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r
in
g
th
e
C
OVI
D
p
er
io
d
in
M
o
r
o
cc
o
s
h
o
wed
th
at
th
e
in
cid
en
ce
o
f
m
en
in
g
itis
was 6
tim
es h
ig
h
er
d
u
r
in
g
co
n
f
i
n
em
en
t in
th
e
s
tu
d
y
ar
ea
[
1
2
].
I
n
Mo
r
o
cc
o
,
b
ac
te
r
ial
m
en
i
n
g
itis
h
as
alwa
y
s
b
ee
n
a
p
u
b
lic
h
ea
lth
p
r
o
b
lem
,
with
m
en
i
n
g
o
co
cc
al
m
en
in
g
itis
in
th
e
f
i
r
s
t
p
lace
.
Sin
ce
1
9
6
7
,
it
h
as b
ee
n
a
n
o
tifi
ab
le
d
is
ea
s
e
[
1
3
]
.
Pu
r
u
le
n
t m
e
n
in
g
itis
is
th
e
ca
u
s
e
o
f
a
wo
r
r
y
in
g
an
n
u
al
m
o
r
tality
r
ate,
esp
ec
ially
in
y
o
u
n
g
c
h
ild
r
en
,
as
in
2
0
2
0
,
th
e
ca
s
e
-
f
atality
r
ate
f
o
r
all
f
o
r
m
s
o
f
m
en
in
g
itis
(
MT
FC
)
will b
e
1
1
.
2
% [
1
0
]
.
I
n
ad
d
itio
n
,
p
u
r
u
len
t
m
e
n
in
g
itis
i
s
m
o
r
e
co
m
m
o
n
in
d
ev
elo
p
in
g
co
u
n
tr
ies
with
a
h
ig
h
er
r
is
k
o
f
m
o
r
tality
co
m
p
ar
e
d
to
d
ev
elo
p
ed
co
u
n
t
r
ies
[
8
]
an
d
[
14
]
.
A
m
o
n
g
th
e
m
o
s
t
im
p
o
r
tan
t
r
is
k
f
ac
to
r
s
lead
in
g
to
in
v
asiv
e
m
en
in
g
o
co
cc
al
d
is
ea
s
e
ar
e
liv
in
g
in
o
v
er
c
r
o
wd
ed
en
v
ir
o
n
m
en
ts
,
lo
w
s
o
cio
-
ec
o
n
o
m
ic
s
tatu
s
,
v
ir
al
r
esp
ir
ato
r
y
i
n
f
ec
tio
n
s
,
a
n
d
a
p
ar
ticu
lar
clim
atic
c
o
n
tex
t
(
d
r
y
s
ea
s
o
n
,
s
an
d
s
to
r
m
s
)
[
1
5
]
-
[
1
7
]
.
E
f
f
ec
tiv
el
y
co
m
b
atin
g
m
en
in
g
itis
r
eq
u
ir
e
s
a
co
m
p
r
eh
e
n
s
iv
e
u
n
d
er
s
tan
d
in
g
o
f
th
e
d
is
ea
s
e,
as
in
co
m
p
lete
k
n
o
wled
g
e
s
ig
n
if
ican
tly
co
n
tr
ib
u
tes
to
its
m
o
r
tality
an
d
m
o
r
b
id
ity
r
a
tes
[
5
]
,
[
1
8
]
.
A
d
d
itio
n
ally
,
p
ar
en
ts
'
in
ad
eq
u
ate
u
n
d
er
s
tan
d
i
n
g
o
f
th
e
d
is
ea
s
e
ca
n
jeo
p
ar
d
ize
th
eir
ch
ild
'
s
life
an
d
e
x
ac
er
b
ate
th
e
b
u
r
d
e
n
o
f
th
is
in
f
ec
tio
n
o
n
b
o
th
th
e
f
am
ily
an
d
s
o
ciety
.
L
im
ited
r
esear
ch
h
as
ex
p
l
o
r
e
d
th
e
p
o
p
u
latio
n
s
’
b
elief
s
a
n
d
p
er
ce
p
tio
n
s
ab
o
u
t
th
e
d
is
ea
s
e
.
A
ca
s
e
-
co
n
tr
o
l
s
tu
d
y
i
n
Gh
an
a
ass
ess
ed
awa
r
en
ess
o
f
m
en
in
g
itis
s
y
m
p
to
m
s
,
h
ea
lth
-
s
ee
k
in
g
b
eh
a
v
io
r
s
,
an
d
tr
ea
tm
en
t
k
n
o
wled
g
e
[
1
9
]
.
Similar
ly
,
Mu
eller
et
a
l.
[
2
0
]
co
n
d
u
cte
d
a
q
u
an
titativ
e
s
tu
d
y
in
B
o
b
o
-
Dio
u
lass
o
,
B
u
r
k
in
a
Fas
o
,
ex
am
in
in
g
k
n
o
wled
g
e
,
b
elie
f
s
,
an
d
p
r
e
v
en
tiv
e
p
r
ac
ti
ce
s
r
elate
d
to
m
en
in
g
itis
am
o
n
g
y
o
u
n
g
ad
u
lts
.
A
q
u
alitativ
e
s
tu
d
y
in
Kete
-
Kr
ac
h
i,
Gh
an
a,
u
s
in
g
t
h
e
h
ea
l
th
b
elief
m
o
d
el
(
HB
M)
,
e
x
p
lo
r
ed
p
ar
ticip
an
ts
'
p
er
ce
p
tio
n
s
a
n
d
ac
tio
n
s
with
in
th
eir
s
p
ec
if
ic
co
n
te
x
t
[
2
1
]
.
B
u
ild
in
g
o
n
Mu
eller
'
s
r
esear
ch
,
th
is
s
tu
d
y
u
n
iq
u
ely
f
o
cu
s
es
o
n
p
ar
e
n
ts
an
d
is
co
n
d
u
cted
o
u
ts
id
e
th
e
m
en
i
n
g
itis
b
elt,
ad
d
r
ess
in
g
cr
itical
g
ap
s
in
th
e
liter
atu
r
e.
T
h
is
f
o
cu
s
is
p
ar
ticu
lar
ly
r
elev
a
n
t
g
iv
en
th
e
p
o
ten
tial
ex
p
a
n
s
io
n
o
f
th
e
Af
r
ican
m
en
in
g
itis
b
el
t
in
to
n
ew
r
eg
io
n
s
,
pr
o
m
p
tin
g
th
e
n
ee
d
f
o
r
r
e
v
is
ed
h
ea
lth
p
o
licies to
s
tr
en
g
th
en
p
r
ev
en
tio
n
an
d
tr
ea
tm
en
t e
f
f
o
r
ts
[
2
2
]
.
