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sta
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in
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ts.
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e
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iate
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it
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t
th
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rsity
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p
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st
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h
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n
a
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s
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six
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s
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t
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so
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ired
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o
d
isin
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t
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s.
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ly
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th
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se
n
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tee
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re
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sti
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lu
ti
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d
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fe
c
ti
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c
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re
c
tl
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Risk
s
o
f
c
h
e
m
ica
l
in
h
a
latio
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m
u
sc
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lo
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i
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ju
r
ies
,
c
u
ts,
a
n
d
trau
m
a
ti
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ies
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lu
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ted
a
s
h
i
g
h
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re
v
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o
f
in
c
i
d
e
n
t
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g
isters
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v
e
a
led
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n
d
e
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p
o
rti
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g
o
f
in
ju
ries
.
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il
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th
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y
s
h
o
we
d
si
g
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ifi
c
a
n
t
g
a
p
s
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th
e
o
c
c
u
p
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ti
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n
a
l
sa
fe
ty
o
f
m
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rti
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s
in
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re
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n
v
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m
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ts,
it
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lso
p
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se
n
ts
a
n
o
p
p
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rt
u
n
it
y
fo
r
imp
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v
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m
e
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t
.
Re
g
u
lato
r
y
a
g
e
n
c
ies
fo
r
m
o
rt
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c
ian
s
in
G
h
a
n
a
m
u
st
se
t
o
u
t
m
in
imu
m
q
u
a
li
fica
ti
o
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s f
o
r
th
is crit
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l
c
a
teg
o
r
y
o
f
h
e
a
lt
h
wo
rk
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rs.
K
ey
w
o
r
d
s
:
Dec
is
io
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m
atr
ix
Gh
an
a
Mo
r
tician
s
Occ
u
p
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al
h
ea
lth
R
is
k
as
s
ess
m
en
t
T
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is i
s
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c
c
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a
rticle
u
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d
e
r th
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CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
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s
p
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A
uth
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r
:
J
am
es Ko
jo
Pra
h
Dep
ar
tm
en
t o
f
C
o
m
m
u
n
ity
M
ed
icin
e,
Sch
o
o
l
o
f
Me
d
ical
Sc
ien
ce
,
Un
iv
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s
ity
o
f
C
ap
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C
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New
Ad
m
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tr
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lo
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C
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C
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Gh
an
a
E
m
ail:
jam
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@
u
cc
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u
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g
h
1.
I
NT
RO
D
UCT
I
O
N
T
h
r
o
u
g
h
its
s
u
s
tain
ab
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d
ev
elo
p
m
en
t
g
o
al
8
,
th
e
Un
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Natio
n
s
aim
s
to
ac
h
iev
e
co
m
p
lete,
p
r
o
d
u
ctiv
e,
a
n
d
d
ec
en
t
jo
b
s
f
o
r
all
b
y
2
0
3
0
[
1
]
.
T
h
e
d
ea
th
c
ar
e
in
d
u
s
tr
y
is
e
x
p
er
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cin
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wth
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to
th
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ld
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ag
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g
p
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latio
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[
2
]
a
n
d
t
h
e
r
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in
g
n
u
m
b
er
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d
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f
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m
in
f
ec
tio
u
s
an
d
ch
r
o
n
ic
illn
ess
es
[
3
]
.
Alth
o
u
g
h
h
az
ar
d
s
ar
e
ass
o
ciate
d
with
ev
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y
wo
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k
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b
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ciate
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with
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ly
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win
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s
in
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T
h
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“p
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Or
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(
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)
[
1
]
d
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f
in
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ass
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m
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t.
Stu
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in
r
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d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2252
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8
8
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6
Occ
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p
a
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l sa
fety
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f m
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r
ticia
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s
:
A
ca
s
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f m
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cilities
in
C
a
p
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C
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…
(
Ja
mes Ko
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P
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h
)
1541
th
r
ee
m
ain
ca
teg
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f
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iq
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T
h
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itativ
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q
u
alitativ
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an
d
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i
-
q
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an
titativ
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[
4
]
.
Qu
an
titativ
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tech
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a
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atica
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.
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ch
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ce
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m
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d
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k
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g
,
wh
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o
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e
r
p
ar
a
m
eter
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ex
p
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ess
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q
u
an
titativ
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[
5
]
.
Qu
alitativ
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tech
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iq
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s
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d
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r
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m
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ical
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k
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ca
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to
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'
s
p
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ten
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tco
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d
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b
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.
C
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s
im
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r
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f
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tical
an
d
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in
an
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es,
an
d
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b
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d
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tak
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b
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-
ex
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.
As
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th
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s
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r
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k
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s
is
tech
n
iq
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[
6
]
.
T
h
e
y
allo
w
clar
ity
a
n
d
p
r
io
r
itizatio
n
o
f
task
s
m
o
r
e
q
u
ick
l
y
an
d
c
o
s
t
-
ef
f
ec
tiv
ely
.
T
h
e
r
ef
o
r
e,
th
is
s
tu
d
y
will e
m
p
lo
y
th
e
d
ec
is
io
n
m
atr
ix
tech
n
iq
u
e
,
a
q
u
alitativ
e
tech
n
iq
u
e.
W
h
e
n
r
is
k
s
a
r
e
s
i
g
n
i
f
i
c
a
n
t
,
a
h
i
e
r
a
r
c
h
y
o
f
c
o
n
t
r
o
l
s
(
HO
C
)
c
an
b
e
a
p
p
l
i
e
d
.
I
n
o
c
c
u
p
a
t
i
o
n
a
l
s
a
f
e
t
y
a
n
d
h
e
a
l
t
h
,
t
h
e
h
i
e
r
a
r
c
h
y
o
f
c
o
n
t
r
o
l
s
f
r
a
m
e
w
o
r
k
is
u
s
e
d
t
o
u
n
d
e
r
s
ta
n
d
t
h
e
r
e
l
a
t
i
v
e
e
f
f
i
c
a
c
y
o
f
v
a
r
i
o
u
s
r
i
s
k
r
e
d
u
ct
i
o
n
m
e
a
s
u
r
e
s
a
n
d
h
e
l
p
i
d
e
n
t
i
f
y
w
o
r
k
a
b
l
e
a
n
d
e
f
f
i
c
i
e
n
t
s
o
l
u
t
io
n
s
[
7
]
.
T
h
e
H
OC
m
o
d
e
l
h
as
f
i
v
e
c
at
e
g
o
r
i
e
s
i
n
d
e
c
r
e
a
s
i
n
g
o
r
d
e
r
o
f
e
f
f
i
c
a
c
y
:
E
l
i
m
i
n
a
t
i
o
n
,
s
u
b
s
t
i
t
u
t
i
o
n
,
e
n
g
i
n
e
e
r
i
n
g
c
o
n
t
r
o
l
s
,
a
d
m
i
n
i
s
t
r
a
t
i
v
e
c
o
n
t
r
o
l
s
,
a
n
d
p
e
r
s
o
n
a
l
p
r
o
t
e
c
ti
v
e
e
q
u
i
p
m
e
n
t
(
P
P
E
)
.
Se
v
e
r
a
l
t
ec
h
n
i
q
u
e
s
f
o
r
i
d
e
n
t
i
f
y
i
n
g
h
a
z
a
r
d
s
i
n
cl
u
d
e
i
n
t
e
r
v
i
e
w
i
n
g
w
o
r
k
e
r
s
a
b
o
u
t
p
o
t
e
n
t
i
a
l
r
is
k
s
,
h
a
v
i
n
g
e
x
p
e
r
t
s
v
is
u
a
l
l
y
e
v
al
u
a
t
e
t
h
e
w
o
r
k
p
l
a
c
e
,
a
n
d
r
e
v
i
e
w
i
n
g
i
n
ci
d
e
n
t
r
e
g
i
s
t
e
r
s
[
8
]
.
M
o
r
t
i
c
i
a
n
s
h
a
n
d
l
e
a
n
d
t
r
e
a
t
d
e
a
d
b
o
d
i
e
s
,
e
x
p
o
s
i
n
g
t
h
e
m
to
a
v
a
r
i
e
t
y
o
f
a
i
r
b
o
r
n
e
p
a
r
t
i
cu
l
a
t
e
s
a
n
d
a
e
r
o
s
o
l
s
o
f
h
a
z
a
r
d
o
u
s
o
r
g
a
n
i
c
p
o
l
l
u
t
a
n
t
s
f
o
u
n
d
i
n
d
i
s
i
n
f
e
c
t
a
n
t
s
,
e
m
b
a
l
m
i
n
g
,
a
n
d
a
n
t
i
m
i
c
r
o
b
i
a
l
a
g
e
n
t
s
[
9
]
,
[
1
0
]
.
