co
u
n
tr
ies
wo
r
ld
wid
e.
MD
R
-
T
B
r
ef
e
r
s
to
a
s
tr
ain
o
f
Myco
b
a
cteriu
m
tu
b
ercu
lo
s
is
r
esis
tan
t
to
f
ir
s
t
-
lin
e
an
ti
-
TB
m
ed
icatio
n
s
,
s
p
ec
if
ically
r
if
am
p
icin
(
R
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a
n
d
is
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n
iazid
(
H)
,
wh
ich
ar
e
h
ig
h
l
y
ef
f
ec
tiv
e
ag
ai
n
s
t
Myco
b
a
cte
r
iu
m
tu
b
ercu
lo
s
is
b
ac
ter
ia.
M
DR
-
T
B
p
o
s
es
a
n
ew
ch
allen
g
e
in
T
B
co
n
tr
o
l
in
itiativ
es
d
u
e
to
its
ch
allen
g
in
g
d
iag
n
o
s
is
an
d
h
ig
h
r
ates
o
f
th
er
ap
eu
tic
f
ailu
r
e
an
d
m
o
r
tality
[
1
]
.
T
h
e
W
o
r
ld
Hea
l
th
Or
g
a
n
izatio
n
(
W
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d
ata
f
r
o
m
2
0
1
5
-
2
0
2
0
in
d
icate
s
th
at
th
e
g
lo
b
al
esti
m
ate
o
f
MD
R
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T
B
ca
s
e
s
r
em
ain
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co
n
s
is
ten
t.
I
n
2
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2
1
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th
e
p
r
e
d
icted
p
r
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tio
n
o
f
MD
R
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T
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p
atien
ts
i
s
3
.
6
%,
wh
ich
am
o
u
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ts
to
4
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0
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0
0
0
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T
h
e
cu
r
r
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ig
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r
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h
as
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m
p
ar
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d
to
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h
ich
s
to
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d
at
3
.
1
%
(
4
3
7
,
0
0
0
ca
s
es).
T
h
is
is
b
eliev
ed
to
b
e
c
o
n
n
ec
te
d
to
th
e
c
o
r
o
n
a
v
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u
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is
ea
s
e
2
0
1
9
(
C
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-
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)
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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8
8
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6
Mu
ltid
r
u
g
r
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ta
n
t tu
b
ercu
lo
s
is
(
MDR
-
TB)
r
i
s
k
fa
cto
r
s
in
Ma
ka
s
s
a
r
,
I
n
d
o
n
esia
(
S
iti La
tifa
h
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u
r
h
a
n
)
1657
wh
ich
h
as
h
in
d
e
r
ed
th
e
ea
r
ly
d
etec
tio
n
o
f
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h
e
an
ticip
at
ed
g
lo
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al
p
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tio
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in
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als
s
u
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f
er
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m
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T
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in
2
0
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1
is
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.
6
%.
A
m
o
n
g
th
ese,
3
.
6
%
o
f
i
n
d
iv
id
u
als
with
MD
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e
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ca
s
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ile
1
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%
h
ad
a
h
is
to
r
y
o
f
T
B
tr
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en
t.
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n
So
u
th
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s
t
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a
in
2
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2
0
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th
er
e
wer
e
1
6
4
,
0
0
0
ca
s
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o
f
MD
R
-
T
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,
an
d
in
2
0
2
1
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th
er
e
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a
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is
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to
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7
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0
0
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ases
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T
en
co
u
n
tr
ies,
in
cl
u
d
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g
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h
in
a,
Dem
o
cr
atic
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ep
u
b
li
c
o
f
C
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g
o
,
I
n
d
ia,
I
n
d
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esia,
Nig
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Pak
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tan
,
Ph
ilip
p
in
es,
R
u
s
s
ian
Fed
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atio
n
,
So
u
th
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r
ica,
an
d
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m
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esen
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s
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7
0
% o
f
th
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p
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g
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DR
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T
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e
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1
[
2
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.
I
n
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o
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3
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atio
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with
th
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ig
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th
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ld
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n
2
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1
[
2
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n
2
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0
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is
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p
ated
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at
2
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4
%
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ew
T
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atien
ts
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d
1
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o
f
p
r
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s
ly
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ea
ted
T
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p
atien
ts
wo
u
ld
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a
v
e
MD
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T
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,
to
talin
g
ap
p
r
o
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im
ately
2
4
,
0
0
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ca
s
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(
8
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8
p
er
1
0
0
,
0
0
0
p
o
p
u
latio
n
)
[
1
]
.
I
n
2
0
2
1
,
th
er
e
will
b
e
an
in
cr
ea
s
e
o
f
2
8
,
0
0
0
ca
s
es
(
1
0
p
er
1
0
0
,
0
0
0
p
o
p
u
latio
n
)
o
f
MD
R
-
T
B
,
wh
ich
is
attr
ib
u
ted
to
th
e
in
f
lu
en
ce
o
f
th
e
C
OVI
D
-
1
9
p
an
d
em
ic
o
n
th
e
d
etec
tio
n
o
f
TB
[
2
].
T
h
e
n
o
tific
atio
n
r
ate
f
o
r
all
tu
b
er
cu
lo
s
is
ca
s
es
in
So
u
th
Su
lawe
s
i
Pro
v
in
ce
is
escalatin
g
an
n
u
ally
.
I
n
2
0
2
1
,
Min
is
tr
y
o
f
Hea
lth
o
f
th
e
R
ep
u
b
lic
o
f
I
n
d
o
n
esia,
r
ep
o
r
te
d
1
6
5
ca
s
es
p
er
1
0
0
,
0
0
0
p
o
p
u
latio
n
,
r
is
e
to
2
6
7
ca
s
es
p
er
1
0
0
,
0
0
0
p
o
p
u
latio
n
in
2
0
2
2
[
3
]
.
In
2
0
2
0
,
th
e
So
u
t
h
Su
lawe
s
i
Pro
v
in
cial
Hea
lth
Of
f
ice
r
ep
o
r
t
ed
2
8
.
7
%
o
f
T
B
ca
s
es
in
Ma
k
ass
ar
is
th
e
h
ig
h
est
p
er
ce
n
tag
e
am
o
n
g
all
cities an
d
d
is
tr
icts
in
So
u
th
Su
lawe
s
i Pr
o
v
in
ce
[
4
].
I
n
Su
d
a
n
,
r
esear
ch
f
o
u
n
d
t
h
at
p
atien
ts
wh
o
h
ad
b
ee
n
in
co
n
tact
with
MD
R
-
T
B
p
atien
ts
wer
e
f
iv
e
tim
es
m
o
r
e
lik
ely
to
g
et
MD
R
-
T
B
th
an
p
atien
ts
wh
o
h
ad
n
o
t
b
ee
n
in
c
o
n
tact
with
MD
R
-
T
B
p
atien
ts
[
5
]
.
R
esear
ch
in
Pak
is
tan
in
d
icate
s
th
at
ca
v
ities
s
h
o
wn
o
n
X
-
r
a
y
ex
am
s
ar
e
a
r
is
k
f
ac
to
r
f
o
r
MD
R
-
T
B
.
