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K
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w
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C
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-
19
Den
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p
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ev
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am
Hea
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CC B
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SA
li
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se
.
C
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s
p
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A
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:
Nar
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Mu
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Nasir
Facu
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o
f
Hea
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Scien
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s
,
Sy
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if
Hid
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State
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lam
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Un
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T
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J
ak
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n
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id
.
1.
I
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RO
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UCT
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Den
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p
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to
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f
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tr
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to
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DHF
[
1
]
.
C
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to
th
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tr
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is
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p
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.
T
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[
3
]
.
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I
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8
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267
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g
en
s
[
4
]
.
T
h
e
r
ap
id
t
r
an
s
m
is
s
io
n
o
f
c
o
r
o
n
av
ir
u
s
d
is
ea
s
e
2
0
1
9
(
C
OVI
D
-
1
9
)
,
d
r
i
v
en
b
y
SAR
S
-
C
o
V
-
2
,
is
p
ar
ti
cu
lar
ly
n
o
tab
le
in
L
atin
Am
er
ica,
a
r
eg
i
o
n
with
a
h
is
to
r
y
o
f
n
u
m
e
r
o
u
s
ep
id
em
i
cs
[
5
]
.
T
h
e
clin
ical
an
d
lab
o
r
ato
r
y
p
r
o
f
iles
o
f
d
en
g
u
e
f
ev
er
an
d
C
OVI
D
-
19
ex
h
ib
it
p
r
o
n
o
u
n
ce
d
s
im
ilar
ities
,
in
clu
d
in
g
ac
u
te
f
e
v
er
,
m
y
al
g
ia,
f
atig
u
e
,
an
d
o
th
e
r
in
f
l
u
en
za
-
lik
e
s
y
m
p
to
m
s
,
in
ad
d
itio
n
t
o
th
r
o
m
b
o
c
y
to
p
e
n
ia
an
d
leu
k
o
p
en
ia
[
6
]
.
T
h
ese
o
v
er
lap
p
i
n
g
clin
ical
p
r
esen
tatio
n
s
f
r
eq
u
en
tly
lead
to
d
iag
n
o
s
tic
in
ac
cu
r
ac
ies,
d
elay
s
in
tr
ea
tm
en
t,
an
d
ch
allen
g
es
in
p
atien
t
is
o
latio
n
[
7
]
,
[
8
]
.
Owin
g
to
th
e
s
y
m
p
to
m
atic
o
v
er
lap
,
th
e
co
n
f
lu
en
ce
o
f
d
en
g
u
e
an
d
C
OVI
D
-
1
9
in
co
u
n
tr
ies
s
u
ch
as
I
n
d
o
n
esia
n
o
ta
b
ly
in
ten
s
if
ies
th
e
b
u
r
d
e
n
o
n
h
ea
lth
ca
r
e
s
y
s
tem
s
[
9
]
.
I
n
s
tan
ce
s
o
f
m
is
d
iag
n
o
s
is
,
ex
em
p
lifie
d
b
y
ca
s
es
in
Sin
g
ap
o
r
e
wh
e
r
e
in
itial
d
iag
n
o
s
es
o
f
d
en
g
u
e
we
r
e
later
r
e
v
is
ed
to
C
OVI
D
-
1
9
,
ac
ce
n
tu
ate
th
e
in
tr
icac
y
o
f
clin
ical
m
an
if
estatio
n
s
an
d
th
e
r
is
k
in
h
er
en
t
i
n
f
alse
-
p
o
s
itiv
e
d
en
g
u
e
s
er
o
lo
g
ical
r
esu
lts
[
1
0
]
.
Mo
r
eo
v
e
r
,
th
e
co
n
s
id
er
ab
le
a
n
n
u
al
in
cid
e
n
c
e
r
ates
o
f
d
e
n
g
u
e
in
I
n
d
o
n
es
ia,
wh
ich
t
h
e
C
OVI
D
-
1
9
p
an
d
em
ic
m
ay
f
u
r
th
er
ag
g
r
av
ate,
h
ig
h
lig
h
t
th
e
c
o
m
p
lex
ch
allen
g
es
p
r
esen
ted
b
y
th
ese
s
im
u
ltan
eo
u
s
h
ea
lth
th
r
ea
ts
[
1
1
]
.
T
h
is
co
m
p
lex
s
ce
n
ar
i
o
em
p
h
asis
es
th
e
n
ee
d
f
o
r
an
i
n
-
d
ep
t
h
an
d
s
y
s
tem
atic
in
v
esti
g
atio
n
to
elu
cid
ate
th
e
m
u
ltifa
ce
ted
im
p
ac
ts
an
d
i
n
ter
r
elatio
n
s
b
etwe
en
th
ese
two
p
r
o
m
in
en
t h
ea
lth
co
n
ce
r
n
s.
T
h
e
d
y
n
am
ic
a
n
d
co
m
p
le
x
n
atu
r
e
o
f
th
e
ep
id
em
i
o
lo
g
ical
tr
en
d
s
o
f
d
e
n
g
u
e
f
ev
e
r
in
I
n
d
o
n
esia
is
ev
id
en
t.
Or
ig
i
n
ally
d
etec
ted
i
n
m
etr
o
p
o
litan
r
e
g
io
n
s
s
u
ch
as
J
ak
ar
ta
an
d
Su
r
a
b
ay
a,
th
e
d
is
ea
s
e
f
o
llo
ws
a
cy
clica
l
p
atter
n
,
with
a
m
ar
k
ed
in
cr
ea
s
e
in
ca
s
es
ev
er
y
two
y
ea
r
s
[
1
2
]
.
T
h
e
r
is
e
in
th
e
v
u
ln
er
ab
ilit
y
o
f
th
e
u
r
b
an
p
o
p
u
latio
n
is
a
d
ir
ec
t
c
o
n
s
eq
u
en
ce
o
f
s
ev
e
r
al
in
ter
lin
k
ed
f
ac
to
r
s
:
s
wif
t
u
r
b
an
i
s
atio
n
,
lack
o
f
a
d
eq
u
ate
in
f
r
astru
ctu
r
e,
an
d
in
te
n
s
if
ied
ef
f
ec
ts
o
f
clim
ate
ch
a
n
g
e.
T
h
ese
f
ac
to
r
s
co
llectiv
ely
d
im
i
n
i
s
h
th
e
r
esil
ien
ce
o
f
u
r
b
an
c
o
m
m
u
n
ities
,
m
ak
in
g
t
h
em
m
o
r
e
p
r
o
n
e
to
v
ar
i
o
u
s
en
v
ir
o
n
m
en
tal,
s
o
cial,
an
d
ec
o
n
o
m
ic
ch
allen
g
es
[
1
3
]
.
Hig
h
p
o
p
u
latio
n
d
e
n
s
ity
ar
ea
s
with
s
u
b
s
tan
d
ar
d
e
n
v
ir
o
n
m
en
tal
c
o
n
d
itio
n
s
an
d
in
ad
eq
u
ate
u
r
b
a
n
p
lan
n
in
g
h
av
e
b
ec
o
m
e
h
o
ts
p
o
ts
f
o
r
th
e
r
ap
id
p
r
o
p
ag
atio
n
o
f
th
e
d
is
ea
s
e,
th
er
e
b
y
estab
lis
h
in
g
th
e
m
s
elv
es
as
ce
n
tr
es o
f
tr
an
s
m
is
s
io
n
an
d
s
i
g
n
if
ican
t p
u
b
lic
h
ea
lth
c
o
n
ce
r
n
s
[
1
4
]
,
[
1
5
]
.
T
h
ese
p
r
ess
in
g
s
tatis
tic
s
h
ig
h
lig
h
t a
n
im
m
ed
iate
n
ee
d
f
o
r
b
o
th
th
o
r
o
u
g
h
a
n
d
ef
f
ec
tiv
e
p
r
e
v
en
tiv
e
s
tr
ateg
ies,
e
n
h
an
ce
d
p
u
b
lic
h
ea
lth
in
f
r
astru
ctu
r
e,
an
d
a
n
o
ta
b
le
in
cr
ea
s
e
in
co
m
m
u
n
ity
-
f
o
cu
s
ed
ed
u
ca
tio
n
al
an
d
awa
r
en
ess
in
itiativ
es.
S
u
ch
m
ea
s
u
r
es
ar
e
cr
u
cial
f
o
r
s
ig
n
if
ica
n
tly
r
e
d
u
cin
g
th
e
in
cid
e
n
ce
o
f
s
ev
er
e
DHF
o
u
tb
r
ea
k
s
an
d
m
itig
ati
n
g
th
ei
r
b
r
o
ad
an
d
v
ar
ied
im
p
ac
t
s
in
th
e
f
u
tu
r
e.
