I
nte
rna
t
io
na
l J
o
urna
l o
f
P
u
bli
c
H
ea
lt
h Science
(
I
J
P
H
S)
Vo
l.
1
4
,
No
.
1
,
Ma
r
ch
20
2
5
,
p
p
.
1
9
~
26
I
SS
N:
2
2
5
2
-
8
8
0
6
,
DOI
: 1
0
.
1
1
5
9
1
/ijp
h
s
.
v
1
4
i
1
.
2
4
6
2
6
19
J
o
ur
na
l ho
m
ep
a
g
e
:
h
ttp
:
//
ijp
h
s
.
ia
esco
r
e.
co
m
Cha
lleng
es
in imp
lementing
d
eng
ue
surv
eilla
nce in
B
a
ntul
District
Spec
ia
l R
eg
io
n of Yog
y
a
ka
rta, Indo
nesia
F
a
rdhia
s
ih Dwi
A
s
t
uti
1,
2
,
Vit
ri
Widy
a
nin
g
s
i
h
3
,
E
t
i P
o
nco
rini P
a
m
un
g
k
a
s
a
ri
3
,
Achm
a
d Ar
m
a
n Sub
ij
a
nto
3
1
D
o
c
t
o
r
a
l
P
r
o
g
r
a
m
o
n
P
u
b
l
i
c
H
e
a
l
t
h
,
U
n
i
v
e
r
si
t
a
s
S
e
b
e
l
a
s
M
a
r
e
t
,
S
u
r
a
k
a
r
t
a
,
I
n
d
o
n
e
si
a
2
F
a
c
u
l
t
y
o
f
P
u
b
l
i
c
H
e
a
l
t
h
,
A
h
ma
d
D
a
h
l
a
n
U
n
i
v
e
r
si
t
y
,
Y
o
g
y
a
k
a
r
t
a
,
I
n
d
o
n
e
s
i
a
3
F
a
c
u
l
t
y
o
f
M
e
d
i
c
i
n
e
,
U
n
i
v
e
r
s
i
t
a
s Se
b
e
l
a
s
M
a
r
e
t
,
S
u
r
a
k
a
r
t
a
,
I
n
d
o
n
e
s
i
a
Art
icle
I
nfo
AB
S
T
RAC
T
A
r
ticle
his
to
r
y:
R
ec
eiv
ed
Feb
11
,
2
0
2
4
R
ev
is
ed
May
13
,
2
0
2
4
Acc
ep
ted
May
19
,
2
0
2
4
Th
e
su
r
v
e
il
lan
c
e
s
y
ste
m
is
a
s
o
u
rc
e
o
f
i
n
fo
rm
a
ti
o
n
fo
r
p
o
li
c
y
m
a
k
e
r
to
a
d
d
re
ss
th
e
d
e
n
g
u
e
o
u
t
b
re
a
k
.
H
o
we
v
e
r,
th
e
re
wa
s
a
lac
k
o
f
i
n
fo
r
m
a
ti
o
n
o
n
th
e
e
ffe
c
ti
v
e
n
e
ss
o
f
d
e
n
g
u
e
s
u
rv
e
il
lan
c
e
sy
ste
m
in
re
p
o
rt
in
g
th
e
o
u
t
b
re
a
k
.
Th
is
st
u
d
y
a
ims
to
a
ss
e
ss
d
e
n
g
u
e
su
rv
e
il
lan
c
e
a
c
ti
v
it
ies
in
Ba
n
t
u
l
District,
S
p
e
c
ial
Re
g
io
n
o
f
Yo
g
y
a
k
a
rta,
I
n
d
o
n
e
sia
,
o
n
e
o
f
th
e
d
istri
c
ts
wi
th
a
h
ig
h
b
u
r
d
e
n
o
f
d
e
n
g
u
e
,
to
p
ro
v
i
d
e
in
f
o
rm
a
ti
o
n
o
n
c
u
rre
n
t
e
ffe
c
t
iv
e
n
e
ss
a
n
d
n
e
e
d
a
ss
e
ss
m
e
n
t
fo
r
fu
rth
e
r
imp
r
o
v
e
m
e
n
t
fo
r
d
e
n
g
u
e
su
rv
e
il
lan
c
e
sy
ste
m
.
T
h
is
q
u
a
li
tati
v
e
stu
d
y
wa
s
c
o
n
d
u
c
te
d
i
n
Ba
n
t
u
l
D
istri
c
t,
S
p
e
c
ial
Re
g
io
n
o
f
Yo
g
y
a
k
a
rta.
T
h
e
a
ss
e
ss
m
e
n
t
a
p
p
ro
a
c
h
wa
s
b
a
se
d
o
n
th
e
i
n
p
u
t
-
p
ro
c
e
ss
-
o
u
t
p
u
t
-
o
u
tc
o
m
e
(IP
OO
)
m
o
d
e
l.
T
h
e
stu
d
y
p
a
rt
icip
a
n
ts
we
re
se
lec
ted
b
a
se
d
o
n
p
u
r
p
o
si
v
e
sa
m
p
li
n
g
.
Da
ta
we
re
c
o
ll
e
c
ted
th
ro
u
g
h
in
ter
v
iew
s.
Ei
g
h
t
p
ro
g
ra
m
h
o
ld
e
r
su
rv
e
il
lan
c
e
we
re
in
terv
iew
e
d
b
a
se
d
o
n
t
h
e
in
terv
i
e
w
g
u
i
d
e
.
T
h
e
su
rv
e
il
la
n
c
e
sy
ste
m
in
Ba
n
tu
l
Re
g
e
n
c
y
a
lrea
d
y
u
ti
li
z
e
s
e
lec
tro
n
ic
re
p
o
rti
n
g
.
Re
p
o
rti
n
g
c
a
se
s
o
f
d
e
n
g
u
e
u
se
s
t
h
e
sy
ste
m
f
o
r
s
u
rv
e
i
ll
a
n
c
e
o
f
o
u
t
b
re
a
k
e
v
e
n
ts
(
S
IS
KLB).
An
a
l
y
sis
a
n
d
in
terp
re
tati
o
n
a
re
d
o
n
e
t
o
m
o
n
it
o
r
p
ro
g
re
ss
in
c
a
se
s.
Th
e
fo
ll
o
w
-
u
p
e
v
a
lu
a
ti
o
n
c
a
se
s is
v
e
c
to
r
c
o
n
tro
l
to
p
re
v
e
n
t
th
e
sp
re
a
d
o
f
th
e
c
a
se
.
Th
e
in
c
id
e
n
c
e
o
f
d
e
n
g
u
e
is
stil
l
h
ig
h
e
r
th
a
n
th
e
n
a
ti
o
n
a
l
ra
te.
T
h
e
c
a
se
fa
talit
y
ra
t
e
(CF
R)
f
o
r
d
e
n
g
u
e
is
<
1
%
;
CF
R
h
a
s
h
it
it
s
targ
e
t.
Th
e
larv
a
e
-
fre
e
ra
te
h
a
sn
'
t
re
a
c
h
e
d
it
s
targ
e
t
y
e
t.
Op
ti
m
izin
g
e
lec
tro
n
ic
re
p
o
rti
n
g
c
a
n
imp
ro
v
e
th
e
q
u
a
li
t
y
o
f
in
f
o
rm
a
ti
o
n
u
se
d
a
s
a
re
fe
re
n
c
e
in
d
e
c
isio
n
-
m
a
k
in
g
.
S
I
S
KLB
wa
s
c
re
a
ted
fo
r
ti
m
e
ly
re
p
o
rti
n
g
a
n
d
m
o
n
it
o
r
in
g
o
f
d
e
n
g
u
e
c
a
se
s.
M
o
n
it
o
rin
g
a
v
a
il
a
b
le
d
a
ta
lab
o
ra
to
ry
c
a
n
b
e
u
se
d
a
s a
q
u
ick
re
sp
o
n
se
t
o
tak
e
a
c
ti
o
n
t
o
p
re
v
e
n
t
a
n
i
n
c
re
a
se
in
c
a
se
s.
K
ey
w
o
r
d
s
:
Den
g
u
e
Den
g
u
e
h
ae
m
o
r
ag
ic
f
ev
er
E
lectr
o
n
ic
r
ep
o
r
tin
g
E
v
alu
atio
n
s
u
r
v
eillan
ce
Pu
b
lic
h
ea
lth
p
r
ac
tice
Pu
b
lic
h
ea
lth
s
u
r
v
eillan
ce
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
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Far
d
h
iasi
h
Dwi
Ast
u
ti
Do
cto
r
al
Pro
g
r
a
m
o
n
Pu
b
lic
H
ea
lth
,
Un
iv
er
s
itas
Seb
elas M
ar
et
Su
r
ak
ar
ta,
I
n
d
o
n
esia
E
m
ail:
f
ar
d
h
iasi
h
@
s
tu
d
en
t.u
n
s
.
ac
.
id
1.
I
NT
RO
D
UCT
I
O
N
Den
g
u
e
h
em
o
r
r
h
a
g
ic
f
ev
er
h
a
s
b
ee
n
a
p
u
b
lic
h
ea
lth
p
r
o
b
le
m
f
o
r
th
e
last
twen
ty
y
ea
r
s
[
1
]
.
Mo
r
e
th
an
1
0
0
tr
o
p
ical
an
d
n
o
n
-
tr
o
p
ical
co
u
n
tr
ies
h
a
v
e
r
ep
o
r
ted
d
en
g
u
e
ca
s
es,
an
d
E
u
r
o
p
e
a
n
d
t
h
e
Un
ited
States
h
av
e
r
ep
o
r
ted
d
e
n
g
u
e
ca
s
es
[
2
]
.
So
u
th
ea
s
t
Asi
a
h
as
m
an
y
d
en
g
u
e
ca
s
es,
ac
co
u
n
tin
g
f
o
r
al
m
o
s
t
h
alf
th
e
g
lo
b
al
b
u
r
d
e
n
o
f
d
en
g
u
e
[
3
]
.
Sy
m
p
t
o
m
s
o
f
d
en
g
u
e
in
f
ec
tio
n
ca
n
r
an
g
e
f
r
o
m
m
ild
to
s
ev
er
e
,
f
r
o
m
asy
m
p
to
m
atic
to
d
en
g
u
e
h
em
o
r
r
h
ag
ic
f
e
v
er
an
d
d
en
g
u
e
s
h
o
ck
s
y
n
d
r
o
m
e
[
4
]
.
T
h
ese
m
an
if
estatio
n
s
p
ar
tially
r
eq
u
ir
e
h
o
s
p
italizatio
n
.
Ho
s
p
italizatio
n
is
an
e
co
n
o
m
ic
b
u
r
d
e
n
th
at
th
e
g
o
v
er
n
m
e
n
t
b
ea
r
s
[
5
]
.
T
h
e
in
cr
ea
s
ed
ca
s
es
o
f
d
en
g
u
e
h
av
e
an
im
p
ac
t
o
n
s
o
cio
ec
o
n
o
m
ics.
T
h
e
n
u
m
b
er
o
f
h
o
s
p
ital
d
ay
s
is
th
e
p
r
o
x
y
f
o
r
s
o
cieta
l
im
p
ac
t
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
4
,
No
.
1
,
Ma
r
ch
20
2
5
:
1
9
-
26
20
b
ec
au
s
e
it
im
p
lies
s
ch
o
o
l/wo
r
k
ab
s
en
teeism
.
T
h
e
ec
o
n
o
m
ic
im
p
ac
t
i
s
d
ir
ec
t
an
d
in
d
ir
ec
t
c
o
s
ts
as
s
o
ciate
d
with
h
o
s
p
italized
an
d
am
b
u
lato
r
y
d
en
g
u
e
ca
s
es
[
2
]
.
I
n
d
o
n
esia
is
n
u
m
b
er
two
o
f
th
e
3
0
c
o
u
n
tr
ies
with
th
e
m
o
s
t
d
en
g
u
e
ca
s
es
[
3
]
.
T
h
e
Sp
ec
ial
R
eg
io
n
o
f
Yo
g
y
a
k
ar
ta
(
DI
Y)
is
a
d
e
n
g
u
e
-
en
d
e
m
ic
ar
ea
.
T
h
e
in
cid
en
ce
o
f
d
e
n
g
u
e
ca
s
es
in
f
o
u
r
d
is
tr
icts
an
d
cities
i
n
DI
Y
in
2
0
2
0
was
all
h
ig
h
er
th
an
th
e
n
atio
n
al
tar
g
et
o
f
4
9
/1
0
0
th
o
u
s
an
d
p
o
p
u
latio
n
.
I
n
2
0
2
0
,
DI
Y
b
ec
am
e
th
e
th
ir
d
p
r
o
v
in
ce
with
th
e
h
ig
h
est
d
en
g
u
e
f
e
v
er
in
cid
en
ce
r
ate
in
I
n
d
o
n
esia,
n
am
ely
9
3
.
2
p
er
1
0
0
,
0
0
0
p
o
p
u
latio
n
[
6
]
.
Mo
s
t
d
en
g
u
e
ca
s
es
in
DI
Yco
m
e
f
r
o
m
B
an
tu
l
R
eg
en
cy
[
7
]
.
B
an
tu
l
R
eg
en
cy
h
as
th
e
h
ig
h
est
ca
s
es
w
ith
an
in
cid
en
ce
r
ate
o
f
1
2
8
p
er
1
0
0
,
0
0
0
p
o
p
u
latio
n
in
2
0
2
0
.
Du
r
in
g
t
h
e
last
f
iv
e
y
ea
r
s
,
th
e
in
cid
en
ce
o
f
d
en
g
u
e
h
as
f
lu
c
tu
ated
,
b
u
t
B
an
tu
l
R
eg
en
c
y
is
s
till
th
e
ar
ea
wit
h
th
e
h
ig
h
est
DI
Y
ca
s
es
[
8
]
.
C
o
n
tin
u
o
u
s
d
ata
c
o
llectio
n
,
a
n
aly
s
is
,
in
ter
p
r
etatio
n
,
an
d
in
f
o
r
m
atio
n
d
is
s
em
in
atio
n
ar
e
s
u
r
v
eillan
ce
ac
tiv
ities
[
9
]
.
T
h
e
r
ec
o
r
d
in
g
o
f
d
e
n
g
u
e
h
ae
m
o
r
ag
ic
f
ev
er
(
DHF)
s
u
f
f
er
er
s
in
I
n
d
o
n
esia
was
co
llected
with
a
p
ass
iv
e
s
u
r
v
eillan
ce
s
y
s
tem
.
R
ep
o
r
tin
g
is
d
o
n
e
f
r
o
m
th
e
h
ea
lth
ce
n
ter
lev
el
to
th
e
city
o
r
d
is
tr
ict
h
ea
lth
o
f
f
ice
an
d
co
m
p
iled
at
th
e
h
ea
lth
ce
n
ter
[
1
0
]
.
An
o
n
g
o
in
g
s
u
r
v
eillan
ce
s
y
s
tem
m
u
s
t
p
r
o
v
id
e
in
f
o
r
m
atio
n
th
at
ca
n
b
e
u
s
ed
as
a
r
ef
er
en
ce
in
p
o
licy
-
m
a
k
in
g
b
y
s
tak
eh
o
l
d
er
[
1
1
]
.
