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2
0
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ta
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n
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ly
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n
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m
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1
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ti
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s
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re
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se
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n
d
5
1
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0
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we
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d
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n
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c
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li
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siti
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i
p
ro
f
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a
c
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li
n
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0
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u
tb
re
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k
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te
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ti
o
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n
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h
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c
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is
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d
y
p
ro
v
i
d
e
s
e
v
id
e
n
c
e
o
n
lo
n
g
-
term
e
ffe
c
ti
v
e
n
e
ss
o
f
two
-
d
o
se
s
o
f
OCV
in
a
n
e
n
d
e
m
ic
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rb
a
n
se
tt
in
g
.
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c
c
in
a
ti
o
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sta
t
u
s
re
li
e
d
o
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p
a
rti
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ip
a
n
t
re
c
a
ll
a
n
d
v
a
c
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ti
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rd
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th
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a
b
se
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o
f
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c
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tral
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a
n
d
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il
e
t
h
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st
u
d
y
wa
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s
u
fficie
n
tl
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o
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d
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a
ss
e
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th
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e
ffe
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ti
v
e
n
e
ss
o
f
t
h
e
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,
th
e
n
u
m
b
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r
o
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c
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se
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li
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d
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v
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ti
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ig
n
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m
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n
d
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d
.
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Dec
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20
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,
B
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8
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1
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t
r
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l
.
2.
M
E
T
H
O
D
2
.
1
.
Study
des
ig
n
A
1
:2
u
n
m
atc
h
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ca
s
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co
n
tr
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was
co
n
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in
Har
ar
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W
ester
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Dis
tr
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,
wh
er
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ca
s
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wer
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ef
in
ed
as
r
esid
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f
Har
a
r
e
W
ester
n
Dis
tr
ict
wh
o
wer
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d
iag
n
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s
ed
with
a
co
n
f
ir
m
e
d
ch
o
ler
a
in
f
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tio
n
b
etwe
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th
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d
ates
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f
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r
il
2
2
n
d
,
2
0
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3
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d
J
u
ly
2
0
,
2
0
2
3
.
A
co
n
f
ir
m
e
d
ch
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ler
a
ca
s
e
was
b
ased
o
n
a
c
u
ltu
r
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-
p
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s
itiv
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test
th
at
d
etec
ts
th
e
p
r
esen
ce
o
f
V
ib
r
io
ch
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in
th
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p
atien
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s
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to
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l
s
am
p
le.
C
o
n
tr
o
ls
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e
d
ef
in
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as
r
esid
en
ts
in
t
h
e
Har
a
r
e
W
e
s
ter
n
Dis
tr
ict
wh
o
we
r
e
at
r
is
k
o
f
c
o
n
tr
ac
tin
g
ch
o
ler
a
b
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t
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id
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th
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s
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d
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r
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g
th
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f
r
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m
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2
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2
0
2
3
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to
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ly
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2
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2
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a
n
d
wer
e
n
o
t
in
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id
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al
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atch
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e
o
r
s
ex
.
A
ca
s
e
-
co
n
tr
o
l
d
esig
n
was
u
s
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to
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f
icien
tly
ass
ess
v
ac
cin
atio
n
ef
f
ec
tiv
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n
ess
an
d
o
t
h
er
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is
k
an
d
p
r
o
tectiv
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f
ac
to
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s
at
th
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s
am
e
t
im
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am
o
n
g
in
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id
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als af
f
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te
d
b
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th
e
ch
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ler
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o
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tb
r
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k
.
2
.
2
.
Study
s
et
t
ing
T
h
is
s
tu
d
y
was
ca
r
r
ied
o
u
t
in
Har
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e
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ester
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tr
ict
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wh
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in
clu
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u
b
u
r
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Gle
n
v
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.
T
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h
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to
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v
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in
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s
m
all
-
s
ca
le
b
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s
in
ess
[
1
6
]
.
T
h
e
m
ajo
r
ity
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f
c
h
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ler
a
o
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tb
r
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in
2
0
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cc
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r
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d
in
th
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s
ity
Z
im
b
ab
wea
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b
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wh
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co
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r
ep
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ted
.
Du
r
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am
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t
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r
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Glen
v
iew
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ler
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d
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e
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th
,
Glen
No
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ah
to
th
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E
ast.
I
n
t
h
e
cu
r
r
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n
t
ch
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ler
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o
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ea
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o
th
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v
iew
a
n
d
B
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d
ir
ir
o
h
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e
th
e
h
ig
h
est co
n
f
ir
m
ed
ca
s
es o
f
c
h
o
ler
a
,
with
p
o
p
u
latio
n
s
o
f
a
to
tal
o
f
3
0
3
,
5
7
9
wh
en
co
m
b
in
e
d
.
2
.
3
.
Study
po
pu
la
t
io
n
O
u
r
s
t
u
d
y
p
o
p
u
l
a
t
i
o
n
i
n
c
l
u
d
e
d
c
a
s
e
p
a
t
ie
n
t
s
a
n
d
c
o
n
t
r
o
ls
i
n
H
a
r
a
r
e
W
e
s
te
r
n
D
i
s
t
r
i
ct
,
w
h
o
w
e
r
e
a
t
r
is
k
o
f
c
h
o
l
e
r
a
b
e
t
w
e
e
n
A
p
r
i
l
2
2
a
n
d
2
0
J
u
l
y
,
2
0
2
3
,
r
e
g
a
r
d
l
e
s
s
o
f
v
a
c
c
i
n
a
t
i
o
n
s
t
a
t
u
s
.
E
n
v
i
r
o
n
m
e
n
t
a
l
H
e
a
lt
h
O
f
f
i
c
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r
s
,
E
n
v
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r
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m
e
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t
a
l
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e
a
l
t
h
T
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c
h
n
i
ci
a
n
s
a
n
d
N
u
r
s
e
s
i
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c
h
a
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a
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k
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s
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n
f
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r
m
a
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Sa
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a
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S
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8
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,
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:
c
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[
1
7
]
,
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3
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2
.
5
.
Da
t
a
c
o
llect
io
n a
nd
a
na
ly
s
is
W
e
u
s
ed
in
ter
v
iewe
r
-
ad
m
in
is
ter
ed
q
u
esti
o
n
n
air
es
am
o
n
g
ca
s
es
an
d
co
n
tr
o
ls
d
u
r
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g
t
h
e
ch
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ler
a
o
u
tb
r
ea
k
to
co
llect
i
n
f
o
r
m
atio
n
o
n
f
ac
to
r
s
ass
o
ciate
d
with
c
o
n
tr
ac
tin
g
ch
o
le
r
a.
T
h
e
p
r
im
a
r
y
o
u
tco
m
e
o
f
th
e
s
tu
d
y
was
co
n
tr
ac
tin
g
ch
o
ler
a.
