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Ku
ala
L
u
m
p
u
r
,
Ma
lay
s
ia,
tr
ig
g
er
ed
an
ex
p
o
n
en
tial
in
cr
ea
s
e
in
C
OVI
D
-
1
9
ca
s
es
[
1
1
]
.
Af
ter
a
f
ew
wee
k
s
o
f
th
e
g
ath
er
in
g
,
th
e
n
u
m
b
er
o
f
C
OVI
D
-
1
9
p
o
s
itiv
e
ca
s
es
th
r
o
u
g
h
o
u
t
th
e
wh
o
le
co
u
n
tr
y
in
Ma
lay
s
ia
was
r
ep
o
r
ted
th
e
h
ig
h
est
am
o
n
g
So
u
th
ea
s
t
Asi
a
co
u
n
tr
ies
[
1
1
]
,
[
1
2
]
.
T
h
u
s
,
s
tan
d
ar
d
o
p
er
atin
g
p
r
o
ce
d
u
r
es
ar
e
im
p
o
r
tan
t
t
o
p
r
ev
en
t
a
n
d
to
co
n
tr
o
l
th
e
d
i
s
ea
s
e
m
o
r
e
ef
f
icien
tly
.
I
n
f
ac
t,
m
o
s
t
co
u
n
tr
ies
h
a
v
e
im
p
le
m
en
ted
m
o
v
em
en
t
co
n
tr
o
l
o
r
d
er
s
(
MCOs
)
an
d
s
o
cial
d
is
tan
cin
g
to
av
er
t
th
e
g
r
o
wth
o
f
th
e
n
u
m
b
er
o
f
ca
s
es
an
d
to
co
n
tain
th
e
s
p
r
ea
d
o
f
t
h
e
p
an
d
em
ic
[
1
1
]
,
[
1
3
]
.
B
y
Sep
tem
b
er
2
0
2
2
,
a
cu
m
u
lativ
e
to
tal
o
f
5
.
8
m
illi
o
n
an
d
4
.
8
m
illi
o
n
C
OVI
D
-
1
9
ca
s
es
wer
e
r
ep
o
r
ted
in
C
h
in
a
an
d
Ma
lay
s
ia,
r
esp
ec
tiv
ely
[
3
]
.
Desp
ite
a
d
en
s
ely
p
o
p
u
lated
d
ev
el
o
p
in
g
co
u
n
t
r
y
lik
e
C
h
in
a
with
n
ea
r
ly
5
0
tim
es
m
o
r
e
p
o
p
u
lated
co
m
p
ar
e
d
to
th
at
o
f
Ma
lay
s
ia,
it
ca
n
b
e
u
n
d
o
u
b
ted
ly
co
n
clu
d
ed
th
at
th
e
p
an
d
em
ic
was
well
co
n
tr
o
lled
in
C
h
in
a.
B
esid
e
s
,
n
u
m
er
o
u
s
s
tu
d
ies
h
av
e
b
ee
n
r
ep
o
r
ted
o
n
th
e
k
n
o
wled
g
e,
attitu
d
es
,
an
d
p
r
ac
tices
(
KAP)
in
p
r
ev
e
n
tin
g
an
d
co
n
tr
o
llin
g
th
e
o
u
tb
r
ea
k
o
f
C
OVI
D
-
1
9
in
th
e
p
o
p
u
latio
n
s
o
f
C
h
in
a
an
d
Ma
lay
s
ia
[
1
0
]
,
[
1
4
]
.
Ho
wev
er
,
a
s
tu
d
y
co
m
p
ar
in
g
th
e
KAP
o
f
C
h
in
a'
s
an
d
Ma
lay
s
ia's
p
o
p
u
latio
n
r
eg
ar
d
in
g
th
e
p
an
d
em
ic
r
em
ai
n
s
o
b
s
cu
r
e
.
S
in
ce
KAP
ar
e
im
p
o
r
tan
t
elem
en
ts
in
co
n
tain
in
g
th
e
o
u
tb
r
ea
k
,
it
is
wo
r
th
to
in
v
esti
g
ate
th
e
KAP
in
p
r
ev
en
tin
g
C
OVI
D
-
1
9
d
is
ea
s
e
[
1
5
]
,
to
ass
ess
th
e
co
r
r
elatio
n
b
etwe
en
d
em
o
g
r
a
p
h
ic
f
ac
t
o
r
s
an
d
to
co
m
p
a
r
e
th
e
KAP
am
o
n
g
C
h
in
ese
an
d
Ma
lay
s
ian
p
o
p
u
latio
n
d
u
r
i
n
g
th
e
o
u
t
b
r
ea
k
.
W
h
ile
ex
is
tin
g
r
esear
ch
h
as
p
r
o
v
id
e
d
v
al
u
ab
le
in
s
ig
h
ts
,
s
e
v
er
al
is
s
u
es
r
em
ain
u
n
r
eso
lv
e
d
.
Fo
r
e
x
am
p
le,
t
h
e
im
p
ac
t
o
f
cu
ltu
r
al
d
if
f
e
r
en
ce
s
o
n
KAP
is
n
o
t
well
u
n
d
e
r
s
to
o
d
,
an
d
t
h
er
e
is
a
n
ee
d
f
o
r
m
o
r
e
c
o
m
p
r
e
h
en
s
iv
e
c
o
m
p
ar
ativ
e
s
tu
d
ies.
