I
nte
rna
t
io
na
l J
o
urna
l o
f
P
u
bli
c
H
ea
lt
h Science
(
I
J
P
H
S)
Vo
l.
15
,
No
.
2
,
J
u
n
e
20
26
,
p
p
.
449
~
4
5
7
I
SS
N:
2
2
5
2
-
8
8
0
6
,
DOI
: 1
0
.
1
1
5
9
1
/
ijp
h
s
.
v
15
i
2
.
2
7
0
6
7
449
J
o
ur
na
l ho
m
ep
a
g
e
:
h
ttp
:
//
ijp
h
s
.
ia
esco
r
e.
co
m
Effec
tivenes
s o
f
a
brea
stfee
di
ng
self
-
eff
i
ca
cy
int
erven
tion o
n
BSE
S
-
SF
sco
res a
nd e
x
clusiv
e br
ea
stfee
ding
:
a
quas
i
-
ex
peri
menta
l s
tu
dy
in
po
stpa
rtum
mo
thers
Arif
a
ra
hm
i
1
,
Asria
l A
s
ria
l
2
,
M
uh
a
m
m
a
d Rus
di
2
,
So
lha
E
lrif
da
3
1
D
e
p
a
r
t
me
n
t
o
f
M
i
d
w
i
f
e
r
y
,
U
n
i
v
e
r
si
t
y
o
f
B
a
i
t
u
r
r
a
h
i
m,
J
a
m
b
i
,
I
n
d
o
n
e
si
a
2
D
e
p
a
r
t
me
n
t
o
f
C
h
e
m
i
st
r
y
E
d
u
c
a
t
i
o
n
,
F
a
c
u
l
t
y
o
f
T
e
a
c
h
e
r
Tr
a
i
n
i
n
g
a
n
d
E
d
u
c
a
t
i
o
n
,
U
n
i
v
e
r
s
i
t
y
o
f
Ja
mb
i
,
J
a
m
b
i
,
I
n
d
o
n
e
si
a
3
D
e
p
a
r
t
me
n
t
o
f
P
u
b
l
i
c
H
e
a
l
t
h
S
c
i
e
n
c
e
s,
P
o
l
t
e
k
k
e
s
K
e
m
e
n
k
e
s
Jam
b
i
,
J
a
mb
i
,
I
n
d
o
n
e
si
a
Art
icle
I
nfo
AB
S
T
RAC
T
A
r
ticle
his
to
r
y:
R
ec
eiv
ed
Ma
r
5
,
2
0
2
6
R
ev
is
ed
Ma
y
7
,
2
0
2
6
Acc
ep
ted
Ma
y
2
2
,
2
0
2
6
De
sp
it
e
In
d
o
n
e
s
ia
'
s
n
a
ti
o
n
a
l
b
r
e
a
st
fe
e
d
in
g
p
ro
m
o
t
io
n
e
f
fo
rt
s,
e
x
c
lu
siv
e
b
re
a
s
tf
e
e
d
in
g
ra
t
e
s
r
e
m
a
in
b
e
lo
w
th
e
8
0
%
targ
e
t,
w
it
h
li
m
it
e
d
e
v
i
d
e
n
c
e
o
n
stru
c
tu
r
e
d
b
r
e
a
s
tf
e
e
d
in
g
s
e
l
f
-
e
f
fi
c
a
c
y
(BS
E
)
in
t
e
rv
e
n
ti
o
n
s
in
lo
w
-
re
so
u
r
c
e
In
d
o
n
e
s
ian
s
e
t
ti
n
g
s.
To
e
v
a
lu
a
t
e
th
e
e
ff
e
c
ti
v
e
n
e
ss
o
f
a
BS
E
in
te
rv
e
n
ti
o
n
o
n
BS
ES
-
S
F
sc
o
re
s
a
n
d
e
x
c
lu
siv
e
b
re
a
s
tf
e
e
d
in
g
c
o
n
ti
n
u
a
ti
o
n
d
u
rin
g
th
e
fi
rs
t
six
m
o
n
th
s
p
o
s
tp
a
rtu
m
.
A
q
u
a
si
-
e
x
p
e
ri
m
e
n
ta
l
p
r
e
t
e
s
t
-
p
o
stt
e
s
t
d
e
s
ig
n
wi
th
a
c
o
n
tro
l
g
ro
u
p
w
a
s
c
o
n
d
u
c
ted
o
n
1
0
4
p
o
s
tp
a
rtu
m
m
o
th
e
r
s
(5
2
in
t
e
rv
e
n
t
io
n
,
5
2
c
o
n
tro
l
).
M
e
a
su
r
e
m
e
n
ts
we
re
c
o
n
d
u
c
t
e
d
lo
n
g
i
tu
d
in
a
ll
y
a
t
b
a
s
e
li
n
e
,
we
e
k
s
2
,
6
,
1
2
,
a
n
d
2
4
p
o
stp
a
rtu
m
.
Da
t
a
w
e
r
e
a
n
a
ly
z
e
d
u
sin
g
in
d
e
p
e
n
d
e
n
t
t
-
t
e
st
,
Ch
i
-
sq
u
a
re
,
Co
x
p
ro
p
o
r
ti
o
n
a
l
h
a
z
a
rd
re
g
re
ss
io
n
,
a
n
d
li
n
e
a
r
m
ix
e
d
m
o
d
e
l
(LM
M
)
.
Th
e
in
te
rv
e
n
t
io
n
g
ro
u
p
'
s
BS
ES
-
S
F
s
c
o
r
e
in
c
r
e
a
s
e
d
sig
n
if
ic
a
n
tl
y
fro
m
4
2
.
3
5
to
5
9
.
7
3
c
o
m
p
a
re
d
to
th
e
c
o
n
tro
l
g
ro
u
p
(4
1
.
8
8
to
4
8
.
0
6
,
p
<
0
.
0
0
1
).
Ex
c
lu
siv
e
b
r
e
a
st
fe
e
d
in
g
a
t
2
4
w
e
e
k
s
w
a
s
s
i
g
n
ifi
c
a
n
t
ly
h
ig
h
e
r
in
th
e
in
t
e
rv
e
n
t
io
n
g
ro
u
p
(7
1
.
2
%
v
s.
4
0
.
4
%
,
R
R
=
1
.
7
6
,
p
=
0
.
0
0
1
).
Co
x
a
n
a
ly
sis
id
e
n
ti
f
ied
th
e
in
t
e
r
v
e
n
ti
o
n
a
s
th
e
s
tro
n
g
e
st
p
ro
t
e
c
ti
v
e
f
a
c
to
r
(HR
=
0
.
4
1
,
p
=
0
.
0
0
1
),
fo
l
lo
w
e
d
b
y
h
u
sb
a
n
d
'
s
su
p
p
o
r
t
(
HR
=
0
.
5
4
,
p
=
0
.
0
3
9
),
wh
il
e
e
m
p
lo
y
m
e
n
t
w
a
s
a
risk
f
a
c
to
r
(
HR
=
1
.
7
2
,
p
=
0
.
0
3
4
).
Th
e
non
-
ra
n
d
o
m
i
z
e
d
d
e
s
ig
n
a
n
d
sin
g
le
-
sit
e
s
e
t
ti
n
g
m
a
y
li
m
it
g
e
n
e
r
a
li
z
a
b
il
i
ty
.
Th
e
BS
E
in
te
rv
e
n
t
io
n
e
ff
e
c
ti
v
e
ly
in
c
r
e
a
s
e
d
se
lf
-
e
ffi
c
a
c
y
s
c
o
r
e
s
a
n
d
e
x
c
lu
siv
e
b
r
e
a
s
tf
e
e
d
in
g
r
a
t
e
s
,
su
g
g
e
stin
g
in
teg
ra
ti
o
n
in
to
ro
u
ti
n
e
p
o
stp
a
rtu
m
c
a
re
a
s
a
s
c
a
l
a
b
l
e
p
u
b
li
c
h
e
a
lt
h
st
ra
teg
y
.
K
ey
w
o
r
d
s
:
B
r
ea
s
tf
ee
d
in
g
s
elf
-
ef
f
icac
y
B
SES
-
SF
E
x
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
Po
s
tp
ar
tu
m
Qu
asi
-
ex
p
er
im
en
tal
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Ar
if
ar
ah
m
i
Dep
ar
tm
en
t o
f
Mid
wif
er
y
,
U
n
iv
er
s
ity
o
f
B
aitu
r
r
ah
im
J
am
b
i,
I
n
d
o
n
esia
E
m
ail:
ar
if
ar
ah
m
i1
8
@
g
m
ail.
co
m
1.
I
NT
RO
D
UCT
I
O
N
Pro
v
id
in
g
o
n
ly
b
r
ea
s
t
m
ilk
d
u
r
in
g
th
e
in
itial
h
alf
-
y
ea
r
o
f
a
n
in
f
an
t'
s
life
r
ep
r
esen
ts
o
n
e
o
f
th
e
m
o
s
t
im
p
ac
tf
u
l
p
u
b
lic
h
ea
lth
s
tr
ate
g
ies
f
o
r
d
ec
r
ea
s
in
g
illn
ess
an
d
d
ea
th
a
m
o
n
g
in
f
a
n
ts
wo
r
ld
wid
e
[
1
]
,
[
2
]
.
I
n
th
e
Un
ited
States
,
f
o
r
ex
am
p
le,
o
n
ly
ab
o
u
t
a
q
u
ar
ter
o
f
m
o
th
er
s
an
d
b
ab
ies
s
u
cc
ess
f
u
lly
r
ea
ch
ed
th
e
s
ix
-
m
o
n
th
m
iles
to
n
e
o
f
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
[
3
]
.
A
p
r
o
s
p
ec
tiv
e
c
o
h
o
r
t
s
tu
d
y
in
th
e
Un
ited
Ar
ab
E
m
ir
ates
(
UAE
)
f
o
u
n
d
th
at
d
esp
ite
n
ea
r
-
u
n
i
v
er
s
al
b
r
ea
s
tf
ee
d
in
g
in
itiatio
n
d
u
r
in
g
h
o
s
p
italizatio
n
,
o
n
ly
2
6
.
7
%
o
f
m
o
th
e
r
s
m
ain
tain
ed
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
at
s
ix
m
o
n
th
s
p
o
s
tp
ar
t
u
m
[
2
]
.
Similar
ly
,
r
esear
ch
i
n
Sh
an
g
h
ai,
C
h
in
a,
r
ep
o
r
ted
th
at
th
e
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
r
ate
in
p
r
em
atu
r
e
b
ab
ies
d
r
o
p
p
ed
d
r
asti
ca
lly
to
o
n
ly
1
0
.
4
%
s
ix
m
o
n
th
s
af
te
r
d
is
ch
ar
g
e
[
4
]
.
A
n
o
th
er
co
h
o
r
t
s
tu
d
y
in
C
h
in
a
n
o
ted
th
at
e
x
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
r
ates
d
ec
lin
e
d
f
r
o
m
9
1
%
at
d
is
ch
ar
g
e
to
5
8
%
at
s
ix
m
o
n
th
s
p
o
s
tp
ar
t
u
m
[
5
]
.
T
h
e
l
o
w
r
ate
o
f
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
is
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.
15
,
No
.
2
,
J
u
n
e
20
26
:
4
4
9
-
4
5
7
450
in
f
lu
en
ce
d
b
y
v
ar
i
o
u
s
s
o
cio
cu
ltu
r
al,
ec
o
n
o
m
ic,
an
d
in
d
iv
i
d
u
al
f
ac
to
r
s
,
wh
er
e
b
r
ea
s
tf
ee
d
in
g
s
elf
-
ef
f
icac
y
(
B
SE)
h
as b
ee
n
id
en
tifie
d
as o
n
e
o
f
th
e
m
o
s
t c
r
u
cial
p
s
y
c
h
o
l
o
g
ical
an
d
m
o
tiv
atio
n
al
d
eter
m
in
an
ts
[
1
]
,
[
6
]
-
[
8
]
.
I
n
I
n
d
o
n
esia,
ex
clu
s
iv
e
b
r
ea
s
t
f
ee
d
in
g
co
v
e
r
ag
e
f
o
r
in
f
an
ts
ag
ed
0
-
5
m
o
n
t
h
s
r
em
ain
s
r
elativ
ely
lo
w
an
d
h
as
n
o
t
y
et
r
ea
ch
e
d
th
e
n
atio
n
al
tar
g
et.
Data
s
h
o
w
th
at
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
co
v
e
r
ag
e
in
I
n
d
o
n
esia
i
n
2
0
1
8
was
o
n
ly
3
7
.
3
%
[
9
]
.
M
o
r
e
r
ec
en
t
d
ata
s
h
o
w
a
s
lig
h
t
i
m
p
r
o
v
e
m
en
t,
with
o
n
ly
5
1
.
5
%
o
f
in
f
a
n
ts
u
n
d
er
s
ix
m
o
n
th
s
b
ein
g
ex
clu
s
iv
ely
b
r
e
astfe
d
[
1
0
]
.
T
h
is
lo
w
f
ig
u
r
e
is
ca
u
s
ed
b
y
v
a
r
io
u
s
f
ac
to
r
s
,
in
clu
d
in
g
th
e
lac
k
o
f
in
f
o
r
m
atio
n
m
o
th
er
s
r
ec
eiv
e
ab
o
u
t
b
r
ea
s
tf
ee
d
in
g
,
wh
ich
im
p
ac
ts
th
eir
k
n
o
wled
g
e
an
d
b
elief
s
[
9
]
.
C
h
u
ek
to
n
g
et
a
l
.
[
1
1
]
r
ep
o
r
te
d
th
at
a
b
r
ea
s
tf
ee
d
in
g
s
elf
-
ef
f
icac
y
en
h
an
ce
m
e
n
t
p
r
o
g
r
am
co
m
b
in
ed
with
th
e
L
I
NE
ap
p
licatio
n
in
m
o
th
er
s
with
ce
s
ar
ea
n
s
ec
tio
n
s
r
esu
lted
in
h
ig
h
er
b
r
ea
s
tf
ee
d
in
g
s
elf
-
ef
f
icac
y
s
co
r
es
an
d
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
r
ates
at
f
o
u
r
wee
k
s
p
o
s
tp
ar
tu
m
.
H
o
wev
er
,
s
u
cc
ess
f
u
l
s
elf
-
ef
f
icac
y
im
p
r
o
v
e
m
en
t
in
th
e
h
o
s
p
ital
d
o
es
n
o
t
alwa
y
s
g
u
ar
an
tee
co
n
ti
n
u
ed
ex
cl
u
s
iv
e
b
r
ea
s
tf
ee
d
in
g
f
o
r
u
p
to
s
i
x
m
o
n
th
s
,
as
n
ew
b
r
ea
s
tf
ee
d
in
g
-
r
elate
d
is
s
u
es
ca
n
ar
is
e
in
th
e
f
ir
s
t
wee
k
s
p
o
s
tp
ar
tu
m
a
n
d
lead
to
a
d
ec
lin
e
i
n
s
elf
-
ef
f
icac
y
[
1
2
]
,
[
1
3
]
.
Seco
n
d
,
th
e
B
SES
-
SF
(
b
r
ea
s
tf
ee
d
in
g
s
elf
-
ef
f
icac
y
s
ca
le
-
s
h
o
r
t
f
o
r
m
)
s
co
r
e
was
a
s
tr
o
n
g
p
r
ed
icto
r
o
f
f
ee
d
in
g
p
atter
n
s
at
th
r
ee
a
n
d
s
ix
m
o
n
t
h
s
p
o
s
tp
ar
tu
m
[
1
4
]
,
[
1
5
]
.
T
h
is
s
tu
d
y
aim
s
to
ev
alu
ate
th
e
ef
f
ec
tiv
en
ess
o
f
a
B
SE
in
ter
v
en
tio
n
o
n
B
SES
-
SF
s
co
r
es
an
d
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
co
n
ti
n
u
atio
n
d
u
r
in
g
th
e
f
ir
s
t
s
ix
m
o
n
th
s
p
o
s
tp
ar
tu
m
u
s
in
g
a
q
u
asi
-
ex
p
er
im
e
n
tal
d
esig
n
with
lo
n
g
itu
d
in
al
m
ea
s
u
r
em
en
ts
at
b
aselin
e,
wee
k
s
2
,
6
,
1
2
,
an
d
2
4
.
T
h
e
s
tu
d
y
'
s
n
o
v
elty
lies
in
th
e
u
s
e
o
f
m
u
ltip
le
ev
alu
atio
n
p
o
in
ts
to
ca
p
tu
r
e
th
e
d
y
n
a
m
ics
o
f
B
S
E
ch
an
g
es
an
d
b
r
ea
s
tf
ee
d
in
g
b
eh
av
io
r
o
v
er
tim
e.
T
h
is
ap
p
r
o
ac
h
p
r
o
v
id
es
s
tr
o
n
g
er
ev
id
e
n
ce
f
o
r
in
teg
r
atin
g
s
u
ch
in
ter
v
e
n
tio
n
s
in
to
r
o
u
tin
e
p
o
s
tp
ar
tu
m
ca
r
e
i
n
I
n
d
o
n
esian
s
ettin
g
s
.
2.
M
E
T
H
O
D
2
.
1
.
Resea
rc
h
d
esig
n
T
h
is
r
esear
ch
was
co
n
d
u
cted
in
J
am
b
i
C
ity
.
T
h
is
s
tu
d
y
u
s
ed
a
q
u
asi
-
ex
p
er
im
e
n
tal
d
esig
n
with
a
p
r
etest
-
p
o
s
ttes
t
with
a
co
n
tr
o
l
g
r
o
u
p
d
esig
n
to
e
v
alu
ate
t
h
e
ef
f
ec
tiv
e
n
ess
o
f
an
in
ter
v
en
tio
n
to
im
p
r
o
v
e
b
r
ea
s
tf
ee
d
in
g
s
elf
-
ef
f
icac
y
.
Me
asu
r
em
en
ts
wer
e
co
n
d
u
ct
ed
lo
n
g
itu
d
in
ally
at
f
iv
e
tim
e
p
o
in
ts
:
b
ef
o
r
e
th
e
in
ter
v
en
tio
n
(
b
aselin
e/p
r
e
-
test
)
,
wee
k
2
(
p
o
s
t
-
test
1
)
,
wee
k
6
(
p
o
s
t
-
test
2
)
,
wee
k
1
2
(
p
o
s
t
-
t
est
3
)
,
an
d
wee
k
2
4
(
p
o
s
t
-
test
4
)
p
o
s
tp
ar
tu
m
.
