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ater
n
al
h
ea
lth
s
u
c
h
as
b
ir
th
p
r
ep
ar
ed
n
ess
an
d
r
ea
d
in
ess
lev
el
ar
e
also
lo
w
er
in
h
ar
d
-
to
-
r
ea
ch
ar
ea
s
[
1
1
]
.
All
th
is
e
v
i
d
en
ce
s
u
g
g
e
s
ts
th
at
ad
d
r
ess
in
g
h
ar
d
-
to
-
r
ea
ch
p
o
p
u
latio
n
s
as
a
tar
g
et
i
n
ter
v
e
n
tio
n
to
i
m
p
r
o
v
e
m
a
ter
n
al
an
d
ch
ild
h
ea
lt
h
,
esp
ec
iall
y
i
m
m
u
n
izatio
n
,
i
s
cr
u
cial
in
ac
h
ie
v
in
g
1
4
o
f
th
e
1
7
s
u
s
tai
n
ab
le
d
ev
elo
p
m
e
n
t g
o
als
[
1
2
]
.
Sp
ec
ial
ef
f
o
r
ts
ar
e
n
ee
d
ed
to
co
n
d
u
ct
v
ac
ci
n
atio
n
in
h
ar
d
-
to
-
r
ea
ch
a
n
d
ar
ea
s
.
T
h
is
k
in
d
o
f
in
ter
v
e
n
tio
n
is
u
s
u
a
ll
y
h
i
g
h
-
c
o
s
t
[
1
3
]
,
w
it
h
n
o
n
-
v
ac
ci
n
e
co
s
t
(
p
r
o
g
r
am
m
a
n
a
g
e
m
en
t,
h
u
m
an
r
eso
u
r
ce
s
,
s
o
cial
m
o
b
il
izatio
n
,
s
u
r
v
eilla
n
ce
,
ca
p
ac
it
y
b
u
ild
i
n
g
)
w
as
h
i
g
h
er
th
an
v
ac
cin
e
co
s
t
[
1
4
]
.
Ho
w
e
v
er
,
th
e
f
i
n
d
in
g
f
r
o
m
a
p
r
ev
io
u
s
m
o
d
eli
n
g
s
t
u
d
y
i
n
Ken
y
a
s
h
o
w
ed
t
h
at
u
n
v
ac
c
in
ated
ch
ild
r
en
w
it
h
m
ea
s
les
v
ac
cin
e
f
r
o
m
2
0
1
6
to
2
0
2
0
r
esu
lted
in
a
lo
s
s
o
f
$
9
.
5
m
ill
io
n
i
n
m
ed
ical
co
s
ts
an
d
p
r
o
d
u
ctiv
it
y
,
an
d
co
n
d
u
c
tin
g
v
ac
ci
n
atio
n
i
n
g
eo
g
r
ap
h
y
h
ar
d
-
t
o
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r
ea
ch
ar
e
a
ar
e
h
ig
h
l
y
co
s
t
-
e
f
f
ec
tiv
e
[
1
5
]
.
A
m
o
d
eled
v
ac
ci
n
atio
n
s
tr
ate
g
y
i
n
th
e
De
m
o
cr
atic
R
ep
u
b
lic
o
f
C
o
n
g
o
also
s
h
o
w
ed
t
h
at
d
eli
v
er
in
g
a
s
ec
o
n
d
d
o
s
e
o
f
M
C
V
w
o
u
ld
s
av
e
m
o
r
e
th
a
n
t
h
e
US
$
1
9
9
m
ill
io
n
[
1
6
]
.
T
h
is
f
i
g
u
r
e
also
i
n
d
icate
s
t
h
e
i
m
p
o
r
tan
ce
o
f
i
n
cr
ea
s
i
n
g
v
ac
cin
at
io
n
co
v
er
a
g
e
i
n
h
ar
d
-
to
-
r
ea
ch
p
o
p
u
latio
n
s
.
A
s
y
s
te
m
a
tic
r
ev
ie
w
o
n
d
eli
v
er
in
g
p
r
ev
en
tio
n
o
f
i
n
f
ec
tio
u
s
d
is
ea
s
e
in
w
o
m
en
a
n
d
ch
ild
r
en
i
n
co
n
f
lic
t
h
ar
d
-
to
-
re
ac
h
s
ett
in
g
s
h
ad
b
ee
n
co
n
d
u
cted
p
r
ev
io
u
s
l
y
[
1
7
]
,
b
u
t
n
o
t
ev
al
u
ati
n
g
t
h
e
co
v
er
ag
e
in
cr
ea
s
e
d
o
f
in
ter
v
e
n
tio
n
s
i
m
p
le
m
en
ted
.
T
h
er
e
h
as
b
ee
n
n
o
s
y
s
te
m
ati
c
r
ev
ie
w
o
f
w
h
ic
h
s
tr
ate
g
ies
ef
f
ec
tiv
e
l
y
i
n
cr
ea
s
e
ch
ild
h
o
o
d
i
m
m
u
n
izatio
n
co
v
er
ag
e
i
n
h
ar
d
-
to
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r
ea
c
h
p
o
p
u
l
atio
n
s
.
T
h
er
ef
o
r
e,
t
h
is
s
y
s
te
m
atic
r
e
v
ie
w
w
a
s
p
r
ep
ar
e
d
to
ev
alu
ate
in
ter
v
en
ti
o
n
s
to
in
cr
ea
s
e
c
h
ild
v
ac
ci
n
ati
o
n
co
v
er
ag
e
i
n
h
ar
d
-
to
-
r
ea
ch
p
o
p
u
latio
n
s
.
2.