Ad
d
itio
n
ally
,
th
e
lo
n
g
-
ter
m
ef
f
ec
tiv
en
ess
o
f
p
u
b
lic
h
ea
lth
in
ter
v
en
tio
n
s
an
d
th
e
r
o
le
o
f
d
em
o
g
r
ap
h
ic
f
ac
to
r
s
in
s
h
ap
in
g
KAP
ar
e
ar
ea
s
th
at
r
eq
u
ir
e
f
u
r
th
er
in
v
esti
g
atio
n
.
T
h
is
s
tu
d
y
ad
d
r
ess
es
th
e
g
ap
in
th
e
liter
atu
r
e
b
y
c
o
m
p
ar
in
g
th
e
KAP
o
f
ad
u
lts
in
Ma
in
lan
d
C
h
in
a
an
d
Ma
lay
s
ia
d
u
r
in
g
th
e
C
OVI
D
-
1
9
p
an
d
em
ic.
Ou
r
r
esear
ch
p
r
o
v
id
es
n
ew
in
s
ig
h
ts
in
to
h
o
w
d
i
f
f
er
en
t
p
o
p
u
latio
n
s
f
r
o
m
d
if
f
er
en
t
co
u
n
tr
ies
in
r
esp
o
n
d
to
p
an
d
e
m
ics
an
d
id
en
tifie
d
th
e
b
est
p
r
ac
tices
f
o
r
p
u
b
li
c
h
ea
lth
co
m
m
u
n
icatio
n
.
T
h
is
co
m
p
ar
ativ
e
an
aly
s
is
h
as
n
o
t
b
ee
n
r
ep
o
r
ted
an
d
wo
u
ld
co
n
t
r
ib
u
te
to
th
e
g
lo
b
al
u
n
d
er
s
tan
d
i
n
g
o
f
th
e
r
esp
o
n
s
es o
n
th
e
p
a
n
d
em
ic.
T
h
e
f
o
llo
win
g
s
ec
tio
n
s
o
f
th
i
s
m
an
u
s
cr
ip
t
d
em
o
n
s
tr
ated
o
u
r
r
esear
ch
m
eth
o
d
o
l
o
g
y
,
r
esu
lts
o
f
o
u
r
co
m
p
ar
ativ
e
a
n
aly
s
is
,
an
d
d
is
cu
s
s
ed
th
e
im
p
licatio
n
s
o
f
o
u
r
f
in
d
in
g
s
.
W
e
s
h
o
wed
h
o
w
o
u
r
s
tu
d
y
co
n
tr
ib
u
ted
to
th
e
ex
is
tin
g
b
o
d
y
o
f
k
n
o
wl
ed
g
e
an
d
wh
y
it
is
r
elev
an
t
f
o
r
p
u
b
lic
h
ea
lth
p
o
licy
m
ak
e
r
s
an
d
r
esear
ch
er
s
.
T
h
e
s
u
b
s
eq
u
en
t
s
ec
tio
n
s
wer
e
s
tr
u
ctu
r
ed
as:
i)
Stu
d
y
d
esig
n
,
p
ar
ticip
an
t
r
ec
r
u
itm
en
t,
d
ata
co
ll
ec
tio
n
,
an
d
an
al
y
s
is
tech
n
iq
u
es
wer
e
p
r
esen
ted
in
th
e
M
eth
o
d
s
ec
tio
n
;
ii)
Fin
d
i
n
g
s
an
d
in
ter
p
r
etatio
n
o
f
f
in
d
in
g
s
,
co
n
te
x
tu
alize
th
em
with
in
th
e
ex
is
tin
g
liter
a
tu
r
e,
an
d
d
is
cu
s
s
th
eir
im
p
licatio
n
s
o
n
th
e
KAP
o
f
t
h
e
C
h
in
ese
an
d
Ma
lay
s
ian
p
o
p
u
latio
n
s
wer
e
p
r
esen
ted
i
n
R
esu
lts
an
d
Dis
cu
s
s
io
n
s
ec
tio
n
;
iii)
Key
co
n
tr
ib
u
tio
n
s
an
d
s
u
g
g
est
d
ir
ec
tio
n
s
f
o
r
f
u
t
u
r
e
r
esear
ch
wer
e
s
u
m
m
ar
ized
in
C
o
n
clu
s
io
n
.
Ou
r
s
tu
d
y
f
o
u
n
d
th
at
p
ar
ticip
an
ts
in
Ma
lay
s
ia
an
d
C
h
in
a
d
em
o
n
s
tr
ated
a
g
o
o
d
u
n
d
er
s
tan
d
in
g
o
f
C
OVI
D
-
1
9
.
C
h
in
ese
r
esp
o
n
d
en
ts
d
em
o
n
s
tr
ated
b
e
tter
k
n
o
wled
g
e
a
n
d
m
o
r
e
p
o
s
itiv
e
attitu
d
es c
o
m
p
a
r
ed
to
Ma
lay
s
ian
s
.
2.
M
E
T
H
O
D
2
.
1
.
Study
des
ig
n
A
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
was
co
n
d
u
cte
d
to
co
m
p
ar
e
th
e
k
n
o
wled
g
e,
attitu
d
es,
an
d
p
r
ac
ti
ce
s
(
KAP)
r
elate
d
to
C
OVI
D
-
1
9
am
o
n
g
ad
u
lts
in
Ma
in
lan
d
C
h
in
a
a
n
d
Ma
lay
s
ia.