A
th
o
r
o
u
g
h
u
n
d
er
s
tan
d
in
g
o
f
th
e
co
m
m
u
n
ity
'
s
k
n
o
wled
g
e
ab
o
u
t
t
h
e
d
is
ea
s
e
ca
n
h
elp
h
ea
lth
ca
r
e
p
r
o
v
id
e
r
s
tar
g
et
in
ter
v
en
ti
o
n
s
m
o
r
e
ef
f
ec
tiv
ely
an
d
ad
d
r
ess
th
e
in
f
lu
en
ce
o
f
b
elief
s
o
n
h
ea
lth
-
s
ee
k
in
g
b
eh
av
io
r
s
[
2
3
]
,
[
2
4
]
.
T
h
is
r
e
s
ea
r
ch
aim
s
to
b
r
i
d
g
e
g
a
p
s
in
th
e
Mo
r
o
cc
an
p
o
p
u
latio
n
’
s
u
n
d
e
r
s
tan
d
in
g
o
f
b
ac
ter
ial
m
en
in
g
itis
an
d
d
e
v
e
lo
p
h
ea
lth
p
lan
s
tailo
r
e
d
to
c
o
m
m
u
n
ity
n
ee
d
s
.
T
h
ese
ef
f
o
r
ts
ar
e
ex
p
ec
ted
to
r
ed
u
ce
m
o
r
ta
lity
an
d
s
eq
u
ela
e
in
ch
ild
r
e
n
,
u
ltima
tely
im
p
r
o
v
in
g
th
eir
q
u
ality
o
f
life
.
Alth
o
u
g
h
o
f
f
icial
g
u
id
elin
es
f
o
r
d
ia
g
n
o
s
in
g
an
d
tr
ea
tin
g
m
en
in
g
itis
in
ch
il
d
r
en
a
n
d
ad
u
lts
ex
is
t,
th
e
r
e
is
n
o
d
ata
o
n
th
e
Mo
r
o
cc
an
p
o
p
u
latio
n
'
s
p
er
ce
p
tio
n
s
an
d
b
elief
s
ab
o
u
t
th
is
d
is
ea
s
e.
T
h
er
ef
o
r
e,
th
e
o
b
jectiv
e
o
f
th
is
s
tu
d
y
is
to
ev
alu
ate
th
e
p
er
ce
p
tio
n
s
an
d
k
n
o
wled
g
e
o
f
th
e
p
o
p
u
la
tio
n
co
n
s
u
ltin
g
h
ea
lth
s
er
v
i
ce
s
ab
o
u
t
b
ac
ter
ial
m
en
in
g
itis
in
Mo
r
o
cc
o
.
2.
M
E
T
H
O
D
2
.
1
.
Study
f
r
a
m
ewo
r
k
T
h
e
s
t
u
d
y
w
as
c
ar
r
i
e
d
o
u
t
in
t
h
e
Ma
r
r
ak
ec
h
-
Sa
f
i
r
e
g
i
o
n
,
wh
i
ch
is
o
n
e
o
f
M
o
r
o
cc
o
'
s
1
2
a
d
m
i
n
is
t
r
at
iv
e
r
e
g
i
o
n
s
i
n
ce
n
t
r
a
l
-
west
er
n
M
o
r
o
cc
o
.
T
h
e
r
e
g
i
o
n
c
o
v
e
r
s
a
n
ar
ea
o
f
4
4
,
3
0
1
k
m
²
an
d
h
as
a
p
o
p
u
la
ti
o
n
o
f
4
,
5
2
0
,
5
6
9
ac
co
r
d
i
n
g
t
o
t
h
e
l
atest
p
o
p
u
lat
io
n
c
e
n
s
u
s
in
2
0
1
4
[
2
5
]
.
T
h
e
s
tu
d
y
was
c
h
o
s
e
n
b
e
ca
u
s
e
o
f
its
o
r
ig
in
ali
ty
,
as
it
h
as
n
ev
er
b
e
e
n
ca
r
r
ie
d
o
u
t
i
n
M
o
r
o
c
c
o
,
p
a
r
ti
cu
l
a
r
l
y
i
n
t
h
e
Ma
r
r
a
k
e
c
h
-
S
af
i
r
eg
i
o
n
.
2
.
2
.
Study
des
ig
n
T
h
e
p
r
esen
t stu
d
y
is
a
q
u
an
titativ
e
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
th
at
was c
ar
r
ied
o
u
t in
h
ea
lth
f
ac
ili
ties
in
th
e
Ma
r
r
ak
ec
h
-
Saf
i
r
eg
io
n
,
p
ar
ti
cu
lar
ly
in
r
u
r
al
h
ea
lth
ce
n
te
r
s
,
co
m
m
u
n
al
h
ea
lth
ce
n
ter
s
,
an
d
th
e
p
ed
iatr
ic
em
er
g
en
cy
d
e
p
ar
tm
en
t
o
f
th
e
Mo
h
am
e
d
VI
Un
iv
er
s
ity
H
o
s
p
ital,
b
etwe
en
Ma
y
2
0
2
2
an
d
J
an
u
ar
y
2
0
2
3
,
to
d
eter
m
in
e
an
d
ev
al
u
ate
th
e
k
n
o
wled
g
e
an
d
p
er
ce
p
tio
n
s
o
f
th
e
p
o
p
u
latio
n
,
an
d
m
o
r
e
s
p
e
cif
ically
p
ar
en
ts
,
in
th
is
r
eg
io
n
ab
o
u
t b
ac
ter
ial
m
e
n
in
g
itis
.
2
.
3
.
P
o
pu
la
t
io
n a
nd
inclu
s
io
n c
rit
er
ia
Par
ticip
an
ts
wer
e
r
ec
r
u
ited
u
s
i
n
g
co
n
v
en
ie
n
ce
s
am
p
lin
g
,
wh
i
ch
is
m
o
s
t
s
u
itab
le
f
o
r
s
tu
d
y
in
g
p
eo
p
le'
s
p
er
ce
p
tio
n
s
a
n
d
attitu
d
es
[
2
6
]
at
d
if
f
er
en
t
h
ea
lth
estab
lis
h
m
en
ts
in
th
e
Ma
r
r
a
k
ec
h
-
Saf
i
r
e
g
io
n
.
Ho
wev
er
,
th
e
ch
o
ice
o
f
p
o
p
u
latio
n
was
f
o
c
u
s
ed
o
n
p
ar
en
ts
,
g
iv
e
n
th
e
h
i
g
h
r
is
k
o
f
m
o
r
tality
a
n
d
m
o
r
b
id
ity
f
o
r
ch
ild
r
e
n
,
esp
ec
ially
y
o
u
n
g
ch
ild
r
e
n
,
d
u
e
t
o
b
ac
ter
ial
m
en
in
g
itis
.
T
h
is
s
tu
d
y
in
clu
d
ed
all
p
ar
en
ts
wh
o
v
is
ited
to
co
n
s
u
lt,
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
:
1
2
1
0
-
1
2
2
0
1212
r
ec
eiv
e
ca
r
e,
o
r
a
d
m
in
is
ter
a
v
ac
cin
e
to
th
ei
r
ch
ild
an
d
w
h
o
v
o
lu
n
tar
ily
a
g
r
ee
d
t
o
p
ar
tic
ip
ate.