Pu
b
li
c
h
ea
lth
m
o
n
ito
r
in
g
s
y
s
tem
s
an
aly
ze
lar
g
e
d
ata
s
ets
to
lo
o
k
f
o
r
p
atter
n
s
o
r
tr
e
n
d
s
th
at
ca
n
h
elp
with
d
is
ea
s
e
co
n
tr
o
l
o
r
p
r
ev
e
n
tio
n
in
th
e
lo
n
g
r
u
n
.
T
h
e
ev
alu
atio
n
o
f
t
h
e
d
en
g
u
e
s
u
r
v
eillan
ce
s
y
s
tem
is
a
cr
u
cial
task
to
g
u
ar
an
tee
p
r
o
p
er
d
is
ea
s
e
s
u
r
v
eillan
ce
[
1
2
]
.
Po
licy
m
ak
e
r
s
s
h
o
u
ld
ta
k
e
im
m
e
d
iate
p
r
ec
au
tio
n
s
if
s
u
r
v
eillan
ce
d
ata
s
h
o
ws
an
in
cr
ea
s
e
in
ca
s
es.
T
h
is
is
b
ad
ly
n
ee
d
e
d
in
d
is
ea
s
e
co
n
tr
o
l.
T
h
e
f
r
u
ctu
ate
d
in
cid
en
ce
o
f
d
en
g
u
e
i
n
th
e
d
is
tr
ict
h
elp
s
m
ak
e
a
q
u
esti
o
n
m
ar
k
o
n
h
o
w
th
e
s
u
r
v
eillan
ce
s
y
s
tem
r
u
n
s
.
T
h
e
s
u
r
v
eillan
ce
s
y
s
tem
in
B
an
t
u
l
R
eg
en
cy
n
ee
d
s
ass
es
s
m
en
t
to
d
eter
m
in
e
th
e
p
o
licy
im
p
lem
en
ted
.
T
h
is
ar
ticle
aim
s
to
an
aly
ze
d
en
g
u
e
s
u
r
v
eillan
ce
ac
tiv
ities
r
u
n
n
in
g
in
B
an
tu
l D
is
tr
ict,
DI
Y,
I
n
d
o
n
esia.
2.
M
E
T
H
O
D
T
h
is
r
esear
ch
u
s
es
a
q
u
alitativ
e
d
esig
n
with
a
n
ee
d
s
ass
ess
m
en
t
ap
p
r
o
ac
h
b
ased
o
n
th
e
m
o
d
el
f
o
r
p
u
b
lic
h
ea
lth
a
d
m
in
is
tr
atio
n
,
t
h
e
in
p
u
t
-
p
r
o
ce
s
s
-
o
u
t
p
u
t
-
o
u
tco
m
e
(
I
POO)
m
o
d
el
[
1
3
]
o
f
th
e
d
en
g
u
e
s
u
r
v
eillan
ce
s
y
s
tem
in
B
an
tu
l
R
eg
en
cy
.
As
s
ess
m
en
t
in
th
i
s
s
tu
d
y
was
ca
r
r
ied
o
u
t
o
n
in
p
u
ts
,
p
r
o
ce
s
s
es,
an
d
o
u
tp
u
ts
.
I
n
p
u
t
,
p
r
o
ce
s
s
,
o
u
tp
u
t,
an
d
o
u
tco
m
e
co
n
s
is
t
o
f
s
ev
er
al
co
m
p
o
n
en
ts
.
T
h
e
in
p
u
t
s
tag
e
in
clu
d
ed
h
e
a
lth
r
eso
u
r
ce
s
,
s
u
ch
as
m
ed
ical
an
d
h
ea
lth
in
s
tit
u
tio
n
s
an
d
h
ea
lth
wo
r
k
e
r
s
.
T
h
e
p
r
o
ce
s
s
s
tag
e,
also
ca
ll
ed
ac
ti
v
ities
,
r
ef
er
s
ex
p
licitly
to
p
u
b
lic
h
ea
lth
m
an
ag
em
en
t;
th
e
o
u
tp
u
t
s
tag
e
r
ef
lects
th
e
r
esu
lts
o
f
p
u
b
lic
h
ea
lth
’
s
in
p
u
t
a
n
d
p
r
o
ce
s
s
s
tag
es,
wh
ich
ca
n
b
e
n
ec
ess
ar
y
f
o
r
p
u
b
lic
h
ea
lt
h
ev
al
u
atio
n
with
in
g
o
v
er
n
m
en
ts
.
Fi
n
ally
,
th
e
o
u
tco
m
e
s
tag
e
r
ef
lects
th
e
cu
s
to
m
er
s
’
ev
alu
atio
n
,
s
u
ch
as
wh
eth
er
t
h
ey
ar
e
s
atis
f
ied
with
th
e
p
u
b
lic
h
ea
lth
s
er
v
ices
d
eliv
er
ed
.
I
n
th
is
s
tu
d
y
,
th
e
o
u
tco
m
e
o
f
th
e
Su
r
v
eillan
ce
s
y
s
tem
is
q
u
ality
o
f
life
in
t
h
e
co
m
m
u
n
ity
.
T
h
e
co
m
m
u
n
ity
’
s
q
u
ality
o
f
life
is
a
b
ig
p
ar
t
o
f
th
e
r
esear
ch
,
s
o
r
ese
ar
ch
er
s
ca
n
n
o
t
d
o
it
s
im
u
ltan
eo
u
s
ly
.
T
h
is
is
o
n
e
o
f
th
e
wea
k
n
ess
es o
f
th
is
r
esear
ch
,
s
o
th
e
r
esear
ch
e
r
h
as
y
et
to
ass
ess
th
e
o
u
tco
m
e.
I
n
f
o
r
m
a
n
t
s
i
n
t
h
e
s
t
u
d
y
w
e
r
e
s
e
l
e
c
t
e
d
b
as
e
d
o
n
p
u
r
p
o
s
i
v
e
s
am
p
l
i
n
g
.
P
r
i
m
a
r
y
h
e
a
l
t
h
c
e
n
t
e
r
s
w
i
t
h
a
h
i
g
h
i
n
c
i
d
e
n
c
e
o
f
d
e
n
g
u
e
w
e
r
e
s
ele
c
t
e
d
as
a
s
o
u
r
c
e
o
f
i
n
f
o
r
m
a
t
io
n
.
T
h
e
c
r
i
t
e
r
i
a
f
o
r
i
n
c
l
u
s
i
o
n
i
n
t
h
i
s
s
t
u
d
y
is
t
h
e
d
e
n
g
u
e
p
r
o
g
r
a
m
h
o
l
d
e
r
i
n
t
h
e
r
e
g
i
o
n
w
i
t
h
a
h
i
g
h
i
n
c
i
d
e
n
c
e
o
f
d
e
n
g
u
e
i
n
t
h
e
B
a
n
t
u
l
D
i
s
t
r
i
c
t
.
I
n
f
o
r
m
a
n
t
s
f
r
o
m
t
h
e
h
e
a
l
t
h
o
f
f
i
c
e
a
c
t
a
s
t
r
i
a
n
g
u
l
a
t
i
o
n
i
n
f
o
r
m
a
n
t
s
t
o
e
n
s
u
r
e
t
h
e
q
u
a
li
t
y
o
f
t
h
e
d
a
t
a
o
b
t
a
i
n
e
d
.
T
h
e
ex
c
l
u
s
i
o
n
c
r
i
te
r
i
o
n
is
t
h
a
t
t
h
e
i
n
f
o
r
m
a
n
t
is
u
n
w
il
l
i
n
g
t
o
b
e
i
n
t
e
r
v
i
e
we
d
.
D
a
t
a
c
o
l
l
e
cti
o
n
w
a
s
c
a
r
r
i
e
d
o
u
t
b
y
i
n
t
e
r
v
i
ew
.
I
n
t
e
r
v
i
e
ws
w
e
r
e
c
o
n
d
u
c
t
e
d
w
i
t
h
t
h
e
i
n
f
o
r
m
e
r
u
s
i
n
g
a
n
i
n
t
e
r
v
i
e
w
g
u
i
d
e
.
S
e
v
e
n
o
u
t
o
f
t
w
e
n
t
y
-
s
e
v
e
n
d
e
n
g
u
e
p
r
o
g
r
a
m
h
o
l
d
e
r
s
a
t
t
h
e
(
P
HC
s
)
a
n
d
o
n
e
p
e
r
s
o
n
a
t
t
h
e
h
e
a
l
t
h
o
f
f
i
c
e
we
r
e
i
n
f
o
r
m
a
n
t
s
o
f
t
h
i
s
s
t
u
d
y
a
s
s
h
o
w
n
i
n
T
a
b
l
e
1.
T
ab
le
1
.
C
h
ar
ac
ter
is
tic
in
f
o
r
m
er
s
o
f
in
-
d
e
p
th
in
ter
v
iew
N
o
o
f
i
n
f
o
r
m
a
n
t
s
S
e
x
A
g
e
(
y
)
Ed
u
c
a
t
i
o
n
l
e
v
e
l
W
o
r
k
e
x
p
e
r
i
e
n
c
e
(
y
)
P
H
C
1
F
e
mal
e
51
A
sso
c
i
a
t
e
d
e
g
r
e
e
3
P
H
C
2
F
e
mal
e
42
A
sso
c
i
a
t
e
d
e
g
r
e
e
5
P
H
C
3
F
e
mal
e
35
B
a
c
h
e
l
o
r
2
.
5
P
H
C
4
M
a
l
e
47
A
sso
c
i
a
t
e
d
e
g
r
e
e
6
P
H
C
5
M
a
l
e
45
A
sso
c
i
a
t
e
d
e
g
r
e
e
4
P
H
C
6
F
e
mal
e
27
A
sso
c
i
a
t
e
d
e
g
r
e
e
3
P
H
C
7
M
a
l
e
46
B
a
c
h
e
l
o
r
21
HO
F
e
mal
e
51
B
a
c
h
e
l
o
r
27
N
o
t
e
:
P
H
C
:
p
r
i
m
a
r
y
h
e
a
l
t
h
c
a
r
e
;
H
O
:
h
e
a
l
t
h
o
f
f
i
c
e
T
h
e
n
u
m
b
er
o
f
in
f
o
r
m
an
ts
u
s
ed
is
b
ased
o
n
th
e
s
atu
r
atio
n
o
f
th
e
d
ata
o
b
tai
n
ed
.
Au
d
io
r
ec
o
r
d
in
g
was
u
s
ed
f
o
r
d
ata
co
llectio
n
.
T
h
e
r
esu
lts
o
f
th
e
in
ter
v
iews
wer
e
tr
an
s
cr
ib
ed
,
a
n
d
a
q
u
alitativ
e
a
n
aly
s
is
was
ca
r
r
ied
o
u
t
b
ased
o
n
th
e
t
h
em
e.
T
h
e
f
ir
s
t
s
tep
in
th
e
q
u
alitativ
e
an
aly
s
is
is
f
r
o
m
th
e
tr
an
s
cr
ip
t
r
esu
lts
th
en
th
e
c
o
d
in
g
is
ca
r
r
ied
o
u
t.
T
h
e
s
am
e
co
d
i
n
g
is
g
r
o
u
p
e
d
b
y
ca
teg
o
r
y
ac
co
r
d
in
g
to
th
e
r
esear
ch
o
b
ject
iv
es.
Ass
es
s
m
en
t
o
f
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
C
h
a
llen
g
es in
imp
leme
n
tin
g
d
en
g
u
e
s
u
r
ve
illa
n
ce
in
B
a
n
tu
l
Dis
tr
ict
S
p
ec
ia
l
…
(
F
a
r
d
h
i
a
s
ih
Dw
i A
s
tu
ti
)
21
s
u
r
v
eillan
ce
ac
tiv
ities
in
th
e
B
an
tu
l
D
is
tr
ict
b
ased
o
n
in
p
u
t a
p
p
r
o
ac
h
,
p
r
o
ce
s
s
,
an
d
o
u
t
p
u
t.
T
h
e
th
em
e
g
iv
en
to
th
e
in
p
u
t
is
s
taf
f
av
ailab
ilit
y
,
in
f
r
astru
ctu
r
e,
an
d
av
ailab
le
b
u
d
g
et
allo
ca
tio
n
.
B
ased
o
n
th
e
p
r
o
ce
s
s
o
b
tain
ed
th
em
a,
d
ata
r
ep
o
r
tin
g
p
r
o
ce
s
s
es,
p
r
o
ce
s
s
in
g
d
at
a,
p
r
esen
tat
io
n
s
,
in
f
o
r
m
atio
n
d
is
s
em
in
atio
n
,
an
d
e
v
alu
atio
n
.
B
ased
o
n
th
e
o
u
tp
u
ts
,
it
i
s
d
en
g
u
e
r
ate
in
cid
e
n
t,
ca
s
e
f
atality
r
ate
(
C
FR
)
,
an
d
f
r
ee
lar
v
a
r
ate
co
m
p
ar
ed
to
t
h
e
n
atio
n
al
tar
g
et.
T
h
e
an
aly
s
is
r
esu
lts
o
f
in
ter
v
iews
with
h
ea
lth
ce
n
ter
p
r
o
g
r
am
h
o
ld
e
r
s
an
d
th
e
h
ea
lth
o
f
f
ice
o
b
tain
ed
t
h
e
f
o
llo
win
g
th
e
m
e
s
in
T
ab
le
2
.
T
h
e
r
esear
ch
h
as
b
ee
n
ap
p
r
o
v
ed
b
y
A
h
m
ad
Dah
lan
Un
iv
e
r
s
ity
eth
ics co
m
m
ittee
with
etic
ap
p
r
o
v
al
n
u
m
b
er
0
1
2
1
1
1
0
8
1
.
T
a
b
l
e
2
.
K
e
y
f
i
n
d
i
n
g
t
h
e
m
e
i
n
-
d
e
p
t
h
i
n
t
e
r
v
i
e
w
No
F
r
a
m
e
a
r
e
a
d
i
s
c
u
s
s
i
o
n
C
o
d
i
n
g
K
e
y
f
i
n
d
i
n
g
s
t
h
e
m
e
1
I
n
p
u
t
H
u
m
a
n
r
e
s
o
u
r
c
e
s
E
d
u
c
a
t
i
o
n
D
u
a
l
t
a
s
k
L
e
n
g
t
h
o
f
w
o
r
k
T
r
a
i
n
i
n
g
A
v
a
i
l
a
b
i
l
i
t
y
o
f
s
t
a
f
f
T
r
a
i
n
i
n
g
I
n
f
r
a
s
t
r
u
c
t
u
r
e
V
e
h
i
c
l
e
O
w
n
e
r
s
h
i
p
E
q
u
i
p
m
e
n
t
c
o
n
d
i
t
i
o
n
A
v
a
i
l
a
b
i
l
i
t
y
o
f
s
u
p
p
o
r
t
i
n
g
e
q
u
i
p
m
e
n
t
P
r
o
v
i
s
i
o
n
o
f
b
u
d
g
e
t
S
o
u
r
c
e
b
u
d
g
e
t
U
t
i
l
i
z
a
t
i
o
n
S
u
f
f
i
c
i
e
n
c
y
S
o
u
r
c
e
o
f
b
u
d
g
e
t
a
n
d
a
d
e
q
u
a
c
y
2
P
r
o
c
e
s
s
D
a
t
a
c
o
l
l
e
c
t
i
o
n
C
a
s
e
r
e
p
o
r
t
i
n
g
,
d
a
t
a
s
o
u
r
c
e
E
p
i
d
e
m
i
o
l
o
g
i
c
a
l
i
n
v
e
s
t
i
g
a
t
i
o
n
c
r
i
t
e
r
i
a
,
p
r
e
v
e
n
t
i
o
n
,
c
o
n
d
u
c
t
e
d
e
p
i
d
e
m
i
o
l
o
g
i
c
a
l
i
n
v
e
s
t
i
g
a
t
i
o
n
s
R
e
p
o
r
t
i
n
g
,
d
e
n
g
u
e
d
i
a
g
n
o
s
i
s
,
e
p
i
d
e
m
i
o
l
o
g
i
c
a
l
i
n
v
e
s
t
i
g
a
t
i
o
n
o
f
f
i
c
e
r
,
t
r
a
n
s
m
i
s
s
i
o
n
,
a
c
c
u
r
a
c
y
o
f
r
e
p
o
r
t
,
f
o
l
l
o
w
-
u
p
e
p
i
d
e
m
i
o
l
o
g
i
c
a
l
i
n
v
e
s
t
i
g
a
t
i
o
n
D
a
t
a
r
e
p
o
r
t
i
n
g
p
r
o
c
e
s
s
a
n
d
f
o
l
l
o
w
-
u
p
o
f
d
e
n
g
u
e
c
a
s
e
s
.
