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Vo
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14
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Dec
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er
20
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p
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1
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Dep
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Mic
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Facu
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Scien
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Alli Un
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Nig
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co
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1.
I
NT
RO
D
UCT
I
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N
C
a
n
d
id
a
s
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a
f
u
n
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tio
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to
th
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s
C
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[
1
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.
T
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2
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p
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C
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wh
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C
a
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d
id
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a
lb
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s
[
2
]
,
[
3
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.
Al
th
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g
h
C
a
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d
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is
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m
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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:
2
2
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2
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8
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6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
4
,
Dec
em
b
er
20
25
:
17
57
-
17
64
1758
th
ese
o
r
g
an
is
m
s
ca
n
ca
u
s
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s
y
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p
to
m
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[
4
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[
5
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[
7
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.
Vu
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ca
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C
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s
[
8
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.
Vag
in
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ch
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[
9
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[
1
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.
C
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[
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o
n
ly
ca
u
s
ed
b
y
in
f
ec
tio
n
,
with
7
0
%
o
f
all
ca
s
es
ass
o
ciate
d
with
v
u
lv
o
v
ag
in
al
ca
n
d
i
d
iasi
s
,
b
ac
ter
ial
v
a
g
in
o
s
is
,
o
r
Tr
ich
o
mo
n
a
s
v
a
g
in
a
lis
[
1
1
]
,
[
1
2
]
.
T
h
e
m
o
s
t
co
m
m
o
n
in
f
ec
tio
n
in
p
r
eg
n
an
cy
in
m
o
s
t
s
tu
d
ies
is
C
.
a
lb
ica
n
s
in
f
ec
tio
n
[
1
3
]
-
[
1
5
]
.
T
h
is
in
f
ec
tio
n
co
u
ld
r
esu
lt
in
s
ig
n
if
ican
t
n
eg
ativ
e
m
ate
r
n
al,
f
o
e
tal
,
an
d
ev
e
n
n
e
o
n
atal
o
u
tc
o
m
es
[
8
]
,
[
1
6
]
.
T
h
e
h
ig
h
er
in
cid
e
n
ce
r
ate
o
f
v
a
g
in
al
in
f
ec
tio
n
s
in
p
r
eg
n
an
t
wo
m
en
th
an
in
n
o
n
-
p
r
eg
n
a
n
t
wo
m
en
is
attr
ib
u
ted
to
th
e
in
cr
ea
s
e
o
estro
g
e
n
co
n
te
n
t o
f
v
a
g
in
al
m
u
c
o
s
a
[
1
7
]
,
[
1
8
]
.
Pre
g
n
an
cy
alter
s
th
e
im
m
u
n
e
s
y
s
tem
,
leav
in
g
wo
m
en
m
o
r
e
s
u
s
ce
p
tib
le
to
in
f
ec
tio
n
s
.
Am
o
n
g
th
ese,
v
ag
in
al
in
f
ec
tio
n
s
ar
e
esp
ec
i
ally
f
r
eq
u
e
n
t,
with
v
u
lv
o
v
ag
in
al
ca
n
d
id
iasi
s
,
wh
ich
is
p
r
im
ar
ily
ca
u
s
ed
b
y
C
a
n
d
id
a
a
lb
ica
n
s
,
b
ein
g
a
co
m
m
o
n
co
n
ce
r
n
.
Desp
ite
its
p
r
ev
alen
ce
,
d
ata
co
m
p
ar
in
g
C
a
n
d
id
a
in
f
ec
tio
n
s
in
p
r
eg
n
a
n
t
v
er
s
u
s
n
o
n
-
p
r
eg
n
an
t
wo
m
en
r
em
ain
s
ca
r
ce
i
n
m
a
n
y
p
a
r
ts
o
f
E
d
o
State.
T
h
is
lack
o
f
in
f
o
r
m
atio
n
co
m
p
licates
ef
f
o
r
ts
to
estab
li
s
h
ef
f
ec
tiv
e
s
cr
ee
n
in
g
an
d
tr
ea
tm
en
t
p
r
o
to
co
ls
d
u
r
in
g
p
r
e
n
atal
ca
r
e.
Fro
m
a
clin
ical
s
tan
d
p
o
in
t,
id
en
tify
i
n
g
t
h
e
e
x
ac
t
C
a
n
d
i
d
a
s
p
ec
ies
is
cr
u
cial
b
ec
a
u
s
e
n
o
t
all
r
esp
o
n
d
e
q
u
ally
t
o
an
tifu
n
g
al
m
ed
icatio
n
s
.
T
h
is
ca
n
r
esu
lt
in
p
er
s
is
ten
t
in
f
ec
tio
n
s
an
d
f
ailed
tr
ea
tm
en
ts
.
T
h
er
ef
o
r
e
,
ac
cu
r
ate
s
p
ec
ies
id
en
tific
atio
n
d
ir
ec
tly
in
f
lu
en
ce
s
h
o
w
ca
s
es
ar
e
m
an
ag
ed
,
h
elp
s
p
r
e
v
e
n
t
co
m
p
licatio
n
s
,
an
d
u
ltima
tely
s
u
p
p
o
r
ts
b
etter
h
ea
lth
o
u
tco
m
es
f
o
r
ex
p
ec
tan
t
m
o
th
er
s
.
I
n
th
is
wo
r
k
,
we
in
ten
d
to
p
r
o
v
id
e
u
p
d
ated
m
icr
o
b
io
lo
g
ical
d
ata
th
at
is
la
ck
in
g
ab
o
u
t
C
a
n
d
id
a
s
p
ec
ies
ca
u
s
in
g
in
f
ec
tio
n
s
in
p
r
e
g
n
an
t
an
d
n
o
n
-
p
r
e
g
n
an
t
wo
m
en
in
a
p
ar
t
o
f
th
e
wo
r
ld
th
at
h
as
lim
ited
f
ac
il
ities
f
o
r
b
asic
h
ea
lth
ca
r
e.