C
o
n
v
er
s
ely
,
p
ar
en
ts
wh
o
d
ec
li
n
ed
to
ta
k
e
p
ar
t in
th
e
s
tu
d
y
wer
e
ex
clu
d
ed
.
2
.
4
.
Sa
m
pli
ng
a
nd
da
t
a
co
lle
ct
io
n
T
h
e
d
ata
co
llectio
n
to
o
l
was
a
q
u
esti
o
n
n
air
e
with
2
s
ec
tio
n
s
:
i
)
ch
ar
ac
ter
is
tics
o
f
th
e
p
o
p
u
l
atio
n
,
an
d
ii
)
k
n
o
wled
g
e
ab
o
u
t
m
en
in
g
itis
in
g
en
er
al,
its
clin
ical
s
ig
n
s
,
an
d
its
r
is
k
f
ac
to
r
s
.
T
h
is
to
o
l
was
in
s
p
ir
ed
b
y
a
v
alid
ate
d
q
u
esti
o
n
n
air
e
o
n
k
n
o
wled
g
e
an
d
b
elief
s
ab
o
u
t
b
a
c
ter
ial
m
en
in
g
itis
in
Af
r
ica
[
2
0
]
an
d
ad
a
p
ted
to
th
e
Mo
r
o
cc
an
co
n
tex
t.
T
h
is
q
u
esti
o
n
n
air
e
was
d
e
v
elo
p
e
d
in
F
r
en
ch
a
n
d
t
h
en
tr
a
n
s
lated
in
t
o
Ar
ab
ic
a
n
d
was
test
ed
with
2
0
p
e
o
p
le.
Ho
wev
er
,
th
e
r
eliab
ilit
y
o
f
th
e
q
u
esti
o
n
n
air
e
was
v
er
if
ied
u
s
in
g
C
r
o
n
b
ac
h
'
s
Alp
h
a
test
,
wh
ich
is
o
f
th
e
o
r
d
er
o
f
7
2
%.
T
h
e
q
u
esti
o
n
n
air
e
was
ad
m
in
is
ter
ed
with
th
e
ass
is
tan
ce
o
f
an
illi
ter
ate
p
er
s
o
n
in
th
e
s
tu
d
y
ar
ea
.
A
g
r
o
u
p
o
f
h
ea
lth
p
r
o
f
ess
io
n
als wo
r
k
in
g
i
n
th
ese
estab
lis
h
m
en
ts
was
ab
le
to
co
llect
th
e
d
ata.
Sam
p
lin
g
:
T
h
e
to
tal
s
am
p
le
s
i
ze
was c
alcu
lated
u
s
in
g
C
o
h
en
’
s
D
f
o
r
m
u
la
:
=
(
2
×
(
1
−
)
)
2
(
1
)
wh
er
e
n
=
r
eq
u
ir
ed
s
am
p
le
s
ize
,
t
=
9
5
%
co
n
f
id
en
ce
lev
el
(
s
tan
d
ar
d
v
alu
e
1
.
9
6
)
,
p
=
est
im
ated
p
r
ev
alen
ce
,
m
=
5
%
m
ar
g
in
o
f
er
r
o
r
(
s
tan
d
ar
d
v
al
u
e
0
.
0
5
)
.
T
h
e
r
ec
o
m
m
en
d
ed
s
am
p
le
s
ize
is
th
er
ef
o
r
e
ab
o
u
t
3
8
4
.
I
t
is
im
p
o
r
tan
t
t
o
n
o
te
th
at
d
u
r
i
n
g
d
ata
p
r
o
ce
s
s
in
g
,
we
elim
in
ate
d
in
co
m
p
lete
q
u
esti
o
n
n
air
es,
wh
ich
r
ed
u
ce
d
o
u
r
s
am
p
le
to
2
9
5
.
2
.
5
.
St
a
t
is
t
ica
l pro
ce
s
s
ing
a
nd
a
na
ly
s
is
T
h
e
d
ata
co
llected
wer
e
e
n
ter
ed
an
d
o
r
g
a
n
ized
in
an
E
x
c
el
f
ile.
T
h
ey
wer
e
th
e
n
an
al
y
ze
d
u
s
in
g
d
escr
ip
tiv
e
s
tatis
tics
,
u
s
in
g
f
r
eq
u
en
c
y
,
m
ea
n
,
a
n
d
s
tan
d
a
r
d
d
ev
iatio
n
to
d
eter
m
in
e
th
e
p
er
ce
p
tio
n
s
an
d
ch
ar
ac
ter
is
tics
o
f
th
e
p
o
p
u
lati
o
n
.
O
n
th
e
o
t
h
er
h
a
n
d
,
a
b
iv
a
r
iate
an
aly
s
is
an
d
an
o
r
d
in
al
r
e
g
r
ess
io
n
wer
e
u
s
ed
to
ass
es
s
th
e
p
ar
ticip
an
t's
le
v
el
o
f
k
n
o
wled
g
e.
T
o
d
eter
m
in
e
th
e
lev
el
o
f
k
n
o
wled
g
e,
we
o
p
ted
f
o
r
th
e
f
o
llo
win
g
m
eth
o
d
to
ad
ap
t it
t
o
th
e
L
ik
er
t scale
:
-
C
alcu
late
th
e
av
er
ag
e
(
A)
a
n
d
th
e
s
tan
d
ar
d
d
ev
iatio
n
(
SD)
o
f
th
e
s
co
r
es o
b
tain
ed
-
C
alcu
late
A
-
SD a
n
d
A+
SD
-
Ass
ig
n
ea
ch
p
ar
ticip
an
t th
e
a
p
p
r
o
p
r
iate
le
v
el
(
lo
w,
m
e
d
iu
m
,
o
r
g
o
o
d
)
,
d
ep
e
n
d
in
g
o
n
:
-
Sco
r
e
<A
-
SD
-
-
-
-
-
-
>
lo
w
k
n
o
wled
g
e
-
A
-
SD Sco
r
e
A+
SD
------
>
a
v
e
r
ag
e
k
n
o
wled
g
e
-
Sco
r
e
>
A+
SD
-----
>
g
o
o
d
k
n
o
wled
g
e
T
h
u
s
,
th
e
r
esp
o
n
s
e
v
ar
iab
le
i
n
th
is
s
tu
d
y
was
k
n
o
wled
g
e
o
f
m
en
in
g
itis
in
p
ar
ticip
an
ts
.
T
o
ass
es
s
k
n
o
wled
g
e,
1
0
q
u
esti
o
n
s
wer
e
u
s
ed
in
wh
ich
a
co
r
r
e
ct
an
s
wer
r
ec
eiv
ed
a
s
co
r
e
f
r
o
m
an
in
co
r
r
ec
t
an
s
wer
r
ec
eiv
ed
a
s
co
r
e
o
f
ze
r
o
.
T
h
e
s
co
r
es
wer
e
s
u
m
m
ed
to
g
iv
e
a
to
tal
s
co
r
e.
T
h
e
h
ig
h
est
s
co
r
es
in
d
icate
b
etter
k
n
o
wled
g
e.