I
n
p
r
e
v
en
tiv
e
m
ea
s
u
r
es,
m
a
n
ag
in
g
p
o
ten
tial
m
o
s
q
u
ito
b
r
ee
d
in
g
s
ites
b
y
d
r
ain
in
g
,
c
o
v
er
in
g
,
o
r
r
ec
y
clin
g
wate
r
-
h
o
ld
in
g
co
n
tain
er
s
is
p
iv
o
tal,
an
d
th
e
s
tr
ateg
ic
u
s
e
o
f
m
o
s
q
u
ito
n
e
ts
an
d
lar
v
icid
es
co
m
p
lem
en
ts
th
ese
ef
f
o
r
t
s
.
A
n
o
tab
le
co
r
r
elat
io
n
h
as
b
e
en
o
b
s
er
v
e
d
b
etwe
en
th
ese
p
r
ev
en
tiv
e
p
r
ac
tices,
co
m
m
u
n
ity
awa
r
en
ess
r
eg
a
r
d
i
n
g
DHF,
an
d
th
e
p
r
ev
ale
n
ce
o
f
A
ed
es
a
eg
yp
ti
lar
v
ae
,
c
o
llectiv
ely
in
f
lu
e
n
cin
g
d
is
ea
s
e
in
cid
en
ce
r
ates
[
1
6
]
.
Desp
ite
th
ese
in
s
ig
h
ts
,
s
ig
n
if
i
ca
n
tly
r
ed
u
ci
n
g
th
e
p
r
ev
ale
n
c
e
o
f
DHF
is
f
r
au
g
h
t
with
ch
allen
g
es,
ch
ief
l
y
d
u
e
t
o
th
e
h
u
r
d
les
in
v
o
lv
ed
in
e
d
u
c
atin
g
co
m
m
u
n
ities
an
d
n
av
ig
a
tin
g
co
m
p
lex
u
r
b
an
lan
d
s
ca
p
es
ch
ar
ac
ter
is
ed
b
y
h
ig
h
p
o
p
u
latio
n
d
e
n
s
ity
.
No
n
et
h
eless
,
ed
u
ca
tio
n
al
in
itiativ
es,
p
ar
ticu
lar
ly
th
o
s
e
tar
g
etin
g
s
ch
o
o
l
s
tu
d
e
n
ts
th
r
o
u
g
h
t
o
o
ls
s
u
ch
as
p
o
s
ter
s
an
d
f
lip
ch
a
r
ts
,
h
av
e
s
h
o
wn
p
r
o
m
is
e
in
en
h
an
cin
g
co
m
m
u
n
ity
awa
r
en
ess
an
d
f
o
s
ter
in
g
p
r
o
ac
tiv
e
en
g
ag
em
en
t i
n
p
r
ev
e
n
tiv
e
p
r
ac
tices
[
1
7
]
.
T
h
e
im
p
o
r
ta
n
ce
o
f
c
o
m
m
u
n
ity
lead
er
s
,
in
clu
d
i
n
g
r
elig
io
u
s
f
ig
u
r
es,
lo
ca
l
h
ea
lth
p
r
o
f
ess
io
n
als,
an
d
o
th
er
in
f
lu
e
n
tial
p
er
s
o
n
alities
,
in
s
h
ap
in
g
p
u
b
lic
h
ea
lth
o
u
tco
m
es
h
as
b
ec
o
m
e
in
c
r
ea
s
in
g
ly
ev
id
en
t,
p
ar
ticu
lar
ly
in
t
h
e
co
n
tex
t
o
f
DHF
an
d
C
OVI
D
-
19
[
1
8
]
.
De
s
p
ite
th
eir
p
o
ten
tial
to
s
way
c
o
m
m
u
n
ity
b
eh
a
v
io
u
r
an
d
attitu
d
es
to
war
d
s
h
ea
lth
i
n
itiativ
es,
a
n
o
tab
le
g
a
p
ex
is
ts
in
r
eg
io
n
s
s
u
ch
as
So
u
th
T
an
g
er
an
g
C
ity
.
Hea
lth
in
ter
v
en
tio
n
s
,
esp
ec
ially
th
o
s
e
tar
g
etin
g
d
en
g
u
e
f
ev
er
p
r
e
v
en
tio
n
,
ar
e
p
r
ed
o
m
in
an
tly
d
r
i
v
en
b
y
h
ea
lth
wo
r
k
er
s
with
m
in
im
al
in
p
u
t
f
r
o
m
c
o
m
m
u
n
ity
lead
e
r
s
.
T
h
is
o
v
er
s
i
g
h
t
m
ay
s
tem
f
r
o
m
lead
e
r
s
'
li
m
ited
ex
p
er
ien
ce
in
h
ea
lth
m
atter
s
o
r
t
h
eir
g
en
er
al
ab
s
en
ce
in
h
ea
lth
-
r
elate
d
ac
tiv
ities
,
wh
ich
in
tu
r
n
d
im
in
is
h
es
th
eir
p
ar
ticip
atio
n
in
h
ea
lth
ca
m
p
aig
n
s
[
1
9
]
.
T
h
e
r
ef
o
r
e,
ad
d
r
ess
in
g
th
is
g
ap
is
cr
u
cial.
B
y
lev
er
ag
in
g
th
e
in
f
lu
en
ce
o
f
co
m
m
u
n
ity
lead
er
s
,
it
is
p
o
s
s
ib
le
to
en
h
a
n
ce
p
u
b
lic
en
g
ag
em
e
n
t
an
d
a
d
h
er
en
ce
to
h
ea
lth
p
r
o
t
o
co
ls
,
th
er
eb
y
f
o
r
tify
in
g
co
llectiv
e
ef
f
o
r
ts
ag
ain
s
t
d
en
g
u
e
f
ev
er
an
d
C
OVI
D
-
1
9
.
T
h
is
ap
p
r
o
ac
h
also
b
ec
o
m
es
im
p
e
r
ativ
e
as
th
e
latter
ex
ac
er
b
ates
th
e
h
ea
lth
lan
d
s
ca
p
e,
d
e
m
an
d
i
n
g
e
f
f
icien
t
allo
ca
tio
n
o
f
s
ca
r
ce
m
ed
ical
r
eso
u
r
c
es
an
d
s
tr
ict
p
u
b
lic
h
ea
lth
s
tr
ateg
ies.
T
o
ad
d
r
ess
th
is
is
s
u
e,
s
tr
ateg
ies
n
ee
d
to
b
e
r
ec
alib
r
ated
w
ith
a
f
o
cu
s
o
n
em
p
o
wer
in
g
c
o
m
m
u
n
ity
lead
er
s
th
r
o
u
g
h
tar
g
eted
m
e
n
t
o
r
in
g
an
d
ex
ten
s
iv
e
tr
ain
in
g
p
r
o
g
r
a
ms
[
2
0
]
.
L
o
ca
l
h
ea
lth
ce
n
tr
es
(
p
u
s
ke
s
ma
s
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,
s
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o
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tr
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s
f
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s
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ch
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p
ac
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g
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m
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ac
tiv
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h
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b
s
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ca
tio
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co
llab
o
r
atio
n
,
a
n
d
co
m
m
u
n
ity
m
o
b
ilis
atio
n
.
B
y
tap
p
in
g
in
to
,
en
h
an
cin
g
,
a
n
d
ch
a
n
n
ellin
g
th
e
in
f
lu
en
ce
o
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co
m
m
u
n
ity
a
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d
r
elig
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s
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as
well
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h
e
alth
ca
d
r
es,
th
e
r
esil
ien
ce
o
f
co
m
m
u
n
ities
ag
ain
s
t
DHF,
C
O
VI
D
-
1
9
,
an
d
o
th
er
h
ea
lth
ad
v
er
s
ities
ca
n
b
e
s
ig
n
if
ican
tly
s
tr
en
g
th
en
e
d
.
T
h
is
s
tr
ateg
y
alig
n
s
with
th
e
b
r
o
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r
o
b
jectiv
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f
m
ak
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h
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lth
p
r
o
g
r
am
s
a
n
d
p
o
licies
m
o
r
e
in
clu
s
iv
e,
p
a
r
ticip
ato
r
y
,
an
d
r
esp
o
n
s
iv
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t
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ch
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m
m
u
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ity
'
s
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if
ic
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am
ics
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d
n
ee
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s
,
en
r
ich
i
n
g
t
h
eir
im
p
lem
e
n
tatio
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a
n
d
en
s
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r
in
g
th
ei
r
lo
n
g
-
ter
m
v
iab
ilit
y
an
d
a
d
ap
tab
ilit
y
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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:
2
2
5
2
-
8
8
0
6
I
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t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
1
,
Ma
r
ch
20
25
:
2
6
6
-
276
268
I
n
th
e
co
n
te
x
t
o
f
th
e
B
an
ten
Pro
v
in
ce
,
th
e
an
n
u
al
r
ec
u
r
r
en
ce
o
f
DHF
r
em
ain
s
a
p
er
s
is
t
en
t
p
u
b
lic
h
ea
lth
co
n
ce
r
n
,
as
ev
id
e
n
ce
d
b
y
co
n
s
is
ten
t
ep
id
em
io
l
o
g
ical
d
ata.
Fo
r
in
s
tan
ce
,
in
2
0
1
6
,
th
e
p
r
o
v
i
n
ce
r
ep
o
r
ted
5
,
0
8
7
d
en
g
u
e
ca
s
es,
co
r
r
esp
o
n
d
in
g
to
an
in
ci
d
en
ce
r
ate
o
f
3
9
.
