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P
H
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Vo
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14
,
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3
,
Sep
tem
b
er
20
25
,
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p
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1
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K
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B
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C
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Han
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th
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3
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
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6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
4
7
9
-
1
4
8
8
1480
h
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d
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C
O
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-
1
9
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t
b
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k
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s
[
7
]
.
M
a
n
y
p
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h
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v
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.
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n
B
a
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s
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ti
m
e
[
8
]
.
R
e
c
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t
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[
9
]
.
S
t
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OV
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D
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[
1
0
]
.
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[
1
1
]
.
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[
1
2
]
.
H
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Hea
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n
,
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ato
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co
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d
itio
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s
[
1
3
]
.
D
u
e
to
th
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lack
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ad
eq
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o
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m
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d
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cr
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f
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in
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id
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al
[
1
4
]
.
E
m
p
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ev
id
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ests
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ick
ly
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o
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AHBS
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b
ased
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y
g
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e
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ac
tices
[
1
5
]
.
Un
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s
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s
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d
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in
Dh
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k
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s
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b
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p
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in
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[
1
6
]
.
T
h
e
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e
f
o
r
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ti
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[
1
7
]
.
A
s
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r
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s
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n
ess
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t
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h
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ts
[
1
8
]
.
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[
9
]
.
R
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t
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[
1
9
]
.
M
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C
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D
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M
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h
2
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2
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[
2
0
]
.
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ased
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ily
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th
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ically
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9
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ts
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tical
ly
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ce
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s
,
2
4
8
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1
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f
th
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s
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d
en
ts
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u
s
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ess
s
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ies
m
ajo
r
s
,
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9
8
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4
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7
5
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o
f
th
e
s
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d
en
ts
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e
I
T
a
n
d
e
n
g
in
ee
r
in
g
m
aj
o
r
s
,
1
8
4
(
2
3
%
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o
f
th
e
s
tu
d
en
ts
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ce
s
m
ajo
r
s
,
8
9
(
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1
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1
3
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o
f
t
h
e
s
tu
d
en
ts
wer
e
s
o
cial
s
cien
ce
m
ajo
r
,
6
5
(
8
.
1
3
%)
o
f
th
e
s
tu
d
en
ts
wer
e
h
ea
lth
a
n
d
b
io
lo
g
ical
s
cien
ce
s
m
ajo
r
,
1
0
(
1
.
2
5
%)
o
f
th
e
s
tu
d
en
ts
wer
e
Ar
ts
an
d
h
u
m
an
ities
m
ajo
r
an
d
th
e
r
est
6
(
0
.
0
7
%)
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tu
d
en
ts
wer
e
a
n
o
th
er
m
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r
,
with
s
tatis
t
ically
s
ig
n
if
ican
t
d
if
f
er
en
ce
s
b
etwe
en
all
th
e
lev
els
(
p
<0
.
0
0
0
1
)
.
Am
o
n
g
th
e
r
esp
o
n
d
en
ts
,
3
8
0
(
4
7
.
5
0
%)
o
f
th
em
h
av
e
th
eir
p
r
im
ar
y
s
o
u
r
ce
o
f
f
am
ily
in
c
o
m
e
as
s
elf
-
em
p
lo
y
e
d
,
3
7
4
(
4
6
.
7
5
%)
th
e
p
r
im
ar
y
s
o
u
r
ce
o
f
f
am
ily
in
co
m
e
was
a
p
r
iv
ate
jo
b
,
an
d
th
e
r
est,
4
6
(
5
.
7
5
%
)
h
ad
a
p
r
im
ar
y
s
o
u
r
ce
o
f
f
a
m
ily
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co
m
e
was
a
g
o
v
er
n
m
en
t
jo
b
,
with
s
tatis
ti
ca
lly
s
ig
n
if
ican
t
d
if
f
e
r
en
ce
s
b
etwe
en
all
lev
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ls
(
p
<0
.
0
0
0
1
)
.