I
n
a
d
d
itio
n
,
t
h
e
SP
SS
s
tatis
t
ical
to
o
l
(
V
er
s
io
n
1
8
)
was
u
s
ed
to
s
tu
d
y
th
e
ass
o
ciatio
n
b
etwe
en
th
e
lev
el
o
f
k
n
o
wled
g
e
a
n
d
t
h
e
v
a
r
io
u
s
f
ac
to
r
s
i
n
th
e
s
tu
d
y
.
A
p
-
v
alu
e
was
ca
lcu
lated
wit
h
a
s
ig
n
if
ican
ce
lev
el
o
f
p
=
0
.
0
5
.
2
.
6
.
E
t
hica
l c
o
ns
idera
t
io
ns
T
h
r
o
u
g
h
o
u
t
th
e
s
tu
d
y
p
er
io
d
,
eth
ical
v
alu
es
wer
e
r
esp
ec
ted
,
m
ain
ly
in
f
o
r
m
ed
co
n
s
en
t
an
d
r
esp
ec
t
f
o
r
an
o
n
y
m
ity
.
Similar
ly
,
th
e
s
tu
d
y
was
co
n
d
u
cted
af
ter
o
b
tai
n
in
g
a
u
th
o
r
izatio
n
f
r
o
m
lo
ca
l
an
d
r
eg
io
n
al
h
ea
lth
s
er
v
ices.
T
h
e
s
tu
d
y
was c
o
n
d
u
cted
f
o
llo
win
g
t
h
e
Helsin
k
i D
ec
lar
atio
n
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
W
HO,
to
g
eth
er
with
its
p
ar
tn
er
s
ar
o
u
n
d
t
h
e
wo
r
ld
,
h
as
d
ev
el
o
p
ed
a
r
o
ad
m
ap
t
o
d
ef
ea
t
m
en
in
g
itis
b
y
2
0
3
0
,
b
ased
o
n
f
iv
e
p
illar
s
:
ep
id
em
ic
p
r
e
v
en
tio
n
an
d
co
n
tr
o
l;
d
iag
n
o
s
is
an
d
tr
ea
tm
en
t;
d
is
ea
s
e
s
u
r
v
eillan
ce
;
s
u
p
p
o
r
t
a
n
d
ca
r
e
f
o
r
p
eo
p
le
af
f
ec
ted
b
y
m
en
i
n
g
itis
,
an
d
f
in
ally
,
awa
r
en
ess
an
d
d
ialo
g
u
e.
T
h
u
s
,
th
is
s
tu
d
y
alig
n
s
with
th
e
W
HO
g
o
als r
elate
d
to
th
e
f
if
t
h
p
illar
[
2
7
]
.
3
.
1
.
So
c
io
-
dem
o
g
ra
ph
ic
cha
ra
ct
er
is
t
ics o
f
pa
rt
icipa
nts
A
to
tal
o
f
2
9
5
in
d
iv
id
u
als
p
ar
ticip
ated
in
th
e
s
tu
d
y
,
with
an
av
er
ag
e
ag
e
o
f
3
6
.
8
±
1
6
.
2
y
ea
r
s
.
T
h
e
s
o
cio
d
em
o
g
r
ap
h
ic
ch
ar
ac
ter
is
t
ics
o
f
th
e
p
a
r
ticip
an
ts
ar
e
d
eta
iled
in
T
ab
le
1
.
T
h
e
f
in
d
in
g
s
i
n
d
icate
d
a
n
o
tab
le
p
r
ed
o
m
i
n
an
ce
o
f
f
em
ales,
co
m
p
r
is
in
g
6
4
.
4
%
o
f
th
e
s
am
p
l
e.
Nea
r
ly
h
alf
(
4
7
.
5
%)
o
f
th
e
r
esp
o
n
d
en
ts
wer
e
m
ar
r
ied
,
wh
ile
o
n
ly
1
.
7
%
wer
e
s
in
g
le
m
o
th
er
s
.
Sin
g
le
-
p
ar
en
t
f
am
ilies
wer
e
m
o
r
e
co
m
m
o
n
(
5
2
.
5
%)
co
m
p
ar
e
d
to
n
u
clea
r
f
am
ilies
(
4
7
.
5
%).
T
h
e
p
r
ed
o
m
in
an
ce
o
f
wo
m
en
(
6
4
.
4
%)
h
i
g
h
lig
h
ts
th
e
s
ig
n
if
i
ca
n
t
r
esp
o
n
s
ib
ilit
ies
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
B
a
cteria
l m
en
in
g
itis
kn
o
w
led
g
e,
a
ttit
u
d
e
,
a
n
d
p
r
a
ctice
s
tu
d
y
a
mo
n
g
p
a
r
en
ts
:
…
(
S
i
h
a
m
Jb
a
r
i
)
1213
th
ey
b
ea
r
,
p
ar
ticu
lar
ly
in
c
h
ild
-
r
ea
r
in
g
.
E
co
n
o
m
ic
s
tab
ilit
y
an
d
p
a
r
tn
er
s
h
ip
ar
e
cr
u
cia
l
f
o
r
b
etter
h
ea
lth
o
u
tco
m
es,
b
u
t
s
in
g
le
m
o
th
er
h
o
o
d
,
esp
ec
ially
am
o
n
g
wo
m
e
n
,
o
f
ten
e
x
ac
er
b
ates
in
eq
u
aliti
es
[
2
8
]
-
[
3
0
]
.
T
h
ese
m
o
th
er
s
f
ac
e
th
e
d
u
al
ch
alle
n
g
e
o
f
r
aisi
n
g
a
c
h
ild
alo
n
e
an
d
m
an
ag
in
g
all
asp
ec
ts
o
f
ch
ild
c
ar
e
[
3
1
]
,
[
3
2
]
.
Fu
r
th
er
m
o
r
e
,
th
e
m
o
s
t
r
ep
r
ese
n
ted
ag
e
g
r
o
u
p
is
2
1
to
3
0
y
e
ar
s
with
a
p
er
ce
n
tag
e
o
f
3
1
.
5
%
an
d
th
e
least
r
ep
r
esen
ted
is
4
1
t
o
5
1
y
ea
r
s
with
a
p
er
ce
n
tag
e
o
f
1
1
.
9
%.
I
n
ter
m
s
o
f
t
h
e
s
tu
d
y
p
o
p
u
latio
n
,
th
e
r
esu
lts
s
h
o
w
th
at
h
ig
h
er
ed
u
ca
tio
n
is
th
e
m
o
s
t
d
o
m
in
an
t,
with
a
r
a
te
o
f
3
9
.
7
%,
wh
ile
p
r
im
ar
y
e
d
u
ca
tio
n
is
th
e
least
r
ep
r
esen
ted
,
with
a
r
ate
o
f
1
4
.
9
%.
T
h
er
e
is
a
s
ig
n
if
ican
t
illi
t
er
ac
y
r
ate
o
f
2
0
%
in
o
u
r
s
tu
d
y
.
I
n
ter
m
s
o
f
liv
in
g
co
n
d
itio
n
s
,
o
v
er
h
alf
(
6
4
.