5
p
er
1
0
0
,
0
0
0
p
o
p
u
latio
n
,
an
d
witn
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ed
th
e
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s
s
o
f
s
ix
ty
-
f
iv
e
liv
es
to
th
e
d
is
ea
s
e.
A
s
tu
d
y
at
th
e
C
ip
u
tat
T
im
u
r
C
o
m
m
u
n
ity
Hea
lth
C
en
ter
in
So
u
th
T
an
g
er
an
g
C
ity
f
u
r
th
er
h
ig
h
li
g
h
ted
th
e
co
n
tin
u
in
g
ch
allen
g
e
o
f
d
en
g
u
e
f
e
v
er
,
with
5
2
ca
s
es
r
ec
o
r
d
ed
f
r
o
m
2
0
1
8
to
J
u
n
e
2
0
1
9
[
2
1
]
.
De
s
p
ite
o
v
er
a
d
ec
ad
e
o
f
p
r
ev
e
n
tiv
e
ef
f
o
r
ts
,
th
e
p
er
s
is
ten
t
p
r
ev
alen
ce
o
f
DHF
h
ig
h
lig
h
ts
th
e
n
ee
d
f
o
r
in
-
d
e
p
th
r
ea
s
s
ess
m
en
t
an
d
r
ef
in
em
en
t
o
f
ex
is
tin
g
s
tr
ateg
ies.
T
h
is
s
tu
d
y
,
co
n
d
u
cted
in
2
0
2
0
am
id
s
t
t
h
e
c
o
m
p
lex
ities
o
f
th
e
C
OVI
D
-
1
9
p
an
d
em
ic
,
was
s
et
ag
ain
s
t
t
h
e
u
r
b
a
n
b
ac
k
d
r
o
p
o
f
So
u
t
h
T
an
g
er
an
g
,
B
an
ten
Pr
o
v
in
ce
.
I
t
aim
s
to
d
is
s
ec
t
an
d
u
n
d
e
r
s
tan
d
th
e
s
u
b
tle
n
u
an
ce
s
an
d
in
ter
r
elatio
n
s
h
ip
s
in
tr
in
s
ic
to
DHF
p
r
ev
en
tio
n
an
d
co
m
m
u
n
ity
in
v
o
l
v
em
e
n
t,
p
ar
ticu
lar
ly
in
ar
ea
s
f
r
e
q
u
en
tly
b
esieg
ed
b
y
ep
id
em
ics.
B
y
d
o
in
g
s
o
,
th
is
r
esear
ch
p
r
o
v
id
es
a
c
o
m
p
r
e
h
en
s
iv
e
r
o
a
d
m
ap
f
o
r
n
a
v
ig
ati
n
g
th
e
m
u
ltifa
ce
ted
ter
r
ain
o
f
DHF
m
an
ag
em
e
n
t,
co
m
m
u
n
ity
m
o
b
ilis
atio
n
,
an
d
p
u
b
lic
h
ea
lth
r
esp
o
n
s
e
d
u
r
in
g
th
e
co
n
c
u
r
r
en
t
ch
allen
g
es p
o
s
ed
b
y
th
e
C
OVI
D
-
1
9
cr
is
is
.
2.
M
E
T
H
O
D
2
.
1
.
Study
des
ig
n
a
nd
t
im
eline
T
h
is
s
tu
d
y
aim
ed
to
co
n
d
u
ct
an
an
aly
tical
in
v
esti
g
atio
n
u
s
in
g
a
cr
o
s
s
-
s
ec
tio
n
al
m
eth
o
d
o
l
o
g
y
.
T
h
is
r
esear
ch
was
co
n
d
u
cte
d
with
in
th
e
u
r
b
an
ar
ea
s
o
f
So
u
th
T
a
n
g
er
an
g
C
ity
,
wh
ich
is
s
itu
ated
in
th
e
p
r
o
v
in
c
e
o
f
B
an
ten
.
R
esear
ch
ac
tiv
ities
w
er
e
co
n
d
u
cte
d
b
etwe
en
Au
g
u
s
t
an
d
Sep
tem
b
er
2
0
2
0
,
co
i
n
cid
in
g
with
th
e
p
ea
k
im
p
ac
t
o
f
th
e
C
OVI
D
-
1
9
p
an
d
em
ic
.
T
h
e
tim
in
g
o
f
t
h
is
ev
en
t
was
ca
r
ef
u
lly
ch
o
s
en
to
p
r
o
v
id
e
a
co
m
p
r
eh
e
n
s
iv
e
u
n
d
er
s
tan
d
in
g
o
f
th
e
n
u
m
er
o
u
s
im
p
ac
ts
an
d
ch
allen
g
es
th
at
h
av
e
s
u
r
f
ac
ed
d
u
r
in
g
t
h
is
cr
itical
p
h
ase
o
f
th
e
h
ea
lth
cr
is
is
.
E
m
p
h
asis
was
p
lace
d
o
n
m
eticu
l
o
u
s
ly
an
al
y
zin
g
d
ata
r
elev
an
t
to
th
e
u
r
b
an
s
ettin
g
to
g
ain
in
s
ig
h
tf
u
l
o
b
s
er
v
atio
n
s
o
f
h
o
w
th
e
p
an
d
em
ic
af
f
ec
ted
u
r
b
an
p
o
p
u
latio
n
s
,
h
ea
lth
ca
r
e
s
y
s
tem
s
,
an
d
p
u
b
lic
h
ea
lth
in
itiativ
es
with
in
th
is
g
eo
g
r
ap
h
ical
co
n
te
x
t.
T
h
is
s
tu
d
y
aim
ed
t
o
d
i
s
co
v
er
a
n
u
an
ce
d
u
n
d
er
s
tan
d
i
n
g
o
f
t
h
e
d
y
n
am
i
cs
o
f
th
e
p
a
n
d
em
ic,
wh
ich
wo
u
ld
allo
w
f
o
r
a
d
etailed
ex
p
lo
r
atio
n
o
f
th
e
s
tr
ateg
ies
em
p
lo
y
ed
t
o
m
itig
a
te
its
ef
f
ec
ts
an
d
t
h
e
o
u
tco
m
es
th
at
r
esu
lt
in
p
u
b
lic
h
ea
lt
h
an
d
s
o
cieta
l
well
-
b
ein
g
in
t
h
e
u
r
b
an
ce
n
t
r
es o
f
S
o
u
th
T
an
g
er
an
g
C
ity
.
2
.
2
.
P
a
rt
icipa
nts a
nd
da
t
a
c
o
llect
io
n
T
h
e
s
tu
d
y
em
p
lo
y
e
d
an
o
n
lin
e
q
u
esti
o
n
n
air
e,
ac
co
m
p
a
n
ied
b
y
in
f
o
r
m
e
d
co
n
s
en
t,
d
is
tr
ib
u
ted
am
o
n
g
p
ar
ticip
an
ts
r
ec
r
u
ited
v
ia
s
n
o
wb
all
s
am
p
lin
g
,
u
s
i
n
g
r
ef
er
r
als
f
r
o
m
f
am
ily
m
em
b
er
s
o
r
co
lleag
u
es.
T
h
is
r
ec
r
u
itm
en
t
s
tr
ateg
y
r
esu
lted
in
th
e
s
elec
tio
n
o
f
2
3
4
r
ep
r
esen
tativ
e
r
esid
en
ts
.
T
o
en
s
u
r
e
in
clu
s
iv
ity
,
p
ar
ticu
lar
ly
f
o
r
eld
e
r
ly
p
a
r
ticip
an
ts
o
r
th
o
s
e
with
lim
i
ted
ca
p
ab
ilit
y
to
c
o
m
p
lete
th
e
q
u
esti
o
n
n
air
e
in
d
ep
en
d
en
tly
,
th
e
s
u
r
v
ey
d
e
s
ig
n
allo
wed
f
o
r
ass
is
tan
ce
f
r
o
m
f
am
ily
m
em
b
er
s
o
r
co
ll
ea
g
u
es
d
u
r
in
g
th
e
co
m
p
letio
n
p
r
o
ce
s
s
.
I
n
th
is
s
t
u
d
y
,
d
ata
co
llectio
n
was
m
eticu
lo
u
s
ly
co
n
d
u
cted
b
y
f
o
u
r
e
n
u
m
er
ato
r
s
tr
ain
ed
in
p
u
b
lic
h
ea
lth
,
to
e
n
s
u
r
e
th
e
p
r
ec
is
io
n
an
d
d
e
p
e
n
d
ab
ilit
y
o
f
th
e
r
esu
lts
.