T
h
e
h
an
d
h
y
g
ien
e
k
n
o
wled
g
e
o
f
th
e
s
tu
d
en
ts
was a
s
s
es
s
ed
b
y
1
3
item
s
,
wh
ich
a
r
e
p
r
o
v
id
ed
i
n
T
ab
le
2
.
I
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4.
DIS
CU
SS
I
O
N
T
h
e
s
tu
d
y
h
i
g
h
lig
h
ts
th
e
s
ig
n
if
ican
t
d
is
p
ar
ities
in
th
e
k
n
o
wled
g
e
an
d
p
r
ac
tice
o
f
AB
HS
am
o
n
g
u
n
iv
er
s
ity
s
tu
d
en
ts
in
Dh
a
k
a,
B
an
g
lad
esh
.
I
t
r
e
v
ea
ls
th
at
th
e
o
v
er
all
k
n
o
wled
g
e
r
e
g
ar
d
i
n
g
th
e
e
f
f
icac
y
o
f
AB
HS
i
s
r
elativ
ely
h
ig
h
.
Ho
wev
er
,
cr
itical
g
ap
s
r
em
ain
in
th
e
d
o
m
ain
s
ass
o
ciate
d
with
th
e
u
n
d
e
r
s
tan
d
in
g
o
f
s
af
e
an
d
e
f
f
ec
tiv
e
u
s
e
o
f
th
es
e
p
r
o
d
u
cts.
Hen
ce
,
we
aim
to
d
elv
e
d
ee
p
er
in
to
th
e
f
in
d
in
g
s
in
th
is
Dis
cu
s
s
io
n
s
ec
tio
n
b
y
co
n
tex
tu
alizin
g
t
h
e
m
with
in
th
e
liter
atu
r
e
a
n
d
r
e
co
m
m
en
d
p
r
ac
tical
in
ter
v
en
ti
o
n
s
.
As
m
en
tio
n
ed
ea
r
lier
,
m
ajo
r
ity
o
f
th
e
s
tu
d
en
ts
h
av
e
a
r
elativ
ely
s
tr
o
n
g
id
e
a
ab
o
u
t
th
e
ef
f
icac
y
o
f
AB
HS
in
p
r
ev
en
tin
g
th
e
s
p
r
ea
d
o
f
in
f
ec
tio
u
s
ag
en
ts
,
s
o
m
e
m
is
co
n
ce
p
tio
n
s
p
r
ev
ail
r
e
g
ar
d
in
g
th
e
s
af
e
u
s
e
o
f
AB
HS
.
I
t
is
n
o
tewo
r
th
y
to
m
en
tio
n
th
at
s
o
m
e
s
tu
d
en
ts
a
r
e
n
o
t
awa
r
e
o
f
th
e
p
o
ten
tial
r
i
s
k
s
an
d
th
r
ea
ts
ass
o
ciate
d
with
th
e
im
p
r
o
p
er
u
s
e
an
d
h
a
n
d
lin
g
o
f
AB
HS.
Fo
r
in
s
tan
ce
,
th
ey
c
o
u
ld
n
o
t
id
en
tify
th
e
r
is
k
s
o
f
m
eth
a
n
o
l
p
o
is
o
n
i
n
g
an
d
th
e
n
ee
d
f
o
r
f
o
llo
win
g
th
e
W
HO
o
r
C
DC
s
tan
d
ar
d
p
r
o
to
c
o
l
.
T
h
ese
f
in
d
i
n
g
s
alig
n
wi
th
th
e
g
l
o
b
al
c
o
n
ce
r
n
s
o
f
th
e
W
o
r
ld
Hea
lth
Or
g
an
izatio
n
r
e
g
ar
d
in
g
th
e
wid
esp
r
ea
d
g
r
o
wth
a
n
d
u
s
e
o
f
s
u
b
s
tan
d
ar
d
s
an
itizer
s
,
esp
ec
ially
in
th
e
d
ev
elo
p
in
g
c
o
u
n
tr
ies
s
in
ce
th
e
b
eg
in
n
in
g
o
f
th
e
C
OVI
D
-
1
9
p
a
n
d
em
ic
[
2
4
]
.