D
a
t
a
p
r
o
c
e
s
s
i
n
g
D
a
t
a
t
y
p
e
,
d
a
t
a
b
e
n
e
f
i
t
s
,
p
r
o
c
e
s
s
i
n
g
t
i
m
e
D
a
t
a
p
r
o
c
e
s
s
i
n
g
D
a
t
a
a
n
a
l
y
s
i
s
P
r
e
s
e
n
t
a
t
i
o
n
o
f
d
a
t
a
,
c
a
s
e
i
n
c
r
e
a
s
e
.
f
a
c
t
o
r
a
f
f
e
c
t
i
n
g
D
a
t
a
p
r
e
s
e
n
t
a
t
i
o
n
I
n
f
o
r
m
a
t
i
o
n
d
i
s
s
e
m
i
n
a
t
i
o
n
D
i
s
s
e
m
i
n
a
t
i
o
n
o
f
i
n
f
o
r
m
a
t
i
o
n
,
i
n
f
o
r
m
a
t
i
o
n
t
a
r
g
e
t
s
,
i
n
f
o
r
m
a
t
i
o
n
c
o
n
t
e
n
t
,
d
i
s
s
e
m
i
n
a
t
i
o
n
m
e
t
h
o
d
I
n
f
o
r
m
a
t
i
o
n
d
i
s
s
e
m
i
n
a
t
i
o
n
F
e
e
d
b
a
c
k
F
e
e
d
b
a
c
k
,
e
v
a
l
u
a
t
i
o
n
E
v
a
l
u
a
t
i
o
n
f
o
r
d
e
c
i
s
i
o
n
m
a
k
i
n
g
.
3
O
u
t
p
u
t
I
n
c
i
d
e
n
t
r
a
t
e
C
a
s
e
s
m
o
n
i
t
o
r
i
n
g
,
n
a
t
i
o
n
a
l
t
a
r
g
e
t
s
c
a
s
e
s
.
I
n
c
i
d
e
n
c
e
r
a
t
e
d
e
n
g
u
e
i
n
B
a
n
t
u
l
h
i
g
h
e
r
n
a
t
i
o
n
a
l
t
a
r
g
e
t
C
F
R
F
o
l
l
o
w
-
u
p
i
n
c
a
s
e
o
f
d
e
a
t
h
,
a
c
h
i
e
v
e
m
e
n
t
t
a
r
g
e
t
s
,
d
e
a
t
h
c
a
s
e
C
F
R
d
e
n
g
u
e
i
n
B
a
n
t
u
l
D
i
s
t
r
i
c
t
h
a
s
r
e
a
c
h
e
d
t
h
e
n
a
t
i
o
n
a
l
l
y
t
a
r
g
e
t
F
r
e
e
l
a
r
v
a
i
n
d
e
x
M
o
n
i
t
o
r
i
n
g
f
r
e
e
l
a
r
v
a
i
n
d
e
x
,
i
m
p
r
o
v
e
m
e
n
t
e
f
f
o
r
t
s
f
r
e
e
l
a
r
v
a
i
n
d
e
x
,
r
e
p
o
r
t
i
n
g
a
p
p
l
i
c
a
t
i
o
n
T
h
e
f
r
e
e
l
a
r
v
a
e
r
a
t
e
i
n
B
a
n
t
u
l
h
a
s
n
o
t
y
e
t
r
e
a
c
h
e
d
i
t
s
n
a
t
i
o
n
a
l
t
a
r
g
e
t
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
I
n
f
o
r
m
an
ts
in
th
is
s
tu
d
y
c
o
n
s
is
ted
o
f
s
ev
en
o
f
f
ice
r
s
r
esp
o
n
s
ib
le
f
o
r
th
e
d
e
n
g
u
e
p
r
o
g
r
am
at
th
e
p
r
im
ar
y
h
ea
lth
ca
r
e
(
PHC
)
le
v
el
an
d
o
n
e
s
taf
f
h
o
ld
in
g
t
h
e
p
r
o
g
r
am
f
r
o
m
th
e
h
ea
lth
o
f
f
ice.
Alm
o
s
t
all
in
f
o
r
m
a
n
ts
ar
e
f
em
ale.
Acc
o
r
d
in
g
t
o
wo
r
k
ex
p
e
r
ien
ce
,
th
e
in
f
o
r
m
a
n
t
wo
r
k
ed
m
o
s
tly
f
o
r
less
th
an
ten
y
ea
r
s
,
b
u
t
s
o
m
e
wo
r
k
e
d
f
o
r
m
o
r
e
t
h
an
twen
ty
y
ea
r
s
.
B
ased
o
n
ed
u
ca
tio
n
lev
el,
m
o
s
t
h
av
e
a
n
Ass
o
ciate
d
eg
r
ee
.
T
ab
le
1
s
h
o
ws
th
e
in
f
o
r
m
atio
n
o
n
ch
ar
ac
ter
is
tic
o
f
in
f
o
r
m
a
n
ts
o
f
th
is
s
tu
d
y
.
Den
g
u
e
s
u
r
v
eillan
ce
ac
tiv
ities
ru
n
n
in
g
in
th
e
B
an
tu
l
Dis
tr
ict
wer
e
ass
es
s
ed
q
u
alitativ
ely
.
An
in
-
d
ep
t
h
in
ter
v
iew
was
p
er
f
o
r
m
ed
with
th
e
h
o
ld
er
s
o
f
th
e
d
en
g
u
e
p
r
o
g
r
am
.
Fro
m
th
e
in
-
d
ep
th
in
ter
v
iews,
we
also
id
e
n
tifie
d
th
em
es
wh
ich
wer
e
class
if
ied
in
to
in
p
u
t,
p
r
o
ce
s
s
,
an
d
o
u
t
p
u
t p
r
esen
ted
as
f
o
llo
w
s
.
3
.
1
.
I
np
ut
Qu
a
li
ta
tiv
e
in
ter
v
ie
w
s
w
ith
o
f
f
ic
er
s
h
o
ld
in
g
th
e
d
en
g
u
e
p
r
o
g
r
am
a
t
th
e
p
r
im
ar
y
h
ea
l
th
ce
n
ter
s
o
b
ta
in
ed
th
e
f
o
l
lo
win
g
r
e
s
u
l
t
s
.
D
en
g
u
e
h
em
o
r
r
h
ag
ic
f
ev
er
i
n
th
e
s
u
r
v
e
il
lan
ce
s
y
s
te
m
at
t
h
e
h
ea
lth
o
f
f
ic
e
an
d
p
r
im
a
r
y
h
ea
l
th
ce
n
ter
s
i
s
th
e
r
es
p
o
n
s
ib
il
it
y
o
f
o
n
e
o
f
th
e
s
taf
f
a
s
th
e
h
o
ld
er
o
f
th
e
d
e
n
g
u
e
p
r
o
g
r
a
m
.
E
a
ch
h
ea
l
th
ce
n
ter
a
lr
e
ad
y
h
a
s
d
e
n
g
u
e
p
r
o
g
r
am
h
o
ld
er
s
.
Ho
w
e
v
er
,
ap
ar
t
f
r
o
m
m
an
ag
in
g
th
e
d
en
g
u
e
p
r
o
g
r
am
,
o
th
er
p
r
o
g
r
am
s
m
u
s
t
b
e
h
an
d
led
b
y
th
e
s
am
e
o
f
f
ic
er
.
Ap
a
r
t
f
r
o
m
th
at
,
to
c
ar
r
y
o
u
t
th
e
o
b
l
ig
at
io
n
s
o
f
th
e
d
en
g
u
e
p
r
o
g
r
am
,
t
h
er
e
ar
e
s
t
il
l
o
f
f
i
ce
r
s
wh
o
h
av
e
n
ev
er
r
ec
e
iv
ed
tr
a
in
in
g
r
el
at
ed
to
d
en
g
u
e
s
u
r
v
e
il
lan
ce
ac
t
iv
it
ie
s
.
“Ac
tu
a
lly,
I
'm
(
a
n
)
ex
tr
a
in
t
h
e
d
en
g
u
e
p
r
o
g
r
a
m.
I
’
m
s
a
n
i
ta
r
y.
S
a
n
ita
tio
n
w
o
r
k
h
a
s
n
o
t
h
in
g
to
d
o
w
ith
d
en
g
u
e.
B
ec
a
u
s
e
o
f th
e
l
a
ck
o
f h
u
ma
n
r
eso
u
r
ce
s
,
it is
a
d
o
u
b
le
j
o
b
.
”
(
PHC
7
)
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
4
,
No
.
1
,
Ma
r
ch
20
2
5
:
1
9
-
26
22
T
h
e
p
u
b
lic
h
ea
lth
ce
n
ter
h
as
f
ac
ilit
ies
an
d
in
f
r
astru
ctu
r
e
av
ailab
le
to
s
u
p
p
o
r
t
p
r
o
g
r
a
m
ac
tiv
ities
.
Av
ailab
le
co
m
p
u
te
r
s
ar
e
u
s
ed
to
g
eth
er
.
No
th
in
g
s
p
ec
if
ic
f
o
r
o
n
e
p
r
o
g
r
am
.
T
elec
o
m
m
u
n
i
c
atio
n
s
eq
u
ip
m
e
n
t
an
d
v
e
h
icles
f
o
r
o
f
f
icer
s
u
s
e
p
r
iv
ate
p
r
o
p
er
t
y
to
ca
r
r
y
o
u
t
th
eir
d
u
ties
.
T
h
is
co
n
d
itio
n
is
n
o
t
an
o
b
s
tacle
in
ca
r
r
y
in
g
o
u
t its
o
b
lig
atio
n
s
.
“L
a
p
to
p
,
ce
ll
p
h
o
n
e,
ve
h
icle,
a
n
d
my
p
r
iva
te
p
r
o
p
erty.
Th
e
p
u
b
lic
h
e
a
lth
ce
n
ter
h
a
s
a
c
o
mp
u
ter;
y
o
u
ca
n
u
s
e
it
if
y
o
u
w
a
n
t
to
b
o
r
r
o
w
it,
b
u
t
it
is
n
o
t
a
s
p
ec
ia
l
iz
ed
fa
cility
fo
r
d
en
g
u
e
p
r
o
g
r
a
mme
r
s
.
”
(
PHC
3
)
B
ased
o
n
b
u
d
g
et
av
ailab
ilit
y
,
f
o
r
d
en
g
u
e
p
r
o
g
r
am
ac
ti
v
ities
,
th
e
b
u
d
g
et
co
m
es
f
r
o
m
h
ea
lth
o
p
er
atio
n
al
ass
is
tan
ce
(
B
OK)
f
u
n
d
s
u
s
ed
f
o
r
v
ec
to
r
co
n
tr
o
l
ac
tiv
ities
an
d
ca
d
r
e
m
ee
ti
n
g
s
.
B
ased
o
n
th
e
ad
eq
u
ac
y
o
f
th
e
b
u
d
g
et,
th
e
p
r
o
g
r
am
h
o
ld
e
r
d
ec
la
r
es
th
at
t
h
e
b
u
d
g
et
is
s
u
f
f
icien
t
a
n
d
a
d
ju
s
ted
ac
co
r
d
in
g
to
th
e
p
lan
n
e
d
ac
tiv
ities
.
“If
th
ere
is
fu
n
d
in
g
fr
o
m
th
e
B
OK
,
it's fo
r
mee
tin
g
s
.
”
(
PH
C
4
)
3
.
2
.
P
r
o
ce
s
s
T
h
e
ass
ess
m
en
t
p
r
o
ce
s
s
o
f
t
h
e
s
u
r
v
eillan
ce
ac
tiv
ities
ca
r
r
ied
o
u
t
d
u
r
in
g
th
e
c
o
llectio
n
p
r
o
ce
s
s
,
p
r
o
ce
s
s
in
g
,
a
n
aly
s
is
,
an
d
in
te
r
p
r
etatio
n
o
f
d
ata
r
eg
u
lar
ly
a
n
d
c
o
n
tin
u
o
u
s
ly
,
a
n
d
th
en
th
e
d
is
s
em
in
atio
n
o
f
in
f
o
r
m
atio
n
to
u
n
its
th
at
n
ee
d
to
b
e
ab
le
to
ta
k
e
ac
tio
n
a
n
d
p
r
ev
en
t
d
is
ea
s
e.
R
ep
o
r
tin
g
d
e
n
g
u
e
ca
s
es
u
s
es
an
in
f
o
r
m
atio
n
s
y
s
tem
f
o
r
s
u
r
v
ei
llan
ce
o
f
o
u
t
b
r
ea
k
ev
en
ts
(
SISKL
B
)
f
o
r
d
en
g
u
e
.
T
h
is
s
y
s
tem
is
an
elec
tr
o
n
ic
in
f
o
r
m
atio
n
s
y
s
tem
d
ev
elo
p
ed
in
t
h
e
B
an
tu
l
D
is
tr
ict
o
f
f
ice.
E
v
er
y
h
ea
lth
s
er
v
ice,
p
r
im
ar
y
h
ea
l
th
ce
n
ter
,
an
d
h
o
s
p
ital
in
B
an
tu
l
R
eg
en
cy
ca
n
ac
ce
s
s
th
is
s
y
s
tem
.
T
h
is
s
y
s
tem
h
as
b
ee
n
u
s
ed
s
in
ce
2
0
2
0
.
Hea
lth
s
er
v
ices
in
th
e
B
an
tu
l
D
is
tr
ict
ca
n
en
ter
p
atien
t
in
f
o
r
m
atio
n
d
ir
ec
tly
in
to
th
is
s
y
s
tem
u
s
in
g
s
ep
ar
at
e
ac
ce
s
s
k
ey
s
f
r
o
m
ea
ch
h
ea
lth
s
er
v
ice.