W
e
en
s
u
r
ed
ex
t
en
s
iv
e
an
d
d
iv
er
s
e
p
ar
ticip
atio
n
b
y
u
tili
s
in
g
a
ca
r
ef
u
lly
c
r
af
ted
o
n
lin
e
q
u
e
s
tio
n
n
air
e
d
is
s
em
in
ated
v
ia
Go
o
g
le
Fo
r
m
s
a
n
d
f
ac
ilit
ated
b
y
co
o
r
d
in
ato
r
s
o
f
h
ea
lth
ca
d
r
es
(
J
u
m
an
tik
)
at
th
e
So
u
th
T
an
g
er
a
n
g
C
o
m
m
u
n
ity
Hea
l
th
C
en
ter
.
Self
-
r
ep
o
r
ted
r
esp
o
n
s
es
wer
e
m
ar
k
ed
b
y
r
ic
h
n
ess
an
d
d
e
p
th
.
2
.
3
.
Va
ri
a
bles
T
h
e
p
r
im
ar
y
d
ep
en
d
en
t
v
ar
ia
b
le
was
th
e
en
g
ag
em
en
t
lev
e
l
o
f
in
d
iv
id
u
als
in
ac
tiv
ities
r
elate
d
to
d
en
g
u
e
f
e
v
er
p
r
ev
e
n
tio
n
p
r
o
g
r
am
s
.
I
n
d
ep
en
d
en
t
v
ar
iab
les
wer
e
ca
teg
o
r
is
ed
in
to
s
ev
er
al
k
ey
d
im
e
n
s
io
n
s
:
i
)
p
r
ed
is
p
o
s
in
g
f
ac
to
r
s
,
wh
ich
e
n
co
m
p
ass
th
e
lev
el
o
f
ed
u
ca
t
io
n
,
em
p
lo
y
m
en
t
s
tatu
s
,
k
n
o
wled
g
e
ab
o
u
t
DHF
p
r
ev
en
tio
n
,
a
d
h
er
e
n
ce
to
DHF
p
r
ev
en
tiv
e
p
r
ac
tices
in
f
l
u
en
ce
d
b
y
b
elief
s
y
s
tem
s
,
c
o
m
m
itm
en
t
to
th
e
clea
n
lin
ess
o
f
th
e
h
o
u
s
e
a
n
d
s
u
r
r
o
u
n
d
in
g
s
i
n
f
lu
en
ce
d
b
y
r
e
lig
io
u
s
b
elief
s
,
s
leep
p
atter
n
s
s
p
ec
if
ically
d
u
r
i
n
g
th
e
h
o
u
r
s
–
0
8
:0
0
-
1
2
:0
0
an
d
1
5
:0
0
-
1
7
:
0
0
,
a
n
d
g
e
n
er
al
a
ttit
u
d
es
to
war
d
s
DHF
p
r
ev
en
tio
n
;
i
i
)
e
n
ab
lin
g
f
ac
to
r
s
,
r
ep
r
esen
ted
b
y
th
e
v
ar
iety
an
d
r
eliab
ilit
y
o
f
in
f
o
r
m
atio
n
s
o
u
r
ce
s
av
ailab
le
to
in
d
iv
id
u
als,
f
ac
ilit
ate
o
r
h
i
n
d
er
th
eir
p
ar
ticip
atio
n
in
d
en
g
u
e
p
r
ev
en
tio
n
ac
tiv
ities
;
iii
)
r
ei
n
f
o
r
cin
g
f
ac
to
r
s
in
clu
d
e
s
u
p
p
o
r
t
r
ec
eiv
e
d
f
r
o
m
f
am
ily
m
em
b
er
s
,
h
ea
lth
ca
d
r
es
(
J
u
m
an
tik
)
,
h
ea
lth
p
r
o
f
ess
io
n
als,
an
d
co
m
m
u
n
ity
lead
e
r
s
in
en
co
u
r
ag
in
g
p
ar
ticip
atio
n
in
d
en
g
u
e
p
r
e
v
en
tio
n
ef
f
o
r
ts
.
2
.
4
.
Sa
m
ple size
I
t
is
n
o
tewo
r
th
y
th
at
d
ata
co
llectio
n
o
cc
u
r
r
e
d
d
u
r
in
g
th
e
C
OVI
D
-
1
9
p
an
d
em
ic
in
So
u
th
T
an
g
er
an
g
.
Giv
en
th
e
ch
allen
g
es
a
n
d
c
o
n
s
tr
ain
ts
p
o
s
ed
b
y
t
h
e
p
a
n
d
em
ic,
th
is
s
tu
d
y
o
p
ted
f
o
r
a
m
ar
g
i
n
er
r
o
r
(
6
.
5
%)
.
T
h
is
d
ec
is
io
n
was
m
ad
e
to
ac
co
m
m
o
d
ate
s
am
p
le
s
ize
r
e
d
u
ctio
n
,
en
s
u
r
in
g
th
e
f
ea
s
ib
ilit
y
a
n
d
s
af
ety
o
f
th
e
r
esear
c
h
p
r
o
ce
s
s
u
n
d
er
th
e
p
an
d
em
ic'
s
ex
tr
ao
r
d
in
ar
y
cir
c
u
m
s
tan
ce
s
.
Ad
ju
s
tm
en
t
o
f
th
e
m
ar
g
in
er
r
o
r
r
ef
lects
a
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
E
va
lu
a
tin
g
f
a
cto
r
s
in
u
r
b
a
n
d
e
n
g
u
e
p
r
ev
en
tio
n
a
n
d
co
n
tr
o
l d
u
r
in
g
I
n
d
o
n
esia
’
s
…
(
B
a
eq
u
n
i B
o
erma
n
)
269
p
r
ag
m
atic
ap
p
r
o
ac
h
to
s
am
p
l
e
s
ize
d
eter
m
in
atio
n
,
b
alan
cin
g
th
e
n
ee
d
f
o
r
r
eliab
le
d
ata
with
lo
g
is
tical
an
d
h
ea
lth
co
n
s
id
er
atio
n
s
d
u
r
in
g
t
h
e
p
an
d
em
ic
p
er
io
d
an
d
th
e
ca
lcu
latio
n
o
f
th
e
mi
ni
m
u
m
s
am
p
le
[
2
2
]
.
=
2
(
1
−
)
∈
2
=
ℎ
;
2
=
ℎ
(
6
.
5%
)
=
(
0
.
5
)
;
=
1
.
96
(
C
I
9
5
%)
=
1
.
96
2
.
0
.
5
(
1
−
0
.
5
)
0
.
065
=2
2
8
(
o
u
r
t
o
tal
s
am
p
le
was 2
3
4
Ho
u
s
eh
o
ld
s
)
T
o
co
n
d
u
ct
th
e
h
y
p
o
th
esis
test
,
we
u
s
ed
th
e
f
o
llo
win
g
f
o
r
m
u
la:
h
y
p
o
th
esis
test
f
o
r
s
am
p
le
s
ize
ca
lcu
latio
n
to
co
m
p
ar
e
th
e
two
p
r
o
p
o
r
tio
n
s
[
2
3
]
.
=
5%
;
(
1
−
)
=
80%
;
1
=
0
.
40
;
2
=
0
.
60
;
=
1
.
96
;
=
0
.
84
1
=
{
(
1
−
/
2
)
+
(
1
−
)
}
2
1
(
1
−
1
)
+
2
(
1
−
2
)
{
1
−
2
}
2
1
=
95
a
n
d
2
=
95
2
.
5
.
P
o
t
ent
ia
l bia
s
T
h
e
u
s
e
o
f
o
n
lin
e
q
u
esti
o
n
n
air
es
an
d
p
u
r
p
o
s
iv
e
s
am
p
lin
g
m
eth
o
d
s
in
th
is
s
tu
d
y
p
o
s
es
p
o
ten
tial
b
iases
,
in
clu
d
in
g
s
elf
-
s
elec
tio
n
an
d
r
esp
o
n
s
e
b
ias
d
u
e
t
o
v
o
lu
n
tar
y
p
ar
ticip
atio
n
an
d
u
n
co
n
tr
o
lled
c
o
n
d
itio
n
s
d
u
r
in
g
q
u
esti
o
n
n
air
e
co
m
p
leti
o
n
.
Desp
ite
e
f
f
o
r
ts
t
o
m
it
ig
at
e
th
ese
b
iases
th
r
o
u
g
h
r
a
n
d
o
m
s
elec
tio
n
b
y
d
ata
co
llecto
r
s
,
lim
itatio
n
s
in
I
n
ter
n
et
ac
ce
s
s
an
d
p
ar
ticip
an
ts
’
tech
n
o
lo
g
ical
ca
p
a
b
ilit
ies
m
i
g
h
t
s
till
im
p
ac
t
th
e
r
ep
r
esen
tativ
en
ess
an
d
ac
c
u
r
a
cy
o
f
th
e
r
esp
o
n
s
es.
T
o
a
d
d
r
es
s
th
e
p
o
ten
tial
ef
f
ec
ts
o
f
th
ese
b
iases
o
n
r
esear
ch
o
u
tco
m
es,
th
is
s
tu
d
y
e
m
p
lo
y
e
d
d
ata
tr
ian
g
u
latio
n
s
tr
ateg
ies
th
r
o
u
g
h
f
ield
o
b
s
er
v
atio
n
s
co
n
d
u
cted
b
y
s
ev
er
al
d
ata
co
llecto
r
s
,
th
er
e
b
y
en
h
an
cin
g
th
e
v
alid
ity
o
f
th
e
f
in
d
i
n
g
s
an
d
r
ed
u
ci
n
g
th
e
im
p
ac
t o
f
p
o
ten
tial b
iases
.