Patien
t
s
with
lu
n
g
ca
v
ities
ar
e
3
0
tim
es
m
o
r
e
lik
ely
to
d
ev
elo
p
MD
R
-
T
B
th
an
p
atien
ts
wi
th
o
u
t
lu
n
g
ca
v
ities
o
n
X
-
r
ay
[
6
]
.
A
s
tu
d
y
co
n
d
u
cted
in
Ma
li
in
d
icate
s
th
at
t
h
e
p
r
esen
ce
o
f
3
+
ac
id
-
f
ast
b
ac
illi
(
AFB
)
s
p
u
tu
m
s
ig
n
if
ican
tl
y
af
f
ec
ts
th
e
o
cc
u
r
r
en
ce
o
f
MD
R
-
T
B
.
Patien
ts
with
3
+
AFB
s
p
u
tu
m
r
esu
lts
h
av
e
a
two
f
o
ld
i
n
cr
ea
s
ed
ch
an
c
e
o
f
ac
q
u
ir
in
g
MD
R
-
T
B
[
7
]
.
Patie
n
ts
with
p
r
ev
io
u
s
T
B
tr
ea
tm
en
t
ar
e
f
iv
e
tim
es
m
o
r
e
lik
el
y
to
d
ev
elo
p
MD
R
-
T
B
th
an
p
atie
n
ts
with
o
u
t
s
u
ch
a
h
is
to
r
y
[
8
]
.
A
co
r
r
elatio
n
ex
is
ts
b
etwe
en
ad
v
e
r
s
e
d
r
u
g
ev
en
t
an
d
th
e
p
r
ev
alen
ce
o
f
MD
R
-
T
B
[
9
]
.
MD
R
-
T
B
p
atien
ts
with
co
m
o
r
b
id
d
iab
e
tes
m
ellitu
s
ar
e
f
o
u
r
tim
es
a
s
lik
ely
to
d
ev
elo
p
MD
R
-
T
B
th
an
MD
R
-
T
B
p
atien
ts
n
o
n
-
co
m
o
r
b
id
[
1
0
]
.
A
c
o
r
r
elatio
n
ex
is
ts
b
etwe
en
d
ietar
y
s
tatu
s
an
d
th
e
p
r
ev
alen
ce
o
f
MD
R
-
T
B
.
Patie
n
ts
with
b
o
d
y
m
ass
in
d
ex
(
B
MI
)
<1
8
.
5
k
g
/m
2
h
av
e
a
1
.
5
7
tim
es
h
ig
h
er
r
is
k
o
f
MD
R
-
T
B
co
m
p
ar
ed
to
th
o
s
e
with
a
B
MI
≥
1
8
.
5
k
g
/m
2
[
1
1
]
.
E
x
ten
s
iv
e
s
tu
d
ies
h
av
e
b
ee
n
ca
r
r
ied
o
u
t
o
n
r
is
k
f
ac
to
r
s
f
o
r
MD
R
-
T
B
.
Fu
r
th
er
ex
p
lo
r
atio
n
o
f
clin
ical
f
ac
t
o
r
r
esear
ch
is
s
till
r
eq
u
ir
e
d
.
T
h
e
p
r
e
v
alen
ce
o
f
MD
R
-
T
B
r
em
ain
s
h
ig
h
.
I
t
is
cr
u
cial
to
ad
d
r
ess
th
e
r
is
k
f
ac
to
r
s
ass
o
ciate
d
with
MD
R
-
T
B
to
r
ed
u
ce
its
o
cc
u
r
r
e
n
ce
.
R
esear
ch
er
s
a
r
e
in
ter
ested
in
in
v
esti
g
atin
g
f
a
cto
r
s
th
at
m
ay
elev
ate
t
h
e
o
cc
u
r
r
e
n
ce
o
f
MD
R
-
T
B
at
B
B
K
PM
in
Ma
k
ass
ar
C
ity
.
2.
M
E
T
H
O
D
T
h
i
s
q
u
a
n
t
it
a
ti
v
e
a
n
a
l
y
ti
c
a
l
r
e
s
e
a
r
c
h
i
s
c
o
n
d
u
c
t
e
d
t
h
r
o
u
g
h
a
c
as
e
-
c
o
n
t
r
o
l
s
t
u
d
y
d
es
i
g
n
.
M
DR
-
T
B
p
a
t
i
e
n
ts
as
c
as
es
a
n
d
n
o
n
-
M
DR
-
T
B
p
a
ti
e
n
t
s
as
c
o
n
t
r
o
ls
.
T
h
e
s
t
u
d
y
w
a
s
c
o
n
d
u
c
t
e
d
f
r
o
m
Oc
t
o
b
e
r
t
o
D
e
c
e
m
b
er
2
0
2
3
a
t
B
B
KP
M
i
n
M
a
k
a
s
s
a
r
C
i
t
y
.
T
h
e
e
t
h
i
c
al
c
l
e
a
r
a
n
c
e
o
f
r
e
s
e
a
r
c
h
h
a
s
b
e
e
n
a
p
p
r
o
v
e
d
b
y
t
h
e
H
a
s
a
n
u
d
d
i
n
U
n
i
v
e
r
s
it
y
R
es
e
a
r
c
h
E
t
h
i
cs
C
o
m
m
i
s
s
i
o
n
u
n
d
e
r
t
h
e
n
u
m
b
e
r
5
6
1
9
/
U
N
4
.
1
4
.
1
/
T
P
.
0
1
.
0
2
/
2
0
2
3
.
T
h
e
s
t
u
d
y
'
s
p
o
p
u
l
a
t
i
o
n
c
o
n
s
is
t
s
o
f
a
l
l
TB
p
a
ti
e
n
t
s
w
h
o
h
av
e
r
e
c
e
i
v
e
d
a
n
d
a
r
e
p
r
e
s
e
n
t
l
y
r
e
c
e
i
v
i
n
g
t
r
e
a
t
m
e
n
t
at
B
B
K
PM
i
n
2
0
2
2
.
T
h
e
s
a
m
p
l
i
n
g
m
et
h
o
d
u
s
e
d
i
n
t
h
i
s
s
t
u
d
y
w
as
t
o
t
a
l
s
a
m
p
l
i
n
g
,
a
1
:
1
r
a
t
i
o
b
e
tw
e
e
n
c
a
s
es
a
n
d
c
o
n
t
r
o
l
s
.
T
h
e
s
a
m
p
le
s
i
z
e
w
as
1
3
2
s
a
m
p
l
e
s
,
wi
t
h
6
6
c
a
s
e
s
a
n
d
6
6
c
o
n
t
r
o
l
s
.