T
h
e
s
tu
d
y
was
co
n
d
u
cte
d
b
etwe
en
Dec
em
b
er
1
s
t,
2
0
2
1
,
an
d
Feb
r
u
ar
y
1
s
t,
2
0
2
2
,
to
ca
p
tu
r
e
d
ata
d
u
r
in
g
a
p
er
io
d
o
f
ac
tiv
e
p
a
n
d
em
ic
m
an
ag
em
e
n
t
an
d
p
u
b
lic
h
ea
lth
m
ea
s
u
r
es.
T
h
e
ch
o
s
en
m
eth
o
d
o
l
o
g
y
,
in
clu
d
in
g
th
e
cr
o
s
s
-
s
ec
tio
n
al
d
esig
n
an
d
c
o
n
v
e
n
ien
ce
s
am
p
lin
g
,
was
s
elec
ted
t
o
ca
p
tu
r
e
a
s
n
ap
s
h
o
t
o
f
KAP
d
u
r
in
g
a
cr
itical
p
h
ase
o
f
th
e
p
an
d
e
m
ic.
T
h
e
u
s
e
o
f
an
o
n
lin
e
q
u
esti
o
n
n
air
e
allo
wed
f
o
r
a
wid
e
r
ea
ch
an
d
ad
h
er
en
c
e
to
s
o
cial
d
is
tan
cin
g
m
ea
s
u
r
e
s
.
T
h
e
p
ilo
t
test
in
g
en
s
u
r
ed
th
e
r
eliab
ilit
y
an
d
v
ali
d
ity
o
f
th
e
q
u
esti
o
n
n
air
e.
T
h
e
s
tatis
t
ical
m
eth
o
d
s
wer
e
ch
o
s
en
to
an
aly
ze
an
d
to
in
ter
p
r
et
th
e
d
ata,
p
r
o
v
id
in
g
a
co
m
p
r
eh
e
n
s
iv
e
u
n
d
er
s
tan
d
in
g
o
f
th
e
KAP
r
elate
d
to
C
OVI
D
-
1
9.
2
.
2
.
Da
t
a
c
o
llect
io
n a
nd
et
hics
a
pp
ro
v
a
l
T
h
e
tar
g
et
p
o
p
u
latio
n
co
n
s
i
s
ted
o
f
ad
u
lts
ag
ed
1
8
y
ea
r
s
an
d
ab
o
v
e
f
r
o
m
b
o
th
c
o
u
n
tr
ies.
A
co
n
v
en
ie
n
ce
s
am
p
lin
g
m
eth
o
d
was
em
p
lo
y
e
d
to
r
ec
r
u
it
p
ar
ti
cip
an
ts
,
en
s
u
r
in
g
a
d
iv
er
s
e
r
e
p
r
esen
tatio
n
ac
r
o
s
s
v
ar
io
u
s
d
em
o
g
r
ap
h
ic
g
r
o
u
p
s
,
in
clu
d
in
g
g
en
d
er
,
ag
e,
ed
u
c
atio
n
lev
el,
an
d
in
co
m
e.
An
an
o
n
y
m
o
u
s
o
n
lin
e
q
u
esti
o
n
n
air
e
was
d
ev
elo
p
e
d
u
s
in
g
Go
o
g
le
Fo
r
m
s
a
n
d
d
is
s
em
in
ated
th
r
o
u
g
h
s
o
cia
l
m
ed
ia
p
latf
o
r
m
s
(
W
eCh
at®,
Face
b
o
o
k
®,
an
d
T
witter
®)
in
C
h
in
a
an
d
Ma
lay
s
ia.
T
h
e
q
u
esti
o
n
n
air
e
was
d
esig
n
ed
in
E
n
g
lis
h
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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t J Pu
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lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
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mp
r
o
ve
d
kn
o
w
led
g
e
,
a
ttit
u
d
e
a
n
d
p
r
a
ctice
d
u
r
in
g
C
OV
I
D
-
1
9
p
a
n
d
emic
…
(
S
h
u
ch
e
n
g
Li
)
1181
an
d
tr
a
n
s
lated
in
to
Ma
n
d
a
r
in
an
d
Ma
lay
lan
g
u
ag
es
t
o
e
n
s
u
r
e
b
etter
co
m
p
r
eh
e
n
s
iv
en
ess
am
o
n
g
r
esp
o
n
d
en
ts
r
eg
ar
d
less
o
f
d
if
f
er
e
n
t
eth
n
ic
ities
.
Par
ticip
atio
n
was
v
o
lu
n
tar
y
,
an
d
co
n
f
id
en
tiality
was
ass
u
r
ed
.
I
n
f
o
r
m
ed
co
n
s
en
t w
as o
b
tain
ed
im
p
licitly
th
r
o
u
g
h
t
h
e
co
m
p
letio
n
o
f
th
e
q
u
esti
o
n
n
air
e.
2
.
3
.
Q
ues
t
io
nn
a
ire
dev
elo
p
m
ent
T
h
e
q
u
esti
o
n
n
air
e
was d
iv
id
ed
in
to
th
e
f
o
llo
win
g
s
ec
tio
n
s
:
i)
So
cio
d
em
o
g
r
ap
h
ic
i
n
f
o
r
m
atio
n
:
C
o
llected
d
ata
o
n
ag
e
,
g
en
d
er
,
n
atio
n
ality
,
ed
u
ca
tio
n
,
an
d
m
o
n
th
l
y
in
co
m
e.