2
.
6
.
St
a
t
is
t
ica
l a
n
a
ly
s
is
T
h
e
s
tu
d
y
g
ath
er
e
d
d
ata
o
n
p
r
ev
en
tiv
e
b
eh
a
v
io
u
r
s
,
tr
ea
ted
th
em
as
in
d
ep
en
d
en
t
v
a
r
iab
le
s
,
an
d
th
en
class
if
ied
th
e
m
in
to
two
ca
teg
o
r
ies:
ef
f
ec
tiv
e
an
d
i
n
ef
f
ec
ti
v
e
p
r
ev
e
n
tio
n
p
r
o
g
r
a
m
s
,
u
s
in
g
th
e
m
ea
n
v
al
u
e
as
th
e
d
iv
is
io
n
p
o
in
t.
T
h
is
g
r
o
u
p
in
g
m
a
d
e
it
e
asier
to
u
s
e
t
h
e
C
hi
-
s
q
u
ar
ed
test
to
ex
am
i
n
e
th
e
r
elatio
n
s
h
ip
b
etwe
en
th
e
d
ep
e
n
d
en
t a
n
d
in
d
ep
en
d
e
n
t v
ar
iab
les.
I
t a
ls
o
m
ad
e
it e
asier
to
d
eter
m
in
e
th
e
o
d
d
s
r
atio
(
OR
)
with
a
9
5
% c
o
n
f
i
d
en
ce
in
ter
v
al
(
C
I
)
to
b
etter
u
n
d
er
s
tan
d
th
e
s
tr
en
g
th
o
f
t
h
ese
r
elatio
n
s
h
ip
s
an
d
t
h
e
way
th
ey
go.
Descr
ip
tiv
e
s
tatis
tics
p
r
o
v
id
ed
an
o
v
e
r
v
iew
o
f
p
a
r
ticip
an
ts
’
d
em
o
g
r
ap
h
ics.
B
iv
ar
iate
an
d
s
u
b
g
r
o
u
p
an
aly
s
es
f
o
u
n
d
lin
k
s
b
etwe
en
th
e
d
ep
en
d
en
t
v
ar
ia
b
le
an
d
th
e
f
ac
to
r
s
th
at
m
ad
e
it
m
o
r
e
lik
e
ly
to
h
ap
p
e
n
,
m
o
r
e
ac
ce
s
s
ib
le
f
o
r
p
eo
p
le
to
d
o
s
o
m
eth
in
g
,
o
r
m
o
r
e
lik
ely
t
o
h
ap
p
en
ag
ain
.
T
h
is
m
eth
o
d
o
l
o
g
ic
al
ap
p
r
o
ac
h
allo
we
d
f
o
r
a
co
n
cise y
et
co
m
p
r
e
h
en
s
iv
e
an
aly
s
is
o
f
th
e
f
ac
to
r
s
in
f
lu
en
cin
g
d
en
g
u
e
p
r
e
v
en
tio
n
en
g
ag
em
en
t a
m
o
n
g
th
e
So
u
th
T
an
g
e
r
an
g
p
o
p
u
latio
n
,
co
n
tr
ib
u
tin
g
v
alu
a
b
le
in
s
ig
h
ts
f
o
r
im
p
r
o
v
in
g
d
en
g
u
e
p
r
e
v
en
tio
n
ef
f
o
r
ts
an
d
p
u
b
lic
h
ea
lth
s
tr
ateg
ies.
Usi
n
g
Mic
r
o
s
o
f
t
E
x
ce
l,
s
ec
o
n
d
ar
y
d
ata
f
r
o
m
all
p
u
b
lic
h
ea
lth
ce
n
tr
es
i
n
So
u
th
T
a
n
g
er
a
n
g
f
r
o
m
2
0
1
0
to
2
0
2
7
wer
e
an
aly
s
ed
t
o
ascer
tain
th
e
r
eg
io
n
'
s
s
tatu
s
a
s
a
d
en
g
u
e
e
n
d
em
ic
a
r
ea
.
T
h
is
d
e
tailed
ex
am
in
atio
n
,
f
ac
ilit
ated
b
y
E
x
ce
l'
s
r
o
b
u
s
t
d
ata
an
aly
s
is
to
o
ls
,
s
h
ed
s
lig
h
t
o
n
th
e
p
r
ev
ale
n
ce
an
d
e
v
o
lv
in
g
tr
e
n
d
s
o
f
th
is
d
is
ea
s
e.
T
h
e
f
in
d
in
g
s
s
er
v
e
as
a
f
o
u
n
d
atio
n
f
o
r
d
ev
el
o
p
in
g
tar
g
eted
h
ea
lth
in
ter
v
en
tio
n
s
an
d
s
h
ap
in
g
p
o
licy
d
ec
is
io
n
s
to
ef
f
ec
tiv
ely
m
itig
a
te
th
e
im
p
ac
t o
f
t
h
is
p
er
s
is
ten
t p
u
b
lic
h
ea
lth
is
s
u
e
.
2.
7
.
E
t
hica
l
a
pp
ro
v
a
l
T
h
e
R
esear
ch
E
t
h
ics
R
ev
iew
C
o
m
m
ittee
f
o
r
R
esear
ch
I
n
v
o
l
v
in
g
H
u
m
an
R
esear
ch
Par
ticip
an
ts
o
f
th
e
R
esear
ch
E
th
ics
C
o
m
m
is
s
io
n
at
th
e
Facu
lty
o
f
Hea
lth
Scie
n
ce
s
,
UI
N
Sy
ar
if
Hid
a
y
atu
lla
h
J
ak
ar
ta,
ap
p
r
o
v
e
d
th
e
s
tu
d
y
p
r
o
to
c
o
l
af
ter
th
e
en
tire
b
o
ar
d
th
o
r
o
u
g
h
ly
r
ev
iewe
d
it.
I
t
was
ap
p
r
o
v
ed
b
y
Un
.
0
1
/F.1
0
/KP.0
1
.
1
/KE
.
SP
/0
8
.
0
8
.
0
0
1
/2
0
2
0
.
All p
ar
tici
p
an
ts
p
r
o
v
i
d
ed
in
f
o
r
m
e
d
co
n
s
en
t f
o
r
th
is
s
tu
d
y
af
ter
b
ei
n
g
i
n
f
o
r
m
e
d
ab
o
u
t th
eir
p
ar
ticip
ati
o
n
an
d
th
e
p
o
s
s
ib
ilit
y
o
f
f
o
llo
w
-
u
p
in
th
e
f
u
tu
r
e.
T
o
m
ain
tain
co
n
f
id
e
n
tiality
,
p
ar
ticip
an
t
d
ata
wer
e
an
o
n
y
m
is
ed
,
an
d
c
o
n
s
en
t
was
co
llected
elec
tr
o
n
ically
.
Ad
d
i
tio
n
ally
,
p
ar
ticip
an
ts
wer
e
ad
v
is
ed
to
c
o
n
tact
th
e
s
tu
d
y
team
f
o
r
th
er
a
p
y
r
e
f
er
r
al
s
o
r
ad
d
itio
n
a
l i
n
f
o
r
m
atio
n
,
as
well
as f
o
r
u
r
g
e
n
t c
ar
e.
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.
14
,
No
.
1
,
Ma
r
ch
20
25
:
2
6
6
-
276
270
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
T
he
s
it
ua
t
io
n in So
uth
T
a
ng
er
a
ng
So
u
th
T
an
g
e
r
an
g
C
ity
,
n
estl
ed
with
in
B
an
ten
Pro
v
in
ce
,
I
n
d
o
n
esia,
h
as
ex
p
er
ien
ce
d
s
ig
n
if
ican
t
p
o
p
u
latio
n
g
r
o
wth
,
estab
lis
h
in
g
its
elf
as
o
n
e
o
f
th
e
n
atio
n
'
s
r
ap
id
ly
ev
o
lv
in
g
u
r
b
an
r
e
g
i
o
n
s
.
C
o
v
er
in
g
ab
o
u
t
1
4
7
.
1
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Respo
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a
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1
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Fi
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in
d
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.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2252
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8
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(
B
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i B
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)
271
T
ab
le
1
.
T
h
e
im
p
ac
t o
f
p
r
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d
is
p
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s
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f
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c
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D
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n
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r
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g
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R
(
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%
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3
.
7
4
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S
e
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r
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h
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92
39
73
31
1
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B
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R
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59
P
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N
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cr
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e
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[
2
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.
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2
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]
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2
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ter
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[
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.
E
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[
31]
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2
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.
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co
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Su
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tr
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d
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.
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im
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tan
ce
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in
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m
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ities
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b
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tly
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p
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id
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[
3
3
]
.
T
h
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tu
d
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a
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0
5
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ed
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tial,
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[
3
4
]
.