Hen
ce
,
th
is
s
tu
d
y
aim
s
to
d
eter
m
in
e
th
e
v
ar
iatio
n
in
t
h
e
C
a
n
d
id
a
s
p
ec
ies
ca
u
s
in
g
v
u
lv
o
v
a
g
in
al
ca
n
d
i
d
iasi
s
in
p
r
eg
n
a
n
t
an
d
n
o
n
-
p
r
eg
n
a
n
t
wo
m
en
atten
d
i
n
g
p
r
i
m
ar
y
h
ea
lth
ca
r
e
ce
n
tr
es
in
E
k
p
o
m
a,
E
d
o
S
tate,
Nig
er
ia,
wh
er
e
th
e
s
tate
-
o
wn
ed
Am
b
r
o
s
e
Alli Un
iv
er
s
ity
is
lo
ca
ted
.
2.
M
E
T
H
O
D
T
h
e
lab
o
r
at
o
r
y
in
v
esti
g
atio
n
f
o
r
th
is
s
tu
d
y
was
ca
r
r
ie
d
o
u
t
at
th
e
Mic
r
o
b
io
lo
g
y
lab
o
r
at
o
r
y
o
f
th
e
Dep
ar
tm
en
t o
f
Me
d
ical
L
ab
o
r
ato
r
y
Scien
ce
,
Am
b
r
o
s
e
Alli Un
iv
er
s
ity
,
E
k
p
o
m
a.
E
d
o
State
.
2
.
1
.
Study
des
ig
n
A
co
m
m
u
n
ity
-
b
ased
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
d
esig
n
was
u
s
ed
am
o
n
g
p
r
eg
n
an
t
a
n
d
n
o
n
-
p
r
eg
n
an
t
wo
m
en
wh
o
r
eg
is
ter
ed
in
Uj
u
o
len
a
n
d
Up
k
en
u
Prim
ar
y
Hea
lth
C
ar
e
ce
n
ter
s
in
E
k
p
o
m
a
,
E
s
an
-
W
est
L
o
ca
l
Go
v
er
n
m
e
n
t a
r
ea
,
E
d
o
State
,
Nig
er
ia.
2
.
2
.
I
nclus
io
n/
ex
clus
io
n c
rit
er
ia
T
h
e
in
clu
s
io
n
cr
iter
ia
f
o
r
t
h
is
s
tu
d
y
ar
e:
all
c
o
n
s
en
tin
g
p
r
e
g
n
an
t
a
n
d
n
o
n
-
p
r
e
g
n
an
t
wo
m
e
n
in
d
icate
d
f
o
r
h
ig
h
v
a
g
in
al
s
wab
cu
ltu
r
e,
atten
d
in
g
Prim
ar
y
Hea
lth
C
ar
e
C
en
ter
s
,
E
s
an
W
est,
with
n
o
h
is
to
r
y
o
f
an
tifu
n
g
al
u
s
ag
e
in
t
h
e
last
two
m
o
n
th
s
.
T
h
e
e
x
clu
d
e
d
g
r
o
u
p
in
th
is
s
tu
d
y
:
n
o
n
-
co
n
s
en
tin
g
wo
m
en
;
wo
m
en
n
o
t
in
d
icate
d
f
o
r
h
ig
h
v
a
g
in
al
s
wab
cu
ltu
r
e;
n
o
t
atten
d
in
g
P
HC
s
;
with
a
h
is
to
r
y
o
f
an
tifu
n
g
al
u
s
ag
e
in
t
h
e
last
two
m
o
n
th
s
.
2
.
3
.
Are
a
o
f
s
t
ud
y
/s
a
m
ple size
T
h
e
p
r
im
ar
y
h
ea
lt
h
ca
r
e
ce
n
t
er
s
wh
er
e
p
r
eg
n
an
t
wo
m
e
n
g
o
f
o
r
a
n
ten
atal
ca
r
e
a
r
e
lo
ca
te
d
in
E
s
an
-
W
est L
o
ca
l G
o
v
er
n
m
en
t A
r
ea
o
f
E
d
o
State,
Nig
er
ia.
E
k
p
o
m
a
is
th
e
ad
m
in
is
tr
ativ
e
h
ea
d
q
u
ar
ter
s
o
f
E
s
an
-
W
est
L
o
ca
l
Go
v
er
n
m
e
n
t
Ar
ea
an
d
h
as
a
to
tal
p
o
p
u
latio
n
o
f
1
6
7
,
7
2
1
(
NPC
,
2
0
0
6
)
.
T
h
e
in
h
ab
itan
ts
ar
e
m
ain
ly
f
ar
m
er
s
,
ar
tis
an
s
,
g
o
v
er
n
m
e
n
t
wo
r
k
er
s
,
a
n
d
s
tu
d
e
n
ts
o
f
ter
tiar
y
in
s
titu
tio
n
s
,
o
f
w
h
ich
Am
b
r
o
s
e
Alli
Un
iv
er
s
ity
is
o
n
e
o
f
th
em
.
T
h
e
n
u
m
b
er
o
f
s
u
b
jects
u
s
ed
in
th
is
s
tu
d
y
was
g
u
id
ed
b
y
an
u
p
p
er
lim
it
to
g
iv
e
9
5
% c
o
n
f
id
en
ce
at
an
ex
p
ec
te
d
p
r
ev
ale
n
ce
o
f
ab
o
u
t 3
7
% f
r
o
m
a
p
r
ev
i
o
u
s
s
tu
d
y
[
1
9
]
.
S
a
mp
le
s
iz
e
=
²
²
W
h
er
e
Z
=
co
n
f
i
d
en
ce
lev
el
(
9
5
%)
=
1
.
9
6
.
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
C
h
a
r
a
teri
z
a
tio
n
o
f Ca
n
d
id
a
s
p
ec
ies is
o
la
ted
fr
o
m
p
r
eg
n
a
n
t
w
o
men
w
ith
…
(
Ma
r
ce
llin
u
s
Oko
d
u
a
)
1759
P =
ex
p
ec
ted
p
r
ev
alen
ce
=
3
7
% =
0
.
3
7
.
q
=
1
.