T
h
e
c
o
n
t
r
o
l
s
a
m
p
l
i
n
g
m
e
t
h
o
d
e
m
p
l
o
y
e
d
w
a
s
p
u
r
p
o
s
iv
e
s
a
m
p
l
i
n
g
b
a
s
e
d
o
n
c
e
r
t
ai
n
c
r
i
t
e
r
i
a
,
i
)
t
h
is
s
t
u
d
y
i
n
c
l
u
d
e
d
T
B
p
a
t
i
e
n
t
s
r
e
c
ei
v
i
n
g
o
u
t
p
a
t
i
e
n
t
t
r
e
at
m
e
n
t
a
t
t
h
e
B
B
K
P
M
Ma
k
a
s
s
a
r
C
i
t
y
i
n
2
0
2
2
,
ii
)
e
x
c
l
u
d
e
d
f
r
o
m
t
h
e
s
t
u
d
y
w
er
e
T
B
p
a
t
ie
n
t
s
w
i
th
h
u
m
a
n
i
m
m
u
n
o
d
e
f
i
c
i
e
n
c
y
v
i
r
u
s
(
H
I
V
)
,
T
B
p
a
t
i
e
n
ts
a
g
e
d
1
-
1
4
y
e
a
r
s
,
a
n
d
T
B
p
a
t
i
e
n
t
s
w
i
t
h
i
n
c
o
m
p
l
e
t
e
d
a
t
a
i
n
t
h
e
m
e
d
i
c
a
l
r
e
c
o
r
d
s
B
B
K
P
M
M
a
k
a
s
s
a
r
C
i
t
y
i
n
2
0
2
2
.
T
h
e
s
t
u
d
y
g
at
h
e
r
e
d
d
a
t
a
f
r
o
m
t
h
e
S
I
T
B
a
n
d
m
e
d
i
c
a
l
r
e
c
o
r
d
s
o
f
t
h
e
B
B
KP
M
M
a
k
a
s
s
a
r
C
ity
i
n
2
0
2
2
.
T
h
e
d
a
t
a
w
a
s
e
x
a
m
i
n
e
d
u
s
i
n
g
S
t
a
t
a
v
e
r
s
i
o
n
1
4
.
D
a
t
a
w
a
s
a
n
al
y
z
e
d
u
s
i
n
g
u
n
i
v
a
r
i
a
t
e
,
b
i
v
a
r
i
a
te
,
a
n
d
m
u
l
t
i
v
a
r
i
a
t
e
a
n
a
l
y
s
is
.
T
h
e
o
d
d
s
r
a
t
i
o
(
OR
)
te
s
t
as
s
ess
e
d
t
h
e
r
e
l
a
ti
o
n
s
h
i
p
a
n
d
m
a
g
n
i
t
u
d
e
o
f
r
i
s
k
f
a
c
t
o
r
s
b
e
tw
e
e
n
t
h
e
d
e
p
e
n
d
e
n
t
a
n
d
i
n
d
e
p
e
n
d
e
n
t
v
a
r
i
a
b
l
e
s
.
T
h
e
m
e
t
h
o
d
o
l
o
g
y
e
m
p
l
o
y
e
d
i
s
m
u
l
t
i
v
a
r
i
a
te
a
n
d
i
n
v
o
l
v
e
s
m
u
l
t
i
p
l
e
l
o
g
i
s
ti
c
r
e
g
r
e
s
s
i
o
n
.
T
h
i
s
s
t
u
d
y
'
s
li
m
i
t
at
i
o
n
s
i
n
c
l
u
d
e
a
d
i
s
c
r
e
p
a
n
c
y
b
e
tw
e
e
n
T
B
p
a
t
i
e
n
t
d
a
t
a
f
r
o
m
t
h
e
S
I
T
B
an
d
m
e
d
i
c
a
l
r
e
c
o
r
d
s
,
r
e
s
u
l
t
i
n
g
i
n
t
h
e
e
x
c
l
u
s
i
o
n
o
f
o
n
e
r
e
s
p
o
n
d
e
n
t
d
u
e
t
o
d
a
t
a
b
e
i
n
g
s
o
l
e
l
y
d
o
c
u
m
e
n
t
e
d
i
n
t
h
e
S
I
T
B
w
i
t
h
o
u
t
c
o
r
r
e
s
p
o
n
d
i
n
g
m
e
d
i
c
a
l
r
e
c
o
r
d
s
.
A
d
d
i
t
i
o
n
a
l
l
y
,
c
o
m
o
r
b
i
d
i
t
y
f
ac
t
o
r
s
i
n
t
h
e
s
t
u
d
y
w
e
r
e
r
e
s
t
r
ict
e
d
t
o
h
y
p
e
r
t
e
n
s
i
o
n
a
n
d
d
i
a
b
e
t
e
s
m
e
l
li
t
u
s
.
A
t
t
h
e
s
a
m
e
t
i
m
e
,
c
o
m
o
r
b
i
d
H
I
V
w
a
s
r
e
m
o
v
e
d
a
s
a
s
t
u
d
y
f
a
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p
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.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
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1659
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MD
R
-
T
B
,
OR
=3
.
9
0
(
9
5
%
C
I
:
1
.
2
4
2
-
1
4
.
4
5
1
)
.
C
o
m
o
r
b
id
ity
v
ar
iab
les
an
d
B
MI
ar
e
n
o
t sig
n
if
ican
tly
ass
o
ciate
d
with
MD
R
-
T
B
(
p
-
v
alu
e
>0
.
0
5
)
.
T
ab
le
2
.
B
iv
ar
iate
an
aly
s
is
MD
R
-
T
B
r
is
k
f
ac
to
r
s
at
B
B
KP
M
Ma
k
ass
ar
2
0
2
2
V
a
r
i
a
b
l
e
s
M
D
R
-
TB
To
t
a
l
C
a
ses
C
o
n
t
r
o
l
s
n
=
6
6
%
n
=
6
6
%
P
v
a
l
u
e
O
d
d
s
r
a
t
i
o
C
I
9
5
%
A
F
B
sp
u
t
u
m
P
o
si
t
i
v
e
47
7
1
.
2
1
27
4
0
.
9
1
0
.
0
0
0
3
.
5
7
1
.
6
3
2
-
7
.
8
8
2
*
N
e
g
a
t
i
v
e
19
2
8
.
7
9
39
5
9
.
0
9
C
a
v
i
t
y
Y
e
s
39
5
9
.
0
9
30
4
5
.
4
5
0
.
1
1
6
1
.
7
3
0
.
8
2
2
-
3
.
6
6
2
No
27
4
0
.
9
1
36
5
4
.
5
5
P
r
e
v
i
o
u
s T
B
t
r
e
a
t
me
n
t
R
e
l
a
p
se/
l
o
ss
t
o
f
o
l
l
o
w
u
p
(
L
TFU
)
/
f
a
i
l
u
r
e
39
5
9
.
0
9
14
2
1
.
2
1
0
.
0
0
0
5
.
3
6
2
.
3
4
1
-
1
2
.
5
1
3
*
N
e
w
27
4
0
.
9
1
52
7
8
.
7
9
A
d
v
e
r
se
d
r
u
g
e
v
e
n
t
H
i
g
h
r
i
s
k
16
2
4
.
2
4
5
7
.
5
8
0
.
0
0
8
3
.
9
0
1
.
2
4
2
-
1
4
.