RE
S
E
ARCH
M
E
T
H
O
D
W
e
co
n
d
u
cted
a
s
y
s
te
m
at
ic
r
ev
ie
w
o
f
in
ter
v
e
n
tio
n
s
to
in
cr
ea
s
e
ch
ild
v
ac
ci
n
atio
n
co
v
er
a
g
e
in
h
ar
d
-
to
-
r
ea
ch
p
o
p
u
latio
n
s
.
W
e
u
s
ed
th
e
P
R
I
SM
A
c
h
ec
k
lis
t
a
s
a
wr
itin
g
g
u
id
eli
n
e
to
en
s
u
r
e
all
s
t
ep
s
ar
e
ca
r
r
ied
o
u
t
co
r
r
ec
tly
[
1
8
]
.
T
w
o
r
ev
ie
w
er
s
w
er
e
r
esp
o
n
s
ib
le
f
o
r
r
ev
ie
w
i
n
g
titl
e
s
,
ab
s
tr
ac
t
s
,
a
n
d
f
u
l
l
te
x
ts
f
o
r
in
cl
u
s
io
ns
.
P
o
p
u
latio
n
,
in
ter
v
e
n
tio
n
,
co
m
p
ar
is
o
n
,
o
u
tco
m
e
(
P
I
C
O)
f
r
a
m
e
w
o
r
k
w
a
s
u
s
ed
to
clar
if
y
t
h
e
elig
ib
ilit
y
cr
i
ter
ia
f
o
r
in
cl
u
s
io
n
an
d
ex
cl
u
s
io
n
o
f
r
elev
an
t a
r
ticle
s
[
1
9
]
,
s
u
m
m
ar
i
ze
d
in
T
ab
le
1
.
T
ab
le
1
.
P
I
C
O
f
o
r
in
clu
s
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n
a
n
d
ex
cl
u
s
io
n
cr
iter
ia
I
n
c
l
u
d
e
Ex
c
l
u
d
e
P
o
p
u
l
a
t
i
o
n
S
t
u
d
i
e
s o
n
p
r
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a
n
t
w
o
me
n
,
c
h
i
l
d
r
e
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d
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r
f
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a
r
s
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l
d
,
h
e
a
l
t
h
c
a
r
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st
a
f
f
s fr
o
m
h
a
r
d
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to
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e
a
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t
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t
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o
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g
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h
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d
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t
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a
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(
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w
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9
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c
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ti
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f
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o
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k
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w
o
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d
s
:
i
)
C
h
i
l
d
,
i
n
f
an
t
,
p
e
d
i
a
t
r
i
cs
;
ii
)
h
a
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8806
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.,
Vo
l.
10
,
No
.
3
,
Sep
tem
b
er
2021
:
646
–
6
5
6
648
T
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I
n
t.
J
.
P
u
b
lic
Hea
lth
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I
SS
N:
2
252
-
8806
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
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8806
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P
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Hea
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Sci.,
Vo
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10
,
No
.
3
,
Sep
tem
b
er
2021
:
646
–
6
5
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co
n
te
x
t
o
f
i
n
ter
v
en
t
io
n
.
A
l
l
f
iv
e
s
t
u
d
ies
h
ad
s
o
m
e
co
n
ce
r
n
s
in
m
ea
s
u
r
in
g
t
h
e
o
u
tco
m
e;
ca
r
eg
iv
er
r
ec
all
w
as
u
s
ed
to
o
b
tain
v
ac
ci
n
atio
n
s
tat
u
s
.
A
l
th
o
u
g
h
th
is
m
et
h
o
d
h
ad
q
u
alit
y
co
n
ce
r
n
s
[
2
9
]
,
th
i
s
m
et
h
o
d
w
as
s
till
ac
ce
p
tab
le,
e
s
p
ec
iall
y
in
lo
w
er
a
n
d
m
id
d
le
-
i
n
co
m
e
co
u
n
tr
ies,
a
n
d
en
co
u
r
ag
ed
to
b
e
u
s
ed
i
n
co
m
b
i
n
atio
n
w
i
th
v
ac
ci
n
atio
n
ca
r
d
s
an
d
h
ea
lt
h
ca
r
e
f
ac
ili
ties
d
o
cu
m
e
n
tatio
n
[
3
0
]
.
Du
e
to
t
h
e
d
esi
g
n
o
f
q
u
a
s
i
-
ex
p
er
i
m
e
n
tal,
r
ep
ea
ted
cr
o
s
s
-
s
ec
tio
n
al
s
t
u
d
ies,
t
h
er
e
w
as
u
n
clea
r
ev
id
en
ce
o
f
m
is
s
in
g
o
u
tco
m
e
d
ata
i
n
t
h
r
ee
s
tu
d
ie
s
[
2
4
]
-
[
2
6
]
.
B
ased
o
n
o
u
r
p
r
e
-
e
x
is
ti
n
g
cr
iter
ia
a
s
s
e
s
s
m
en
t,
f
o
u
r
s
tu
d
ies
w
er
e
ca
te
g
o
r
ized
as
lo
w
[
2
4
]
,
[
2
6
]
-
[
2
8
]
,
an
d
o
n
e
s
tu
d
y
ca
te
g
o
r
ized
as h
i
g
h
r
i
s
k
o
f
b
ias
[
2
5
]
.
3
.
2
.
Dis
cus
s
io
n
T
h
i
s
s
y
s
t
em
at
i
c
r
ev
iew
a
im
e
d
t
o
i
d
e
n
tif
y
a
p
p
r
o
p
r
i
a
t
e
in
t
er
v
en
t
i
o
n
s
t
o
in
c
r
e
as
e
ch
il
d
v
a
c
c
in
a
t
i
o
n
c
o
v
e
r
ag
e
in
h
a
r
d
-
to
-
r
e
a
ch
p
o
p
u
l
a
t
i
o
n
s
.