T
h
e
s
o
u
r
ce
o
f
d
r
in
k
in
g
wa
ter
,
wate
r
tr
ea
tm
en
t,
ty
p
e
o
f
co
n
tain
er
f
o
r
wate
r
s
to
r
ag
e,
p
r
o
x
im
ity
to
s
ewa
g
e
b
u
r
s
ts
,
ty
p
e
o
f
to
ilet,
g
ar
b
ag
e
co
llectio
n
,
v
ac
cin
atio
n
s
tatu
s
,
h
an
d
wash
in
g
an
d
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s
e
o
f
s
o
ap
,
ea
tin
g
f
o
o
d
s
o
ld
o
n
th
e
r
o
ad
,
ed
u
ca
tio
n
,
em
p
l
o
y
m
en
t
s
tatu
s
,
ag
e,
s
ex
,
m
ar
ital
s
tatu
s
,
an
d
n
u
m
b
er
o
f
p
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p
le
in
a
h
o
u
s
eh
o
l
d
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co
n
tact
with
ca
s
e
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e
e
x
p
o
s
u
r
e
v
ar
iab
les.
A
g
e,
s
ex
,
a
n
d
o
cc
u
p
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wer
e
p
r
ed
icto
r
v
ar
iab
les,
s
o
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r
ce
s
o
f
d
r
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k
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r
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y
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e
o
f
to
ilet
,
an
d
h
an
d
wash
in
g
p
r
ac
t
ices
wer
e
p
o
ten
tial
co
n
f
o
u
n
d
er
s
,
a
n
d
a
p
o
ten
tial e
f
f
ec
t m
o
d
if
ie
r
was th
e
n
u
m
b
er
o
f
d
o
s
es o
f
th
e
v
ac
ci
n
e.
I
n
ter
v
iews
f
o
r
k
ey
in
f
o
r
m
a
n
ts
wer
e
co
n
d
u
cted
u
s
in
g
a
k
ey
in
f
o
r
m
a
n
t
in
ter
v
iew
g
u
id
e
to
ass
es
s
th
e
p
r
esen
ce
o
f
en
v
ir
o
n
m
e
n
tal
s
u
r
v
eillan
ce
(
wate
r
an
d
s
ewa
g
e
s
am
p
lin
g
)
.
Giv
en
th
e
ab
s
en
c
e
o
f
a
ce
n
tr
alize
d
v
ac
cin
atio
n
r
eg
is
ter
,
v
ac
cin
atio
n
s
tatu
s
was d
eter
m
in
ed
b
y
a
co
m
b
in
atio
n
o
f
p
ar
ticip
an
t r
e
ca
ll,
o
f
f
icial
ch
o
ler
a
lin
e
lis
ts
,
an
d
p
er
s
o
n
al
v
ac
cin
atio
n
ca
r
d
s
.
T
h
is
s
tr
ateg
y
e
m
p
lo
y
ed
d
ata
tr
ian
g
u
latio
n
to
m
in
im
ize
th
e
r
is
k
o
f
in
f
o
r
m
atio
n
b
ias
an
d
p
o
ten
tia
l
m
is
class
if
icat
io
n
o
f
e
x
p
o
s
u
r
e
s
tatu
s
r
esu
ltin
g
f
r
o
m
r
elian
ce
o
n
s
elf
-
r
ep
o
r
t
o
r
in
co
m
p
lete
d
o
cu
m
e
n
tatio
n.
Fo
r
an
tib
i
o
tic
s
u
s
ce
p
tib
ilit
y
p
a
tter
n
s
,
lab
o
r
ato
r
y
r
esu
lts
o
n
a
n
tib
io
tic
s
en
s
itiv
ity
test
s
f
o
r
ch
o
ler
a
co
n
f
i
r
m
ed
ca
s
es
wer
e
u
s
ed
.
Fo
r
wate
r
s
u
r
v
eillan
ce
d
ata,
W
HO
Gu
id
elin
e
s
f
o
r
d
r
in
k
in
g
-
wate
r
q
u
ality
(
f
o
u
r
th
ed
itio
n
p
u
b
lis
h
ed
in
2
0
1
1
a
n
d
c
o
m
p
lem
en
t
ed
b
y
th
e
f
i
r
s
t
ad
d
en
d
u
m
i
n
2
0
1
7
)
wer
e
u
s
ed
to
in
ter
p
r
et
th
e
to
tal
co
lifo
r
m
co
u
n
ts
(
E
.
co
li
o
r
th
er
m
o
to
ler
a
n
t
co
lifo
r
m
b
ac
ter
ia
m
u
s
t
n
o
t
b
e
d
etec
tab
le
in
an
y
1
0
0
m
l sam
p
le
)
[
1
8
]
.
Data
en
tr
y
a
n
d
all
s
tatis
tical
a
n
aly
s
es
wer
e
p
er
f
o
r
m
e
d
in
E
p
i
I
n
f
o
™
v
er
s
io
n
7
.
2
.
5
.
T
h
e
d
a
ta
an
aly
s
is
was
d
o
n
e
t
h
r
o
u
g
h
d
escr
ip
tiv
e
s
ta
tis
tics
u
s
in
g
u
n
iv
ar
iate
an
aly
s
is
to
ch
ar
ac
ter
ize
th
e
ch
o
ler
a
o
u
tb
r
ea
k
b
y
p
er
s
o
n
,
p
lace
,
an
d
tim
e.
C
h
i
-
s
q
u
ar
e/Fis
h
er
’
s
ex
ac
t
was
u
s
ed
to
ev
alu
ate
th
e
eq
u
ality
o
f
ca
s
es
an
d
co
n
tr
o
ls
an
d
to
test
f
o
r
in
d
ep
en
d
en
ce
b
etw
ee
n
ca
teg
o
r
ical
v
ar
iab
les.
L
im
it
g
r
o
u
p
in
g
was
u
s
ed
f
o
r
q
u
an
titativ
e
v
ar
iab
les.
Mic
r
o
s
o
f
t
E
x
ce
l™
was
u
s
ed
to
g
en
er
ate
an
e
p
id
em
ic
cu
r
v
e.
Ar
cGI
S
s
o
f
twar
e
was
u
s
ed
to
g
en
e
r
ate
a
s
p
o
t
m
ap
o
f
th
e
o
u
tb
r
ea
k
.
B
iv
ar
iat
e
an
aly
s
is
o
n
r
is
k
f
ac
to
r
s
co
n
tr
ib
u
tin
g
to
th
e
ch
o
ler
a
o
u
tb
r
ea
k
was
co
n
d
u
cted
,
an
d
v
a
r
iab
les
with
p
<
0
.
0
5
wer
e
co
n
s
id
er
e
d
to
b
e
s
ig
n
if
ican
t.
B
ac
k
war
d
s
tep
wis
e
m
u
ltiv
ar
iate
lo
g
is
tic
r
eg
r
ess
io
n
an
aly
s
is
was
p
er
f
o
r
m
ed
o
n
v
a
r
iab
les
th
at
wer
e
s
ig
n
if
ican
t
at
p
≤
0
.
2
5
.