C
OVI
D
-
1
9
d
is
ea
s
e
h
as
cr
ea
ted
u
n
p
r
ec
e
d
en
ted
ch
allen
g
es
wo
r
ld
wid
e
o
v
er
th
e
last
f
ew
y
ea
r
s
[
2
5
]
.
L
ea
d
in
g
s
cien
tific
o
r
g
an
izatio
n
s
,
in
clu
d
in
g
th
e
W
o
r
ld
Hea
lth
Or
g
an
izatio
n
an
d
th
e
C
en
ter
s
f
o
r
Dis
ea
s
e
C
o
n
tr
o
l
an
d
Pre
v
en
tio
n
,
h
a
v
e
ad
o
p
ted
h
ea
lth
a
n
d
s
af
ety
p
r
o
to
co
ls
b
y
in
co
r
p
o
r
at
in
g
p
r
ev
en
tiv
e
m
ea
s
u
r
es
f
o
r
C
OVI
D
-
1
9
d
is
ea
s
e
[
2
6
]
.
Simi
lar
m
is
co
n
ce
p
tio
n
s
wer
e
also
h
ig
h
lig
h
ted
in
th
e
r
esear
ch
b
y
Alwan
et
al
.
[
2
7
]
r
eiter
atin
g
th
e
n
ee
d
f
o
r
m
o
r
e
p
u
b
lic
ed
u
ca
tio
n
in
itiativ
es
o
n
th
e
s
af
ety
is
s
u
e
s
ass
o
ciate
d
with
th
e
u
s
e
an
d
h
an
d
lin
g
o
f
AB
HS
.
Sin
ce
in
ap
p
r
o
p
r
iate
u
s
e
o
f
h
an
d
s
an
itizer
s
p
o
s
e
s
s
ig
n
if
ican
t
h
ea
lth
r
is
k
s
,
th
e
p
r
esen
t
s
tu
d
y
attem
p
ted
to
e
x
p
lo
r
e
t
h
e
k
n
o
wled
g
e
an
d
p
r
ac
tice
o
f
h
an
d
s
an
itizer
u
s
e
am
o
n
g
u
n
iv
e
r
s
ity
s
tu
d
en
ts
in
Dh
ak
a,
B
an
g
lad
esh
.
Sig
n
if
ican
t
p
r
ed
icto
r
s
o
f
k
n
o
wled
g
e
an
d
p
r
ac
tice
s
co
r
es
ar
e
s
ex
,
ag
e,
cu
r
r
en
t
m
ajo
r
,
an
d
f
am
ily
in
c
o
m
e
s
o
u
r
ce
s
,
id
en
tifie
d
in
th
e
m
u
ltip
le
r
eg
r
ess
io
n
an
aly
s
is
.
T
h
e
r
esu
lts
o
f
o
u
r
s
tu
d
y
ar
e
f
o
u
n
d
to
b
e
co
n
s
is
ten
t
with
s
o
m
e
o
th
er
s
tu
d
ies
co
n
d
u
cte
d
in
th
e
m
id
d
le
-
in
c
o
m
e
an
d
lo
wer
m
id
d
le
-
i
n
co
m
e
co
u
n
tr
ies.
I
n
th
o
s
e
s
tu
d
ies,
it
h
as
b
ee
n
s
ee
n
th
at
th
e
co
r
r
elatio
n
b
etwe
en
s
o
cio
-
d
em
o
g
r
ap
h
ic
f
ac
to
r
s
an
d
h
ea
lth
k
n
o
wled
g
e
a
n
d
b
e
h
av
i
o
r
ar
e
s
tatis
tically
s
ig
n
if
ican
t.
Fo
r
in
s
tan
ce
,
o
n
e
o
f
th
e
s
tu
d
ies
f
o
u
n
d
t
h
at
y
o
u
n
g
er
f
em
ale
s
tu
d
e
n
ts
an
d
o
ld
er
s
tu
d
en
ts
ten
d
t
o
h
av
e
a
h
ig
h
er
lev
el
o
f
k
n
o
wl
ed
g
e
as
well
as
p
r
ac
tice
s
r
ela
ted
to
th
e
u
s
e
o
f
AB
HS
to
p
r
ev
en
t
th
e
s
p
r
ea
d
o
f
co
r
o
n
a
v
ir
u
s
[
2
8
]
.