T
h
e
ed
u
ca
tio
n
al
lev
el
g
r
o
u
p
was
d
iv
id
e
d
i
n
to
f
iv
e
s
u
b
g
r
o
u
p
s
,
s
u
ch
as
n
o
p
r
o
p
er
s
ch
o
o
lin
g
,
s
ec
o
n
d
ar
y
s
ch
o
o
l
o
r
lo
wer
,
d
i
p
lo
m
a
o
r
ce
r
tific
ate,
d
eg
r
ee
,
m
aster
’
s
d
eg
r
ee
,
an
d
ab
o
v
e.
T
h
e
ag
e
g
r
o
u
p
was
d
iv
id
ed
in
to
f
iv
e
s
u
b
g
r
o
u
p
s
,
s
u
ch
as
1
8
-
3
0
,
3
1
-
4
0
,
4
1
-
5
0
,
5
1
-
60
,
an
d
>6
0
y
ea
r
s
o
l
d
.
Mo
n
th
ly
i
n
co
m
e
g
r
o
u
p
was
d
iv
id
ed
in
to
f
o
u
r
ca
teg
o
r
ies,
s
u
ch
as
<RM
2
,
0
0
0
(
<RMB
3
,
0
0
0
)
,
R
M
2
,
0
0
0
-
5
,
0
0
0
(
R
MB
3
,
0
0
0
-
7
,
5
0
0
)
,
R
M
5
,
0
0
0
-
1
0
,
0
0
0
(
R
MB
7
,
5
0
0
-
1
0
,
0
0
0
)
,
>R
M
1
0
,
0
0
0
(
R
MB
1
5
,
0
0
0
)
with
th
e
ex
c
h
an
g
e
r
ate
f
ix
ed
at
1
R
M:
1
.
5
R
MB.
ii)
Kn
o
wled
g
e
as
s
ess
m
en
t:
I
n
cl
u
d
ed
q
u
esti
o
n
s
o
n
C
OVI
D
-
1
9
s
y
m
p
to
m
s
,
tr
an
s
m
is
s
io
n
,
p
r
ev
en
tio
n
,
an
d
co
n
tr
o
l
m
ea
s
u
r
es,
a
d
ap
ted
f
r
o
m
p
r
ev
io
u
s
s
tu
d
ies
[
1
4
]
.
T
h
e
s
ec
tio
n
s
wer
e
o
n
s
y
m
p
to
m
s
a
n
d
tr
an
s
m
is
s
io
n
o
f
C
OVI
D
-
1
9
,
with
ea
ch
q
u
es
tio
n
h
av
i
n
g
t
h
e
p
o
s
s
ib
ilit
y
to
a
n
s
wer
‘
y
es’
(
s
co
r
e
1
)
,
‘
n
o
’
an
d
‘
I
d
o
n
'
t
k
n
o
w’
(
s
co
r
e
0
)
b
y
th
e
r
esp
o
n
d
en
ts
.
T
h
e
to
tal
s
co
r
es
r
an
g
ed
f
r
o
m
0
t
o
2
5
.
Sco
r
es
a
b
o
v
e
1
8
wer
e
co
n
s
id
er
e
d
k
n
o
wled
g
ea
b
le.
I
n
t
h
e
s
e
c
o
n
d
s
e
c
ti
o
n
,
c
o
n
s
ti
p
a
t
i
o
n
a
n
d
f
r
e
q
u
e
n
c
y
o
f
u
r
i
n
a
t
i
o
n
a
r
e
n
o
t
t
h
e
ac
t
u
a
l
s
y
m
p
t
o
m
s
o
f
C
O
V
I
D
-
1
9
,
s
o
t
h
e
‘
n
o
’
o
p
t
i
o
n
w
a
s
c
o
u
n
t
e
d
f
o
r
o
n
e
p
o
i
n
t
.
T
h
e
r
e
s
t
a
r
e
t
h
e
‘
c
o
r
r
e
ct
’
o
p
t
i
o
n
f
o
r
C
O
V
I
D
-
1
9
s
y
m
p
t
o
m
s
,
c
o
u
n
t
e
d
f
o
r
o
n
e
p
o
i
n
t
.
I
n
t
h
e
t
h
i
r
d
s
e
c
ti
o
n
,
t
h
e
f
o
l
l
o
w
i
n
g
s
t
a
t
e
m
e
n
t
h
a
d
d
i
f
f
er
e
n
t
s
c
o
r
i
n
g
f
o
r
M
a
l
a
y
s
i
a
n
a
n
d
C
h
i
n
es
e
p
a
r
t
i
ci
p
a
n
t
s
.
F
o
r
C
h
i
n
es
e
r
e
s
p
o
n
d
e
n
t
s
,
t
h
e
s
t
at
e
m
e
n
t
o
f
‘
A
C
O
V
I
D
-
1
9
s
u
s
p
ec
t
ed
i
n
d
i
v
i
d
u
a
l
s
h
o
u
l
d
b
e
s
e
l
f
-
q
u
a
r
an
t
i
n
e
d
a
t
h
o
m
e
a
n
d
a
l
l
c
o
n
f
i
r
m
e
d
c
a
s
e
s
o
f
C
O
V
I
D
-
1
9
s
h
o
u
l
d
b
e
q
u
a
r
a
n
t
i
n
e
d
i
n
q
u
a
r
a
n
t
i
n
e
d
c
e
n
t
e
r
’
i
s
c
o
n
s
id
e
r
e
d
‘
y
e
s
’
a
s
c
o
r
r
e
c
t
a
n
s
we
r
.