D
u
r
i
n
g
d
i
f
f
e
r
e
n
t
s
t
a
g
e
s
o
f
h
a
n
d
l
i
n
g
d
e
a
d
b
o
d
i
e
s
,
M
o
r
t
i
c
i
a
n
s
a
r
e
a
t
v
e
r
y
h
i
g
h
r
i
s
k
o
f
s
e
v
e
r
e
s
i
c
k
n
es
s
b
e
c
a
u
s
e
o
f
t
h
e
h
i
g
h
v
o
l
at
i
l
it
y
o
f
t
o
x
i
c
v
a
p
o
r
s
t
h
a
t
m
a
y
f
l
o
w
c
o
n
ti
n
u
a
l
l
y
f
r
o
m
ca
d
a
v
e
r
s
.
F
o
r
m
a
l
d
eh
y
d
e
,
a
s
i
g
n
i
f
i
c
a
n
t
c
o
m
p
o
n
e
n
t
o
f
e
m
b
a
l
m
i
n
g
s
o
l
u
ti
o
n
s
,
is
k
n
o
w
n
t
o
b
e
c
a
r
c
i
n
o
g
en
i
c
a
n
d
c
a
n
c
a
u
s
e
s
e
v
e
r
e
d
e
r
m
a
t
i
t
is
w
h
e
n
it
c
o
m
es
i
n
t
o
c
o
n
t
a
c
t
w
it
h
t
h
e
s
k
i
n
[
1
1
]
.
M
o
r
t
u
a
r
y
a
t
te
n
d
a
n
t
s
h
a
v
e
a
w
i
d
e
r
a
n
g
e
o
f
d
u
ti
e
s
,
s
u
c
h
as
h
a
n
d
l
i
n
g
,
s
t
o
r
i
n
g
,
p
a
r
t
i
c
i
p
a
ti
n
g
i
n
a
u
t
o
p
s
ie
s
,
a
n
d
e
m
b
a
l
m
i
n
g
[
1
2
]
.
A
s
t
u
d
y
r
e
v
e
a
l
e
d
t
h
a
t
m
o
r
ti
c
i
a
n
s
i
n
G
h
a
n
a
a
l
s
o
p
a
r
ti
c
i
p
a
te
i
n
a
u
t
o
p
s
i
es
a
n
d
e
m
b
a
l
m
i
n
g
[
1
2
]
.
S
o
m
e
p
r
e
v
i
o
u
s
s
t
u
d
i
es
c
o
n
d
u
c
t
e
d
g
l
o
b
a
l
l
y
h
a
v
e
f
o
u
n
d
t
h
a
t
m
o
r
t
i
c
i
a
n
s
a
r
e
e
x
p
o
s
e
d
t
o
m
a
n
y
o
c
c
u
p
a
t
i
o
n
al
h
a
z
a
r
d
s
d
u
r
i
n
g
t
h
ei
r
w
o
r
k
[
1
3
]
,
[
1
4
]
.
W
h
e
n
t
h
e
y
r
e
c
e
i
v
e
m
u
t
i
l
a
te
d
b
o
d
i
e
s
,
m
o
r
t
u
a
r
y
w
o
r
k
e
r
s
h
a
v
e
t
h
e
t
as
k
o
f
s
u
t
u
r
i
n
g
,
m
o
b
i
l
i
zi
n
g
,
a
n
d
p
u
t
t
i
n
g
t
h
e
b
o
d
y
p
i
e
c
e
s
to
g
e
t
h
e
r
[
1
2
]
.
W
h
i
l
e
u
n
d
e
r
t
a
k
i
n
g
t
h
e
s
e
d
u
t
i
es
,
t
h
e
y
a
r
e
e
x
p
o
s
e
d
t
o
n
e
e
d
l
e
s
ti
c
k
i
n
ju
r
i
e
s
[
1
5
]
.
F
u
r
t
h
e
r
m
o
r
e
,
m
o
r
t
i
ci
a
n
s
al
s
o
c
a
r
r
y
d
e
ad
b
o
d
i
e
s
f
r
o
m
t
h
e
h
o
s
p
i
t
al
w
a
r
d
s
t
o
t
h
e
m
o
r
g
u
e
.
M
o
r
t
u
a
r
y
s
ta
f
f
a
r
e
a
l
s
o
a
t
r
i
s
k
o
f
s
e
c
o
n
d
a
r
y
t
r
a
u
m
a
t
i
c
s
t
r
es
s
d
i
s
o
r
d
e
r
a
s
a
r
es
u
l
t
o
f
e
x
c
e
s
s
iv
e
e
x
p
o
s
u
r
e
t
o
t
r
a
u
m
a
a
n
d
h
o
r
r
i
f
i
c
e
v
e
n
t
s
[
1
6
]
.
A
n
x
i
e
t
y
a
n
d
d
e
p
r
e
s
s
i
o
n
a
r
e
tw
o
m
a
j
o
r
p
s
y
c
h
o
l
o
g
i
c
al
h
e
a
lt
h
o
u
tc
o
m
e
s
t
h
at
m
i
g
h
t r
e
s
u
l
t
f
r
o
m
th
e
s
e
k
i
n
d
s
o
f
e
x
p
o
s
u
r
es
[
1
7
]
.
H
o
w
e
v
e
r
,
o
n
l
y
a
f
e
w
o
f
t
h
e
s
e
s
t
u
d
i
e
s
h
a
v
e
b
e
e
n
c
o
n
d
u
c
t
e
d
i
n
t
h
e
A
f
r
ic
a
n
s
u
b
r
e
g
i
o
n
,
s
e
e
k
i
n
g
t
o
as
s
ess
t
h
e
k
n
o
w
l
ed
g
e
a
n
d
p
r
a
c
t
i
c
es
o
f
m
o
r
t
u
a
r
y
w
o
r
k
e
r
s
r
e
g
a
r
d
i
n
g
o
c
c
u
p
a
t
i
o
n
a
l
h
e
a
lt
h
a
n
d
s
a
f
e
t
y
[
1
5
]
,
[
1
8
]
,
[
1
9
]
.
I
n
r
eso
u
r
ce
-
co
n
s
tr
ain
ed
en
v
ir
o
n
m
en
ts
lik
e
Gh
an
a,
th
e
r
is
k
s
ar
e
ex
ac
e
r
b
ated
b
y
lim
ited
ac
ce
s
s
to
s
af
ety
tr
ain
in
g
,
in
ad
e
q
u
ate
av
ailab
ilit
y
o
f
PP
E
,
an
d
in
s
u
f
f
icie
n
t
r
eg
u
lato
r
y
o
v
er
s
ig
h
t.
Prio
r
s
tu
d
ies
in
Gh
an
a
h
av
e
r
e
p
o
r
ted
m
o
r
t
u
ar
y
w
o
r
k
er
s
'
d
ir
ec
t
ex
p
o
s
u
r
e
to
h
u
m
a
n
f
lu
id
s
[
1
8
]
,
[
2
0
]
,
lo
w
v
ac
cin
atio
n
r
ates
ag
ain
s
t
o
cc
u
p
atio
n
al
in
f
ec
tio
n
s
[
2
1
]
,
an
d
p
o
o
r
a
d
h
er
e
n
ce
to
u
n
i
v
er
s
al
s
af
ety
p
r
o
to
co
ls
[
2
1
]
.
Fu
r
th
er
m
o
r
e,
t
h
e
p
s
y
ch
o
lo
g
ical
to
ll
o
f
wo
r
k
in
g
with
tr
a
u
m
atic
ca
s
es
an
d
b
er
ea
v
ed
f
am
ilies
is
co
m
p
o
u
n
d
ed
b
y
th
e
lack
o
f
m
en
tal
h
ea
lth
s
u
p
p
o
r
t
[
1
2
]
.
D
esp
ite
th
ese
ch
allen
g
es,
th
er
e
i
s
a
d
ea
r
th
o
f
r
esear
c
h
ass
ess
in
g
th
e
s
p
ec
if
ic
r
is
k
s
f
ac
ed
b
y
m
o
r
tu
a
r
y
wo
r
k
e
r
s
an
d
th
e
ef
f
icac
y
o
f
e
x
is
tin
g
wo
r
k
p
lace
s
af
ety
m
ea
s
u
r
es
i
n
lo
w
-
r
eso
u
r
ce
s
ettin
g
s
.
Ou
r
s
ea
r
ch
in
p
u
b
lis
h
ed
liter
at
u
r
e
f
o
u
n
d
n
o
r
is
k
ass
ess
m
en
t
s
tu
d
ies
co
n
d
u
cted
in
Gh
a
n
a'
s
d
ea
th
ca
r
e
in
d
u
s
tr
y
.