0
–
p
=1
1
-
0
.
3
7
=
0
.
6
3
.
d
=
m
ar
g
i
n
o
f
er
r
o
r
=
0
.
0
6
5
.
Sam
p
le
s
ize
=
1
.
96
²
×
0
.
37
×
0
.
63
0
.
065²
.
Sam
p
le
s
ize
=
2
1
1
.
9
5
~2
1
2
s
am
p
les
.
2
.
4
.
Da
t
a
c
o
llect
io
n ins
t
rum
ent
s
/pro
ce
du
re
T
h
e
s
tu
d
y
co
m
p
r
is
ed
2
2
0
s
u
b
j
ec
ts
:
1
5
1
p
r
eg
n
an
t
wo
m
e
n
wh
o
r
eg
is
ter
ed
in
th
e
Prim
ar
y
Hea
lth
C
ar
e
C
en
tr
e
f
o
r
an
ten
atal
ca
r
e
a
n
d
6
9
n
o
n
-
p
r
eg
n
an
t
wo
m
en
wh
o
als
o
v
is
ited
th
e
h
ea
lth
f
ac
ilit
y
.
T
h
e
s
o
cio
-
d
em
o
g
r
a
p
h
ic
i
n
f
o
r
m
atio
n
u
s
ed
f
o
r
th
e
s
tu
d
y
was
co
llecte
d
f
r
o
m
t
h
e
r
ec
o
r
d
s
o
f
t
h
e
s
u
b
jects
in
th
e
h
ea
lth
f
ac
ilit
ies
.
T
h
e
s
p
ec
im
en
s
wer
e
co
llected
f
r
o
m
ea
ch
s
u
b
ject
b
y
m
ea
n
s
o
f
a
s
ter
ile
s
wab
s
tick
b
y
th
e
atten
d
in
g
p
h
y
s
ician
.
T
h
ey
we
r
e
p
r
o
p
er
l
y
lab
elled
with
an
id
en
tific
ati
o
n
n
u
m
b
er
an
d
s
en
t
im
m
ed
iat
ely
to
th
e
lab
o
r
ato
r
y
f
o
r
an
al
y
s
is
.
2
.
5
.
I
s
o
la
t
io
n,
identif
ica
t
io
n,
a
nd
cha
ra
ct
er
iza
t
io
n
o
f
C
a
nd
id
a
T
h
e
s
am
p
le
o
n
th
e
s
wab
s
tic
k
was
u
s
ed
t
o
m
a
k
e
a
p
r
im
a
r
y
in
o
c
u
lu
m
o
n
th
e
s
u
r
f
ac
e
o
f
p
r
ep
a
r
ed
S
ab
o
u
r
au
d
d
ex
t
r
o
s
e
ag
ar
(
SDA)
,
s
tr
ea
k
ed
with
th
e
ai
d
o
f
a
wir
e
lo
o
p
,
an
d
i
n
cu
b
ate
d
at
3
7
°C
f
o
r
4
8
h
o
u
r
s
.
Af
ter
in
cu
b
atio
n
,
th
e
p
late
s
wer
e
o
b
s
er
v
ed
f
o
r
f
u
n
g
al
g
r
o
wth
,
an
d
th
e
is
o
lates
wer
e
id
en
tifie
d
as
C
a
n
d
id
a
u
s
in
g
th
e
Gr
am
s
tain
in
g
tec
h
n
i
q
u
e.
T
h
e
Gr
am
s
tain
r
ev
ea
led
g
r
am
-
p
o
s
itiv
e
y
ea
s
t
-
lik
e
b
u
d
d
i
n
g
ce
lls
.
T
h
e
SDA
is
o
lates
wer
e
in
o
cu
lated
in
C
a
n
d
id
a
s
elec
tiv
e
m
ed
iu
m
,
u
s
in
g
C
HR
OM
TM
Ca
n
d
id
a
(
C
AC
)
,
an
d
in
c
u
b
ated
at
37
°
C
f
o
r
7
2
h
o
u
r
s
to
en
s
u
r
e
d
etec
tio
n
o
f
m
ix
ed
cu
ltu
r
es.
On
SDA
,
C
.
a
lb
ica
n
s
s
h
o
wed
a
wh
ite
co
lo
u
r
ed
,
s
m
o
o
th
,
a
n
d
y
ea
s
t
-
lik
e
a
p
p
ea
r
an
ce
;
C
a
n
d
id
a
p
a
r
a
p
s
ilo
s
is
co
lo
n
ies
w
ere
w
h
ite
to
crea
my,
s
h
in
y,
a
n
d
s
mo
o
t
h
;
C
a
n
d
id
a
d
u
b
lin
ien
s
is
w
a
s
crea
m
to
w
h
ite;
C
a
n
d
id
a
g
la
b
r
a
ta
co
lo
n
ies
w
ere
s
mo
o
th
a
n
d
w
h
ite
-
co
lo
u
r
ed
;
wh
ile
C
a
n
d
id
a
kru
s
ei
s
h
o
wed
r
o
u
g
h
co
lo
n
ies.
On
C
AC
,
C
.
a
lb
ica
n
s
was
g
r
ee
n
;
C.
g
la
b
r
a
t
a
was
p
in
k
-
p
u
r
p
le;
C.
p
a
r
a
s
ip
lo
s
is
was
wh
ite
to
p
ale
p
in
k
,
a
n
d
C
.
kru
s
ei
a
p
p
e
ar
ed
as
p
i
n
k
co
lo
n
ies.
T
h
e
C
AC
m
eth
o
d
is
b
ased
o
n
th
e
d
if
f
er
e
n
tial
r
elea
s
e
o
f
ch
r
o
m
o
g
en
ic
b
r
ea
k
d
o
wn
p
r
o
d
u
cts
f
r
o
m
v
ar
io
u
s
s
u
b
s
tr
ates
b
y
C
a
n
d
id
a
s
p
ec
ies
af
ter
d
if
f
er
e
n
tial e
x
o
e
n
zy
m
e
a
ctiv
ity
.
2
.
6
.