1
%)
wer
e
o
f
u
r
b
an
o
r
ig
i
n
,
an
d
8
2
.
4
%
r
esid
ed
in
s
tr
u
ctu
r
e
d
h
o
u
s
in
g
.
T
h
e
m
ajo
r
ity
o
f
r
esp
o
n
d
en
ts
wer
e
h
o
u
s
ewiv
es
(
3
1
.
9
%),
wh
ile
o
n
l
y
3
%
wer
e
r
etir
ed
as
s
h
o
wn
in
T
ab
le
1
.
T
h
is
u
r
b
a
n
p
r
ed
o
m
i
n
an
ce
c
o
n
t
r
asts
with
d
ata
f
r
o
m
th
e
Hig
h
C
o
m
m
is
s
io
n
f
o
r
Plan
n
in
g
in
2
0
2
0
,
wh
i
ch
r
ep
o
r
ted
th
at
th
e
Ma
r
r
ak
ec
h
-
Saf
i
r
eg
io
n
is
p
r
ed
o
m
in
an
tly
r
u
r
al,
with
5
7
%
o
f
th
e
p
o
p
u
latio
n
liv
in
g
in
r
u
r
al
ar
ea
s
co
m
p
a
r
ed
t
o
4
3
%
in
u
r
b
an
ar
ea
s
[
2
5
]
.
T
h
e
p
r
o
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Hau
t
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Plan
also
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r
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eg
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es
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ed
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ca
r
e
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2
5
]
.
I
n
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esear
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Ho
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wh
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ly
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th
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h
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n
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m
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s
tatu
s
[
1
6
]
,
[
3
3
]
.
T
ab
le
1
.
C
h
ar
ac
ter
is
tics
o
f
p
ar
ticip
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ts
V
a
r
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a
b
l
e
N
%
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e
(
M
o
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n
±
ET)
36
.
8
±
16
.
2
G
e
n
d
e
r
F
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mal
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1
9
0
6
4
.
4
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a
l
e
1
0
5
3
5
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6
A
g
e
r
a
n
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<
2
0
y
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r
s
42
1
4
.
2
21
-
30
y
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r
s
93
3
1
.
5
31
-
40
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r
s
60
2
0
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41
-
51
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r
s
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1
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>
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r
s
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2
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0
Le
v
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r
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mary
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d
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3
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2
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ple's
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ity
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m
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attr
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t
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Mo
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h
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Ar
ab
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s
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ial
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ly
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d
4
3
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,
r
esp
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.
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s
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icate
s
th
at
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M
o
r
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cc
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p
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p
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latio
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s
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ically
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6
8
.
8
%
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s
e
th
e
ter
m
s
"Sk
h
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n
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lk
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)
,
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em
"
(
co
n
tr
ac
te
d
b
y
th
e
win
d
)
(
1
6
.
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%),
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h
o
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k
tay
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h
"
(
s
tiff
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k
)
(
6
.
8
%).
W
e
ca
n
th
er
ef
o
r
e
p
r
o
p
o
s
e
th
at
th
is
d
i
f
f
er
en
ce
in
n
am
in
g
s
tem
s
f
r
o
m
th
e
clin
ic
al
s
y
m
p
to
m
s
o
f
p
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r
u
le
n
t
m
en
i
n
g
itis
ch
ar
ac
ter
ized
b
y
th
e
tr
iad
(
m
en
in
g
itis
an
d
s
tiff
n
ec
k
)
[
3
4
]
.
Fo
r
C
HE
M
th
is
asp
ec
t
tak
es
its
s
o
u
r
ce
f
r
o
m
th
e
en
v
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m
en
t
o
r
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
2
5
2
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8
8
0
6
I
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t J Pu
b
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Hea
lth
Sci
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Vo
l.
14
,
No
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3
,
Sep
tem
b
er
20
25
:
1
2
1
0
-
1
2
2
0
1214
th
e
in
cid
en
ce
o
f
b
ac
ter
ial
m
en
in
g
itis
wh
ich
is
th
e
h
ig
h
est
d
u
r
in
g
th
e
d
r
y
s
ea
s
o
n
wh
en
t
h
er
e
is
n
aso
p
h
ar
y
n
x
ir
r
itatio
n
[
3
5
]
,
[
3
6
]
.
T
h
is
c
o
in
cid
es
with
B
o
u
m
a
’
s
r
em
ar
k
s
in
2
0
1
2
,
wh
ich
s
tates
th
at
th
e
p
o
p
u
lar
ap
p
o
in
tm
e
n
ts
o
f
b
ac
ter
ial
m
e
n
in
g
itis
o
r
ig
in
ate
f
r
o
m
s
ev
e
r
a
l
s
o
cial
in
ter
p
r
etatio
n
s
r
elate
d
to
th
e
etio
lo
g
ies
o
f
m
en
in
g
itis
[
3
7
]
.
Mu
eller
et
al
ad
d
th
at
in
ter
m
s
o
f
s
o
cial
r
ep
r
esen
tatio
n
s
,
th
e
ter
m
Al
Ho
n
k
T
ay
ih
(
s
tiff
n
ec
k
)
is
attr
ib
u
ted
s
p
ec
if
ically
to
p
n
eu
m
o
c
o
cc
al
an
d
m
e
n
in
g
o
co
cc
al
m
en
in
g
itis
[
2
0
]
.
9
0
.
5
%
wer
e
awa
r
e
o
f
th
e
s
er
io
u
s
n
ess
o
f
p
u
r
u
len
t
m
e
n
i
n
g
itis
an
d
8
7
.
5
%.
I
d
en
tifie
d
it
as
an
ac
u
te
illn
ess
.
Als
o
,
in
an
o
th
er
s
tu
d
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d
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cte
d
in
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taly
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d
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ad
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o
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t
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ar
en
ts
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e
awa
r
e
o
f
th
e
r
is
k
o
f
m
en
in
g
itis
as
a
co
n
tag
io
u
s
in
f
ec
tio
n
,
esp
ec
ially
f
o
r
th
eir
c
h
ild
r
en
[
3
8
]
,
[
3
9
]
.
Fo
r
k
n
o
wled
g
e
o
f
t
h
e
s
y
m
p
to
m
ato
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o
s
t
h
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v
e
s
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r
ea
d
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r
r
ec
tly
.
T
h
is
is
d
u
e
f
ir
s
tly
to
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n
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s
n
ess
an
d
its
h
ig
h
r
is
k
o
f
m
o
r
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id
ity
m
o
r
tality
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e
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s
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o
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ch
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en
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1
8
it
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e
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0
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lead
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s
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ch
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r
en
u
n
d
er
5
y
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r
s
o
ld
[
8
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,
[
4
0
]
.
Fo
r
th
is
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ea
s
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n
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it is
cr
u
cial
th
at
p
ar
e
n
ts
ar
e
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in
f
o
r
m
ed
ab
o
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t th
is
in
f
ec
tio
n
.
Ou
r
r
es
u
lts
s
h
o
w
th
at
m
o
r
e
t
h
a
n
h
a
lf
1
6
4
(
5
5
.