4
5
1
*
Lo
w
r
i
s
k
50
7
5
.
7
6
61
9
2
.
4
2
C
o
m
o
r
b
i
d
i
t
y
H
i
g
h
r
i
s
k
18
2
7
.
2
7
23
3
4
.
8
5
0
.
3
4
7
0
.
7
0
0
.
3
1
1
-
1
.
5
6
8
Lo
w
r
i
s
k
48
7
2
.
7
3
43
6
5
.
1
5
B
M
I
<
1
8
.
5
k
g
/
m
2
37
5
6
.
0
6
28
4
2
.
4
2
0
.
1
1
7
1
.
7
3
0
.
8
2
2
-
3
.
6
5
5
≥
1
8
.
5
k
g
/
m
2
29
4
3
.
9
4
38
5
7
.
5
8
*
=
S
t
a
t
i
st
i
c
a
l
l
y
s
i
g
n
i
f
i
c
a
n
t
T
ab
le
3
d
is
p
lay
s
th
e
v
ar
iab
le
s
co
n
s
id
er
ed
in
th
e
lo
g
is
tic
r
eg
r
ess
io
n
test
b
ased
o
n
t
h
eir
s
tatis
tical
s
ig
n
if
ican
ce
with
a
p
-
v
alu
e<
0
.
2
5
f
r
o
m
th
e
b
iv
a
r
iate
test
.
T
h
e
v
ar
ia
b
les
in
clu
d
ed
AF
B
s
p
u
tu
m
,
ca
v
ity
,
p
r
ev
io
u
s
T
B
tr
ea
tm
en
t,
a
d
v
er
s
e
d
r
u
g
ev
en
t,
an
d
B
MI
.
T
h
e
f
in
al
r
esu
lts
o
f
th
e
m
u
ltiv
ar
i
ate
an
aly
s
is
u
s
in
g
lo
g
is
tic
r
eg
r
ess
io
n
in
d
icate
th
at
p
r
ev
i
o
u
s
T
B
tr
ea
tm
e
n
t,
AF
B
s
p
u
tu
m
,
a
n
d
ad
v
er
s
e
d
r
u
g
e
v
en
t
ar
e
r
is
k
f
ac
to
r
s
o
f
MD
R
-
T
B
.
T
ab
le
3
.
Mu
ltiv
ar
iate
a
n
aly
s
is
MD
R
-
T
B
r
is
k
f
ac
to
r
s
at
B
B
K
PM
Ma
k
ass
ar
2
0
2
2
R
e
se
a
r
c
h
v
a
r
i
a
b
l
e
s
C
o
e
f
.
p
-
v
a
l
u
e
A
d
j
u
st
e
d
o
d
d
s ra
t
i
o
C
I
9
5
%
(
LL
-
UL
)
P
r
e
v
i
o
u
s T
B
t
r
e
a
t
me
n
t
1
.
8
5
8
0
.
0
0
0
8
.
4
6
3
.
2
7
8
-
2
1
.
8
5
8
A
F
B
sp
u
t
u
m
2
.
1
3
6
0
.
0
0
0
6
.
4
0
2
.
5
2
5
-
1
6
.
2
6
0
A
d
v
e
r
se
d
r
u
g
e
v
e
n
t
1
.
2
4
0
0
.
0
4
9
3
.
4
5
1
.
0
0
8
-
1
1
.
8
6
7
Am
o
n
g
th
ese
th
r
ee
v
a
r
iab
les,
p
r
e
v
io
u
s
T
B
tr
ea
tm
en
t
h
as
th
e
h
ig
h
est
im
p
ac
t
as
a
r
i
s
k
f
ac
to
r
,
AOR=8
.
6
4
(
9
5
%
CI
=3
.
2
7
8
-
2
1
.
8
5
8
)
.
T
h
e
lo
g
is
tic
r
eg
r
ess
io
n
eq
u
atio
n
is
d
is
p
lay
ed
in
(
1
)
an
d
th
e
p
r
o
b
ab
ilit
y
o
f
MD
R
-
T
B
f
o
r
h
ig
h
-
r
is
k
r
esp
o
n
d
en
ts
is
in
d
icate
d
in
(
2
)
.
=
+
(
)
+
(
)
+
(
)
=
−
2
.
064
+
1
.
858
+
2
.
136
+
1
.
240
(
1
)
=
3
.
17
Af
ter
o
b
tain
in
g
th
e
v
al
u
e
o
f
y
,
th
e
p
r
o
b
ab
ilit
y
o
f
th
e
s
u
b
ject
i
s
ca
lcu
lated
u
s
in
g
(
2
)
:
=
1
(
1
+
(
−
)
)
=
1
(
1
+
(
−
3
.
17
)
)
(
2
)
=
95
.
9%
T
h
e
m
u
ltiv
ar
iate
an
al
y
s
is
r
esu
lts
in
d
icate
d
th
at
r
esp
o
n
d
en
ts
with
p
o
s
itiv
e
AFB
s
p
u
tu
m
,
p
r
ev
io
u
s
T
B
tr
ea
tm
en
t
(
r
elap
s
e/
lo
s
s
to
f
o
llo
w
u
p
(
L
T
FU
)
/tre
atm
en
t
f
ailu
r
e)
,
an
d
ad
v
er
s
e
d
r
u
g
ev
en
t
at
h
ig
h
r
is
k
h
ad
a
9
5
.
9
% p
r
o
b
ab
ilit
y
o
f
d
e
v
elo
p
i
n
g
MD
R
-
T
B
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
3
,
No
.
4
,
Dec
em
b
er
20
24
:
1
65
6
-
1
6
6
3
1660
3
.
1
.
AF
B
s
pu
t
um
AFB
s
p
u
tu
m
is
a
r
is
k
f
ac
to
r
f
o
r
MD
R
-
T
B
.
R
esp
o
n
d
en
ts
with
p
o
s
itiv
e
AFB
s
p
u
tu
m
wer
e
3
.
5
7
tim
es
m
o
r
e
lik
ely
t
o
d
ev
el
o
p
MD
R
-
T
B
th
an
th
o
s
e
with
n
e
g
ativ
e
AFB
s
p
u
tu
m
.
T
h
is
s
tu
d
y
ali
g
n
s
with
p
r
ev
i
o
u
s
r
esear
ch
co
n
d
u
cte
d
in
Ma
li,
in
d
icatin
g
th
at
th
o
s
e
with
s
p
u
tu
m
B
T
A
(
3
+)
h
av
e
a
1
.
9
8
tim
es
h
ig
h
er
r
is
k
o
f
MD
R
-
T
B
co
m
p
ar
ed
to
th
o
s
e
with
s
p
u
tu
m
B
T
A
(
<3
+)
[
7
]
.
T
h
e
f
in
d
i
n
g
s
f
r
o
m
a
s
tu
d
y
c
o
n
d
u
cte
d
in
C
h
in
a
in
d
icate
d
th
at
th
e
p
r
esen
ce
o
f
p
o
s
itiv
e
AFB
s
p
u
tu
m
in
n
e
w
p
atien
ts
u
n
d
er
g
o
in
g
a
lo
n
g
-
ter
m
r
e
g
im
en
was
lin
k
ed
to
th
e
d
e
v
elo
p
m
e
n
t
o
f
MD
R
-
TB
[
1
4
]
.