Vac
cin
e
ef
f
ec
tiv
en
ess
was
ass
es
s
ed
b
y
co
m
p
ar
in
g
c
h
o
ler
a
ca
s
es
b
etwe
en
v
ac
cin
ated
a
n
d
u
n
v
ac
cin
ated
g
r
o
u
p
s
u
s
in
g
o
d
d
s
r
atio
(
1
-
OR
×
1
0
0
)
,
9
5
%
co
n
f
id
e
n
ce
in
ter
v
al
s
(
C
I
)
d
er
iv
ed
f
r
o
m
th
e
OR
9
5
%
C
I
s
u
s
in
g
VE
l
o
wer
=
(
1
-
o
d
d
s
r
atio
u
p
p
er
C
I
)
×
1
0
0
%
a
n
d
VE
u
p
p
e
r
=
(
1
−
o
d
d
s
r
atio
lo
wer
C
I
)
×
1
0
0
%.
A
th
em
atic
an
aly
s
is
o
f
k
ey
in
f
o
r
m
an
ts
’
r
esp
o
n
s
es
on
en
v
i
r
o
n
m
e
n
tal
s
u
r
v
eillan
ce
o
f
ch
o
ler
a
was d
o
n
e
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
Resul
t
A
to
tal
of
46
ca
s
es
an
d
92
co
n
tr
o
ls
wer
e
ex
am
in
ed
f
o
r
elig
ib
ilit
y
,
in
clu
d
ed
in
th
e
s
tu
d
y
,
an
d
th
e
r
esu
lts
wer
e
an
aly
ze
d
.
Fig
u
r
e
1
p
r
esen
ts
a
f
lo
wch
a
r
t
illu
s
tr
atin
g
th
e
s
elec
tio
n
p
r
o
ce
s
s
of
ca
s
es
an
d
co
n
tr
o
ls
.
3
.
1
.
1
.
O
utbre
a
k descript
io
n by
perso
n
T
h
e
m
ajo
r
ity
o
f
s
tu
d
y
r
esp
o
n
d
en
ts
wer
e
f
em
ales
,
2
4
(
5
2
.
2
%)
ca
s
es
an
d
4
7
(
5
1
.
1
%)
co
n
tr
o
ls
(
p
=
0
.
9
0
4
)
.
T
h
e
m
aj
o
r
ity
o
f
th
e
ca
s
es
wer
e
i
n
th
e
1
0
-
2
0
y
e
ar
s
ag
e
g
r
o
u
p
,
with
a
to
tal
o
f
1
5
(
3
2
.
6
)
c
ases
an
d
2
6
(
2
9
.
2
)
co
n
tr
o
ls
(
p
=
0
.
6
0
8
)
.
T
h
e
m
ed
ian
ag
e
f
o
r
ca
s
es
was
2
6
y
ea
r
s
(
Q1
=
1
7
,
Q3
=
3
4
)
,
wh
ils
t
th
e
m
ed
ian
ag
e
o
f
co
n
tr
o
ls
was
2
8
y
ea
r
s
(
Q1
=
1
9
,
Q
3
=
3
4
)
.
On
o
cc
u
p
atio
n
,
4
3
.
5
%
o
f
th
e
ca
s
es
wer
e
n
o
t
em
p
lo
y
ed
wh
ils
t
o
n
co
n
tr
o
ls
,
4
3
.
5
%
wer
e
s
elf
-
em
p
lo
y
e
d
(
p
=
.
0
.
0
0
0
)
.
Mo
r
e
th
a
n
h
alf
(
5
2
.
2
%)
o
f
th
e
ca
s
es
h
ad
a
n
u
m
b
er
o
f
p
e
o
p
le
in
th
eir
h
o
u
s
eh
o
ld
o
f
m
o
r
e
th
an
1
0
(
p
=
0
.
0
5
1
)
an
d
5
4
.
4
%
o
f
c
o
n
tr
o
ls
h
ad
a
n
u
m
b
e
r
o
f
p
eo
p
le
in
th
eir
h
o
u
s
eh
o
ld
b
et
wee
n
5
an
d
1
0
.
Six
ty
-
th
r
ee
p
er
ce
n
t
(
6
3
.
0
%)
o
f
th
e
ca
s
es
wer
e
s
in
g
le
,
wh
ils
t
7
8
.
3
% o
f
th
e
co
n
tr
o
ls
wer
e
m
a
r
r
ied
(
p
=
0
.
0
0
0
)
.
3
.
1
.
2
.
Va
cc
ina
t
io
n sta
t
us
Mo
s
t
co
n
f
ir
m
e
d
ca
s
es
an
d
s
u
s
p
ec
ted
ca
s
es
wer
e
f
r
o
m
p
atien
ts
wh
o
wer
e
n
o
t
v
ac
cin
ated
(
9
2
%
o
f
9
8
co
n
f
ir
m
e
d
ca
s
es
an
d
9
8
%
o
f
1
2
4
3
s
u
s
p
ec
ted
ca
s
es
,
r
esp
ec
tiv
ely
)
.
T
h
is
led
to
th
e
h
y
p
o
th
e
s
is
th
at
v
ac
cin
atio
n
s
tatu
s
wa
s
a
p
r
o
tectiv
e
f
ac
to
r
ag
ain
s
t
co
n
tr
ac
tin
g
ch
o
ler
a
s
in
ce
f
ewe
r
p
eo
p
le
with
a
h
is
to
r
y
o
f
v
ac
ci
n
atio
n
wer
e
af
f
ec
ted
b
y
th
e
c
h
o
ler
a
o
u
tb
r
ea
k
,
r
eg
ar
d
less
o
f
wh
eth
er
it wa
s
o
n
e
d
o
s
e
v
ac
cin
atio
n
o
r
two
d
o
s
es.
3
.
1
.
3
.
O
utbre
a
k descript
io
n by
pla
ce
T
h
e
s
p
o
t
m
ap
o
f
th
e
o
u
t
b
r
ea
k
r
ev
ea
led
two
m
ain
ep
icen
te
r
s
,
B
u
d
ir
ir
o
an
d
Glen
v
iew.
T
h
ese
ar
ea
s
s
tan
d
o
u
t
with
clu
s
ter
s
o
f
ca
s
es
co
n
ce
n
tr
a
ted
in
th
ese
r
eg
io
n
s
.
Sp
ec
if
ically
,
B
u
d
ir
ir
o
1
,
lo
ca
ted
n
ea
r
t
h
e
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
:
1
6
3
5
-
1
6
4
6
1638
B
u
d
ir
ir
o
Po
ly
clin
ic,
an
d
Glen
v
iew
3
,
wh
ich
is
also
in
clo
s
e
p
r
o
x
im
ity
to
B
u
d
i
r
ir
o
1
,
we
r
e
id
en
tifie
d
as
th
e
m
o
s
t h
ea
v
ily
af
f
ec
te
d
ar
ea
s
as
s
h
o
wn
in
Fig
u
r
e
2
.
Fig
u
r
e
1
.