A
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ield
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ter
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m
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ities
.
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n
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o
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icials an
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m
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ity
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e
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f
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d
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last
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s
tr
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f
o
r
d
is
ea
s
e
p
r
e
v
en
tio
n
an
d
co
n
tr
o
l.
Pro
p
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s
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m
ea
s
u
r
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in
clu
d
e
estab
lis
h
in
g
tr
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in
g
p
r
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r
am
s
aim
ed
at
h
e
alth
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d
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es,
wh
ich
wo
u
l
d
co
v
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r
f
ield
in
te
r
v
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tio
n
tech
n
iq
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es,
d
is
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s
e
p
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ev
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tio
n
s
tr
ateg
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an
d
c
o
m
m
u
n
ity
en
g
a
g
em
en
t
m
eth
o
d
s
.
B
y
b
r
id
g
in
g
th
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ap
s
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ities
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ac
tiv
ely
p
ar
ticip
ate
in
d
en
g
u
e
p
r
ev
en
tio
n
ef
f
o
r
ts
.
Su
ch
a
d
v
an
ce
m
en
ts
in
h
ea
lth
p
r
o
g
r
am
ef
f
ec
tiv
en
ess
ca
n
s
ig
n
if
ican
tly
co
n
tr
ib
u
te
to
a
d
ec
r
ea
s
e
in
d
en
g
u
e
in
ci
d
en
ce
r
ates,
u
n
d
er
s
co
r
in
g
t
h
e
p
iv
o
tal
r
o
l
e
o
f
s
k
illed
an
d
en
g
ag
ed
co
m
m
u
n
ity
p
a
r
ticip
atio
n
in
h
ea
lth
in
itiativ
es.
3
.
3
.
P
re
dis
po
s
ing
,
ena
bli
ng
,
a
nd
re
info
rc
ing
f
a
ct
o
rs
T
ab
le
1
s
h
o
wca
s
es
th
e
s
ig
n
if
ican
t
co
r
r
elatio
n
s
b
etwe
en
v
ar
io
u
s
p
r
e
d
is
p
o
s
in
g
f
ac
to
r
s
an
d
th
e
ad
o
p
tio
n
o
f
p
r
e
v
en
tiv
e
b
eh
av
io
r
s
ag
ain
s
t
d
en
g
u
e.
A
k
ey
f
in
d
in
g
f
r
o
m
th
is
an
aly
s
is
is
t
h
e
s
u
b
s
tan
tial
lin
k
b
etwe
en
an
in
d
iv
id
u
al'
s
lev
el
o
f
k
n
o
wled
g
e
r
eg
a
r
d
in
g
d
en
g
u
e
an
d
th
eir
p
a
r
ticip
atio
n
in
p
r
ev
en
tio
n
ac
tiv
ities
,
as
ev
id
en
ce
d
b
y
a
p
-
v
alu
e
o
f
less
th
an
0
.
0
5
a
n
d
an
OR
r
an
g
in
g
f
r
o
m
1
.
1
3
to
3
.
3
3
(
p
-
v
al
u
e
<0
.
0
5
;
OR
=
1
.
1
3
-
3
.
3
3
)
.
No
tab
ly
,
4
9
.
6
%
o
f
t
h
e
s
u
r
v
ey
ed
in
d
iv
id
u
als
d
is
p
lay
ed
a
co
m
p
r
e
h
en
s
iv
e
u
n
d
er
s
tan
d
in
g
o
f
d
en
g
u
e
p
r
ev
en
tio
n
m
ea
s
u
r
es,
an
d
th
is
well
-
in
f
o
r
m
ed
g
r
o
u
p
was
1
.
9
4
tim
es
m
o
r
e
lik
ely
to
ac
tiv
el
y
en
g
ag
e
in
d
en
g
u
e
p
r
ev
en
tio
n
an
d
co
n
tr
o
l in
itiativ
es.
Mo
r
eo
v
er
,
th
e
s
tu
d
y
h
ig
h
lig
h
ted
th
e
im
p
o
r
tan
ce
o
f
awa
r
en
ess
co
n
ce
r
n
in
g
t
h
e
r
is
k
s
o
f
ex
p
o
s
u
r
e
d
u
r
in
g
p
ea
k
m
o
s
q
u
ito
ac
tiv
it
y
h
o
u
r
s
(
0
8
:0
0
-
1
2
:
0
0
an
d
1
5
:0
0
-
1
7
:
0
0
)
.
Par
ticip
an
ts
wh
o
wer
e
co
g
n
izan
t
o
f
th
ese
r
is
k
s
wer
e
2
.
5
tim
es
m
o
r
e
in
clin
e
d
t
o
a
d
o
p
t
p
r
e
v
en
ti
v
e
m
ea
s
u
r
es,
with
a
n
OR
b
et
wee
n
1
.
3
9
an
d
4
.
5
6
(
p
-
v
alu
e
<
0
.
0
5
;
OR
=
1
.
3
9
-
4
.
5
6
)
.
T
h
is
f
in
d
in
g
u
n
d
e
r
s
co
r
es
th
e
cr
itical
r
o
le
o
f
tem
p
o
r
al
awa
r
en
ess
in
en
h
a
n
cin
g
th
e
ef
f
ec
tiv
e
n
ess
o
f
in
d
iv
id
u
al
-
an
d
co
m
m
u
n
ity
-
le
v
el
d
e
n
g
u
e
p
r
ev
en
tio
n
e
f
f
o
r
ts
.
A
d
d
it
io
n
ally
,
attitu
d
in
al
f
ac
to
r
s
em
er
g
e
d
as
s
ig
n
if
ican
t
,
illu
s
tr
atin
g
th
e
i
n
tr
icate
r
elatio
n
s
h
ip
b
etwe
en
attitu
d
es
an
d
t
h
e
im
p
lem
en
tatio
n
o
f
p
r
e
v
en
tiv
e
b
e
h
av
io
u
r
s
in
th
e
f
ig
h
t
ag
ain
s
t
d
e
n
g
u
e.
T
h
is
asp
ec
t
p
o
in
ts
to
th
e
co
m
p
lex
in
ter
ac
tio
n
o
f
k
n
o
wled
g
e,
attitu
d
es,
an
d
p
r
a
ctice
s
(
KAP)
in
d
eter
m
in
in
g
th
e
lik
elih
o
o
d
o
f
in
d
iv
id
u
als
e
n
g
ag
in
g
in
ac
tio
n
s
th
at
m
itig
ate
th
e
r
is
k
o
f
d
en
g
u
e
tr
an
s
m
is
s
io
n
.
T
h
ese
in
s
ig
h
ts
u
n
d
er
lin
e
th
e
n
ec
ess
ity
o
f
m
u
ltifa
ce
ted
ap
p
r
o
ac
h
es
to
p
u
b
lic
h
ea
lth
ca
m
p
ai
g
n
s
aim
ed
at
d
en
g
u
e
p
r
e
v
en
tio
n
.
E
d
u
ca
ti
o
n
al
p
r
o
g
r
am
s
th
at
n
o
t
o
n
ly
i
n
cr
ea
s
e
k
n
o
wled
g
e
ab
o
u
t
d
en
g
u
e
an
d
its
v
ec
to
r
s
,
b
u
t
also
ad
d
r
ess
attitu
d
in
al
s
h
if
ts
to
war
d
p
r
o
ac
t
iv
e
p
r
ev
en
tio
n
m
ea
s
u
r
es
ar
e
cr
u
ci
al.
B
y
f
o
s
ter
in
g
a
co
m
p
r
eh
e
n
s
iv
e
u
n
d
er
s
tan
d
in
g
o
f
a
n
d
f
a
v
o
u
r
ab
le
attitu
d
es
t
o
war
d
p
r
ev
en
tio
n
,
in
d
iv
id
u
als
an
d
c
o
m
m
u
n
ities
ca
n
s
ig
n
if
ican
tly
co
n
tr
ib
u
te
t
o
r
ed
u
cin
g
th
e
in
cid
e
n
ce
o
f
d
en
g
u
e
,
h
ig
h
lig
h
tin
g
th
e
p
o
w
er
o
f
in
f
o
r
m
ed
an
d
en
g
ag
ed
p
o
p
u
latio
n
s
in
co
m
b
a
tin
g
th
is
p
u
b
lic
h
ea
lth
ch
allen
g
e.
T
h
e
ess
en
tial
in
ter
p
lay
b
etwe
en
u
n
d
er
s
tan
d
in
g
a
n
d
ac
tio
n
s
in
c
o
m
b
atin
g
d
e
n
g
u
e
u
n
d
er
s
co
r
es
th
e
cr
itical
r
o
le
o
f
in
f
o
r
m
e
d
d
e
cisi
o
n
-
m
ak
in
g
a
n
d
b
eh
av
io
u
r
al
ch
an
g
es
in
d
en
g
u
e
p
r
e
v
e
n
tio
n
ef
f
o
r
ts
[
3
5
]
.