T
h
e
s
e
r
ep
ea
ted
m
ea
s
u
r
es
ap
p
r
o
a
ch
was
ch
o
s
en
to
c
o
m
p
r
eh
en
s
iv
ely
m
o
n
ito
r
th
e
d
y
n
am
ics
o
f
ch
a
n
g
es
in
b
r
ea
s
tf
ee
d
in
g
s
elf
-
ef
f
icac
y
an
d
th
e
p
r
o
p
o
r
tio
n
o
f
ex
clu
s
iv
e
b
r
ea
s
t
f
ee
d
in
g
th
r
o
u
g
h
o
u
t
th
e
f
ir
s
t six
m
o
n
th
s
p
o
s
tp
ar
tu
m
,
as r
ec
o
m
m
e
n
d
ed
b
y
W
HO.
2
.
2
.
P
o
pu
la
t
io
n,
s
a
m
ple,
a
nd
s
a
m
ple size
T
h
e
tar
g
et
p
o
p
u
latio
n
was
all
p
o
s
tp
ar
tu
m
m
o
th
er
s
with
n
ewb
o
r
n
s
.
T
h
e
s
am
p
lin
g
tech
n
iq
u
e
u
s
ed
was
co
n
s
ec
u
tiv
e
s
am
p
lin
g
.
I
n
clu
s
i
o
n
c
r
iter
ia
in
clu
d
ed
:
p
o
s
tp
ar
t
u
m
m
o
th
er
s
with
a
s
in
g
le
liv
eb
o
r
n
in
f
a
n
t,
ter
m
g
estatio
n
al
ag
e
(
≥
3
7
wee
k
s
)
,
i
n
f
an
ts
with
o
u
t
co
n
g
en
ital
a
b
n
o
r
m
alities
th
at
h
in
d
er
b
r
ea
s
tf
e
ed
in
g
(
s
u
ch
as
clef
t
lip
/p
alate
)
,
m
o
th
e
r
s
with
o
u
t
m
ed
ical
co
n
tr
ai
n
d
icatio
n
s
to
b
r
ea
s
tf
ee
d
in
g
,
an
d
willin
g
n
ess
to
s
ig
n
a
n
in
f
o
r
m
ed
co
n
s
en
t.
E
x
clu
s
io
n
c
r
iter
ia
in
clu
d
ed
:
m
o
th
e
r
s
with
s
ev
er
e
p
s
y
ch
iatr
ic
d
is
o
r
d
er
s
,
in
f
a
n
ts
r
eq
u
ir
in
g
NI
C
U
ca
r
e
f
o
r
m
o
r
e
th
an
4
8
h
o
u
r
s
,
an
d
m
o
th
er
s
p
lan
n
i
n
g
to
m
o
v
e
d
u
r
in
g
th
e
s
tu
d
y
p
er
io
d
.
T
h
e
s
am
p
le
s
ize
was
ca
lcu
lated
u
s
in
g
th
e
two
-
p
r
o
p
o
r
tio
n
d
if
f
er
en
ce
h
y
p
o
th
esis
test
f
o
r
m
u
l
a
with
α
=
0
.
0
5
,
8
0
%
p
o
wer
,
a
n
d
e
f
f
ec
t
s
ize
esti
m
ates
b
ased
o
n
p
r
e
v
io
u
s
r
esear
ch
.
A
m
in
im
u
m
s
am
p
le
s
ize
o
f
5
2
r
esp
o
n
d
en
ts
p
er
g
r
o
u
p
was
o
b
tain
ed
,
r
esu
ltin
g
in
a
to
ta
l
o
f
1
0
4
p
o
s
tp
ar
t
u
m
m
o
th
er
s
allo
ca
ted
to
th
e
in
ter
v
en
tio
n
g
r
o
u
p
(
n
=
5
2
)
an
d
th
e
co
n
tr
o
l g
r
o
u
p
(
n
=
5
2
)
.
Allo
ca
tio
n
was
b
ased
o
n
th
e
h
ea
lth
s
er
v
ice
u
n
it
o
r
r
ec
r
u
itm
en
t tim
e
to
m
in
im
ize
cr
o
s
s
-
g
r
o
u
p
co
n
tam
i
n
atio
n
.
2
.
3
.
Respo
nd
ent
a
llo
ca
t
io
n p
ro
ce
du
re
a
nd
bia
s
m
ini
m
iza
t
io
n str
a
t
eg
ies
R
esp
o
n
d
en
t
allo
ca
tio
n
to
th
e
in
ter
v
en
tio
n
a
n
d
co
n
tr
o
l
g
r
o
u
p
s
was
co
n
d
u
cted
u
s
in
g
a
clu
s
ter
allo
ca
tio
n
m
eth
o
d
b
ased
o
n
p
r
im
ar
y
h
ea
lth
ca
r
e
u
n
its
(
P
u
s
ke
s
ma
s
)
to
m
in
im
ize
cr
o
s
s
-
g
r
o
u
p
co
n
ta
m
in
atio
n
.
E
lig
ib
le
h
ea
lth
ca
r
e
u
n
its
wer
e
p
u
r
p
o
s
iv
ely
s
elec
ted
b
ased
o
n
co
m
p
ar
a
b
le
r
eg
io
n
al
ch
ar
ac
t
er
is
tics
an
d
s
er
v
ice
co
v
er
ag
e,
th
en
r
an
d
o
m
ly
ass
ig
n
ed
v
ia
co
in
to
s
s
in
g
in
to
in
ter
v
en
tio
n
a
n
d
co
n
tr
o
l
clu
s
ter
s
.
All
p
o
s
tp
ar
tu
m
m
o
th
er
s
m
ee
tin
g
in
cl
u
s
io
n
cr
i
ter
ia
with
in
ea
ch
clu
s
ter
wer
e
co
n
s
ec
u
tiv
ely
r
ec
r
u
ited
u
n
til
t
h
e
r
eq
u
ir
e
d
s
am
p
le
s
ize
wa
s
ac
h
iev
ed
.
B
aselin
e
h
o
m
o
g
e
n
eity
b
etwe
en
g
r
o
u
p
s
was
s
tatis
t
ically
v
er
if
ied
u
s
in
g
in
d
ep
en
d
en
t
t
-
test
s
an
d
C
h
i
-
s
q
u
ar
e
test
s
.
Sev
er
al
s
tr
ateg
ies
wer
e
im
p
lem
en
ted
to
m
in
im
ize
r
esear
ch
b
ias.
Selectio
n
b
ias
was
m
itig
ated
th
r
o
u
g
h
s
tr
ict
a
p
p
licatio
n
o
f
in
clu
s
io
n
an
d
ex
cl
u
s
io
n
cr
iter
ia
an
d
s
tatis
tical
v
er
if
icatio
n
o
f
b
aselin
e
eq
u
iv
alen
ce
.
Per
f
o
r
m
an
ce
b
i
as
was
r
ed
u
ce
d
th
r
o
u
g
h
g
e
o
g
r
ap
h
ical
s
ep
ar
atio
n
o
f
in
ter
v
en
tio
n
an
d
co
n
tr
o
l
clu
s
ter
s
.
Dete
ctio
n
b
ias
was
m
in
im
ized
b
y
em
p
lo
y
in
g
tr
ain
e
d
en
u
m
er
ato
r
s
b
lin
d
ed
t
o
g
r
o
u
p
allo
ca
tio
n
(
s
in
g
le
b
lin
d
in
g
)
.
Attr
itio
n
b
ias
was
an
ticip
ated
th
r
o
u
g
h
r
eg
u
lar
telep
h
o
n
e
co
m
m
u
n
icatio
n
a
n
d
h
o
m
e
v
is
its
to
m
ain
tain
p
ar
ticip
an
t
r
eten
tio
n
th
r
o
u
g
h
o
u
t
th
e
2
4
-
wee
k
f
o
llo
w
-
u
p
p
er
i
o
d
.
Fu
r
th
er
m
o
r
e,
m
u
ltiv
ar
iate
an
aly
s
es
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
E
ffective
n
ess
o
f a
b
r
ea
s
tfeed
in
g
s
elf
-
effica
cy
in
terven
tio
n
o
n
B
S
E
S
-
S
F
s
co
r
es a
n
d
…
(
A
r
ifa
r
a
h
mi
)
451
u
s
in
g
C
o
x
p
r
o
p
o
r
tio
n
al
h
az
ar
d
r
eg
r
ess
io
n
an
d
lin
ea
r
m
ix
e
d
m
o
d
els
(
L
MM
)
wer
e
em
p
l
o
y
ed
to
s
tatis
tically
co
n
tr
o
l f
o
r
p
o
ten
tial c
o
n
f
o
u
n
d
in
g
v
ar
iab
les.
2
.
4
.
Resea
rc
h
v
a
ria
bles
T
h
e
in
d
ep
en
d
en
t
v
ar
ia
b
le
was
th
e
ty
p
e
o
f
tr
ea
tm
en
t
g
r
o
u
p
(
in
ter
v
en
tio
n
v
er
s
u
s
co
n
tr
o
l)
.
T
h
e
m
ain
d
ep
en
d
e
n
t
v
a
r
iab
les
co
n
s
is
ted
o
f
:
i
)
b
r
ea
s
tf
ee
d
in
g
s
elf
-
ef
f
ic
ac
y
s
co
r
es
m
ea
s
u
r
ed
u
s
in
g
th
e
b
r
ea
s
tf
ee
d
in
g
s
elf
-
ef
f
icac
y
s
ca
le
-
s
h
o
r
t
f
o
r
m
(
B
SES
-
SF
)
,
an
d
ii
)
th
e
p
r
o
p
o
r
tio
n
o
f
ex
cl
u
s
iv
e
b
r
ea
s
tf
ee
d
i
n
g
a
t
ea
ch
m
ea
s
u
r
em
en
t
tim
e
p
o
in
t.
C
o
n
tr
o
lled
co
n
f
o
u
n
d
in
g
v
ar
iab
les
in
clu
d
ed
m
ater
n
al
ag
e,
ed
u
ca
tio
n
le
v
el,
em
p
lo
y
m
e
n
t
s
tatu
s
,
p
ar
ity
,
ty
p
e
o
f
d
eliv
er
y
,
h
u
s
b
a
n
d
'
s
s
u
p
p
o
r
t,
an
d
b
aselin
e
B
SES
-
SF
s
co
r
es.
2
.
5
.
Resea
rc
h
i
ns
t
rum
ent
s
T
h
e
m
ain
in
s
tr
u
m
e
n
t
is
th
e
B
SES
-
SF
co
n
s
is
tin
g
o
f
1
4
item
s
with
a
5
-
p
o
i
n
t
L
ik
er
t
s
ca
le
(
1
=
v
er
y
ce
r
tain
to
5
=
v
er
y
ce
r
tain
)
,
w
ith
a
s
co
r
e
r
an
g
e
o
f
1
4
-
7
0
.
T
h
e
in
s
tr
u
m
en
t
h
as
b
ee
n
tr
an
s
lated
in
to
I
n
d
o
n
esian
th
r
o
u
g
h
th
e
b
ac
k
-
tr
an
s
latio
n
m
eth
o
d
an
d
h
as
b
ee
n
test
ed
f
o
r
v
alid
ity
a
n
d
r
eliab
ilit
y
in
th
e
I
n
d
o
n
esian
b
r
ea
s
tf
ee
d
in
g
m
o
th
er
p
o
p
u
latio
n
with
a
C
r
o
n
b
ac
h
'
s
alp
h
a
o
f
0
.
8
3
.
Dem
o
g
r
ap
h
ic
d
ata
wer
e
co
llected
u
s
in
g
a
s
tr
u
ctu
r
ed
q
u
esti
o
n
n
air
e
co
v
e
r
in
g
ag
e,
ed
u
ca
tio
n
,
em
p
lo
y
m
e
n
t
s
tatu
s
,
p
ar
ity
,
ty
p
e
o
f
d
eliv
er
y
,
an
d
h
u
s
b
an
d
'
s
s
u
p
p
o
r
t.
E
x
clu
s
iv
e
b
r
ea
s
tf
ee
d
i
n
g
s
tatu
s
was
m
ea
s
u
r
ed
t
h
r
o
u
g
h
a
s
tr
u
ct
u
r
ed
in
ter
v
iew
a
n
d
i
n
f
an
t
f
ee
d
in
g
r
ec
all
r
ef
er
r
in
g
to
th
e
W
HO
d
ef
in
itio
n
.
T
h
e
ty
p
e
o
f
r
ec
all
u
s
ed
was
cu
m
u
lativ
e
p
r
e
v
alen
ce
(
s
in
ce
b
ir
th
).
2
.
6
.
Da
t
a
c
o
llect
io
n pro
ce
du
re
s
Data
co
llectio
n
b
e
g
an
wit
h
r
esp
o
n
d
en
t
s
cr
ee
n
in
g
an
d
r
ec
r
u
itm
en
t,
f
o
llo
wed
b
y
b
aselin
e
m
ea
s
u
r
em
en
ts
in
clu
d
in
g
a
d
e
m
o
g
r
ap
h
ic
q
u
esti
o
n
n
air
e
an
d
th
e
B
SES
-
SF
.
T
h
e
in
ter
v
en
tio
n
g
r
o
u
p
r
ec
ei
v
ed
a
b
r
ea
s
tf
ee
d
in
g
s
elf
-
e
f
f
icac
y
im
p
r
o
v
em
e
n
t
p
r
o
g
r
a
m
,
wh
ile
th
e
co
n
tr
o
l
g
r
o
u
p
r
ec
eiv
ed
s
tan
d
a
r
d
ca
r
e.
Fo
llo
w
-
u
p
m
ea
s
u
r
em
en
ts
wer
e
c
o
n
d
u
cted
at
wee
k
s
2
,
6
,
1
2
,
a
n
d
2
4
th
r
o
u
g
h
h
o
m
e
o
r
h
ea
lth
f
ac
ilit
y
v
is
its
,
s
u
p
p
o
r
ted
b
y
telep
h
o
n
e
co
m
m
u
n
icatio
n
to
m
in
im
ize
lo
s
s
to
f
o
llo
w
-
u
p
.
All
d
ata
co
llectio
n
was
co
n
d
u
cted
b
y
tr
ain
ed
en
u
m
er
ato
r
s
.
2
.
7
.
Da
t
a
a
na
ly
s
is
Data
an
aly
s
is
u
s
ed
s
tatis
tical
s
o
f
twar
e
with
α
=
0
.
0
5
.
Descr
ip
tiv
e
an
aly
s
is
p
r
esen
ts
f
r
e
q
u
en
cies
an
d
p
er
ce
n
tag
es
f
o
r
ca
te
g
o
r
ical
d
ata
an
d
m
ea
n
s
an
d
s
tan
d
ar
d
d
ev
iatio
n
s
f
o
r
n
u
m
er
ical
d
ata
.
Ho
m
o
g
en
eity
o
f
ch
ar
ac
ter
is
tics
b
etwe
en
g
r
o
u
p
s
was
tes
ted
u
s
in
g
th
e
in
d
e
p
en
d
en
t
t
-
test
(
n
u
m
er
ical
v
ar
ia
b
les)
an
d
th
e
C
h
i
-
s
q
u
ar
e
test
(
ca
teg
o
r
ical
v
ar
ia
b
les)
to
en
s
u
r
e
eq
u
ality
o
f
in
itial
ch
ar
ac
ter
is
tics
.
B
iv
ar
iate
an
aly
s
is
co
m
p
ar
e
d
B
SES
-
S
F
s
co
r
es
b
etwe
en
g
r
o
u
p
s
u
s
in
g
a
n
in
d
e
p
en
d
e
n
t
t
-
test
with
m
ea
n
d
if
f
er
e
n
ce
a
n
d
9
5
%
co
n
f
id
e
n
ce
in
ter
v
al
(
C
I
)
.
T
h
e
p
r
o
p
o
r
tio
n
o
f
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
i
n
g
wa
s
co
m
p
ar
ed
u
s
in
g
a
C
h
i
-
s
q
u
a
r
e
test
with
r
elativ
e
r
is
k
(
R
R
)
ca
lcu
latio
n
s
an
d
9
5
%
C
I
.
Mu
ltiv
ar
iate
an
aly
s
is
u
s
ed
C
o
x
p
r
o
p
o
r
tio
n
al
h
az
ar
d
r
e
g
r
ess
io
n
to
id
en
tify
f
ac
to
r
s
th
at
in
d
ep
e
n
d
en
tly
in
f
lu
en
ce
t
h
e
ce
s
s
atio
n
o
f
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
f
o
r
2
4
wee
k
s
wh
ile
s
im
u
ltan
eo
u
s
ly
co
n
tr
o
llin
g
f
o
r
co
n
f
o
u
n
d
in
g
v
ar
iab
les.
T
h
e
C
o
x
m
o
d
el
was
ch
o
s
en
b
ec
au
s
e
it
is
ap
p
r
o
p
r
iate
f
o
r
tim
e
-
to
-
e
v
en
t
d
ata
an
d
is
ab
le
to
ac
co
m
m
o
d
ate
ce
n
s
o
r
ed
d
ata.
R
esu
lts
ar
e
p
r
esen
te
d
as
a
h
az
ar
d
r
atio
(
HR
)
with
9
5
%
C
I
,
wh
er
e
HR
<1
in
d
icate
s
a
p
r
o
tectiv
e
f
ac
t
o
r
an
d
HR
>1
in
d
icate
s
a
r
is
k
f
ac
to
r
f
o
r
ce
s
s
atio
n
o
f
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
.
L
in
ea
r
m
ix
ed
m
o
d
el
(
L
MM
)
a
n
aly
s
is
f
o
r
c
h
an
g
es
in
B
SES
-
SF
Sco
r
es
b
y
T
im
e
an
d
Gr
o
u
p
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
T
ab
le
1
p
r
esen
ts
th
e
d
e
m
o
g
r
a
p
h
ic
ch
ar
ac
te
r
is
tics
o
f
th
e
in
t
er
v
en
tio
n
(
n
=
5
2
)
an
d
co
n
tr
o
l
(
n
=
5
2
)
g
r
o
u
p
s
.
T
h
e
m
ea
n
m
ater
n
al
ag
e
was 2
7
.
4
6
±
4
.
8
2
a
n
d
2
8
.
1
2
±
5
.
1
4
y
ea
r
s
,
r
esp
ec
tiv
ely
,
with
m
o
s
t r
esp
o
n
d
en
ts
a
g
e
d
2
0
-
3
5
y
e
a
r
s
.
T
h
e
m
a
j
o
r
i
t
y
h
a
d
a
h
i
g
h
s
c
h
o
o
l
e
d
u
c
at
i
o
n
,
w
e
r
e
h
o
u
s
e
wi
v
e
s
,
m
u
l
t
i
p
a
r
o
u
s
,
d
e
l
i
v
e
r
e
d
v
a
g
i
n
a
ll
y
,
an
d
r
ec
eiv
e
d
th
eir
h
u
s
b
an
d
'
s
s
u
p
p
o
r
t.