T
h
e
f
iv
e
s
e
le
c
t
e
d
s
t
u
d
ie
s
p
r
o
v
i
d
e
d
a
n
o
v
e
r
v
i
ew
o
f
p
o
t
e
n
ti
a
l
in
t
e
r
v
en
ti
o
n
s
t
o
i
n
c
r
e
a
s
e
c
h
i
l
d
v
a
c
ci
n
a
t
i
o
n
co
v
e
r
ag
e
in
h
a
r
d
-
to
-
r
e
a
ch
p
o
p
u
l
a
t
i
o
n
s
.
T
h
e
l
im
it
e
d
n
u
m
b
e
r
o
f
s
tu
d
i
es
th
a
t
r
ai
s
e
d
t
h
is
i
s
s
u
e
s
h
o
w
e
d
th
a
t c
h
i
l
d
im
m
u
n
i
z
at
i
o
n
in
h
a
r
d
-
to
-
r
e
a
ch
p
o
p
u
l
a
ti
o
n
s
h
a
d
n
o
t b
e
en
g
iv
en
m
u
ch
at
t
en
t
i
o
n
,
e
v
en
t
h
o
u
g
h
c
h
i
l
d
v
a
c
ci
n
a
t
i
o
n
c
o
v
e
r
a
g
e
is
s
t
il
l
o
n
e
o
f
th
e
w
o
r
l
d
'
s
g
lo
b
a
l
h
e
al
th
p
r
o
b
l
em
s
[
3
1
]
.
3
.
2
.
1
.
P
o
s
t
-
inte
rv
ent
io
n v
a
cc
ina
t
io
n c
o
v
er
a
g
e
On
e
o
f
t
h
e
es
s
en
tial
m
ea
n
in
g
s
o
f
v
ac
ci
n
atio
n
co
v
er
ag
e
i
s
f
in
d
in
g
o
u
t c
o
m
m
u
n
i
t
y
ac
ce
s
s
to
h
ea
lt
h
ca
r
e
[
3
2
]
.
Me
asles
co
v
er
ag
e
is
a
n
i
m
p
o
r
tan
t
in
d
icato
r
o
f
ac
h
iev
i
n
g
s
u
s
ta
in
ab
le
d
e
v
elo
p
m
en
t
g
o
a
l
(
SD
G
)
3
,
―
e
n
s
u
r
e
h
ea
lt
h
y
li
v
e
s
an
d
p
r
o
m
o
tin
g
w
ell
-
b
ein
g
f
o
r
all
at
all
ag
es‖.
T
h
e
h
ig
h
r
ate
o
f
m
ea
s
les
tr
an
s
m
i
s
s
io
n
r
eq
u
ir
es
at
least
9
5
%
o
f
m
ea
s
l
es1
an
d
m
ea
s
les2
v
ac
ci
n
es
co
v
er
ag
e
to
p
r
ev
en
t
tr
an
s
m
i
s
s
io
n
[
3
3
]
.
Ou
r
f
in
d
i
n
g
s
in
t
h
is
s
t
u
d
y
i
n
d
icate
t
h
at
d
es
p
ite
a
s
i
g
n
i
f
ica
n
t
i
n
cr
ea
s
e
i
n
c
o
v
er
ag
e
a
f
ter
in
ter
v
e
n
tio
n
s
w
e
r
e
r
ea
ch
ed
,
n
o
n
e
o
f
th
e
s
tu
d
ie
s
ac
h
iev
ed
a
m
in
i
m
u
m
co
v
er
a
g
e
o
f
m
ea
s
les
i
m
m
u
n
izat
io
n
o
f
9
5
%
as
s
h
o
w
n
in
T
ab
le
3
(
s
ee
i
n
ap
p
en
d
ix
)
.
Oth
er
f
in
d
i
n
g
s
i
n
t
h
is
s
tu
d
y
also
s
h
o
w
t
h
at
o
n
l
y
o
n
e
s
t
u
d
y
a
c
h
iev
ed
t
h
e
tar
g
et
o
f
at
least 8
0
% o
f
al
l
ch
ild
h
o
o
d
i
m
m
u
n
izatio
n
co
v
er
ag
e
in
ev
er
y
d
is
tr
ict
[
4
]
.
T
h
e
lo
w
p
o
s
t
-
i
n
ter
v
e
n
tio
n
co
v
er
ag
e
in
d
icate
s
th
at
d
if
f
ic
u
lt
-
to
-
r
ea
ch
p
o
p
u
lati
o
n
s
w
er
e
s
til
l a
s
i
g
n
i
f
ica
n
t c
h
a
llen
g
e
in
t
h
e
i
m
m
u
n
izat
io
n
p
r
o
g
r
a
m
.
R
e
m
o
te
an
d
co
n
f
lic
t
-
p
r
o
n
e
ar
ea
s
h
a
v
e
w
o
r
s
e
m
a
ter
n
al
a
n
d
c
h
ild
h
ea
lth
t
h
an
o
th
er
ar
ea
s
d
u
e
to
t
h
e
d
i
f
f
icu
lt
y
o
f
p
r
o
v
id
in
g
p
r
ev
en
tio
n
a
n
d
tr
ea
t
m
en
t
s
er
v
ices
[
3
4
]
.
Mo
r
e
th
an
j
u
s
t
te
m
p
o
r
ar
y
in
ter
v
en
tio
n
s
w
er
e
n
ee
d
ed
.