St
a
t
is
t
ica
l
a
na
ly
s
is
Statis
t
ical
an
aly
s
is
wa
s
d
o
n
e
u
s
in
g
th
e
C
h
i
-
s
q
u
ar
e
test
an
d
th
e
s
tu
d
en
t
t
-
test
to
d
eter
m
in
e
lev
el
o
f
s
ig
n
if
ican
ce
.
A
p
-
v
alu
e
o
f
less
th
an
o
r
eq
u
al
to
0
.
0
5
(
p
≤
0
.
0
5
)
was c
o
n
s
id
er
ed
to
s
tatis
tically
s
ig
n
if
ican
t.
3.
RE
SU
L
T
S
AND
D
I
SCU
SS
I
O
N
T
ab
le
1
s
h
o
ws
th
e
s
o
cio
-
d
e
m
o
g
r
ap
h
ic
ch
ar
ac
ter
is
tics
o
f
th
e
s
tu
d
y
p
o
p
u
latio
n
.
A
to
tal
o
f
2
2
0
p
ar
ticip
an
ts
wer
e
in
cl
u
d
ed
in
th
e
s
tu
d
y
.
T
h
e
m
ajo
r
ity
wer
e
b
etwe
en
th
e
a
g
es
o
f
2
1
–
3
0
y
e
ar
s
(
6
8
.
6
%),
wh
il
e
1
3
.
7
%
wer
e
ag
ed
0
–
2
0
y
ea
r
s
an
d
1
8
.
2
%
wer
e
o
ld
e
r
th
an
3
0
y
ea
r
s
.
W
ith
r
esp
ec
t
to
o
cc
u
p
atio
n
,
m
er
ch
a
n
ts
(
3
2
.
7
%)
an
d
s
tu
d
en
ts
(
3
0
.
5
%)
co
n
s
titu
ted
th
e
lar
g
est
g
r
o
u
p
s
,
f
o
llo
wed
b
y
tailo
r
s
(
1
0
.
5
%),
h
o
u
s
ewiv
es
(
1
0
.
0
%),
an
d
h
ai
r
s
ty
lis
ts
(
9
.
1
%).
Sm
aller
p
r
o
p
o
r
tio
n
s
wer
e
teac
h
er
s
(
2
.
7
%),
f
o
o
d
v
en
d
o
r
s
(
2
.
3
%),
f
ar
m
er
s
(
0
.
9
%
)
,
an
d
o
t
h
er
s
,
s
u
ch
as
n
u
r
s
es,
s
ec
r
etar
ies,
an
d
s
o
ld
ier
s
(
1
.
4
%).
R
eg
ar
d
in
g
p
r
eg
n
a
n
cy
s
tatu
s
,
6
8
.
6
%
wer
e
p
r
eg
n
a
n
t,
d
is
tr
ib
u
ted
ac
r
o
s
s
f
ir
s
t
(
6
.
8
%),
s
ec
o
n
d
(
3
5
.
0
%),
an
d
th
ir
d
(
2
6
.
8
%)
tr
im
ester
s
,
wh
ile
3
1
.
4
%
wer
e
non
-
p
r
eg
n
a
n
t.
T
ab
le
1
.
So
cio
-
d
em
o
g
r
ap
h
ic
c
h
ar
ac
ter
is
tics
o
f
th
e
s
tu
d
y
p
o
p
u
latio
n
C
h
a
r
a
c
t
e
r
i
s
t
i
c
s
V
a
r
i
a
b
l
e
F
r
e
q
u
e
n
c
y
(
n
=
2
2
0
)
P
e
r
c
e
n
t
a
g
e
(
%)
A
g
e
(
y
e
a
r
s)
0
–
20
29
1
3
.
6
8
2
1
–
30
1
5
1
6
8
.
6
4
>
3
0
40
1
8
.
1
8
O
c
c
u
p
a
t
i
o
n
M
e
r
c
h
a
n
t
72
3
2
.
7
3
S
t
u
d
e
n
t
67
3
0
.
4
5
Ta
i
l
o
r
23
1
0
.
4
5
H
o
u
s
e
w
i
f
e
22
1
0
.
0
0
H
a
i
r
st
y
l
i
st
20
9
.
0
9
Te
a
c
h
e
r
6
2
.
7
3
F
o
o
d
v
e
n
d
o
r
5
2
.
2
7
F
a
r
mer
2
0
.
9
1
O
t
h
e
r
s
(
n
u
r
se,
se
c
r
e
t
a
r
y
,
& s
o
l
d
i
e
r
)
3
1
.
3
6
P
r
e
g
n
a
n
c
y
st
a
t
u
s
P
r
e
g
n
a
n
t
1
st
15
6
.
8
2
2
nd
77
3
5
.
0
0
3
rd
59
2
6
.
8
2
N
o
n
-
p
r
e
g
n
a
n
t
69
3
1
.
3
6
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
.
4
,
Dec
em
b
er
20
25
:
17
57
-
17
64
1760
T
ab
le
2
s
h
o
ws
th
e
d
is
tr
ib
u
tio
n
o
f
C
a
n
d
id
a
(
s
p
ec
ies
an
d
in
te
n
s
ity
o
f
g
r
o
wth
)
ac
co
r
d
in
g
to
p
r
eg
n
a
n
cy
s
tatu
s
.
T
h
er
e
wer
e
n
o
s
ig
n
if
ic
an
t
v
ar
iatio
n
s
(
p
>0
.
0
5
)
in
th
e
s
p
ec
ies
o
f
C
a
n
d
i
d
a
is
o
lated
f
r
o
m
p
r
eg
n
an
t
a
n
d
non
-
p
r
eg
n
a
n
t
wo
m
en
.
C
.
a
lb
i
ca
n
s
was
th
e
m
o
s
t
co
m
m
o
n
s
p
ec
ies
is
o
lated
f
r
o
m
p
r
eg
n
a
n
t
wo
m
en
an
d
n
o
n
-
p
r
eg
n
a
n
t
wo
m
e
n
,
7
5
.
8
6
%
an
d
7
7
.