Dem
o
g
r
ap
h
ic
c
h
ar
ac
te
r
is
tics
wer
e
co
m
p
ar
ab
le
b
etwe
en
th
e
two
g
r
o
u
p
s
.
T
ab
le
2
d
em
o
n
s
tr
ates
eq
u
iv
al
en
t
b
aselin
e
B
SES
-
SF
s
co
r
es
b
etwe
en
g
r
o
u
p
s
(
4
2
.
3
5
±
8
.
7
2
v
s
4
1
.
8
8
±
9
.
1
4
,
p
=
0
.
7
8
6
)
,
c
o
n
f
ir
m
i
n
g
i
n
itial
h
o
m
o
g
e
n
eity
.
Sig
n
if
ica
n
t
b
etwe
en
-
g
r
o
u
p
d
if
f
er
e
n
ce
s
em
er
g
ed
at
1
-
wee
k
p
o
s
t
-
test
(
m
ea
n
d
if
f
e
r
en
ce
=
5
.
3
5
,
p
=
0
.
0
0
2
)
an
d
p
r
o
g
r
ess
iv
ely
in
cr
ea
s
ed
th
r
o
u
g
h
th
e
4
-
w
ee
k
p
o
s
t
-
test
(
m
ea
n
d
if
f
er
en
ce
=
1
1
.
6
7
,
p
<
0
.
0
0
1
)
.
T
h
e
in
ter
v
en
tio
n
g
r
o
u
p
d
em
o
n
s
tr
ated
a
1
7
.
3
8
-
p
o
i
n
t
in
cr
ea
s
e
(
4
2
.
3
5
to
5
9
.
7
3
)
,
s
u
b
s
tan
tially
ex
ce
ed
in
g
th
e
co
n
tr
o
l g
r
o
u
p
'
s
6
.
1
8
-
p
o
in
t in
c
r
ea
s
e
(
4
1
.
8
8
to
4
8
.
0
6
)
.
T
ab
le
3
s
h
o
ws
th
e
p
r
o
p
o
r
tio
n
o
f
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
i
n
b
o
th
g
r
o
u
p
s
at
th
e
f
o
u
r
m
e
asu
r
em
en
t
tim
e
p
o
in
ts
.
At
2
wee
k
s
p
o
s
tp
ar
tu
m
,
th
e
p
r
o
p
o
r
tio
n
o
f
e
x
clu
s
iv
e
b
r
ea
s
tf
ee
d
i
n
g
in
t
h
e
in
ter
v
e
n
tio
n
g
r
o
u
p
(
9
2
.
3
%)
was
h
ig
h
er
th
an
in
th
e
co
n
tr
o
l
g
r
o
u
p
(
8
2
.
7
%),
b
u
t
t
h
is
d
if
f
er
en
ce
was
n
o
t
s
tatis
tically
s
ig
n
if
ican
t
(
p
=
0
.
1
4
3
)
.
A
s
ig
n
if
ican
t
d
if
f
er
e
n
ce
b
eg
an
to
ap
p
ea
r
at
wee
k
6
,
wh
er
e
th
e
in
ter
v
en
tio
n
g
r
o
u
p
(
8
6
.
5
%)
was
s
ig
n
if
ican
tly
h
i
g
h
er
th
an
th
e
c
o
n
tr
o
l
g
r
o
u
p
(
6
9
.
2
%)
,
with
an
R
R
o
f
1
.
2
5
(
p
=
0
.
0
3
2
)
.
T
h
is
tr
en
d
s
tr
en
g
th
en
e
d
at
wee
k
1
2
(
8
0
.
8
%
v
s
.
5
5
.
8
%,
R
R
=
1
.
4
5
,
p
=
0
.
0
0
5
)
a
n
d
r
ea
ch
e
d
its
lar
g
est
d
if
f
er
e
n
ce
at
wee
k
2
4
o
r
6
m
o
n
th
s
(
7
1
.
2
% v
s
.
4
0
.
4
%,
R
R
=
1
.
7
6
,
p
=
0
.
0
0
1
)
.
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.
15
,
No
.
2
,
J
u
n
e
20
26
:
4
4
9
-
4
5
7
452
C
o
x
p
r
o
p
o
r
tio
n
al
h
az
ar
d
r
eg
r
ess
io
n
(
s
ee
T
ab
le
4
)
id
en
tifie
d
f
o
u
r
s
ig
n
if
ica
n
t
p
r
ed
icto
r
s
o
f
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
ce
s
s
atio
n
(
p
<
0
.
0
5
)
.
T
h
e
i
n
ter
v
en
tio
n
g
r
o
u
p
d
e
m
o
n
s
tr
ated
th
e
s
tr
o
n
g
e
s
t
p
r
o
tectiv
e
ef
f
ec
t,
r
ed
u
cin
g
d
is
co
n
tin
u
atio
n
r
is
k
b
y
5
9
%
(
HR
=
0
.
4
1
,
9
5
%
C
I
:
0
.
2
4
–
0
.
7
0
,
p
=
0
.
0
0
1
)
.
Hu
s
b
a
n
d
'
s
s
u
p
p
o
r
t
(
HR
=
0
.
5
4
,
p
=
0
.
0
3
9
)
an
d
h
ig
h
er
b
aselin
e
B
SES
-
SF
s
co
r
es
(
HR
=
0
.
9
6
,
p
=
0
.
0
1
8
)
wer
e
also
p
r
o
tectiv
e.
C
o
n
v
er
s
ely
,
m
ater
n
al
em
p
lo
y
m
en
t
in
cr
ea
s
ed
d
is
co
n
tin
u
atio
n
r
is
k
1
.
7
2
-
f
o
ld
(
HR
=
1
.
7
2
,
9
5
%
C
I
:
1
.
0
4
–
2
.
8
4
,
p
=
0
.
0
3
4
)
.
Ma
ter
n
al
ag
e,
e
d
u
ca
t
io
n
,
p
ar
ity
,
an
d
d
eliv
er
y
ty
p
e
wer
e
n
o
n
-
s
ig
n
if
ican
t (
p
>
0
.
0
5
)
.
T
ab
le
1
.
Dem
o
g
r
ap
h
ic
ch
ar
ac
t
er
is
tics
o
f
r
esp
o
n
d
en
ts
C
h
a
r
a
c
t
e
r
i
s
t
i
c
s
I
n
t
e
r
v
e
n
t
i
o
n
g
r
o
u
p
(
n
=
5
2
)
C
o
n
t
r
o
l
g
r
o
u
p
(
n
=
5
2
)
p
-
v
a
l
u
e
M
o
t
h
e
r
's
a
g
e
(
y
e
a
r
s)
M
e
a
n
±
S
D
2
7
.
4
6
±
4
.
8
2
2
8
.
1
2
±
5
.
1
4
0
.
4
8
7
ᵃ
<
2
0
y
e
a
r
s
3
(
5
.
8
)
2
(
3
.
8
)
20
-
3
5
y
e
a
r
s
4
3
(
8
2
.
7
)
4
2
(
8
0
.
8
)
0
.
7
6
2
ᵇ
>
3
5
y
e
a
r
s
6
(
1
1
.
5
)
8
(
1
5
.
4
)
Ed
u
c
a
t
i
o
n
El
e
m
e
n
t
a
r
y
a
n
d
j
u
n
i
o
r
h
i
g
h
sc
h
o
o
l
(
l
o
w
)
8
(
1
5
.
4
)
1
0
(
1
9
.
2
)
S
e
n
i
o
r
h
i
g
h
s
c
h
o
o
l
(
l
o
w
)
2
6
(
5
0
.
0
)
2
4
(
4
6
.
2
)
0
.
6
8
4
ᵇ
D
i
p
l
o
m
a
/
b
a
c
h
e
l
o
r
's
d
e
g
r
e
e
(
h
i
g
h
e
r
)
1
8
(
3
4
.
6
)
1
8
(
3
4
.
6
)
Emp
l
o
y
me
n
t
st
a
t
u
s
W
o
r
k
2
2
(
4
2
.
3
)
2
4
(
4
6
.
2
)
0
.
6
9
7
ᵇ
H
o
u
s
e
w
i
f
e
3
0
(
5
7
.
7
)
2
8
(
5
3
.
8
)
P
a
r
i
t
y
P
r
i
mi
p
a
r
a
2
3
(
4
4
.
2
)
2
1
(
4
0
.
4
)
0
.
6
9
4
ᵇ
M
u
l
t
i
p
a
r
a
2
9
(
5
5
.
8
)
3
1
(
5
9
.
6
)
Ty
p
e
s
o
f
d
e
l
i
v
e
r
y
V
a
g
i
n
a
l
3
8
(
7
3
.
1
)
3
6
(
6
9
.
2
)
0
.
6
6
5
ᵇ
C
a
e
s
a
r
e
a
n
s
e
c
t
i
o
n
1
4
(
2
6
.
9
)
1
6
(
3
0
.
8
)
H
u
sb
a
n
d
's s
u
p
p
o
r
t
S
u
p
p
o
r
t
4
1
(
7
8
.
8
)
3
9
(
7
5
.
0
)
0
.
6
4
1
ᵇ
Le
ss s
u
p
p
o
r
t
i
v
e
1
1
(
2
1
.
2
)
1
3
(
2
5
.
0
)
D
e
scri
p
t
i
o
n
:
ᵃ
I
n
d
e
p
e
n
d
e
n
t
t
-
t
e
st
,
ᵇ
C
h
i
-
sq
u
a
r
e
t
e
st
,
S
D
=
S
t
a
n
d
a
r
d
D
e
v
i
a
t
i
o
n
.
A
p
-
v
a
l
u
e
>
0
.
0
5
i
n
d
i
c
a
t
e
s
n
o
s
i
g
n
i
f
i
c
a
n
t
d
i
f
f
e
r
e
n
c
e
b
e
t
w
e
e
n
t
h
e
t
w
o
g
r
o
u
p
s (
h
o
mo
g
e
n
e
o
u
s)
T
ab
le
2
.
B
r
ea
s
tf
ee
d
in
g
s
elf
-
e
f
f
icac
y
s
co
r
es (
B
SES
-
SF
)
in
th
e
in
ter
v
en
tio
n
an
d
c
o
n
tr
o
l g
r
o
u
p
s
at
v
ar
io
u
s
m
ea
s
u
r
em
en
t tim
es
M
e
a
su
r
e
me
n
t
t
i
me
I
n
t
e
r
v
e
n
t
i
o
n
g
r
o
u
p
(
n
=
5
2
)
C
o
n
t
r
o
l
g
r
o
u
p
(
n
=
5
2
)
M
e
a
n
d
i
f
f
e
r
e
n
c
e
9
5
%
C
I
p
-
v
a
l
u
e
M
e
a
n
±
S
D
M
e
a
n
±
S
D
Pre
-
t
e
st
(
b
a
sel
i
n
e
)
4
2
.
3
5
±
8
.
7
2
4
1
.
8
8
±
9
.
1
4
0
.
4
7
-
2
.
9
7
-
3
.
9
1
0
.
7
8
6
ᵃ
P
o
st
-
t
e
st
1
(
2
w
e
e
k
s)
4
9
.
6
2
±
7
.
8
4
4
4
.
2
7
±
8
.
9
6
5
.
3
5
2
.
1
0
-
8
.
6
0
0
.
0
0
2
*
ᵃ
P
o
st
-
t
e
st
2
(
6
w
e
e
k
s)
5
4
.
8
1
±
7
.
2
1
4
6
.
1
5
±
8
.
5
3
8
.
6
6
5
.
6
2
-
1
1
.
7
0
<
0
.
0
0
1
*
ᵃ
P
o
st
-
t
e
st
3
(
1
2
w
e
e
k
s)
5
7
.
9
4
±
6
.
5
8
4
7
.
4
2
±
8
.
8
7
1
0
:
5
2
7
.
5
2
-
1
3
.
5
2
<
0
.
0
0
1
*
ᵃ
P
o
st
-
t
e
st
4
(
2
4
w
e
e
k
s)
5
9
.
7
3
±
6
.
1
2
4
8
.
0
6
±
9
.
2
4
1
1
.
6
7
8
.
6
3
-
1
4
.
7
1
<
0
.
0
0
1
*
ᵃ
D
e
scri
p
t
i
o
n
:
ᵃ
i
n
d
e
p
e
n
d
e
n
t
t
-
t
e
s
t
,
si
g
n
i
f
i
c
a
n
t
a
t
α
=
0
.
0
5
,
B
S
ES
-
S
F
=
b
r
e
a
st
f
e
e
d
i
n
g
s
e
l
f
-
e
f
f
i
c
a
c
y
sca
l
e
-
sh
o
r
t
f
o
r
m
(
sco
r
e
r
a
n
g
e
1
4
-
7
0
)
,
S
D
=
st
a
n
d
a
r
d
d
e
v
i
a
t
i
o
n
,
C
I
=
c
o
n
f
i
d
e
n
c
e
i
n
t
e
r
v
a
l
*
T
ab
le
3
.
Pro
p
o
r
tio
n
o
f
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
at
ea
ch
m
ea
s
u
r
em
en
t tim
e
M
e
a
su
r
e
me
n
t
t
i
me
I
n
t
e
r
v
e
n
t
i
o
n
g
r
o
u
p
(
n
=
5
2
)
n
(
%)
C
o
n
t
r
o
l
g
r
o
u
p
(
n
=
5
2
)
n
(
%)
R
R
(
9
5
%
C
I
)
p
-
v
a
l
u
e
Ex
c
l
u
si
v
e
b
r
e
a
st
f
e
e
d
i
n
g
a
t
2
w
e
e
k
s
4
8
(
9
2
.
3
)
4
3
(
8
2
.
7
)
1
.
1
2
(
0
.
9
7
-
1
.
2
8
)
0
.
1
4
3
ᵃ
Ex
c
l
u
si
v
e
b
r
e
a
st
f
e
e
d
i
n
g
a
t
6
w
e
e
k
s
4
5
(
8
6
.
5
)
3
6
(
6
9
.
2
)
1
.
2
5
(
1
.
0
2
-
1
.
5
3
)
0
.
0
3
2
ᵃ
Ex
c
l
u
si
v
e
b
r
e
a
st
f
e
e
d
i
n
g
a
t
1
2
w
e
e
k
s
4
2
(
8
0
.
8
)
2
9
(
5
5
.
8
)
1
.
4
5
(
1
.
1
0
-
1
.
9
0
)
0
.
0
0
5
ᵃ
Ex
c
l
u
si
v
e
b
r
e
a
st
f
e
e
d
i
n
g
a
t
2
4
w
e
e
k
s (
6
m
o
n
t
h
s)
3
7
(
7
1
.
2
)
2
1
(
4
0
.
4
)
1
.
7
6
(
1
.
2
2
-
2
.
5
5
)
0
.
0
0
1
ᵃ
D
e
scri
p
t
i
o
n
:
ᵃ
C
h
i
-
sq
u
a
r
e
t
e
st
,
s
i
g
n
i
f
i
c
a
n
t
a
t
α
=
0
.
0
5
,
R
R
=
r
e
l
a
t
i
v
e
r
i
s
k
,
C
I
=
c
o
n
f
i
d
e
n
c
e
i
n
t
e
r
v
a
l
,
A
S
I
=
b
r
e
a
st
m
i
l
k
T
ab
le
4
.
C
o
x
p
r
o
p
o
r
tio
n
al
h
az
ar
d
r
eg
r
ess
io
n
an
aly
s
is
f
o
r
f
ac
t
o
r
s
in
f
lu
en
cin
g
d
is
co
n
tin
u
atio
n
o
f
ex
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
V
a
r
i
a
b
l
e
s
B
SE
W
a
l
d
HR
9
5
%
C
I
p
-
v
a
l
u
e
G
r
o
u
p
(
i
n
t
e
r
v
e
n
t
i
o
n
v
s c
o
n
t
r
o
l
)
-
0
.
8
9
2
0
.
2
7
4
1
0
.
6
1
0
.
4
1
0
.
2
4
-
0
.
7
0
0
.
0
0
1
*
M
o
t
h
e
r
's
a
g
e
(
y
e
a
r
s)
-
0
.
0
2
4
0
.
0
3
1
0
.
6
0
0
.
9
8
0
.
9
2
-
1
.
0
4
0
.
4
3
8
Ed
u
c
a
t
i
o
n
(
h
i
g
h
v
s
l
o
w
)
-
0
.
3
8
6
0
.
2
6
8
2
.
0
7
0
.
6
8
0
.
4
0
-
1
.
1
5
0
.
1
5
0
Emp
l
o
y
me
n
t
st
a
t
u
s (w
o
r
k
i
n
g
v
s
n
o
t
)
0
.
5
4
2
0
.
2
5
6
4
.
4
8
1
.
7
2
1
.
0
4
-
2
.
8
4
0
.
0
3
4
*
P
a
r
i
t
y
(
m
u
l
t
i
p
a
r
a
v
s
p
r
i
mi
p
a
r
a
)
-
0
.
4
7
8
0
.
2
6
1
3
.
3
6
0
.
6
2
0
.
3
7
-
1
.
0
3
0
.
0
6
7
Ty
p
e
o
f
d
e
l
i
v
e
r
y
(
c
s
v
s
.
V
a
g
i
n
a
l
)
0
.
3
2
4
0
.
2
8
4
1
.
3
0
1
.
3
8
0
.
7
9
-
2
.
4
1
0
.
2
5
4
H
u
sb
a
n
d
s
u
p
p
o
r
t
(
y
e
s
v
s
n
o
)
-
0
.
6
1
4
0
.
2
9
8
4
.
2
5
0
.
5
4
0
.
3
0
-
0
.
9
7
0
.
0
3
9
*
B
S
ES
-
SF
b
a
se
l
i
n
e
sc
o
r
e
-
0
.
0
3
8
0
.
0
1
6
5
.
6
4
0
.
9
6
0
.
9
3
-
0
.
9
9
0
.
0
1
8
*
D
e
scri
p
t
i
o
n
:
B
=
R
e
g
r
e
ssi
o
n
c
o
e
f
f
i
c
i
e
n
t
,
S
E
=
st
a
n
d
a
r
d
e
r
r
o
r
,
H
R
=
h
a
z
a
r
d
r
a
t
i
o
,
C
I
=
c
o
n
f
i
d
e
n
c
e
i
n
t
e
r
v
a
l
,
S
C
=
sec
t
i
o
n
C
a
e
s
a
r
e
a
.