Den
g
u
e
p
atien
ts
tr
ea
ted
at
t
h
e
h
o
s
p
ital
will
b
e
r
ep
o
r
te
d
u
s
in
g
SISKL
B
,
wh
ich
h
o
s
p
itals
in
th
e
B
an
tu
l
D
is
tr
ict
ac
ce
s
s
.
Fo
r
p
atien
ts
d
o
m
iciled
in
B
an
tu
l
D
is
tr
ict
tr
e
ated
o
u
ts
id
e
B
an
tu
l
D
is
tr
ict,
r
ep
o
r
ts
o
f
h
o
s
p
ital's
ea
r
ly
v
i
g
ilan
ce
(
KDRS
)
d
en
g
u
e
will
b
e
s
en
t
t
o
th
e
h
ea
lth
o
f
f
ice.
Hea
lth
s
er
v
ice
o
f
f
icer
s
will
ca
r
r
y
o
u
t
p
atien
t
in
p
u
t.
R
ep
o
r
t
d
e
n
g
u
e
in
f
ec
tio
n
ca
s
es
o
n
ly
d
en
g
u
e
p
atien
ts
wh
o
wer
e
h
o
s
p
italized
.
Patien
ts
d
iag
n
o
s
ed
with
d
en
g
u
e
at
p
u
b
lic
h
ea
lth
ce
n
ter
s
h
av
e
n
o
t
b
ee
n
r
e
p
o
r
ted
in
th
e
SISKL
B
s
y
s
tem
.
“Re
p
o
r
ts
fr
o
m
th
e
h
o
s
p
ita
l,
fr
o
m
th
e
K
DR
S
.”
(
PHC
1
)
C
o
m
m
u
n
icatio
n
b
etwe
en
d
en
g
u
e
p
r
o
g
r
am
h
o
ld
er
s
,
th
e
h
ea
l
th
o
f
f
ice,
an
d
th
e
p
u
b
lic
h
ea
lth
ce
n
ter
is
m
o
r
e
ac
ce
s
s
ib
le
b
y
W
h
atsAp
p
g
r
o
u
p
(
W
AG)
.
I
f
a
p
atie
n
t
with
DHF
wer
e
tr
ea
ted
at
a
h
o
s
p
ital,
W
A
G
p
r
o
v
id
es
in
f
o
r
m
atio
n
o
n
KDRS
.
T
h
e
p
r
esen
ce
o
f
W
AG
ca
n
b
e
im
m
ed
iately
f
o
llo
wed
u
p
b
y
co
n
d
u
ctin
g
ep
id
em
io
lo
g
ical
in
v
esti
g
atio
n
s
in
th
e
af
f
ec
te
d
ar
ea
.
T
h
e
r
esu
l
ts
o
f
th
e
in
v
esti
g
atio
n
ca
n
b
e
i
n
p
u
t in
to
SISKL
B
.
“
Y
es,
p
u
t
in
ev
ery
ca
s
e.
I
t
g
o
es
s
tr
a
ig
h
t
to
S
I
S
K
LB,
a
n
d
s
o
d
o
es
th
e
e
p
id
emio
lo
g
y
in
ve
s
tig
a
tio
n
.
”
(
PHC
2
)
T
h
e
ex
is
ten
ce
o
f
DHF
s
u
f
f
er
er
s
h
as
th
en
ca
r
r
ied
o
u
t
ep
id
em
io
lo
g
ical
in
v
esti
g
atio
n
in
th
e
p
atien
t
’
s
ar
ea
,
wh
ich
p
u
b
lic
h
ea
lth
ce
n
ter
o
f
f
icer
s
ca
r
r
y
o
u
t.
E
p
id
em
io
lo
g
y
r
esear
ch
is
d
o
n
e
o
n
p
atien
ts
w
h
o
ar
e
d
iag
n
o
s
ed
with
DHF.
Fo
g
g
i
n
g
was
co
n
d
u
cte
d
if
th
e
r
es
u
lt
was
p
o
s
itiv
e
in
in
v
esti
g
atio
n
ep
id
em
io
lo
g
y
.
Po
s
itiv
e
r
esu
lts
f
r
o
m
t
h
e
ep
i
d
em
io
lo
g
ical
in
v
esti
g
atio
n
in
d
icate
lo
ca
l
co
n
tag
io
n
o
r
m
an
y
ca
s
es
o
f
d
en
g
u
e
in
th
e
s
u
f
f
er
er
a
r
ea
.
Fo
g
g
in
g
is
ca
r
r
ied
o
u
t
b
y
o
f
f
icer
s
f
r
o
m
t
h
e
h
ea
lth
o
f
f
ice
in
co
llab
o
r
ati
o
n
with
th
e
p
u
b
lic
h
ea
lth
ce
n
ter
an
d
lo
ca
l
co
m
m
u
n
ity
lead
e
r
s
.
Fo
g
g
in
g
ac
tiv
ities
ar
e
ca
r
r
ied
o
u
t
o
n
ce
in
ea
c
h
ar
ea
wh
er
e
lo
ca
l
tr
an
s
m
is
s
io
n
is
f
o
u
n
d
.
I
f
th
e
in
v
esti
g
ated
ep
id
em
io
lo
g
y
r
esu
lts
ar
e
n
eg
ativ
e,
th
e
v
ec
to
r
co
n
tr
o
l
r
ec
o
m
m
en
d
atio
n
s
ar
e
s
till
im
p
lem
en
ted
.
“Fro
m
th
e
S
I
S
K
LB,
a
ll
o
f
th
i
s
h
a
s
a
p
p
ea
r
ed
,
in
to
ta
l,
s
ta
r
tin
g
fr
o
m
th
e
a
d
d
r
ess
.
We
w
ill
i
n
ve
s
tig
a
te
ep
id
emio
lo
g
ic
o
n
ly
DHF
d
ia
g
n
o
s
es,
b
u
t if
n
o
t D
HF
,
w
e
d
o
n
’
t in
ve
s
tig
a
te
.
”
(
PHC
7
)
R
ep
o
r
tin
g
DHF
p
atien
ts
in
B
an
tu
l
Dis
tr
ict
h
as
b
ee
n
d
o
n
e
u
s
in
g
SISKL
B
d
en
g
u
e.
Data
p
r
o
ce
s
s
in
g
ac
tiv
ities
in
SISKL
B
ar
e
alr
ea
d
y
av
ailab
le
in
t
h
e
s
y
s
tem
s
o
th
at
o
f
f
icer
s
ca
n
v
iew
d
en
g
u
e
p
atien
t
d
ata
b
y
r
eg
io
n
.
T
h
is
m
o
n
ito
r
in
g
is
u
s
ed
to
d
eter
m
in
e
th
e
c
o
n
tr
o
l
p
r
o
g
r
am
to
b
e
p
er
f
o
r
m
ed
.
O
f
f
icer
s
h
av
e
b
ee
n
m
o
n
ito
r
in
g
th
e
d
en
g
u
e
tr
a
n
s
m
is
s
io
n
s
ea
s
o
n
.
T
h
ey
u
s
ed
m
o
n
ito
r
in
g
as
a
r
ef
er
en
ce
in
ca
r
r
y
in
g
o
u
t
p
r
ev
e
n
tio
n
d
u
r
in
g
th
e
tr
an
s
m
is
s
io
n
s
ea
s
o
n
an
d
m
o
b
ilizin
g
th
e
c
o
m
m
u
n
ity
to
ca
r
r
y
o
u
t
v
ec
to
r
co
n
tr
o
l
b
ef
o
r
e
th
e
r
ain
y
s
ea
s
o
n
.
R
ef
r
esh
in
f
o
r
m
atio
n
r
elate
d
to
d
en
g
u
e
h
as
b
ee
n
m
a
d
e
to
in
cr
ea
s
e
k
n
o
wled
g
e
f
o
r
o
f
f
icer
s
an
d
h
ea
lth
ca
d
r
es.
Hea
lth
p
r
o
m
o
tio
n
f
o
r
th
e
co
m
m
u
n
ity
co
n
tin
u
o
u
s
ly
b
u
ild
s
awa
r
en
ess
an
d
co
m
m
u
n
ity
p
ar
ticip
atio
n
in
g
o
o
d
b
eh
av
i
o
r
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
C
h
a
llen
g
es in
imp
leme
n
tin
g
d
en
g
u
e
s
u
r
ve
illa
n
ce
in
B
a
n
tu
l
Dis
tr
ict
S
p
ec
ia
l
…
(
F
a
r
d
h
i
a
s
ih
Dw
i A
s
tu
ti
)
23
3
.
3
.
O
utput
T
h
e
ca
lcu
latio
n
o
f
th
e
in
cid
e
n
t
r
ate,
C
FR
,
an
d
lar
v
ae
-
f
r
ee
r
ate
th
e
h
ea
lth
o
f
f
ice
p
r
o
g
r
a
m
m
er
h
a
s
an
aly
ze
d
ea
c
h
y
ea
r
.
T
h
e
i
n
c
id
en
t
r
ate
i
n
B
an
tu
l
Dis
tr
ict
f
r
o
m
2
0
1
6
h
as
in
c
r
ea
s
ed
,
an
d
in
2
0
1
7
-
2
0
1
8
d
ec
r
ea
s
ed
,
b
u
t
in
2
0
1
9
an
d
2
0
2
2
,
it
in
cr
ea
s
ed
ag
ain
.
I
f
w
e
l
o
o
k
at
th
e
n
atio
n
al
tar
g
et,
th
e
ex
p
ec
ted
DHF
in
cid
en
ce
r
ate
is
<4
9
/1
0
0
,
0
0
0
p
o
p
u
latio
n
,
s
o
th
e
DHF
in
cid
e
n
ce
r
ate
in
B
an
tu
l
Dis
tr
ict
is
s
till
h
ig
h
er
th
an
th
e
n
atio
n
al
tar
g
et
-
d
escr
ip
tio
n
o
f
i
n
cid
en
t
d
e
n
g
u
e
h
em
o
r
r
h
ag
ic
f
ev
er
in
B
an
tu
l
Dis
tr
ict
in
2
0
1
6
-
2
0
2
2
as
s
h
o
wn
in
Fig
u
r
e
1
.
T
h
e
t
r
e
n
d
o
f
D
H
F
c
a
s
es
f
r
o
m
2
0
1
6
-
2
0
1
8
h
a
s
d
e
c
r
e
a
s
e
d
b
u
t
i
n
c
r
e
as
e
d
a
g
a
i
n
in
2
0
1
9
.
D
u
r
i
n
g
t
h
e
C
O
V
I
D
-
1
9
p
a
n
d
e
m
i
c
,
2
0
2
0
a
n
d
2
0
2
1
d
e
c
l
i
n
e
d
a
n
d
e
x
p
e
r
i
e
n
c
e
d
a
n
i
n
c
r
e
a
s
e
a
g
ai
n
i
n
2
0
2
2
[
1
4
]
,
[
1
5
]
.
Fig
u
r
e
1
.
I
n
cid
en
t
r
ate
an
d
C
F
R
d
en
g
u
e
h
e
m
o
r
r
h
ag
ic
f
e
v
er
i
n
B
an
tu
l
Dis
tr
ict
i
n
2
0
1
6
-
2
0
2
2
So
u
r
ce
:
Seco
n
d
a
r
y
d
ata
f
r
o
m
th
e
B
an
tu
l D
is
tr
ict
Hea
lth
Of
f
ice
B
ased
o
n
th
e
n
atio
n
al
ta
r
g
et,
th
e
d
en
g
u
e
C
FR
is
<1
%,
an
d
th
e
C
FR
in
B
an
tu
l
Dis
tr
ict
h
as
r
ea
ch
ed
th
e
n
atio
n
al
tar
g
et.
E
v
en
s
o
,
t
h
er
e
ar
e
s
till
ca
s
e
s
o
f
d
ea
th
d
u
e
to
DHF
in
B
an
tu
l
Dis
tr
ict.
T
h
e
n
atio
n
al
tar
g
et
f
o
r
lar
v
ae
-
f
r
ee
r
ates
is
m
o
r
e
th
an
9
5
%,
b
u
t
th
e
ac
h
iev
e
m
e
n
t
r
ate
in
B
an
tu
l
Dis
tr
ict
is
s
till
less
th
an
9
5
%.
Vec
to
r
s
wer
e
o
b
s
er
v
ed
d
u
r
in
g
an
ep
id
em
io
lo
g
ical
in
v
esti
g
atio
n
an
d
r
ep
o
r
ted
to
th
e
s
y
s
tem
SISKL
B
in
an
y
ca
s
e
o
f
DHF.
Ho
wev
er
,
th
e
r
e
is
a
p
ar
ticu
lar
r
e
p
o
r
tin
g
s
y
s
tem
ass
o
ciate
d
with
v
ec
to
r
d
en
s
ity
.
T
h
e
v
ec
to
r
r
ep
o
r
tin
g
s
y
s
tem
s
n
atio
n
wid
e
u
s
e
s
u
r
v
eillan
ce
s
y
s
tem
s
v
ec
to
r
s
an
d
d
is
ea
s
e
-
ca
r
r
y
in
g
an
i
m
als
(
SIL
ANT
OR
)
.
SIL
AT
OR
r
ep
o
r
tin
g
is
d
o
n
e
e
v
er
y
m
o
n
th
.
SIL
ANT
OR
is
u
s
ed
to
r
ec
o
r
d
th
e
d
en
s
ity
o
f
v
ec
to
r
s
f
o
r
d
en
g
u
e
an
d
m
alar
ia.
Sev
er
al
p
u
b
lic
h
ea
lth
ce
n
ter
s
s
tated
th
at
th
ey
h
ad
r
ep
o
r
ted
v
ec
to
r
m
o
n
ito
r
in
g
ev
er
y
m
o
n
th
.
Du
r
in
g
th
e
p
an
d
e
m
ic,
th
ey
d
id
n
o
t r
eg
u
lar
ly
r
ep
o
r
t m
o
n
ito
r
in
g
lar
v
a
e.
“
I
f
it
is
in
clu
d
e
d
in
S
I
S
K
LB,
ev
ery
time
th
ere
is
a
ca
s
e.
B
u
t
if
S
I
LANT
OR
h
a
p
p
en
s
o
n
ce
a
mo
n
t
h
.
”
(
PHC
2
)
Ou
r
s
tu
d
y
f
o
u
n
d
th
at
m
o
s
t
d
en
g
u
e
p
r
o
g
r
am
h
o
ld
er
s
h
a
d
m
u
ltip
le
r
esp
o
n
s
ib
ilit
ies,
s
o
o
f
f
i
ce
r
s
wer
e
o
v
er
wo
r
k
ed
.
T
h
is
e
x
ce
s
s
iv
e
lo
ad
m
a
k
es
th
e
p
r
o
g
r
am
im
p
le
m
en
ted
n
o
t
o
p
tim
al,
b
u
t
th
e
s
u
r
v
eillan
ce
s
y
s
tem
s
h
av
e
b
ee
n
b
ac
k
ed
u
p
b
y
elec
tr
o
n
ic
r
ep
o
r
tin
g
.
Sy
s
tem
s
ar
e
ac
ce
s
s
ib
le
b
o
th
to
h
o
s
p
itals
an
d
p
r
im
ar
y
h
ea
lt
h
ca
r
e
in
th
e
ter
r
ito
r
y
o
f
B
an
tu
l
Dis
tr
ict.
