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J
P
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S)
Vo
l.
14
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No
.
4
,
Dec
em
b
er
20
25
,
p
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.
1
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I
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ia
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co
m
Repro
ductive
t
ra
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in
fect
io
ns a
mo
ng
geria
tric
po
pul
a
tion in a
blo
ck of Wes
t
Be
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a
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kno
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la
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Re
p
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Is)
a
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o
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re
m
a
in
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ted
,
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a
u
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se
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m
o
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it
y
.
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is
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to
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t
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ly
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ris
k
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e
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c
o
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b
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r
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0
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3
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m
e
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s
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d
se
p
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tely
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f
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(s).
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d
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ra
tely
p
o
sit
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c
o
rre
latio
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wa
s o
b
tain
e
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a
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d
ris
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a
v
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r.
K
ey
w
o
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d
s
:
Ger
iatr
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p
o
p
u
latio
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Kn
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wled
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R
ep
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o
d
u
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tr
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f
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R
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io
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R
is
k
f
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to
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s
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rticle
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r th
e
CC B
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se
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C
o
r
r
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s
p
o
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ing
A
uth
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r
:
Ku
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tala
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ay
Dep
ar
tm
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m
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M
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I
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s
titu
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Po
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r
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Me
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ical
E
d
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ca
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1.
I
NT
RO
D
UCT
I
O
N
R
ep
r
o
d
u
ctiv
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tr
ac
t
in
f
ec
tio
n
s
(
R
T
I
s
)
ar
e
co
n
d
itio
n
s
af
f
ec
tin
g
th
e
g
en
ital
tr
ac
t
in
b
o
th
m
en
an
d
wo
m
en
ac
r
o
s
s
all
ag
e
g
r
o
u
p
s
.
W
h
ile
s
o
m
e
R
T
I
s
ar
e
tr
an
s
m
itted
s
ex
u
ally
,
o
th
e
r
s
ar
is
e
f
r
o
m
p
o
o
r
h
y
g
ien
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p
r
ac
tices
o
r
u
n
s
af
e
m
ed
ical
p
r
o
ce
d
u
r
es
[
1
]
.
Acc
o
r
d
i
n
g
to
W
HO
esti
m
ates,
th
er
e
wer
e
3
7
4
m
illi
o
n
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ally
in
2
0
2
0
,
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n
g
1
2
9
m
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o
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o
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8
2
m
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r
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7
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1
m
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an
d
1
5
6
m
illi
o
n
o
f
tr
ich
o
m
o
n
iasi
s
[
1
]
,
[
2
]
.
C
o
m
m
u
n
ity
-
b
ased
s
tu
d
ies
f
u
r
t
h
er
s
u
g
g
est th
at
a
p
p
r
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x
im
ately
3
0
–
3
5
m
illi
o
n
n
ew
R
T
I
ca
s
e
s
o
cc
u
r
an
n
u
ally
[
2
]
.
I
n
I
n
d
ia,
ar
o
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n
d
4
0
%
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f
wo
m
en
ar
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ted
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y
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s
at
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en
tim
e,
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ly
ab
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t 1
% c
o
m
p
lete
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e
f
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ll c
o
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r
s
e
o
f
tr
ea
tm
en
t f
o
r
b
o
t
h
p
ar
tn
e
r
s
[
3
]
,
[
4
]
.
In
wo
m
e
n
,
t
h
e
ex
ce
s
s
iv
e
g
r
o
wth
o
f
en
d
o
g
en
o
u
s
m
icr
o
o
r
g
a
n
is
m
s
n
o
r
m
ally
p
r
esen
t
i
n
th
e
v
ag
in
a
ca
n
lead
to
R
T
I
s
,
s
u
ch
as
y
ea
s
t
in
f
ec
tio
n
s
an
d
b
ac
ter
ial
v
ag
in
o
s
is
[
5
]
.
Du
r
in
g
tr
a
n
s
ce
r
v
ical
p
r
o
ce
d
u
r
es,
th
ese
en
d
o
g
e
n
o
u
s
o
r
g
an
is
m
s
o
r
s
ex
u
ally
tr
an
s
m
itted
p
ath
o
g
en
s
f
r
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th
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ce
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v
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a
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to
th
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u
p
p
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g
en
ital
tr
ac
t,
r
esu
ltin
g
in
s
ev
er
e
in
f
ec
tio
n
s
[
6
]
.
I
n
th
e
Un
ited
States
,
th
e
p
r
ev
alen
ce
o
f
b
ac
te
r
ial
v
ag
in
o
s
is
am
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g
wo
m
en
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esti
m
ated
at
2
9
.
2
%,
wh
ile
n
ea
r
ly
7
5
%
o
f
ad
u
lt
wo
m
en
—
an
d
o
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all
y
m
en
—
ex
p
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v
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o
v
ag
in
al
ca
n
d
i
d
iasi
s
(
VV
C
)
at
least
o
n
ce
in
th
eir
life
tim
e.
I
n
th
e
Un
ited
Kin
g
d
o
m
,
b
ac
ter
ial
v
ag
in
o
s
is
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cc
u
r
s
at
twice
th
e
r
ate
o
f
VVC
an
d
af
f
ec
ts
ap
p
r
o
x
im
atel
y
o
n
e
-
th
ir
d
o
f
wo
m
en
at
least
o
n
ce
[
7
]
.
A
s
tu
d
y
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
2
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8
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6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
4
,
Dec
em
b
er
20
25
:
1
6
7
5
-
1
6
8
5
1676
co
n
d
u
cte
d
in
C
h
in
a
i
n
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f
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d
th
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alth
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2
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8
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o
f
p
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ts
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its
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p
to
m
s
[
8
]
,
[
9
]
.
Sy
n
d
r
o
m
ic
m
a
n
ag
em
en
t,
wh
i
ch
r
elies
o
n
id
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tify
in
g
co
n
s
is
ten
t
s
y
m
p
to
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clu
s
ter
s
an
d
r
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o
g
n
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s
ig
n
s
,
p
r
o
v
id
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ef
f
ec
tiv
e
tr
ea
t
m
en
t
ag
ain
s
t
th
e
m
ajo
r
ity
o
r
m
o
s
t
s
ev
er
e
p
ath
o
g
en
s
r
esp
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n
s
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le
f
o
r
a
s
y
n
d
r
o
m
e.
T
h
is
ap
p
r
o
ac
h
is
ap
p
licab
le
to
b
o
t
h
wo
m
en
a
n
d
m
en
[
10
]
,
[
1
1
]
.