H
R
<
1
i
n
d
i
c
a
t
e
s
a
p
r
o
t
e
c
t
i
v
e
f
a
c
t
o
r
a
g
a
i
n
s
t
d
i
s
c
o
n
t
i
n
u
i
n
g
e
x
c
l
u
si
v
e
b
r
e
a
s
t
f
e
e
d
i
n
g
;
H
R
>
1
i
n
d
i
c
a
t
e
s
a
r
i
sk
f
a
c
t
o
r
.
*
S
i
g
n
i
f
i
c
a
n
t
a
t
α
=
0
.
0
5
.
T
h
e
r
e
s
u
l
t
s
o
f
th
e
L
MM
an
a
ly
s
i
s
(
s
ee
T
ab
le
5
)
s
h
o
wed
t
h
at
th
e
r
e
wa
s
a
s
ig
n
if
ic
an
t
i
n
ter
ac
tio
n
b
et
wee
n
g
r
o
u
p
an
d
tim
e
o
n
c
h
an
g
e
s
in
B
SE
S
-
S
F
s
co
r
e
s
(
F
(
4
,
4
7
2
)
=
9
.
5
3
,
p
<
0
.
0
0
1
)
,
wh
i
ch
in
d
ic
at
ed
th
at
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
E
ffective
n
ess
o
f a
b
r
ea
s
tfeed
in
g
s
elf
-
effica
cy
in
terven
tio
n
o
n
B
S
E
S
-
S
F
s
co
r
es a
n
d
…
(
A
r
ifa
r
a
h
mi
)
453
th
e
tr
aje
ct
o
r
y
o
f
b
r
e
a
s
tf
ee
d
in
g
s
e
lf
-
ef
f
ica
cy
im
p
r
o
v
e
m
en
t
w
as
s
ig
n
if
ica
n
t
ly
d
if
f
er
en
t
b
et
we
en
th
e
in
t
er
v
en
t
io
n
a
n
d
co
n
tr
o
l
g
r
o
u
p
s
th
r
o
u
g
h
o
u
t
th
e
m
ea
s
u
r
e
m
e
n
t
p
e
r
io
d
.
Al
th
o
u
g
h
th
e
m
a
in
ef
f
e
ct
o
f
g
r
o
u
p
at
b
as
el
in
e
wa
s
n
o
t
s
ig
n
if
ica
n
t
(
B
=
1
.
2
4
,
p
=
0
.
5
6
7
)
,
in
d
ic
at
in
g
eq
u
al
ity
o
f
th
e
in
it
ia
l
co
n
d
i
tio
n
s
o
f
b
o
th
g
r
o
u
p
s
,
th
e
g
r
o
u
p
×
ti
m
e
in
t
er
ac
t
io
n
ef
f
e
ct
in
cr
e
as
ed
p
r
o
g
r
e
s
s
iv
ely
f
r
o
m
we
ek
2
(
B
=
4
.
2
6
,
p
=
0
.
0
0
2
)
,
w
ee
k
6
(
B
=
6
.
8
3
,
p
<
0
.
0
0
1
)
,
we
e
k
1
2
(
B
=
8
.
9
4
,
p
<
0
.
0
0
1
)
,
t
o
we
ek
2
4
(
B
=
1
1
.
5
8
,
p
<
0
.
0
0
1
)
.
T
ab
le
5
also
s
h
o
ws
th
at
th
e
an
aly
s
i
s
u
s
ed
a
lin
ea
r
m
ix
ed
m
o
d
el
with
an
u
n
s
tr
u
ctu
r
ed
co
v
ar
ian
ce
s
tr
u
ctu
r
e
f
o
r
r
an
d
o
m
ef
f
ec
ts
.
T
h
e
co
n
tr
o
l
g
r
o
u
p
an
d
b
aselin
e
tim
e
wer
e
u
s
ed
as
r
ef
er
en
ce
ca
teg
o
r
ies.
E
s
tim
ates
wer
e
o
b
tain
ed
u
s
in
g
th
e
r
estricte
d
m
ax
im
u
m
-
lik
elih
o
o
d
(
R
E
ML
)
m
eth
o
d
.
A
s
ig
n
if
ican
t
g
r
o
u
p
×
tim
e
in
ter
ac
tio
n
in
d
icate
d
th
at
th
e
in
cr
ea
s
e
in
B
SES
-
SF
s
co
r
es
o
v
er
tim
e
was
s
ig
n
if
ica
n
tly
g
r
ea
ter
i
n
th
e
in
ter
v
en
tio
n
g
r
o
u
p
th
a
n
in
t
h
e
co
n
tr
o
l g
r
o
u
p
.
T
h
e
r
esu
lts
s
h
o
wed
t
h
at
b
o
t
h
g
r
o
u
p
s
h
ad
h
o
m
o
g
en
eo
u
s
d
em
o
g
r
ap
h
ic
ch
ar
ac
ter
is
tics
,
with
n
o
s
ig
n
if
ican
t
d
if
f
e
r
en
ce
s
ac
r
o
s
s
all
d
em
o
g
r
ap
h
ic
v
ar
iab
les (
p
>
0
.
0
5
)
.
T
h
is
h
o
m
o
g
e
n
eity
is
a
cr
itical
p
r
er
eq
u
is
ite
in
q
u
asi
-
ex
p
er
im
en
tal
d
esig
n
s
to
en
s
u
r
e
th
at
o
b
s
er
v
ed
o
u
tc
o
m
e
d
if
f
e
r
en
ce
s
ar
e
attr
ib
u
tab
le
to
th
e
in
ter
v
e
n
tio
n
r
ath
er
th
an
co
n
f
o
u
n
d
in
g
f
ac
t
o
r
s
.
T
h
e
m
ajo
r
ity
o
f
r
esp
o
n
d
en
ts
wer
e
o
f
r
ep
r
o
d
u
ctiv
e
ag
e
(
2
0
-
3
5
y
ea
r
s
)
,
co
m
p
r
is
in
g
8
2
.
7
%
in
th
e
in
te
r
v
en
tio
n
g
r
o
u
p
an
d
8
0
.
8
%
in
th
e
co
n
tr
o
l
g
r
o
u
p
.
T
h
e
p
r
o
p
o
r
tio
n
o
f
w
o
r
k
in
g
m
o
th
er
s
(
4
2
.
3
%
v
s
.
4
6
.
2
%)
r
ef
lects
th
e
s
o
cio
d
em
o
g
r
a
p
h
ic
r
ea
lity
wh
er
e
m
o
s
t
m
o
t
h
er
s
r
em
ain
h
o
u
s
ewiv
es.
T
h
is
f
in
d
in
g
is
p
ar
ticu
lar
ly
r
e
lev
an
t,
as
m
ater
n
al
em
p
lo
y
m
e
n
t
s
tatu
s
h
as
b
ee
n
id
en
tifie
d
as
a
s
ig
n
if
ican
t
r
is
k
f
ac
to
r
f
o
r
d
is
co
n
tin
u
in
g
e
x
clu
s
iv
e
b
r
ea
s
tf
ee
d
in
g
[
1
6
]
-
[
1
8
]
.
T
h
e
m
ain
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
in
d
icate
th
at
th
e
b
r
ea
s
tf
ee
d
in
g
s
elf
-
ef
f
icac
y
e
n
h
an
ce
m
en
t
in
ter
v
en
tio
n
s
ig
n
i
f
ican
tly
im
p
r
o
v
ed
B
SES
-
SF
s
co
r
es
in
th
e
in
ter
v
en
tio
n
g
r
o
u
p
c
o
m
p
ar
e
d
t
o
th
e
co
n
tr
o
l
g
r
o
u
p
,
with
th
e
d
if
f
er
en
ce
wid
e
n
in
g
o
v
er
tim
e.
At
b
aselin
e,
b
o
th
g
r
o
u
p
s
s
h
o
wed
e
q
u
iv
alen
t
s
co
r
es
(
4
2
.
3
5
±
8
.
7
2
v
s
.
4
1
.
8
8
±
9
.
1
4
,
p
=
0
.
7
8
6
)
,
in
d
i
ca
tin
g
g
o
o
d
in
itial
h
o
m
o
g
e
n
eity
.
T
h
ese
b
aselin
e
s
co
r
es
f
all
with
in
th
e
m
o
d
er
ate
s
elf
-
ef
f
icac
y
ca
teg
o
r
y
ac
c
o
r
d
i
n
g
to
th
e
B
SES
-
SF
clas
s
if
ica
tio
n
,
wh
er
e
a
s
co
r
e
o
f
3
3
-
5
3
is
ca
teg
o
r
ized
as
m
o
d
er
ate
s
elf
-
ef
f
icac
y
[
1
9
]
.
Sig
n
if
ican
t
d
if
f
er
en
ce
s
b
eg
a
n
to
em
er
g
e
at
t
h
e
2
n
d
we
ek
p
o
s
t
-
test
(
m
ea
n
d
if
f
er
en
ce
=
5
.
3
5
,
p
=
0
.
0
0
2
)
an
d
co
n
tin
u
ed
to
i
n
cr
ea
s
e
co
n
s
is
ten
tly
u
n
til
th
e
2
4
th
w
ee
k
p
o
s
t
-
test
(
m
ea
n
d
if
f
er
en
ce
=
1
1
.
6
7
,
p
<
0
.
0
0
1
)
.
T
h
is
p
atter
n
o
f
p
r
o
g
r
ess
iv
e
in
cr
ea
s
e
is
in
lin
e
with
th
e
f
in
d
in
g
s
o
f
Saee
d
et
a
l
.
[
2
0
]
,
wh
o
r
ep
o
r
ted
s
ig
n
if
ican
t
d
if
f
er
e
n
ce
s
in
b
r
ea
s
tf
ee
d
in
g
s
elf
-
ef
f
icac
y
s
co
r
es
b
etwe
en
th
e
in
ter
v
en
tio
n
a
n
d
co
n
tr
o
l g
r
o
u
p
s
at
d
ay
1
5
(
p
<
0
.
0
0
1
)
,
2
m
o
n
t
h
s
(
p
<
0
.
0
0
1
)
,
an
d
4
m
o
n
th
s
(
p
<
0
.
0
0
1
)
p
o
s
tp
ar
tu
m
[
6
]
.
T
h
e
in
ter
v
e
n
tio
n
g
r
o
u
p
s
h
o
wed
a
1
7
.
3
8
-
p
o
i
n
t
in
cr
ea
s
e
(
4
2
.
3
5
to
5
9
.
7
3
)
,
wh
ile
t
h
e
co
n
tr
o
l
g
r
o
u
p
in
cr
ea
s
ed
o
n
l
y
6
.
1
8
p
o
i
n
ts
(
4
1
.
8
8
to
4
8
.
0
6
)
.
T
h
e
in
ter
v
e
n
tio
n
g
r
o
u
p
'
s
f
in
al
s
co
r
e
o
f
5
9
.
7
3
is
clin
ically
s
ig
n
if
ican
t,
r
ea
c
h
in
g
th
e
h
ig
h
s
elf
-
ef
f
icac
y
ca
teg
o
r
y
(
5
3
-
7
0
)
p
er
B
SES
-
SF
class
if
icatio
n
.
T
h
e
co
n
tr
o
l
g
r
o
u
p
'
s
m
o
d
est
im
p
r
o
v
em
e
n
t
ca
n
b
e
attr
ib
u
ted
to
b
r
ea
s
tf
ee
d
in
g
p
r
ac
tice
its
elf
,
wh
ich
n
atu
r
ally
en
h
an
ce
s
m
ater
n
al
co
n
f
id
en
ce
th
r
o
u
g
h
p
e
r
f
o
r
m
a
n
ce
ac
co
m
p
lis
h
m
en
ts
,
as
s
u
p
p
o
r
ted
b
y
p
r
e
v
io
u
s
r
esear
c
h
[
2
1
]
-
[
2
3
]
.
T
h
e
m
eta
-
an
aly
s
is
f
in
d
in
g
s
b
y
R
ah
m
ad
a
n
i
an
d
R
ah
m
awa
ti
[
2
4
]
also
s
u
p
p
o
r
t
th
ese
r
esu
lts
,
wh
er
e
p
r
eg
n
an
t
wo
m
en
wh
o
r
ec
eiv
ed
b
r
ea
s
tf
ee
d
in
g
e
d
u
ca
t
io
n
in
ter
v
e
n
tio
n
s
h
ad
s
elf
-
ef
f
icac
y
s
co
r
es
0
.
4
3
tim
es
h
ig
h
er
th
an
th
e
c
o
n
tr
o
l
g
r
o
u
p
(
SMD
=
0
.
4
3
; 9
5
% C
I
:
0
.
2
7
-
0
.
6
0
; p
<
0
.
0
0
1
)
.
T
ab
l
e
5
.
L
M
M
an
a
ly
s
i
s
f
o
r
c
h
an
g
e
s
in
B
SE
S
-
S
F
s
co
r
e
s
b
y
t
im
e
an
d
g
r
o
u
p
F
i
x
e
d
e
f
f
e
c
t
s
Est
i
mat
e
(
B
)
SE
9
5
%
C
I
p
-
v
a
l
u
e
I
n
t
e
r
c
e
p
t
4
6
.
3
2
1
.
8
4
4
2
.
7
1
-
4
9
.
9
3
<
0
.
0
0
1
*
G
r
o
u
p
(
i
n
t
e
r
v
e
n
t
i
o
n
v
s c
o
n
t
r
o
l
)
1
.
2
4
2
.
1
6
-
3
.
0
1
-
5
.
4
9
0
.
5
6
7
Ti
me
(
w
e
e
k
2
v
s b
a
sel
i
n
e
)
3
.
1
8
0
.
9
2
1
.
3
8
-
4
.
9
8
0
.
0
0
1
*
Ti
me
(
w
e
e
k
6
v
s b
a
sel
i
n
e
)
5
.
4
7
1
.
0
4
3
.
4
3
-
7
.
5
1
<
0
.
0
0
1
*
Ti
me
(
w
e
e
k
1
2
v
s b
a
sel
i
n
e
)
6
.
8
2
1
.
1
8
4
.
5
1
-
9
.
1
3
<
0
.
0
0
1
*
Ti
me
(
w
e
e
k
2
4
v
s b
a
sel
i
n
e
)
8
.
1
4
1
.
4
5
5
.
3
0
-
1
0
.
9
8
<
0
.
0
0
1
*
G
r
o
u
p
i
n
t
e
r
a
c
t
i
o
n
×
t
i
me
(
w
e
e
k
2
)
4
.
2
6
1
.
3
4
1
.
6
3
-
6
.
8
9
0
.
0
0
2
*
G
r
o
u
p
i
n
t
e
r
a
c
t
i
o
n
×
t
i
me
(
w
e
e
k
6
)
6
.
8
3
1
.
4
8
3
.
9
3
-
9
.
7
3
<
0
.
0
0
1
*
G
r
o
u
p
i
n
t
e
r
a
c
t
i
o
n
×
t
i
me
(
w
e
e
k
1
2
)
8
.
9
4
1
.
6
2
5
.
7
6
-
1
2
.
1
2
<
0
.
0
0
1
*
G
r
o
u
p
i
n
t
e
r
a
c
t
i
o
n
×
t
i
me
(
w
e
e
k
2
4
)
1
1
.
5
8
1
.
9
1
7
.
8
4
-
1
5
.
3
2
<
0
.
0
0
1
*
R
a
n
d
o
m e
f
f
e
c
t
s
V
a
r
i
a
n
c
e
SE
I
n
t
e
r
c
e
p
t
(
b
e
t
w
e
e
n
su
b
j
e
c
t
s)
2
8
.
6
4
5
.
1
2
Ti
me
sl
o
p
e
(
b
e
t
w
e
e
n
su
b
j
e
c
t
s
)
1
.
8
6
0
.
7
4
R
e
si
d
u
a
l
(
i
n
t
r
a
-
su
b
j
e
c
t
)
1
4
.
2
3
1
.
6
8
O
mn
i
b
u
s T
e
st
(
Ty
p
e
I
I
I
)
F
d
f
1
d
f
2
p
-
v
a
l
u
e
G
r
o
u
p
1
2
.
8
4
1
118
<
0
.
0
0
1
*
Ti
me
2
4
.
6
7
472
<
0
.
0
0
1
*
G
r
o
u
p
×
t
i
me
9
.
5
3
4
472
<
0
.
0
0
1
*
G
o
o
d
n
e
ss o
f
f
i
t
M
a
r
k
-
2
Lo
g
Li
k
e
l
i
h
o
o
d
3
.
8
4
2
.
6
A
I
C
3
.
8
6
2
.
6
B
I
C
3
.
9
0
1
.
3
*
S
i
g
n
i
f
i
c
a
n
t
a
t
α =
0
.
0
5
.
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.
15
,
No
.
2
,
J
u
n
e
20
26
:
4
4
9
-
4
5
7
454
T
h
e
s
m
ar
tp
h
o
n
e
-
b
a
s
ed
i
n
te
r
v
en
t
io
n
co
n
d
u
ct
ed
b
y
Sey
y
e
d
i
et
a
l
.
[
2
5
]
al
s
o
s
h
o
w
ed
co
n
s
i
s
t
en
t
r
es
u
l
t
s
,
wh
er
e
th
e
in
cr
e
a
s
e
in
b
r
ea
s
tf
e
ed
in
g
s
e
lf
-
ef
f
ica
cy
s
co
r
e
s
in
th
e
in
te
r
v
en
tio
n
g
r
o
u
p
wa
s
2
6
.
8
5
±
7
.
1
3
co
m
p
ar
ed
to
o
n
ly
0
.
4
0
±
5
.
1
7
in
th
e
co
n
tr
o
l
g
r
o
u
p
(
p
<
0
.
0
0
1
)
.
Al
th
o
u
g
h
t
h
e
m
ag
n
itu
d
e
o
f
im
p
r
o
v
em
en
t
v
ar
i
es
ac
r
o
s
s
s
tu
d
ie
s
d
e
p
en
d
i
n
g
o
n
t
h
e
ty
p
e
an
d
i
n
t
en
s
i
ty
o
f
i
n
t
er
v
en
ti
o
n
,
a
co
n
s
i
s
t
en
t
g
e
n
er
a
l
p
at
te
r
n
i
s
th
at
in
t
er
v
en
t
io
n
s
d
e
s
ig
n
ed
b
a
s
ed
o
n
s
e
lf
-
ef
f
ic
ac
y
th
eo
r
y
ef
f
ec
t
iv
e
ly
i
m
p
r
o
v
e
B
S
E
S
-
S
F
s
co
r
es
[
1
0
]
,
[
1
9
]
,
[
2
4
]
,
[
2
6
]
.
T
h
is
i
s
s
u
p
p
o
r
ted
b
y
a
s
co
p
in
g
r
ev
i
ew
b
y
Ab
o
u
l
-
E
n
ei
n
et
a
l
.