6
%
)
b
e
lie
v
e
b
a
ct
er
i
al
m
e
n
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n
g
it
is
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an
b
e
co
n
t
r
a
cte
d
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y
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h
e
r
e
,
w
h
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le
2
0
3
p
ar
tic
ip
a
n
ts
(
6
8
.
8
%)
p
er
ce
i
v
e
t
h
e
r
is
k
t
o
b
e
s
i
m
i
la
r
i
n
b
o
th
u
r
b
a
n
an
d
r
u
r
al
a
r
e
as.
T
h
e
tw
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f
a
ct
o
r
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e
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t
o
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e
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s
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b
l
e
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o
r
th
e
r
is
k
o
f
b
a
cte
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l
m
e
n
i
n
g
it
is
ar
e
d
ir
t
an
d
s
u
n
s
h
in
e
(
4
7
.
8
%
a
n
d
4
0
%
r
es
p
ec
ti
v
el
y
)
.
I
n
a
d
d
iti
o
n
,
6
7
.
6
%
o
f
p
a
r
t
ici
p
an
ts
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d
en
t
if
ie
d
p
o
o
r
h
y
g
ie
n
e
as
a
co
n
t
r
i
b
u
ti
n
g
f
ac
to
r
.
Me
n
in
g
itis
is
a
h
u
m
a
n
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to
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h
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m
a
n
tr
an
s
m
is
s
io
n
d
is
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s
e
a
n
d
co
n
ta
m
i
n
ati
o
n
r
eq
u
i
r
es
d
i
r
e
ct
co
n
t
ac
t
[
2
]
,
[
4
1
]
,
wh
i
ch
m
a
k
es
t
h
e
s
p
a
ce
s
c
o
n
g
est
e
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ase
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At
t
h
e
l
ev
el
o
f
o
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r
s
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u
d
y
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n
ly
2
p
eo
p
l
e
(
0
.
7
%
)
i
d
e
n
t
if
i
ed
i
t a
s
a
f
ac
t
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r
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ase
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7
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ip
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te
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h
y
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a
s
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o
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s
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T
h
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i
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ates
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la
ck
o
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s
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f
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cie
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t
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ess
a
b
o
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a
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ig
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in
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e
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e
ed
f
o
r
i
n
c
r
e
ase
d
ed
u
ca
t
i
o
n
al
e
f
f
o
r
ts
.
T
ab
le
2
.
Po
p
u
lar
n
a
m
es f
o
r
m
en
in
g
itis
an
d
wh
at
p
e
o
p
le
k
n
o
w
ab
o
u
t it
Q
u
e
st
i
o
n
A
n
sw
e
r
s
N
%
P
o
p
u
l
a
r
n
a
m
e
s fo
r
me
n
i
n
g
i
t
i
s
S
k
h
a
n
a
l
k
h
a
y
i
b
a
2
0
3
6
8
.
8
C
h
e
m
48
1
6
.
3
A
l
h
o
n
k
t
a
y
i
h
(
R
a
i
d
e
u
r
d
e
l
a
n
u
q
u
e
)
20
6
.
8
I
l
t
i
h
a
b
S
a
h
a
y
a
11
3
.
7
I
d
o
n
'
t
k
n
o
w
7
2
.
4
O
t
h
e
r
6
2
.
0
D
o
y
o
u
t
h
i
n
k
me
n
i
n
g
i
t
i
s
i
s
a
ser
i
o
u
s
d
i
sea
s
e
?
Y
e
s
2
6
7
9
0
.
5
No
28
9
.
5
W
h
a
t
k
i
n
d
o
f
d
i
se
a
se
d
o
y
o
u
t
h
i
n
k
me
n
i
n
g
i
t
i
s
i
s?
A
c
u
t
e
2
5
8
8
7
.
5
C
h
r
o
n
i
c
l
e
37
1
2
.
5
I
f
y
e
s,
w
h
a
t
a
r
e
t
h
e
s
y
m
p
t
o
ms
o
f
m
e
n
i
n
g
i
t
i
s?
F
e
v
e
r
1
8
5
6
2
.
7
S
e
v
e
r
e
h
e
a
d
a
c
h
e
s
1
2
8
4
3
.
4
R
i
g
i
d
i
t
y
o
f
t
h
e
l
i
mb
s
1
2
7
4
3
.
1
V
o
mi
t
i
n
g
1
0
5
3
5
.
6
S
t
i
f
f
n
e
c
k
97
3
2
.
9
Lo
ss
o
f
a
p
p
e
t
i
t
e
90
3
0
.
5
C
y
a
n
o
si
s
2
0
.
7
D
i
a
r
r
h
e
a
2
0
.
7
F
a
t
i
g
u
e
2
0
.
7
P
h
o
t
o
p
h
o
b
i
a
1
0
.
3
W
h
e
r
e
d
o
y
o
u
t
h
i
n
k
p
e
o
p
l
e
c
o
n
t
r
a
c
t
men
i
n
g
i
t
i
s?
M
o
o
r
i
s
h
b
a
t
h
71
2
4
.
1
C
l
o
se
d
a
r
e
a
s
73
2
4
.
7
O
v
e
r
c
r
o
w
d
i
n
g
92
3
1
.
2
A
l
l
t
h
e
p
l
a
c
e
s
1
6
4
5
5
.
6
A
r
e
t
h
e
r
e
c
e
r
t
a
i
n
r
e
g
i
o
n
s
t
h
a
t
a
r
e
m
o
r
e
a
t
r
i
sk
o
f
m
e
n
i
n
g
i
t
i
s?
U
r
b
a
n
a
r
e
a
34
1
1
.
5
R
u
r
a
l
a
r
e
a
s
58
1
9
.
7
Th
e
t
w
o
2
0
3
6
8
.
8
W
h
i
c
h
o
f
t
h
e
f
o
l
l
o
w
i
n
g
d
o
y
o
u
c
o
n
s
i
d
e
r
t
o
b
e
a
d
i
r
e
c
t
f
a
c
t
o
r
i
n
m
e
n
i
n
g
i
t
i
s?
D
i
r
t
1
4
1
4
7
.
8
S
u
n
1
1
8
40
W
i
n
d
31
1
0
.
5
I
d
o
n
'
t
k
n
o
w
5
1
.
7
I
n
y
o
u
r
o
p
i
n
i
o
n
,
me
n
i
n
g
i
t
i
s
i
s
c
a
u
se
d
b
y
:
P
o
o
r
h
y
g
i
e
n
e
2
0
0
6
7
.
8
La
c
k
o
f
v
e
n
t
i
l
a
t
i
o
n
71
2
4
.
1
Ty
p
e
o
f
p
o
w
e
r
s
u
p
p
l
y
59
2
0
.
0
P
o
l
l
u
t
e
d
w
a
t
e
r
(
s
e
w
a
g
e
)
48
1
6
.
3
Ex
p
o
s
u
r
e
t
o
t
h
e
s
u
n
10
3
.
4
I
d
o
n
'
t
k
n
o
w
8
2
.