E
d
u
ca
tio
n
a
n
d
awa
r
en
ess
-
r
aisi
n
g
in
itiativ
es
ar
e
k
ey
to
f
o
s
ter
in
g
an
u
n
d
e
r
s
tan
d
in
g
th
at
tr
an
s
lates
in
to
ac
tiv
e
co
m
m
u
n
ity
in
v
o
lv
em
en
t
in
d
e
n
g
u
e
c
o
n
tr
o
l
[
3
6
]
.
T
h
e
c
o
m
b
i
n
atio
n
o
f
k
n
o
wled
g
ea
b
le
awa
r
en
ess
an
d
p
r
ac
tical
m
ea
s
u
r
es
is
f
u
n
d
am
en
tal
to
r
ed
u
cin
g
d
en
g
u
e
s
p
r
ea
d
an
d
m
an
ag
in
g
o
u
tb
r
ea
k
s
,
h
ig
h
li
g
h
tin
g
th
e
n
ee
d
f
o
r
o
n
g
o
in
g
ed
u
ca
tio
n
al
an
d
en
g
a
g
em
en
t p
r
o
g
r
a
m
s
tailo
r
ed
to
d
if
f
er
en
t c
o
m
m
u
n
ity
c
o
n
tex
ts
.
A
s
o
p
h
is
ticated
,
co
m
p
r
e
h
en
s
iv
e
s
tr
ateg
y
in
co
r
p
o
r
atin
g
e
d
u
ca
tio
n
,
i
n
f
r
astru
ctu
r
e
im
p
r
o
v
em
en
ts
,
en
ab
lin
g
p
o
li
cies,
an
d
s
tr
o
n
g
co
m
m
u
n
ity
en
g
ag
em
en
t
is
v
ital
f
o
r
a
d
d
r
ess
in
g
th
e
th
r
ea
t
[
3
7
]
.
E
d
u
ca
ti
o
n
al
ef
f
o
r
ts
s
h
o
u
ld
ex
ten
d
b
ey
o
n
d
awa
r
en
ess
to
eq
u
ip
c
o
m
m
u
n
ities
with
p
r
ee
m
p
tiv
e
to
o
ls
a
n
d
k
n
o
wled
g
e
[
3
7
]
.
Pre
v
en
tiv
e
m
ea
s
u
r
es
n
ee
d
to
b
e
in
teg
r
ated
with
ed
u
ca
tio
n
a
l
ca
m
p
aig
n
s
f
o
r
p
r
ac
tical
ap
p
l
icatio
n
[
3
8
]
,
wh
ile
p
o
licies
s
h
o
u
ld
s
u
p
p
o
r
t
p
r
e
v
en
tio
n
as
a
s
tan
d
ar
d
p
r
ac
tice
[
3
9
]
,
p
o
s
itio
n
in
g
co
m
m
u
n
ities
as
p
r
o
ac
tiv
e
p
ar
ticip
an
ts
in
d
en
g
u
e
p
r
ev
e
n
tio
n
.
Hea
lth
p
r
o
f
ess
io
n
als
p
lay
a
cr
u
cial
r
o
le
in
co
m
m
u
n
ity
-
lev
el
d
e
n
g
u
e
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
E
va
lu
a
tin
g
f
a
cto
r
s
in
u
r
b
a
n
d
e
n
g
u
e
p
r
ev
en
tio
n
a
n
d
co
n
tr
o
l d
u
r
in
g
I
n
d
o
n
esia
’
s
…
(
B
a
eq
u
n
i B
o
erma
n
)
273
p
r
ev
en
tio
n
,
ex
ten
d
i
n
g
b
ey
o
n
d
m
ed
ical
s
er
v
ices
to
in
clu
d
e
m
en
to
r
s
h
ip
an
d
ed
u
ca
tio
n
f
o
r
co
m
m
u
n
ity
lead
e
r
s
,
lo
ca
l
ca
d
r
es,
a
n
d
th
e
g
en
er
al
p
o
p
u
lace
[
4
0
]
.
I
n
teg
r
atin
g
t
h
ese
ed
u
ca
tio
n
al
ef
f
o
r
ts
with
th
e
f
r
am
ewo
r
k
s
o
f
p
u
s
ke
s
ma
s
en
h
an
ce
s
th
e
ef
f
ec
t
iv
en
ess
o
f
d
en
g
u
e
p
r
ev
en
tio
n
s
tr
ateg
ies
[
2
8
]
.
T
ab
le
2
in
d
icate
th
at
f
am
ily
s
u
p
p
o
r
t
as
th
e
r
ein
f
o
r
cin
g
f
ac
to
r
s
h
as
s
ig
n
if
ican
t
r
elatio
n
s
h
ip
i
n
en
h
an
cin
g
d
en
g
u
e
p
r
ev
en
tio
n
p
r
o
g
r
a
m
(
p
-
v
al
u
e
0
.
0
5
with
OR
7
.
2
5
9
)
.
Mo
r
eo
v
er
,
s
u
p
p
o
r
t
f
r
o
m
h
ea
lth
o
f
f
icer
is
also
im
p
o
r
tan
t
to
im
p
r
o
v
e
th
e
p
r
o
g
r
am
(
p
-
v
alu
e
0
.
0
1
with
OR
2
.
6
4
9
)
.
Fam
ily
s
u
p
p
o
r
t
s
ig
n
if
ican
tly
in
f
lu
en
ce
s
ad
h
er
e
n
ce
to
d
en
g
u
e
p
r
ev
en
tio
n
m
ea
s
u
r
es,
with
f
am
ily
b
ac
k
ed
in
d
iv
i
d
u
als
b
ein
g
m
o
r
e
lik
ely
to
f
o
llo
w
p
r
o
to
co
ls
[
4
1
]
.
T
h
is
e
m
p
h
asis
es
th
e
f
am
ily
'
s
s
tr
ateg
ic
r
o
le
in
r
ein
f
o
r
cin
g
p
u
b
lic
h
ea
lth
in
itiativ
es
an
d
h
ig
h
lig
h
ts
th
e
im
p
o
r
tan
ce
o
f
co
llab
o
r
atio
n
b
etwe
en
h
ea
lth
p
r
o
f
ess
io
n
als
an
d
f
am
ilies
f
o
r
d
is
ea
s
e
er
ad
icatio
n
ef
f
o
r
ts
at
th
e
co
m
m
u
n
ity
le
v
el.
T
h
e
C
OVI
D
-
1
9
p
a
n
d
e
m
ic
p
r
esen
ts
a
s
tr
ateg
ic
o
p
p
o
r
tu
n
ity
f
o
r
h
ea
lth
p
r
o
f
ess
io
n
als
to
s
tr
ess
th
e
im
p
o
r
tan
ce
o
f
p
er
s
o
n
al
an
d
f
a
m
ily
h
ea
lth
p
r
ac
tices
in
m
ain
ta
in
in
g
o
v
er
all
well
-
b
ein
g
an
d
p
r
e
v
en
tin
g
d
is
ea
s
e
t
r
an
s
m
is
s
io
n
[
4
2
]
.
T
h
e
h
eig
h
ten
ed
p
u
b
lic
h
ea
lth
awa
r
en
ess
d
u
r
in
g
th
e
p
an
d
e
m
ic
cr
ea
tes
an
i
d
ea
l
b
ac
k
d
r
o
p
f
o
r
h
ea
lth
ed
u
ca
tio
n
i
n
itiativ
es,
wh
ich
ar
e
cr
u
cial
f
o
r
f
o
s
ter
in
g
p
r
ev
en
tiv
e
h
ea
lth
b
eh
av
io
u
r
s
[
4
3
]
.
Ho
wev
er
,
a
n
o
tab
le
s
h
o
r
tf
all
in
co
m
m
u
n
ity
lead
e
r
en
g
ag
em
en
t
with
in
DHF
p
r
ev
en
tio
n
p
r
o
g
r
am
s
h
as
b
ee
n
id
en
tifie
d
[
3
7
]
,
[
3
9
]
,
[
4
4
]
.
T
h
is
g
ap
h
as
b
ec
o
m
e
m
o
r
e
p
r
ess
in
g
d
u
r
in
g
th
e
p
an
d
em
i
c,
em
p
h
asis
in
g
th
e
n
ee
d
f
o
r
s
tr
ateg
ic
in
cl
u
s
io
n
o
f
co
m
m
u
n
ity
lead
er
s
i
n
DHF
p
r
ev
en
tio
n
an
d
m
a
n
ag
em
e
n
t.
T
h
eir
in
f
lu
en
ce
an
d
ac
ce
s
s
ca
n
s
ig
n
if
ican
tly
co
n
t
r
ib
u
te
to
ed
u
ca
tin
g
,
m
o
tiv
ati
n
g
,
a
n
d
m
o
b
ilis
in
g
co
m
m
u
n
i
ty
p
ar
ticip
atio
n
in
ef
f
ec
tiv
e
DHF
p
r
ev
en
tio
n
p
r
a
ctice
s
[
3
9
]
,
[
4
4
]
.