Po
s
itiv
e
A
FB
s
p
u
tu
m
h
as
a
f
o
u
r
f
o
ld
h
ig
h
er
r
is
k
o
f
p
o
o
r
tr
ea
tm
en
t
o
u
tco
m
es
f
o
r
MD
R
-
T
B
co
m
p
ar
ed
to
n
eg
ativ
e
AF
B
s
p
u
tu
m
[
1
5
]
.
A
s
tu
d
y
in
W
est
J
av
a
f
o
u
n
d
th
at
s
p
u
tu
m
s
m
ea
r
r
esu
lts
wer
e
a
s
ig
n
if
ican
t
f
ac
to
r
in
p
r
ed
ictin
g
th
e
o
u
tco
m
e
o
f
MD
R
-
T
B
tr
ea
tm
en
t
[
1
6
]
.
Mo
s
t
ca
s
es
s
h
o
wed
th
e
p
r
esen
ce
o
f
p
o
s
itiv
e
AFB
s
p
u
tu
m
.
R
esp
o
n
d
en
ts
h
av
i
n
g
p
o
s
itiv
e
s
p
u
tu
m
r
esu
lts
f
o
r
ac
id
-
f
ast
b
ac
illi
ar
e
v
er
y
co
n
tag
io
u
s
a
n
d
ca
n
s
p
r
ea
d
p
u
lm
o
n
ar
y
TB
illn
ess
to
o
th
er
s
.
I
n
cr
ea
s
ed
p
o
s
itiv
ity
in
s
p
u
tu
m
r
esu
lts
co
r
r
elate
s
with
a
h
ig
h
er
r
is
k
o
f
tr
an
s
m
is
s
io
n
to
o
th
er
s
[
1
5
]
.
Po
s
itiv
e
s
p
u
tu
m
r
esu
lts
f
o
r
ac
id
-
f
ast
b
ac
illi
co
n
tr
ib
u
te
to
th
e
tr
an
s
m
is
s
io
n
o
f
TB
an
d
MD
R
-
TB
,
p
o
ten
tial
ly
lead
in
g
to
d
r
u
g
r
esis
tan
ce
.
3
.
2
.
Ca
v
it
y
C
av
ity
is
n
o
t
a
s
ig
n
if
ican
t
r
is
k
f
ac
to
r
f
o
r
MD
R
-
T
B
.
T
h
is
s
tu
d
y
alig
n
s
[
1
6
]
in
d
icatin
g
th
at
ca
v
ities
r
ep
r
esen
t
a
n
eg
lig
ib
le
r
is
k
f
ac
to
r
.
I
n
C
h
in
a,
it
was
f
o
u
n
d
th
at
ca
v
ities
in
n
ewly
d
iag
n
o
s
ed
p
atien
ts
ar
e
n
o
t
a
r
is
k
f
ac
to
r
f
o
r
MD
R
-
TB
[
1
4
]
.
A
s
tu
d
y
co
n
d
u
cte
d
in
C
h
in
a
f
o
u
n
d
th
at
ca
v
ities
wer
e
n
o
t
lin
k
ed
to
n
eg
ativ
e
tr
ea
tm
en
t
r
esu
lts
in
in
d
iv
id
u
a
ls
with
MD
R
-
TB
[
1
5
]
.
C
o
n
tr
ar
y
to
th
e
s
tu
d
y
,
th
e
r
e
is
a
co
n
n
ec
tio
n
b
etwe
en
X
-
r
ay
an
d
th
e
o
cc
u
r
r
en
ce
o
f
MD
R
-
TB
[
1
7
]
.
Patien
ts
with
ca
v
ities
o
n
X
-
r
ay
h
av
e
a
3
0
.
1
tim
es
h
ig
h
er
r
is
k
o
f
g
ettin
g
MD
R
-
T
B
co
m
p
ar
ed
t
o
p
atien
ts
with
o
u
t c
av
ities
[
6
]
.
3.
3
.
P
re
v
io
us
T
B
t
re
a
t
m
ent
Pre
v
io
u
s
T
B
tr
ea
tm
en
t
in
cr
ea
s
es
th
e
lik
elih
o
o
d
o
f
d
ev
elo
p
i
n
g
MD
R
-
T
B
.
R
e
s
p
o
n
d
en
ts
with
a
h
is
to
r
y
o
f
p
r
e
v
io
u
s
T
B
tr
ea
tm
en
t
(
r
el
ap
s
e/L
T
FU/fa
ilu
r
e)
h
ad
a
5
.
3
6
tim
es
h
ig
h
er
p
r
o
b
ab
ilit
y
o
f
MD
R
-
T
B
co
m
p
ar
ed
to
th
o
s
e
in
th
e
n
ew
d
iag
n
o
s
is
.
T
h
is
s
tu
d
y
alig
n
s
with
ea
r
lier
s
tu
d
ies
in
d
icatin
g
th
at
p
atien
ts
with
p
r
e
v
io
u
s
T
B
tr
ea
tm
en
t
ar
e
2
.
8
tim
es
m
o
r
e
lik
ely
to
d
e
v
elo
p
MD
R
-
T
B
co
m
p
ar
ed
to
n
ewly
d
iag
n
o
s
ed
p
atien
ts
[
1
8
]
.
T
h
is
s
tu
d
y
alig
n
s
with
r
esear
ch
co
n
d
u
cted
in
Ma
li,
in
d
icatin
g
th
at
p
r
ev
io
u
s
T
B
tr
ea
tm
en
t
is
a
r
is
k
f
ac
to
r
f
o
r
t
h
e
d
ev
elo
p
m
e
n
t
o
f
MD
R
-
T
B
.
Pa
tien
ts
with
a
h
is
to
r
y
o
f
two
p
r
ev
io
u
s
tr
ea
tm
e
n
ts
ar
e
3
.
2
5
ti
m
es
m
o
r
e
lik
ely
to
d
ev
elo
p
MD
R
-
T
B
co
m
p
ar
e
d
to
p
atien
ts
with
m
o
r
e
th
an
two
p
r
ev
io
u
s
tr
ea
tm
en
ts
.
Ma
n
y
p
atien
ts
with
MD
R
-
T
B
ar
e
r
esp
o
n
d
en
ts
r
ec
eiv
in
g
in
itial
TB
th
er
ap
y
wh
o
f
ail
to
ad
h
er
e
t
o
p
r
o
p
er
d
r
u
g
ad
m
in
is
tr
atio
n
(
d
o
s
ag
e,
s
ch
ed
u
le,
an
d
p
r
ev
en
tiv
e
s
tr
ateg
ies)
[
7
]
.