C
u
r
ab
le
s
ex
u
ally
tr
a
n
s
m
itted
in
f
ec
tio
n
s
(
STI
s
)
—
in
clu
d
in
g
s
y
p
h
ilis
,
g
o
n
o
r
r
h
ea
,
ch
lam
y
d
ia,
an
d
tr
ic
h
o
m
o
n
iasi
s
—
ca
n
ca
u
s
e
s
er
io
u
s
co
m
p
licatio
n
s
in
p
r
eg
n
a
n
cy
,
s
u
ch
as
p
r
e
m
atu
r
e
r
u
p
tu
r
e
o
f
m
em
b
r
an
es,
p
r
eter
m
lab
o
r
,
p
r
eter
m
d
eliv
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r
y
,
ch
o
r
io
am
n
io
n
itis
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lo
w
b
ir
th
weig
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t,
co
n
g
e
n
ital
in
f
ec
tio
n
s
,
an
d
ev
en
s
till
b
ir
th
o
r
n
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o
n
atal
d
ea
th
.
Mo
r
eo
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r
ec
en
t
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s
u
g
g
ests
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at
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ac
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STI
s
m
ay
in
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r
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e
th
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is
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o
f
m
o
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to
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ch
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an
s
m
is
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o
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u
m
an
im
m
u
n
o
d
ef
icien
c
y
v
ir
u
s
(
HI
V)
[
1
2
]
,
[
1
3
]
.
R
ep
r
o
d
u
ctiv
e
tr
ac
t
in
f
ec
tio
n
s
(
R
T
I
s
)
d
ir
ec
tly
af
f
ec
t
s
ex
u
al
an
d
r
ep
r
o
d
u
ctiv
e
h
ea
lth
,
co
n
t
r
ib
u
tin
g
to
s
tig
m
atiza
tio
n
,
in
f
er
tili
ty
,
ca
n
ce
r
s
,
an
d
p
r
eg
n
a
n
cy
-
r
elate
d
c
o
m
p
licatio
n
s
[
1
3
]
.
T
h
ey
r
ep
r
esen
t
a
s
u
b
s
tan
tial
d
is
ea
s
e
b
u
r
d
en
,
ca
u
s
in
g
s
ig
n
i
f
ican
t
s
u
f
f
er
in
g
am
o
n
g
b
o
th
m
e
n
an
d
wo
m
e
n
,
in
clu
d
i
n
g
o
ld
e
r
ad
u
lts
,
with
s
er
io
u
s
co
n
s
eq
u
en
ce
s
.
Glo
b
ally
,
R
T
I
s
r
em
ain
a
m
ajo
r
h
ea
lth
,
s
o
cial,
an
d
ec
o
n
o
m
ic
ch
allen
g
e,
with
th
eir
co
m
p
licatio
n
s
r
an
k
in
g
am
o
n
g
th
e
lead
in
g
ca
u
s
es
o
f
m
o
r
b
id
ity
an
d
m
o
r
tality
,
p
ar
ticu
lar
ly
in
d
ev
elo
p
i
n
g
n
atio
n
s
.
Gr
o
win
g
atten
tio
n
h
as
b
ee
n
d
ir
ec
ted
t
o
war
d
R
T
I
s
an
d
t
h
eir
m
an
a
g
em
en
t,
as
in
f
ec
tio
n
in
o
n
e
p
ar
tn
er
in
cr
ea
s
es
th
e
lik
elih
o
o
d
o
f
HI
V
t
r
an
s
m
is
s
i
o
n
to
th
e
o
th
e
r
[
1
4
]
.
I
n
ad
d
i
tio
n
,
R
T
I
s
ac
co
u
n
t
f
o
r
a
co
n
s
id
er
ab
le
s
h
ar
e
o
f
g
y
n
ec
o
l
o
g
ical
m
o
r
b
id
ities
i
n
eld
er
ly
wo
m
en
,
wh
ich
ar
e
m
o
r
e
p
r
e
v
alen
t
th
an
r
ep
r
o
d
u
cti
v
e
o
r
co
n
tr
ac
ep
tiv
e
m
o
r
b
id
ities
an
d
c
o
n
tr
ib
u
te
s
u
b
s
tan
tially
to
o
v
er
all
d
is
ea
s
e
b
u
r
d
en
[
1
4
]
,
[
1
5
]
.
As
m
en
tio
n
ed
ea
r
lier
,
R
T
I
s
c
an
af
f
ec
t
p
e
o
p
le
o
f
all
a
g
e
g
r
o
u
p
s
,
in
clu
d
i
n
g
th
e
el
d
er
ly
[
1
6
]
.
I
n
t
h
e
g
er
iatr
ic
ag
e
g
r
o
u
p
(
≥
6
0
y
ea
r
s
o
f
a
g
e)
,
s
cr
ee
n
i
n
g
f
o
r
R
T
I
s
is
n
o
t
g
i
v
en
m
u
ch
im
p
o
r
ta
n
ce
,
a
s
m
o
r
e
em
p
h
asis
is
g
iv
en
p
r
im
ar
ily
o
n
ad
o
lescen
ts
an
d
th
o
s
e
b
el
o
n
g
in
g
to
t
h
e
r
ep
r
o
d
u
ctiv
e
ag
e
g
r
o
u
p
.
T
h
e
W
HO
g
en
er
ally
h
as
r
ep
o
r
ted
HI
V/AI
DS
r
ates
o
n
l
y
u
p
to
4
9
y
ea
r
s
o
f
a
g
e
[
1
7
]
.
So
m
e
n
atio
n
al
h
ea
lth
ag
e
n
c
ies
d
o
n
o
t
p
r
o
v
id
e
s
tr
atif
ied
R
T
I
d
ata
b
ey
o
n
d
4
5
y
ea
r
s
o
f
ag
e,
p
o
ten
tially
m
is
s
in
g
im
p
o
r
ta
n
t
v
ar
iatio
n
s
in
R
T
I
r
ates
with
in
th
e
la
s
t
th
r
ee
to
f
o
u
r
d
ec
ad
es
o
f
life
.
Ma
n
y
n
atio
n
al
s
u
r
v
e
y
s
co
n
ce
n
tr
ate
m
ain
ly
o
n
t
h
e
y
o
u
n
g
er
p
o
p
u
latio
n
s
;
h
en
ce
,
R
T
I
s
o
f
ten
g
o
u
n
n
o
ticed
in
t
h
e
g
er
iatr
ic
p
eo
p
le,
lea
v
in
g
th
e
m
u
n
d
iag
n
o
s
ed
a
n
d
u
n
tr
ea
ted
[
18]
.