Selectio
n
o
f
ca
s
es/co
n
tr
o
ls
,
Har
ar
e
W
ester
n
Dis
tr
ict
,
2
0
2
3
Fig
u
r
e
2
.
C
h
o
ler
a
o
u
tb
r
ea
k
d
is
tr
ib
u
tio
n
o
f
co
n
f
ir
m
ed
ca
s
es,
Har
ar
e
W
ester
n
Dis
tr
ict
,
2
0
2
3
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
va
lu
a
tin
g
ch
o
lera
v
a
cc
in
e
ef
fective
n
ess
in
Ha
r
a
r
e
We
s
tern
D
is
tr
ict
a
mid
s
t a
…
(
Ma
r
y
Mu
n
a
s
h
e
Mw
a
s
h
ita
)
1639
3
.
1
.
4
.
O
utbre
a
k descript
io
n by
t
im
e
T
h
e
o
n
s
et
o
f
th
e
o
u
tb
r
ea
k
was
o
n
Ap
r
il
2
2
,
2
0
2
3
.
C
ases
g
r
ad
u
ally
in
cr
ea
s
ed
f
r
o
m
1
c
o
n
f
i
r
m
ed
ca
s
e
o
n
Ap
r
il
2
2
to
7
1
co
n
f
ir
m
ed
c
ases
b
y
Ma
y
1
5
,
2
0
2
3
,
with
a
p
ea
k
o
f
th
e
ca
s
es
o
n
Ma
y
5
(N
=
8
)
a
n
d
Ma
y
8
,
2
0
2
3
(
N
=
8
)
.
C
ases
s
tar
ted
d
ec
r
ea
s
in
g
f
r
o
m
Ma
y
16
to
J
u
ly
11,
2
0
2
3
.
As
o
f
J
u
ly
17
,
9
8
co
n
f
ir
m
ed
ca
s
es
wer
e
r
ec
o
r
d
ed
in
Har
ar
e
W
ester
n
Dis
tr
ict
,
an
d
a
to
tal
o
f
1
1
4
co
n
f
ir
m
e
d
ca
s
es
in
Har
ar
e.
On
Sep
tem
b
er
23
rd
,
2
0
2
3
,
a
n
o
th
e
r
ch
o
ler
a
o
u
tb
r
e
ak
s
tar
ted
,
an
d
ca
s
es
wer
e
d
e
tecte
d
in
Har
ar
e
W
ester
n
Dis
tr
ict
.
T
h
e
ep
id
em
ic
cu
r
v
e
p
atter
n
r
esem
b
led
a
co
n
t
in
u
o
u
s
co
m
m
o
n
s
o
u
r
ce
p
atter
n
,
as sh
o
wn
in
Fig
u
r
e
3
.
3
.
1
.
5
.
Ant
ibi
o
t
ic
s
us
ce
pti
bil
it
y
pa
t
t
er
ns
An
an
tib
io
tic
s
en
s
itiv
ity
test
was
co
n
d
u
cted
o
n
s
to
o
l
s
am
p
l
es
th
at
test
ed
p
o
s
itiv
e
f
o
r
V
ib
r
io
ch
o
lera
.
L
ab
o
r
ato
r
y
r
esu
lts
r
ev
iewe
d
t
h
at
cip
r
o
f
lo
x
ac
i
n
d
is
p
lay
ed
t
h
e
h
ig
h
est
s
u
s
ce
p
tib
ilit
y
r
ate
o
f
9
0
.
2
%
(
1
0
1
o
u
t
o
f
112
s
am
p
les)
,
f
o
llo
wed
b
y
tetr
ac
y
clin
e
,
wh
ich
also
ex
h
ib
ited
a
r
elativ
ely
h
ig
h
s
u
s
ce
p
tib
ilit
y
r
ate
o
f
8
6
.
6
% (
9
7
o
u
t
o
f
1
1
2
s
am
p
les).
On
th
e
c
o
n
tr
ar
y
,
co
tr
im
o
x
az
o
le
d
em
o
n
s
tr
ated
th
e
lo
west
s
u
s
ce
p
tib
ilit
y
r
ate
o
f
1
%
(
1
o
u
t
o
f
1
1
2
s
am
p
les).
E
ig
h
ty
o
u
t o
f
1
1
2
(
7
1
.
4
%)
o
f
t
h
e
s
to
o
l sam
p
les we
r
e
s
u
s
ce
p
tib
le
to
Azith
r
o
m
y
cin
.
3
.
1
.
6
.
E
nv
iro
nm
ent
a
l su
rv
eilla
nce
o
f
cho
lera
Fiv
e
k
ey
in
f
o
r
m
a
n
t
in
ter
v
iews
wer
e
co
n
d
u
cted
.
All
p
a
r
ticip
an
ts
r
ep
o
r
ted
th
at
th
e
y
co
n
d
u
cte
d
en
v
ir
o
n
m
en
tal
s
u
r
v
eillan
ce
,
p
r
im
ar
ily
th
r
o
u
g
h
wate
r
s
am
p
l
i
n
g
.
W
ater
s
am
p
lin
g
is
b
ein
g
d
o
n
e
r
o
u
tin
ely
f
o
r
test
in
g
wate
r
tu
r
b
id
ity
,
ch
lo
r
in
e
lev
els
,
an
d
pH
lev
els
f
o
r
m
u
n
icip
al
wate
r
.
Du
r
in
g
t
h
e
o
u
tb
r
ea
k
,
wate
r
s
am
p
lin
g
was
ca
r
r
ied
o
u
t
o
n
b
o
r
eh
o
les
,
wells,
an
d
h
o
u
s
eh
o
ld
wate
r
f
o
r
co
n
s
u
m
p
tio
n
.
On
e
p
ar
ticip
an
t
s
aid
,
“T
h
er
e
is
cu
r
r
en
tly
n
o
s
p
ec
if
ic
m
ac
h
in
e
a
v
ailab
le
f
o
r
d
ir
ec
t
test
in
g
o
f
V
ib
r
io
c
h
o
lera
e
.
H
o
wev
er
,
th
e
p
r
esen
ce
o
f
E
.
c
o
li
is
o
f
ten
ass
o
ciate
d
with
th
e
p
r
esen
ce
o
f
V
ib
r
io
ch
o
l
era
e
.
”
A
to
tal
o
f
9
2
wate
r
s
am
p
les
w
er
e
co
llected
f
r
o
m
A
p
r
il
to
J
u
l
y
2
0
2
3
,
co
m
p
r
i
s
in
g
8
9
b
o
r
eh
o
le
s
am
p
les
an
d
3
well
s
am
p
les
as
s
h
o
w
n
in
T
ab
le
1
.
Am
o
n
g
b
o
r
e
h
o
le
s
am
p
les
,
4
2
(
4
7
.
2
%)
wer
e
u
n
s
atis
f
ac
to
r
y
f
o
r
d
r
in
k
in
g
wate
r
q
u
ality
as
th
ey
co
n
tain
ed
d
etec
tab
le
to
tal
co
lifo
r
m
s
,
an
d
5
(
5
.