H
o
w
e
v
e
r
,
f
o
r
M
a
l
a
y
s
ia
n
r
e
s
p
o
n
d
e
n
t
s
,
‘
n
o
’
w
as
t
h
e
c
o
r
r
e
c
t
a
n
s
w
e
r
.
T
h
e
c
o
r
r
e
c
t
a
n
s
w
e
r
is
w
o
r
t
h
o
n
e
p
o
i
n
t
,
f
o
r
a
t
o
t
a
l
s
c
o
r
e
o
f
1
1
p
o
i
n
t
s
.
iii)
Attitu
d
e
ev
alu
atio
n
:
Used
a
5
-
p
o
in
t
L
ik
e
r
t
s
ca
le
to
ass
ess
attitu
d
es
to
war
d
s
C
OVI
D
-
1
9
p
r
ev
en
tio
n
an
d
co
n
tr
o
l
m
ea
s
u
r
es,
b
ased
o
n
estab
lis
h
ed
s
ca
les
[
1
6
]
.
T
h
e
s
ec
tio
n
r
eg
ar
d
i
n
g
th
e
attitu
d
e
,
co
n
s
is
ted
o
f
n
in
e
q
u
esti
o
n
s
th
at
r
esp
o
n
d
en
ts
we
r
e
ask
ed
to
f
ill
o
u
t
b
a
s
ed
o
n
5
-
p
o
in
t
L
ik
e
r
t
s
ca
le
as
1
(
s
tr
o
n
g
ly
d
is
ag
r
ee
)
,
2
(
d
is
ag
r
ee
)
,
3
(
n
eu
tr
al)
,
4
(
ag
r
ee
)
,
an
d
5
(
s
tr
o
n
g
ly
ag
r
ee
)
.
T
h
o
s
e
wh
o
an
s
wer
ed
1
,
2
b
e
in
g
class
if
ied
as
h
av
in
g
a
'
n
eg
ativ
e'
attitu
d
e
;
3
class
if
ied
as
a
'
n
eu
tr
al'
;
an
d
th
o
s
e
wh
o
a
n
s
wer
ed
4
an
d
5
p
o
s
s
ess
ed
'
p
o
s
itiv
e'
attitu
d
e.
T
h
e
to
tal
s
co
r
e
r
a
n
g
e
d
f
r
o
m
0
to
4
5
p
o
in
ts
.
R
esp
o
n
d
en
ts
with
h
ig
h
er
to
tal
s
co
r
e
wo
u
ld
p
o
s
s
ess
m
o
r
e
p
o
s
itiv
e
attitu
d
e
to
war
d
s
C
OVI
D
-
19.
iv
)
Pra
ctice
su
r
v
ey
:
E
n
q
u
ir
ed
ab
o
u
t
p
ar
ticip
an
ts
'
s
elf
-
r
ep
o
r
ted
ad
h
er
en
ce
t
o
p
r
e
v
en
tiv
e
p
r
ac
tices
d
u
r
in
g
th
e
p
an
d
em
ic.
T
h
e
s
ec
tio
n
co
n
s
is
ted
o
f
q
u
esti
o
n
s
r
eg
a
r
d
in
g
w
h
at
h
as
b
ee
n
d
o
n
e
an
d
wh
at
will
b
e
d
o
n
e
b
y
p
ar
ticip
an
ts
in
r
esp
o
n
s
e
to
C
OVI
D
-
1
9
,
with
ea
ch
r
esp
o
n
s
e
b
ein
g
an
s
wer
ed
as '
y
es'
,
'
n
o
'
an
d
'
I
am
n
o
t su
r
e'
.
T
h
e
to
tal
s
co
r
e
r
an
g
ed
f
r
o
m
0
to
1
4
,
with
a
h
ig
h
er
to
tal
s
co
r
e
in
d
icatin
g
b
etter
co
n
tr
o
l
m
ea
s
u
r
es
b
ee
n
p
r
ac
ticed
d
u
r
in
g
t
h
e
p
an
d
em
ic
.
2
.
4
.
Sa
m
pli
ng
s
ize
T
h
e
s
am
p
le
s
ize
was
ca
lcu
lat
ed
u
s
in
g
C
o
ch
r
an
'
s
f
o
r
m
u
la
t
o
en
s
u
r
e
ad
e
q
u
ate
r
ep
r
esen
tatio
n
with
a
co
n
f
id
en
ce
in
ter
v
al
o
f
9
5
%
a
n
d
a
m
ar
g
in
o
f
er
r
o
r
o
f
5
%.
n
=
Z
2
p
q
/e
2
(
n
:
s
am
p
le
s
ize;
Z
:
9
5
%
co
n
f
i
d
en
t
in
te
r
v
al;
p
:
esti
m
ated
p
r
o
p
o
r
tio
n
o
f
th
e
p
o
p
u
latio
n
;
q
=
1
–
p
;
e:
m
ar
g
in
o
f
e
r
r
o
r
)
.
T
h
e
c
alcu
lated
m
in
im
u
m
s
am
p
le
s
ize
was
3
8
5
p
er
co
u
n
tr
y
,
wh
ic
h
was
in
cr
ea
s
ed
to
4
0
5
t
o
ac
co
u
n
t
f
o
r
a
5
%
d
r
o
p
o
u
t
r
ate.