I
n
ter
v
en
tio
n
s
th
at
w
er
e
s
u
s
tai
n
ab
le
an
d
ap
p
lied
to
a
b
r
o
ad
e
r
lo
ca
tio
n
w
er
e
ex
p
ec
ted
to
in
cr
ea
s
e
v
ac
cin
atio
n
co
v
er
ag
e
w
it
h
lo
n
g
-
ter
m
i
m
p
ac
t
s
.
C
o
m
m
u
n
i
ca
tio
n
ab
o
u
t
th
e
i
m
p
o
r
tan
ce
o
f
v
ac
ci
n
atio
n
a
n
d
v
ac
ci
n
e
s
af
et
y
s
h
o
u
ld
b
e
i
m
p
r
o
v
ed
,
an
d
a
s
tr
ateg
y
f
o
r
tr
ac
k
in
g
d
r
o
p
-
o
u
t
ca
s
e
s
s
h
o
u
ld
also
b
e
a
p
r
io
r
ity
[
3
5
]
.
3
.
2
.
2
.
I
nte
rv
ent
io
n
s
t
ra
t
eg
ies
t
o
i
ncre
a
s
e
v
a
cc
ina
t
io
n c
o
v
e
ra
g
e
Of
t
h
e
f
iv
e
ar
ticle
s
s
elec
ted
f
o
r
th
is
s
tu
d
y
,
in
ter
v
en
tio
n
s
th
at
s
ee
m
to
g
iv
e
r
i
s
e
s
i
g
n
if
ican
t
l
y
co
m
p
ar
e
d
to
th
e
co
v
er
ag
e
n
u
m
b
er
o
f
b
aselin
e
co
n
d
itio
n
s
is
t
h
e
ap
p
licatio
n
o
f
m
Hea
l
th
m
T
i
k
a
an
d
th
e
m
u
ltip
le
in
ter
v
e
n
tio
n
s
i
n
B
an
g
lad
es
h
,
w
it
h
ea
ch
h
av
i
n
g
a
v
alu
e
o
f
OR
m
o
r
e
th
a
n
th
r
ee
[
2
4
]
,
[
2
6
]
.
On
e
s
tu
d
y
w
it
h
m
u
ltip
le
i
n
ter
v
e
n
tio
n
s
:
co
m
m
u
n
i
t
y
m
o
b
ilizatio
n
,
i
m
p
r
o
v
ed
co
m
m
u
n
icatio
n
,
a
n
d
h
ea
lt
h
ca
m
p
s
i
n
cr
ea
s
ed
3
to
1
5
%
o
v
er
b
aselin
e
d
esp
ite
r
eq
u
ir
in
g
h
i
g
h
er
co
s
ts
[
27]
.
T
h
e
in
ter
v
e
n
tio
n
w
i
th
t
h
e
m
o
b
ile
h
ea
lth
tea
m
in
t
h
e
Af
g
h
a
n
i
s
tan
s
tu
d
y
d
id
n
o
t
r
ec
o
r
d
b
aselin
e
v
al
u
es
an
d
th
er
e
f
o
r
e
co
u
ld
n
o
t
b
e
co
m
p
ar
ed
[
2
5
]
.
T
h
e
m
Hea
lt
h
i
n
ter
v
e
n
tio
n
w
it
h
I
m
T
eCHO
d
id
n
o
t sh
o
w
a
s
ig
n
i
f
i
ca
n
t in
cr
ea
s
e
in
co
v
er
a
g
e
[
3
6
]
.
m
T
i
k
a
m
Hea
lt
h
ap
p
licatio
n
s
h
o
w
ed
th
e
lar
g
e
s
t
s
ize
o
f
t
h
e
i
m
p
ac
t
o
f
i
n
cr
ea
s
i
n
g
co
v
er
ag
e
i
n
t
h
e
in
ter
v
e
n
tio
n
ar
ea
w
it
h
O
R
3
.
6
.
T
h
is
s
tr
ateg
y
w
o
r
k
ed
w
ell
in
B
an
g
lad
es
h
[
2
4
]
b
u
t
n
o
t
I
n
d
i
a
[
2
8
]
.
W
e
esti
m
ate
th
is
is
d
u
e
to
d
i
f
f
er
en
ce
s
i
n
a
p
p
licatio
n
u
s
er
s
.
I
n
B
an
g
lad
esh
,
t
h
e
m
T
i
k
a
ap
p
licatio
n
w
a
s
g
iv
e
n
d
ir
ec
tl
y
to
v
ac
cin
e
o
f
f
icer
s
to
ca
r
r
y
o
u
t
d
ir
ec
t
tr
ac
k
in
g
[
2
4
]
.
Fu
r
th
er
m
o
r
e,
p
er
i
o
d
ic
au
to
m
atic
SM
S
r
em
i
n
d
er
s
to
m
o
t
h
er
s
b
ef
o
r
e
th
e
i
m
m
u
n
izatio
n
s
c
h
ed
u
le
m
ad
e
t
h
e
m
T
ik
a
ap
p
licatio
n
m
o
r
e
e
f
f
ec
tiv
e
in
i
n
cr
ea
s
in
g
v
ac
cin
a
tio
n
Evaluation Warning : The document was created with Spire.PDF for Python.
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Ho
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.
T
h
is
in
co
n
s
is
te
n
t
b
en
e
f
it
w
as
also
r
ep
o
r
ted
in
a
p
r
ev
io
u
s
s
y
s
t
e
m
atic
r
ev
ie
w
co
n
d
u
c
ted
b
y
C
o
ck
et
a
l
.
[
3
7
]
Fu
r
t
h
er
m
o
r
e,
Oli
v
er
-
W
ill
ia
m
s
et
a
l
.
[3
8
]
r
ep
o
r
te
d
th
at
o
n
l
y
a
l
ittl
e
e
v
id
en
ce
s
u
p
p
o
r
ts
m
o
b
ile
ap
p
s
'
u
s
e
to
in
cr
ea
s
e
v
ac
cin
at
io
n
co
v
er
a
g
e.