Ho
wev
e
r
,
f
ew
s
tu
d
ies
h
av
e
s
h
o
wn
t
h
at
th
e
i
n
cid
en
ce
o
f
R
T
I
s
am
o
n
g
t
h
e
eld
er
ly
h
as
d
r
a
m
atica
lly
in
cr
e
ased
in
r
ec
en
t
y
ea
r
s
,
esp
ec
ially
am
o
n
g
th
o
s
e
wh
o
ar
e
wid
o
wed
an
d
d
i
v
o
r
ce
d
.
I
t
is
p
o
s
s
ib
le
th
at
o
ld
er
in
d
iv
id
u
als
h
av
e
d
if
f
er
en
t
s
u
s
ce
p
tib
ilit
y
to
R
T
I
s
th
an
th
e
ir
y
o
u
n
g
e
r
co
u
n
ter
p
ar
ts
.
Ph
y
s
i
o
lo
g
ica
l
ch
a
n
g
es
ca
n
af
f
ec
t
th
e
s
ex
u
al
r
esp
o
n
s
es
o
f
m
en
an
d
wo
m
e
n
an
d
m
a
y
i
n
h
ib
it
o
r
en
h
an
ce
s
ex
u
al
f
u
n
ct
io
n
as
p
e
o
p
le
ag
e
[
1
8
]
,
[
1
9
]
.
L
ac
k
o
f
awa
r
en
ess
,
in
ad
eq
u
ate
k
n
o
wled
g
e
,
a
n
d
n
e
g
lig
en
ce
ar
e
b
eliev
ed
to
h
av
e
l
ed
to
an
in
cr
ea
s
e
in
th
e
in
cid
e
n
ce
o
f
R
T
I
s
am
o
n
g
th
e
eld
er
ly
in
all
o
v
er
th
e
wo
r
ld
.
Diag
n
o
s
is
an
d
tr
ea
tm
en
t
o
f
th
ese
in
f
ec
tio
n
s
in
g
er
iatr
ic
p
atien
ts
v
ar
y
wh
en
co
m
p
ar
ed
to
y
o
u
n
g
er
p
atien
ts
an
d
ar
e
o
f
ten
d
if
f
icu
lt
d
u
e
to
t
h
e
ab
s
en
ce
o
f
s
p
ec
if
ic
s
y
m
p
to
m
s
an
d
lack
o
f
clea
r
clin
ical
h
is
to
r
y
[
1
9
]
.
T
h
er
e
is
n
o
t
m
u
ch
in
f
o
r
m
at
io
n
p
er
tain
in
g
t
o
v
ar
io
u
s
asp
ec
ts
o
f
R
T
I
s
in
th
e
eld
er
ly
in
I
n
d
ia.
T
h
e
k
n
o
wled
g
e
an
d
r
is
k
ass
ess
m
en
t
am
o
n
g
th
em
is
o
f
u
tm
o
s
t
p
u
b
lic
h
ea
lth
r
elev
an
ce
,
n
o
t
o
n
ly
f
o
r
tim
el
y
d
iag
n
o
s
is
an
d
m
an
ag
em
e
n
t b
u
t a
ls
o
f
o
r
im
p
lem
en
tin
g
awa
r
e
n
ess
ca
m
p
aig
n
s
an
d
p
o
licies f
o
r
th
e
b
etter
m
en
t o
f
th
e
g
er
iatr
ic
p
o
p
u
latio
n
[
1
9
]
.
W
ith
th
is
b
ac
k
g
r
o
u
n
d
,
th
e
cu
r
r
en
t
s
tu
d
y
aim
ed
at
ass
es
s
in
g
th
e
k
n
o
wled
g
e
an
d
r
is
k
b
eh
av
io
u
r
r
e
g
ar
d
in
g
R
T
I
s
am
o
n
g
th
e
g
er
iatr
ic
p
o
p
u
latio
n
r
esid
in
g
in
a
r
u
r
al
b
lo
ck
o
f
W
est
B
en
g
al.
2.
M
E
T
H
O
D
Stu
d
y
ty
p
e,
s
tu
d
y
d
esig
n
,
a
n
d
s
tu
d
y
s
ettin
g
: T
h
is
d
escr
ip
tiv
e,
co
m
m
u
n
ity
-
b
ased
cr
o
s
s
-
s
ec
ti
o
n
al
s
tu
d
y
was
co
n
d
u
cte
d
am
o
n
g
th
e
g
e
r
iatr
ic
p
o
p
u
latio
n
r
esid
in
g
in
th
e
B
u
d
g
e
B
u
d
g
e
-
I
I
b
lo
c
k
o
f
So
u
th
2
4
Par
g
an
as
d
is
tr
ict,
W
est
B
en
g
al,
I
n
d
ia.
T
h
e
s
tu
d
y
ar
ea
also
s
er
v
es
as
th
e
r
u
r
al
f
ield
p
r
ac
tice
s
ite
f
o
r
th
e
I
n
s
titu
te
o
f
Po
s
t
Gr
ad
u
ate
Me
d
ical
E
d
u
ca
tio
n
an
d
R
esear
ch
(
I
PGME
&
R
)
an
d
Seth
Su
k
h
lal
Kar
n
an
i
Me
m
o
r
ial
(
SS
KM
)
Ho
s
p
ital,
Ko
lk
ata.
Stu
d
y
d
u
r
atio
n
an
d
s
tu
d
y
p
a
r
ticip
an
ts
:
T
h
e
s
tu
d
y
was
co
n
d
u
cted
f
r
o
m
Ma
y
t
o
J
u
ly
,
2
0
2
3
(
ap
p
r
o
x
.
3
m
o
n
th
s
)
.
All
g
e
r
iatr
ic
r
esid
en
t
s
(
≥
6
0
y
ea
r
s
o
f
a
g
e)
o
f
B
u
d
g
e
B
u
d
g
e
-
I
I
b
lo
ck
we
r
e
ch
o
s
en
a
s
s
tu
d
y
p
ar
ticip
an
ts
.
T
h
e
g
e
r
iatr
ic
r
esid
en
ts
o
f
B
u
d
g
e
B
u
d
g
e
-
I
I
b
lo
c
k
,
b
elo
n
g
in
g
t
o
an
y
g
en
d
e
r
,
an
d
r
esid
in
g
in
t
h
e
b
lo
ck
f
o
r
≥
1
y
ea
r
wer
e
in
clu
d
ed
,
wh
ile
t
h
o
s
e
wh
o
wer
e
n
o
t
p
r
esen
t
at
th
ei
r
h
o
m
es
d
u
r
i
n
g
d
ata
co
llecti
o
n
,
th
o
s
e
wh
o
wer
e
s
er
io
u
s
ly
ill
,
an
d
t
h
o
s
e
wh
o
d
i
d
n
o
t g
i
v
e
in
f
o
r
m
ed
wr
itten
co
n
s
en
t to
p
ar
ticip
ate
in
t
h
e
s
tu
d
y
wer
e
ex
clu
d
ed
.