7
8
%
r
esp
ec
tiv
ely
.
I
n
p
r
eg
n
an
t
w
o
m
en
,
th
is
was
f
o
llo
wed
b
y
C
.
kru
s
ei
(
1
0
.
3
4
%),
C
.
d
u
b
lin
ien
s
is
an
d
C
.
g
la
b
r
a
ta
(
5
.
1
7
%
ea
ch
)
,
a
n
d
C
.
p
a
r
a
p
s
ilo
s
is
was
f
o
u
n
d
in
(
1
.
7
2
%),
wh
ile
m
ix
ed
i
n
f
ec
tio
n
,
b
o
th
C
.
d
u
b
li
n
ien
s
is
an
d
C
.
p
a
r
a
p
s
ilo
s
is
w
er
e
f
o
u
n
d
in
1
.
7
2
%.
Am
o
n
g
t
h
e
n
o
n
-
p
r
eg
n
an
t
C
.
a
lb
ica
n
s
was
th
e
m
o
s
t
co
m
m
o
n
s
p
ec
ies
is
o
lated
,
f
o
llo
wed
b
y
C
.
d
u
b
lin
ien
s
is
an
d
C
.
g
la
b
r
a
ta
(
1
1
.
1
1
%
ea
ch
)
.
C
.
kru
s
ei
an
d
C
.
p
a
r
a
p
s
ilo
s
is
wer
e
n
o
t
is
o
lated
f
r
o
m
n
o
n
-
p
r
eg
n
an
t
wo
m
en
.
Fig
u
r
es
1
-
4
s
h
o
w
th
e
ap
p
ea
r
an
c
e
o
f
v
ar
io
u
s
s
p
ec
ies
o
f
C
a
n
d
id
a
o
n
C
HR
OM
ag
ar
C
a
n
d
id
a
.
T
h
er
e
was
also
n
o
s
ig
n
if
ican
t
v
ar
iatio
n
(
p
>0
.
0
5
)
in
th
e
in
ten
s
ity
o
f
C
a
n
d
id
a
g
r
o
wth
ac
co
r
d
in
g
to
p
r
e
g
n
an
c
y
s
tatu
s
,
b
u
t
th
e
n
o
n
-
p
r
eg
n
a
n
t
wo
m
en
h
ad
h
ea
v
ie
r
g
r
o
wth
(
2
2
.
2
2
%)
co
m
p
ar
ed
t
o
th
eir
p
r
e
g
n
an
t c
o
u
n
ter
p
ar
ts
(
1
8
.
9
7
%).
T
ab
le
2
.
Dis
tr
ib
u
tio
n
of
C
a
n
d
id
a
s
p
ec
ies
an
d
in
te
n
s
ity
of
g
r
o
wth
am
o
n
g
p
r
eg
n
an
t
an
d
n
o
n
-
p
r
eg
n
a
n
t
wo
m
en
V
a
r
i
a
b
l
e
C
a
t
e
g
o
r
y
P
r
e
g
n
a
n
t
(
n
=
5
8
)
(
%)
N
o
n
-
p
r
e
g
n
a
n
t
(
n
=
1
8
)
(
%)
X
2
p
-
v
a
l
u
e
S
p
e
c
i
e
s
C
.
a
l
b
i
c
a
n
s
4
4
(
7
5
.
8
6
)
1
4
(
7
7
.
7
8
)
3
.
9
6
2
0
.
5
5
5
C
.
d
u
b
l
i
n
i
e
n
s
i
s
3
(
5
.
1
7
)
2
(
1
1
.
1
1
)
C
.
g
l
a
b
ra
t
a
3
(
5
.
1
7
)
2
(
1
1
.
1
1
)
C
.
k
ru
s
e
i
6
(
1
0
.
3
4
)
0
(
0
.
0
0
)
C
.
p
a
ra
p
si
l
o
si
s
1
(
1
.
7
2
)
0
(
0
.
0
0
)
M
i
x
e
d
1
(
1
.
7
2
)
0
(
0
.
0
0
)
I
n
t
e
n
s
i
t
y
o
f
g
r
o
w
t
h
H
e
a
v
y
1
1
(
1
8
.
9
7
)
4
(
2
2
.
2
2
)
0
.
0
9
2
0
.
7
6
2
M
o
d
e
r
a
t
e
4
7
(
8
1
.
0
3
)
1
4
(
7
7
.
7
8
)
Fig
u
r
e
1
.
Pro
p
o
r
tio
n
o
f
C
a
n
d
i
d
a
s
p
ec
ies is
o
lated
f
r
o
m
p
r
eg
n
a
n
t w
o
m
en
atten
d
i
n
g
an
ten
atal
C
lin
ics in
J
u
o
elen
an
d
U
k
p
en
u
Prim
ar
y
Hea
lth
C
ar
e
C
en
tr
es,
E
s
an
W
est L
o
ca
l G
o
v
er
n
m
en
t
Ar
ea
,
E
d
o
State,
Nig
er
ia
Fig
u
r
e
2
.
C
HR
OM
ag
ar
C
a
n
d
i
d
a
p
late
s
h
o
win
g
C
.
kru
s
ei
(
p
in
k
-
1
1
5
,
1
2
0
,
1
2
5
,
a
n
d
1
3
0
)
a
n
d
C
.
g
la
b
r
a
ta
(
wh
ite
–
1
1
7
an
d
1
2
7
)
Fig
u
r
e
3
.
C
HR
OM
ag
ar
C
a
n
d
i
d
a
p
late
s
h
o
win
g
C
.
p
a
r
a
p
s
ilo
s
is
(
f
ain
t p
in
k
-
2
1
)
,
C
.
a
lb
ica
n
s
(
lig
h
t g
r
ee
n
-
2
4
,
2
9
,
3
3
,
an
d
3
4
)
;
C
.
p
a
r
a
p
s
i
lo
s
is
an
d
C
.
d
u
b
lin
en
s
is
Fig
u
r
e
4
.