T
h
er
ef
o
r
e,
d
esp
ite
4
.
5
b
illi
o
n
p
eo
p
le
h
av
e
m
o
b
ile
p
h
o
n
e
s
an
d
SMS tec
h
n
o
lo
g
y
h
as p
r
o
v
e
n
to
i
m
p
r
o
v
e
m
a
ter
n
al
an
d
ch
ild
h
ea
l
th
s
er
v
ice
s
i
n
d
ev
elo
p
in
g
co
u
n
tr
ies
[
3
9
]
,
th
e
u
s
e
o
f
m
o
b
ile
ap
p
s
to
in
cr
ea
s
e
v
ac
ci
n
atio
n
co
v
er
ag
e
in
h
ar
d
-
to
-
r
ea
ch
p
o
p
u
latio
n
s
s
till
n
ee
d
s
f
u
r
t
h
er
r
esear
ch
.
T
r
a
v
e
l
t
o
h
e
al
th
s
e
r
v
ic
e
s
af
f
e
cts
in
f
a
n
t
v
a
c
c
in
a
ti
o
n
c
o
v
e
r
ag
e
.
Pe
n
t
a
3
v
a
c
c
in
at
i
o
n
c
o
v
e
r
ag
e
w
a
s
l
o
w
e
r
i
n
c
h
il
d
r
e
n
w
h
o
l
iv
e
w
it
h
t
r
av
el
t
im
e
t
o
h
e
a
l
th
s
e
r
v
i
c
es
>
6
0
m
in
u
t
es
t
h
a
n
<
3
0
m
i
n
u
t
e
s
[
4
0
]
.
I
n
th
i
s
c
as
e
,
m
o
b
i
le
h
e
a
lth
t
e
am
s
ef
f
e
c
t
iv
ely
r
e
d
u
ce
d
t
r
a
v
el
t
im
e
t
o
h
e
a
lth
c
a
r
e
c
e
n
te
r
s
.
A
m
o
b
il
e
c
l
in
i
c
w
as
a
u
n
i
t
th
at
a
im
s
t
o
p
r
o
v
i
d
e
m
e
d
i
c
a
l
s
e
r
v
i
c
es
,
d
ia
g
n
o
s
i
s
,
an
d
t
r
e
a
tm
en
t
f
o
r
p
a
t
i
en
ts
i
n
r
em
o
te
a
r
e
a
s
[
4
1
]
.
A
l
th
o
u
g
h
c
o
m
m
o
n
o
b
s
t
a
c
l
es
t
o
th
is
ty
p
e
o
f
in
t
e
r
v
en
t
i
o
n
a
r
e
f
in
an
ci
a
l
p
r
o
b
l
em
s
,
h
u
m
an
r
e
s
o
u
r
c
es
,
an
d
l
o
g
i
s
tic
a
l
l
im
it
a
ti
o
n
s
[
4
2
]
,
t
h
is
s
e
r
v
ic
e
i
s
c
o
n
s
i
d
e
r
e
d
c
o
s
t
-
e
f
f
e
ct
iv
e
c
o
m
p
a
r
e
d
t
o
b
u
i
l
d
a
p
e
r
m
an
en
t
h
e
a
lt
h
u
n
i
t
in
r
em
o
te
a
n
d
h
a
r
d
-
to
-
r
e
a
ch
a
r
e
a
s
[
4
1
]
.
T
h
e
r
ef
o
r
e
,
t
o
h
av
e
s
u
s
t
a
in
a
b
il
i
ty
i
n
im
p
l
em
en
t
in
g
t
h
i
s
ty
p
e
o
f
s
e
r
v
i
ce
,
g
o
o
d
p
l
a
n
n
in
g
o
f
v
a
r
i
o
u
s
p
r
o
g
r
am
s
an
d
f
u
n
d
i
n
g
m
u
s
t
b
e
d
o
n
e
s
im
u
l
t
an
e
o
u
s
ly
b
y
s
t
ak
eh
o
l
d
e
r
s
.
A
g
o
o
d
s
ch
ed
u
le
o
f
tea
m
v
is
it
s
also
en
h
a
n
ce
d
m
o
b
ile
h
ea
lt
h
tea
m
s
'
ef
f
ec
t
iv
e
n
es
s
.
Stu
d
ie
s
in
Ni
g
er
ia
s
h
o
w
ed
th
a
t
i
m
m
u
n
izatio
n
u
ti
lizatio
n
w
a
s
af
f
ec
ted
b
y
h
ea
lt
h
ca
r
e
p
r
o
b
lem
s
.
L
ac
k
o
f
s
er
v
ices,
lack
o
f
h
ea
l
t
h
p
er
s
o
n
n
el,
an
d
v
ac
ci
n
es
'
ab
s
e
n
ce
o
n
a
p
r
ed
eter
m
i
n
ed
s
ch
e
d
u
le
lead
to
lo
w
i
m
m
u
n
izati
o
n
u
tili
za
tio
n
[
4
3
]
.
Mo
d
if
icatio
n
s
to
th
e
i
m
m
u
n
iz
atio
n
s
ch
ed
u
le
s
u
ch
as
t
h
o
s
e
ca
r
r
ied
o
u
t
in
B
an
g
lad
esh
w
er
e
a
s
tr
ateg
ic
w
a
y
o
f
d
ea
lin
g
w
it
h
t
h
is
.