T
h
er
ef
o
r
e,
litt
le
is
k
n
o
wn
ab
o
u
t
th
e
s
af
ety
o
f
m
o
r
tu
ar
y
f
a
cilities
in
Gh
an
a
an
d
h
o
w
m
o
r
tician
s
'
k
n
o
wled
g
e
im
p
ac
ts
th
eir
o
cc
u
p
atio
n
al
h
ea
lth
an
d
s
af
ety
(
OHS
)
p
r
ac
tices.
T
h
is
s
tu
d
y
,
th
e
r
ef
o
r
e
,
ad
d
r
ess
es
th
ese
cr
itical
g
ap
s
b
y
ass
ess
in
g
th
e
o
cc
u
p
atio
n
al
h
ea
lth
a
n
d
s
a
f
ety
k
n
o
wled
g
e,
attitu
d
es,
an
d
p
r
a
ctice
s
o
f
m
o
r
tu
ar
y
wo
r
k
er
s
i
n
two
f
ac
ilit
ies
in
C
ap
e
C
o
ast,
Gh
an
a.
Usi
n
g
a
d
ec
is
io
n
m
atr
ix
r
is
k
ass
ess
m
en
t
to
o
l,
th
is
s
tu
d
y
aim
s
to
id
en
tify
co
m
m
o
n
wo
r
k
p
lac
e
h
az
ar
d
s
,
ev
alu
ate
ass
o
ciate
d
r
is
k
s
,
an
d
p
r
o
v
id
e
ac
tio
n
ab
le
in
s
ig
h
ts
to
m
itig
a
te
th
ese
r
is
k
s
.
B
y
h
ig
h
lig
h
tin
g
th
ese
is
s
u
es,
th
e
s
tu
d
y
s
ee
k
s
to
in
f
o
r
m
p
o
licy
m
ak
er
s
an
d
s
tak
eh
o
l
d
er
s
,
o
f
f
er
in
g
a
p
ath
way
t
o
im
p
r
o
v
e
t
h
e
s
af
ety
an
d
well
-
b
ein
g
o
f
m
o
r
tu
ar
y
w
o
r
k
er
s
,
w
h
o
r
em
ain
an
o
v
er
lo
o
k
ed
y
et
v
ital c
o
m
p
o
n
e
n
t o
f
th
e
h
ea
lth
ca
r
e
co
n
tin
u
u
m
.
2.
M
E
T
H
O
D
2
.
1
.
Study
s
et
t
ing
T
h
e
s
tu
d
y
was
co
n
d
u
cted
at
t
h
e
Un
iv
er
s
ity
o
f
C
ap
e
C
o
ast,
wh
ich
h
as
two
m
o
r
tu
ar
y
f
ac
ilit
ies:
th
e
Un
iv
er
s
ity
o
f
C
ap
e
C
o
ast
Ho
s
p
ital
m
o
r
tu
ar
y
an
d
th
e
Sch
o
o
l o
f
Me
d
ical
Scien
ce
s
m
o
r
t
u
ar
y
.
T
h
e
Un
iv
e
r
s
ity
o
f
C
ap
e
C
o
ast
is
a
p
u
b
lic
u
n
iv
er
s
ity
lo
ca
ted
in
C
ap
e
C
o
ast,
th
e
ca
p
ital
o
f
th
e
C
en
tr
al
R
eg
io
n
o
f
Gh
an
a.
T
h
ese
two
co
n
v
en
ie
n
tly
s
elec
ted
p
u
b
lic
m
o
r
tu
ar
ies h
av
e
t
h
e
m
o
s
t sig
n
if
ican
t n
u
m
b
er
o
f
s
taf
f
i
n
th
e
m
etr
o
p
o
lis
.
2
.
2
.
Study
des
ig
n
T
h
is
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
em
p
lo
y
ed
an
ar
r
ay
o
f
ap
p
r
o
ac
h
e
s
.
Haz
ar
d
s
wer
e
m
eticu
lo
u
s
ly
id
en
tifie
d
th
r
o
u
g
h
a
q
u
esti
o
n
n
air
e,
s
u
r
p
r
is
e
wo
r
k
p
lace
v
is
its
to
m
o
n
i
to
r
wo
r
k
p
r
o
ce
d
u
r
es
an
d
in
s
p
ec
tio
n
o
f
ac
cid
e
n
t
r
ep
o
r
ts
.
T
h
e
s
tu
d
y
b
e
g
an
in
Feb
r
u
ar
y
2
0
2
3
an
d
was c
o
m
p
lete
d
in
J
u
n
e
2
0
2
3
.
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
.
3
,
Sep
tem
b
er
20
25
:
15
40
-
15
51
1542
2
.
3
.
Stu
dy
po
pu
la
t
io
n a
nd
s
a
m
pli
ng
T
h
e
s
tu
d
y
s
am
p
le
in
clu
d
ed
al
l
m
o
r
tician
s
em
p
lo
y
ed
b
y
th
e
f
ac
ilit
y
an
d
h
av
in
g
wo
r
k
ed
t
h
er
e
f
o
r
at
least
o
n
e
y
ea
r
.
T
wen
ty
-
f
iv
e
p
eo
p
le
wo
r
k
in
th
e
m
o
r
g
u
e
at
th
e
U
n
iv
er
s
ity
o
f
C
ap
e
C
o
ast
Ho
s
p
ital,
wh
ile
f
if
teen
em
p
l
o
y
ee
s
at
th
e
Sch
o
o
l
o
f
Me
d
ical
Scien
ce
h
av
e
b
ee
n
t
h
er
e
f
o
r
at
least
a
y
e
ar
.
Fo
llo
win
g
th
e
in
clu
s
io
n
cr
iter
ia,
th
e
ce
n
s
u
s
s
am
p
le
tech
n
iq
u
e
was u
s
ed
o
n
all
4
0
elig
ib
le
s
taf
f
m
em
b
er
s
.
2
.
4
.
P
o
t
ent
ia
l
s
o
urce
s
o
f
bia
s
R
ec
o
g
n
izin
g
th
e
p
o
ten
tial
s
o
u
r
ce
s
o
f
b
ias,
we
to
o
k
s
ev
er
al
m
ea
s
u
r
es
to
en
s
u
r
e
th
e
v
a
lid
ity
an
d
r
eliab
ilit
y
o
f
o
u
r
f
in
d
in
g
s
.
T
h
e
two
id
e
n
tifie
d
s
o
u
r
ce
s
we
r
e
th
e
p
o
s
s
ib
ilit
y
o
f
p
ar
ticip
a
n
ts
g
iv
in
g
s
o
cially
ac
ce
p
tab
le
an
s
wer
s
an
d
ex
p
er
ts
'
s
u
b
jectiv
e
as
s
es
s
m
en
t
o
f
h
az
ar
d
s
.
A
v
ar
iety
o
f
ad
d
itio
n
a
l
d
ata
s
o
u
r
ce
s
wer
e
u
ti
lized
to
co
u
n
ter
ac
t
th
ese.
An
o
b
s
er
v
atio
n
ch
ec
k
lis
t
was
in
clu
d
ed
to
v
er
if
y
p
ar
ticip
an
ts
'
s
tatem
en
t
s
,
an
d
th
r
ee
ex
p
e
r
ts
in
d
ep
en
d
en
tly
ev
alu
ated
th
e
r
is
k
s
to
av
o
id
p
o
ten
tial b
ias r
esu
ltin
g
f
r
o
m
s
u
b
je
ctiv
ity
.
2
.
5
.
Study
v
a
ria
bles
T
h
is
s
tu
d
y
h
ad
two
r
esp
o
n
s
e
v
ar
iab
les an
d
elev
en
ex
p
lan
ato
r
y
v
ar
iab
les.
Me
tr
ic
s
ca
le
v
ar
ia
b
les m
ad
e
u
p
th
e
r
esp
o
n
s
e
o
r
d
e
p
en
d
e
n
t
v
ar
iab
les.
T
h
ese
wer
e
th
e
s
af
ety
p
r
ec
au
tio
n
s
th
at
th
e
r
esp
o
n
d
er
s
wer
e
awa
r
e
o
f
an
d
h
ad
tak
en
.
Occ
u
p
atio
n
(
ca
teg
o
r
ical
b
u
t
n
o
m
i
n
al)
,
e
d
u
ca
tio
n
al
attain
m
en
t
(
ca
teg
o
r
ical
b
u
t
o
r
d
in
al
v
ar
iab
le)
,
ag
e,
jo
b
ex
p
er
ien
ce
,
attitu
d
e,
p
er
ce
iv
ed
d
a
n
g
er
,
a
war
en
ess
,
an
d
av
ailab
ilit
y
o
f
PP
E
s
(
m
etr
ic
s
ca
le
v
ar
iab
les)
wer
e
th
e
e
x
p
lan
ato
r
y
o
r
in
d
ep
en
d
en
t v
a
r
iab
les.