I
n
Ma
l
d
iv
es,
Su
r
v
eillan
c
e
o
f
f
icer
s
also
e
x
p
er
ie
n
ce
th
is
co
n
d
itio
n
[
1
6
]
.
I
n
ad
d
itio
n
,
th
e
s
taf
f
'
s
ab
ilit
y
m
u
s
t
s
u
p
p
o
r
ted
b
y
tr
ain
i
n
g
to
i
m
p
r
o
v
e
th
e
ca
p
ab
ilit
ies
an
d
r
esp
o
n
s
ib
ilit
ies
th
at
m
u
s
t
b
e
ca
r
r
ied
[
1
6
]
.
T
h
e
el
ec
tr
o
n
ic
s
y
s
tem
(
SISKL
B
)
r
ep
o
r
t
u
s
ed
in
B
an
tu
l
R
eg
en
cy
is
an
ad
v
an
ta
g
e
o
f
th
e
ex
is
tin
g
s
u
r
v
eillan
ce
s
y
s
tem
co
m
p
ar
ed
t
o
o
th
er
a
r
ea
s
,
wh
ich
s
till
u
s
e
p
ap
er
as th
eir
r
ep
o
r
tin
g
s
y
s
tem
.
SISKL
B
ca
n
b
e
ac
ce
s
s
ed
ev
e
r
y
tim
e.
T
h
at
ca
n
im
m
e
d
iately
b
e
m
o
n
it
o
r
ed
at
t
h
e
p
u
b
lic
h
ea
lth
ce
n
te
r
an
d
h
ea
lth
o
f
f
ice
lev
els.
T
h
e
u
s
e
o
f
elec
tr
o
n
ic
r
ep
o
r
ts
is
r
ec
o
m
m
en
d
ed
[
1
7
]
.
B
u
d
g
et
elec
tr
o
n
ic
r
e
p
o
r
tin
g
is
af
f
o
r
d
ab
le
an
d
ca
n
b
e
im
p
lem
en
ted
n
atio
n
wid
e
[
1
8
]
.
E
lectr
o
n
ic
r
ep
o
r
tin
g
f
r
o
m
r
esear
ch
in
Nig
er
ia
s
h
o
ws
th
at
s
u
r
v
eillan
ce
r
ep
o
r
tin
g
ca
n
in
cr
ea
s
e
p
r
ec
is
io
n
an
d
co
m
p
leten
ess
[
1
9
]
.
E
lectr
o
n
ic
r
e
p
o
r
tin
g
en
a
b
les
h
ea
lth
s
er
v
ices
to
m
o
n
ito
r
th
e
i
n
cr
ea
s
e
in
ca
s
es,
wh
ich
ca
n
b
e
u
s
ed
to
p
r
o
m
p
t
ac
tio
n
f
o
r
p
r
e
v
en
tio
n
.
Go
o
d
p
r
ec
is
io
n
en
ab
les
p
u
b
lic
h
ea
lth
au
t
h
o
r
ities
to
b
e
m
o
r
e
ef
f
ec
tiv
e
i
n
p
r
o
tectin
g
an
d
p
r
o
m
o
tin
g
p
u
b
lic
h
ea
lth
.
T
h
u
s
,
p
u
b
lic
h
ea
lth
s
u
r
v
eillan
ce
is
ess
en
tial
to
p
u
b
lic
h
ea
lth
p
r
ac
tice
[
2
0
]
.
B
ase
d
ata
f
o
r
SISKL
B
in
d
en
g
u
e
i
s
h
o
s
p
italized
ca
s
es
263
58
19.4
150
128
42.9
99.1
0.2
0.4
0
0.6
0.8
0.2
0.5
0
50
100
150
200
250
300
2016
2017
2018
2019
2020
2021
2022
Cas
e
s
p
e
r
100.00
0
p
e
rs
o
n
s
Y
e
ar
In
c
i
d
e
n
t
R
ate
CF
R
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
4
,
No
.
1
,
Ma
r
ch
20
2
5
:
1
9
-
26
24
th
at
ca
n
ca
u
s
e
a
late
r
esp
o
n
s
e
.
T
h
e
ca
s
e
f
iles
th
at
wer
e
m
o
n
ito
r
ed
o
n
l
y
th
o
s
e
h
o
s
p
italized
f
o
r
d
e
n
g
u
e
ca
s
es
r
esu
lted
in
a
lack
o
f
s
en
s
itiv
ity
to
s
u
r
v
eillan
ce
.
No
t
all
ca
s
es
o
f
in
f
ec
tio
n
with
d
en
g
u
e
n
e
ed
h
o
s
p
italizatio
n
.
Mo
s
t
d
en
g
u
e
f
ev
er
in
f
ec
tio
n
s
ar
e
ju
s
t
d
en
g
u
e
f
e
v
er
a
n
d
ca
n
h
ea
l
in
d
e
p
en
d
e
n
tly
with
o
u
t
c
o
m
p
licatio
n
s
[
2
1
]
.
Den
g
u
e
s
u
r
v
eillan
ce
ca
n
b
e
im
p
r
o
v
e
d
with
ea
r
ly
d
etec
tio
n
o
f
d
en
g
u
e
ca
s
es with
d
iag
n
o
s
tics
NS1
.
B
esid
es
th
at,
th
e
r
esu
lts
o
f
ep
id
em
io
l
o
g
ical
in
v
esti
g
atio
n
s
h
av
e
b
ee
n
in
te
g
r
ated
in
t
o
SISKL
B
.
Pre
v
en
tiv
e
m
ea
s
u
r
es
ca
n
b
e
ta
k
en
im
m
e
d
iately
in
ar
ea
s
with
d
en
g
u
e
ca
s
es.
I
n
a
p
r
ev
io
u
s
s
t
u
d
y
,
v
ec
to
r
co
n
tr
o
l
was
ca
r
r
ied
o
u
t
as
s
o
o
n
as
p
o
s
s
ib
le
af
ter
d
is
co
v
er
in
g
th
at
a
d
en
g
u
e
p
atien
t
ca
n
r
e
d
u
ce
th
e
p
o
s
s
ib
ilit
y
o
f
tr
an
s
m
is
s
io
n
b
y
u
p
to
9
0
%.
I
t
is
n
ec
ess
ar
y
to
d
etec
t
ca
s
es
as
ea
r
ly
as
p
o
s
s
ib
le
an
d
f
o
llo
w
u
p
with
co
n
tr
o
l
as
s
o
o
n
as
p
o
s
s
ib
le
to
p
r
ev
e
n
t
an
ep
id
em
ic
f
r
o
m
o
cc
u
r
r
in
g
[
2
2
]
.
C
o
n
tr
o
l
ca
n
b
e
ca
r
r
ie
d
o
u
t
with
an
in
teg
r
ate
d
v
ec
to
r
co
n
tr
o
l stra
teg
y
u
s
in
g
c
h
em
ical
an
d
n
o
n
-
c
h
em
ical
s
tr
a
teg
ies
[
2
3
]
.
E
v
en
th
o
u
g
h
th
e
B
an
tu
l
D
is
tr
ict
h
as
u
s
ed
elec
tr
o
n
ic
r
ep
o
r
tin
g
f
o
r
d
e
n
g
u
e,
it
ca
n
s
till
n
o
t
s
u
p
p
r
ess
th
e
ca
s
e
o
f
d
en
g
u
e.
T
h
e
p
r
ev
alen
ce
o
f
DHF
in
th
e
B
an
tu
l
D
is
t
r
ict
is
s
till
ex
p
er
ien
cin
g
f
lu
ct
u
atio
n
s
.
Natio
n
ally
,
th
e
in
cid
en
ce
o
f
DHF
in
I
n
d
o
n
esia
is
s
t
ill
a
p
u
b
lic
h
ea
lth
p
r
o
b
lem
.
T
h
e
tr
e
n
d
o
f
d
en
g
u
e
c
ases
in
I
n
d
o
n
esia
is
s
im
ilar
to
B
r
az
il
’
s
,
wh
ich
h
as
in
cr
ea
s
ed
in
r
ec
en
t
d
ec
a
d
es
[
2
]
.
Ma
n
y
f
a
cto
r
s
ar
e
a
s
s
o
ciate
d
with
th
e
o
cc
u
r
r
e
n
ce
o
f
d
en
g
u
e
f
ev
er
.
So
m
e
r
esear
ch
in
d
icate
s
t
h
er
e
is
a
s
ea
s
o
n
al
lin
k
to
th
e
o
c
cu
r
r
en
ce
o
f
d
e
n
g
u
e
f
ev
er
[
2
4
]
.
Oth
e
r
f
ac
to
r
s
th
a
t
p
r
o
m
o
ted
th
e
in
cid
en
ce
o
f
d
en
g
u
e
f
ev
er
in
clu
d
e
s
o
cial
-
ec
o
lo
g
ical
h
ab
itats
ass
o
ciate
d
with
m
o
s
q
u
ito
d
e
n
s
ity
[
2
5
]
.
I
n
o
u
r
s
tu
d
y
,
th
e
o
f
f
icials
to
o
k
p
r
ec
a
u
tio
n
s
b
y
m
o
v
in
g
th
e
p
u
b
lic
to
co
n
d
u
ct
v
ec
to
r
co
n
t
r
o
l
b
e
f
o
r
e
m
o
n
s
o
o
n
s
ea
s
o
n
.
Ho
wev
er
,
it
s
till
s
h
o
w
n
o
s
i
g
n
if
ican
t
r
e
s
u
lts
,
r
eq
u
ir
in
g
all
co
m
m
u
n
ity
i
n
v
o
lv
e
m
en
t
to
p
a
r
ticip
ate
ac
tiv
ely
in
v
ec
to
r
co
n
tr
o
l
[
2
6
]
.
E
d
u
ca
tin
g
th
e
p
u
b
l
ic
was
n
ec
ess
ar
y
to
im
p
r
o
v
e
k
n
o
wled
g
e
a
n
d
g
o
o
d
p
r
ac
tice
in
p
r
ev
e
n
tin
g
d
en
g
u
e.
T
elev
is
io
n
,
r
a
d
io
,
an
d
o
th
e
r
s
o
cial
m
ed
ia
ca
n
p
r
o
m
o
te
co
m
m
u
n
icatio
n
ab
o
u
t
d
en
g
u
e
[
2
7
]
.
Pro
v
id
in
g
m
ess
ag
es
o
n
th
e
r
is
k
o
f
d
en
g
u
e
f
ev
er
an
d
h
ea
lth
p
r
o
m
o
tio
n
ca
n
i
n
cr
ea
s
e
p
r
e
v
e
n
tio
n
b
e
h
av
io
r
[
2
8
]
.
T
h
e
h
ig
h
n
u
m
b
er
o
f
d
e
n
g
u
e
ca
s
es
is
an
im
p
licatio
n
o
n
th
e
s
tate
'
s
ec
o
n
o
m
ic
b
u
r
d
en
.
T
h
e
f
in
an
cial
b
u
r
d
e
n
in
c
u
r
r
e
d
b
y
t
h
e
s
tate
i
n
th
e
Yo
g
y
ak
ar
ta
r
eg
io
n
c
o
u
l
d
r
ea
c
h
5
1
m
illi
o
n
d
o
llar
s
in
2
0
1
5
[
2
9
]
.
B
an
tu
l
R
eg
en
cy
is
th
e
m
o
s
t
s
ig
n
if
ican
t
co
n
tr
ib
u
t
o
r
to
d
en
g
u
e
ca
s
es
in
th
e
DI
Y
.
T
h
e
d
en
g
u
e
ca
s
es
r
ec
o
r
d
ed
i
n
SISKL
B
ar
e
b
ased
o
n
h
o
s
p
italized
p
atien
ts
.
T
h
is
co
n
d
i
tio
n
n
ee
d
s
ea
r
ly
d
etec
tio
n
f
o
r
d
e
n
g
u
e
ca
s
es.
L
ab
o
r
ato
r
y
test
s
to
s
u
p
p
o
r
t th
e
d
iag
n
o
s
is
ar
e
r
eq
u
ir
e
d
.
T
h
e
u
s
e
o
f
NS1
ca
n
b
e
an
alter
n
ativ
e
d
iag
n
o
s
is
th
at
h
as
h
ig
h
s
en
s
itiv
ity
[
3
0
]
.
T
h
e
s
en
s
itiv
ity
an
d
s
p
ec
if
icatio
n
o
f
s
ev
er
al
NS1
d
iag
n
o
s
tic
r
ap
id
t
ests
in
d
icate
g
o
o
d
r
esu
lts
s
o
th
at
th
ey
ca
n
b
e
u
s
ed
as
eq
u
ip
m
en
t
f
o
r
d
e
n
g
u
e
s
cr
ee
n
in
g
[
3
1
]
.
E
x
a
m
in
atio
n
with
NS1
h
as
h
i
g
h
s
en
s
itiv
ity
o
n
th
e
th
ir
d
d
ay
a
f
ter
th
e
o
n
s
et
o
f
f
ev
e
r
[
3
2
]
.
Pre
v
io
u
s
r
esear
ch
in
d
icate
d
NS1
was
d
etec
ted
in
th
e
b
lo
o
d
f
r
o
m
t
h
e
f
ir
s
t d
ay
u
n
til
d
ay
1
8
af
ter
th
e
o
n
s
et
o
f
s
y
m
p
to
m
s
[
3
3
]
.
B
ased
o
n
th
is
s
tu
d
y
,
we
r
ec
o
m
m
e
n
d
an
NS1
u
s
e
o
f
a
f
ir
s
t
-
lev
el
h
ea
lt
h
ca
r
e
f
ac
ilit
y
to
s
cr
ee
n
f
o
r
d
e
n
g
u
e
s
u
s
p
ec
ts
.
Ne
x
t,
r
e
p
o
r
tin
g
o
n
th
e
SISKL
B
o
f
all
in
f
ec
ted
s
u
s
p
ec
ts
is
u
s
ed
as
a
r
ef
e
r
en
ce
in
th
e
p
r
ev
e
n
ti
o
n
o
f
th
e
in
cr
ea
s
e
in
ca
s
es
o
f
d
e
n
g
u
e.
T
h
e
elec
tr
o
n
ic
r
ep
o
r
tin
g
s
y
s
tem
s
u
p
p
o
r
te
d
b
y
th
e
ea
r
ly
d
etec
tio
n
o
f
d
en
g
u
e
ca
s
es will
s
tr
en
g
th
en
th
e
s
u
r
v
e
illan
ce
s
y
s
tem
.
Vect
o
r
to
d
eter
m
in
e
t
h
e
r
is
k
o
f
d
e
n
g
u
e
in
f
ec
tio
n
b
y
lar
v
a
o
r
p
u
p
a
s
tag
e
m
o
n
ito
r
in
g
in
co
n
tain
er
s
in
s
id
e
an
d
o
u
ts
id
e
th
e
h
o
m
e.
I
n
d
o
n
esia
aim
s
at
th
e
r
is
k
o
f
d
en
g
u
e
in
f
ec
tio
n
if
th
e
f
r
ee
lar
v
a
r
ate
is
less
th
an
9
5
%.