T
h
e
q
u
esti
o
n
n
air
e
was
p
ilo
ted
wi
th
a
s
m
all
s
am
p
le
s
ize
(
n
=
4
0
)
to
ass
ess
clar
ity
an
d
c
o
m
p
r
eh
e
n
s
iv
en
ess
.
Feed
b
ac
k
was u
s
ed
to
r
e
f
in
e
t
h
e
in
s
tr
u
m
en
t,
ac
h
iev
in
g
a
C
r
o
n
b
ac
h
'
s
α
o
f
0
.
8
2
f
o
r
in
ter
n
al
r
eliab
ilit
y
.
2
.
5
.
St
a
t
is
t
ica
l a
na
ly
s
is
Data
we
r
e
an
aly
ze
d
u
s
in
g
S
PS
S
v
er
s
io
n
2
5
.
Descr
ip
tiv
e
s
tatis
tic
s
wer
e
u
s
ed
t
o
s
u
m
m
ar
ize
th
e
d
em
o
g
r
a
p
h
ic
ch
ar
ac
ter
is
tics
an
d
KAP
s
co
r
es.
C
h
i
-
s
q
u
ar
e
test
s
an
d
t
-
test
s
wer
e
co
n
d
u
cted
to
co
m
p
ar
e
d
if
f
er
en
ce
s
in
KAP
b
etwe
en
d
em
o
g
r
a
p
h
ic
g
r
o
u
p
s
an
d
co
u
n
tr
ies.
A
o
n
e
-
wa
y
A
NOVA
was
u
s
ed
to
ex
p
lo
r
e
d
if
f
er
en
ce
s
in
KAP
s
co
r
es
ac
r
o
s
s
m
u
ltip
le
d
em
o
g
r
ap
h
ic
ca
teg
o
r
ies.
A
b
in
ar
y
lo
g
is
tic
r
eg
r
ess
io
n
an
aly
s
is
wa
s
p
er
f
o
r
m
ed
to
id
en
tif
y
f
ac
to
r
s
ass
o
ciate
d
with
KA
P.
A
p
-
v
alu
e
o
f
less
th
an
0
.
0
5
was
co
n
s
id
er
ed
s
tatis
tically
s
ig
n
if
ican
t.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
T
o
th
e
b
est
o
f
o
u
r
k
n
o
wled
g
e,
th
e
p
r
esen
t
s
tu
d
y
is
th
e
o
n
ly
co
m
p
ar
ativ
e
s
tu
d
y
d
o
n
e
to
ass
es
s
th
e
k
n
o
wled
g
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,
[
2
0
]
.
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co
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in
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[
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[
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an
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C
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-
1
9
p
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ev
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tativ
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s
tr
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s
u
ch
as
r
ed
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cin
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h
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p
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s
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d
i
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cr
ea
s
in
g
th
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wn
p
r
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tectio
n
[
1
6
]
.
I
n
f
o
r
m
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d
is
s
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in
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,
d
escr
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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
1
7
9
-
1
1
8
8
1186
ac
ce
s
s
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b
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co
m
m
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n
ity
[
2
4
]
,
[
2
5
]
.
T
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co
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s
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is
th
at
p
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with
g
r
ea
t
er
k
n
o
wled
g
e
o
f
a
d
is
ea
s
e
ar
e
b
etter
to
b
e
ab
le
to
ad
h
er
e
to
p
r
ev
en
tiv
e
an
d
th
e
r
ap
eu
tic
m
ea
s
u
r
es
[
2
6
]
.
T
h
e
s
am
p
le
o
f
p
ar
ticip
an
ts
in
b
o
th
co
u
n
tr
ies
s
h
o
wed
a
g
o
o
d
lev
el
o
f
k
n
o
wled
g
e
a
n
d
atti
tu
d
e,
wh
ich
m
ay
s
er
v
e
as
a
g
o
o
d
b
aselin
e
f
o
r
an
y
f
o
r
m
o
f
h
ea
lth
ed
u
ca
tio
n
in
ter
v
en
tio
n
to
f
a
cilitate
p
r
ev
en
tio
n
,
m
o
r
e
v
ig
ilan
t
in
co
n
tr
o
llin
g
th
e
p
an
d
em
ic
[
2
7
]
.
Hen
ce
,
p
er
h
ap
s
,
t
h
e
p
r
esen
t
f
i
n
d
in
g
s
a
r
e
in
f
o
r
m
ativ
e
f
o
r
p
u
b
lic
h
ea
lth
p
o
licy
m
ak
e
r
s
an
d
h
ea
lth
w
o
r
k
er
s
to
p
r
o
v
id
e
m
o
r
e
c
o
n
d
u
civ
e
h
ea
l
th
ed
u
ca
tio
n
,
awa
r
en
ess
o
n
v
ac
cin
atio
n
f
o
r
co
u
n
ter
in
g
th
e
n
ex
t
p
an
d
em
ic
in
v
iew
o
f
th
e
im
p
o
r
tan
ce
o
f
k
n
o
wled
g
e
[
2
8
]
an
d
v
ac
cin
e
[
2
9
]
,
[
3
0
]
to
er
ad
icate
th
e
d
is
ea
s
e.
3
.
5
.
Study
lim
it
a
t
io
ns
I
n
d
ee
d
,
th
e
r
e
ar
e
s
ev
er
al
lim
itatio
n
s
in
co
n
d
u
ctin
g
th
e
p
r
esen
t
s
tu
d
y
.