2
.
6
.
St
a
t
is
t
ica
l m
et
ho
ds
Stan
d
ar
d
d
ev
iatio
n
s
an
d
m
ea
n
s
wer
e
em
p
lo
y
ed
to
s
u
m
m
ar
iz
e
co
n
tin
u
o
u
s
v
ar
iab
les,
f
r
eq
u
e
n
cies
an
d
p
er
ce
n
tag
es
wer
e
u
s
ed
to
s
u
m
m
ar
ize
ca
teg
o
r
ical
v
ar
iab
les,
an
d
C
hi
-
s
q
u
ar
e
was
u
s
ed
to
esti
m
ate
th
e
r
elatio
n
s
h
ip
b
etwe
en
th
e
in
d
e
p
en
d
en
t
an
d
d
e
p
en
d
e
n
t
v
a
r
iab
les.
T
h
e
co
m
p
u
ter
s
o
f
twar
e
p
ac
k
ag
e
SP
SS
v
2
2
was
u
s
ed
to
p
r
o
ce
s
s
th
e
d
ata.
T
h
e
9
5
%
an
d
5
%
co
n
f
id
e
n
ce
in
ter
v
als
wer
e
u
s
ed
to
d
eter
m
in
e
s
tatis
tica
l
s
ig
n
if
ican
ce
.
2
.
7
.
I
ns
t
rum
ent
s
2
.
7
.
1
.
Q
ues
t
io
nn
a
ires
T
h
is
s
tu
d
y
in
clu
d
ed
a
s
elf
-
a
d
m
in
is
ter
ed
,
s
tr
u
ctu
r
e
d
q
u
esti
o
n
n
air
e.
A
p
ilo
t
s
tu
d
y
in
v
o
lv
in
g
te
n
m
o
r
tu
ar
y
s
taf
f
m
e
m
b
er
s
at
C
ap
e
C
o
ast
Me
tr
o
p
o
litan
Ho
s
p
ital
was
ca
r
r
ied
o
u
t
to
v
er
if
y
th
e
v
alid
ity
o
f
th
e
q
u
esti
o
n
n
air
e.
T
h
is
m
ad
e
it
p
o
s
s
ib
le
to
m
ak
e
th
e
r
e
q
u
ir
e
d
c
h
an
g
es
to
th
e
q
u
esti
o
n
n
air
e.
Ad
d
itio
n
ally
,
p
r
o
v
en
in
s
tr
u
m
en
ts
f
r
o
m
r
elate
d
in
v
es
tig
atio
n
s
wer
e
m
o
d
if
ied
[
2
2
]
.
C
o
m
p
ar
in
g
th
r
ee
i
n
d
ep
e
n
d
en
t
ex
p
er
ts
'
ev
alu
atio
n
r
esu
lts
f
o
r
th
e
s
am
e
r
is
k
s
in
cr
ea
s
ed
r
eliab
ilit
y
.
Six
co
m
p
o
n
en
ts
m
ad
e
u
p
th
e
q
u
esti
o
n
n
air
e.
Sectio
n
A
aim
ed
to
g
ath
er
in
f
o
r
m
atio
n
o
n
th
e
r
esp
o
n
d
en
ts
'
s
o
cio
d
em
o
g
r
a
p
h
ic
tr
aits
.
Sectio
n
B
g
ath
er
ed
in
f
o
r
m
atio
n
o
n
r
esp
o
n
d
en
ts
'
lev
els
o
f
awa
r
en
ess
,
k
n
o
wled
g
e,
an
d
p
r
ac
tice
ab
o
u
t
o
cc
u
p
atio
n
al
h
ea
lth
a
n
d
s
af
ety
.
Sectio
n
C
ass
es
s
ed
th
e
p
ar
ticip
an
ts
'
attit
u
d
es
to
war
d
r
is
k
s
an
d
th
e
u
s
e
o
f
o
cc
u
p
atio
n
al
h
ea
lth
a
n
d
s
af
ety
.
Sectio
n
D
ev
alu
ated
t
h
e
wo
r
k
er
s
'
s
elf
-
r
ep
o
r
ted
ex
p
o
s
u
r
e
t
o
wo
r
k
p
lace
h
az
ar
d
s
.
W
h
ile
Sectio
n
F
in
v
e
s
tig
ated
th
e
ef
f
ec
ts
o
f
o
cc
u
p
atio
n
al
h
az
ar
d
s
o
n
t
h
e
s
taf
f
th
e
p
r
ev
io
u
s
y
ea
r
,
Sectio
n
E
was
u
s
ed
to
g
ath
er
d
ata
o
n
wo
r
k
p
lace
m
ea
s
u
r
es
av
ailab
le
f
o
r
h
az
ar
d
co
n
t
r
o
l.
T
h
e
c
u
m
u
lativ
e
s
c
o
r
es
o
f
th
e
k
n
o
wled
g
e,
attitu
d
e,
p
r
ac
tices,
an
d
awa
r
en
ess
v
ar
iab
les
wer
e
s
u
m
m
ar
ized
an
d
class
if
ied
as
g
o
o
d
o
r
b
ad
(
k
n
o
wled
g
e
an
d
p
r
ac
tice)
,
lo
w
o
r
h
ig
h
(
awa
r
en
ess
)
,
an
d
p
o
s
itiv
e
o
r
n
eg
ativ
e
(
attitu
d
e)
.
T
h
e
cr
iter
ia
f
o
r
class
if
icatio
n
was
th
e
d
er
iv
ed
m
ed
ian
s
co
r
e
f
o
r
ea
ch
v
ar
ia
b
le.
L
o
w/p
o
o
r
/n
eg
ativ
e
s
co
r
es
wer
e
d
ef
in
ed
as
th
o
s
e
b
elo
w
th
e
m
ed
ian
,
wh
ile
h
ig
h
/g
o
o
d
/p
o
s
itiv
e
s
co
r
es we
r
e
d
ef
in
ed
as th
o
s
e
eq
u
al
to
o
r
ab
o
v
e.
2
.
7
.
2
.
O
bs
er
v
a
t
io
na
l
che
ck
lis
t
Af
ter
ex
am
in
in
g
ea
r
lier
c
o
m
p
ar
ab
le
r
esear
ch
,
a
n
o
b
s
er
v
atio
n
al
ch
ec
k
lis
t
was
cr
ea
ted
[
1
2
]
,
[
2
0
]
,
[
2
3
]
.
I
t
was
d
iv
id
e
d
in
t
o
eig
h
t
s
ec
tio
n
s
:
f
ir
s
t
aid
,
g
en
e
r
al
s
ec
u
r
ity
,
elec
tr
ical
s
af
ety
,
f
ir
e
s
af
ety
,
g
e
n
er
al
s
af
ety
,
PP
E
av
ailab
ilit
y
,
OHS
p
o
licies,
an
d
wo
r
k
er
PP
E
u
s
e.
T
h
e
t
ea
m
o
f
e
x
p
er
ts
u
s
ed
th
e
c
h
ec
k
lis
t
to
co
r
r
o
b
o
r
ate
s
elf
-
r
ep
o
r
ted
w
o
r
k
p
lace
s
af
ety
co
n
d
itio
n
s
.
2
.
7
.
3
.
I
ncident
re
g
is
t
er
T
h
e
m
o
r
tu
ar
y
f
ac
ilit
ies'
in
cid
en
t
r
eg
is
ter
s
wer
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.
T
ab
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3
.
Dem
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g
r
ap
h
ic
ch
ar
ac
t
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is
tics
o
f
r
esp
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d
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D
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F
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–
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5
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6
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f
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<
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2
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4
4
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1
1
–
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4
1
1
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>
1
5
8
2
2
.
2
Ed
u
c
a
t
i
o
n
a
l
l
e
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e
l
B
a
si
c
21
5
8
.
3
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7
.
8
Te
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t
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a
r
y
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1
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9
3
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2
.
P
er
ce
pti
o
n o
f
risk
a
nd
a
t
t
it
ud
es t
o
wa
rds
o
cc
up
a
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na
l sa
f
et
y
All
p
ar
ticip
an
ts
p
er
ce
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ed
th
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jo
b
s
as
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is
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y
.
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h
ese
wer
e
m
ain
ly
class
if
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as
h
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-
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is
k
.
Su
ch
a
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llectiv
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p
tio
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is
a
cr
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ca
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in
s
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t,
as
it
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th
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ical
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er
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t
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e
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r
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p
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f
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p
.
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h
e
o
v
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all
attitu
d
e
s
co
r
e
was
5
1
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6
±
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.
1
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(
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ax
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s
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f
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)
.
T
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g
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in
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atio
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am
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n
g
wo
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k
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s
to
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in
s
af
e
p
r
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tices.