Vec
to
r
d
e
n
s
ity
ca
n
b
e
s
ee
n
b
y
th
e
b
r
etea
u
i
n
d
e
x
(
B
I
)
,
c
o
n
tain
er
in
d
ex
(
C
I
)
,
h
o
u
s
e
in
d
ex
(
HI
)
,
a
n
d
p
u
p
ae
p
er
p
er
s
o
n
in
d
e
x
(
PP
I
)
.
L
e
v
els
o
f
r
is
k
f
o
r
d
en
g
u
e
tr
a
n
s
m
is
s
io
n
:
lo
w
(
HI
<0
.
1
%),
m
ed
i
u
m
(
HI
0
.
1
%
-
5
%),
an
d
h
ig
h
(
HI
>5
%)
[
3
4
]
.
Mo
n
ito
r
i
n
g
d
en
g
u
e
v
ir
u
s
in
an
ad
u
lt
m
o
s
q
u
ito
ca
n
b
e
u
s
ed
as
ea
r
ly
d
etec
tin
g
h
az
ar
d
o
u
s
ar
ea
f
o
r
d
en
g
u
e
tr
an
s
m
is
s
io
n
[
3
5
]
.
T
h
e
s
u
r
v
eillan
ce
s
y
s
tem
s
’
v
ec
to
r
s
an
d
d
is
ea
s
e
-
ca
r
r
y
in
g
a
n
im
als
(
SIL
AT
OR
)
ca
n
b
e
u
s
ed
to
m
o
n
ito
r
h
az
a
r
d
o
u
s
ar
ea
s
.
Sy
s
te
m
SISKL
B
an
d
SIL
AT
OR
in
th
e
B
an
tu
l
D
is
tr
ict
ca
n
s
u
p
p
o
r
t
t
h
e
d
e
n
g
u
e
s
u
r
v
ei
llan
ce
s
y
s
tem
in
th
e
B
an
tu
l
D
is
tr
ict.
Data
av
ailab
ilit
y
in
b
o
t
h
s
y
s
tem
s
ca
n
h
elp
s
tak
eh
o
ld
er
s
tak
e
a
p
p
r
o
p
r
iate
p
r
ec
au
tio
n
a
r
y
m
ea
s
u
r
es.
I
t n
ee
d
s
to
b
e
awa
r
e
o
f
all
th
e
elem
e
n
ts
in
v
o
lv
ed
in
t
h
e
s
u
r
v
eillan
ce
s
y
s
tem
o
f
b
o
th
g
o
v
er
n
m
en
ts
an
d
co
m
m
u
n
ities
to
tr
y
to
p
r
ev
e
n
t th
e
o
cc
u
r
r
e
n
ce
o
f
d
e
n
g
u
e.
T
h
is
r
esear
ch
o
n
ly
ass
ess
es
th
e
d
en
g
u
e
s
u
r
v
eillan
ce
s
y
s
tem
q
u
alitativ
ely
.
Qu
an
titativ
e
an
a
ly
s
is
,
lik
e
d
ata
q
u
ality
n
ee
d
s
to
b
e
ass
es.
Data
q
u
ality
to
ass
es
s
co
m
p
leten
ess
an
d
v
alid
ity
in
p
u
b
lic
h
ea
lth
s
u
r
v
eillan
ce
.
T
h
is
is
a
lim
itatio
n
in
th
is
r
e
s
ea
r
ch
.
I
t
is
n
ec
ess
ar
y
to
ass
ess
th
e
q
u
ality
o
f
d
ata
o
b
tain
ed
o
n
SISKL
B
f
o
r
f
u
r
th
er
r
esear
ch
.
4.
CO
NCLU
SI
O
N
T
h
e
d
en
g
u
e
f
ev
e
r
s
u
r
v
eillan
ce
s
y
s
tem
r
u
n
n
in
g
in
B
an
tu
l
D
is
tr
ict
n
ee
d
s
th
e
u
s
e
o
f
o
p
tim
ized
elec
tr
o
n
ic
r
ep
o
r
tin
g
.
O
p
tim
izin
g
elec
tr
o
n
ic
r
ep
o
r
tin
g
with
lab
o
r
ato
r
y
d
etec
tio
n
in
p
r
im
a
r
y
h
ea
lth
ca
r
e
ca
n
im
p
r
o
v
e
th
e
q
u
ality
o
f
in
f
o
r
m
atio
n
u
s
ed
as
a
r
ef
er
en
ce
i
n
d
ec
is
io
n
-
m
ak
in
g
.
L
a
b
o
r
at
o
r
y
d
etec
tio
n
with
NS1
r
ap
id
test
s
ca
n
d
etec
t
d
en
g
u
e
in
th
e
ea
r
ly
p
h
ase.
SISKL
B
was
cr
ea
te
d
t
o
r
e
p
o
r
t
an
d
m
o
n
it
o
r
d
en
g
u
e
ca
s
es
o
n
tim
e.
Mo
n
ito
r
in
g
av
ailab
le
d
ata
lab
o
r
ato
r
y
ca
n
b
e
u
s
ed
a
s
a
q
u
ick
r
esp
o
n
s
e
to
tak
e
a
ctio
n
to
p
r
ev
en
t
an
in
cr
ea
s
e
in
ca
s
es
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
C
h
a
llen
g
es in
imp
leme
n
tin
g
d
en
g
u
e
s
u
r
ve
illa
n
ce
in
B
a
n
tu
l
Dis
tr
ict
S
p
ec
ia
l
…
(
F
a
r
d
h
i
a
s
ih
Dw
i A
s
tu
ti
)
25
ACK
NO
WL
E
DG
E
M
E
NT
S
Au
th
o
r
t
h
an
k
s
t
o
th
e
B
an
tu
l
Dis
tr
ict
Hea
lth
Of
f
ice
an
d
th
e
C
o
m
m
u
n
ity
Hea
lth
C
en
ter
in
B
an
tu
l
Dis
tr
ict
f
o
r
p
r
o
v
i
d
in
g
a
n
o
p
p
o
r
tu
n
ity
f
o
r
th
is
r
esear
ch
.
RE
F
E
R
E
NC
E
S
[
1
]
D
.
J.
G
u
b
l
e
r
,
“
T
h
e
g
l
o
b
a
l
e
m
e
r
g
e
n
c
e
/
r
e
su
r
g
e
n
c
e
o
f
a
r
b
o
v
i
r
a
l
d
i
se
a
ses
a
s
p
u
b
l
i
c
h
e
a
l
t
h
p
r
o
b
l
e
ms,
”
Ar
c
h
i
v
e
s
o
f
Me
d
i
c
a
l
Re
s
e
a
rc
h
,
v
o
l
.
3
3
,
n
o
.
4
,
p
p
.
3
3
0
–
3
4
2
,
2
0
0
2
,
d
o
i
:
1
0
.
1
0
1
6
/
S
0
1
8
8
-
4
4
0
9
(
0
2
)
0
0
3
7
8
-
8.
[
2
]
J.
B
.
S
.
J
u
n
i
o
r
,
E.
M
a
ss
a
d
,
A
.
Lo
b
a
o
-
N
e
t
o
,
R
.
K
a
st
n
e
r
,
L
.
O
l
i
v
e
r
,
a
n
d
E
.
G
a
l
l
a
g
h
e
r
,
“
E
p
i
d
e
mi
o
l
o
g
y
a
n
d
c
o
st
s o
f
d
e
n
g
u
e
i
n
B
r
a
z
i
l
:
a
sy
s
t
e
ma
t
i
c
l
i
t
e
r
a
t
u
r
e
r
e
v
i
e
w
,
”
I
n
t
e
rn
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
I
n
f
e
c
t
i
o
u
s
D
i
sea
s
e
s
,
v
o
l
.
1
2
2
,
p
p
.
5
2
1
–
5
2
8
,
2
0
2
2
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
i
j
i
d
.
2
0
2
2
.
0
6
.
0
5
0
.
[
3
]
W
o
r
l
d
H
e
a
l
t
h
O
r
g
a
n
i
z
a
t
i
o
n
(
W
H
O
)
,
“
D
e
n
g
u
e
i
n
t
h
e
S
o
u
t
h
-
Ea
s
t
A
si
a
,
”
W
o
r
l
d
H
e
a
l
t
h
O
rg
a
n
i
z
a
t
i
o
n
(
WHO
)
,
2
0
2
3
.
h
t
t
p
s
:
/
/
w
w
w
.
w
h
o
.
i
n
t
/
s
o
u
t
h
e
a
st
a
si
a
/
h
e
a
l
t
h
-
t
o
p
i
c
s/
d
e
n
g
u
e
-
a
n
d
-
se
v
e
r
e
-
d
e
n
g
u
e
(
a
c
c
e
sse
d
J
a
n
.
3
0
,
2
0
2
3
)
.
[
4
]
W
.
H
.
W
a
n
g
e
t
a
l
.
,
“
D
e
n
g
u
e
h
e
m
o
r
r
h
a
g
i
c
f
e
v
e
r
-
a
s
y
s
t
e
m
i
c
l
i
t
e
r
a
t
u
r
e
r
e
v
i
e
w
o
f
c
u
r
r
e
n
t
p
e
r
s
p
e
c
t
i
v
e
s
o
n
p
a
t
h
o
g
e
n
e
s
i
s
,
p
r
e
v
e
n
t
i
o
n
a
n
d
c
o
n
t
r
o
l
,
”
J
o
u
r
n
a
l
o
f
M
i
c
r
o
b
i
o
l
o
g
y
,
I
m
m
u
n
o
l
o
g
y
a
n
d
I
n
f
e
c
t
i
o
n
,
v
o
l
.
5
3
,
n
o
.
6
,
p
p
.
9
6
3
–
9
7
8
,
2
0
2
0
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
j
m
i
i
.
2
0
2
0
.
0
3
.
0
0
7
.
[
5
]
H
.
C
.
S
t
a
h
l
e
t
a
l
.
,
“
C
o
st
o
f
d
e
n
g
u
e
o
u
t
b
r
e
a
k
s:
l
i
t
e
r
a
t
u
r
e
r
e
v
i
e
w
a
n
d
c
o
u
n
t
r
y
c
a
s
e
st
u
d
i
e
s
,
”
B
MC
P
u
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
1
3
,
n
o
.
1
,
p
.
1
0
4
8
,
2
0
1
3
,
d
o
i
:
1
0
.
1
1
8
6
/
1
4
7
1
-
2458
-
13
-
1
0
4
8
.
[
6
]
M
i
n
i
s
t
r
y
o
f
H
e
a
l
t
h
I
n
d
o
n
e
si
a
n
,
I
n
d
o
n
e
si
a
n
h
e
a
l
t
h
p
ro
f
i
l
e
2
0
2
0
(
i
n
I
n
d
o
n
e
si
a
n
:
Pro
f
i
l
k
e
se
h
a
t
a
n
I
n
d
o
n
e
si
a
2
0
2
0
)
.
Jak
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
s
i
a
,
2
0
2
1
.
[
7
]
Y
o
g
y
a
k
a
r
t
a
S
p
e
c
i
a
l
R
e
g
i
o
n
a
l
H
e
a
l
t
h
S
e
r
v
i
c
e
,
H
e
a
l
t
h
p
ro
f
i
l
e
o
f
D
.
I
.
Y
o
g
y
a
k
a
rt
a
i
n
2
0
1
8
(
i
n
I
n
d
o
n
e
s
i
a
n
:
Pr
o
f
i
l
k
e
s
e
h
a
t
a
n
D
.
I
.
Y
o
g
y
a
k
a
r
t
a
T
a
h
u
n
2
0
1
8
)
.
Y
o
g
y
a
k
a
r
t
a
:
Y
o
g
y
a
k
a
r
t
a
S
p
e
c
i
a
l
R
e
g
i
o
n
a
l
H
e
a
l
t
h
S
e
r
v
i
c
e
,
2
0
1
9.
[
8
]
B
a
n
t
u
l
D
i
st
r
i
c
t
H
e
a
l
t
h
S
e
r
v
i
c
e
,
B
a
n
t
u
l
D
i
st
r
i
c
t
h
e
a
l
t
h
p
ro
f
i
l
e
2
0
2
0
(
i
n
I
n
d
o
n
e
s
i
a
n
:
Pro
f
i
l
k
e
se
h
a
t
a
n
K
a
b
u
p
a
t
e
n
Ba
n
t
u
l
t
a
h
u
n
2
0
2
0
)
.
B
a
n
t
u
l
:
B
a
n
t
u
l
D
i
s
t
r
i
c
t
H
e
a
l
t
h
S
e
r
v
i
c
e
,
2
0
2
1
.
[
9
]
S
.
L.
G
r
o
se
c
l
o
se
a
n
d
D
.
L
.
B
u
c
k
e
r
i
d
g
e
,
“
P
u
b
l
i
c
h
e
a
l
t
h
su
r
v
e
i
l
l
a
n
c
e
s
y
st
e
ms
:
r
e
c
e
n
t
a
d
v
a
n
c
e
s
i
n
t
h
e
i
r
u
s
e
a
n
d
e
v
a
l
u
a
t
i
o
n
,
”
A
n
n
u
a
l
Re
v
i
e
w
o
f
Pu
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
3
8
,
p
p
.
5
7
–
7
9
,
2
0
1
7
,
d
o
i
:
1
0
.
1
1
4
6
/
a
n
n
u
r
e
v
-
p
u
b
l
h
e
a
l
t
h
-
0
3
1
8
1
6
-
0
4
4
3
4
8
.
[
1
0
]
T.
Y
.
M
.
W
a
h
y
o
n
o
e
t
a
l
.
,
“
I
n
d
o
n
e
s
i
a
n
d
e
n
g
u
e
b
u
r
d
e
n
e
s
t
i
m
a
t
e
s:
r
e
v
i
e
w
o
f
e
v
i
d
e
n
c
e
b
y
a
n
e
x
p
e
r
t
p
a
n
e
l
,
”
E
p
i
d
e
m
i
o
l
o
g
y
a
n
d
I
n
f
e
c
t
i
o
n
,
v
o
l
.
1
4
5
,
n
o
.
1
1
,
p
p
.
2
3
2
4
–
2
3
2
9
,
2
0
1
7
,
d
o
i
:
1
0
.
1
0
1
7
/
S
0
9
5
0
2
6
8
8
1
7
0
0
1
0
3
0
.
[
1
1
]
M
.
E
.
W
.
P
.
N
su
b
u
g
a
,
“
P
u
b
l
i
c
h
e
a
l
t
h
su
r
v
e
i
l
l
a
n
c
e
:
a
t
o
o
l
f
o
r
t
a
r
g
e
t
i
n
g
a
n
d
mo
n
i
t
o
r
i
n
g
i
n
t
e
r
v
e
n
t
i
o
n
s,
”
i
n
N
a
t
i
o
n
a
l
L
i
b
r
a
ry
o
f
m
e
d
i
c
i
n
e
,
2
0
1
6
.
[
1
2
]
C
.
Lu
c
e
r
o
-
O
b
u
sa
n
,
G
.
O
d
a
,
A
.
M
o
s
t
a
g
h
i
mi
,
P
.
S
c
h
i
r
m
e
r
,
a
n
d
M
.
H
o
l
o
d
n
i
y
,
“
P
u
b
l
i
c
h
e
a
l
t
h
su
r
v
e
i
l
l
a
n
c
e
i
n
t
h
e
U
.
S
.