7
V
i
r
u
ses
o
r
b
a
c
t
e
r
i
a
a
n
d
mi
c
r
o
b
e
s
6
2
.
0
C
o
n
t
a
c
t
w
i
t
h
a
si
c
k
p
e
r
so
n
2
0
.
7
C
l
i
ma
t
e
c
h
a
n
g
e
2
0
.
7
D
e
n
t
i
t
i
o
n
1
0
.
3
N
o
n
-
v
a
c
c
i
n
a
t
i
o
n
1
0
.
3
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
B
a
cteria
l m
en
in
g
itis
kn
o
w
led
g
e,
a
ttit
u
d
e
,
a
n
d
p
r
a
ctice
s
tu
d
y
a
mo
n
g
p
a
r
en
ts
:
…
(
S
i
h
a
m
Jb
a
r
i
)
1215
Fu
r
th
er
m
o
r
e
,
o
n
ly
0
.
3
% o
f
r
esp
o
n
d
e
n
ts
m
en
tio
n
e
d
n
o
n
-
v
ac
c
in
atio
n
as
a
r
is
k
f
ac
to
r
,
d
esp
ite
it
b
ein
g
a
p
r
im
ar
y
an
d
ef
f
ec
tiv
e
p
r
ev
e
n
tiv
e
m
ea
s
u
r
e
ag
ai
n
s
t
b
ac
ter
ia
l
m
en
in
g
itis
[
2
3
]
.
Vac
cin
atio
n
h
as
s
ig
n
if
ican
tly
alter
ed
th
e
ep
id
em
io
lo
g
y
o
f
th
e
d
is
ea
s
e
an
d
r
ed
u
c
ed
its
in
cid
en
ce
,
u
n
d
e
r
s
co
r
in
g
th
e
im
p
o
r
tan
ce
o
f
r
aisi
n
g
awa
r
en
ess
ab
o
u
t
v
ac
cin
es
as
a
k
ey
p
r
ev
e
n
tiv
e
s
tr
ateg
y
.
Acc
o
r
d
in
g
t
o
th
e
r
esear
c
h
,
t
h
e
two
f
ac
to
r
s
m
o
s
t
im
p
licated
in
th
e
r
is
k
o
f
b
ac
t
er
ial
m
en
in
g
itis
ar
e
d
ir
t
a
n
d
s
u
n
s
h
in
e
(
4
7
.
8
%
an
d
4
0
%,
r
esp
ec
tiv
el
y
)
,
wh
ic
h
alig
n
s
with
ex
is
tin
g
li
ter
atu
r
e.
Hig
h
lev
els o
f
d
u
s
t,
s
tr
o
n
g
wi
n
d
s
,
elev
ated
tem
p
er
atu
r
es,
an
d
lo
w
h
u
m
id
ity
ca
n
d
am
ag
e
th
e
n
aso
p
h
ar
y
n
g
ea
l
m
u
co
s
a,
in
cr
ea
s
in
g
s
u
s
ce
p
tib
ilit
y
to
p
u
r
u
len
t
m
e
n
in
g
itis
[
4
2
]
,
[
4
3
]
.
W
h
en
co
m
b
in
ed
with
cr
o
wd
ed
liv
i
n
g
co
n
d
i
tio
n
s
,
th
ese
f
ac
t
o
r
s
ca
n
lead
to
an
o
u
tb
r
ea
k
[
4
0
]
.
T
h
u
s
,
o
u
r
p
o
p
u
latio
n
is
awa
r
e
o
f
th
e
im
p
ac
t o
f
clim
ati
c
co
n
d
itio
n
s
o
n
th
e
s
p
r
ea
d
o
f
i
n
f
ec
tio
u
s
d
is
ea
s
es lik
e
b
ac
ter
ial
m
en
in
g
itis
.
3
.
3
.
Ass
ess
m
ent
o
f
t
he
po
pu
la
t
io
n's
k
no
wledg
e
o
f
m
ening
it
is
dis
ea
s
e
3
.
3
.
1
.
L
ev
el
o
f
pu
bli
c
a
wa
re
nes
s
o
f
m
ening
it
is
Ass
es
s
m
en
t
o
f
th
e
lev
el
o
f
k
n
o
wled
g
e
in
Fig
u
r
e
1
s
h
o
wed
t
h
at
th
e
s
co
r
e
r
an
g
e
d
b
etwe
en
0
an
d
1
7
,
an
d
th
e
av
er
ag
e
k
n
o
wled
g
e
s
c
o
r
e
was
8
.
4
5
.
Fu
r
th
er
m
o
r
e,
o
n
ly
5
%
o
f
r
esp
o
n
d
e
n
ts
h
ad
a
g
o
o
d
k
n
o
wled
g
e
o
f
m
en
in
g
itis
,
co
m
p
ar
e
d
with
8
2
%
o
f
p
ar
ticip
an
ts
with
an
av
er
ag
e
lev
el
o
f
k
n
o
wled
g
e
o
f
th
e
d
is
ea
s
e
an
d
1
3
%
with
a
lo
w
lev
el
,
as sh
o
wn
in
Fig
u
r
e
1
.
C
o
n
v
er
s
ely
,
th
e
ass
ess
m
en
t
o
f
th
e
p
o
p
u
latio
n
'
s
lev
el
o
f
k
n
o
wled
g
e
a
b
o
u
t
m
en
in
g
itis
s
h
o
wed
th
at
8
2
%
h
ad
an
av
e
r
ag
e
l
ev
el
o
f
k
n
o
wled
g
e
ab
o
u
t
th
e
d
is
ea
s
e
,
an
d
1
3
%
h
ad
a
lo
w
l
ev
el.
T
h
is
lack
o
f
co
m
p
r
eh
e
n
s
iv
e
u
n
d
er
s
tan
d
in
g
m
ay
b
e
attr
ib
u
ted
to
s
o
m
e
in
co
n
s
is
ten
t
r
esp
o
n
s
es
co
n
c
er
n
in
g
p
r
e
v
en
tio
n
,
tr
an
s
m
is
s
io
n
,
an
d
r
is
k
f
ac
to
r
s
;
f
o
r
ex
am
p
le,
2
0
r
esp
o
n
d
en
t
s
in
co
r
r
ec
tly
class
if
ie
d
p
u
r
u
le
n
t
m
en
in
g
itis
as
a
b
en
ig
n
in
f
ec
tio
n
.
Similar
ly
,
a
s
tu
d
y
ca
r
r
ied
o
u
t
in
I
taly
o
n
th
e
ev
alu
atio
n
o
f
p
ar
en
tal
ap
p
r
o
ac
h
es
t
o
m
en
in
g
o
c
o
cc
al
s
er
o
g
r
o
u
p
B
v
ac
cin
es
[
4
4
]
s
h
o
wed
th
at
7
1
%
o
f
t
h
e
p
a
r
en
ts
q
u
esti
o
n
e
d
s
aid
th
ey
d
id
n
o
t
k
n
o
w
ab
o
u
t
b
ac
ter
ial
m
e
n
in
g
itis
,
w
h
ile
in
a
n
o
th
er
s
tu
d
y
o
n
ly
3
4
%
s
aid
th
ey
h
ad
in
f
o
r
m
atio
n
ab
o
u
t
its
etio
lo
g
y
.