C
h
a
n
g
i
n
g
t
h
e
o
u
tr
ea
ch
s
c
h
ed
u
le
b
y
m
o
b
ile
i
m
m
u
n
izatio
n
f
r
o
m
o
n
e
d
a
y
m
o
n
th
l
y
to
ev
er
y
t
w
o
m
o
n
th
s
f
o
r
t
w
o
d
a
y
s
p
r
o
v
id
es
m
o
r
e
o
p
p
o
r
tu
n
ities
f
o
r
e
v
er
y
c
h
ild
to
ac
ce
s
s
i
m
m
u
n
izati
o
n
s
.
Mo
r
e
c
h
ild
r
en
ca
n
b
e
s
er
v
ed
b
y
s
ta
y
i
n
g
lo
n
g
er
b
ec
au
s
e
t
h
e
v
ac
ci
n
atio
n
s
er
v
ice
is
n
o
t
li
m
ited
to
p
ar
ticu
lar
h
o
u
r
s
.
P
ar
en
ts
w
h
o
w
o
r
k
in
th
e
m
o
r
n
in
g
ca
n
b
r
in
g
t
h
eir
c
h
ild
i
n
t
h
e
a
f
t
er
n
o
o
n
o
r
th
e
f
o
llo
w
i
n
g
d
a
y
.
Fo
r
o
f
f
icer
s
,
t
h
i
s
s
ch
ed
u
le
m
o
d
i
f
icatio
n
al
s
o
s
a
v
es
e
x
p
en
s
es
b
ec
au
s
e
t
h
e
y
d
o
n
o
t
n
ee
d
to
co
m
e
ev
er
y
m
o
n
th
.
T
h
i
s
s
c
h
ed
u
l
e
ch
an
g
e
is
al
s
o
in
ac
co
r
d
an
ce
w
it
h
t
h
e
W
HO
r
o
u
ti
n
e
i
m
m
u
n
izatio
n
s
c
h
ed
u
le
r
ec
o
m
m
e
n
d
atio
n
s
,
w
h
ich
allo
ws
in
ter
v
a
ls
b
et
w
ee
n
DP
T
v
a
cc
in
es o
f
f
o
u
r
an
d
eig
h
t
w
ee
k
s
[
4
4
]
.
O
n
e
o
f
th
e
th
in
g
s
th
at
a
r
e
v
e
r
y
c
r
u
ci
a
l
in
im
m
u
n
i
z
a
ti
o
n
s
e
r
v
i
c
es
b
e
s
i
d
es
c
o
v
e
r
a
g
e
is
th
e
q
u
a
l
ity
o
f
v
a
c
ci
n
e
s
.
T
h
e
m
o
s
t
p
o
t
en
t
i
al
o
f
th
e
v
a
cc
in
e
c
an
b
e
a
c
h
i
ev
e
d
if
th
e
c
o
l
d
c
h
a
in
s
y
s
t
em
is
w
e
ll
im
p
l
em
en
te
d
.
T
h
i
s
i
n
cl
u
d
es
v
a
cc
in
e
s
t
o
r
ag
e
an
d
t
r
a
n
s
p
o
r
t
a
t
i
o
n
f
r
o
m
f
a
ct
o
r
i
e
s
t
o
h
e
a
lth
f
a
c
il
i
ti
e
s
w
h
e
r
e
v
ac
c
in
a
ti
o
n
s
a
r
e
ca
r
r
i
e
d
o
u
t
a
n
d
o
u
t
r
e
ac
h
l
o
c
at
i
o
n
s
.
V
a
r
i
o
u
s
m
e
th
o
d
s
w
e
r
e
d
ev
e
l
o
p
e
d
to
im
p
r
o
v
e
th
e
v
a
cc
in
e
d
el
iv
er
y
s
y
s
t
em
,
n
am
el
y
p
r
e
v
en
t
in
g
v
a
c
c
in
e
f
r
e
e
zin
g
u
s
i
n
g
c
o
l
d
w
a
te
r
i
n
s
t
ea
d
o
f
i
c
e
,
tem
p
e
r
at
u
r
e
m
o
n
i
t
o
r
i
n
g
s
y
s
t
em
s
i
n
v
ia
l
s
,
an
d
b
e
t
te
r
c
o
l
d
c
h
a
in
r
e
l
a
te
d
c
o
n
t
r
o
l
an
d
r
e
g
u
la
t
o
r
y
s
y
s
tem
s
[
4
5
]
.
O
n
e
o
f
t
h
e
ef
f
o
r
ts
m
a
d
e
t
o
m
a
in
t
ai
n
th
e
c
o
l
d
ch
a
in
s
y
s
tem
'
s
in
t
eg
r
ity
in
h
a
r
d
-
to
-
r
ea
c
h
a
r
e
as
is
r
e
-
d
es
ig
n
in
g
th
e
v
a
c
c
in
e
d
el
iv
e
r
y
s
y
s
tem
,
as
r
e
p
o
r
t
e
d
b
y
U
d
d
in
e
t
a
l
.
i
n
B
an
g
l
a
d
esh
.
Va
c
c
in
es
w
e
r
e
n
o
l
o
n
g
e
r
s
en
t
f
r
o
m
an
a
r
e
a'
s
ca
p
i
t
a
l
b
u
t
r
a
th
e
r
s
en
t
f
r
o
m
a
d
ja
c
e
n
t c
i
ti
es
[
2
6
]
.
T
h
e
g
o
a
l
w
as
t
o
cu
t
th
e
m
i
l
ea
g
e
an
d
r
e
d
u
c
e
t
r
av
e
l
t
im
e
t
o
r
e
d
u
c
e
v
a
c
ci
n
e
d
am
ag
e
d
u
e
t
o
th
e
l
o
n
g
t
r
i
p
.