Sam
p
le
s
ize
esti
m
atio
n
an
d
s
am
p
lin
g
tech
n
iq
u
e:
T
h
e
s
am
p
le
s
ize
was
ca
lcu
lated
b
y
ap
p
ly
in
g
C
o
ch
r
an
’
s
f
o
r
m
u
la,
w
h
ich
is
-
Z
2
x
p
q
/d
2
wh
er
e
p
(
p
r
o
p
o
r
tio
n
o
f
g
er
iatr
ic
p
o
p
u
latio
n
h
av
in
g
ad
eq
u
ate
k
n
o
wled
g
e
o
f
R
T
I
s
=
5
0
% o
r
0
.
5
,
s
in
ce
th
er
e
is
d
ea
r
th
o
f
liter
atu
r
e
s
tatin
g
th
e
ad
eq
u
ac
y
o
f
k
n
o
wled
g
e
o
f
R
T
I
s
am
o
n
g
th
e
g
er
iatr
ic
ag
e
-
g
r
o
u
p
)
,
q
=
(
1
-
p
)
,
Z
(
s
tan
d
a
r
d
n
o
r
m
al
d
ev
ia
te)
=
1
.
9
8
,
d
(
ab
s
o
lu
te
p
r
ec
i
s
io
n
)
=
1
0
%.
Af
ter
m
u
ltip
ly
in
g
with
a
d
esig
n
e
f
f
e
ct
o
f
1
.
5
,
t
h
e
s
am
p
le
s
ize
b
ec
am
e
1
4
4
.
T
h
en
,
a
f
ter
co
n
s
id
er
i
n
g
1
0
%
n
o
n
-
r
esp
o
n
s
e
r
ate,
th
e
f
in
al
s
am
p
le
s
ize
o
b
tain
ed
was
1
5
8
.
Mu
ltis
tag
e
r
an
d
o
m
s
am
p
lin
g
was
em
p
lo
y
ed
to
ac
h
iev
e
th
e
f
in
al
ca
lcu
lated
s
am
p
le
s
ize.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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N:
2252
-
8
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6
R
ep
r
o
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ctive
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a
ct
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fectio
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a
mo
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ic
p
o
p
u
la
tio
n
in
a
b
lo
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f West B
en
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a
l
…
(
K
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n
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a
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)
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er
e
w
er
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4
H
ea
lt
h
a
n
d
W
ell
n
ess
C
e
n
t
r
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(
HW
C
s
)
a
t
B
u
d
g
e
B
u
d
g
e
-
I
I
b
lo
c
k
,
d
u
r
in
g
th
e
s
t
u
d
y
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I
n
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ir
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t
s
ta
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4
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e
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n
d
o
m
l
y
c
h
o
s
e
n
,
n
am
el
y
-
Mu
c
h
is
a,
C
h
a
n
d
i
p
u
r
,
D
eu
li
,
a
n
d
Do
n
g
a
r
i
a.
I
n
t
h
e
n
e
x
t
s
t
ag
e,
r
a
n
d
o
m
s
el
ec
ti
o
n
o
f
4
v
ill
ag
es
f
r
o
m
e
ac
h
o
f
t
h
e
4
HW
C
s
w
as
d
o
n
e
,
n
am
el
y
-
C
h
a
k
d
a
u
l
at
(
f
r
o
m
Mu
c
h
is
a
)
,
C
h
an
d
r
a
m
o
u
k
h
al
i
(
f
r
o
m
C
h
a
n
d
i
p
u
r
)
,
T
a
lb
e
r
ia
(
f
r
o
m
De
u
l
i)
,
an
d
Do
n
g
a
r
i
a
v
il
la
g
e
(
f
r
o
m
D
o
n
g
a
r
ia
)
.
Fin
all
y
,
f
r
o
m
ea
ch
o
f
th
e
4
s
e
lect
e
d
v
ill
ag
es,
h
o
u
s
e
h
o
l
d
s
c
o
n
ta
in
in
g
th
e
e
li
g
i
b
le
g
er
iat
r
i
c
s
u
b
je
cts
w
er
e
a
g
ai
n
r
a
n
d
o
m
l
y
s
el
ec
t
ed
.
I
f
a
n
y
h
o
u
s
eh
o
l
d
h
ad
>
1
el
ig
ib
le
p
a
r
ti
ci
p
a
n
t
,
t
h
en
a
n
y
o
n
e
o
f
t
h
e
m
was
d
r
aw
n
r
an
d
o
m
l
y
i
n
t
o
th
e
s
a
m
p
le
f
o
r
t
h
e
p
u
r
p
o
s
e
o
f
d
at
a
c
o
ll
ec
t
io
n
.
T
h
e
d
eta
il
o
f
t
h
e
s
a
m
p
li
n
g
t
ec
h
n
i
q
u
e
is
p
r
es
e
n
te
d
i
n
F
ig
u
r
e
1
.
Fig
u
r
e
1
.
Mu
ltis
tag
e
r
a
n
d
o
m
s
am
p
lin
g
f
o
r
s
elec
tio
n
o
f
s
tu
d
y
p
ar
ticip
an
ts
(
n
=
1
5
8
)
Stu
d
y
to
o
ls
an
d
s
tu
d
y
tech
n
i
q
u
e:
A
p
r
ed
esig
n
ed
,
p
r
etested
,
an
d
s
tr
u
ctu
r
e
d
s
ch
e
d
u
le
was
p
r
e
p
ar
ed
,
wh
ich
co
llected
d
ata
ac
r
o
s
s
th
e
f
o
llo
win
g
d
o
m
ai
n
s
:
i)
So
cio
d
em
o
g
r
a
p
h
ic
p
r
o
f
ile
o
f
th
e
s
tu
d
y
p
ar
ticip
a
n
ts
ii)
R
is
k
b
eh
av
io
u
r
f
o
r
R
T
I
s
.
Data
o
n
th
e
k
n
o
wled
g
e
d
o
m
ain
wer
e
co
llected
b
y
m
o
d
if
y
in
g
item
s
f
r
o
m
th
e
v
alid
ated
s
ex
u
ally
tr
an
s
m
itted
d
is
ea
s
es
-
k
n
o
wled
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e
q
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esti
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n
air
e
(
ST
D
-
KQ)
[
2
0
]
.