3
.
3
.
Av
a
ila
bil
it
y
o
f
a
nd
us
e
o
f
P
P
E
s
E
v
er
y
p
a
r
ticip
an
t
s
tated
th
at
f
ac
e
m
ask
s
,
g
lo
v
es,
h
an
d
-
wash
in
g
s
tatio
n
s
,
an
d
lab
co
ats
wer
e
alwa
y
s
av
ailab
le.
No
n
eth
eless
,
a
f
e
w
p
ar
ticip
an
ts
m
en
t
io
n
ed
t
h
at
g
o
g
g
les
(
2
4
,
6
6
.
7
%)
a
n
d
s
af
ety
f
o
o
twea
r
(
1
2
,
3
3
.
3
%)
wer
e
n
o
t
alwa
y
s
ac
ce
s
s
ib
le.
Par
ticip
an
ts
'
u
s
e
o
f
PP
E
s
an
d
th
eir
av
ailab
ilit
y
s
h
o
wed
a
s
u
b
s
tan
tial
an
d
p
o
s
itiv
e
ass
o
ciatio
n
(
r
=
0
.
7
4
6
,
p
=
0
.
0
0
1
)
.
E
v
en
t
h
o
u
g
h
all
p
a
r
ticip
an
ts
s
tated
th
at
h
ep
a
titi
s
B
v
ac
cin
es
wer
e
av
ailab
le,
o
n
ly
8
(
2
2
.
2
%)
wer
e
s
u
r
e
o
f
co
m
p
letin
g
t
h
eir
v
ac
cin
atio
n
s
ag
ain
s
t
h
e
p
a
titi
s
B
.
T
h
er
e
was
a
lo
w
u
p
tak
e
o
f
tetan
u
s
to
x
o
id
v
ac
cin
e.
On
ly
7
(
1
9
.
4
%)
p
a
r
ticip
an
ts
in
d
icate
d
th
ey
h
ad
r
ec
eiv
ed
a
tetan
u
s
v
ac
cin
e
ev
er
i
n
th
eir
a
d
u
lt lif
e.
3
.
4
.
Awa
re
nes
s
a
nd
pra
ct
ice
o
f
s
a
f
et
y
prec
a
utio
ns
T
h
e
p
ar
ticip
a
n
ts
'
awa
r
en
ess
o
f
s
af
ety
co
n
ce
r
n
s
was
r
ated
h
ig
h
ly
(
1
0
.
7
±
2
.
4
2
)
with
a
m
ax
im
u
m
s
co
r
e
o
f
1
4
.
T
h
er
e
was
a
wea
k
an
d
n
o
n
-
s
ig
n
if
ica
n
t
co
n
n
ec
tio
n
b
e
twee
n
k
n
o
wled
g
e
o
f
s
af
ety
p
r
ec
au
tio
n
s
an
d
th
eir
ac
tu
al
ap
p
licatio
n
(
r
=
0
.
1
4
9
,
p
=
0
.
3
8
7
)
.
T
h
is
h
ig
h
lig
h
ts
a
p
o
t
en
tial g
ap
b
etwe
en
awa
r
e
n
ess
an
d
b
e
h
av
io
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
Occ
u
p
a
tio
n
a
l sa
fety
o
f m
o
r
ticia
n
s
:
A
ca
s
e
s
tu
d
y
o
f m
o
r
tu
a
r
y
fa
cilities
in
C
a
p
e
C
o
a
s
t
…
(
Ja
mes Ko
jo
P
r
a
h
)
1545
3
.
5
.
P
er
ce
i
v
ed
ef
f
ec
t
s
o
f
o
cc
up
a
t
io
na
l ha
za
rds
o
n hea
lt
h
An
y
h
ea
lt
h
is
s
u
es
r
esp
o
n
d
en
ts
h
ad
ex
p
er
ien
ce
d
in
th
e
y
ea
r
b
ef
o
r
e
t
h
e
s
u
r
v
ey
th
at
th
ey
b
eli
ev
ed
wer
e
r
elate
d
to
th
eir
lin
e
o
f
wo
r
k
wer
e
d
is
clo
s
ed
.
Sk
i
n
c
o
n
d
itio
n
s
ac
co
u
n
ted
f
o
r
1
5
(
4
1
.
7
%)
o
f
th
e
r
esp
o
n
d
e
n
ts
'
h
ea
lth
co
n
ce
r
n
s
,
f
o
llo
wed
b
y
lo
w
b
ac
k
p
ain
1
2
(
3
3
.
3
%),
ey
e
is
s
u
es
1
0
(
2
7
.
8
%),
wr
is
t
jo
i
n
t
p
ain
8
(
2
2
.
2
%),
an
d
n
ec
k
p
ain
6
(
1
6
.
7
%).
T
h
e
h
ig
h
lev
el
o
f
m
u
s
cu
lo
s
k
eleta
l
d
is
o
r
d
er
s
,
m
ain
ly
lo
w
b
ac
k
a
n
d
wr
is
t
jo
in
t
p
ain
s
r
ep
o
r
ted
,
ag
r
ee
s
with
an
ea
r
l
ier
s
tu
d
y
th
at
also
f
o
u
n
d
m
u
s
cu
lo
s
k
eleta
l
in
ju
r
ies
to
b
e
a
s
ig
n
if
ican
t
h
ea
lth
co
n
ce
r
n
f
o
r
m
o
r
tu
ar
y
wo
r
k
er
s
in
th
e
Un
ited
States
o
f
Am
e
r
ica
[
1
3
]
.
T
h
is
h
ig
h
in
cid
e
n
ce
o
f
m
u
s
cu
lo
s
k
eleta
l
d
is
o
r
d
er
s
am
o
n
g
th
e
p
ar
ticip
an
ts
is
n
o
t
s
u
r
p
r
is
in
g
co
n
s
id
er
in
g
th
at
t
h
eir
wo
r
k
r
o
u
tin
e
ly
in
v
o
lv
es
m
an
u
al
liftin
g
o
f
ca
d
av
er
s
,
p
u
s
h
an
d
p
u
ll
f
o
r
ce
s
in
v
o
l
v
ed
in
m
o
v
in
g
co
r
p
s
es,
an
d
a
d
o
p
tin
g
n
o
n
-
n
eu
tr
al
p
o
s
itio
n
s
wh
ile
wo
r
k
in
g
[
1
3
]
.
I
n
th
is
s
tu
d
y
,
it
was
o
b
s
er
v
ed
th
at
th
e
r
e
wer
e
n
o
h
o
is
ts
f
o
r
liftin
g
t
h
e
b
o
d
ies,
a
n
d
th
e
wo
r
k
er
s
ass
u
m
ed
awk
war
d
p
o
s
tu
r
es
an
d
e
n
g
ag
e
d
in
r
ep
etit
iv
e
m
o
tio
n
s
wh
e
n
p
er
f
o
r
m
in
g
em
b
alm
in
g
.
T
h
e
r
e
wer
e
r
ep
o
r
ts
o
f
s
k
in
d
is
o
r
d
e
r
s
a
m
o
n
g
p
ar
ticip
a
n
ts
.
So
m
e
p
a
r
ticip
an
ts
in
p
r
e
v
io
u
s
s
tu
d
ies
h
av
e
also
r
e
p
o
r
ted
ex
p
er
ien
cin
g
s
k
in
d
is
o
r
d
er
s
as
a
r
esu
lt
o
f
o
cc
u
p
atio
n
al
ex
p
o
s
u
r
es
[
2
9
]
,
[
3
0
]
.
I
n
an
ea
r
lie
r
q
u
alitati
v
e
s
tu
d
y
th
at
ex
p
lo
r
ed
t
h
e
ef
f
ec
ts
o
f
f
o
r
m
alin
o
n
m
o
r
tu
ar
y
atten
d
an
t
s
in
Gh
an
a
[
2
0
]
,
m
an
y
p
ar
tici
p
an
ts
r
ep
o
r
ted
t
h
at
th
ey
h
ad
ex
p
er
ien
ce
d
th
e
a
d
v
er
s
e
ef
f
ec
ts
o
f
th
e
ch
em
ical
o
n
th
e
ey
es,
r
esp
ir
ato
r
y
tr
ac
t,
an
d
s
k
in
.
Mo
r
tu
a
r
y
wo
r
k
er
s
r
is
k
s
k
in
d
is
o
r
d
e
r
s
b
ec
au
s
e
o
f
e
x
p
o
s
u
r
e
to
c
h
em
i
ca
ls
s
u
ch
as
f
o
r
m
al
d
eh
y
d
e,
g
lu
tar
ald
eh
y
d
e
,
an
d
ch
lo
r
in
e.