Firstl
y
,
co
n
v
en
ien
ce
s
am
p
lin
g
was
p
er
f
o
r
m
ed
t
o
s
elec
t
o
u
r
r
esp
o
n
d
en
ts
an
d
we
h
ad
to
r
el
y
o
n
s
elf
-
r
e
p
o
r
tin
g
r
ath
er
th
a
n
d
ir
ec
t
o
b
s
er
v
atio
n
.
T
h
u
s
,
wh
eth
e
r
t
h
is
m
ea
s
u
r
e
was
in
f
lu
en
ce
d
b
y
s
o
cial
d
esira
b
ilit
y
b
ias
was
u
n
ab
le
to
v
er
if
y
.
Seco
n
d
ly
,
th
e
n
u
m
b
er
o
f
q
u
esti
o
n
s
to
m
ea
s
u
r
e
th
e
lev
el
o
f
k
n
o
wled
g
e,
a
ttit
u
d
es,
an
d
p
r
ac
tices
was
li
m
ited
as
th
e
s
u
r
v
ey
was
co
n
d
u
cted
o
n
lin
e.
T
h
ir
d
l
y
,
th
e
ag
e
o
f
th
e
r
esp
o
n
d
e
n
ts
ab
o
v
e
1
8
y
ea
r
o
ld
wer
e
n
o
t
a
b
le
to
b
e
en
s
u
r
ed
b
y
in
v
esti
g
ato
r
s
d
u
e
to
th
e
web
-
b
ased
lim
itatio
n
s
o
n
th
e
s
u
r
v
ey
d
o
n
e
wh
ich
m
ay
p
r
o
n
e
to
s
am
p
lin
g
b
ias
ev
en
th
o
u
g
h
it h
ad
b
ee
n
c
o
n
s
en
ted
.
3
.
6
.
F
uture
re
s
ea
rc
h direc
t
i
o
n
T
h
e
C
OVI
D
-
1
9
p
an
d
em
ic
h
as
u
n
d
er
s
co
r
ed
th
e
im
p
o
r
ta
n
ce
o
f
u
n
d
er
s
tan
d
in
g
p
u
b
lic
p
er
ce
p
tio
n
s
an
d
b
eh
av
io
r
s
.
T
h
is
s
tu
d
y
co
n
tr
i
b
u
tes
to
th
is
u
n
d
er
s
tan
d
i
n
g
an
d
o
f
f
er
s
a
f
o
u
n
d
atio
n
f
o
r
f
u
tu
r
e
r
esear
ch
a
n
d
p
r
ac
tice.
B
y
co
n
tin
u
in
g
to
ex
p
lo
r
e
th
e
d
y
n
am
ics
o
f
KAP,
we
ca
n
b
etter
p
r
ep
ar
e
f
o
r
a
n
d
r
esp
o
n
d
to
p
u
b
lic
he
alth
cr
is
es.
Fo
r
f
u
tu
r
e
r
ese
ar
ch
,
th
is
s
tu
d
y
s
u
g
g
ests
s
ev
er
al
d
ir
ec
tio
n
s
.
L
o
n
g
itu
d
in
al
s
tu
d
ies
co
u
ld
tr
ac
k
ch
an
g
es
in
KAP
o
v
er
tim
e
an
d
ass
ess
th
e
lo
n
g
-
ter
m
im
p
ac
t
o
f
p
u
b
lic
h
ea
lth
in
ter
v
en
t
io
n
s
.
Ad
d
itio
n
ally
,
r
esear
ch
with
s
y
s
tem
atic
s
tr
atif
ied
s
am
p
lin
g
m
eth
o
d
c
o
u
ld
ex
p
l
o
r
e
th
e
r
o
le
o
f
s
o
cial
m
ed
ia
a
n
d
o
th
e
r
co
m
m
u
n
icatio
n
ch
an
n
els
in
s
h
ap
in
g
p
u
b
lic
p
er
ce
p
tio
n
s
d
u
r
in
g
p
an
d
e
m
ics.
Fu
r
th
er
m
o
r
e,
th
e
im
p
ac
t
o
f
d
em
o
g
r
a
p
h
ic
f
ac
t
o
r
s
o
n
KAP
s
h
o
u
ld
b
e
e
x
am
in
ed
in
m
o
r
e
d
ep
th
to
in
f
o
r
m
tar
g
eted
h
e
alth
p
o
licies.
4.
CO
NC
L
U
SI
O
N
I
n
co
n
clu
s
io
n
,
p
ar
ticip
an
ts
in
Ma
lay
s
ia
an
d
C
h
in
a
d
e
m
o
n
s
tr
ated
a
g
o
o
d
u
n
d
er
s
t
an
d
in
g
o
f
C
OVI
D
-
1
9
.
C
h
in
ese
r
esp
o
n
d
en
ts
d
em
o
n
s
tr
ated
b
etter
k
n
o
wled
g
e
an
d
m
o
r
e
p
o
s
itiv
e
attitu
d
es
co
m
p
ar
ed
to
Ma
lay
s
ian
s
,
h
ig
h
lig
h
tin
g
th
e
n
ee
d
f
o
r
co
m
p
r
eh
en
s
iv
e
ed
u
c
atio
n
al
p
r
o
g
r
am
s
i
n
Ma
lay
s
ia
to
e
n
h
an
ce
p
u
b
lic
KAP
r
eg
ar
d
in
g
C
OVI
D
-
1
9
p
r
ev
en
tio
n
,
p
ar
ticu
lar
ly
a
m
o
n
g
less
ed
u
ca
ted
an
d
o
l
d
er
p
o
p
u
lat
io
n
s
.