T
h
e
in
ter
v
iew
s
ch
ed
u
le
h
ad
a
m
ix
o
f
o
p
en
an
d
clo
s
ed
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en
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ed
,
s
in
g
le
an
d
m
u
ltip
le
-
r
esp
o
n
s
e
q
u
esti
o
n
s
,
wh
ich
was
v
alid
ated
f
o
r
i
ts
co
n
ten
t
b
y
th
r
ee
s
u
b
ject
m
atter
ex
p
er
ts
b
elo
n
g
i
n
g
to
I
PGME
&
R
an
d
SS
KM
Ho
s
p
ital
-
two
f
r
o
m
C
o
m
m
u
n
it
y
Me
d
icin
e
an
d
o
n
e
f
r
o
m
Ob
s
tetr
ics
-
Gy
n
ae
co
lo
g
y
,
f
o
llo
wed
b
y
in
co
r
p
o
r
atio
n
o
f
n
ec
ess
ar
y
ch
an
g
es
b
ef
o
r
e
p
r
etestin
g
.
Pre
test
in
g
was
d
o
n
e
o
n
1
5
g
e
r
iatr
ic
p
ati
en
ts
atten
d
in
g
th
e
out
-
p
atien
t
d
ep
ar
tm
en
t
(
OPD)
o
f
L
.
B
.
Du
tta
R
u
r
al
Ho
s
p
ital
lo
ca
ted
at
Mu
ch
is
a
v
illag
e
o
f
B
u
d
g
e
B
u
d
g
e
-
I
I
b
lo
c
k
,
wh
ich
is
th
e
R
u
r
al
Hea
lth
T
r
ain
in
g
C
en
tr
e
(
R
HT
C
)
o
f
I
PGME
&
R
an
d
SS
KM
Ho
s
p
it
al.
T
h
ese
1
5
eld
er
ly
p
ar
ticip
an
ts
wer
e
later
ex
clu
d
ed
f
r
o
m
th
e
f
in
al
s
am
p
le.
T
h
e
s
ch
ed
u
le
was
in
itially
co
n
s
tr
u
cted
in
E
n
g
lis
h
,
later
tr
a
n
s
lated
in
to
B
en
g
ali
a
n
d
Hin
d
i
lan
g
u
ag
es
b
y
r
esp
ec
tiv
e
lan
g
u
ag
e
e
x
p
er
ts
an
d
was f
in
a
lly
r
etr
an
s
lated
to
E
n
g
lis
h
to
e
n
s
u
r
e
v
alid
ity
.
T
h
e
STD
-
KQ
[
2
0
]
is
a
p
r
e
-
v
a
lid
ated
q
u
esti
o
n
n
air
e
,
wh
ich
g
iv
es
a
b
r
ief
b
u
t
c
o
m
p
r
eh
en
s
iv
e
m
ea
s
u
r
e
o
f
k
n
o
wled
g
e
ab
o
u
t
s
ex
u
ally
tr
an
s
m
itted
d
is
ea
s
es
(
STD
s
)
.
T
h
er
e
wer
e
2
7
item
s
in
th
e
s
aid
q
u
esti
o
n
n
air
e
with
o
p
tio
n
s
r
an
g
i
n
g
f
r
o
m
‘
T
r
u
e’
,
‘
Fals
e’
,
an
d
‘
Do
n
’
t
k
n
o
w’
.
E
ac
h
co
r
r
ec
t
an
s
wer
(
T
r
u
e)
was
g
iv
en
1
p
o
i
n
t,
an
d
f
o
r
b
o
th
‘
Fals
e’
an
d
‘
Do
n
’
t
k
n
o
w
’
=
0
p
o
in
ts
.
I
tem
s
f
r
o
m
th
is
q
u
esti
o
n
n
air
e
wer
e
s
lig
h
tly
m
o
d
if
ied
an
d
u
s
ed
to
f
r
am
e
q
u
esti
o
n
s
f
o
r
t
h
e
k
n
o
wl
ed
g
e
d
o
m
ai
n
.
Af
ter
th
o
r
o
u
g
h
l
y
ex
p
lain
in
g
t
h
e
p
u
r
p
o
s
e
o
f
th
e
s
tu
d
y
an
d
o
b
tai
n
in
g
wr
itten
co
n
s
en
t
f
r
o
m
th
e
s
elec
ted
s
tu
d
y
p
ar
ticip
an
ts
,
f
ac
e
-
to
-
f
ac
e
in
ter
v
iews
we
r
e
co
n
d
u
cted
u
s
in
g
th
e
s
ch
e
d
u
le.
Stu
d
y
v
a
r
iab
les:
Stu
d
y
v
ar
iab
l
es
co
m
p
r
is
ed
o
f
th
e
d
ep
en
d
en
t
an
d
in
d
e
p
en
d
e
n
t
v
a
r
iab
les.
I
n
d
ep
en
d
e
n
t
v
a
r
iab
le
was
th
e
s
o
cio
d
em
o
g
r
ap
h
ic
ch
ar
ac
ter
is
tics
o
f
th
e
s
tu
d
y
s
u
b
jects.
T
h
e
d
ep
en
d
e
n
t
v
ar
iab
les
wer
e
th
e
k
n
o
wled
g
e
an
d
r
is
k
b
e
h
av
io
u
r
f
o
r
R
T
I
s
.
Statis
t
ical
an
aly
s
is
:
Data
wer
e
tab
u
lated
in
MS
Of
f
ice
E
x
ce
l
2
0
2
1
(
Mic
r
o
s
o
f
t
C
o
r
p
,
R
ed
m
o
n
d
,
W
A,
USA)
an
d
an
aly
ze
d
u
s
in
g
th
e
Statis
tical
Pack
ag
e
f
o
r
th
e
So
cial
Scien
ce
s
(
SP
SS
)
v
er
s
io
n
2
5
.
0
.
(
I
B
M
C
o
r
p
.
,
USA)
.
C
ateg
o
r
ical
d
ata
wer
e
r
ep
r
esen
ted
as
p
r
o
p
o
r
tio
n
s
an
d
with
th
e
h
elp
o
f
s
u
itab
le
d
iag
r
am
s
.
C
o
n
tin
u
o
u
s
d
ata
wer
e
r
ep
r
esen
ted
as
m
ea
n
/m
ed
ian
an
d
o
th
er
s
u
itab
le
m
e
asu
r
es.
T
h
e
Kn
o
wled
g
e
d
o
m
ai
n
h
ad
8
item
s
,
an
d
ea
ch
item
was sco
r
ed
0
o
r
1
,
with
th
e
m
ax
im
u
m
an
d
m
in
im
u
m
s
co
r
es b
ein
g
8
an
d
0
,
r
esp
ec
tiv
ely
,
an
d
th
en
a
n
o
v
er
all
m
ed
ian
s
co
r
e
(
4
)
was c
alcu
lated
.