T
h
ese
f
in
d
in
g
s
alig
n
[
6
]
,
[
8
]
,
[
1
9
]
th
at
p
atien
ts
in
Pak
is
tan
,
B
h
u
tan
,
an
d
Z
im
b
ab
we
wh
o
h
ad
r
ec
eiv
e
d
t
h
er
ap
y
b
e
f
o
r
e
we
r
e
at
a
s
ig
n
if
ican
tly
h
ig
h
er
r
is
k
o
f
1
9
.
2
tim
es,
5
.
9
tim
es,
an
d
3
.
5
3
tim
es
d
e
v
elo
p
in
g
MD
R
-
T
B
co
m
p
ar
ed
to
p
a
r
ticip
an
ts
d
iag
n
o
s
ed
with
a
n
e
w
th
er
ap
y
.
Un
lik
e
a
s
tu
d
y
co
n
d
u
cte
d
in
Pak
is
tan
,
p
r
ev
io
u
s
T
B
tr
ea
tm
en
t
was
n
o
t
lin
k
ed
to
d
ea
th
an
d
tr
ea
tm
en
t
f
ailu
r
e
in
MD
R
-
T
B
p
atien
ts
[
2
0
]
.
A
s
tu
d
y
c
o
n
d
u
cte
d
in
E
r
itre
a,
E
ast
Af
r
ica,
f
o
u
n
d
n
o
co
r
r
elatio
n
b
e
twee
n
p
r
ev
io
u
s
T
B
tr
ea
tm
en
t
an
d
th
e
f
ailu
r
e
o
f
M
DR
-
T
B
tr
ea
tm
en
t
[
2
1
]
.
MD
R
-
T
B
d
ev
elo
p
s
d
u
e
to
t
h
e
p
atien
t's
n
o
n
co
m
p
lian
ce
with
th
er
ap
y
,
lead
in
g
to
b
ac
ter
ial
m
u
tatio
n
an
d
r
esis
tan
ce
to
th
e
p
r
escr
ib
ed
d
r
u
g
s
.
I
n
a
d
eq
u
ate
s
u
p
er
v
is
io
n
d
u
r
in
g
tr
ea
tm
en
t
an
d
lim
ited
ac
ce
s
s
to
h
ea
lth
s
er
v
ices
ar
e
c
lo
s
ely
lin
k
ed
to
t
h
e
em
er
g
en
c
e
o
f
MD
R
-
T
B
[
1
8
]
.
3.
4
.
Adv
er
s
e
drug
ev
ent
Ad
v
er
s
e
d
r
u
g
ev
en
t
in
cr
ea
s
es
th
e
lik
elih
o
o
d
o
f
d
e
v
elo
p
in
g
MD
R
-
T
B
.
R
esp
o
n
d
en
ts
with
h
ig
h
-
r
is
k
ad
v
er
s
e
d
r
u
g
ev
en
t
wer
e
3
.
9
tim
es
m
o
r
e
lik
ely
to
h
av
e
MD
R
-
T
B
o
cc
u
r
r
en
ce
s
th
a
n
t
h
o
s
e
with
lo
w
-
r
is
k
ad
v
er
s
e
d
r
u
g
ev
en
t.
T
h
is
s
tu
d
y
alig
n
s
in
d
icatin
g
a
co
r
r
elatio
n
b
etwe
en
ad
v
er
s
e
d
r
u
g
e
v
en
t
an
d
th
e
p
r
e
v
alen
ce
o
f
MD
R
-
T
B
[
9
]
.
Patien
ts
wh
o
u
n
d
er
g
o
2
4
m
o
n
t
h
s
o
f
tr
ea
tm
en
t a
r
e
1
.
4
tim
es m
o
r
e
lik
ely
t
o
d
ev
elo
p
MD
R
-
T
B
co
m
p
ar
ed
to
p
atien
ts
wh
o
u
n
d
er
g
o
s
h
o
r
t
-
ter
m
tr
ea
tm
e
n
t
[
2
2
]
.
Nilam
s
ar
i
et
a
l.
[
2
3
]
f
o
u
n
d
th
at
7
0
%
o
f
p
atien
ts
u
n
d
er
g
o
in
g
a
n
ti
-
T
B
th
er
ap
y
s
u
f
f
er
ed
f
r
o
m
at
least
o
n
e
u
n
f
av
o
r
ab
le
co
n
d
itio
n
as
a
r
es
u
lt
o
f
ad
v
e
r
s
e
d
r
u
g
ev
en
t.
T
h
e
s
tu
d
y
id
en
tifie
d
f
iv
e
s
ig
n
if
ican
t n
eg
ativ
e
ef
f
ec
ts
:
h
y
p
er
u
r
icem
ia
(
5
2
.
5
%),
g
astro
in
test
in
al
d
is
o
r
d
er
s
(
4
0
%),
o
t
o
to
x
icity
(
3
7
.
5
%),
h
y
p
o
k
alem
ia
(
2
7
.
5
%),
an
d
ar
th
r
alg
ia
(
1
2
.
5
%).
Kam
ar
a
et
a
l
.
[
2
4
]
in
d
icate
d
t
h
at
p
atien
ts
with
lo
n
g
-
ter
m
r
eg
im
en
s
wer
e
m
o
r
e
p
r
o
n
e
to
en
co
u
n
ter
in
g
n
eg
ati
v
e
s
id
e
ef
f
ec
ts
th
an
th
o
s
e
o
n
s
h
o
r
t
-
ter
m
r
eg
im
en
s
.
R
esear
ch
s
h
o
ws
th
at
1
6
r
esp
o
n
d
en
ts
h
av
in
g
ad
v
er
s
e
d
r
u
g
ev
en
t
ar
e
class
if
ied
as
h
ig
h
r
is
k
,
6
2
.
5
% o
f
th
em
b
ein
g
o
n
lo
n
g
-
t
er
m
r
eg
im
e
n
s
.
A
d
v
e
r
s
e
d
r
u
g
e
v
e
n
t
s
u
f
f
e
r
e
d
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y
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e
s
p
o
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t
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e
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l
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y
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M
DR
-
T
B
.
3.
5
.
Co
m
o
rbidi
t
y
C
o
m
o
r
b
id
ity
is
n
o
t
a
s
ig
n
if
ic
an
t
r
is
k
f
ac
to
r
f
o
r
MD
R
-
T
B
.
T
h
e
s
tu
d
y
in
clu
d
e
d
4
1
in
d
i
v
id
u
als
with
co
m
o
r
b
i
d
ities
.
Am
o
n
g
th
em
,
1
9
.
5
1
%
h
ad
a
h
is
to
r
y
o
f
h
y
p
er
ten
s
io
n
,
5
8
.
5
4
%
h
ad
a
h
is
to
r
y
o
f
d
iab
etes
m
ellitu
s
,
an
d
2
1
.
9
5
%
h
ad
a
h
is
to
r
y
o
f
b
o
th
h
y
p
er
ten
s
io
n
an
d
d
iab
etes
m
ellitu
s
.