Fo
r
m
ald
eh
y
d
e
is
a
v
o
latile
ch
em
ical
th
at
is
also
k
n
o
wn
t
o
ca
u
s
e
r
esp
ir
at
o
r
y
a
n
d
ey
e
p
r
o
b
lem
s
as
well
as
ca
n
ce
r
o
f
th
e
n
o
s
e
an
d
lu
n
g
s
[
3
1
]
.
T
h
er
ef
o
r
e,
it
is
u
r
g
en
tly
n
ec
ess
ar
y
to
en
s
u
r
e
th
at
all
m
o
r
tician
s
p
r
o
tect
th
eir
s
k
in
a
n
d
r
esp
ir
ato
r
y
tr
ac
t u
s
in
g
PP
E
s
s
u
ch
as g
l
o
v
es a
n
d
f
a
ce
m
ask
s
.
3
.
6
.
E
x
po
s
ure
t
o
ha
z
a
rds
Su
r
v
ey
p
ar
ticip
an
ts
s
elf
-
r
ep
o
r
t
ed
th
e
p
r
ev
alen
ce
o
f
e
x
p
o
s
u
r
e
to
o
cc
u
p
atio
n
al
h
az
ar
d
s
in
an
y
f
o
r
m
in
th
e
y
ea
r
p
r
ec
ed
i
n
g
th
e
s
tu
d
y
.
T
ab
le
4
p
r
esen
ts
th
e
s
elf
-
r
ep
o
r
ted
ex
p
o
s
u
r
es
to
s
p
ec
if
ic
o
cc
u
p
atio
n
al
h
az
ar
d
s
.
C
h
em
ical
in
h
a
latio
n
(
3
2
,
8
8
.
9
%)
an
d
tim
e
p
r
ess
u
r
es
(
2
2
,
6
1
.
1
%)
wer
e
th
e
m
o
s
t
co
m
m
o
n
l
y
cited
d
an
g
e
r
s
.
T
h
e
h
ig
h
s
elf
-
r
ep
o
r
te
d
e
x
p
o
s
u
r
e
t
o
v
o
latile
ch
em
icals
co
u
l
d
b
e
d
u
e
to
t
h
e
f
r
eq
u
e
n
t
u
s
e
o
f
s
u
ch
c
h
em
icals
lik
e
f
o
r
m
ald
e
h
y
d
e
an
d
wo
r
k
er
s
n
o
t
ad
h
er
in
g
to
th
e
u
s
e
o
f
f
ac
e
m
ask
s
,
as
f
o
u
n
d
b
y
r
esear
ch
er
s
wh
en
th
ey
v
is
ited
th
e
wo
r
k
s
ites
.
1
6
(
4
4
.
4
%)
r
ep
o
r
ted
e
x
p
er
ie
n
cin
g
n
e
ed
le
s
tick
in
ju
r
ies.
T
h
is
p
r
ev
alen
ce
o
f
n
ee
d
le
s
tick
in
ju
r
ies
is
lo
wer
th
an
th
e
7
3
.
5
%
f
o
u
n
d
in
a
s
tu
d
y
co
n
d
u
cte
d
in
Nig
er
ia
[
1
5
]
b
u
t
h
ig
h
er
th
a
n
th
e
3
2
.
7
%
f
o
u
n
d
in
an
I
n
d
ian
s
tu
d
y
[
3
2
]
.
I
t
is
,
h
o
wev
er
,
s
im
ilar
to
th
e
4
3
%
p
r
ev
alen
ce
f
o
u
n
d
am
o
n
g
m
o
r
tu
ar
y
wo
r
k
er
s
in
I
r
an
[
3
3
]
.
Desp
ite
th
is
h
ig
h
s
elf
-
r
ep
o
r
ted
p
r
ev
alen
ce
o
f
n
ee
d
le
s
tick
in
ju
r
ies
in
th
is
s
tu
d
y
,
o
n
ly
8
(
2
2
.
2
%
)
we
r
e
s
u
r
e
o
f
co
m
p
letin
g
t
h
eir
v
ac
cin
atio
n
s
ag
ain
s
t
Hep
atitis
B
.
An
ea
r
lier
s
tu
d
y
co
n
d
u
cte
d
am
o
n
g
m
o
r
tu
ar
y
wo
r
k
er
s
in
So
u
th
Af
r
ica
also
f
o
u
n
d
a
lo
w
Hep
atitis
B
v
ac
cin
e
u
p
tak
e
o
f
1
7
%
[
1
9
]
.
T
h
er
e
is
,
th
er
ef
o
r
e,
th
e
n
ee
d
to
en
f
o
r
ce
p
o
licies
o
n
Hep
atitis
B
v
ac
cin
atio
n
in
th
e
wo
r
k
p
lace
.
T
h
e
u
p
tak
e
o
f
th
e
tetan
u
s
to
x
o
id
v
ac
cin
e
was
also
d
ef
icien
t.
T
etan
u
s
v
ac
cin
e
u
p
tak
e
is
lo
w
in
lo
w
-
r
eso
u
r
ce
s
ettin
g
s
.
A
s
tu
d
y
in
So
m
alia
[
3
4
]
f
o
u
n
d
a
1
0
.
8
%
s
elf
-
r
e
p
o
r
ted
u
p
tak
e
am
o
n
g
p
ar
ticip
an
ts
w
h
o
wer
e
h
ea
lth
wo
r
k
er
s
.
T
h
e
lo
w
u
p
tak
e
o
f
th
e
tetan
u
s
v
ac
cin
e
am
o
n
g
p
ar
tici
p
an
ts
co
u
ld
b
e
d
u
e
to
th
e
lack
o
f
a
p
o
licy
o
n
im
m
u
n
izatio
n
m
an
d
atin
g
a
d
u
lts
to
t
ak
e
th
e
tetan
u
s
v
ac
cin
e
in
Gh
an
a
an
d
th
e
p
o
s
s
ib
ilit
y
th
at
m
an
y
o
f
th
e
m
m
ay
h
av
e
r
ec
e
iv
ed
th
e
v
ac
cin
e
as
in
f
an
ts
.
T
e
t
a
n
u
s
v
a
c
c
i
n
es
h
a
v
e
b
e
e
n
p
a
r
t
o
f
G
h
a
n
a
’
s
i
m
m
u
n
i
z
a
t
i
o
n
p
r
o
g
r
a
m
s
i
n
c
e
1
9
8
7
[
3
5
]
.
H
o
w
e
v
e
r
,
t
o
e
n
s
u
r
e
c
o
n
t
i
n
u
e
d
p
r
o
t
e
c
t
i
o
n
a
g
a
i
n
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t
t
et
a
n
u
s
a
n
d
d
i
p
h
t
h
e
r
i
a
,
t
h
e
A
d
v
i
s
o
r
y
C
o
m
m
i
tt
e
e
o
n
I
m
m
u
n
i
z
a
t
i
o
n
P
r
a
c
ti
c
es
o
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t
h
e
C
e
n
t
e
r
s
f
o
r
D
is
e
as
e
C
o
n
tr
o
l
r
e
c
o
m
m
e
n
d
e
d
t
h
a
t
i
n
d
i
v
i
d
u
a
l
s
o
b
t
ai
n
a
b
o
o
s
t
e
r
s
h
o
t
e
v
e
r
y
t
e
n
y
e
a
r
s
[
3
6
]
.
Mo
s
t
r
esp
o
n
d
e
n
ts
,
2
9
(
8
0
.
6
%
)
,
v
iewe
d
th
eir
jo
b
as
s
tr
ess
f
u
l.
T
h
e
p
r
im
a
r
y
s
o
u
r
ce
s
o
f
s
t
r
ess
wer
e
g
iv
en
b
y
p
ar
ticip
an
ts
as
h
an
d
lin
g
an
d
p
r
ep
ar
in
g
b
o
d
ies
2
0
(
6
8
.
9
%),
d
ea
lin
g
with
wailin
g
b
er
ea
v
e
d
f
am
ilies
1
8
(
6
2
.
1
%),
an
d
lis
ten
in
g
to
d
etails
o
f
wh
at
k
illed
p
eo
p
le
f
r
o
m
r
elativ
es
1
5
(
5
1
.
7
%).
T
h
e
m
ain
d
r
iv
er
s
o
f
s
tr
ess
f
o
u
n
d
in
th
is
s
tu
d
y
,
s
u
ch
as
d
ea
lin
g
with
wailin
g
b
er
ea
v
ed
f
am
ilies
an
d
h
an
d
lin
g
an
d
p
r
ep
ar
i
n
g
b
o
d
ies,
h
av
e
also
b
ee
n
r
e
p
o
r
ted
b
y
ea
r
lier
s
tu
d
ies
[
3
7
]
,
[
3
8
]
.