Kn
o
wled
g
e
was c
ateg
o
r
ized
as ‘
ad
eq
u
ate’
an
d
‘
in
ad
eq
u
ate’
b
ased
o
n
th
e
o
v
er
all
m
ed
ian
s
co
r
e;
th
o
s
e
wh
o
s
co
r
e
d
≥
4
wer
e
co
n
s
id
e
r
ed
as
h
a
v
in
g
‘
Ad
eq
u
ate
k
n
o
wled
g
e’
wh
ile
th
o
s
e
s
co
r
in
g
<4
wer
e
c
ateg
o
r
ize
d
as
h
av
in
g
‘
I
n
ad
e
q
u
ate
k
n
o
wl
ed
g
e’
.
T
h
er
e
wer
e
9
item
s
in
th
e
R
is
k
b
eh
av
io
u
r
d
o
m
ain
,
ea
ch
item
was
s
co
r
e
d
as
0
o
r
1
,
with
th
e
m
ax
im
u
m
an
d
m
i
n
im
u
m
s
co
r
es
b
ein
g
9
an
d
1
,
r
esp
ec
tiv
ely
.
T
h
e
item
s
4
-
8
in
th
e
s
ch
e
d
u
le
wer
e
r
ev
er
s
ely
s
co
r
ed
.
An
o
v
e
r
all
m
ed
ian
s
co
r
e
(
2
)
was
ca
lcu
lated
.
T
h
o
s
e
wh
o
s
co
r
ed
≥
2
wer
e
ca
teg
o
r
ized
a
s
h
av
in
g
‘
h
ig
h
’
r
is
k
b
e
h
av
io
u
r
,
an
d
f
o
r
th
o
s
e
s
co
r
in
g
<2
,
r
is
k
b
eh
av
io
u
r
was
co
n
s
id
er
ed
as
‘
lo
w’
.
Un
iv
ar
i
ate
r
eg
r
ess
io
n
an
aly
s
is
was
p
er
f
o
r
m
ed
to
ex
am
in
e
t
h
e
ass
o
ciatio
n
b
etwe
en
s
o
cio
d
em
o
g
r
ap
h
ic
c
h
ar
ac
ter
is
tics
an
d
p
ar
ticip
a
n
ts
’
k
n
o
wled
g
e
an
d
r
is
k
b
e
h
av
io
r
s
.
Var
iab
les
with
a
p
<0
.
2
in
th
e
u
n
iv
ar
iate
lo
g
is
tic
r
eg
r
ess
io
n
wer
e
co
n
s
id
er
e
d
b
io
lo
g
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p
lau
s
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d
s
u
b
s
eq
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e
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tly
in
clu
d
ed
in
t
h
e
Evaluation Warning : The document was created with Spire.PDF for Python.
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SS
N
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2
5
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8
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n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
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4
,
Dec
em
b
er
20
25
:
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6
7
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5
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u
ltiv
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r
eg
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ess
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s
m
o
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el
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itn
ess
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o
r
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h
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o
m
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h
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ltico
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ity
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in
f
latio
n
f
ac
to
r
>
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d
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1
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.
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h
e
r
el
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n
s
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ip
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k
n
o
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e
an
d
r
is
k
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eh
a
v
io
r
s
co
r
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alu
ated
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s
in
g
Sp
ea
r
m
an
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s
c
o
r
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n
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tic
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ig
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0
5
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th
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n
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ter
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er
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n
al
d
e
f
in
itio
n
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ep
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o
d
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e
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ac
t
in
f
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s
(
R
T
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s
)
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in
f
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o
f
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e
r
ep
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u
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ir
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asit
es,
d
u
e
to
u
n
h
y
g
ien
ic
p
r
ac
tices
o
r
th
r
o
u
g
h
s
ex
u
al
c
o
n
tact
[
2
1
]
.
I
n
th
is
s
tu
d
y
,
an
y
p
ar
ticip
an
t
h
av
in
g
o
n
e
o
r
m
o
r
e
o
f
th
e
f
o
llo
win
g
s
y
m
p
to
m
s
:
Pain
f
u
l
an
d
/o
r
b
u
r
n
i
n
g
m
ictu
r
iti
o
n
,
itch
in
g
in
g
r
o
in
,
ex
ce
s
s
wh
ite
d
is
ch
ar
g
e
P/
V,
lo
wer
ab
d
o
m
en
p
ai
n
,
p
u
r
u
len
t
p
en
ile/v
ag
in
al
d
is
ch
ar
g
e
(
f
o
u
l
-
s
m
ellin
g
/o
d
o
u
r
less
)
,
ab
n
o
r
m
al
p
en
ile/v
ag
i
n
al
b
lee
d
in
g
,
b
leed
in
g
af
ter
i
n
ter
co
u
r
s
e,
war
ty
lesi
o
n
s
o
n
t
h
e
g
e
n
i
tals
,
p
ain
f
u
l
s
cr
o
tal
s
wellin
g
,
d
y
s
p
ar
eu
n
ia,
wer
e
c
o
n
s
id
er
ed
as h
a
v
in
g
a
n
R
T
I
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
T
h
e
m
ea
n
ag
e
o
f
s
tu
d
y
p
a
r
ticip
an
ts
was
6
5
.
8
(
±
4
.
8
)
y
ea
r
s
.
Am
o
n
g
th
em
,
7
4
%
wer
e
f
em
ales
an
d
6
7
.
1
%
b
elo
n
g
e
d
to
L
o
wer
-
m
id
d
le
(
C
lass
I
V)
s
o
cio
ec
o
n
o
m
ic
s
tatu
s
(
as
p
er
Mo
d
if
ie
d
B
.
G.
Pra
s
ad
So
cio
ec
o
n
o
m
ic
s
tatu
s
s
ca
le,
u
p
d
ated
in
2
0
2
3
)
.
Ar
o
u
n
d
6
5
%
o
f
th
e
m
av
ailed
o
f
an
y
s
o
cial
s
ec
u
r
ity
s
ch
em
e,
th
e
m
o
s
t
co
m
m
o
n
b
ein
g
Swast
h
y
a
Saath
i
ca
r
d
(
3
2
.
6
%).
No
n
e
o
f
th
e
p
ar
ticip
an
ts
h
ad
a
p
ast
h
is
to
r
y
o
f
an
y
d
iag
n
o
s
e
d
R
T
I
,
an
d
n
o
n
e
o
f
th
eir
r
esp
ec
tiv
e
s
p
o
u
s
es
cu
r
r
e
n
tly
s
u
f
f
er
ed
f
r
o
m
a
n
y
R
T
I
.