On
ly
a
tin
y
p
er
ce
n
tag
e
o
f
r
esp
o
n
d
er
s
h
a
v
e
co
m
o
r
b
id
itie
s
(
h
y
p
er
ten
s
io
n
an
d
/o
r
d
iab
et
es
m
ellitu
s
)
,
in
d
icatin
g
n
o
c
o
r
r
elatio
n
b
etwe
en
co
m
o
r
b
i
d
v
ar
iab
les
an
d
th
e
o
cc
u
r
r
en
ce
o
f
MD
R
-
T
B
.
T
h
is
s
tu
d
y
alig
n
s
with
a
s
tu
d
y
c
o
n
d
u
cted
i
n
E
th
i
o
p
ia
[
2
5
]
,
w
h
ich
f
o
u
n
d
n
o
co
r
r
elat
io
n
b
etwe
en
h
y
p
er
te
n
s
io
n
an
d
th
e
o
cc
u
r
r
en
ce
o
f
MD
R
-
T
B
.
Stu
d
ies
co
n
d
u
cted
[
5
]
in
Su
d
a
n
an
d
[
2
5
]
f
o
u
n
d
n
o
co
r
r
elatio
n
b
etwe
en
Diab
etes
Me
llit
u
s
an
d
th
e
p
r
ev
alen
ce
o
f
MD
R
-
T
B
.
T
h
is
s
tu
d
y
alig
n
s
b
y
f
in
d
in
g
n
o
c
o
r
r
elatio
n
b
etwe
en
h
y
p
er
ten
s
i
o
n
o
r
d
iab
etes
m
ellitu
s
in
ad
u
lt
T
B
p
atien
ts
at
Sirin
d
h
o
r
n
Ho
s
p
ital,
B
an
g
k
o
k
[
2
6
]
.
Dif
f
er
en
t
f
r
o
m
th
e
r
esear
ch
in
C
h
in
a
h
as
f
o
u
n
d
t
h
at
in
d
iv
id
u
als
wh
o
h
a
v
e
a
h
is
to
r
y
o
f
d
iab
etes m
ellitu
s
ar
e
ass
o
ciate
d
with
p
o
o
r
tr
ea
tm
en
t o
f
MD
R
-
T
B
[
1
5
]
.
3.
6
.
BMI
B
MI
d
o
es
n
o
t
p
o
s
e
a
r
is
k
f
o
r
MD
R
-
T
B
.
T
h
is
s
tu
d
y
alig
n
s
th
at
p
atien
ts
with
a
B
MI
<1
8
.
5
k
g
/m
2
d
o
n
o
t
co
r
r
elate
with
th
e
o
cc
u
r
r
en
ce
o
f
MD
R
-
T
B
in
p
r
im
ar
y
r
esis
tan
t
p
atien
ts
[
2
7
]
.
T
h
is
s
tu
d
y
alig
n
s
with
p
r
ev
io
u
s
r
esear
ch
co
n
d
u
cted
i
n
E
th
io
p
ia,
i
n
d
icatin
g
th
at
d
ia
b
etic
p
atien
ts
with
a
B
MI
<
1
8
.
5
o
r
>
2
5
k
g
/m
2
d
o
n
o
t
h
a
v
e
a
s
ig
n
if
ican
t
ass
o
ciatio
n
with
th
e
o
cc
u
r
r
e
n
ce
o
f
MD
R
-
T
B
[
2
8
]
.
T
h
is
s
tu
d
y
a
lig
n
s
with
r
esear
ch
co
n
d
u
cte
d
in
E
th
io
p
ia,
p
atien
ts
with
B
MI
<1
8
.
5
k
g
/m
2
d
o
n
o
t
h
av
e
a
c
o
r
r
elatio
n
with
th
e
o
cc
u
r
r
en
ce
o
f
MD
R
-
T
B
in
p
r
im
ar
y
r
esis
tan
ce
p
atien
ts
[
2
7
]
.
B
B
KPM
Ma
k
ass
ar
o
f
f
er
s
s
u
p
p
lem
en
ta
r
y
ass
is
tan
ce
to
TB
s
u
f
f
er
er
s
in
th
e
f
o
r
m
o
f
"Pr
o
t
en
"
m
ilk
.
T
h
is
m
ilk
is
p
r
o
v
id
e
d
b
y
th
e
g
o
v
er
n
m
en
t
as
a
s
u
b
s
id
y
to
en
h
an
ce
th
e
n
u
tr
itio
n
al
s
tatu
s
o
f
TB
s
u
f
f
e
r
er
s
.
A
s
tu
d
y
co
n
d
u
cted
in
C
h
in
a
f
o
u
n
d
th
at
b
ein
g
o
v
e
r
weig
h
t
o
r
o
b
ese
h
as
a
r
ed
u
ce
d
r
is
k
o
f
TB
co
m
p
ar
e
d
to
in
d
iv
id
u
als
with
n
o
r
m
a
l
weig
h
t
[
2
9
]
.
Ob
esit
y
in
p
e
r
s
o
n
s
with
TB
i
s
ass
o
ciate
d
with
h
ig
h
er
lev
els
o
f
C
D4
+
T
ce
lls
an
d
th
e
h
o
r
m
o
n
e
lep
tin
,
wh
ich
en
h
a
n
c
es
im
m
u
n
o
lo
g
ical
d
ef
en
s
e
an
d
lo
wer
s
th
e
ch
a
n
ce
s
o
f
d
ev
elo
p
in
g
ac
tiv
e
TB
[
3
0
]
.
4.
CO
NCLU
SI
O
N
TB
p
atien
ts
ca
n
en
h
a
n
ce
th
ei
r
m
ed
icatio
n
a
d
h
er
e
n
ce
.
T
h
e
in
s
titu
tio
n
al
f
o
cu
s
in
clu
d
es
a
n
ef
f
icie
n
t
d
ir
ec
tly
o
b
s
er
v
ed
tr
ea
tm
en
t
s
h
o
r
t
c
o
u
r
s
e
(
DOT
S
)
s
tr
ateg
y
,
p
ar
ticu
lar
ly
in
th
e
m
a
n
ag
em
en
t
o
f
ad
v
e
r
s
e
d
r
u
g
ev
en
t,
o
v
er
s
ee
in
g
a
n
d
s
u
p
p
o
r
t
in
g
p
atien
ts
wh
o
h
av
e
r
ec
o
v
er
ed
f
r
o
m
MD
R
-
T
B
,
in
v
o
lv
es
t
h
e
co
llab
o
r
atio
n
o
f
MD
R
-
T
B
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als
an
d
p
atien
t
s
u
p
p
o
r
t
er
s
in
th
e
Yam
ali
T
B
co
m
m
u
n
ity
,
m
o
v
in
g
s
y
n
er
g
is
tically
with
an
i
n
n
o
v
ativ
e
h
ea
lth
s
y
s
tem
,
a
d
ig
ital
TB
s
er
v
ice
n
etwo
r
k
s
y
s
tem
in
h
ea
lth
s
er
v
ice
f
ac
ilit
ies
,
b
o
th
g
o
v
er
n
m
e
n
t
an
d
p
r
iv
ate
,
to
im
p
r
o
v
e
ac
ce
s
s
to
q
u
ality
T
B
s
er
v
ices.