T
h
is
m
e
th
o
d
i
s
g
o
o
d
en
o
u
g
h
b
u
t
r
e
q
u
i
r
es
m
o
r
e
c
o
o
r
d
i
n
a
t
i
o
n
w
i
th
o
th
e
r
d
is
t
r
i
c
t
s
as
it
w
i
ll
a
ls
o
c
h
a
n
g
e
th
e
i
r
c
o
l
d
ch
ai
n
s
y
s
t
em
.
T
h
i
s
n
e
e
d
e
d
a
d
d
i
t
i
o
n
al
w
o
r
k
b
y
o
f
f
i
ci
a
ls
f
r
o
m
o
th
e
r
d
i
s
t
r
i
c
ts
to
g
et
th
e
v
a
c
c
in
e
t
o
a
c
e
r
t
ain
p
o
i
n
t
,
w
h
i
ch
r
e
q
u
i
r
e
s
a
d
d
i
t
i
o
n
a
l
c
o
s
t
s
a
n
d
t
h
e
r
ef
o
r
e
s
h
o
u
l
d
b
e
in
c
lu
d
e
d
in
th
e
e
v
a
lu
at
i
o
n
c
o
m
p
o
n
en
t
.
I
n
B
an
g
lad
es
h
,
t
h
e
e
s
tab
lis
h
m
en
t
o
f
a
co
m
m
u
n
it
y
s
u
p
p
o
r
t
g
r
o
u
p
co
n
s
i
s
ti
n
g
o
f
i
m
m
u
n
izat
io
n
h
o
s
ts
,
m
o
th
er
s
w
i
th
f
u
ll
y
i
m
m
u
n
ize
d
ch
ild
r
en
,
v
illa
g
e
d
ef
e
n
s
e
m
e
m
b
er
s
,
m
ale
a
n
d
f
e
m
ale
s
t
u
d
en
ts
,
r
ep
r
esen
tat
iv
e
s
o
f
n
o
n
-
p
r
o
f
it
o
r
g
a
n
izatio
n
s
,
tr
ad
itio
n
al
b
ir
th
atten
d
a
n
ts
,
an
d
tr
ad
itio
n
al
h
ea
ler
s
i
n
c
r
ea
s
ed
v
ac
cin
atio
n
co
v
er
ag
e
[
2
6
]
.
A
s
tu
d
y
f
r
o
m
P
ak
is
tan
al
s
o
r
ep
o
r
ted
in
cr
ea
s
ed
v
ac
cin
atio
n
co
v
er
ag
e
af
ter
tr
ain
i
n
g
lad
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m
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b
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s
[
4
6
]
.
Hab
ib
et
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l
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o
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ted
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m
m
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o
r
al
p
o
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im
m
u
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izatio
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co
v
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ag
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[
2
7
]
.
Ho
w
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v
er
,
th
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k
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ter
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tio
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al
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R
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ar
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le,
w
i
th
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3
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0
2
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p
ar
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T
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ter
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R
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d
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HO
[
4
8
]
,
an
d
UNI
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r
ap
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r
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m
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ld
lev
el
[
4
9
]
.
T
h
u
s
,
t
h
e
co
m
b
i
n
atio
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o
f
th
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in
ter
v
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n
tio
n
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w
a
s
w
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k
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etter
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8806
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.,
Vo
l.
10
,
No
.
3
,
Sep
tem
b
er
2021
:
646
–
6
5
6
652
3
.
2
.
3
.
Co
s
t
-
E
f
f
ec
t
iv
eness
o
f
I
nte
rv
ent
io
ns
Vac
cin
atio
n
w
as
k
n
o
w
n
as
a
lif
eti
m
e
i
n
v
est
m
e
n
t.
E
v
e
n
i
n
t
h
e
lo
w
er
an
d
m
id
d
le
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i
n
co
m
e
co
u
n
tr
ies
,
v
ac
cin
a
tio
n
co
n
tr
ib
u
ted
as
p
r
o
tectio
n
ag
ain
s
t
p
o
v
er
t
y
[
5
0
]
.
Nev
er
th
ele
s
s
,
th
e
co
s
t
is
h
i
g
h
in
h
ar
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-
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h
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Of
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m
Hea
lt
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m
T
ik
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ter
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as
t
h
e
m
o
s
t
co
s
t
-
e
f
f
ec
ti
v
e
b
ec
au
s
e
o
n
l
y
u
s
in
g
SMS
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e
m
i
n
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er
s
to
o
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tain
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s
ig
n
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f
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t
i
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cr
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in
v
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c
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er
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g
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Mo
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ile
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d
h
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m
o
f
o
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tr
ea
ch
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tiv
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w
h
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n
d
u
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in
Af
g
h
a
n
is
ta
n
o
r
P
ak
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ar
e
co
n
s
id
er
ed
to
b
e
at
a
h
i
g
h
-
co
s
t
[
2
5
]
,
[
2
7
]
.
Hab
ib
et
a
l.
n
o
ted
th
at
th
e
co
s
t
o
f
ad
d
i
n
g
a
lo
w
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co
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t
h
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ca
m
p
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n
o
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lo
w
.
A
p
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f
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m
th
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d
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co
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t
s
,
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h
u
m
a
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s
,
tr
ain
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d
s
u
p
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v
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d
ed
to
s
tan
d
ar
d
i
m
m
u
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er
v
ices.
T
h
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o
r
e,
th
ese
in
ter
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ca
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o
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n
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[
2
7
]
.
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th
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ce
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th
at
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w
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ter
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ites
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p
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ec
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s
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p
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b
y
u
s
i
n
g
ex
is
ti
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g
r
eso
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r
ce
s
[
2
6
]
.
T
h
is
k
in
d
o
f
in
ter
v
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ee
d
s
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w
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p
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ar
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ize
th
e
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y
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te
m
's
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ab
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.