[
2
7
]
,
[
28]
,
wh
i
ch
f
o
u
n
d
th
a
t
ed
u
ca
tio
n
al
in
t
er
v
en
t
io
n
s
p
o
s
i
t
iv
e
ly
in
f
lu
e
n
ce
d
m
o
th
er
s
'
b
r
ea
s
tf
e
ed
i
n
g
s
elf
-
ef
f
ica
cy
.
T
h
e
r
e
s
u
l
t
s
s
h
o
wed
th
at
th
e
p
r
o
p
o
r
t
io
n
o
f
e
x
cl
u
s
iv
e
b
r
ea
s
tf
e
ed
in
g
in
th
e
in
t
er
v
en
t
io
n
g
r
o
u
p
w
a
s
co
n
s
i
s
t
en
t
ly
h
ig
h
er
t
h
an
in
th
e
co
n
tr
o
l
g
r
o
u
p
at
ea
ch
m
ea
s
u
r
em
en
t
p
o
in
t,
wi
th
t
h
e
d
if
f
er
en
ce
w
id
en
in
g
o
v
er
tim
e.
At
we
ek
2
,
al
th
o
u
g
h
th
e
p
r
o
p
o
r
tio
n
o
f
ex
clu
s
iv
e
b
r
e
as
tf
e
ed
i
n
g
in
th
e
in
ter
v
en
tio
n
g
r
o
u
p
(
9
2
.
3
%)
wa
s
h
ig
h
er
th
an
in
t
h
e
co
n
t
r
o
l
g
r
o
u
p
(
8
2
.
7
%),
th
i
s
d
if
f
er
en
c
e
w
as
n
o
t
s
ta
ti
s
ti
ca
lly
s
ig
n
if
ica
n
t
(
p
=
0
.
1
4
3
)
.
T
h
is
m
ay
b
e
ex
p
l
ai
n
ed
b
y
th
e
f
ac
t
th
a
t
in
th
e
ea
r
ly
p
o
s
tp
ar
tu
m
p
er
io
d
,
m
o
s
t
m
o
th
er
s
ar
e
s
t
il
l
h
ig
h
ly
m
o
t
iv
a
ted
to
b
r
ea
s
t
f
ee
d
an
d
h
av
e
n
o
t
y
et
f
a
ce
d
s
i
g
n
if
ic
an
t
ch
a
ll
en
g
e
s
th
at
co
u
ld
in
t
er
f
e
r
e
wi
th
ex
c
lu
s
iv
e
b
r
ea
s
t
f
ee
d
in
g
[
2
9
]
.
Sig
n
if
ic
an
t
d
if
f
er
en
ce
s
b
eg
an
to
e
m
er
g
e
a
t
we
ek
6
(
8
6
.
5
%
v
s
.
6
9
.
2
%,
R
R
=
1
.
2
5
,
p
=
0
.
0
3
2
)
,
wh
ic
h
is
a
c
r
i
ti
ca
l
p
er
io
d
wh
en
m
an
y
m
o
th
er
s
b
eg
in
to
ex
p
er
i
en
c
e
b
r
ea
s
tf
e
ed
in
g
d
if
f
ic
u
lt
ie
s
an
d
co
n
s
id
e
r
s
u
p
p
lem
en
t
in
g
w
ith
f
o
r
m
u
la.
T
h
i
s
f
in
d
in
g
i
s
co
n
s
i
s
t
en
t
w
ith
th
e
s
tu
d
y
b
y
An
t
o
ñ
an
z
a
s
‐
B
a
zt
án
et
a
l
.
[
1
6
]
,
wh
o
r
e
p
o
r
t
ed
th
a
t
th
e
b
r
ea
s
t
f
ee
d
in
g
s
e
lf
-
e
f
f
i
ca
cy
p
r
o
m
o
t
i
o
n
p
r
o
g
r
a
m
(
SIA
L
A
C
)
ac
h
i
ev
ed
a
s
ig
n
if
i
ca
n
t
d
if
f
e
r
en
c
e
in
b
r
ea
s
tf
e
ed
in
g
c
o
n
tin
u
i
ty
b
e
tw
ee
n
th
e
i
n
t
er
v
e
n
tio
n
an
d
co
n
tr
o
l
g
r
o
u
p
s
(
X²
=
4
.
9
4
,
p
=
0
.
0
2
6
)
.
T
h
i
s
f
in
d
in
g
h
a
s
i
m
p
o
r
t
an
t
cl
in
i
ca
l
im
p
li
ca
tio
n
s
,
g
iv
en
t
h
at
b
r
e
a
s
tf
ee
d
in
g
ed
u
ca
tio
n
p
r
o
g
r
am
s
i
m
p
r
o
v
e
ex
cl
u
s
iv
e
b
r
e
a
s
tf
ee
d
in
g
p
r
ac
t
i
ce
s
[
3
0
]
,
[
3
1
]
.
C
o
x
p
r
o
p
o
r
t
io
n
a
l
h
az
ar
d
s
r
eg
r
es
s
io
n
an
a
ly
s
is
id
en
tif
ie
d
f
o
u
r
v
ar
iab
le
s
t
h
at
s
i
g
n
if
ic
an
t
ly
i
n
f
lu
en
ce
d
ex
cl
u
s
iv
e
b
r
e
a
s
tf
ee
d
in
g
ce
s
s
a
tio
n
.
I
n
ter
v
en
t
io
n
w
as
th
e
s
tr
o
n
g
e
s
t
p
r
o
t
ec
tiv
e
f
ac
to
r
in
th
e
m
o
d
el,
w
it
h
t
h
e
in
t
er
v
en
t
io
n
g
r
o
u
p
h
av
in
g
a
5
9
%
lo
wer
r
is
k
o
f
ex
clu
s
iv
e
b
r
ea
s
t
f
ee
d
in
g
c
es
s
at
io
n
co
m
p
ar
ed
to
th
e
co
n
t
r
o
l
g
r
o
u
p
(
H
R
=
0
.
4
1
;
9
5
%
C
I
:
0
.
2
4
–
0
.
7
0
;
p
=
0
.
0
0
1
)
.
T
h
i
s
f
in
d
in
g
i
s
co
n
s
i
s
t
en
t
wi
th
a
s
t
u
d
y
b
y
An
t
o
ñ
an
za
s
‐
B
a
zt
án
et
a
l
.
[
1
6
]
,
wh
ich
r
ep
o
r
ted
th
at
b
r
e
a
s
tf
ee
d
in
g
ce
s
s
at
io
n
in
th
e
co
n
tr
o
l
g
r
o
u
p
w
as
3
.
3
t
im
e
s
h
ig
h
er
th
an
in
th
e
in
t
er
v
en
t
io
n
g
r
o
u
p
at
6
m
o
n
th
s
(
C
I
1
.
1
–
1
0
.
1
)
.
Si
m
il
ar
ly
,
Kar
im
ian
-
Ma
r
n
an
i
e
t
a
l
.
[
3
2
]
f
o
u
n
d
th
a
t
h
ig
h
er
b
r
ea
s
tf
e
ed
in
g
s
e
lf
-
ef
f
i
ca
cy
s
ig
n
i
f
i
ca
n
tly
r
ed
u
c
ed
th
e
r
i
s
k
o
f
d
i
s
co
n
t
in
u
in
g
ex
c
lu
s
i
v
e
b
r
ea
s
t
f
ee
d
in
g
(
H
R
=
0
.
8
7
; 9
5
%
C
I
: 0
.
7
7
-
0
.
9
8
; p
=
0
.
0
2
)
.
Hu
s
b
an
d
's
s
u
p
p
o
r
t
a
s
a
p
r
o
t
ec
t
iv
e
f
ac
to
r
(
H
R
=
0
.
5
4
;
p
=
0
.
0
3
9
)
,
wh
ich
r
ed
u
c
ed
t
h
e
r
i
s
k
o
f
d
i
s
co
n
tin
u
at
io
n
b
y
4
6
%,
is
a
h
ig
h
ly
r
e
lev
an
t
f
in
d
in
g
.
A
s
tu
d
y
in
E
th
io
p
i
a
b
y
Ad
u
g
n
aw
e
t
a
l
.
[
3
3
]
r
ep
o
r
ted
th
a
t
f
a
m
i
ly
s
u
p
p
o
r
t
f
o
r
ex
c
lu
s
iv
e
b
r
e
a
s
tf
ee
d
in
g
wa
s
s
i
g
n
if
i
ca
n
t
ly
a
s
s
o
c
ia
ted
w
ith
d
i
s
co
n
tin
u
at
io
n
o
f
ex
cl
u
s
iv
e
b
r
ea
s
tf
e
ed
in
g
b
ef
o
r
e
6
m
o
n
th
s
(
H
R
=
3
.
9
9
;
9
5
%
C
I
:
1
.
9
-
8
.
3
)
.
Mo
th
er
s
wh
o
r
e
ce
iv
e
s
u
p
p
o
r
t
f
r
o
m
th
e
ir
p
ar
t
n
er
s
ar
e
m
o
r
e
lik
el
y
to
h
av
e
t
h
e
in
ten
tio
n
to
p
r
o
v
id
e
ex
clu
s
iv
e
b
r
e
a
s
tf
ee
d
i
n
g
[
3
4
]
.
A
h
ig
h
er
b
as
el
in
e
B
S
E
S
-
S
F
s
co
r
e
s
ig
n
i
f
ic
an
t
ly
r
ed
u
c
ed
th
e
r
i
s
k
o
f
d
i
s
co
n
t
in
u
a
tio
n
(
H
R
=
0
.
9
6
;
p
=
0
.
0
1
8
)
,
m
ea
n
in
g
th
a
t
ea
ch
o
n
e
-
p
o
in
t
in
cr
e
a
s
e
i
n
th
e
b
a
s
el
in
e
B
SE
S
-
S
F
s
co
r
e
r
ed
u
ce
d
th
e
r
i
s
k
o
f
d
i
s
co
n
tin
u
at
io
n
b
y
4
%.
T
h
i
s
f
in
d
i
n
g
i
s
co
n
s
i
s
t
en
t
wi
th
W
a
n
g
an
d
C
h
an
g
's
[
3
5
]
r
ep
o
r
t
th
at
b
r
e
a
s
tf
ee
d
in
g
s
e
lf
-
ef
f
i
ca
cy
in
th
e
h
o
s
p
i
ta
l
w
as
a
s
ig
n
if
ican
t r
i
s
k
f
ac
to
r
co
n
t
r
i
b
u
tin
g
to
b
r
e
a
s
tf
ee
d
in
g
d
u
r
a
ti
o
n
at
6
m
o
n
th
s
p
o
s
tp
ar
tu
m
(
H
R
=
0
.
9
8
)
.
3
.
1
.
E
p
id
em
io
lo
g
ica
l a
nd
p
u
bl
ic
h
ea
l
t
h
c
li
ni
ca
l
im
p
li
ca
t
i
o
n
s
T
h
e
s
tu
d
y
f
in
d
in
g
s
d
em
o
n
s
t
r
a
te
s
u
b
s
t
an
t
ia
l
ep
i
d
em
io
lo
g
i
ca
l
s
ig
n
if
ican
ce
.
T
h
e
p
r
o
g
r
e
s
s
iv
e
in
cr
ea
s
e
in
r
e
lat
iv
e
r
i
s
k
(
R
R
)
f
r
o
m
1
.
1
2
t
o
1
.
7
6
y
i
eld
s
an
NN
T
o
f
3
.
2
5
,
wi
th
an
ab
s
o
lu
te
r
i
s
k
d
if
f
e
r
en
c
e
o
f
3
0
.
8
%
p
o
in
t
s
a
t
6
m
o
n
th
s
.
T
h
e
h
a
za
r
d
r
a
tio
o
f
0
.
4
1
in
d
i
ca
te
s
th
a
t
m
o
th
er
s
in
t
h
e
in
ter
v
en
t
io
n
g
r
o
u
p
h
ad
l
es
s
th
an
h
alf
th
e
r
i
s
k
o
f
d
i
s
c
o
n
t
in
u
in
g
ex
c
lu
s
iv
e
b
r
e
a
s
tf
ee
d
in
g
c
o
m
p
ar
ed
to
co
n
tr
o
l
s
.
Ma
ter
n
al
e
m
p
lo
y
m
en
t
(
H
R
=
1
.
7
2
)
an
d
h
u
s
b
an
d
's
s
u
p
p
o
r
t
(
H
R
=
0
.
5
4
)
r
ep
r
es
en
t
m
o
d
if
iab
le
d
et
er
m
in
an
t
s
th
at
co
u
ld
y
ie
ld
s
y
n
e
r
g
i
s
ti
c
im
p
r
o
v
em
en
t
s
a
lo
n
g
s
id
e
s
elf
-
ef
f
i
ca
cy
en
h
an
c
em
en
t.
C
l
in
i
c
al
im
p
li
ca
tio
n
s
in
c
lu
d
e
in
teg
r
at
in
g
b
r
ea
s
t
f
ee
d
in
g
s
e
lf
-
ef
f
i
ca
cy
in
ter
v
en
tio
n
s
in
to
r
o
u
t
in
e
p
o
s
tp
a
r
tu
m
ca
r
e,
ea
r
ly
id
en
t
if
i
ca
ti
o
n
o
f
m
o
th
er
s
wi
th
l
o
w
s
e
lf
-
ef
f
i
ca
cy
th
r
o
u
g
h
B
SE
S
-
S
F
s
cr
ee
n
in
g
,
an
d
p
r
io
r
i
ti
zin
g
h
u
s
b
an
d
in
v
o
lv
em
en
t
in
b
r
e
as
t
f
ee
d
in
g
p
r
o
m
o
tio
n
p
r
o
g
r
am
s
.
4.
CO
NCLU
SI
O
N
T
h
e
r
e
s
u
lt
s
o
f
th
i
s
s
tu
d
y
p
r
o
v
id
e
s
t
r
o
n
g
ev
id
en
ce
th
a
t
a
b
r
ea
s
tf
ee
d
in
g
s
e
lf
-
ef
f
ica
cy
in
te
r
v
en
t
io
n
i
s
ef
f
e
ct
iv
e
in
in
cr
e
a
s
in
g
B
S
E
S
-
S
F
s
co
r
e
s
an
d
th
e
p
r
o
p
o
r
ti
o
n
o
f
ex
c
lu
s
iv
e
b
r
ea
s
t
f
ee
d
in
g
d
u
r
in
g
th
e
f
ir
s
t
s
ix
m
o
n
th
s
p
o
s
tp
ar
tu
m
.
T
h
e
in
cr
e
as
in
g
ef
f
ec
t
o
f
th
e
in
ter
v
en
t
io
n
o
v
er
t
im
e
s
u
g
g
e
s
t
s
th
at
en
h
a
n
cin
g
s
e
lf
-
ef
f
i
ca
cy
cr
ea
te
s
a
s
e
lf
-
p
er
p
e
tu
at
in
g
p
o
s
it
iv
e
cy
cl
e.
T
h
e
s
e
f
i
n
d
in
g
s
ar
e
co
n
s
i
s
ten
t
w
it
h
in
t
er
n
at
io
n
a
l
ev
id
en
ce
d
em
o
n
s
t
r
at
in
g
th
at
b
r
ea
s
tf
e
e
d
in
g
s
elf
-
ef
f
ic
ac
y
i
s
a
s
tr
o
n
g
p
r
e
d
i
cto
r
o
f
b
r
e
a
s
tf
ee
d
i
n
g
s
u
c
ce
s
s
an
d
a
m
o
d
if
iab
le
v
ar
iab
le
th
r
o
u
g
h
t
ar
g
e
ted
in
ter
v
en
t
io
n
.
Fro
m
a
p
u
b
li
c
h
ea
lth
p
er
s
p
ec
tiv
e,
th
i
s
s
tu
d
y
co
n
t
r
ib
u
te
s
m
ea
n
in
g
f
u
l
ev
id
en
ce
th
at
l
o
w
-
co
s
t,
th
eo
r
y
-
d
r
iv
en
s
el
f
-
ef
f
i
ca
cy
in
ter
v
en
t
io
n
s
c
an
ad
d
r
e
s
s
s
u
b
o
p
t
im
al
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
E
ffective
n
ess
o
f a
b
r
ea
s
tfeed
in
g
s
elf
-
effica
cy
in
terven
tio
n
o
n
B
S
E
S
-
S
F
s
co
r
es a
n
d
…
(
A
r
ifa
r
a
h
mi
)
455
ex
cl
u
s
iv
e
b
r
e
a
s
tf
ee
d
in
g
r
at
e
s
,
th
er
eb
y
r
ed
u
c
in
g
in
f
an
t
m
o
r
b
id
i
ty
an
d
m
o
r
ta
l
ity
an
d
al
le
v
ia
tin
g
h
ea
l
th
c
ar
e
b
u
r
d
en
s
a
s
s
o
c
ia
ted
wi
th
p
r
ev
en
tab
le
c
h
i
ld
h
o
o
d
i
l
ln
es
s
es
.
R
eg
ar
d
in
g
p
o
li
cy
i
m
p
li
ca
ti
o
n
s
,
h
ea
l
th
p
o
li
cy
m
a
k
er
s
s
h
o
u
ld
co
n
s
id
e
r
in
teg
r
at
in
g
s
elf
-
ef
f
ic
ac
y
-
b
a
s
ed
b
r
e
as
tf
ee
d
in
g
s
u
p
p
o
r
t
in
t
o
r
o
u
t
in
e
an
ten
a
ta
l
an
d
p
o
s
tn
a
ta
l
ca
r
e
p
r
o
to
c
o
l
s
.
Fu
r
th
er
m
o
r
e,
p
o
l
ic
ie
s
th
a
t
f
ac
il
it
at
e
h
u
s
b
an
d
en
g
ag
e
m
en
t
an
d
p
r
o
v
id
e
wo
r
k
p
lac
e
a
cc
o
m
m
o
d
a
ti
o
n
s
f
o
r
b
r
ea
s
tf
e
ed
in
g
m
o
th
er
s
ar
e
es
s
en
t
ia
l
t
o
ac
h
i
ev
in
g
th
e
W
HO
g
lo
b
al
tar
g
et
o
f
7
0
%
ex
c
lu
s
iv
e
b
r
e
a
s
tf
ee
d
in
g
.