C
HR
OM
ag
ar
C
a
n
d
i
d
a
p
late
s
h
o
win
g
C
.
d
u
b
lin
en
s
is
(
d
ee
p
g
r
ee
n
,
1
1
an
d
1
4
)
;
C
.
g
l
a
b
r
a
ta
(
wh
ite
-
9
)
;
C
.
a
l
b
ica
n
s
(
lig
h
t
g
r
ee
n
-
6
,
8
,
an
d
1
9
)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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N:
2252
-
8
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6
C
h
a
r
a
teri
z
a
tio
n
o
f Ca
n
d
id
a
s
p
ec
ies is
o
la
ted
fr
o
m
p
r
eg
n
a
n
t
w
o
men
w
ith
…
(
Ma
r
ce
llin
u
s
Oko
d
u
a
)
1761
4.
DIS
CU
SS
I
O
N
Vag
in
al
in
f
ec
tio
n
s
in
p
r
eg
n
an
cy
ar
e
ass
o
ciate
d
with
co
n
s
id
er
ab
le
d
is
co
m
f
o
r
t
an
d
ad
v
er
s
e
p
r
eg
n
a
n
cy
o
u
tco
m
es
,
in
cl
u
d
in
g
p
r
e
-
ter
m
d
eliv
er
y
,
lo
w
b
ir
th
weig
h
t,
i
n
cr
ea
s
ed
in
f
a
n
t
m
o
r
tality
,
an
d
p
r
e
d
is
p
o
s
itio
n
to
HI
V/AI
DS
[
8
]
,
[
1
7
]
.
Sev
er
a
l
m
icr
o
o
r
g
an
is
m
s
ca
u
s
e
v
ag
i
n
al
in
f
ec
tio
n
s
,
an
d
th
e
m
o
s
t
co
m
m
o
n
v
a
g
in
al
in
f
ec
tio
n
is
v
u
lv
o
v
ag
i
n
al
ca
n
d
id
iasi
s
[
2
0
]
.
T
h
e
s
o
cio
-
d
em
o
g
r
a
p
h
ic
ch
a
r
a
cter
is
tics
o
f
th
e
s
tu
d
y
s
h
o
w
th
at
m
o
s
t
o
f
th
e
s
u
b
jects
wer
e
with
in
2
1
–
3
0
y
ea
r
s
o
f
ag
e
(
6
8
.
6
4
%),
m
er
ch
an
ts
(
3
2
.
7
3
%),
an
d
p
r
eg
n
an
t
(
6
8
.
6
4
%).
Mo
s
t
o
f
th
e
p
r
eg
n
an
t
wo
m
en
wer
e
in
th
eir
s
ec
o
n
d
tr
im
ester
,
f
o
llo
wed
b
y
th
e
th
ir
d
(
2
6
.
8
2
%)
an
d
f
ir
s
t
tr
im
est
er
(
6
.
8
2
%).
T
h
e
h
ig
h
o
cc
u
r
r
en
ce
o
f
s
ec
o
n
d
-
tr
im
ester
p
r
e
g
n
an
t
wo
m
en
in
th
is
s
tu
d
y
co
u
ld
b
e
a
r
esu
lt
o
f
th
e
tim
in
g
o
f
th
e
s
tu
d
y
o
r
b
ec
au
s
e
m
o
s
t
p
r
eg
n
a
n
t w
o
m
en
i
n
E
d
o
State
(
6
3
.
0
%)
i
n
itiate
an
ten
atal
ca
r
e
d
u
r
in
g
th
e
s
ec
o
n
d
tr
im
ester
,
a
s
r
ep
o
r
ted
b
y
[
2
1
]
.
I
n
t
h
is
s
tu
d
y
,
th
e
p
r
e
v
alen
ce
o
f
v
u
lv
o
v
ag
in
al
ca
n
d
id
iasi
s
(
3
5
.
5
5
%)
s
u
p
p
o
r
ts
th
e
n
o
tio
n
t
h
at
at
least
o
n
e
in
ev
er
y
th
r
ee
wo
m
en
with
v
ag
in
itis
is
in
f
ec
ted
with
v
ag
in
al
ca
n
d
i
d
iasi
s
[
2
2
]
.
Fu
r
th
er
m
o
r
e
,
th
e
p
r
ev
alen
ce
r
ep
o
r
ted
h
e
r
e
is
s
lig
h
tly
lo
wer
th
an
th
e
4
0
%
r
ep
o
r
ted
b
y
[
2
3
]
,
b
u
t
f
ar
lo
w
er
th
an
th
e
8
4
.
5
%
r
ep
o
r
ted
b
y
[
2
4
]
.
Am
o
n
g
r
e
p
r
o
d
u
ctiv
e
-
a
g
ed
wo
m
e
n
,
th
e
p
r
e
v
alen
ce
o
f
v
u
lv
o
v
ag
in
al
ca
n
d
i
d
iasi
s
was
3
4
.
5
5
%,
wh
ich
alig
n
s
with
3
6
%
r
ep
o
r
ted
b
y
[
1
3
]
an
d
[
1
4
]
,
b
u
t
is
h
ig
h
er
th
an
th
e
1
0
%
r
ep
o
r
ted
i
n
Ab
ak
alik
i,
So
u
th
-
E
as
ter
n
Nig
er
ia,
b
y
[
2
3
]
.
Var
iatio
n
s
in
wo
m
en
’
s
h
ea
lth
h
y
g
i
en
e
ac
r
o
s
s
d
if
f
er
en
t
s
tu
d
y
ar
e
as
m
ay
ac
c
o
u
n
t
f
o
r
th
ese
d
is
cr
ep
an
cies.
Pre
g
n
an
t
wo
m
en
i
n
th
is
s
tu
d
y
h
ad
a
s
ig
n
if
ican
tly
h
ig
h
e
r
p
r
ev
alen
ce
o
f
v
u
l
v
o
v
a
g
in
al
c
an
d
id
iasi
s
(
p
≤
0
.
0
5
)
co
m
p
ar
ed
to
th
eir
n
o
n
-
p
r
e
g
n
an
t
c
o
u
n
te
r
p
ar
ts
.