6
%)
wer
e
p
o
s
itiv
e
f
o
r
E
.
co
li
.
T
o
tal
co
lifo
r
m
c
o
u
n
ts
in
b
o
r
eh
o
les
r
an
g
ed
f
r
o
m
1
to
>1
0
0
c
f
u
/1
0
0
m
l.
W
ell
wate
r
s
h
o
wed
h
ig
h
er
co
n
tam
in
atio
n
,
2
o
f
3
(
6
6
.
7
%)
s
am
p
les
h
ad
d
etec
tab
le
co
lifo
r
m
s
,
an
d
1
(
3
3
.
3
%)
w
as
p
o
s
itiv
e
f
o
r
E
.
c
o
li
.
T
h
e
to
tal
co
lifo
r
m
c
o
u
n
ts
in
wells r
an
g
ed
f
r
o
m
6
1
t
o
>1
0
0
cf
u
/
1
0
0
m
l,
in
d
icatin
g
h
ea
v
y
c
o
n
ta
m
in
atio
n
.
Fig
u
r
e
3
.
E
p
id
em
ic
cu
r
v
e
f
o
r
c
h
o
ler
a
o
u
tb
r
ea
k
,
Har
ar
e
W
ester
n
Dis
tr
ict
,
2
0
2
3
T
ab
le
1.
Su
m
m
a
r
y
o
f
r
esu
lts
o
n
en
v
ir
o
n
m
en
tal
s
am
p
lin
g
o
f
wate
r
s
o
u
r
ce
s
,
Har
ar
e
city
,
2
0
2
3
W
a
t
e
r
s
o
u
r
c
e
N
o
.
s
a
mp
l
e
s
t
e
st
e
d
n
(
%) U
n
sa
t
i
sf
a
c
t
o
r
y
(
TC
C
>
0
)
n
(
%)
E.
c
o
l
i
p
o
s
i
t
i
v
e
TC
C
r
a
n
g
e
(
c
f
u
/
1
0
0
ml
)
B
o
r
e
h
o
l
e
s
89
4
2
(
4
7
.
2
)
5
(
5
.
6
)
(
1
t
o
>
1
0
0
)
W
e
l
l
s
3
2
(
6
6
.
7
)
1
(
3
3
.
3
)
(
6
1
t
o
>
1
0
0
)
W
ater
s
o
u
r
ce
s
with
u
n
s
atis
f
ac
to
r
y
t
o
tal
co
lif
o
r
m
co
u
n
t
wer
e
f
lu
s
h
ed
,
an
d
s
o
m
e
wer
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in
s
talled
with
in
lin
e
ch
lo
r
in
ato
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s
.
T
h
e
m
u
n
ic
ip
al
wate
r
h
ad
an
ad
eq
u
ate
r
esid
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ch
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r
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was
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o
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to
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s
af
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f
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d
r
in
k
in
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h
ese
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esu
lts
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elp
ed
in
id
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tify
in
g
ch
o
ler
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h
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d
g
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id
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lth
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ter
v
en
tio
n
s
.
T
h
er
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n
o
s
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s
am
p
lin
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d
test
in
g
.
Du
r
i
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g
th
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im
p
le
m
en
tatio
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f
en
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W
ater
Qu
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M
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o
r
tatio
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p
tio
n
s
an
d
f
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el
s
h
o
r
tag
es.
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
:
1
6
3
5
-
1
6
4
6
1640
3
.
1
.
7
.
Ana
ly
t
ica
l
e
pid
em
io
lo
g
y
-
B
iv
ar
iate
an
aly
s
is
o
n
d
em
o
g
r
a
p
h
ic
f
ac
to
r
s
ass
o
ciate
d
with
co
n
tr
ac
tin
g
ch
o
ler
a
Occ
u
p
atio
n
s
h
o
wed
a
s
ig
n
if
i
ca
n
t
ass
o
ciatio
n
,
with
em
p
l
o
y
ed
i
n
d
iv
id
u
als
h
av
in
g
a
lo
wer
r
is
k
o
f
co
n
tr
ac
tin
g
c
h
o
ler
a
(
OR
:
0
.
2
6
,
9
5
%
C
I
:
0
.
1
2
to
0
.
5
5
)
c
o
m
p
ar
ed
to
u
n
em
p
lo
y
ed
i
n
d
iv
i
d
u
als.
Ma
r
ital
s
tatu
s
was sig
n
if
ican
tly
ass
o
ciate
d
w
ith
co
n
tr
ac
tin
g
ch
o
ler
a,
with
m
ar
r
ied
in
d
i
v
id
u
als h
av
in
g
a
lo
wer
r
is
k
(
OR
: 0
.
3
4
,
9
5
% C
I
: 0
.
1
6
t
o
0
.
7
0
)
c
o
m
p
ar
ed
to
th
o
s
e
wh
o
wer
e
s
in
g
le
,
a
s
s
h
o
wn
in
T
ab
l
e
2
.
-
B
iv
ar
iate
an
aly
s
is
o
n
wate
r
,
s
an
itatio
n
,
an
d
h
y
g
ien
e
-
r
elate
d
f
ac
to
r
s
ass
o
ciate
d
with
co
n
tr
ac
tin
g
ch
o
ler
a.
B
iv
ar
iate
an
aly
s
is
r
ev
ea
led
s
e
v
er
al
s
ig
n
if
ican
t
ass
o
ciatio
n
s
with
f
ac
to
r
s
ass
o
ciate
d
with
c
o
n
tr
ac
tin
g
ch
o
ler
a
s
u
c
h
as
a
s
ewa
g
e
b
u
r
s
t
n
ea
r
th
eir
h
o
u
s
es
(
OR
4
.
9
9
,
9
5
%
C
I
2
.
3
1
to
1
0
.
8
0
)
,
u
s
in
g
p
it
to
ilets
(
OR
3
.
3
0
,
9
5
%
C
I
1
.
5
4
to
7
.
0
7
)
an
d
th
o
s
e
with
a
h
is
to
r
y
o
f
co
n
tact
with
a
p
o
s
itiv
e
ca
s
e
o
f
ch
o
le
r
a
(
OR
3
.
9
1
,
9
5
%
C
I
1
.
7
0
to
8
.
9
9
)
,
d
r
in
k
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n
g
b
o
r
e
h
o
le
wate
r
(
OR
3
.
7
5
,
9
5
%
C
I
1
.
5
1
to
9
.
2
7
)
an
d
ea
tin
g
f
o
o
d
s
o
ld
o
n
t
h
e
r
o
ad
(
OR
2
.
4
4
,
9
5
%
C
I
1
.
0
4
to
5
.
6
9
)
wer
e
ass
o
ciate
d
with
in
cr
ea
s
ed
o
d
d
s
o
f
g
ettin
g
in
f
ec
ted
with
ch
o
ler
a.
On
th
e
o
th
er
h
a
n
d
,
wash
in
g
h
a
n
d
s
with
s
o
ap
an
d
wate
r
(
OR
0
.