Fu
tu
r
e
r
e
s
ea
r
ch
s
h
o
u
ld
ex
a
m
in
e
t
h
e
lo
n
g
-
te
r
m
s
u
s
ta
in
ab
il
ity
o
f
s
e
lf
-
ef
f
i
ca
c
y
g
ain
s
b
ey
o
n
d
s
ix
m
o
n
th
s
,
e
x
p
lo
r
e
s
ca
lab
i
li
ty
ac
r
o
s
s
d
iv
er
s
e
h
ea
lth
ca
r
e
s
e
tt
in
g
s
,
in
v
es
tig
at
e
th
e
co
s
t
-
ef
f
e
ct
iv
en
e
s
s
o
f
s
u
ch
i
n
t
er
v
e
n
tio
n
s
,
an
d
a
s
s
e
s
s
th
e
m
o
d
er
at
in
g
r
o
l
es
o
f
s
o
c
io
e
co
n
o
m
ic
f
ac
to
r
s
an
d
cu
l
tu
r
al
co
n
t
ex
t
s
in
in
ter
v
en
t
io
n
ef
f
e
ct
iv
en
es
s
.
R
an
d
o
m
i
ze
d
co
n
tr
o
ll
ed
tr
i
al
s
w
ith
l
ar
g
er
,
m
u
lt
i
-
s
i
te
s
am
p
le
s
ar
e
war
r
an
t
ed
to
s
t
r
en
g
th
en
g
en
er
al
izab
i
li
ty
.
ACK
NO
WL
E
DG
M
E
N
T
S
T
h
e
au
th
o
r
s
wo
u
ld
l
ik
e
to
ex
p
r
e
s
s
th
e
ir
s
in
c
er
e
g
r
a
ti
tu
d
e
t
o
t
h
e
Dep
ar
tm
en
t
o
f
Mid
wi
f
er
y
,
Un
iv
er
s
i
ty
o
f
B
a
i
tu
r
r
ah
im
,
J
am
b
i
,
f
o
r
th
ei
r
in
s
t
i
tu
t
io
n
a
l
s
u
p
p
o
r
t
th
r
o
u
g
h
o
u
t
th
i
s
r
e
s
ea
r
ch
.
W
e
ex
te
n
d
o
u
r
ap
p
r
e
ci
at
io
n
to
th
e
h
ea
lt
h
c
en
ter
s
an
d
th
e
ir
s
taf
f
wh
o
f
a
ci
li
t
ated
d
a
ta
co
ll
ec
tio
n
,
a
s
we
ll
a
s
to
a
l
l
p
o
s
t
p
ar
tu
m
m
o
th
e
r
s
wh
o
v
o
lu
n
tar
i
ly
p
ar
t
ic
ip
a
ted
in
th
i
s
s
tu
d
y
.
W
e
al
s
o
ac
k
n
o
w
led
g
e
th
e
co
n
tr
ib
u
ti
o
n
s
o
f
th
e
r
e
s
ea
r
ch
as
s
i
s
t
an
t
s
an
d
m
id
w
iv
e
s
w
h
o
as
s
i
s
t
ed
in
th
e
im
p
lem
en
t
at
io
n
o
f
th
e
b
r
ea
s
tf
e
ed
in
g
s
e
lf
-
ef
f
ica
cy
en
h
a
n
ce
m
en
t
in
t
er
v
en
t
io
n
.
S
p
ec
ia
l
th
an
k
s
ar
e
ex
ten
d
ed
to
th
e
D
ep
a
r
tm
en
t
o
f
C
h
e
m
i
s
tr
y
E
d
u
c
at
io
n
,
Fa
cu
l
ty
o
f
T
e
ac
h
er
T
r
ai
n
in
g
an
d
E
d
u
ca
tio
n
,
Un
i
v
er
s
i
ty
o
f
J
a
m
b
i,
a
n
d
th
e
D
e
p
ar
tm
en
t
o
f
Pu
b
l
ic
H
ea
lt
h
S
cien
ce
s
,
Po
l
tek
k
e
s
Kem
en
k
e
s
J
am
b
i,
f
o
r
th
e
ir
co
l
la
b
o
r
a
tiv
e
s
u
p
p
o
r
t.
Fin
a
lly
,
w
e
ar
e
g
r
a
te
f
u
l
to
th
e
r
ev
ie
wer
s
wh
o
s
e
co
n
s
tr
u
ct
iv
e
f
e
ed
b
a
ck
i
m
p
r
o
v
ed
th
e
q
u
al
ity
o
f
th
i
s
m
an
u
s
cr
ip
t.
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
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
Ar
if
ar
ah
m
i
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Asrial
Asrial
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Mu
h
am
m
ad
R
u
s
d
i
✓
✓
✓
✓
✓
✓
✓
✓
✓
So
lh
a
E
lr
if
d
a
✓
✓
✓
✓
✓
✓
✓
✓
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
i
d
a
t
i
o
n
Fo
:
Fo
r
mal
a
n
a
l
y
s
i
s
I
:
I
n
v
e
s
t
i
g
a
t
i
o
n
R
:
R
e
so
u
r
c
e
s
D
:
D
a
t
a
C
u
r
a
t
i
o
n
O
:
W
r
i
t
i
n
g
-
O
r
i
g
i
n
a
l
D
r
a
f
t
E
:
W
r
i
t
i
n
g
-
R
e
v
i
e
w
&
E
d
i
t
i
n
g
Vi
:
Vi
su
a
l
i
z
a
t
i
o
n
Su
:
Su
p
e
r
v
i
s
i
o
n
P
:
P
r
o
j
e
c
t
a
d
mi
n
i
st
r
a
t
i
o
n
Fu
:
Fu
n
d
i
n
g
a
c
q
u
i
si
t
i
o
n
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
.
E
T
H
I
CAL AP
P
RO
V
AL
T
h
is
s
tu
d
y
was
ap
p
r
o
v
e
d
b
y
th
e
Po
ltek
k
es
Kem
en
k
es
J
am
b
i
(
a
p
p
r
o
v
al
n
u
m
b
er
:
L
B
.
0
2
.
0
6
/2
/
1
0
1
5
/
2
0
2
5
)
.
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
d
y
ar
e
a
v
ailab
le
f
r
o
m
th
e
co
r
r
esp
o
n
d
in
g
a
u
th
o
r
,
[
A]
,
u
p
o
n
r
ea
s
o
n
ab
le
r
eq
u
est.
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.
15
,
No
.
2
,
J
u
n
e
20
26
:
4
4
9
-
4
5
7
456
RE
F
E
R
E
NC
E
S
[
1
]
H
.
N
a
r
o
e
e
,
M
.
R
a
k
h
s
h
k
h
o
r
sh
i
d
,
M
.
S
h
a
k
i
b
a
,
a
n
d
A
.
N
a
v
i
d
i
a
n
,
“
T
h
e
e
f
f
e
c
t
o
f
m
o
t
i
v
a
t
i
o
n
a
l
i
n
t
e
r
v
i
e
w
i
n
g
o
n
sel
f
-
e
f
f
i
c
a
c
y
a
n
d
c
o
n
t
i
n
u
a
t
i
o
n
o
f
e
x
c
l
u
si
v
e
b
r
e
a
s
t
f
e
e
d
i
n
g
r
a
t
e
s:
a
q
u
a
si
-
e
x
p
e
r
i
me
n
t
a
l
st
u
d
y
,
”
Br
e
a
s
t
f
e
e
d
i
n
g
Me
d
i
c
i
n
e
,
v
o
l
.
1
5
,
n
o
.
8
,
p
p
.
5
2
2
–
5
2
7
,
A
u
g
.
2
0
2
0
,
d
o
i
:
1
0
.
1
0
8
9
/
b
f
m
.
2
0
1
9
.
0
2
5
2
.
[
2
]
H
.
R
a
d
w
a
n
e
t
a
l
.
,
“
P
r
e
v
a
l
e
n
c
e
a
n
d
m
u
l
t
i
v
a
r
i
a
b
l
e
p
r
e
d
i
c
t
o
r
s
o
f
b
r
e
a
st
f
e
e
d
i
n
g
o
u
t
c
o
me
s
i
n
t
h
e
U
n
i
t
e
d
A
r
a
b
Emi
r
a
t
e
s:
a
p
r
o
sp
e
c
t
i
v
e
c
o
h
o
r
t
s
t
u
d
y
,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
Br
e
a
st
f
e
e
d
i
n
g
J
o
u
rn
a
l
,
v
o
l
.
1
6
,
n
o
.
1
,
p
.
7
9
,
D
e
c
.
2
0
2
1
,
d
o
i
:
1
0
.
1
1
8
6
/
s
1
3
0
0
6
-
0
2
1
-
0
0
4
2
8
-
7.
[
3
]
S
.
L.
B
o
y
l
e
s,
S
.
R
.
W
e
i
n
s
t
e
i
n
,
A
.
F
.
B
e
l
l
,
a
n
d
E.
N
.
Er
i
c
k
s
o
n
,
“
P
o
st
p
a
r
t
u
m
h
e
m
o
r
r
h
a
g
e
a
n
d
t
h
e
l
i
k
e
l
i
h
o
o
d
o
f
e
x
c
l
u
s
i
v
e
b
r
e
a
s
t
f
e
e
d
i
n
g
t
h
r
o
u
g
h
6
m
o
n
t
h
s
p
o
s
t
p
a
r
t
u
m
:
a
c
a
se‐c
o
n
t
r
o
l
s
t
u
d
y
,
”
J
o
u
rn
a
l
o
f
M
i
d
w
i
f
e
r
y
&
W
o
m
e
n
’
s
H
e
a
l
t
h
,
v
o
l
.
7
0
,
n
o
.
5
,
p
p
.
7
8
0
–
7
9
0
,
S
e
p
.
2
0
2
5
,
d
o
i
:
1
0
.
1
1
1
1
/
j
m
w
h
.
1
3
7
8
1
.
[
4
]
X
.
Ji
a
n
g
a
n
d
H
.
Ji
a
n
g
,
“
F
a
c
t
o
r
s
a
ss
o
c
i
a
t
e
d
w
i
t
h
p
o
st
N
I
C
U
d
i
sc
h
a
r
g
e
e
x
c
l
u
s
i
v
e
b
r
e
a
s
t
f
e
e
d
i
n
g
r
a
t
e
a
n
d
d
u
r
a
t
i
o
n
a
mo
n
g
s
t
f
i
r
st
t
i
m
e
mo
t
h
e
r
s
o
f
p
r
e
t
e
r
m
i
n
f
a
n
t
s
i
n
S
h
a
n
g
h
a
i
:
a
l
o
n
g
i
t
u
d
i
n
a
l
c
o
h
o
r
t
s
t
u
d
y
,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
Bre
a
s
t
f
e
e
d
i
n
g
J
o
u
r
n
a
l
,
v
o
l
.
1
7
,
n
o
.
1
,
p
.
3
4
,
D
e
c
.
2
0
2
2
,
d
o
i
:
1
0
.
1
1
8
6
/
s
1
3
0
0
6
-
0
2
2
-
0
0
4
7
2
-
x.
[
5
]
Y
.
Li
u
e
t
a
l
.
,
“
Tr
a
j
e
c
t
o
r
y
o
f
b
r
e
a
st
f
e
e
d
i
n
g
a
m
o
n
g
C
h
i
n
e
s
e
w
o
m
e
n
a
n
d
r
i
sk
p
r
e
d
i
c
t
i
o
n
m
o
d
e
l
s b
a
se
d
o
n
m
a
c
h
i
n
e
l
e
a
r
n
i
n
g
:
a
c
o
h
o
r
t
st
u
d
y
,
”
BM
C
P
re
g
n
a
n
c
y
a
n
d
C
h
i
l
d
b
i
r
t
h
,
v
o
l
.
2
4
,
n
o
.
1
,
p
.
8
5
8
,
D
e
c
.
2
0
2
4
,
d
o
i
:
1
0
.
1
1
8
6
/
s1
2
8
8
4
-
0
2
4
-
0
7
0
1
0
-
z.
[
6
]
I
.
R
o
d
r
í
g
u
e
z
-
G
a
l
l
e
g
o
,
I
.
C
o
r
r
a
l
e
s
-
G
u
t
i
e
r
r
e
z
,
D
.
G
o
m
e
z
-
B
a
y
a
,
a
n
d
F
.
L
e
o
n
-
La
r
i
o
s
,
“
Ef
f
e
c
t
i
v
e
n
e
ss
o
f
a
p
o
st
p
a
r
t
u
m
b
r
e
a
s
t
f
e
e
d
i
n
g
su
p
p
o
r
t
g
r
o
u
p
i
n
t
e
r
v
e
n
t
i
o
n
i
n
p
r
o
mo
t
i
n
g
e
x
c
l
u
s
i
v
e
b
r
e
a
st
f
e
e
d
i
n
g
a
n
d
p
e
r
c
e
i
v
e
d
s
e
l
f
-
e
f
f
i
c
a
c
y
:
a
mu
l
t
i
c
e
n
t
r
e
r
a
n
d
o
m
i
z
e
d
c
l
i
n
i
c
a
l
t
r
i
a
l
,
”
N
u
t
r
i
e
n
t
s
,
v
o
l
.
1
6
,
n
o
.
7
,
p
.
9
8
8
,
M
a
r
.
2
0
2
4
,
d
o
i
:
1
0
.
3
3
9
0
/
n
u
1
6
0
7
0
9
8
8
.
[
7
]
Z.
R
e
n
,
H
.
Ta
n
g
,
X
.
F
a
n
,
J
.
F
e
n
g
,
a
n
d
A
.
Zh
a
n
g
,
“
T
h
e
m
u
l
t
i
p
l
e
me
d
i
a
t
i
n
g
e
f
f
e
c
t
s
o
f
i
n
t
e
r
n
a
l
i
z
e
d
w
e
i
g
h
t
st
i
g
ma,
b
r
e
a
s
t
f
e
e
d
i
n
g
d
i
f
f
i
c
u
l
t
i
e
s
,
a
n
d
b
r
e
a
s
t
f
e
e
d
i
n
g
s
e
l
f
-
e
f
f
i
c
a
c
y
o
n
t
h
e
a
ss
o
c
i
a
t
i
o
n
b
e
t
w
e
e
n
p
r
e
-
p
r
e
g
n
a
n
c
y
o
v
e
r
w
e
i
g
h
t
/
o
b
e
si
t
y
a
n
d
e
x
c
l
u
s
i
v
e
b
r
e
a
s
t
f
e
e
d
i
n
g
a
t
6
mo
n
t
h
s
p
o
st
p
a
r
t
u
m
:
a
p
r
o
s
p
e
c
t
i
v
e
c
o
h
o
r
t
,
”
R
e
se
a
rc
h
S
q
u
a
re
,
O
c
t
.
2
2
,
2
0
2
4
,
d
o
i
:
1
0
.
2
1
2
0
3
/
r
s.
3
.
r
s
-
5
0
3
1
8
6
6
/
v
1
.
[
8
]
F
.
E.
O
.
G
e
y
i
k
a
n
d
B
.
U
.
U
n
a
l
,
“
F
a
c
t
o
r
s
i
n
f
l
u
e
n
c
i
n
g
e
x
c
l
u
s
i
v
e
b
r
e
a
st
f
e
e
d
i
n
g
d
u
r
a
t
i
o
n
a
n
d
i
t
s
i
m
p
a
c
t
o
n
i
n
f
a
n
t
g
r
o
w
t
h
:
a
c
r
o
ss
-
sec
t
i
o
n
a
l
s
t
u
d
y
f
r
o
m T
u
r
k
e
y
,
”
R
e
se
a
r
c
h
S
q
u
a
r
e
,
M
a
y
3
0
,
2
0
2
5
,
d
o
i
:
1
0
.
2
1
2
0
3
/
r
s
.
3
.
r
s
-
6
5
4
8
2
8
7
/
v
1
.
[
9
]
E.
W
i
d
a
y
a
t
i
,
R
.
L
e
st
a
r
i
,
a
n
d
N
.
W
i
d
i
a
st
u
t
i
,
“
T
h
e
e
f
f
e
c
t
i
v
e
n
e
ss
o
f
l
a
c
t
a
t
i
o
n
c
o
u
n
se
l
i
n
g
o
n
k
n
o
w
l
e
d
g
e
,
s
e
l
f
-
c
o
n
f
i
d
e
n
c
e
,
a
n
d
su
c
c
e
ssf
u
l
b
r
e
a
s
t
f
e
e
d
i
n
g
f
o
r
p
o
st
p
a
r
t
u
m
mo
t
h
e
r
s,”
G
l
o
b
a
l
M
e
d
i
c
a
l
&
H
e
a
l
t
h
C
o
m
m
u
n
i
c
a
t
i
o
n
(
G
MHC)
,
v
o
l
.
1
0
,
n
o
.
1
,
A
p
r
.
2
0
2
2
,
d
o
i
:
1
0
.
2
9
3
1
3
/
g
m
h
c
.
v
1
0
i
1
.
8
8
1
1
.
[
1
0
]
D
.
A
.
H
i
d
a
y
a
t
a
n
d
H
.
A
.
H
e
r
m
a
w
a
n
,
“
T
h
e
r
e
l
a
t
i
o
n
s
h
i
p
b
e
t
w
e
e
n
e
m
o
t
i
o
n
a
l
i
n
t
e
l
l
i
g
e
n
c
e
,
k
i
n
e
s
t
h
e
t
i
c
i
n
t
e
l
l
i
g
e
n
c
e
,
a
n
d
l
e
a
r
n
i
n
g
mo
t
i
v
a
t
i
o
n
a
n
d
p
h
y
si
c
a
l
e
d
u
c
a
t
i
o
n
l
e
a
r
n
i
n
g
o
u
t
c
o
m
e
s,”
I
n
t
e
rn
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
M
u
l
t
i
d
i
sc
i
p
l
i
n
a
ry
Re
se
a
rc
h
A
n
d
An
a
l
y
si
s
,
v
o
l
.
0
7
,
n
o
.
0
8
,
A
u
g
.
2
0
2
4
,
d
o
i
:
1
0
.
4
7
1
9
1
/
i
j
mr
a
/
v
7
-
i
0
8
-
4
2
.
[
1
1
]
C
.
C
h
u
e
k
t
o
n
g
,
M
.
N
i
r
a
t
t
h
a
r
a
d
o
r
n
,
a
n
d
N
.
B
u
a
b
o
o
n
,
“
Th
e
b
r
e
a
st
f
e
e
d
i
n
g
s
e
l
f
-
e
f
f
i
c
a
c
y
e
n
h
a
n
c
e
me
n
t
p
r
o
g
r
a
m
w
i
t
h
L
I
N
E
a
p
p
l
i
c
a
t
i
o
n
a
mo
n
g
mo
t
h
e
r
s
w
i
t
h
c
e
sare
a
n
s
e
c
t
i
o
n
:
a
q
u
a
si
-
e
x
p
e
r
i
me
n
t
a
l
s
t
u
d
y
,
”
P
a
c
i
f
i
c
Ri
m
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
N
u
r
si
n
g
Re
se
a
rc
h
,
v
o
l
.
2
7
,
n
o
.
4
,
p
p
.
7
1
1
–
7
2
1
,
S
e
p
.