T
ab
le
1
clea
r
ly
d
ep
icts
th
e
ab
o
v
e
-
m
en
tio
n
ed
f
in
d
i
n
g
s
.
T
ab
le
1
.
So
cio
d
em
o
g
r
ap
h
ic
c
h
ar
ac
ter
is
tics
o
f
th
e
s
tu
d
y
p
ar
tic
ip
an
ts
(n
=
1
5
8
)
S
o
c
i
o
d
e
m
o
g
r
a
p
h
i
c
p
r
o
f
i
l
e
N
u
mb
e
r
(
%)
A
g
e
o
f
t
h
e
st
u
d
y
s
u
b
j
e
c
t
s (
i
n
c
o
mp
l
e
t
e
d
y
e
a
r
s)
60
-
70
1
0
7
(
6
7
.
7
)
71
-
80
4
9
(
3
1
.
0
)
≥
8
1
2
(
1
.
3
)
G
e
n
d
e
r
M
a
l
e
4
0
(
2
5
.
3
)
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e
mal
e
1
1
8
(
7
4
.
7
)
R
e
l
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g
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o
n
H
i
n
d
u
i
sm
7
5
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sl
a
m
7
9
(
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0
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C
h
r
i
st
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a
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(
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a
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l
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a
t
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s
M
a
r
r
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e
d
8
5
(
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3
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n
marr
i
e
d
9
(
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7
)
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d
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w
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d
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w
i
d
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w
/
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i
d
o
w
e
r
)
6
4
(
4
0
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5
)
H
i
g
h
e
s
t
l
e
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o
f
e
d
u
c
a
t
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t
t
a
i
n
e
d
I
l
l
i
t
e
r
a
t
e
7
3
(
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6
.
2
)
P
r
i
mary
sc
h
o
o
l
5
3
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3
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)
M
i
d
d
l
e
sc
h
o
o
l
2
5
(
1
5
.
8
)
S
e
c
o
n
d
a
r
y
sc
h
o
o
l
a
n
d
a
b
o
v
e
7
(
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.
4
)
O
c
c
u
p
a
t
i
o
n
o
f
st
u
d
y
su
b
j
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c
t
s
U
n
e
m
p
l
o
y
e
d
0
Emp
l
o
y
e
d
4
3
(
2
7
.
2
)
H
o
mem
a
k
e
r
/
R
e
t
i
r
e
e
1
1
5
(
7
2
.
8
)
S
o
c
i
o
e
c
o
n
o
m
i
c
s
t
a
t
u
s
(
M
o
d
i
f
i
e
d
B
.
G
.
P
r
a
sa
d
S
c
a
l
e
,
u
p
d
a
t
e
d
i
n
2
0
2
3
)
C
l
a
s
s II
(
U
p
p
e
r
m
i
d
d
l
e
)
4
(
2
.
5
)
C
l
a
s
s II
I
(
M
i
d
d
l
e
)
2
4
(
1
5
.
2
)
C
l
a
s
s I
V
(
Lo
w
e
r
m
i
d
d
l
e
)
1
0
6
(
6
7
.
1
)
C
l
a
s
s V (
L
o
w
e
r
)
2
4
(
1
5
.
2
)
A
n
y
k
n
o
w
n
c
o
mo
r
b
i
d
i
t
i
e
s
o
f
st
u
d
y
su
b
j
e
c
t
Y
e
s
1
2
4
(
7
8
.
5
)
No
3
4
(
2
1
.
5
)
W
h
e
t
h
e
r
a
v
a
i
l
i
n
g
a
n
y
so
c
i
a
l
s
e
c
u
r
i
t
y
s
c
h
e
me?
Y
e
s
1
0
4
(
6
5
.
8
)
No
5
4
(
3
4
.
2
)
Xu
et
a
l.
[
7
]
r
ep
o
r
ted
th
at
in
C
h
in
a,
4
9
.
0
%
o
f
p
ar
ticip
an
ts
p
r
ac
ticed
d
aily
g
en
ital
h
y
g
ien
e
an
d
3
4
.
9
%
b
ath
ed
ea
ch
d
ay
.
I
n
ter
esti
n
g
ly
,
th
e
s
tu
d
y
f
o
u
n
d
th
at
in
d
i
v
id
u
als
wh
o
m
ain
tain
ed
less
f
r
eq
u
en
t
g
en
ital
clea
n
in
g
an
d
b
ath
i
n
g
,
a
n
d
th
o
s
e
wh
o
u
s
ed
co
n
d
o
m
s
o
r
o
r
al
co
n
tr
ac
e
p
tiv
es,
ex
h
ib
ited
a
lo
wer
p
r
ev
alen
ce
o
f
s
ex
u
ally
tr
an
s
m
itted
in
f
ec
tio
n
s
.
On
th
e
co
n
tr
ar
y
,
t
h
e
cu
r
r
e
n
t
s
tu
d
y
r
e
v
ea
led
th
at
2
9
.
4
%
an
d
2
1
.
9
%
d
id
n
o
t
clea
n
th
eir
in
tim
ate
ar
ea
s
d
u
r
in
g
b
ath
in
g
an
d
af
te
r
s
ex
u
al
in
ter
co
u
r
s
e
,
r
esp
ec
tiv
ely
,
wh
ile
th
o
s
e
eld
er
ly
p
eo
p
le
wh
o
h
a
d
an
y
k
n
o
wn
co
m
o
r
b
id
ity
an
d
d
i
d
n
o
t
av
ail
a
n
y
s
o
cial
s
ec
u
r
ity
s
ch
em
es
h
ad
h
ig
h
er
o
d
d
s
o
f
i
n
a
d
eq
u
ate
k
n
o
wled
g
e
an
d
p
r
esen
ce
o
f
r
is
k
b
eh
av
i
o
r
f
o
r
an
y
R
T
I
.
I
n
a
s
tu
d
y
co
n
d
u
cted
b
y
Po
y
n
t
en
et
a
l.
[
22
]
a
cr
o
s
s
-
s
ec
tio
n
al
clin
ic
-
b
ased
s
tu
d
y
in
So
u
th
Ko
r
ea
,
wh
ich
en
r
o
lled
1
8
0
4
m
e
n
an
d
wo
m
e
n
ag
ed
o
v
er
6
0
y
ea
r
s
,
th
er
e
was
a
v
er
y
lo
w
p
r
e
v
alen
ce
o
f
s
y
p
h
i
lis
(
4
ca
s
es,
0
.
2
%),
ch
lam
y
d
ia
(
1
4
ca
s
es,
0
.