0
6
,
9
5
%
C
I
0
.
0
1
t
o
0
.
2
1
)
an
d
h
av
i
n
g
ac
ce
s
s
to
a
h
a
n
d
wash
in
g
f
ac
ilit
y
(
OR
0
.
1
7
,
9
5
%
C
I
0
.
0
8
to
0
.
3
8
)
wer
e
as
s
o
ciate
d
with
lo
wer
o
d
d
s
o
f
co
n
tr
ac
tin
g
c
h
o
ler
a.
T
h
er
e
was
a
s
ig
n
if
ica
n
t
ass
o
ciatio
n
b
etwe
en
ch
o
ler
a
v
ac
cin
a
tio
n
s
tatu
s
(
OR
=
0
.
2
8
,
9
5
%
C
I
0
.
1
3
to
0
.
6
1
)
an
d
co
n
tr
ac
tin
g
c
h
o
ler
a.
I
n
d
iv
i
d
u
a
ls
wh
o
r
ec
eiv
ed
th
e
OC
V
v
a
cc
in
atio
n
h
ad
l
o
wer
o
d
d
s
o
f
co
n
tr
ac
tin
g
c
h
o
ler
a
co
m
p
ar
ed
to
th
o
s
e
wh
o
d
id
n
o
t
r
ec
eiv
e
it.
Fu
r
th
er
m
o
r
e,
a
m
o
n
g
th
o
s
e
wh
o
r
ec
eiv
ed
th
e
v
ac
cin
e,
in
d
iv
i
d
u
als
wh
o
r
ec
eiv
e
d
two
d
o
s
es
(
OR
=0
.
2
8
,
9
5
%
C
I
0
.
1
2
to
0
.
6
6
)
h
ad
a
lo
wer
o
d
d
o
f
g
ettin
g
in
f
ec
ted
with
c
h
o
ler
a
co
m
p
ar
ed
to
th
o
s
e
wh
o
r
ec
eiv
ed
n
o
v
ac
cin
e
,
as sh
o
wn
i
n
T
a
b
le
2
.
-
Vac
cin
atio
n
e
f
f
ec
tiv
en
ess
:
Vac
cin
e
ef
f
ec
tiv
en
ess
(
VE
)
=
1
-
OR
×
100
=1
-
0
.
2
8
×
100
=
7
2
%
T
h
e
9
5
% c
o
n
f
id
en
ce
in
ter
v
al
f
o
r
VE
was d
er
iv
ed
f
r
o
m
th
e
O
R
co
n
f
id
en
ce
lim
its
(
0
.
1
3
–
0
.
6
1
)
:
VE
lo
wer
=
(
1
−
0
.
6
1
)
×1
0
0
=
3
9
% VE
u
p
p
e
r
=
(
1
−0
.
1
3
)
×
1
0
0
=
8
7
%
.
T
h
u
s
,
VE
=
7
2
% (
9
5
% C
I
: 3
9
–
8
7
%;
p
=
0
.
0
0
1
)
.
T
ab
le
2
.
B
iv
ar
iate
an
aly
s
is
f
o
r
f
ac
to
r
s
ass
o
ciate
d
with
co
n
tr
a
ctin
g
ch
o
ler
a,
Har
ar
e
W
ester
n
Dis
tr
ict
,
2
0
2
3
V
a
r
i
a
b
l
e
C
h
a
r
a
c
t
e
r
i
s
t
i
c
s
C
a
ses
N
=
4
6
(
%)
C
o
n
t
r
o
l
s
N
=
9
2
(
%)
O
d
d
s
r
a
t
i
o
CI
p
-
v
a
l
u
e
X
2
/
F
S
e
x
F
e
mal
e
2
4
(
5
2
.
2
)
4
7
(
5
1
.
1
)
1
.
0
4
0
.
5
1
-
2
.
1
2
0
.
9
0
4
M
a
l
e
2
2
(
4
7
.
8
)
4
5
(
4
8
.
9
)
R
EF
A
g
e
<
1
0
y
e
a
r
s
4
(
8
.
7
)
3
(
3
.
4
)
1
.
3
3
0
.
1
1
-
1
5
.
7
0
0
.
8
2
0
10
-
2
0
y
e
a
r
s
1
5
(
3
2
.
6
)
26
(
2
9
.
2
)
0
.
5
8
0
.
3
7
-
4
.
5
3
0
.
6
0
1
2
1
-
3
0
y
e
a
r
s
9
(
1
9
.
6
)
2
3
(
2
5
.
8
)
0
.
3
9
0
.
0
5
-
3
.
2
1
0
.
3
8
3
3
1
-
4
0
y
e
a
r
s
1
3
(
2
8
.
3
)
3
1
(
3
3
.
8
)
0
.
4
2
0
.
0
5
-
3
.
3
0
0
.
4
0
9
4
1
-
5
0
y
e
a
r
s
3
(
6
.
5
2
)
4
(
4
.
5
)
0
.
7
5
0
.
0
6
-
8
.
8
3
0
.
8
1
9
>
5
0
2
(
4
.
4
)
2
(
2
.
3
)
R
EF
O
c
c
u
p
a
t
i
o
n
Emp
l
o
y
e
d
1
5
(
3
2
.
6
)
6
0
(
6
5
.
2
)
0
.
2
6
0
.
1
2
-
0
.
5
5
<
0
.
0
0
1
U
n
e
m
p
l
o
y
e
d
3
1
(
6
7
.
4
)
3
2
(
3
4
.
8
)
R
EF
M
a
r
i
t
a
l
s
t
a
t
u
s
M
a
r
r
i
e
d
2
0
(
4
3
.
5
)
6
4
(
6
9
.
6
)
0
.
3
4
0
.
1
6
-
0
.
7
0
0
.
0
0
3
S
i
n
g
l
e
2
6
(
5
6
.
5
)
2
8
(
3
0
.
4
)
R
EF
S
e
w
a
g
e
b
u
r
s
t
1
k
m
n
e
a
r
t
h
e
i
r
h
o
u
se
Y
e
s
2
6
(
5
6
.
5
)
1
9
(
2
0
.
7
)
4
.
9
9
2
.
3
1
-
1
0
.
8
0
<
0
.
0
0
1
No
2
0
(
4
3
.
5
)
7
3
(
7
0
.
3
)
R
EF
N
a
t
u
r
e
o
f
t
o
i
l
e
t
P
i
t
t
o
i
l
e
t
2
2
(
4
7
.
8
)
2
0
(
2
1
.
7
)
3
.
3
0
1
.
5
4
-
7
.
0
7
0
.
0
0
2
S
i
t
t
o
i
l
e
t
2
4
(
5
3
.
2
)
7
2
(
7
8
.
3
)
R
EF
H
i
st
o
r
y
o
f
c
o
n
t
a
c
t
Y
e
s
1
8
(
3
9
.
1
)
1
3
(
1
4
.
1
)
3
.
9
1
1
.
7
0
-
8
.
9
9
0
.
0
0
1
No
2
8
(
6
0
.