2
0
2
3
,
d
o
i
:
1
0
.
6
0
0
9
9
/
p
r
i
j
n
r
.
2
0
2
3
.
2
6
2
3
4
9
.
[
1
2
]
S
.
S
.
S
a
n
c
h
e
z
,
I
.
R
o
d
r
í
g
u
e
z
-
G
a
l
l
e
g
o
,
F
.
Le
o
n
-
La
r
i
o
s,
E.
A
n
d
i
n
a
-
D
i
a
z
,
R
.
P
e
r
e
z
-
C
o
n
t
r
e
r
a
s,
a
n
d
J.
D
.
G
o
n
z
a
l
e
z
-
S
a
n
z
,
“
I
n
f
l
u
e
n
c
e
o
f
p
e
r
c
e
i
v
e
d
m
a
t
e
r
n
a
l
s
e
l
f
-
e
f
f
i
c
a
c
y
o
n
e
x
c
l
u
s
i
v
e
b
r
e
a
s
t
f
e
e
d
i
n
g
i
n
i
t
i
a
t
i
o
n
a
n
d
c
o
n
so
l
i
d
a
t
i
o
n
:
a
s
y
st
e
ma
t
i
c
r
e
v
i
e
w
,
”
H
e
a
l
t
h
c
a
re
,
v
o
l
.
1
2
,
n
o
.
2
3
,
p
.
2
3
4
7
,
N
o
v
.
2
0
2
4
,
d
o
i
:
1
0
.
3
3
9
0
/
h
e
a
l
t
h
c
a
r
e
1
2
2
3
2
3
4
7
.
[
1
3
]
L.
N
i
g
u
s
si
e
e
,
T.
D
e
m
e
k
e
,
V
.
B
a
g
i
l
k
a
r
,
Y
.
F
i
r
e
t
si
d
k
,
M
.
A
b
a
g
e
d
a
,
a
n
d
T.
B
e
l
a
c
h
e
w
,
“
B
r
e
a
s
t
f
e
e
d
i
n
g
se
l
f
-
e
f
f
i
c
a
c
y
s
t
a
t
u
s
a
n
d
a
sso
c
i
a
t
e
d
f
a
c
t
o
r
s
a
m
o
n
g
p
o
s
t
p
a
r
t
u
m
mo
t
h
e
r
s
a
t
H
a
d
i
y
a
Z
o
n
e
p
u
b
l
i
c
h
o
sp
i
t
a
l
s,
S
o
u
t
h
e
r
n
Et
h
i
o
p
i
a
,
”
PLO
S
O
N
E
,
v
o
l
.
2
0
,
n
o
.
2
,
p
.
e
0
3
1
7
7
6
3
,
F
e
b
.
2
0
2
5
,
d
o
i
:
1
0
.
1
3
7
1
/
j
o
u
r
n
a
l
.
p
o
n
e
.
0
3
1
7
7
6
3
.
[
1
4
]
M
.
K
r
a
m
u
sc
h
k
e
,
K
.
Li
n
d
e
,
F
.
Le
h
n
i
g
,
M
.
N
a
g
l
,
C
.
-
L
.
D
e
n
n
i
s,
a
n
d
A
.
K
e
r
st
i
n
g
,
“
P
s
y
c
h
o
me
t
r
i
c
a
ssessm
e
n
t
o
f
t
h
e
b
r
e
a
s
t
f
e
e
d
i
n
g
sel
f
-
e
f
f
i
c
a
c
y
sc
a
l
e
—
s
h
o
r
t
f
o
r
m
:
A
n
a
l
t
e
r
n
a
t
i
v
e
G
e
r
ma
n
t
r
a
n
s
l
a
t
i
o
n
,
”
Mi
d
w
i
f
e
ry
,
v
o
l
.
1
4
4
,
n
o
.
5
,
p
.
1
0
4
3
4
8
,
M
a
y
2
0
2
5
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
mi
d
w
.
2
0
2
5
.
1
0
4
3
4
8
.
[
1
5
]
M
.
E
c
o
n
o
mo
u
e
t
a
l
.
,
“
T
h
e
a
s
so
c
i
a
t
i
o
n
o
f
b
r
e
a
st
f
e
e
d
i
n
g
s
e
l
f
-
e
f
f
i
c
a
c
y
w
i
t
h
b
r
e
a
st
f
e
e
d
i
n
g
d
u
r
a
t
i
o
n
a
n
d
e
x
c
l
u
s
i
v
i
t
y
:
l
o
n
g
i
t
u
d
i
n
a
l
a
ssessm
e
n
t
o
f
t
h
e
p
r
e
d
i
c
t
i
v
e
v
a
l
i
d
i
t
y
o
f
t
h
e
G
r
e
e
k
v
e
r
s
i
o
n
o
f
t
h
e
B
S
ES
-
S
F
t
o
o
l
,
”
B
MC
Pre
g
n
a
n
c
y
a
n
d
C
h
i
l
d
b
i
r
t
h
,
v
o
l
.
2
1
,
n
o
.
1
,
p
.
4
2
1
,
D
e
c
.
2
0
2
1
,
d
o
i
:
1
0
.
1
1
8
6
/
s
1
2
8
8
4
-
0
2
1
-
0
3
8
7
8
-
3.
[
1
6
]
E.
A
n
t
o
ñ
a
n
z
a
s‐
B
a
z
t
á
n
e
t
a
l
.
,
“
S
i
x
‐
m
o
n
t
h
b
r
e
a
s
t
f
e
e
d
i
n
g
m
a
i
n
t
e
n
a
n
c
e
a
f
t
e
r
a
s
e
l
f
‐
e
f
f
i
c
a
c
y
p
r
o
m
o
t
i
n
g
p
r
o
g
r
a
mm
e
:
a
n
e
x
p
l
o
r
a
t
o
r
y
t
r
i
a
l
,
”
S
c
a
n
d
i
n
a
v
i
a
n
J
o
u
r
n
a
l
o
f
C
a
ri
n
g
S
c
i
e
n
c
e
s
,
v
o
l
.
3
5
,
n
o
.
2
,
p
p
.
5
4
8
–
5
5
8
,
J
u
n
.
2
0
2
1
,
d
o
i
:
1
0
.
1
1
1
1
/
s
c
s.
1
2
8
7
0
.
[
1
7
]
C
.
R
.
T
i
t
a
l
e
y
e
t
a
l
.
,
“
D
e
t
e
r
m
i
n
a
n
t
s
o
f
l
o
w
b
r
e
a
s
t
f
e
e
d
i
n
g
s
e
l
f
-
e
f
f
i
c
a
c
y
a
m
o
n
g
s
t
m
o
t
h
e
r
s
o
f
c
h
i
l
d
r
e
n
a
g
e
d
l
e
s
s
t
h
a
n
s
i
x
m
o
n
t
h
s
o
l
d
:
R
e
s
u
l
t
s
f
r
o
m
t
h
e
B
A
D
U
T
A
S
t
u
d
y
i
n
E
a
s
t
J
a
v
a
,
I
n
d
o
n
e
s
i
a
,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
B
r
e
a
s
t
f
e
e
d
i
n
g
J
o
u
r
n
a
l
,
N
o
v
.
1
1
,
2
0
2
0
,
d
o
i
:
1
0
.
2
1
2
0
3
/
r
s
.
3
.
r
s
-
7
1
4
9
2
/
v
2
.
[
1
8
]
S
.
H
a
r
t
a
t
i
a
n
d
N
.
H
a
k
i
m,
“
A
n
e
w
e
x
c
l
u
si
v
e
b
r
e
a
st
f
e
e
d
i
n
g
b
o
o
k
l
e
t
t
o
i
m
p
r
o
v
e
sel
f
-
e
f
f
i
c
a
c
y
,
”
K
n
E
L
i
f
e
S
c
i
e
n
c
e
s
,
p
p
.
8
7
0
–
8
8
0
,
M
a
r
.
2
0
2
1
,
d
o
i
:
1
0
.
1
8
5
0
2
/
k
l
s.
v
6
i
1
.
8
7
6
5
.
[
1
9
]
F
.
S
.
S
h
a
f
a
e
i
,
M
.
M
i
r
g
h
a
f
o
u
r
v
a
n
d
,
a
n
d
S
.
H
a
v
i
z
a
r
i
,
“
Ef
f
e
c
t
o
f
p
r
e
n
a
t
a
l
c
o
u
n
se
l
i
n
g
o
n
b
r
e
a
s
t
f
e
e
d
i
n
g
se
l
f
-
e
f
f
i
c
a
c
y
a
n
d
f
r
e
q
u
e
n
c
y
o
f
b
r
e
a
s
t
f
e
e
d
i
n
g
p
r
o
b
l
e
ms i
n
mo
t
h
e
r
s wi
t
h
p
r
e
v
i
o
u
s
u
n
su
c
c
e
ssf
u
l
b
r
e
a
st
f
e
e
d
i
n
g
:
a
r
a
n
d
o
mi
z
e
d
c
o
n
t
r
o
l
l
e
d
c
l
i
n
i
c
a
l
t
r
i
a
l
,
”
B
M
C
W
o
m
e
n
H
e
a
l
t
h
,
F
e
b
.
0
5
,
2
0
2
0
,
d
o
i
:
1
0
.
2
1
2
0
3
/
r
s.2
.
1
4
1
1
8
/
v
2
.
[
2
0
]
R
.
S
a
e
e
d
,
M
.
F
u
a
d
,
S
.
S
a
d
i
q
,
S
.
R
i
z
w
a
n
,
H
.
M
.
A
s
i
m
,
a
n
d
A
.
B
a
s
h
i
r
H
a
s
h
m
i
,
“
B
r
e
a
s
t
f
e
e
d
i
n
g
e
f
f
i
c
a
c
y
a
m
o
n
g
p
r
i
m
i
p
a
r
o
u
s
m
o
t
h
e
r
s
:
a
su
r
v
e
y
f
r
o
m
La
h
o
r
e
,
”
J
o
u
r
n
a
l
o
f
H
e
a
l
t
h
a
n
d
Re
h
a
b
i
l
i
t
a
t
i
o
n
Re
s
e
a
rc
h
,
v
o
l
.
4
,
n
o
.
2
,
J
u
n
.
2
0
2
4
,
d
o
i
:
1
0
.
6
1
9
1
9
/
j
h
r
r
.
v
4
i
2
.
1
0
0
2
.
[
2
1
]
G
.
G
.
W
.
d
e
M
o
r
a
e
s,
M
.
M
.
C
h
r
i
s
t
o
f
f
e
l
,
B
.
R
.
G
.
d
e
O
.
T
o
so
,
a
n
d
C
.
S
.
V
i
e
r
a
,
“
A
ss
o
c
i
a
t
i
o
n
b
e
t
w
e
e
n
d
u
r
a
t
i
o
n
o
f
e
x
c
l
u
si
v
e
b
r
e
a
s
t
f
e
e
d
i
n
g
a
n
d
n
u
r
si
n
g
mo
t
h
e
r
s’
se
l
f
-
e
f
f
i
c
a
c
y
f
o
r
b
r
e
a
st
f
e
e
d
i
n
g
,
”
Re
v
i
st
a
d
a
Es
c
o
l
a
d
e
En
f
e
rm
a
g
e
m
d
a
U
S
P
,
v
o
l
.
5
5
,
2
0
2
1
,
d
o
i
:
1
0
.
1
5
9
0
/
s
1
9
8
0
-
2
2
0
x
2
0
1
9
0
3
8
3
0
3
7
0
2
.
[
2
2
]
P
.
C
a
r
r
o
l
l
,
P
.
B
r
i
ñ
o
l
,
R
.
E
.
P
e
t
t
y
,
a
n
d
J.
K
e
t
c
h
a
m
,
“
F
e
e
l
i
n
g
p
r
e
p
a
r
e
d
i
n
c
r
e
a
ses
c
o
n
f
i
d
e
n
c
e
i
n
a
n
y
a
c
c
e
ssi
b
l
e
t
h
o
u
g
h
t
s
a
f
f
e
c
t
i
n
g
e
v
a
l
u
a
t
i
o
n
u
n
r
e
l
a
t
e
d
t
o
t
h
e
o
r
i
g
i
n
a
l
d
o
ma
i
n
o
f
p
r
e
p
a
r
a
t
i
o
n
,
”
J
o
u
rn
a
l
o
f
Ex
p
e
r
i
m
e
n
t
a
l
S
o
c
i
a
l
Psy
c
h
o
l
o
g
y
,
v
o
l
.
8
9
,
p
.
1
0
3
9
6
2
,
J
u
l
.
2
0
2
0
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
j
e
s
p
.
2
0
2
0
.
1
0
3
9
6
2
.
[
2
3
]
C
.
Lu
c
c
h
i
n
i
‐
R
a
i
e
s,
F
.
M
a
r
q
u
e
z
‐
D
o
r
e
n
,
P
.
B
e
c
a
,
J.
C
.
P
e
r
e
z
,
S
.
C
a
m
p
o
s,
a
n
d
O
.
L
o
p
e
z
‐
D
i
c
a
s
t
i
l
l
o
,
“
T
h
e
C
R
I
A
A
P
r
o
g
r
a
m
c
o
m
p
l
e
x
i
n
t
e
r
v
e
n
t
i
o
n
i
n
p
r
i
mar
y
c
a
r
e
t
o
su
p
p
o
r
t
w
o
me
n
a
n
d
t
h
e
i
r
f
a
m
i
l
i
e
s
i
n
b
r
e
a
st
f
e
e
d
i
n
g
:
S
t
u
d
y
p
r
o
t
o
c
o
l
f
o
r
a
p
i
l
o
t
t
r
i
a
l
,
”
J
o
u
r
n
a
l
o
f
Ad
v
a
n
c
e
d
N
u
rsi
n
g
,
v
o
l
.
7
6
,
n
o
.
1
2
,
p
p
.
3
6
4
1
–
3
6
5
3
,
D
e
c
.
2
0
2
0
,
d
o
i
:
1
0
.
1
1
1
1
/
j
a
n
.
1
4
5
3
4
.
[
2
4
]
A
.
N
.
R
a
h
m
a
d
a
n
i
a
n
d
A
.
F
.
R
a
h
m
a
w
a
t
i
,
“
M
e
t
a
-
a
n
a
l
y
s
i
s
:
e
f
f
e
c
t
o
f
b
r
e
a
s
t
f
e
e
d
i
n
g
e
d
u
c
a
t
i
o
n
p
r
o
g
r
a
m
o
n
t
h
e
b
r
e
a
s
t
f
e
e
d
i
n
g
s
e
l
f
-
e
f
f
i
c
a
c
y
a
n
d
e
x
c
l
u
s
i
v
e
b
r
e
a
s
t
f
e
e
d
i
n
g
,
”
J
o
u
r
n
a
l
o
f
H
e
a
l
t
h
P
r
o
m
o
t
i
o
n
a
n
d
B
e
h
a
v
i
o
r
,
v
o
l
.
7
,
n
o
.
1
,
2
0
2
2
,
d
o
i
:
1
0
.
2
6
9
1
1
/
t
h
e
j
h
p
b
.
2
0
2
1
.
0
7
.
0
1
.
0
5
.
[
2
5
]
N
.
S
e
y
y
e
d
i
,
L
.
R
a
h
ma
t
n
e
z
h
a
d
,
M
.
M
e
sg
a
r
z
a
d
e
h
,
H
.
K
h
a
l
k
h
a
l
i
,
N
.
S
e
y
y
e
d
i
,
a
n
d
B
.
R
a
h
i
mi
,
“
Ef
f
e
c
t
i
v
e
n
e
ss
o
f
a
s
martp
h
o
n
e
-
b
a
se
d
e
d
u
c
a
t
i
o
n
a
l
i
n
t
e
r
v
e
n
t
i
o
n
t
o
i
m
p
r
o
v
e
b
r
e
a
s
t
f
e
e
d
i
n
g
,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
Br
e
a
s
t
f
e
e
d
i
n
g
J
o
u
r
n
a
l
,
v
o
l
.
1
6
,
n
o
.
1
,
p
.
7
0
,
D
e
c
.
2
0
2
1
,
d
o
i
:
1
0
.
1
1
8
6
/
s
1
3
0
0
6
-
0
2
1
-
0
0
4
1
7
-
w.
[
2
6
]
H
.
Y
o
u
,
A
.
L
e
i
,
J
.
X
i
a
n
g
,
Y
.
W
a
n
g
,
B
.
L
u
o
,
a
n
d
J
.
H
u
,
“
E
f
f
e
c
t
s
o
f
b
r
e
a
s
t
f
e
e
d
i
n
g
e
d
u
c
a
t
i
o
n
b
a
s
e
d
o
n
t
h
e
s
e
l
f
-
e
f
f
i
c
a
c
y
t
h
e
o
r
y
o
n
w
o
m
e
n
w
i
t
h
g
e
st
a
t
i
o
n
a
l
d
i
a
b
e
t
e
s m
e
l
l
i
t
u
s
,
”
M
e
d
i
c
i
n
e
,
v
o
l
.
9
9
,
n
o
.
1
6
,
p
.
e
1
9
6
4
3
,
A
p
r
.
2
0
2
0
,
d
o
i
:
1
0
.
1
0
9
7
/
M
D
.
0
0
0
0
0
0
0
0
0
0
0
1
9
6
4
3
.
[
2
7
]
B
.
H
.
A
b
o
u
l
-
E
n
e
i
n
,
E
.
D
o
d
g
e
,
N
.
B
e
n
a
j
i
b
a
,
a
n
d
R
.
M
.
M
a
b
r
y
,
“
I
n
t
e
r
v
e
n
t
i
o
n
s
a
n
d
p
r
o
g
r
a
m
s
t
o
p
r
o
m
o
t
e
b
r
e
a
s
t
f
e
e
d
i
n
g
i
n
A
r
a
b
i
c
-
s
p
e
a
k
i
n
g
c
o
u
n
t
r
i
e
s
:
a
s
c
o
p
i
n
g
r
e
v
i
e
w
,
”
M
a
t
e
r
n
a
l
a
n
d
C
h
i
l
d
H
e
a
l
t
h
J
o
u
r
n
a
l
,
v
o
l
.
2
7
,
n
o
.
5
,
M
a
y
2
0
2
3
,
d
o
i
:
1
0
.
1
0
0
7
/
s
1
0
9
9
5
-
0
2
3
-
03595
-
7.
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
E
ffective
n
ess
o
f a
b
r
ea
s
tfeed
in
g
s
elf
-
effica
cy
in
terven
tio
n
o
n
B
S
E
S
-
S
F
s
co
r
es a
n
d
…
(
A
r
ifa
r
a
h
mi
)
457
[
2
8
]
B
.
H
.