I
n
c
o
n
tr
ast
to
o
u
r
f
in
d
in
g
s
,
v
ar
io
u
s
b
e
h
av
io
r
al
th
eo
r
ies
s
u
c
h
as
He
alth
B
elief
Mo
d
el
s
u
g
g
ests
th
at
o
n
l
y
k
n
o
wled
g
e
ca
n
n
o
t
d
r
iv
e
a
b
e
h
av
io
r
al
ch
an
g
e
[
2
9
]
.
Per
ce
p
tio
n
o
f
i
n
d
iv
id
u
als
r
eg
ar
d
in
g
s
u
s
ce
p
tib
ilit
y
,
s
ev
er
ity
an
d
c
u
es
to
ac
tio
n
s
is
also
cr
itical
to
d
r
iv
e
b
eh
av
io
r
al
ch
a
n
g
e
s
ass
o
ciate
d
with
h
y
g
ien
e.
Mo
r
e
th
a
n
h
alf
o
f
th
e
r
esp
o
n
d
en
ts
u
s
e
h
an
d
s
an
itizer
s
wh
ile
s
tay
in
g
o
u
td
o
o
r
s
wh
e
n
s
u
b
o
p
tim
al
h
an
d
wash
in
g
f
ac
ilit
ies
m
ak
e
it
d
if
f
icu
lt
t
o
en
s
u
r
e
h
a
n
d
h
y
g
ien
e.
T
h
is
is
a
c
o
m
m
o
n
p
r
a
ctice
as
r
ep
o
r
ted
i
n
o
th
er
s
tu
d
ies
as
well
[
3
0
]
.
Mo
s
t
s
tu
d
en
ts
d
ec
id
e
o
n
h
an
d
s
an
itizer
s
b
ased
o
n
th
e
b
r
a
n
d
s
'
p
o
p
u
lar
ity
an
d
m
an
u
f
ac
tu
r
er
s
'
o
r
ig
in
.
T
h
e
co
m
p
o
s
itio
n
o
f
in
g
r
ed
ien
ts
in
th
e
h
an
d
s
an
itizer
s
co
n
tr
ib
u
tes
i
n
s
ig
n
if
ican
tly
wh
ile
p
u
r
ch
asin
g
h
an
d
s
an
itizer
s
b
y
th
e
p
ar
ticip
atin
g
s
tu
d
en
ts
.
T
h
i
s
is
a
ls
o
r
ep
o
r
ted
in
o
th
er
s
tu
d
ies
th
at
in
g
r
ed
ien
ts
o
f
th
e
s
an
itizer
s
r
ar
el
y
p
lay
a
r
o
le
in
p
u
r
c
h
ase
d
ec
is
io
n
m
ak
in
g
[
3
1
]
.
Desp
ite
th
e
c
o
n
v
en
ien
ce
o
f
h
an
d
s
an
itizer
u
s
e,
alm
o
s
t
all
s
tu
d
en
ts
p
er
ce
iv
e
th
at
e
x
ce
s
s
iv
e
u
s
e
o
f
h
a
n
d
s
an
itizer
s
ca
n
ca
u
s
e
a
r
ash
o
n
th
e
s
k
in
,
s
k
in
d
r
y
n
ess
,
ab
r
asio
n
,
f
is
s
u
r
es,
itch
in
g
an
d
s
o
r
e
n
ess
.
A
h
an
d
f
u
l
o
f
s
cien
tific
s
tu
d
ies
also
m
ak
e
it
ev
i
d
en
t
th
a
t
f
r
eq
u
e
n
t
an
d
p
r
o
lo
n
g
ed
h
a
n
d
s
an
itizatio
n
ca
u
s
es
s
k
in
p
r
o
b
lem
s
,
in
clu
d
in
g
lesi
o
n
s
,
ac
n
e,
d
r
y
n
ess
,
itch
in
g
,
an
d
r
ash
[
3
2
]
.