9
)
7
9
(
8
5
.
9
)
R
EF
D
r
i
n
k
i
n
g
b
o
r
e
h
o
l
e
w
a
t
e
r
Y
e
s
3
9
(
8
4
.
8
)
5
5
(
5
9
.
8
)
3
.
7
5
1
.
5
1
-
9
.
2
7
0
.
0
0
3
No
7
(
1
5
.
2
)
3
7
(
4
0
.
2
)
R
EF
W
a
sh
i
n
g
h
a
n
d
s
w
i
t
h
s
o
a
p
a
n
d
w
a
t
e
r
Y
e
s
3
(
6
.
5
)
5
0
(
5
4
.
3
)
0
.
0
6
0
.
0
2
-
0
.
2
0
<
0
.
0
0
1
No
4
3
(
9
3
.
5
)
4
2
(
4
5
.
7
)
R
EF
H
a
n
d
w
a
s
h
i
n
g
f
a
c
i
l
i
t
y
Y
e
s
1
9
(
4
1
.
3
)
7
4
(
8
0
.
4
)
0
.
1
7
0
.
0
8
-
0
.
3
7
<
0
.
0
0
1
No
2
7
(
5
8
.
7
)
1
8
(
1
9
.
6
)
R
EF
Ea
t
i
n
g
f
o
o
d
s
o
l
d
o
n
t
h
e
r
o
a
d
Y
e
s
1
4
(
3
0
.
4
)
1
4
(
1
5
.
2
)
2
.
4
4
1
.
0
4
-
5
.
6
9
0
.
0
3
6
No
3
2
(
6
9
.
6
)
7
8
(
8
4
.
8
)
R
EF
V
a
c
c
i
n
a
t
i
o
n
a
g
a
i
n
st
c
h
o
l
e
r
a
Y
e
s
1
1
(
2
3
.
9
)
4
9
(
5
3
.
3
)
0
.
2
8
0
.
1
3
-
0
.
6
1
0
.
0
0
1
No
3
5
(
7
9
.
1
)
4
3
(
4
6
.
8
)
R
EF
D
o
ses
o
f
v
a
c
c
i
n
e
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No
4
3
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3
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4
2
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5
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6
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R
EF
N
a
t
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a
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4
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0
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6
4
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8
No
3
5
(
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6
.
1
)
4
3
(
4
6
.
7
)
R
EF
P
r
e
sen
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e
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f
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h
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n
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sh
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n
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l
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4
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0
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0
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0
0
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No
2
7
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5
8
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7
)
1
8
(
1
9
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R
EF
3
.
2
.
Dis
cus
s
io
n
3
.
2
.
1
.
Va
cc
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e
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iv
eness
T
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y
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n
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f
ec
tiv
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ess
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f
7
2
%
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5
%
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I
3
9
–
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7
;
p
<0
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0
1
)
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o
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r
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r
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id
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u
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Har
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cin
ated
in
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als
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ler
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d
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ip
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g
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ests
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eg
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en
s
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ain
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im
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u
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ity
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h
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r
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o
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u
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ed
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s
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ilit
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u
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k
s
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Fro
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r
t
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V
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k
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e
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t
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ch
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en
d
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ic
o
r
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u
t
b
r
ea
k
-
p
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n
e
ar
ea
s
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ten
tially
lo
wer
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g
d
is
ea
s
e
in
cid
en
ce
an
d
ass
o
ciate
d
h
ea
lth
c
ar
e
b
u
r
d
en
s
.
T
h
ese
f
in
d
in
g
s
a
r
e
b
r
o
ad
ly
c
o
n
s
is
ten
t
with
o
b
s
er
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atio
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s
f
r
o
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s
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n
I
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ter
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o
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ize
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ial
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ep
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ted
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m
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e
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f
icac
y
o
f
th
e
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e
at
5
y
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r
s
was
6
5
%
(
9
5
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I
5
2
–
7
4
;
p
<0
.
0
0
0
1
)
[
1
9
]
,
wh
ile
in
Haiti,
an
ex
ten
d
ed
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s
e
-
co
n
tr
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d
y
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y
Fra
n
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a
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.
[
2
0
]
f
o
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n
d
7
6
%
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f
ec
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ess
(
9
5
%
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I
5
9
–
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6
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o
v
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r
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n
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in
Har
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s
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y
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B
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V
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f
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6
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I
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9
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d
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8
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with
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1
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a
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e
n
v
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cin
ated
at
1
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s
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f
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e
[
2
1
]
.
Als
o
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B
i
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l.
[
8
]
f
o
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n
d
th
at
OC
V
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f
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tiv
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ess
r
em
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ed
s
tab
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d
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er
f
i
v
e
y
ea
r
s
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r
o
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n
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lo
w
er
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ild
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en
u
n
d
e
r
f
iv
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.
T
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m
o
r
e
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id
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g
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ild
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lect
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g
e
-
s
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if
ic
d
if
f
er
en
ce
s
i
n
im
m
u
n
e
r
e
s
p
o
n
s
e,
as
y
o
u
n
g
er
ch
ild
r
en
o
f
ten
ex
h
i
b
it
p
o
o
r
er
im
m
u
n
e
r
esp
o
n
s
es
to
ch
o
ler
a
v
ac
cin
es
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m
p
ar
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d
to
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ld
er
in
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iv
id
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als.
Ad
d
itio
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ally
,
h
ig
h
er
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p
o
s
u
r
e
t
o
ch
o
ler
a
i
n
e
n
d
em
ic
s
ettin
g
s
,
c
o
u
p
led
with
p
o
ten
tial
n
u
tr
itio
n
al
d
ef
icien
cies
an
d
u
n
d
er
ly
in
g
h
ea
lth
co
n
d
itio
n
s
,
m
ay
in
clu
d
e
d
if
f
er
e
n
ce
s
in
th
e
lev
el
o
f
ef
f
ec
tiv
en
ess
o
f
th
e
v
ac
cin
e
o
v
er
tim
e
.
W
h
ile
th
ese
f
in
d
in
g
s
p
r
o
v
id
e
s
tr
o
n
g
ev
id
e
n
ce
o
f
OC
V
ef
f
ec
tiv
en
ess
,
s
ev
er
al
lim
itatio
n
s
s
h
o
u
ld
b
e
n
o
ted
.
Mu
ltiv
ar
iate
lo
g
is
tic
r
eg
r
ess
io
n
was
u
s
ed
to
ad
ju
s
t
f
o
r
k
ey
co
n
f
o
u
n
d
er
s
,
in
clu
d
in
g
ag
e
an
d
s
ex
.
Vac
cin
atio
n
s
tatu
s
was
v
er
if
ied
u
s
in
g
ch
o
ler
a
lin
e
lis
ts
an
d
v
ac
cin
atio
n
ca
r
d
s
to
m
in
im
i
ze
m
is
class
if
icat
io
n
an
d
r
ec
all
b
ias.