W
h
en
a
s
k
ed
h
o
w
th
e
y
c
o
p
e
with
th
e
s
tr
ess
ex
p
er
ien
ce
d
,
th
e
r
esp
o
n
s
es
wer
e
u
s
in
g
alc
o
h
o
l
1
2
(
4
1
.
4
%)
an
d
p
s
y
c
h
in
g
th
em
s
elv
es
(
2
7
.
6
%).
Oth
e
r
s
tu
d
ies
h
av
e
also
f
o
u
n
d
th
e
u
s
e
o
f
alco
h
o
l
a
m
o
n
g
m
o
r
tician
s
as
a
c
o
p
in
g
s
tr
a
teg
y
[
1
9
]
,
[
3
9
]
.
An
ea
r
lier
s
tu
d
y
in
Nam
ib
ia
[
4
0
]
also
f
o
u
n
d
t
h
at
s
o
m
e
m
o
r
tu
ar
y
wo
r
k
er
s
r
eso
r
te
d
to
alco
h
o
l
in
tak
e
as
a
c
o
p
in
g
s
tr
ateg
y
.
Giv
en
th
e
n
eg
ativ
e
im
p
ac
t
o
f
al
co
h
o
l
o
n
t
h
e
h
u
m
an
b
o
d
y
,
m
o
r
tu
ar
y
wo
r
k
er
s
m
u
s
t
b
e
ass
is
ted
to
u
s
e
b
etter
co
p
i
n
g
s
tr
ateg
ies.
T
h
ese
m
ay
in
clu
d
e
th
e
p
r
o
v
i
s
io
n
o
f
co
u
n
s
ellin
g
s
er
v
ices
[
3
9
]
.
Of
th
o
s
e
s
u
r
v
e
y
ed
,
2
8
(
7
7
.
8
%)
s
aid
th
ey
o
cc
asio
n
a
lly
d
is
clo
s
e
th
eir
ex
p
o
s
u
r
es
to
th
e
au
th
o
r
ities
,
wh
ile
8
(
2
2
.
2
%)
s
aid
th
ey
n
e
v
er
r
ep
o
r
t
th
e
m
.
No
t
k
n
o
win
g
wh
o
to
r
ep
o
r
t
to
2
0
(
5
5
.
6
%),
f
o
r
g
ettin
g
to
r
ep
o
r
t
1
6
(
4
4
.
4
%),
m
in
o
r
in
ju
r
i
es
1
3
(
3
6
.
1
%),
an
d
b
eliev
in
g
th
at
n
o
th
in
g
wo
u
ld
b
e
d
o
n
e
a
b
o
u
t
th
e
co
m
p
lai
n
ts
7
(
1
9
.
4
%)
wer
e
s
o
m
e
o
f
th
e
r
ea
s
o
n
s
wh
y
o
cc
u
r
r
e
n
ce
s
wer
e
o
n
ly
s
o
m
etim
es r
ep
o
r
ted
.
3
.
7
.
E
x
pert
ev
a
lua
t
io
n
Gen
er
al
s
af
ety
:
No
wet
f
lo
o
r
s
wer
e
v
is
ib
le,
an
d
th
e
lig
h
tin
g
s
y
s
tem
was
f
u
n
ctio
n
in
g
co
r
r
ec
tly
.
Un
f
o
r
tu
n
atel
y
,
n
o
t
all
o
f
f
ice
f
u
r
n
itu
r
e,
in
cl
u
d
in
g
th
e
s
ea
t
s
an
d
tab
les,
was
er
g
o
n
o
m
ically
d
esig
n
ed
.
All
wash
r
o
o
m
s
wer
e
f
u
n
ctio
n
in
g
.
T
h
e
s
to
r
ag
e
r
o
o
m
s
f
o
r
ch
em
ic
als
wer
e
in
ad
eq
u
ate.
So
m
e
s
ta
f
f
b
elo
n
g
in
g
s
wer
e
o
b
s
er
v
ed
i
n
th
ese
r
o
o
m
s
.
T
h
is
was
also
o
b
s
er
v
ed
in
an
ea
r
li
er
s
tu
d
y
[
1
9
]
.
C
o
n
s
id
er
in
g
t
h
e
f
lam
m
ab
le
n
at
u
r
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
.
3
,
Sep
tem
b
er
20
25
:
15
40
-
15
51
1546
o
f
co
m
m
o
n
co
m
p
o
u
n
d
s
s
u
ch
as
f
o
r
m
a
ld
e
h
y
d
e
an
d
s
o
m
e
d
is
in
f
ec
tan
ts
,
ap
p
r
o
p
r
iate
s
to
r
ag
e
f
ac
ilit
ies
m
u
s
t
b
e
p
r
o
v
id
e
d
f
o
r
th
em
.
I
n
c
o
n
tr
as
t
to
th
e
f
in
d
i
n
g
s
in
a
So
u
t
h
Af
r
ican
s
tu
d
y
[
1
9
]
,
th
e
m
o
r
tu
ar
y
f
ac
ilit
ies
in
th
is
s
tu
d
y
wer
e
o
b
s
er
v
ed
to
b
e
cle
an
,
ad
eq
u
ately
v
e
n
tilated
,
an
d
f
r
ee
o
f
b
ad
o
d
o
r
s
.
E
lectr
ical
an
d
f
ir
e
s
af
ety
:
T
h
e
r
e
wer
e
n
o
o
v
e
r
lo
ad
e
d
ex
ten
s
i
o
n
co
r
d
s
,
an
d
m
o
s
t
o
u
tlets
wer
e
in
g
o
o
d
wo
r
k
in
g
o
r
d
e
r
.
A
co
u
p
le
o
f
s
witch
es
an
d
s
o
ck
ets
wer
e
b
r
o
k
en
.
Su
f
f
icie
n
t
f
ir
e
ex
tin
g
u
is
h
er
s
wer
e
s
tatio
n
ed
s
tr
ateg
ically
,
an
d
s
m
o
k
e
d
etec
to
r
s
wer
e
in
m
an
y
wo
r
k
in
g
s
p
ac
es.
Ho
wev
er
,
n
o
t
a
s
in
g
l
e
f
ir
e
e
x
it
s
ig
n
was
v
is
ib
le.
I
t
was
im
p
r
o
p
e
r
to
k
ee
p
f
lam
m
a
b
le
g
o
o
d
s
,
an
d
f
ir
e
-
r
esis
tan
t
b
lan
k
ets
wer
e
u
n
av
ail
ab
le.
On
ly
4
o
u
t o
f
1
0
wo
r
k
er
s
co
u
l
d
d
em
o
n
s
tr
at
e
co
r
r
ec
tly
h
o
w
to
o
p
e
r
ate
th
e
f
ir
e
ex
tin
g
u
is
h
er
s
.
All
th
e
wo
r
k
er
s
n
ee
d
to
b
e
tr
ain
ed
in
u
s
in
g
f
ir
e
e
x
tin
g
u
is
h
er
s
.
Gen
er
al
s
ec
u
r
ity
:
Secu
r
ity
p
er
s
o
n
n
el
wer
e
o
n
h
a
n
d
a
n
d
eq
u
ip
p
ed
with
ad
eq
u
ate
r
eso
u
r
ce
s
.
Av
ailab
ilit
y
o
f
PP
E
s
:
E
v
er
y
f
ac
ilit
y
v
is
ited
h
ad
f
ac
e
m
ask
s
,
g
o
g
g
les,
s
af
ety
b
o
o
ts
,
p
last
ic
ap
r
o
n
s
,
an
d
u
tili
ty
g
lo
v
es.
Ho
we
v
er
,
ch
em
ical
-
r
e
s
is
tan
t
g
lo
v
es
an
d
ey
ewa
s
h
f
o
u
n
tain
s
wer
e
n
o
t
av
ailab
le.
First
Aid
:
No
n
e
o
f
th
e
f
ac
ilit
ies
v
is
ited
h
ad
a
well
-
s
to
ck
ed
f
ir
s
t
aid
b
o
x
an
d
n
o
s
taf
f
wer
e
s
k
illed
in
p
r
o
v
id
in
g
f
ir
s
t
aid
.
Po
licies:
Pro
ce
d
u
r
es
wer
e
d
ir
ec
te
d
b
y
p
o
s
ted
g
u
id
elin
es.
Ho
wev
er
,
n
o
co
m
m
ittee
f
o
r
o
cc
u
p
atio
n
al
h
ea
lth
an
d
s
af
ety
o
r
s
af
ety
m
an
ag
er
e
x
is
ted
.
T
r
an
s
p
o
r
t
o
f
b
o
d
ies
an
d
em
b
alm
in
g
:
T
h
e
tr
o
lley
s
u
s
ed
to
tr
an
s
p
o
r
t
b
o
d
ies
f
r
o
m
th
e
war
d
to
th
e
m
o
r
g
u
e
o
r
w
h
en
r
ec
ei
v
in
g
t
h
em
f
r
o
m
f
am
ily
m
e
m
b
er
s
we
r
e
f
o
u
n
d
to
b
e
in
g
o
o
d
c
o
n
d
it
io
n
.