T
h
ese
f
i
n
d
in
g
s
also
h
ig
h
lig
h
t
th
e
im
p
o
r
tan
ce
o
f
m
o
r
e
p
u
b
lic
awa
r
en
ess
an
d
ed
u
ca
tio
n
.
T
h
ese
awa
r
en
ess
in
itiativ
es
s
h
o
u
ld
f
o
cu
s
b
o
th
o
n
awa
r
en
ess
o
n
th
e
s
af
ety
a
n
d
ef
f
icac
y
o
f
AB
HS
an
d
co
r
r
ec
tio
n
o
f
th
e
m
is
co
n
ce
p
tio
n
s
tated
in
th
e
f
in
d
in
g
s
.
T
ailo
r
e
d
p
r
o
g
r
am
s
f
o
cu
s
in
g
o
n
th
e
s
o
cio
-
ec
o
n
o
m
ic
v
ar
iab
ilit
y
o
f
th
e
s
tu
d
en
ts
co
u
ld
m
ak
e
th
e
in
itia
tiv
es
m
o
r
e
ef
f
ec
tiv
e.
L
ev
e
r
ag
i
n
g
th
e
s
o
cial
m
e
d
ia
p
latf
o
r
m
s
ca
n
g
en
e
r
ate
m
o
r
e
b
en
ef
its
in
th
is
r
eg
ar
d
s
in
ce
u
n
iv
er
s
ity
s
tu
d
en
ts
s
p
en
d
m
o
r
e
tim
e
o
n
s
o
cial
m
ed
ia.
I
t
is
c
o
n
f
ir
m
e
d
in
s
tu
d
ies
th
at
s
o
cial
m
ed
ia
p
lay
s
a
n
in
f
lu
en
tial
r
o
le
in
th
e
k
n
o
wled
g
e
an
d
b
eh
a
v
io
r
r
eg
a
r
d
in
g
h
a
n
d
h
y
g
ien
e
p
r
ac
tices
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
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SS
N:
2252
-
8
8
0
6
A
lco
h
o
l
-
b
a
s
ed
h
a
n
d
s
a
n
itiz
er u
s
e
a
mo
n
g
u
n
ivers
ity
s
tu
d
en
ts
in
B
a
n
g
l
a
d
esh
:
…
(
Md
E
kh
tek
h
a
r
u
l I
s
la
m
)
1485
[
3
3
]
,
[
3
4
]
.
T
h
ese
p
latf
o
r
m
s
ar
e
ef
f
ec
tiv
e
f
o
r
d
is
s
em
in
atio
n
o
f
e
f
f
ec
tiv
e
an
d
u
s
ef
u
l
i
n
f
o
r
m
atio
n
to
wid
er
au
d
ien
ce
s
th
r
o
u
g
h
v
er
if
ied
m
e
an
s
.
Ap
ar
t f
r
o
m
th
ese
in
itiativ
es,
s
tr
in
g
en
t p
o
licies n
ee
d
to
b
e
in
p
lace
to
en
s
u
r
e
q
u
ality
co
n
tr
o
l
o
f
th
e
AB
HS
p
r
o
d
u
cts
in
B
an
g
lad
esh
.
Sin
ce
th
e
f
in
d
in
g
s
o
f
o
u
r
s
tu
d
y
al
ig
n
with
th
e
g
lo
b
al
r
ep
o
r
ts
o
n
in
cr
ea
s
ed
h
ea
lth
r
i
s
k
s
ass
o
ciate
d
with
th
e
u
s
e
o
f
s
u
b
s
tan
d
ar
d
s
an
itizer
s
,
r
eg
u
lato
r
y
b
o
d
ies
m
u
s
t
en
f
o
r
ce
s
tan
d
ar
d
g
u
id
elin
es
a
n
d
p
r
o
to
co
ls
.