L
im
ited
s
am
p
le
s
ize
p
r
ev
e
n
ted
f
u
ll
q
u
a
n
t
if
icatio
n
o
f
th
e
ef
f
ec
t
o
f
a
s
i
n
g
le
v
ac
cin
e
d
o
s
e.
Desp
ite
th
ese
m
ea
s
u
r
es,
r
esid
u
al
co
n
f
o
u
n
d
in
g
an
d
m
ea
s
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3
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s
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also
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p
lem
en
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v
estme
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t
in
wate
r
,
s
an
itatio
n
,
an
d
h
y
g
ien
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(
W
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)
in
f
r
astru
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to
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is
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ac
h
iev
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g
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ter
m
elim
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atio
n
.
Evaluation Warning : The document was created with Spire.PDF for Python.
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[
2
2
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.
Nev
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eless
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s
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[
2
3
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d
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m
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[
2
3
]
.
T
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o
r
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v
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g
at
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i
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p
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[
2
4
]
-
[
2
6
]
.
C
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3
.
2
.
3
.
Dem
o
g
ra
ph
ics,
wa
t
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,
s
a
nita
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,
a
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hy
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(
WASH
)
a
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nfr
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s
t
ruct
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T
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ch
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ab
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d
b
o
th
f
em
ales
(
5
5
.
3
%
)
an
d
m
ales
(
4
4
.
7
%)
,
es
p
ec
ially
th
e
ec
o
n
o
m
ically
ac
tiv
e
,
g
iv
en
th
e
m
ed
ian
ag
e
o
f
2
4
(
1
5
to
3
9
y
ea
r
s
o
ld
)
o
f
ca
s
es
an
d
c
o
n
tr
o
ls
.
T
h
is
is
also
th
e
s
am
e
with
f
in
d
i
n
g
s
b
y
Ma
h
a
n
ta
et
a
l.
[
2
7
]
,
wh
er
e
f
em
ale
s
wer
e
m
o
r
e
af
f
ec
ted
th
a
n
m
ales
.
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wev
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t
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co
n
tr
ad
icts
with
f
in
d
in
g
s
f
r
o
m
Go
s
wam
i
et
a
l.
[
2
8
]
,
wh
o
f
o
u
n
d
th
at
m
ales w
er
e
m
o
r
e
af
f
ec
te
d
b
y
ch
o
le
r
a
th
an
f
em
ales
.
T
h
e
v
ar
y
in
g
i
m
p
ac
t
o
f
ch
o
ler
a
o
n
m
ales
an
d
f
e
m
ales,
as
well
as
th
e
co
n
tr
asti
n
g
f
in
d
in
g
s
f
r
o
m
d
if
f
er
en
t
s
tu
d
ies,
ca
n
b
e
attr
i
b
u
ted
s
o
cio
c
u
ltu
r
al
f
ac
to
r
s
,
s
u
ch
as
g
e
n
d
er
r
o
les
wh
er
e
wo
m
en
s
p
en
d
m
o
s
t
o
f
th
eir
tim
e
at
h
o
m
e
,
m
ak
in
g
t
h
em
m
o
r
e
v
u
ln
er
a
b
le
to
th
e
im
p
ac
t
o
f
en
v
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n
m
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tal
f
ac
to
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s
s
u
ch
as
wate
r
s
o
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d
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co
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d
itio
n
s
,
wh
ich
ca
n
in
f
l
u
en
ce
tr
a
n
s
m
is
s
io
n
p
atter
n
s
[
2
9
]
.
A
s
ewa
g
e
b
u
r
s
t
n
ea
r
th
e
p
ar
ticip
an
ts
'
h
o
u
s
es
was
s
tr
o
n
g
ly
ass
o
ciate
d
with
an
in
cr
ea
s
ed
r
is
k
o
f
ch
o
ler
a
in
f
ec
tio
n
.
Du
r
in
g
th
e
2
0
1
8
o
u
tb
r
ea
k
,
th
e
d
eter
io
r
ati
n
g
s
an
itatio
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in
f
r
astru
ctu
r
e
le
d
to
is
s
u
es
s
u
ch
as
r
aw
s
ewa
g
e
f
lo
win
g
in
Har
a
r
e
.
Du
e
to
e
r
r
atic
wate
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s
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p
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ly
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p
e
o
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le
b
e
g
an
to
u
s
e
u
n
r
eg
u
lated
wells
an
d
b
o
r
eh
o
les,
lead
in
g
t
o
p
e
o
p
le
d
r
in
k
in
g
co
n
tam
in
ated
wate
r
[
2
2
]
.
T
h
is
m
ay
b
e
th
e
s
am
e
c
ase
f
o
r
th
is
ch
o
ler
a
o
u
tb
r
ea
k
.
Als
o
,
a
s
tu
d
y
i
n
Har
ar
e
b
y
Ay
lin
g
et
a
l.
[
3
0]
,
wh
e
r
e
a
g
eo
s
p
atial
an
aly
s
is
s
u
g
g
e
s
ted
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at
in
Har
ar
e,
th
e
clo
s
er
to
t
h
e
s
ewe
r
n
etwo
r
k
,
th
e
g
r
ea
ter
th
e
ass
o
ciatio
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with
in
cr
ea
s
ed
c
h
o
ler
a
r
is
k
,
f
o
r
h
o
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s
eh
o
ld
s
with
p
ip
ed
wate
r
.
T
h
is
f
in
d
in
g
h
ig
h
lig
h
ts
th
e
im
p
o
r
tan
ce
o
f
p
r
o
p
er
s
an
itatio
n
a
n
d
s
ewa
g
e
m
an
ag
em
en
t
(
p
r
o
p
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m
ain
ten
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ce
o
f
ex
is
tin
g
p
ip
es
)
in
p
r
ev
en
tin
g
th
e
s
p
r
ea
d
o
f
th
e
d
is
ea
s
e
,
an
d
ac
co
r
d
in
g
to
th
e
J
o
in
t
Mo
n
ito
r
in
g
Pro
g
r
am
o
f
th
e
W
HO
an
d
Un
ited
Natio
n
s
C
h
ild
r
en
’
s
Fu
n
d
(
UNI
C
E
F),
s
ewe
r
ed
s
an
itatio
n
s
its
at
th
e
to
p
o
f
th
e
im
p
r
o
v
ed
s
an
itatio
n
lad
d
e
r
[
3
1
]
.
Ad
d
itio
n
ally
,
u
s
in
g
p
it
to
ilets
was
ass
o
ciate
d
with
co
n
tr
ac
tin
g
c
h
o
ler
a
,
wh
ich
is
s
im
ilar
to
a
Z
am
b
ian
s
tu
d
y
b
y
Nan
za
lu
k
a
et
a
l
.
[
3
2
]
,
wh
er
e
it
was
f
o
u
n
d
th
at
u
s
in
g
p
it
latr
in
es
was
ass
o
ciate
d
with
ch
o
ler
a
co
n
tr
ac
tio
n
.
T
h
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[
3
3
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a
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[
3
3
]
.
H
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[
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RE
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[
1
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2
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