A
s
tu
d
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M
y
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m
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f
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w
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k
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s
a
n
d
ca
d
r
es
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h
ar
d
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to
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h
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s
h
o
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h
at
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e
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ti
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tr
an
s
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p
p
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t,
tr
ain
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,
a
n
d
r
esid
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ts
'
ac
ce
p
tan
ce
af
f
ec
ted
th
eir
w
o
r
k
p
r
o
d
u
ctiv
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[
5
1
]
.
A
s
t
u
d
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ted
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m
T
eCHO
w
a
s
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-
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I
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d
ia's
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f
an
t
m
o
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t
alit
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[
5
2
]
.
Ho
w
e
v
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,
th
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e
w
a
s
n
o
r
ec
o
r
d
o
f
its
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s
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-
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f
f
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s
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n
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v
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ater
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d
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p
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a
m
s
,
esp
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i
n
i
n
cr
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s
i
n
g
v
ac
c
in
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n
co
v
er
a
g
e.
F
u
r
t
h
er
m
o
r
e,
co
n
s
id
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in
g
th
a
t
t
h
e
co
s
ts
in
c
u
r
r
ed
w
it
h
t
h
i
s
s
y
s
te
m
n
o
t
o
n
l
y
t
h
e
p
u
r
ch
ase
o
f
eq
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ip
m
e
n
t
b
u
t
also
cr
ed
it
a
n
d
th
e
co
s
t
o
f
s
er
v
ice,
a
n
d
r
ep
lace
m
e
n
t
w
h
en
lo
s
t
o
r
s
to
len
,
th
e
u
s
e
o
f
I
m
T
eCH
O
w
a
s
in
e
f
f
ec
ti
v
e
an
d
co
s
tl
y
i
n
i
m
p
r
o
v
i
n
g
v
ac
ci
n
atio
n
co
v
er
ag
e.
3
.
2
.
4
.
L
i
m
it
a
t
i
o
ns
T
h
is
s
y
s
te
m
at
ic
r
ev
ie
w
's
m
aj
o
r
lim
ita
tio
n
w
as
t
h
e
s
m
all
n
u
m
b
er
o
f
s
t
u
d
ies
id
en
ti
f
ied
.
Dif
f
er
en
ce
s
i
n
d
esig
n
b
et
w
ee
n
s
t
u
d
ies
m
ak
e
it
d
if
f
ic
u
lt
to
co
n
cl
u
d
e
th
e
s
iz
e
o
f
th
e
i
m
p
ac
t
o
f
m
o
r
e
co
n
tr
o
lled
in
ter
v
en
t
io
n
s
.
T
h
er
e
w
er
e
o
n
l
y
t
w
o
r
an
d
o
m
ized
co
n
tr
o
lled
tr
ial
(
RCT
)
s
tu
d
ies
w
it
h
a
lo
w
r
is
k
o
f
b
ias,
t
w
o
q
u
as
i
-
ex
p
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i
m
e
n
tal
s
tu
d
ie
s
w
it
h
a
l
o
w
r
is
k
o
f
b
ias,
an
d
o
n
e
cr
o
s
s
-
s
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tio
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s
t
u
d
y
w
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th
a
h
i
g
h
r
is
k
o
f
b
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i
n
t
h
is
s
y
s
te
m
a
tic
r
ev
ie
w
.
T
h
er
ef
o
r
e,
co
n
clu
s
io
n
s
r
eg
ar
d
in
g
th
e
i
n
te
r
v
en
tio
n
'
s
e
f
f
ec
ti
v
en
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s
s
ar
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v
a
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y
in
g
.
C
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n
s
id
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in
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all
t
h
ese
l
i
m
itatio
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s
,
t
h
e
le
v
el
o
f
e
v
id
en
ce
f
o
r
i
n
ter
v
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t
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n
s
to
in
cr
ea
s
e
v
ac
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tio
n
co
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ag
e
f
o
r
ch
i
ld
r
en
i
n
h
ar
d
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to
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ea
c
h
p
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p
u
latio
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s
is
t
h
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r
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w
(
NHM
R
C
le
v
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o
f
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I
I
I
-
3
)
.
4
.
CO
NCLU
SI
O
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T
o
o
u
r
k
n
o
w
led
g
e,
t
h
is
is
th
e
f
i
r
s
t
ar
ticle
t
h
at
s
y
s
te
m
atic
all
y
r
e
v
ie
w
ed
i
n
ter
v
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tio
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s
t
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m
p
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v
ac
cin
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ag
e
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ar
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to
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s
.
O
u
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s
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atic
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5
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K.
Ed
m
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,
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6
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D.
M
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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8806
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.,
Vo
l.
10
,
No
.
3
,
Sep
tem
b
er
2021
:
646
–
6
5
6
654
[2
9
]
R.
N.
M
o
d
i,
C.
K
in
g
,
N.
Ba
r
-
Zee
v
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a
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d
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lb
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4
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5
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7
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[3
8
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Oliv
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9
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0
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[4
1
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A
.
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Kh
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.
A
.
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ru
la,
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ter
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He
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[4
2
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[4
3
]
N.
N.
Ak
w
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ta
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,
E.
A
.
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u
n
so
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.
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.
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to
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m
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.
[4
4
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W
o
rld
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Org
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"
WHO
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tt
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[4
5
]
U.
Ka
rto
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lu
a
n
d
J.
M
il
stien
,
"
T
o
o
ls
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d
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c
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[4
6
]
A
.
S
a
h
it
o
,
S
.
A
h
m
e
d
,
a
n
d
Z.
F
a
tm
i,
"
Co
v
e
rin
g
th
e
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t
m
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fo
r
v
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in
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:
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