L
ess
o
n
s
ca
n
b
e
d
r
awn
f
r
o
m
th
e
c
o
u
n
t
r
ies
wh
er
e
th
er
e
ar
e
b
est
ef
f
o
r
ts
o
f
s
tr
in
g
en
t
r
eg
u
lato
r
y
f
r
am
ewo
r
k
s
s
u
ch
as
USA
an
d
E
U.
Un
m
ea
s
u
r
ed
f
ac
to
r
s
lik
e
p
er
ce
p
tio
n
o
f
s
u
s
ce
p
tib
ilit
y
an
d
s
ev
er
ity
ca
n
b
e
u
n
d
er
tak
e
n
in
f
u
tu
r
e
s
tu
d
ie
s
.
L
o
n
g
itu
d
i
n
al
s
tu
d
ies
ca
n
also
b
e
u
n
d
er
ta
k
en
t
o
ass
es
s
th
e
im
p
ac
ts
o
f
s
u
s
tain
e
d
ed
u
ca
tio
n
al
in
itiativ
es
f
o
r
b
eh
av
io
r
al
ch
a
n
g
es
in
ter
m
s
o
f
h
an
d
h
y
g
ien
e
u
s
in
g
s
an
itizer
s
.
5.
CO
NCLU
SI
O
N
T
h
e
f
i
n
d
i
n
g
s
o
f
t
h
i
s
s
t
u
d
y
i
n
d
i
c
a
t
e
t
h
a
t
u
n
i
v
e
r
s
i
t
y
s
t
u
d
e
n
t
s
h
a
v
e
i
n
s
u
f
f
i
c
i
e
n
t
k
n
o
w
l
e
d
g
e
r
e
g
a
r
d
i
n
g
t
h
e
c
o
m
p
o
s
i
t
i
o
n
a
n
d
e
f
f
i
c
a
c
y
o
f
a
l
c
o
h
o
l
-
b
a
s
e
d
h
a
n
d
s
a
n
it
i
z
e
r
s
.
M
o
s
t
f
a
ct
o
r
s
d
i
d
n
o
t
s
i
g
n
i
f
i
c
a
n
t
l
y
a
f
f
e
c
t
t
h
e
k
n
o
w
l
e
d
g
e
a
n
d
p
r
a
c
ti
c
e
s
c
o
r
e
a
s
s
o
c
i
at
e
d
wi
t
h
A
B
H
S
u
s
e
o
f
t
h
e
s
t
u
d
e
n
ts
a
b
o
u
t
s
a
n
it
i
z
e
r
s
a
n
d
d
i
s
i
n
f
e
c
t
a
n
ts
.
H
o
w
e
v
e
r
,
f
a
ct
o
r
s
i
n
c
l
u
d
i
n
g
a
g
e
,
s
e
x
,
a
n
d
f
a
m
i
l
y
i
n
c
o
m
e
i
n
f
lu
e
n
c
e
t
h
e
k
n
o
w
le
d
g
e
a
n
d
p
r
a
ct
i
c
e
s
c
o
r
e
ass
o
c
i
a
te
d
w
i
t
h
u
s
i
n
g
AB
HS
a
m
o
n
g
t
h
e
p
a
r
t
i
c
i
p
at
i
n
g
s
t
u
d
e
n
t
s
.
T
h
e
s
t
u
d
y
r
e
i
t
e
r
a
te
s
t
h
e
n
e
e
d
f
o
r
m
u
lt
i
f
a
ce
t
e
d
a
n
d
d
e
d
i
c
at
e
d
e
f
f
o
r
t
s
i
n
b
e
h
a
v
i
o
r
a
l
a
w
a
r
e
n
ess
p
r
o
g
r
a
m
s
t
o
a
d
d
r
es
s
t
h
e
g
a
p
s
i
n
k
n
o
w
l
e
d
g
e
a
n
d
p
r
a
ct
i
c
e
as
s
o
ci
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[
7
]
W
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[
8
]
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1
3
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.
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4
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.
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1
5
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.
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7
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lsu
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k
.
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