A
b
o
u
l
‐
E
n
e
i
n
,
M
.
V
.
V
e
t
t
o
r
e
,
T
.
K
e
l
l
e
r
,
a
n
d
P
.
J
.
K
e
l
l
y
,
“
B
r
e
a
s
t
f
e
e
d
i
n
g
i
n
t
e
r
v
e
n
t
i
o
n
s
a
n
d
p
r
o
g
r
a
m
m
e
s
c
o
n
d
u
c
t
e
d
i
n
P
o
r
t
u
g
u
e
s
e
‐
s
p
e
a
k
i
n
g
s
o
v
e
r
e
i
g
n
s
t
a
t
e
s
:
A
s
c
o
p
i
n
g
r
e
v
i
e
w
,
”
A
c
t
a
P
a
e
d
i
a
t
r
i
c
a
,
v
o
l
.
1
1
3
,
n
o
.
6
,
p
p
.
1
1
8
6
–
1
2
0
2
,
J
u
n
.
2
0
2
4
,
d
o
i
:
1
0
.
1
1
1
1
/
a
p
a
.
1
7
2
0
3
.
[
2
9
]
E.
P
.
M
u
d
a
h
a
r
i
m
b
i
,
“
S
e
l
f
-
e
f
f
i
c
a
c
y
o
f
p
r
i
mi
g
r
a
v
i
d
a
w
o
r
k
i
n
g
m
o
t
h
e
r
s
i
n
t
h
e
su
c
c
e
ss
o
f
b
r
e
a
st
f
e
e
d
i
n
g
,
”
J
u
rn
a
l
P
R
O
MK
E
S
,
v
o
l
.
9
,
n
o
.
1
,
p
.
2
8
,
M
a
r
.
2
0
2
1
,
d
o
i
:
1
0
.
2
0
4
7
3
/
j
p
k
.
V
9
.
I
1
.
2
0
2
1
.
2
8
-
3
5
.
[
3
0
]
J.
K
e
h
i
n
d
e
,
C
.
O
’
D
o
n
n
e
l
l
,
a
n
d
A
.
G
r
e
a
l
i
s
h
,
“
Th
e
e
f
f
e
c
t
i
v
e
n
e
ss
o
f
p
r
e
n
a
t
a
l
b
r
e
a
s
t
f
e
e
d
i
n
g
e
d
u
c
a
t
i
o
n
o
n
b
r
e
a
st
f
e
e
d
i
n
g
u
p
t
a
k
e
p
o
s
t
p
a
r
t
u
m:
A
s
y
st
e
ma
t
i
c
r
e
v
i
e
w
,
”
M
i
d
w
i
f
e
ry
,
v
o
l
.
1
1
8
,
p
.
1
0
3
5
7
9
,
M
a
r
.
2
0
2
3
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
m
i
d
w
.
2
0
2
2
.
1
0
3
5
7
9
.
[
3
1
]
N
.
B
.
K
.
A
k
t
ü
r
k
a
n
d
M
.
K
o
l
c
u
,
“
T
h
e
e
f
f
e
c
t
o
f
p
o
st
n
a
t
a
l
b
r
e
a
st
f
e
e
d
i
n
g
e
d
u
c
a
t
i
o
n
g
i
v
e
n
t
o
w
o
m
e
n
o
n
b
r
e
a
st
f
e
e
d
i
n
g
se
l
f
-
e
f
f
i
c
a
c
y
a
n
d
b
r
e
a
s
t
f
e
e
d
i
n
g
s
u
c
c
e
ss
,
”
Re
v
i
s
t
a
d
a
Ass
o
c
i
a
ç
ã
o
M
é
d
i
c
a
Br
a
s
i
l
e
i
r
a
,
v
o
l
.
6
9
,
n
o
.
8
,
2
0
2
3
,
d
o
i
:
1
0
.
1
5
9
0
/
1
8
0
6
-
9
2
8
2
.
2
0
2
3
0
2
1
7
.
[
3
2
]
N
.
K
a
r
i
m
i
a
n
-
M
a
r
n
a
n
i
,
E.
Ti
l
l
e
y
,
a
n
d
J.
T
.
W
a
l
l
e
n
b
o
r
n
,
“
O
v
e
r
c
o
m
i
n
g
b
a
r
r
i
e
r
s
t
o
e
x
c
l
u
s
i
v
e
b
r
e
a
s
t
f
e
e
d
i
n
g
i
n
L
a
o
P
D
R
:
S
o
c
i
a
l
t
r
a
n
sf
e
r
i
n
t
e
r
v
e
n
t
i
o
n
r
a
n
d
o
m
i
se
d
c
o
n
t
r
o
l
l
e
d
t
r
i
a
l
,
”
N
u
t
r
i
e
n
t
s
,
v
o
l
.
1
7
,
n
o
.
1
5
,
p
.
2
3
9
6
,
J
u
l
.
2
0
2
5
,
d
o
i
:
1
0
.
3
3
9
0
/
n
u
1
7
1
5
2
3
9
6
.
[
3
3
]
E.
A
d
u
g
n
a
w
e
t
a
l
.
,
“
T
h
e
me
d
i
a
n
t
i
me
t
o
st
o
p
o
v
e
r
e
x
c
l
u
si
v
e
b
r
e
a
st
f
e
e
d
i
n
g
a
mo
n
g
e
m
p
l
o
y
e
d
a
n
d
u
n
e
m
p
l
o
y
e
d
m
o
t
h
e
r
s
o
f
i
n
f
a
n
t
s
a
g
e
d
6
–
1
2
mo
n
t
h
s
i
n
E
t
h
i
o
p
i
a
,
2
0
1
9
,
”
S
c
i
e
n
t
i
f
i
c
Re
p
o
rt
s
,
v
o
l
.
1
3
,
n
o
.
1
,
p
.
6
2
5
9
,
A
p
r
.
2
0
2
3
,
d
o
i
:
1
0
.
1
0
3
8
/
s
4
1
5
9
8
-
0
2
3
-
2
9
7
2
9
-
z.
[
3
4
]
H
.
Zh
a
o
,
L.
M
a
,
Y
.
M
i
,
R
.
G
a
o
,
a
n
d
J.
W
e
i
,
“
E
x
c
l
u
si
v
e
b
r
e
a
st
f
e
e
d
i
n
g
i
n
t
e
n
t
i
o
n
a
n
d
a
ss
o
c
i
a
t
e
d
f
a
c
t
o
r
s
i
n
p
r
e
g
n
a
n
t
w
o
m
e
n
:
f
i
n
d
i
n
g
s
f
r
o
m
a
p
o
p
u
l
a
t
i
o
n
-
b
a
se
d
s
t
u
d
y
,
”
Re
s
e
a
rc
h
S
q
u
a
re
,
A
u
g
.
0
5
,
2
0
2
2
,
d
o
i
:
1
0
.
2
1
2
0
3
/
r
s.
3
.
r
s
-
1
8
5
6
6
0
0
/
v
1
.
[
3
5
]
Y.
-
W
.
W
a
n
g
a
n
d
Y
.
-
J.
C
h
a
n
g
,
“
Ef
f
e
c
t
s
o
f
t
h
e
e
x
p
e
r
i
e
n
c
e
o
f
b
r
e
a
st
f
e
e
d
i
n
g
-
f
r
i
e
n
d
l
y
p
r
a
c
t
i
c
e
s
a
n
d
b
r
e
a
st
f
e
e
d
i
n
g
i
n
t
e
n
t
i
o
n
a
n
d
se
l
f
-
e
f
f
i
c
a
c
y
o
n
b
r
e
a
st
f
e
e
d
i
n
g
b
e
h
a
v
i
o
r
:
a
c
o
h
o
r
t
st
u
d
y
i
n
T
a
i
w
a
n
,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
Br
e
a
s
t
f
e
e
d
i
n
g
J
o
u
r
n
a
l
,
D
e
c
.
2
9
,
2
0
2
1
,
d
o
i
:
1
0
.
2
1
2
0
3
/
r
s
.
3
.
r
s
-
1
1
6
5
6
6
6
/
v
1
.
B
I
O
G
RAP
H
I
E
S O
F
AUTH
O
RS
Ar
ifa
r
a
h
m
i
is
a
n
a
c
a
d
e
m
ic
fa
c
u
lt
y
m
e
m
b
e
r
a
ffil
iate
d
with
t
h
e
De
p
a
rtme
n
t
o
f
M
id
wife
ry
,
U
n
iv
e
rsit
y
o
f
Ba
it
u
rra
h
im
,
Ja
m
b
i,
In
d
o
n
e
sia
.
S
h
e
se
rv
e
s
a
s
a
lec
tu
re
r
a
n
d
re
se
a
rc
h
e
r
in
th
e
field
o
f
m
id
wife
ry
,
c
o
n
tri
b
u
ti
n
g
to
th
e
a
d
v
a
n
c
e
m
e
n
t
o
f
m
a
tern
a
l
a
n
d
re
p
ro
d
u
c
ti
v
e
h
e
a
lt
h
e
d
u
c
a
ti
o
n
a
n
d
re
se
a
rc
h
with
in
t
h
e
In
d
o
n
e
sia
n
a
c
a
d
e
m
ic
c
o
n
tex
t.
Ba
se
d
a
t
th
e
Un
iv
e
rsit
y
o
f
Ba
it
u
rra
h
im
,
a
p
riv
a
te
h
i
g
h
e
r
e
d
u
c
a
ti
o
n
in
stit
u
ti
o
n
lo
c
a
ted
in
Ja
m
b
i
P
ro
v
in
c
e
,
S
u
m
a
tra.
S
h
e
is
e
n
g
a
g
e
d
i
n
tea
c
h
in
g
,
re
se
a
rc
h
,
a
n
d
c
o
m
m
u
n
i
ty
se
rv
ice
a
c
ti
v
it
ies
a
li
g
n
e
d
with
th
e
Th
re
e
P
il
lars
o
f
Hi
g
h
e
r
E
d
u
c
a
ti
o
n
fra
m
e
wo
rk
i
n
In
d
o
n
e
sia
.
He
r
sc
h
o
larly
wo
r
k
c
e
n
ters
o
n
m
id
wife
ry
sc
ien
c
e
,
e
n
c
o
m
p
a
ss
in
g
a
re
a
s
re
lev
a
n
t
to
m
a
tern
a
l
h
e
a
lt
h
,
wo
m
e
n
'
s
h
e
a
lt
h
,
a
n
d
m
id
wife
ry
p
ra
c
ti
c
e
.
As
a
m
e
m
b
e
r
o
f
th
e
m
id
wife
ry
a
c
a
d
e
m
ic
c
o
m
m
u
n
it
y
,
sh
e
c
o
n
tri
b
u
tes
to
th
e
p
r
o
fe
ss
io
n
a
l
d
e
v
e
l
o
p
m
e
n
t
o
f
fu
t
u
re
m
id
wiv
e
s
a
n
d
th
e
b
o
d
y
o
f
k
n
o
wle
d
g
e
i
n
m
id
wife
r
y
sc
ien
c
e
s in
In
d
o
n
e
sia
.
Sh
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
a
rifara
h
m
i1
8
@g
m
a
il
.
c
o
m
.
As
r
ia
l
As
r
ia
l
is
a
fa
c
u
lt
y
m
e
m
b
e
r
a
t
th
e
D
e
p
a
rt
m
e
n
t
o
f
Ch
e
m
i
stry
Ed
u
c
a
t
io
n
,
F
a
c
u
lt
y
o
f
T
e
a
c
h
e
r
Tr
a
in
in
g
a
n
d
Ed
u
c
a
ti
o
n
(F
K
IP
)
,
Un
iv
e
rsi
ty
o
f
J
a
m
b
i,
J
a
m
b
i,
In
d
o
n
e
s
ia.
He
sp
e
c
i
a
li
z
e
s
in
c
h
e
m
i
stry
e
d
u
c
a
ti
o
n
,
wi
th
r
e
se
a
rc
h
in
t
e
r
e
sts
e
n
c
o
m
p
a
ss
in
g
p
e
d
a
g
o
g
i
c
a
l
a
p
p
ro
a
c
h
e
s,
c
u
r
ri
c
u
lu
m
d
e
v
e
lo
p
m
e
n
t,
a
n
d
th
e
i
m
p
ro
v
e
m
e
n
t
o
f
sc
ien
c
e
e
d
u
c
a
t
io
n
p
r
a
c
ti
c
e
s
.
Th
e
Un
iv
e
r
sity
o
f
Ja
m
b
i
is
a
p
ro
m
in
e
n
t
p
u
b
li
c
u
n
iv
e
rsi
ty
lo
c
a
ted
in
J
a
m
b
i
P
ro
v
in
c
e
,
S
u
m
a
t
ra
,
a
n
d
it
s
F
K
IP
p
l
a
y
s
a
s
ig
n
ifi
c
a
n
t
ro
le
in
p
re
p
a
r
in
g
fu
tu
r
e
e
d
u
c
a
to
r
s
a
c
ro
ss
v
a
r
io
u
s
d
i
s
c
ip
li
n
e
s
.
His
s
c
h
o
l
a
rly
c
o
n
t
rib
u
ti
o
n
s
a
d
d
r
e
s
s
c
h
a
ll
e
n
g
e
s
a
n
d
in
n
o
v
a
t
io
n
s
i
n
c
h
e
m
i
st
ry
t
e
a
c
h
in
g
a
t
b
o
th
se
c
o
n
d
a
ry
a
n
d
t
e
rt
ia
ry
l
e
v
e
l
s,
a
d
v
a
n
c
in
g
th
e
b
ro
a
d
e
r
d
i
sc
o
u
rs
e
o
n
s
c
i
e
n
c
e
e
d
u
c
a
t
io
n
in
In
d
o
n
e
s
ia
.
H
e
c
a
n
b
e
c
o
n
t
a
c
t
e
d
a
t
e
m
a
il
:
a
sria
l@u
n
ja.ac
.
id
.
Mu
h
a
m
m
a
d
Rusd
i
is
a
n
a
c
a
d
e
m
ic
a
ffi
li
a
t
e
d
w
it
h
th
e
D
e
p
a
rt
m
e
n
t
o
f
Ch
e
m
is
t
r
y
Ed
u
c
a
ti
o
n
,
F
a
c
u
lt
y
o
f
T
e
a
c
h
e
r
Train
in
g
a
n
d
Ed
u
c
a
ti
o
n
(F
K
IP
),
Un
iv
e
rs
it
y
o
f
J
a
m
b
i
(Un
iv
e
r
sit
a
s
J
a
m
b
i/
UN
J
A),
Ja
m
b
i,
In
d
o
n
e
si
a
.
As
a
f
a
c
u
lt
y
m
e
m
b
e
r
,
h
e
is
d
e
d
i
c
a
t
e
d
to
c
h
e
m
i
st
ry
e
d
u
c
a
ti
o
n
,
c
o
n
t
rib
u
ti
n
g
to
th
e
p
r
e
p
a
r
a
ti
o
n
o
f
fu
tu
r
e
c
h
e
m
is
try
e
d
u
c
a
to
rs
th
ro
u
g
h
te
a
c
h
in
g
,
re
s
e
a
rc
h
,
a
n
d
a
c
a
d
e
m
ic
s
e
rv
ic
e
.
B
a
se
d
a
t
o
n
e
o
f
In
d
o
n
e
si
a
'
s
p
ro
m
in
e
n
t
p
u
b
li
c
u
n
iv
e
r
siti
e
s
in
J
a
m
b
i
P
ro
v
in
c
e
,
S
u
m
a
tr
a
,
h
i
s
wo
rk
fo
c
u
s
e
s
o
n
a
d
v
a
n
c
in
g
p
e
d
a
g
o
g
i
c
a
l
p
ra
c
ti
c
e
s,
c
u
rri
c
u
lu
m
d
e
v
e
lo
p
m
e
n
t,
a
n
d
imp
ro
v
in
g
th
e
q
u
a
li
ty
o
f
c
h
e
m
ist
ry
in
stru
c
t
io
n
.
H
is
in
sti
tu
ti
o
n
a
l
ro
le
u
n
d
e
r
s
c
o
r
e
s
h
is
c
o
m
m
i
tm
e
n
t
to
e
n
h
a
n
c
in
g
s
c
i
e
n
c
e
e
d
u
c
a
t
io
n
a
t
b
o
th
se
c
o
n
d
a
ry
a
n
d
t
e
rt
ia
ry
l
e
v
e
ls
in
In
d
o
n
e
si
a
.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
ru
sd
imu
h
a
m
m
a
d
@u
n
ja.ac
.
id
.
S
o
lh
a
Elrifd
a
is
a
fa
c
u
lt
y
m
e
m
b
e
r
in
th
e
De
p
a
rtme
n
t
o
f
P
u
b
l
ic
He
a
lt
h
S
c
ien
c
e
s
a
t
P
o
lt
e
k
k
e
s
Ke
m
e
n
k
e
s
Ja
m
b
i
(He
a
lt
h
P
o
ly
tec
h
n
ic
o
f
th
e
M
in
istr
y
o
f
He
a
lt
h
Ja
m
b
i),
In
d
o
n
e
sia
.
Th
is
in
st
it
u
t
io
n
o
p
e
ra
tes
u
n
d
e
r
t
h
e
In
d
o
n
e
sia
n
M
in
istr
y
o
f
He
a
lt
h
,
f
o
c
u
sin
g
o
n
v
o
c
a
ti
o
n
a
l
e
d
u
c
a
ti
o
n
a
n
d
a
p
p
l
ied
re
se
a
rc
h
to
p
ro
d
u
c
e
c
o
m
p
e
ten
t
h
e
a
lt
h
p
r
o
fe
ss
io
n
a
ls.
He
r
a
c
a
d
e
m
ic
wo
rk
e
n
c
o
m
p
a
ss
e
s
p
u
b
li
c
h
e
a
lt
h
e
d
u
c
a
ti
o
n
,
re
se
a
rc
h
,
a
n
d
c
o
m
m
u
n
it
y
h
e
a
lt
h
d
e
v
e
l
o
p
m
e
n
t,
c
o
n
tri
b
u
ti
n
g
to
stre
n
g
th
e
n
i
n
g
th
e
p
u
b
li
c
h
e
a
lt
h
w
o
rk
f
o
rc
e
in
Ja
m
b
i
p
ro
v
in
c
e
a
n
d
a
d
d
re
ss
in
g
re
g
io
n
a
l
a
n
d
n
a
ti
o
n
a
l
h
e
a
lt
h
c
h
a
ll
e
n
g
e
s
in
I
n
d
o
n
e
sia
.
Sh
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
so
lh
a
@p
o
lt
e
k
k
e
sja
m
b
i.
a
c
.
id
.
Evaluation Warning : The document was created with Spire.PDF for Python.