D
e
p
a
r
t
m
e
n
t
o
f
V
e
t
e
r
a
n
s
A
f
f
a
i
r
s:
e
v
a
l
u
a
t
i
o
n
o
f
t
h
e
P
r
a
e
d
i
c
o
s
u
r
v
e
i
l
l
a
n
c
e
s
y
st
e
m,”
BM
C
Pu
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
2
2
,
n
o
.
1
,
p
p
.
1
–
1
6
,
2
0
2
2
,
d
o
i
:
1
0
.
1
1
8
6
/
s
1
2
8
8
9
-
0
2
2
-
1
2
5
7
8
-
2.
[
1
3
]
Z
.
S
u
n
a
n
d
J
.
L
i
,
“
T
h
e
e
f
f
e
c
t
s
o
f
p
e
r
f
o
r
m
a
n
c
e
o
f
p
u
b
l
i
c
s
e
c
t
o
r
h
e
a
l
t
h
s
y
s
t
e
m
o
n
q
u
a
l
i
t
y
o
f
l
i
f
e
i
n
C
h
i
n
a
:
e
v
i
d
e
n
c
e
f
r
o
m
t
h
e
C
G
S
S
2
0
1
5
,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
E
n
v
i
r
o
n
m
e
n
t
a
l
R
e
s
e
a
r
c
h
a
n
d
P
u
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
1
7
,
n
o
.
8
,
p
.
2
8
9
6
,
2
0
2
0
,
d
o
i
:
1
0
.
3
3
9
0
/
i
j
e
r
p
h
1
7
0
8
2
8
9
6
.
[
1
4
]
B
a
n
t
u
l
D
i
s
t
r
i
c
t
H
e
a
l
t
h
S
e
r
v
i
c
e
,
B
a
n
t
u
l
D
i
s
t
ri
c
t
h
e
a
l
t
h
p
ro
f
i
l
e
2
0
2
1
(
i
n
I
n
d
o
n
e
s
i
a
n
:
Pr
o
f
i
l
k
e
se
h
a
t
a
n
K
a
b
u
p
a
t
e
n
Ba
n
t
u
l
t
a
h
u
n
2
0
2
1
).
B
a
n
t
u
l
:
B
a
n
t
u
l
D
i
s
t
r
i
c
t
H
e
a
l
t
h
S
e
r
v
i
c
e
,
2
0
2
2
.
[
1
5
]
B
a
n
t
u
l
D
i
s
t
r
i
c
t
H
e
a
l
t
h
S
e
r
v
i
c
e
,
B
a
n
t
u
l
D
i
s
t
ri
c
t
h
e
a
l
t
h
p
ro
f
i
l
e
2
0
2
2
(
i
n
I
n
d
o
n
e
s
i
a
n
:
Pr
o
f
i
l
k
e
se
h
a
t
a
n
K
a
b
u
p
a
t
e
n
Ba
n
t
u
l
t
a
h
u
n
2
0
2
2
)
.
B
a
n
t
u
l
:
B
a
n
t
u
l
D
i
s
t
r
i
c
t
H
e
a
l
t
h
S
e
r
v
i
c
e
,
2
0
2
3
.
[
1
6
]
A
.
A
b
d
u
l
l
a
,
F
.
R
a
sh
e
e
d
a
,
I
.
A
h
m
e
d
,
a
n
d
M
.
A
b
o
o
b
a
k
u
r
,
“
A
n
e
v
a
l
u
a
t
i
o
n
o
f
t
h
e
s
u
r
v
e
i
l
l
a
n
c
e
sy
s
t
e
m
f
o
r
d
e
n
g
u
e
v
i
r
u
s
i
n
f
e
c
t
i
o
n
s
i
n
M
a
l
d
i
v
e
s,
”
WHO
S
o
u
t
h
-
Ea
s
t
As
i
a
J
o
u
rn
a
l
o
f
P
u
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
3
,
n
o
.
1
,
p
p
.
6
0
–
6
8
,
2
0
1
4
,
d
o
i
:
1
0
.
4
1
0
3
/
2
2
2
4
-
3
1
5
1
.
2
0
6
8
8
6
.
[
1
7
]
M
.
E.
B
e
a
t
t
y
e
t
a
l
.
,
“
B
e
s
t
p
r
a
c
t
i
c
e
s
i
n
d
e
n
g
u
e
s
u
r
v
e
i
l
l
a
n
c
e
:
a
r
e
p
o
r
t
f
r
o
m t
h
e
a
si
a
-
p
a
c
i
f
i
c
a
n
d
a
meri
c
a
s
d
e
n
g
u
e
p
r
e
v
e
n
t
i
o
n
b
o
a
r
d
s,
”
PLo
S
N
e
g
l
e
c
t
e
d
T
ro
p
i
c
a
l
D
i
se
a
ses
,
v
o
l
.
4
,
n
o
.
1
1
,
p.
e
8
9
0
,
2
0
1
0
,
d
o
i
:
1
0
.
1
3
7
1
/
j
o
u
r
n
a
l
.
p
n
t
d
.
0
0
0
0
8
9
0
.
[
1
8
]
A
.
Le
v
i
n
e
t
a
l
.
,
“
C
o
s
t
i
n
g
e
l
e
c
t
r
o
n
i
c
p
r
i
v
a
t
e
se
c
t
o
r
ma
l
a
r
i
a
s
u
r
v
e
i
l
l
a
n
c
e
i
n
t
h
e
G
r
e
a
t
e
r
M
e
k
o
n
g
S
u
b
r
e
g
i
o
n
,
”
Ma
l
a
r
i
a
J
o
u
r
n
a
l
,
v
o
l
.
2
0
,
n
o
.
1
,
p
p
.
1
–
1
2
,
2
0
2
1
,
d
o
i
:
1
0
.
1
1
8
6
/
s
1
2
9
3
6
-
0
2
1
-
0
3
7
2
7
-
w.
[
1
9
]
L.
M
.
I
b
r
a
h
i
m
e
t
a
l
.
,
“
E
l
e
c
t
r
o
n
i
c
r
e
p
o
r
t
i
n
g
o
f
i
n
t
e
g
r
a
t
e
d
d
i
se
a
se
s
u
r
v
e
i
l
l
a
n
c
e
a
n
d
r
e
sp
o
n
se:
l
e
sso
n
s
l
e
a
r
n
e
d
f
r
o
m
n
o
r
t
h
e
a
st
,
N
i
g
e
r
i
a
,
2
0
1
9
,
”
BM
C
P
u
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
2
1
,
n
o
.
1
,
p.
9
1
6
,
2
0
2
1
,
d
o
i
:
1
0
.
1
1
8
6
/
s
1
2
8
8
9
-
0
2
1
-
1
0
9
5
7
-
9.
[
2
0
]
Jo
h
n
s
H
o
p
k
i
n
s
M
e
d
i
c
i
n
e
,
“
P
u
b
l
i
c
h
e
a
l
t
h
s
u
r
v
e
i
l
l
a
n
c
e
a
c
t
i
v
i
t
i
e
s,
”
J
o
h
n
s
H
o
p
k
i
n
s
M
e
d
i
c
i
n
e
,
2
0
2
0
.
h
t
t
p
s
:
/
/
w
w
w
.
h
o
p
k
i
n
sme
d
i
c
i
n
e
.
o
r
g
/
i
n
s
t
i
t
u
t
i
o
n
a
l
-
r
e
v
i
e
w
-
b
o
a
r
d
/
g
u
i
d
e
l
i
n
e
s
-
p
o
l
i
c
i
e
s
/
g
u
i
d
e
l
i
n
e
s/
p
u
b
l
i
c
-
h
e
a
l
t
h
-
su
r
v
e
i
l
l
a
n
c
e
-
a
c
t
i
v
i
t
i
e
s
(
a
c
c
e
s
se
d
D
e
c
.
0
1
,
2
0
2
3
)
.
[
2
1
]
S
.
A
.
K
u
l
a
r
a
t
n
e
a
n
d
C
.
D
a
l
u
g
a
m
a
,
“
D
e
n
g
u
e
i
n
f
e
c
t
i
o
n
:
g
l
o
b
a
l
i
m
p
o
r
t
a
n
c
e
,
i
mm
u
n
o
p
a
t
h
o
l
o
g
y
a
n
d
m
a
n
a
g
e
men
t
,
”
C
l
i
n
i
c
a
l
Me
d
i
c
i
n
e
,
J
o
u
r
n
a
l
o
f
t
h
e
R
o
y
a
l
C
o
l
l
e
g
e
o
f
P
h
y
si
c
i
a
n
s
o
f
L
o
n
d
o
n
,
v
o
l
.
2
2
,
n
o
.
1
,
p
p
.
9
–
1
3
,
2
0
2
2
,
d
o
i
:
1
0
.
7
8
6
1
/
c
l
i
n
med
.
2
0
2
1
-
0
7
9
1
.
[
2
2
]
H
.
W
u
,
C
.
W
u
,
Q
.
L
u
,
Z.
D
i
n
g
,
M
.
X
u
e
,
a
n
d
J.
Li
n
,
“
E
v
a
l
u
a
t
i
n
g
t
h
e
e
f
f
e
c
t
s
o
f
c
o
n
t
r
o
l
i
n
t
e
r
v
e
n
t
i
o
n
s
a
n
d
e
s
t
i
m
a
t
i
n
g
t
h
e
i
n
a
p
p
a
r
e
n
t
i
n
f
e
c
t
i
o
n
s
f
o
r
d
e
n
g
u
e
o
u
t
b
r
e
a
k
i
n
H
a
n
g
z
h
o
u
,
C
h
i
n
a
,
”
PLo
S
O
N
E
,
v
o
l
.
1
4
,
n
o
.
8
,
p.
e
0
2
2
0
3
9
1
,
2
0
1
9
,
d
o
i
:
1
0
.
1
3
7
1
/
j
o
u
r
n
a
l
.
p
o
n
e
.
0
2
2
0
3
9
1
.
[
2
3
]
K
a
s
b
a
w
a
t
i
,
S
.
N
i
n
g
s
i
h
,
A
.
R
i
b
a
l
,
a
n
d
F
a
t
m
a
w
a
t
i
,
“
A
n
o
p
t
i
ma
l
i
n
t
e
g
r
a
t
e
d
v
e
c
t
o
r
c
o
n
t
r
o
l
f
o
r
p
r
e
v
e
n
t
i
o
n
t
h
e
t
r
a
n
s
mi
ss
i
o
n
o
f
d
e
n
g
u
e
,
”
J
o
u
r
n
a
l
o
f
P
h
y
s
i
c
s:
C
o
n
f
e
r
e
n
c
e
S
e
ri
e
s
,
v
o
l
.
1
2
4
5
,
n
o
.
1
,
p
.
0
1
2
0
4
3
,
2
0
1
9
,
d
o
i
:
1
0
.
1
0
8
8
/
1
7
4
2
-
6
5
9
6
/
1
2
4
5
/
1
/
0
1
2
0
4
3
.
[
2
4
]
M
.
A
.
K
u
l
k
a
r
n
i
,
C
.
D
u
g
u
a
y
,
a
n
d
K
.
O
st
,
“
C
h
a
r
t
i
n
g
t
h
e
e
v
i
d
e
n
c
e
f
o
r
c
l
i
ma
t
e
c
h
a
n
g
e
i
m
p
a
c
t
s
o
n
t
h
e
g
l
o
b
a
l
sp
r
e
a
d
o
f
ma
l
a
r
i
a
a
n
d
d
e
n
g
u
e
a
n
d
a
d
a
p
t
i
v
e
r
e
sp
o
n
ses
:
a
sc
o
p
i
n
g
r
e
v
i
e
w
o
f
r
e
v
i
e
w
s,
”
G
l
o
b
a
l
i
z
a
t
i
o
n
a
n
d
H
e
a
l
t
h
,
v
o
l
.
1
8
,
n
o
.
1
,
p
p
.
1
–
1
8
,
2
0
2
2
,
d
o
i
:
1
0
.
1
1
8
6
/
s
1
2
9
9
2
-
0
2
1
-
0
0
7
9
3
-
2.
[
2
5
]
C
.
W
.
M
o
r
i
n
,
A
.
C
.
C
o
mr
i
e
,
a
n
d
K
.
E
r
n
st
,
“
C
l
i
m
a
t
e
a
n
d
d
e
n
g
u
e
t
r
a
n
sm
i
ssi
o
n
:
e
v
i
d
e
n
c
e
a
n
d
i
m
p
l
i
c
a
t
i
o
n
s
,
”
E
n
v
i
r
o
n
m
e
n
t
a
l
H
e
a
l
t
h
Pe
rsp
e
c
t
i
v
e
s
,
v
o
l
.
1
2
1
,
p
p
.
1
2
6
4
–
1
2
7
2
,
2
0
1
3
,
d
o
i
:
1
0
.
1
2
8
9
/
e
h
p
.
1
3
0
6
5
5
6
.
[
2
6
]
S
u
l
i
st
y
a
w
a
t
i
e
t
a
l
.
,
“
D
e
n
g
u
e
v
e
c
t
o
r
c
o
n
t
r
o
l
t
h
r
o
u
g
h
c
o
mm
u
n
i
t
y
e
m
p
o
w
e
r
men
t
:
l
e
ss
o
n
s
l
e
a
r
n
e
d
f
r
o
m
a
c
o
mm
u
n
i
t
y
-
b
a
s
e
d
st
u
d
y
i
n
Y
o
g
y
a
k
a
r
t
a
,
I
n
d
o
n
e
si
a
,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
rn
a
l
o
f
E
n
v
i
r
o
n
m
e
n
t
a
l
Re
se
a
r
c
h
a
n
d
P
u
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
1
6
,
n
o
.
6
,
p.
1
0
1
3
,
2
0
1
9
,
d
o
i
:
1
0
.
3
3
9
0
/
i
j
e
r
p
h
1
6
0
6
1
0
1
3
.
[
2
7
]
V
.
M
u
l
d
e
r
i
j
-
Ja
n
se
n
,
J
.
El
s
i
n
g
a
,
I
.
G
e
r
st
e
n
b
l
u
t
h
,
A
.
D
u
i
t
s,
A
.
Ta
m
i
,
a
n
d
A
.
B
a
i
l
e
y
,
“
U
n
d
e
r
s
t
a
n
d
i
n
g
r
i
sk
c
o
mm
u
n
i
c
a
t
i
o
n
f
o
r
p
r
e
v
e
n
t
i
o
n
a
n
d
c
o
n
t
r
o
l
o
f
v
e
c
t
o
r
-
b
o
r
n
e
d
i
se
a
ses
:
a
m
i
x
e
d
-
m
e
t
h
o
d
s
t
u
d
y
i
n
C
u
r
a
ç
a
o
,
”
PL
o
S
N
e
g
l
e
c
t
e
d
T
r
o
p
i
c
a
l
D
i
sea
ses
,
v
o
l
.
1
4
,
n
o
.
4
,
p.
e
0
0
0
8
1
3
6
,
2
0
2
0
,
d
o
i
:
1
0
.
1
3
7
1
/
j
o
u
r
n
a
l
.
p
n
t
d
.
0
0
0
8
1
3
6
.
[
2
8
]
M
.
‘
A
mm
a
r
I
.
A
.