An
o
th
er
s
tu
d
y
o
n
p
ar
en
ts
'
k
n
o
wled
g
e
an
d
attitu
d
es
to
war
d
s
m
en
in
g
o
co
cc
al
in
f
ec
tio
n
s
an
d
v
ac
cin
atio
n
in
T
u
r
k
ey
f
o
u
n
d
th
at
2
7
%
o
f
p
ar
en
ts
wer
e
awa
r
e
o
f
m
en
in
g
o
c
o
cc
al
d
is
ea
s
es,
an
d
2
5
%
k
n
e
w
ab
o
u
t
at
least
o
n
e
m
en
in
g
o
c
o
cc
a
l
v
ac
ci
n
e
[
4
5
]
.
T
h
ese
f
ac
to
r
s
h
ig
h
lig
h
t
th
e
f
a
ct
th
at
b
ac
ter
ial
m
en
in
g
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I
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2252
-
8
8
0
6
B
a
cteria
l m
en
in
g
itis
kn
o
w
led
g
e,
a
ttit
u
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e
,
a
n
d
p
r
a
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s
tu
d
y
a
mo
n
g
p
a
r
en
ts
:
…
(
S
i
h
a
m
Jb
a
r
i
)
1217
4.
CO
NCLU
SI
O
N
T
h
is
r
esear
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s
h
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wed
th
at
k
n
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wled
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m
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itis
was
b
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am
o
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p
e
o
p
le
with
m
o
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e
th
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4
ch
ild
r
en
i
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th
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f
am
ily
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with
a
p
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ar
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ch
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tio
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tr
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wellin
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w
ith
p
≤
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0
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,
wh
ich
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ea
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s
th
at
th
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p
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m
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r
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v
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d
is
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e.
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n
ad
d
itio
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8
2
%
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ad
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g
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er
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tan
d
in
g
o
f
th
e
p
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p
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latio
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'
s
p
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f
an
d
v
u
ln
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ab
ilit
y
to
b
ac
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ial
m
en
i
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g
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will
h
elp
co
n
tr
o
l
th
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d
is
ea
s
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an
d
h
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h
ea
lth
ca
r
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p
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tar
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s
p
ec
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ic
g
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u
p
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to
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n
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way
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f
u
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e
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ased
o
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id
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ter
m
s
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ac
cin
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u
r
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eillan
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o
r
t
h
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co
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tr
o
l
o
f
b
ac
ter
ial
m
e
n
in
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itis
.
I
n
a
d
d
itio
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,
th
e
s
tu
d
y
s
h
o
wed
t
h
at
s
o
cio
-
ec
o
n
o
m
ic
a
n
d
ed
u
ca
tio
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al
f
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cto
r
s
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f
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ce
th
e
k
n
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wled
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f
o
u
r
p
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p
u
latio
n
,
h
e
n
ce
th
e
im
p
o
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ta
n
ce
o
f
co
m
b
atin
g
s
o
cial
in
eq
u
alities
.
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ally
,
th
e
s
tu
d
y
id
en
tifie
d
s
ev
er
al
ar
ea
s
th
at
war
r
an
t
f
u
r
th
er
ex
p
lo
r
atio
n
in
f
u
tu
r
e
r
esear
c
h
.
T
h
is
s
tu
d
y
h
as
s
ev
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al
lim
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s
th
at
co
u
ld
a
f
f
ec
t
th
e
v
alid
ity
an
d
g
en
er
aliza
tio
n
o
f
r
es
u
lts
.
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th
e
elim
in
atio
n
o
f
in
c
o
m
p
lete
q
u
esti
o
n
n
air
es
r
e
d
u
ce
d
th
e
s
a
m
p
le
to
2
9
5
p
ar
ticip
an
ts
,
wh
i
ch
m
ay
i
n
tr
o
d
u
ce
a
non
-
r
esp
o
n
s
e
b
ias.
T
h
e
i
n
d
iv
id
u
als
wh
o
d
id
n
o
t
co
m
p
lete
th
e
q
u
esti
o
n
n
air
e
m
ay
h
a
v
e
d
if
f
er
en
t
ch
ar
ac
ter
is
tics
,
wh
ich
co
u
ld
c
o
m
p
r
o
m
is
e
th
e
r
ep
r
esen
tativ
e
n
e
s
s
o
f
th
e
s
am
p
le.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
Au
th
o
r
s
s
tate
n
o
f
u
n
d
in
g
in
v
o
lv
ed
.
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
M
E
N
T
T
h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
tr
ib
u
to
r
R
o
les
T
ax
o
n
o
m
y
(
C
R
ed
iT)
to
r
ec
o
g
n
ize
in
d
iv
id
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
th
o
r
s
h
ip
d
is
p
u
tes,
an
d
f
ac
ilit
ate
c
o
llab
o
r
atio
n
.
Na
m
e
o
f
Aut
ho
r
C
M
So
Va
Fo
I
R
D
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Vi
Su
P
Fu
Sih
am
J
b
ar
i
✓
✓
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Kar
im
a
E
l
-
Mo
u
h
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i
✓
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Haja
r
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l O
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ar
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Mo
u
n
ir
B
o
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r
r
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s
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Sam
ia
B
o
u
s
s
aa
✓
✓
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✓
✓
✓
✓
✓
C
:
C
o
n
c
e
p
t
u
a
l
i
z
a
t
i
o
n
M
:
M
e
t
h
o
d
o
l
o
g
y
So
:
So
f
t
w
a
r
e
Va
:
Va
l
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d
a
t
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n
Fo
:
Fo
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mal
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y
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s
I
:
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n
v
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e
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p
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Fu
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Au
th
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s
s
tate
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co
n
f
lict o
f
in
t
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est.
E
T
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I
CAL AP
P
RO
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th
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v
alu
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wer
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ec
ted
,
m
ain
ly
in
f
o
r
m
ed
co
n
s
en
t
an
d
r
esp
ec
t
f
o
r
an
o
n
y
m
ity
.
Similar
ly
,
th
e
s
tu
d
y
was
co
n
d
u
cted
af
ter
o
b
tain
in
g
au
t
h
o
r
izatio
n
f
r
o
m
l
o
ca
l
an
d
r
eg
io
n
al
h
ea
lth
s
er
v
ices
(
r
ef
er
en
ce
No
.
2
6
9
2
/2
1
)
.
T
h
e
s
tu
d
y
was c
o
n
d
u
cted
f
o
llo
win
g
th
e
Helsin
k
i
Dec
lar
atio
n
.
DATA AV
AI
L
AB
I
L
I
T
Y
T
h
e
d
ata
th
at
s
u
p
p
o
r
t
th
e
f
in
d
in
g
s
o
f
th
is
s
tu
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[
35
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T.
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[
36
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38
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40
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41
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[
42
]
B
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45
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[
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