T
h
is
ag
r
ee
s
with
f
in
d
in
g
s
f
r
o
m
Den
m
ar
k
[
2
5
]
,
wh
ic
h
also
r
ep
o
r
ted
a
h
i
g
h
er
p
r
e
v
alen
ce
in
p
r
eg
n
a
n
t
wo
m
e
n
.
Ho
w
ev
er
,
a
s
tu
d
y
in
Z
ar
ia,
Nig
e
r
i
a,
b
y
[
2
6
]
f
o
u
n
d
a
h
ig
h
er
i
n
cid
en
ce
o
f
v
u
lv
o
v
ag
i
n
al
ca
n
d
id
iasi
s
in
n
o
n
-
p
r
eg
n
a
n
t
wo
m
en
.
T
h
e
h
ig
h
er
p
r
ev
ale
n
ce
in
p
r
eg
n
a
n
cy
is
lik
ely
d
u
e
to
in
cr
ea
s
ed
r
ep
r
o
d
u
ctiv
e
h
o
r
m
o
n
es
th
at
elev
ate
g
ly
co
g
en
lev
els
in
v
ag
in
al
tis
s
u
e,
p
r
o
v
id
in
g
a
ca
r
b
o
n
s
o
u
r
ce
f
o
r
C
a
n
d
i
d
a
o
r
g
an
is
m
s
[
2
3
]
.
T
h
er
e
was
n
o
s
ig
n
if
ican
t
v
a
r
i
atio
n
(
p
>0
.
0
5
)
i
n
th
e
p
r
e
v
alen
ce
o
f
v
u
l
v
o
v
a
g
in
al
ca
n
d
id
iasi
s
with
ag
e
in
p
r
eg
n
a
n
cy
in
th
is
s
tu
d
y
.
Ho
wev
er
,
[
2
6
]
r
ep
o
r
ted
a
s
ig
n
if
ican
t
v
ar
iatio
n
,
with
th
e
in
f
ec
tio
n
b
ein
g
m
o
r
e
co
m
m
o
n
in
wo
m
en
ab
o
v
e
3
0
y
ea
r
s
(
4
4
.
4
4
%).
T
h
e
p
r
ev
alen
ce
o
f
v
u
l
v
o
v
a
g
in
al
ca
n
d
id
iasi
s
was
h
ig
h
est
i
n
th
e
s
ec
o
n
d
tr
im
ester
(
4
8
.
0
5
%),
s
i
m
ilar
to
f
in
d
in
g
s
b
y
[
2
7
]
i
n
E
d
o
State,
wh
ich
also
r
ep
o
r
te
d
h
ig
h
e
r
p
r
e
v
alen
ce
d
u
r
in
g
th
is
p
er
io
d
.
T
h
is
m
ay
b
e
d
u
e
to
d
ep
letin
g
im
m
u
n
ity
d
u
r
in
g
p
r
e
g
n
an
cy
[
1
7
]
,
as
well
as
i
s
s
u
es
ar
o
u
n
d
an
ten
atal
ca
r
e.
As
n
o
te
d
b
y
[
2
1
]
,
s
in
ce
m
o
s
t
p
r
eg
n
an
t
wo
m
en
in
E
d
o
State
b
e
g
in
a
n
ten
atal
ca
r
e
d
u
r
in
g
th
e
s
ec
o
n
d
tr
im
ester
,
v
a
g
in
al
in
f
ec
tio
n
s
m
ay
n
o
t
h
av
e
b
ee
n
p
r
o
p
e
r
ly
m
an
ag
e
d
b
e
f
o
r
e
th
at
tim
e
.
T
h
e
p
r
esen
t
s
tu
d
y
also
s
h
o
wed
n
o
s
ig
n
if
ican
t
v
ar
iatio
n
in
th
e
p
r
ev
alen
ce
o
f
v
u
lv
o
v
ag
in
al
ca
n
d
id
iasi
s
with
o
cc
u
p
atio
n
.
C
.
a
lb
ica
n
s
was
th
e
m
o
s
t
p
r
ev
alen
t
C
a
n
d
id
a
s
p
ec
ies
ca
u
s
in
g
in
f
ec
tio
n
i
n
b
o
th
p
r
eg
n
a
n
t
an
d
non
-
p
r
eg
n
a
n
t
wo
m
en
,
with
7
5
.
8
6
%
an
d
7
7
.
7
8
%
r
esp
ec
tiv
ely
.
T
h
e
p
r
ed
o
m
i
n
an
ce
o
f
C
.
a
l
b
ica
n
s
in
th
is
s
tu
d
y
ag
r
ee
s
with
th
e
f
in
d
in
g
s
o
f
[
2
3
]
in
Oy
o
State.
Ho
wev
er
,
s
tu
d
ies
f
r
o
m
Ab
u
ja
b
y
[
2
8
]
f
o
u
n
d
a
h
ig
h
er
p
r
ev
alen
ce
o
f
C
.
g
la
b
r
a
ta
.
Similar
ly
,
s
tu
d
ies
in
So
u
th
e
r
n
E
th
io
p
ia
am
o
n
g
p
r
eg
n
an
t
wo
m
en
r
ep
o
r
ted
C
.
a
lb
ica
n
s
as
p
r
ed
o
m
in
an
t
(
6
2
.
3
0
%),
f
o
llo
wed
b
y
C
.
g
l
a
b
r
a
ta
(
1
5
.
3
%),
C
.
kru
s
ei
(
1
4
.
1
%
)
,
an
d
C
.
tr
o
p
ica
lis
(
5
.
9
%)
[
2
9
]
.
Alth
o
u
g
h
th
e
d
is
tr
i
b
u
tio
n
in
th
is
s
tu
d
y
d
if
f
e
r
s
,
C
.
a
l
b
ica
n
s
r
em
ain
e
d
th
e
d
o
m
in
an
t
ca
u
s
e
o
f
v
u
lv
o
v
ag
in
al
ca
n
d
id
iasi
s
(
7
5
.