T
h
e
r
e
wer
e
n
o
ex
p
o
s
ed
m
etal
p
ar
ts
.
Ho
we
v
er
,
m
o
r
tician
s
wer
e
n
o
t
a
d
eq
u
ately
d
r
ess
ed
in
th
e
r
e
q
u
ir
ed
PP
E
s
wh
en
tr
an
s
p
o
r
tin
g
b
o
d
ies
f
r
o
m
th
e
war
d
s
to
th
e
m
o
r
g
u
e
an
d
wh
e
n
r
ec
eiv
in
g
th
e
b
o
d
ies
f
r
o
m
v
eh
icles
th
at
b
r
o
u
g
h
t
th
em
.
E
v
en
th
o
u
g
h
all
o
b
s
er
v
ed
wer
e
in
g
lo
v
es,
n
o
n
e
w
o
r
e
an
ap
r
o
n
an
d
wer
e
n
o
t
wea
r
in
g
f
ac
e
m
ask
s
.
Per
h
ap
s
m
o
r
tu
ar
y
wo
r
k
er
s
v
ie
w
th
is
asp
ec
t
o
f
th
eir
jo
b
as
l
ess
d
an
g
er
o
u
s
ev
e
n
th
o
u
g
h
s
u
ch
b
o
d
ies
m
ay
s
till
h
av
e
b
o
d
y
f
lu
id
s
th
at
th
ey
co
u
ld
b
e
ex
p
o
s
ed
to
.
A
Nig
er
ian
s
tu
d
y
also
n
o
ted
th
at
m
o
r
tu
ar
y
wo
r
k
er
s
wer
e
n
o
t
ap
p
r
o
p
r
iately
d
r
ess
ed
wh
en
tr
an
s
p
o
r
tin
g
b
o
d
ies
to
th
e
m
o
r
g
u
e
[
4
1
]
.
T
h
er
e
wer
e
n
o
h
o
is
ts
f
o
r
lift
in
g
ca
d
a
v
er
s
,
p
u
ttin
g
wo
r
k
e
r
s
at
r
is
k
o
f
d
ev
elo
p
in
g
m
u
s
cu
lo
s
k
eleta
l
in
ju
r
ies.
T
h
e
r
o
o
m
f
o
r
em
b
a
lm
in
g
b
o
d
ies
was
ad
eq
u
ately
v
en
tilated
.
Ho
wev
er
,
o
n
e
o
f
th
e
f
ac
ilit
ies
d
id
n
o
t
h
av
e
a
l
o
ca
l
ex
h
au
s
t
v
en
tilatio
n
s
y
s
tem
.
All
th
e
m
o
r
tician
s
o
b
s
er
v
ed
co
n
d
u
cti
n
g
em
b
alm
in
g
wo
r
e
g
lo
v
es,
b
o
o
ts
,
an
d
ap
r
o
n
s
.
So
m
e
m
o
r
ti
cian
s
d
id
n
o
t
a
d
h
er
e
to
th
e
u
s
e
o
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7
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.
E
v
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d
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n
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o
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h
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f
f
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o
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P
P
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s
,
s
u
c
h
as
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h
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m
i
c
a
l
-
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is
t
a
n
t
g
l
o
v
es
,
m
u
s
t
b
e
p
r
o
c
u
r
e
d
f
o
r
a
l
l
s
t
a
f
f
.
B
ec
au
s
e
th
e
s
tu
d
y
was
lim
ite
d
to
two
m
o
r
tu
ar
y
f
ac
ilit
ies,
its
co
n
clu
s
io
n
s
ca
n
n
o
t
b
e
ap
p
lied
to
o
th
er
Gh
an
aian
m
o
r
g
u
es.
Ho
wev
er
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th
e
r
elativ
ely
s
im
p
le
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k
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s
ess
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en
t
m
eth
o
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n
ea
s
ily
b
e
ap
p
lied
in
o
th
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r
lo
w
-
r
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ce
s
ettin
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s
.
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h
e
s
m
all
s
am
p
le
s
ize
also
li
m
its
th
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s
tu
d
y
.
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r
t
h
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m
o
r
e,
b
ec
au
s
e
t
h
e
s
tu
d
y
was
cr
o
s
s
-
s
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tio
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co
n
clu
s
io
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s
ab
o
u
t c
au
s
ality
co
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ld
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o
t b
e
d
r
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4.
CO
NCLU
SI
O
N
T
h
is
s
tu
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y
h
ig
h
lig
h
ts
cr
itical
o
cc
u
p
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al
h
ea
lth
an
d
s
af
ety
(
OHS)
g
ap
s
am
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g
m
o
r
tu
a
r
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wo
r
k
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s
in
lo
w
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o
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k
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s
u
ch
as
ch
em
ical
e
x
p
o
s
u
r
e,
m
u
s
cu
lo
s
k
eleta
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in
ju
r
ies
an
d
in
ad
eq
u
ate
s
af
ety
p
r
ac
tices.
I
t
d
em
o
n
s
tr
ates
th
e
u
tili
ty
o
f
a
r
elativ
el
y
s
im
p
le
b
u
t
e
f
f
ec
tiv
e
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is
k
a
s
s
es
s
m
en
t
to
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l
f
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id
en
tify
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g
a
n
d
p
r
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o
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itizin
g
o
cc
u
p
atio
n
al
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is
k
s
in
a
r
eso
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r
ce
-
co
n
s
t
r
ain
ed
en
v
ir
o
n
m
e
n
t.
B
u
t
th
e
f
in
d
in
g
s
u
n
d
er
s
co
r
e
a
b
r
o
a
d
er
,
s
y
s
tem
ic
ch
allen
g
e:
a
lack
o
f
in
s
titu
tio
n
alize
d
s
af
ety
tr
ain
in
g
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p
o
lic
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en
f
o
r
ce
m
e
n
t
an
d
in
f
r
astru
ctu
r
e
in
v
estme
n
t
th
at
p
er
p
etu
ate
u
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s
af
e
wo
r
k
in
g
c
o
n
d
itio
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s
in
th
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b
er
ea
v
e
m
en
t
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ec
to
r
.
I
n
ad
d
itio
n
to
ad
d
r
ess
in
g
th
e
im
m
e
d
iate
s
af
ety
is
s
u
es,
th
is
s
tu
d
y
h
ig
h
lig
h
ts
th
e
n
ee
d
f
o
r
a
p
ar
ad
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s
h
if
t
in
th
e
ap
p
r
o
ac
h
t
o
OHS
in
th
e
m
o
r
tu
ar
y
p
r
o
f
es
s
io
n
.
R
eg
u
lato
r
y
b
o
d
ies
s
h
o
u
ld
p
r
io
r
itize
th
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d
e
v
elo
p
m
e
n
t
o
f
s
tan
d
ar
d
ize
d
tr
ain
in
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p
r
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am
s
,
s
u
ch
as
th
o
s
e
f
o
cu
s
ed
o
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th
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u
s
e
o
f
PP
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an
d
p
r
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p
er
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is
in
f
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tio
n
p
r
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to
co
ls
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d
m
an
d
ate
co
n
tin
u
in
g
p
r
o
f
ess
io
n
al
d
ev
el
o
p
m
en
t.
I
n
ad
d
itio
n
,
lo
w
v
a
cc
in
atio
n
u
p
tak
e
an
d
u
n
d
e
r
r
e
p
o
r
tin
g
o
f
in
ju
r
ies
r
ef
lect
s
y
s
tem
ic
d
ef
icien
cies
in
wo
r
k
p
lace
h
ea
lth
m
a
n
ag
em
en
t,
r
eq
u
i
r
in
g
s
tr
o
n
g
er
in
s
titu
t
i
o
n
al
ac
co
u
n
tab
ilit
y
an
d
wo
r
k
er
s
u
p
p
o
r
t.
T
h
e
im
p
li
ca
tio
n
s
g
o
b
ey
o
n
d
f
u
n
er
al
h
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Gh
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Similar
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leav
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p
p
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le
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y
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cr
ea
s
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tio
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ter
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o
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am
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o
cial
d
im
en
s
io
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s
o
f
t
h
e
p
r
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io
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–
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u
ch
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tr
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,
tr
au
m
a
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an
d
c
o
p
in
g
m
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h
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m
s
–
ca
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f
f
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m
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taf
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Un
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s
p
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Sch
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Me
d
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s
Mo
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f
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u
p
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F
UNDING
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s
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DATA AV
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1549
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Evaluation Warning : The document was created with Spire.PDF for Python.