Za
m
z
u
r
i
,
F
.
N
.
A
.
M
a
j
i
d
,
R
.
D
a
p
a
r
i
,
M
.
R
.
H
a
ssa
n
,
a
n
d
A
.
M
.
M
.
I
sa,
“
P
e
r
c
e
i
v
e
d
r
i
s
k
f
o
r
d
e
n
g
u
e
i
n
f
e
c
t
i
o
n
med
i
a
t
e
s
t
h
e
r
e
l
a
t
i
o
n
s
h
i
p
b
e
t
w
e
e
n
a
t
t
i
t
u
d
e
a
n
d
p
r
a
c
t
i
c
e
f
o
r
d
e
n
g
u
e
p
r
e
v
e
n
t
i
o
n
:
a
s
t
u
d
y
i
n
S
e
r
e
m
b
a
n
,
M
a
l
a
y
si
a
,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
rn
a
l
o
f
En
v
i
r
o
n
m
e
n
t
a
l
Re
s
e
a
r
c
h
a
n
d
P
u
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
1
9
,
n
o
.
2
0
,
p.
1
3
2
5
2
,
2
0
2
2
,
d
o
i
:
1
0
.
3
3
9
0
/
i
j
e
r
p
h
1
9
2
0
1
3
2
5
2
.
[
2
9
]
M
.
N
a
d
j
i
b
e
t
a
l
.
,
“
Ec
o
n
o
m
i
c
b
u
r
d
e
n
o
f
d
e
n
g
u
e
i
n
I
n
d
o
n
e
s
i
a
,
”
PLO
S
N
e
g
l
e
c
t
e
d
T
r
o
p
i
c
a
l
D
i
se
a
ses
,
v
o
l
.
1
3
,
n
o
.
1
,
p.
e
0
0
0
7
0
3
8
,
Ja
n
.
2
0
1
9
.
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
4
,
No
.
1
,
Ma
r
ch
20
2
5
:
1
9
-
26
26
[
3
0
]
N
.
R
a
a
f
a
t
,
S
.
D
.
B
l
a
c
k
sel
l
,
a
n
d
R
.
J
.
M
a
u
d
e
,
“
A
r
e
v
i
e
w
o
f
d
e
n
g
u
e
d
i
a
g
n
o
st
i
c
s
a
n
d
i
m
p
l
i
c
a
t
i
o
n
s
f
o
r
su
r
v
e
i
l
l
a
n
c
e
a
n
d
c
o
n
t
r
o
l
,
”
T
ra
n
s
a
c
t
i
o
n
s
o
f
t
h
e
R
o
y
a
l
S
o
c
i
e
t
y
o
f
T
r
o
p
i
c
a
l
M
e
d
i
c
i
n
e
a
n
d
H
y
g
i
e
n
e
,
v
o
l
.
1
1
3
,
n
o
.
1
1
,
p
p
.
6
5
3
–
6
6
0
,
2
0
1
9
,
d
o
i
:
1
0
.
1
0
9
3
/
t
r
s
t
mh
/
t
r
z
0
6
8
.
[
3
1
]
E.
W
o
n
g
saw
a
t
,
P
.
A
v
i
r
u
t
n
a
n
,
Y
.
W
.
K
i
m
,
a
n
d
Y
.
S
u
p
u
t
t
a
m
o
n
g
k
o
l
,
“
P
e
r
f
o
r
man
c
e
o
f
t
w
o
c
o
m
merc
i
a
l
d
e
n
g
u
e
N
S
1
r
a
p
i
d
t
e
s
t
s
f
o
r
t
h
e
d
i
a
g
n
o
si
s
o
f
a
d
u
l
t
p
a
t
i
e
n
t
s
w
i
t
h
d
e
n
g
u
e
i
n
f
e
c
t
i
o
n
,
”
S
i
ri
r
a
j
Me
d
i
c
a
l
J
o
u
rn
a
l
,
v
o
l
.
7
2
,
n
o
.
1
,
p
p
.
7
4
–
7
8
,
2
0
2
0
,
d
o
i
:
1
0
.
3
3
1
9
2
/
S
mj
.
2
0
2
0
.
1
0
.
[
3
2
]
V
.
D
u
o
n
g
e
t
a
l
.
,
“
C
l
i
n
i
c
a
l
a
n
d
v
i
r
o
l
o
g
i
c
a
l
f
a
c
t
o
r
s i
n
f
l
u
e
n
c
i
n
g
t
h
e
p
e
r
f
o
r
ma
n
c
e
o
f
a
n
s
1
a
n
t
i
g
e
n
-
c
a
p
t
u
r
e
a
ss
a
y
a
n
d
p
o
t
e
n
t
i
a
l
u
se
a
s a
mark
e
r
o
f
d
e
n
g
u
e
d
i
se
a
se
se
v
e
r
i
t
y
,
”
PLo
S
N
e
g
l
e
c
t
e
d
T
ro
p
i
c
a
l
D
i
se
a
ses
,
v
o
l
.
5
,
n
o
.
7
,
p.
e
1
2
4
4
,
2
0
1
1
,
d
o
i
:
1
0
.
1
3
7
1
/
j
o
u
r
n
a
l
.
p
n
t
d
.
0
0
0
1
2
4
4
.
[
3
3
]
H
.
X
u
e
t
a
l
.
,
“
S
e
r
o
t
y
p
e
1
-
sp
e
c
i
f
i
c
mo
n
o
c
l
o
n
a
l
a
n
t
i
b
o
d
y
-
b
a
se
d
a
n
t
i
g
e
n
c
a
p
t
u
r
e
i
mm
u
n
o
a
ssa
y
f
o
r
d
e
t
e
c
t
i
o
n
o
f
c
i
r
c
u
l
a
t
i
n
g
n
o
n
s
t
r
u
c
t
u
r
a
l
p
r
o
t
e
i
n
N
S
1
:
i
mp
l
i
c
a
t
i
o
n
s
f
o
r
e
a
r
l
y
d
i
a
g
n
o
si
s
a
n
d
ser
o
t
y
p
i
n
g
o
f
d
e
n
g
u
e
v
i
r
u
s
i
n
f
e
c
t
i
o
n
s,”
J
o
u
rn
a
l
o
f
C
l
i
n
i
c
a
l
Mi
c
r
o
b
i
o
l
o
g
y
,
v
o
l
.
4
4
,
n
o
.
8
,
p
p
.
2
8
7
2
–
2
8
7
8
,
2
0
0
6
,
d
o
i
:
1
0
.
1
1
2
8
/
JC
M
.
0
0
7
7
7
-
0
6
.
[
3
4
]
L.
S
a
n
c
h
e
z
e
t
a
l
.
,
“
A
e
d
e
s
a
e
g
y
p
t
i
l
a
r
v
a
l
i
n
d
i
c
e
s
a
n
d
r
i
s
k
f
o
r
d
e
n
g
u
e
e
p
i
d
e
m
i
c
s,
”
Em
e
rg
i
n
g
I
n
f
e
c
t
i
o
u
s
D
i
s
e
a
s
e
s
,
v
o
l
.
1
2
,
n
o
.
5
,
p
p
.
8
0
0
–
8
0
6
,
2
0
0
6
,
d
o
i
:
1
0
.
3
2
0
1
/
e
i
d
1
2
0
5
.
0
5
0
8
6
6
.
[
3
5
]
B
.
F
u
st
e
c
e
t
a
l
.
,
“
C
o
m
p
l
e
x
r
e
l
a
t
i
o
n
s
h
i
p
s
b
e
t
w
e
e
n
a
e
d
e
s
v
e
c
t
o
r
s,
s
o
c
i
o
-
e
c
o
n
o
mi
c
s
a
n
d
d
e
n
g
u
e
t
r
a
n
smis
si
o
n
-
l
e
ss
o
n
s
l
e
a
r
n
e
d
f
r
o
m
a
c
a
se
-
c
o
n
t
r
o
l
st
u
d
y
i
n
N
o
r
t
h
e
a
s
t
e
r
n
Th
a
i
l
a
n
d
,
”
PL
o
S
N
e
g
l
e
c
t
e
d
T
r
o
p
i
c
a
l
D
i
se
a
ses
,
v
o
l
.
1
4
,
n
o
.
1
0
,
p.
e
0
0
0
8
7
0
3
,
2
0
2
0
,
d
o
i
:
1
0
.
1
3
7
1
/
j
o
u
r
n
a
l
.
p
n
t
d
.
0
0
0
8
7
0
3
.
B
I
O
G
RAP
H
I
E
S O
F
AUTH
O
RS
Fa
r
d
h
i
a
sih
Dw
i
As
tu
ti
is
a
le
c
tu
re
r
in
t
h
e
F
a
c
u
l
ty
o
f
P
u
b
li
c
He
a
lt
h
a
t
Un
i
v
e
rsitas
Ah
m
a
d
Da
h
lan
sin
c
e
2
0
1
1
.
S
h
e
c
o
m
p
lete
d
Ba
c
h
e
lo
r
o
f
P
u
b
li
c
He
lath
a
t
th
e
F
a
c
u
lt
y
o
f
P
u
b
li
c
He
a
lt
h
,
Un
i
v
e
rsitas
Ah
m
a
d
Da
h
l
a
n
a
n
d
M
a
ste
r
i
n
Tro
p
ica
l
M
e
d
icin
e
a
t
F
a
c
u
lt
y
o
f
M
e
d
icin
e
,
P
u
b
l
ic
He
a
lt
h
a
n
d
Nu
rsi
n
g
,
G
a
d
jah
M
a
d
a
Un
iv
e
rsit
y
.
T
h
e
a
u
th
o
r
is
a
c
a
n
d
id
a
te
d
o
c
to
r
o
f
p
u
b
li
c
h
e
a
lt
h
sc
ien
c
e
a
t
S
e
b
e
las
M
a
re
t
Un
iv
e
rsity
,
S
u
ra
k
a
rta.
Th
e
a
u
th
o
r
h
a
s
a
n
e
x
p
e
rien
c
e
in
th
e
fiel
d
s
o
f
e
p
id
e
m
io
l
o
g
y
a
n
d
e
n
to
m
o
l
o
g
y
,
e
sp
e
c
ially
i
n
v
e
c
to
r
-
b
o
r
n
e
d
ise
a
se
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
fa
rd
h
ias
ih
@s
t
u
d
e
n
t
.
u
n
s.a
c
.
i
d
;
fa
r
d
h
ias
ih
.
d
wia
st
u
ti
@ik
m
.
u
a
d
.
a
c
.
i
d
.
Vitr
i
Wid
y
a
n
i
n
g
sih
is
a
lec
tu
re
r
in
th
e
P
u
b
li
c
He
a
lt
h
S
c
ie
n
c
e
s
De
p
a
rtme
n
t,
F
a
c
u
lt
y
o
f
M
e
d
icin
e
,
S
e
b
e
las
M
a
re
t
Un
iv
e
rsity
(UN
S
).
Dr.
Vitri
c
o
m
p
lete
d
h
is
p
r
o
fe
ss
io
n
a
l
m
e
d
ica
l
e
d
u
c
a
ti
o
n
a
t
UN
S
,
a
n
d
p
u
rsu
e
d
a
m
a
ste
r'
s
a
n
d
d
o
c
t
o
ra
l
e
d
u
c
a
ti
o
n
a
t
M
ich
ig
a
n
S
tate
Un
iv
e
rsity
(
M
S
U)
i
n
th
e
fiel
d
o
f
Ep
id
e
m
io
lo
g
y
.
A
p
a
rt
fro
m
t
h
a
t,
h
e
a
lso
c
o
m
p
lete
d
a
g
ra
d
u
a
te
c
e
rti
fica
te
p
ro
g
ra
m
in
P
ro
g
ra
m
Ev
a
lu
a
ti
o
n
a
t
M
S
U.
Re
se
a
rc
h
fo
c
u
s
in
th
e
fiel
d
o
f
s
o
c
ial
e
p
id
e
m
io
l
o
g
y
a
n
d
s
o
c
ial
d
e
term
in
a
n
ts
o
f
h
e
a
lt
h
,
wit
h
t
o
p
ics
o
n
m
a
tern
a
l
a
n
d
c
h
i
ld
h
e
a
lt
h
,
o
c
c
u
p
a
ti
o
n
a
l
h
e
a
lt
h
,
a
n
d
n
o
n
-
c
o
m
m
u
n
ica
b
le
d
ise
a
se
s.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
v
it
ri_
w@
sta
ff.
u
n
s.a
c
.
i
d
.
Eti
Po
n
c
o
r
in
i
Pa
m
u
n
g
k
a
sa
r
i
is
a
lec
tu
re
r
in
th
e
field
o
f
P
u
b
li
c
He
a
lt
h
.
Dr.
Et
i
c
o
m
p
lete
d
m
e
d
ica
l
st
u
d
ies
a
t
S
e
b
e
las
M
a
re
t
Un
iv
e
rsit
y
,
M
a
ste
rs
in
Ed
u
c
a
ti
o
n
a
l
Tec
h
n
o
l
o
g
y
a
t
S
e
b
e
las
M
a
re
t
Un
i
v
e
rsity
,
a
n
d
Do
c
to
ra
l
stu
d
ies
i
n
M
e
d
ica
l
a
n
d
He
a
lt
h
S
c
ien
c
e
s
a
t
G
a
d
jah
M
a
d
a
Un
iv
e
rsity
.
Dr.
Et
i
n
o
w
se
rv
e
s
a
s
He
a
d
o
f
th
e
Un
d
e
rg
ra
d
u
a
t
e
M
e
d
ica
l
S
tu
d
y
P
ro
g
ra
m
a
t
S
e
b
e
las
M
a
re
t
Un
i
v
e
rsity
.
S
h
e
re
se
a
rc
h
e
s
in
tere
sts
a
re
m
a
in
ly
f
o
c
u
se
d
m
e
d
ica
l
e
d
u
c
a
ti
on
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
e
ti
p
o
n
c
o
@s
taff.u
n
s.a
c
.
i
d
.
Ac
h
m
a
d
Ar
m
a
n
S
u
b
ij
a
n
t
o
is
a
F
u
ll
P
r
o
fe
ss
o
r
a
t
S
e
b
e
las
M
a
re
t
Un
iv
e
rsity
.
He
c
o
m
p
lete
d
m
e
d
ica
l
stu
d
ies
a
t
S
e
b
e
las
M
a
re
t
Un
iv
e
rsity
,
M
a
ste
rs
in
M
e
d
ica
l
a
n
d
He
a
lt
h
S
c
ien
c
e
s
a
t
G
a
d
jah
M
a
d
a
a
n
d
D
o
c
to
ra
l
st
u
d
ies
a
t
Un
i
v
e
rsity
Ai
rl
a
n
g
g
a
,
S
u
ra
b
a
y
a
.
Re
se
a
rc
h
fo
c
u
s
i
n
q
u
a
li
tati
v
e
so
c
ial
re
se
a
rc
h
,
q
u
a
n
ti
tativ
e
so
c
ial
re
se
a
rc
h
,
so
c
ial
p
o
li
c
y
,
u
rb
a
n
/r
u
ra
l
so
c
io
lo
g
y
.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
su
b
ij
a
n
to
@s
taff.u
n
s.a
c
.
id
.
Evaluation Warning : The document was created with Spire.PDF for Python.