B
y
en
h
an
cin
g
p
u
b
lic
k
n
o
wled
g
e
an
d
f
o
s
te
r
in
g
p
o
s
itiv
e
attitu
d
es
to
war
d
s
h
ea
lth
p
r
ac
tices,
co
m
m
u
n
ities
ca
n
im
p
r
o
v
e
co
m
p
lian
ce
with
p
r
ev
en
tiv
e
m
ea
s
u
r
es,
u
ltima
tely
r
ed
u
cin
g
th
e
o
u
tb
r
ea
k
p
er
h
ap
s
f
o
r
f
u
t
u
r
e
p
an
d
em
ic.
ACK
NO
WL
E
DG
M
E
N
T
S
T
h
e
au
th
o
r
s
ex
p
r
ess
th
eir
g
r
at
itu
d
e
to
th
e
p
ar
ticip
an
ts
f
o
r
p
r
o
v
id
in
g
th
ei
r
h
o
n
est
an
d
u
n
b
i
ased
d
ata.
Au
th
o
r
s
also
wo
u
ld
lik
e
to
th
a
n
k
Pro
f
D
r
.
Kar
u
th
a
n
C
h
in
n
a
f
o
r
ass
is
tin
g
in
s
tatis
tica
l a
n
aly
s
is
.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
Au
th
o
r
s
s
tate
th
er
e
is
n
o
f
u
n
d
i
n
g
in
v
o
lv
ed
f
o
r
p
r
esen
t r
esear
ch
.
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
co
llab
o
r
atio
n
.
Na
m
e
o
f
Aut
ho
r
C
M
So
Va
Fo
I
R
D
O
E
Vi
Su
P
Fu
Sh
u
ch
en
g
L
i
✓
✓
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✓
✓
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✓
✓
✓
✓
B
in
-
Sen
g
L
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w
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C
:
C
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p
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M
:
M
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h
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So
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So
f
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w
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Va
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Va
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Fo
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I
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8
8
0
6
I
mp
r
o
ve
d
kn
o
w
led
g
e
,
a
ttit
u
d
e
a
n
d
p
r
a
ctice
d
u
r
in
g
C
OV
I
D
-
1
9
p
a
n
d
emic
…
(
S
h
u
ch
e
n
g
Li
)
1187
CO
NF
L
I
C
T
O
F
I
N
T
E
R
E
S
T
ST
A
T
E
M
E
NT
Au
th
o
r
s
s
tate
n
o
co
n
f
lict o
f
in
t
er
est.
I
NF
O
RM
E
D
CO
NS
E
N
T
All p
ar
ticip
an
ts
in
th
e
s
tu
d
y
h
ad
b
ee
n
c
o
n
s
en
ted
.
E
T
H
I
CAL AP
P
RO
V
AL
T
h
e
r
esear
ch
co
m
p
lied
with
all
th
e
r
elev
an
t
n
atio
n
al
r
eg
u
latio
n
s
an
d
in
s
titu
tio
n
al
p
o
licies
in
ac
co
r
d
an
ce
with
th
e
ten
ets
o
f
th
e
Helsin
k
i
Dec
lar
atio
n
an
d
h
as
b
ee
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ap
p
r
o
v
ed
b
y
t
h
e
in
s
titu
tio
n
al
Hu
m
an
E
th
ics C
o
m
m
ittee
(
Ap
p
r
o
v
al
c
o
d
e:
HE
C
2
0
2
1
/
1
6
0
)
.
DATA AV
AI
L
AB
I
L
I
T
Y
Der
iv
ed
d
ata
s
u
p
p
o
r
tin
g
t
h
e
f
in
d
i
n
g
s
o
f
t
h
is
s
tu
d
y
ar
e
av
ailab
le
f
r
o
m
th
e
c
o
r
r
esp
o
n
d
i
n
g
au
th
o
r
,
[
B
SL]
,
o
n
r
eq
u
est.
RE
F
E
R
E
NC
E
S
[
1
]
Y.
-
R
.
G
u
o
e
t
a
l
.
,
“
Th
e
o
r
i
g
i
n
,
t
r
a
n
sm
i
ssi
o
n
a
n
d
c
l
i
n
i
c
a
l
t
h
e
r
a
p
i
e
s
o
n
c
o
r
o
n
a
v
i
r
u
s
d
i
s
e
a
s
e
2
0
1
9
(
C
O
V
I
D
-
1
9
)
o
u
t
b
r
e
a
k
–
a
n
u
p
d
a
t
e
o
n
t
h
e
st
a
t
u
s,”
M
i
l
i
t
a
ry
Me
d
i
c
a
l
Re
s
e
a
rc
h
,
v
o
l
.
7
,
n
o
.
1
,
p
.
1
1
,
D
e
c
.
2
0
2
0
,
d
o
i
:
1
0
.
1
1
8
6
/
s4
0
7
7
9
-
0
2
0
-
0
0
2
4
0
-
0.
[
2
]
C
.
W
a
n
g
,
P
.
W
.
H
o
r
b
y
,
F
.
G
.
H
a
y
d
e
n
,
a
n
d
G
.
F
.
G
a
o
,
“
A
n
o
v
e
l
c
o
r
o
n
a
v
i
r
u
s
o
u
t
b
r
e
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