T
h
is
s
tu
d
y
also
u
n
d
er
s
co
r
es
th
e
s
ig
n
if
ican
t
im
p
ac
t
o
f
s
o
cieta
l
attitu
d
es
an
d
b
elief
s
o
n
h
ea
lth
b
eh
av
io
u
r
,
wh
ich
ca
n
b
e
i
n
f
l
u
en
ce
d
b
y
ed
u
ca
tio
n
an
d
tr
ain
in
g
[
4
5
]
.
Pre
v
e
n
tiv
e
p
r
o
g
r
a
m
s
ar
e
d
ee
m
e
d
th
e
b
est s
o
lu
tio
n
f
o
r
d
en
g
u
e
e
r
ad
icatio
n
,
with
p
r
ev
e
n
tio
n
b
eh
a
v
io
u
r
c
r
u
cial
f
o
r
r
ed
u
cin
g
DHF
ca
s
es
[
4
5
]
.
T
h
is
n
ec
ess
itates
co
n
s
is
ten
t
p
r
ev
en
tiv
e
ac
tio
n
s
am
o
n
g
c
o
m
m
u
n
ity
m
e
m
b
er
s
,
alo
n
g
with
ad
h
er
en
ce
t
o
C
OVI
D
-
1
9
p
r
o
to
co
ls
,
to
f
o
r
tify
t
h
e
co
m
m
u
n
ity
'
s
d
ef
en
s
e
ag
ain
s
t
h
ea
lth
ch
allen
g
es
,
d
em
o
n
s
tr
atin
g
th
e
im
p
o
r
t
a
n
c
e
o
f
a
c
o
h
esiv
e
a
n
d
in
f
o
r
m
e
d
co
m
m
u
n
ity
in
estab
lis
h
in
g
a
r
o
b
u
s
t
s
y
s
tem
o
f
p
r
ev
en
tio
n
an
d
p
r
o
tectio
n
.
T
ab
le
2
.
T
h
e
r
o
le
o
f
en
a
b
lin
g
an
d
r
ein
f
o
r
cin
g
f
ac
to
r
s
in
en
h
a
n
cin
g
d
e
n
g
u
e
p
r
ev
e
n
tio
n
p
r
o
g
r
am
s
C
h
a
r
a
c
t
e
r
i
s
t
i
c
s
D
e
n
g
u
e
p
r
e
v
e
n
t
i
o
n
p
r
o
g
r
a
ms
p
-
v
a
l
u
e
OR
(
9
5
%
C
I
)
N
o
t
g
o
o
d
G
o
o
d
To
t
a
l
n
%
n
%
n
%
En
a
b
l
i
n
g
f
a
c
t
o
r
s
A
v
a
i
l
a
b
i
l
i
t
y
o
f
D
H
F
i
n
f
o
r
m
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t
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n
s
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e
s
1
.
0
0
1
.
1
3
2
(
0
.
4
3
1
-
2
.
9
7
5
)
No
6
2
.
6
40
1
7
.
1
46
20
Y
e
s
22
9
.
4
1
6
6
7
0
.
9
1
8
8
80
R
e
i
n
f
o
r
c
i
n
g
f
a
c
t
o
r
s
F
a
mi
l
y
s
u
p
p
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r
t
0
.
0
5
7
.
2
5
9
(
0
.
9
1
-
5
8
.
2
6
)
No
9
3
.
8
1
0
.
4
10
4
Y
e
s
1
2
4
5
3
.
0
1
0
0
4
2
.
7
2
2
4
96
C
a
d
r
e
s
u
p
p
o
r
t
0
.
1
2
2
.
0
0
4
(
0
.
9
1
-
4
.
4
1
)
No
24
1
0
.
3
10
4
.
3
34
15
Y
e
s
1
0
9
4
6
.
6
91
3
8
.
9
2
0
0
85
H
e
a
l
t
h
o
f
f
i
c
e
r
s
u
p
p
o
r
t
0
.
0
1
2
.
6
4
9
(
1
.
3
0
-
5
.
4
2
)
No
35
1
5
.
0
12
5
.
1
47
20
Y
e
s
98
4
1
.
9
89
3
8
.
0
1
8
7
80
C
o
mm
u
n
i
t
y
l
e
a
d
e
r
s
u
p
p
o
r
t
0
.
3
3
1
.
3
0
6
(
0
.
7
6
-
2
.
2
4
)
No
53
2
2
.
6
34
1
4
.
5
87
3
7
.
2
Y
e
s
80
3
4
.
2
67
2
8
.
6
1
4
7
6
2
.
8
N
o
t
e
s
:
T
h
e
c
o
r
r
e
l
a
t
i
o
n
b
e
t
w
e
e
n
e
n
a
b
l
i
n
g
a
n
d
r
e
i
n
f
o
r
c
i
n
g
f
a
c
t
o
r
s
f
o
r
d
e
n
g
u
e
f
e
v
e
r
i
n
c
i
d
e
n
c
e
w
a
s
e
v
a
l
u
a
t
e
d
u
si
n
g
t
h
e
C
hi
-
s
q
u
a
r
e
d
t
e
st
.
T
h
i
s a
p
p
r
o
a
c
h
g
e
n
e
r
a
t
e
d
a
c
r
u
d
e
O
R
a
n
d
me
a
su
r
e
d
t
h
e
e
f
f
e
c
t
i
v
e
n
e
ss
o
f
t
h
e
d
e
n
g
u
e
p
r
e
v
e
n
t
i
o
n
p
r
o
g
r
a
m
.
4.
CO
NCLU
SI
O
N
T
h
is
s
tu
d
y
h
ig
h
lig
h
ts
k
ey
f
ac
ets
o
f
d
e
n
g
u
e
p
r
ev
en
tio
n
,
u
n
d
er
s
co
r
in
g
t
h
e
im
p
o
r
tan
ce
o
f
c
o
m
m
u
n
ity
in
v
o
lv
em
e
n
t
an
d
th
e
n
ee
d
f
o
r
im
p
r
o
v
ed
p
u
b
lic
awa
r
en
ess
o
f
p
r
ev
en
tiv
e
p
r
ac
tices
s
u
c
h
as
lar
v
al
in
s
p
ec
tio
n
an
d
waste
d
is
p
o
s
al.
T
h
is
h
ig
h
lig
h
ts
th
e
s
ig
n
if
ican
t
r
o
le
o
f
p
u
s
ke
s
ma
s
in
h
ea
lth
ca
r
e
an
d
th
e
ch
allen
g
es
f
ac
ed
o
win
g
to
lim
ited
r
eso
u
r
ce
s
a
n
d
p
e
r
s
o
n
n
el.
T
h
e
f
i
n
d
in
g
s
a
d
v
o
ca
te
f
o
r
g
o
v
e
r
n
m
en
t
i
n
ter
v
en
tio
n
to
en
h
a
n
ce
d
en
g
u
e
co
n
tr
o
l
h
ea
lth
ca
d
r
es
th
r
o
u
g
h
f
o
cu
s
ed
tr
ain
in
g
a
n
d
in
ce
n
tiv
es,
aim
in
g
to
b
o
ls
ter
t
h
e
ef
f
ec
tiv
en
ess
o
f
d
en
g
u
e
p
r
ev
e
n
tio
n
a
n
d
co
n
tr
o
l
s
tr
ateg
ies.
T
h
is
r
esear
ch
f
u
r
t
h
er
h
i
g
h
lig
h
ts
th
e
p
ar
am
o
u
n
t
r
o
le
o
f
h
ea
lt
h
p
r
o
f
ess
io
n
als,
f
am
ily
s
u
p
p
o
r
t,
an
d
th
e
s
tr
ateg
ic
u
s
e
o
f
th
e
C
OVI
D
-
1
9
p
an
d
em
ic
p
er
io
d
f
o
r
h
ea
lth
ed
u
ca
tio
n
.
Hea
lth
p
r
o
f
ess
io
n
als ar
e
n
o
t ju
s
t ser
v
ice
p
r
o
v
id
e
r
s
,
b
u
t
k
ey
f
ig
u
r
es
i
n
m
en
to
r
in
g
a
n
d
o
r
g
a
n
is
in
g
co
m
m
u
n
ity
-
b
ased
d
en
g
u
e
p
r
ev
en
tio
n
p
r
o
g
r
am
s
,
en
s
u
r
in
g
a
c
o
m
p
r
e
h
en
s
iv
e
a
p
p
r
o
ac
h
to
th
e
is
s
u
e.
Fam
il
y
s
u
p
p
o
r
t
is
a
s
tr
o
n
g
in
f
lu
e
n
ce
r
o
f
p
r
ev
e
n
tiv
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b
eh
av
io
u
r
,
with
a
s
ig
n
if
ican
t
co
r
r
elatio
n
b
etwe
en
f
am
ily
i
n
v
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e
n
t
an
d
th
e
ef
f
ec
tiv
e
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o
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p
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v
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Evaluation Warning : The document was created with Spire.PDF for Python.
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Op
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Gr
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.
(
Un
.
0
1
/KPA
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3
4
6
/2
0
1
9
)
.
RE
F
E
R
E
NC
E
S
[
1
]
P
.
W
.
D
h
e
w
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,
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