T
h
is
aim
s
to
co
n
tr
o
l
MD
R
-
T
B
an
d
r
ed
u
ce
ec
o
n
o
m
ic
b
u
r
d
en
,
m
o
r
b
id
ity
,
a
n
d
m
o
r
tality
in
th
e
f
u
tu
r
e
.
Fu
tu
r
e
r
esear
ch
er
s
ar
e
ex
p
ec
ted
t
o
d
ee
p
en
t
h
e
r
esear
ch
to
p
ic
f
o
r
f
u
r
t
h
er
clin
ical
r
is
k
f
ac
to
r
s
,
s
u
ch
as
a
d
d
itio
n
al
la
b
o
r
ato
r
y
test
s
an
d
HI
V
co
m
o
r
b
i
d
ities
,
to
d
eter
m
in
e
th
e
ex
ten
t o
f
r
is
k
ass
o
ciate
d
wit
h
MD
R
-
T
B
an
d
id
en
tify
p
o
ten
tial stra
teg
ies
in
th
e
f
u
tu
r
e
f
o
r
MD
R
-
T
B
co
n
tr
o
l a
n
d
p
r
ev
e
n
tio
n
.
RE
F
E
R
E
NC
E
S
[
1
]
M
i
n
i
s
t
r
y
o
f
H
e
a
l
t
h
o
f
t
h
e
R
e
p
u
b
l
i
c
o
f
I
n
d
o
n
e
s
i
a
,
T
e
c
h
n
i
c
a
l
g
u
i
d
e
l
i
n
e
s
f
o
r
t
h
e
m
a
n
a
g
e
m
e
n
t
o
f
d
r
u
g
-
res
i
st
a
n
t
t
u
b
e
r
c
u
l
o
si
s
i
n
I
n
d
o
n
e
si
a
(
i
n
I
n
d
o
n
e
s
i
a
n
)
.
J
a
k
a
r
t
a
:
G
e
n
e
r
a
l
D
i
r
e
c
t
o
r
a
t
e
o
f
D
i
sea
se
P
r
e
v
e
n
t
i
o
n
a
n
d
C
o
n
t
r
o
l
M
i
n
i
st
r
y
o
f
H
e
a
l
t
h
,
2
0
2
0
.
A
c
c
e
ss
e
d
:
F
e
b
.
0
6
,
2
0
2
3
.
[
O
n
l
i
n
e
]
.
A
v
a
i
l
a
b
l
e
:
h
t
t
p
s
:
/
/
t
b
i
n
d
o
n
e
s
i
a
.
o
r
.
i
d
/
p
u
s
t
a
k
a
_
t
b
c
/
p
e
t
u
n
j
u
k
-
t
e
k
n
i
s
-
p
e
n
a
t
a
l
a
k
sa
n
a
a
n
-
t
u
b
e
r
k
u
l
o
s
i
s
-
r
e
si
s
t
a
n
-
o
b
a
t
-
di
-
i
n
d
o
n
e
si
a
/
.
[
2
]
W
o
r
l
d
H
e
a
l
t
h
O
r
g
a
n
i
z
a
t
i
o
n
,
“
G
l
o
b
a
l
t
u
b
e
r
c
u
l
o
s
i
s
r
e
p
o
r
t
2
0
2
2
,
”
2
0
2
2
.
A
c
c
e
ss
e
d
:
F
e
b
.
0
6
,
2
0
2
3
.
[
O
n
l
i
n
e
]
.
A
v
a
i
l
a
b
l
e
:
h
t
t
p
s
:
/
/
w
w
w
.
w
h
o
.
i
n
t
/
p
u
b
l
i
c
a
t
i
o
n
s
/
i
/
i
t
e
m/
9
7
8
9
2
4
0
0
6
1
7
2
9
.
[
3
]
M
i
n
i
s
t
r
y
o
f
H
e
a
l
t
h
o
f
t
h
e
R
e
p
u
b
l
i
c
o
f
I
n
d
o
n
e
si
a
,
I
n
d
o
n
e
s
i
a
n
H
e
a
l
t
h
Pro
f
i
l
e
2
0
2
2
(
i
n
I
n
d
o
n
e
s
i
a
n
:
P
r
o
f
i
l
K
e
s
e
h
a
t
a
n
I
n
d
o
n
e
s
i
a
2
0
2
2
)
.
Ja
k
a
r
t
a
:
M
i
n
i
st
r
y
o
f
H
e
a
l
t
h
o
f
t
h
e
R
e
p
u
b
l
i
c
o
f
I
n
d
o
n
e
si
a
,
2
0
2
3
.
A
c
c
e
sse
d
:
F
e
b
.
14
,
2
0
2
4
.
[
O
n
l
i
n
e
]
.
A
v
a
i
l
a
b
l
e
:
h
t
t
p
s
:
/
/
w
w
w
.
k
e
m
k
e
s.
g
o
.
i
d
/
a
p
p
_
a
s
set
/
f
i
l
e
_
c
o
n
t
e
n
t
_
d
o
w
n
l
o
a
d
/
1
7
0
2
9
5
8
3
3
6
6
5
8
1
1
5
0
0
8
3
4
5
c
5
.
5
3
2
9
9
4
2
0
.
p
d
f
[
4
]
S
o
u
t
h
S
u
l
a
w
e
s
i
P
r
o
v
i
n
c
i
a
l
H
e
a
l
t
h
O
f
f
i
c
e
,
“
H
e
a
l
t
h
P
r
o
f
i
l
e
2
0
2
1
S
o
u
t
h
S
u
l
a
w
e
si
P
r
o
v
i
n
c
i
a
l
,
”
(
i
n
I
n
d
o
n
e
si
a
n
:
Pro
f
i
l
K
e
se
h
a
t
a
n
Pro
v
i
n
si
S
u
l
a
w
e
s
i
S
e
l
a
t
a
n
T
a
h
u
n
2
0
2
1
)
,
M
a
k
a
ss
a
r
,
2
0
2
1
.
A
c
c
e
s
e
d
:
F
e
b
.
0
6
,
2
0
2
3
.
[
O
n
l
i
n
e
]
.
A
v
a
i
l
a
b
l
e
:
h
t
t
p
s
:
/
/
a
p
i
d
i
n
k
e
s
.
su
l
se
l
p
r
o
v
.
g
o
.
i
d
/
r
e
p
o
/
d
i
n
k
e
s
-
P
R
O
F
I
L_
2
0
2
1
1
.
p
d
f
[
5]
A
.
H
.
E
l
d
u
m
a
e
t
a
l
.
,
“
A
ssessm
e
n
t
o
f
t
h
e
r
i
s
k
f
a
c
t
o
r
s
a
sso
c
i
a
t
e
d
w
i
t
h
m
u
l
t
i
d
r
u
g
-
r
e
s
i
st
a
n
t
t
u
b
e
r
c
u
l
o
s
i
s
i
n
S
u
d
a
n
:
a
c
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se
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Evaluation Warning : The document was created with Spire.PDF for Python.