8
6
%)
am
o
n
g
p
r
eg
n
a
n
t
wo
m
en
,
f
o
llo
wed
b
y
C
.
kru
s
ei
(
1
0
.
3
4
%),
C
.
d
u
b
lin
e
n
s
is
(
5
.
1
7
%),
C
.
g
la
b
r
a
ta
(
5
.
1
7
%
)
,
an
d
C
.
p
a
r
a
p
s
ilo
s
is
(
1
.
7
2
%).
As
n
o
ted
b
y
[
3
0
]
,
wh
i
le
C
.
a
lb
ica
n
s
is
th
e
p
r
im
ar
y
p
ath
o
g
en
r
esp
o
n
s
ib
le
f
o
r
v
u
lv
o
v
ag
i
n
al
ca
n
d
id
iasi
s
in
b
o
th
p
r
e
g
n
an
t a
n
d
n
o
n
-
p
r
eg
n
an
t w
o
m
en
,
an
d
an
ep
id
em
io
lo
g
ical
s
h
if
t
to
war
d
n
o
n
-
alb
ica
n
s
C
a
n
d
id
a
(
NAC)
s
p
ec
ies
is
in
cr
ea
s
in
g
ly
b
ein
g
o
b
s
er
v
ed
g
lo
b
ally
.
Oth
er
C
a
n
d
id
a
s
p
ec
ies
i
s
o
lated
f
r
o
m
p
r
e
g
n
an
t
wo
m
en
in
th
is
s
tu
d
y
in
clu
d
e
C
.
kru
s
ei
,
C
.
d
u
b
lin
en
s
is
,
C
.
g
la
b
r
a
ta
,
a
n
d
C
.
p
a
r
a
p
s
ilo
s
is
.
5.
CO
NCLU
SI
O
N
T
h
e
p
r
esen
t
s
tu
d
y
h
as
id
en
tifie
d
th
e
p
r
esen
ce
o
f
n
o
n
-
alb
ica
n
s
C
a
n
d
id
a
in
ca
u
s
in
g
VVC
i
n
p
r
eg
n
a
n
t
an
d
n
o
n
-
p
r
eg
n
a
n
t
wo
m
en
.
T
h
er
ef
o
r
e
,
r
o
u
tin
e
s
cr
ee
n
in
g
o
f
v
u
l
v
o
v
a
g
in
al
ca
n
d
id
iasi
s
an
d
o
th
e
r
v
a
g
in
al
in
f
ec
tio
n
s
s
h
o
u
ld
b
e
co
n
d
u
cte
d
d
u
r
i
n
g
a
n
ten
atal
v
is
its
to
en
ab
le
ea
r
ly
d
etec
tio
n
an
d
tr
ea
t
m
en
t.
Fu
r
th
er
m
o
r
e,
p
u
b
lic
awa
r
en
ess
an
d
h
ea
lth
e
d
u
ca
tio
n
p
r
o
g
r
am
s
s
h
o
u
ld
b
e
en
co
u
r
a
g
ed
to
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Dec
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1762
AUTHO
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CO
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C
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k
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Prim
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DATA AV
AI
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AB
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ata
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ata
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av
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to
eth
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r
estrictio
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s
.
RE
F
E
R
E
NC
E
S
[
1
]
W
o
r
l
d
H
e
a
l
t
h
O
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a
n
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z
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Fu
n
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1
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.
[
2]
J.
E.
B
e
n
n
e
t
t
,
R
.
D
o
l
i
n
,
a
n
d
M
.
J.
B
l
a
s
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r
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M
a
n
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s
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,
My
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a
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.
[
3
]
S
.
P
a
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a
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.
,
“
C
a
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s
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y
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y
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my
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5
.
[
4
]
J.
A
k
e
r
e
l
e
,
P
.
A
b
h
u
l
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m
e
n
,
a
n
d
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.
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k
o
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o
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u
a
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[
5
]
J.
P
.
Lo
p
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s
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n
d
M
.
S
.
L
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a
k
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s
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[
6
]
J.
Ta
l
a
p
k
o
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t
a
l
.
,
“
C
a
n
d
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d
a
a
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s
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7
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S
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C
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8
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se
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v
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m
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d
p
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h
e
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lt
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a
p
p
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a
ti
o
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s in
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b
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g
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c
a
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tac
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m
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:
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m
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m
a
il
.
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ith
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a
b
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lec
tu
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ro
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fro
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b
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p
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p
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m
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r
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o
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s
e
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rc
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in
tere
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imm
u
o
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p
id
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m
io
l
o
g
y
o
f
d
ise
a
se
c
o
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tro
l.
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e
c
a
n
b
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c
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tac
ted
a
t
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m
a
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:
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it
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n
u
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s@
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m
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c
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m
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sa
m
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m
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h
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a
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lt
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s,
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b
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iv
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p
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m
a
.
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r
sp
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v
ir
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tal
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P
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b
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lt
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icro
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lo
g
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ld
s
a
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S
c
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n
m
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fro
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k
p
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c
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fro
m
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,
c
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m
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h
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c
a
n
b
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c
o
n
tac
ted
a
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m
a
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:
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rh
ie
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rh
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s
a
m
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n
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m
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c
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b
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h
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p
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f
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a
c
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lt
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f
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fe
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s,
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se
All
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m
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h
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h
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s
a
B.
S
c
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in
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d
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m
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ste
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s
d
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g
re
e
in
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b
io
lo
g
y
fr
o
m
th
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Un
i
v
e
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o
f
Be
n
in
.
Nig
e
ria,
a
n
d
a
P
h
.
D.
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n
M
e
d
ica
l
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b
i
o
lo
g
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,
wit
h
a
b
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fo
r
Im
m
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n
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l
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g
y
&
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m
u
n
o
c
h
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m
istry
fro
m
Am
b
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se
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rsit
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p
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m
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.
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r
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re
a
o
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in
tere
st
is
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d
v
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l
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g
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.
S
h
e
c
a
n
b
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c
o
n
tac
te
d
a
t
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m
a
il
:
e
y
a
u
fe
a
@g
m
a
il
.
c
o
m
.
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