8
%)
,
an
d
g
o
n
o
r
r
h
o
ea
(
0
ca
s
es).
W
h
ile
in
o
u
r
s
tu
d
y
,
th
er
e
wer
e
n
o
r
ep
o
r
ted
R
T
I
ca
s
es
in
th
e
last
1
2
m
o
n
t
h
s
am
o
n
g
th
e
eld
er
ly
p
ar
ticip
a
n
ts
as we
ll a
s
am
o
n
g
t
h
eir
r
esp
ec
tiv
e
s
p
o
u
s
es.
Acc
o
r
d
in
g
to
a
s
tu
d
y
d
o
n
e
b
y
Fre
em
an
an
d
An
g
lewicz
[
23
]
in
s
u
b
-
Sah
ar
an
Af
r
ica,
6
.
7
%
a
n
d
7
3
.
8
%
o
f
wo
m
en
a
n
d
m
en
ag
ed
m
o
r
e
th
an
6
5
y
ea
r
s
r
ep
o
r
ted
h
av
i
n
g
s
ex
in
th
e
last
y
ea
r
r
esp
ec
tiv
ely
,
wh
ile
m
en
'
s
av
er
ag
e
n
u
m
b
e
r
o
f
s
ex
u
al
p
a
r
tn
er
s
r
em
ain
ed
ab
o
v
e
o
n
e.
T
h
is
is
in
co
n
tr
ast to
o
u
r
s
tu
d
y
wh
i
ch
s
h
o
wed
th
at
th
e
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
R
ep
r
o
d
u
ctive
tr
a
ct
in
fectio
n
s
a
mo
n
g
g
eria
tr
ic
p
o
p
u
la
tio
n
in
a
b
lo
ck
o
f West B
en
g
a
l
…
(
K
u
n
ta
la
R
a
y
)
1679
p
ar
ticip
an
ts
th
at
o
n
ly
two
eld
er
ly
s
tu
d
y
s
u
b
jects
,
wh
o
wer
e
m
en
,
h
ad
r
ep
o
r
ted
h
av
i
n
g
m
u
l
tip
le
s
ex
p
ar
tn
er
s
in
th
e
last
1
2
m
o
n
th
s
.
T
h
u
s
,
it
ca
n
b
e
co
n
clu
d
e
d
th
at
th
e
lev
el
o
f
s
ex
u
al
ac
tiv
ity
d
ec
lin
es
s
tead
ily
at
o
ld
er
ag
es,
b
u
t a
g
ain
r
em
ain
s
co
n
s
id
er
a
b
l
e,
p
ar
ticu
lar
ly
f
o
r
m
en
.
I
n
th
is
s
tu
d
y
,
8
5
%
o
f
s
tu
d
y
s
u
b
jects
h
ad
h
ea
r
d
a
b
o
u
t
R
T
I
s
,
an
d
am
o
n
g
t
h
em
,
t
h
e
m
o
s
t
co
m
m
o
n
s
o
u
r
ce
s
o
f
in
f
o
r
m
atio
n
wer
e
f
a
m
ily
a
n
d
n
ei
g
h
b
o
r
s
(
7
0
%),
f
o
ll
o
wed
b
y
s
o
cial
m
e
d
ia
(
1
5
%).
Am
o
n
g
th
o
s
e
wh
o
k
n
ew
ab
o
u
t
th
e
r
is
k
f
ac
to
r
s
f
o
r
R
T
I
s
,
th
e
m
o
s
t
co
m
m
o
n
r
esp
o
n
s
es
wer
e
n
o
t
b
ath
in
g
r
eg
u
lar
ly
(
5
6
%)
an
d
h
a
v
in
g
u
n
p
r
o
tecte
d
co
itu
s
(
3
2
%).
Up
o
n
ask
in
g
wh
eth
er
R
T
I
s
ar
e
p
r
e
v
en
tab
le
o
r
n
o
t,
3
%
r
esp
o
n
d
ed
as
‘
No
’
wh
ile
1
1
%
as
‘
Do
n
’
t
k
n
o
w’
.
On
ly
3
(
~
2
%)
o
f
th
e
s
tu
d
y
s
u
b
jects
co
u
ld
n
am
e
HI
V/AI
DS
as
an
STD.
No
n
e
o
f
th
em
k
n
ew
ab
o
u
t
a
n
y
a
v
ailab
le
s
cr
ee
n
i
n
g
an
d
/o
r
tr
ea
tm
e
n
t
s
er
v
ices
f
o
r
R
T
I
s
in
th
eir
r
esid
en
tial
b
l
o
c
k
o
r
d
is
tr
ict.
I
t
was
r
ev
ea
led
th
at
3
0
.
4
% p
a
r
ticip
an
ts
h
ad
‘
in
ad
e
q
u
ate
k
n
o
wled
g
e’
r
eg
ar
d
i
n
g
R
T
I
s
as illu
s
tr
ated
in
Fig
u
r
e
2
.
Alm
o
s
t
2
2
%
o
f
t
h
e
s
t
u
d
y
p
ar
t
ici
p
a
n
ts
h
ad
s
e
x
u
al
i
n
te
r
c
o
u
r
s
e
i
n
t
h
e
l
ast
1
m
o
n
th
(
p
r
i
o
r
t
o
t
h
e
d
at
a
co
l
le
cti
o
n
p
e
r
i
o
d
)
,
o
u
t
o
f
w
h
i
c
h
o
n
l
y
3
.
2
%
h
ad
u
s
e
d
m
al
e
c
o
n
d
o
m
s
.
2
(
1
.
3
%
)
o
f
t
h
e
s
tu
d
y
s
u
b
je
cts
g
av
e
a
h
is
t
o
r
y
o
f
h
a
v
i
n
g
m
u
lti
p
l
e
s
e
x
p
ar
tn
er
s
in
t
h
e
las
t
1
y
e
a
r
.
7
0
.
3
%
,
8
4
.
8
%
a
n
d
7
7
.
8
%
p
a
r
ti
ci
p
a
n
ts
r
ep
o
r
te
d
l
y
d
id
n
o
t
c
lea
n
th
e
ir
i
n
ti
m
at
e
a
r
e
as
d
u
r
i
n
g
b
a
th
in
g
,
a
f
te
r
m
ic
tu
r
i
ti
o
n
,
an
d
af
te
r
co
i
tu
s
,
r
es
p
e
cti
v
el
y
.
No
n
e
o
f
t
h
em
h
a
d
an
y
h
is
to
r
y
o
f
i
n
j
ec
t
a
b
le
d
r
u
g
u
s
ag
e.
T
h
e
m
aj
o
r
it
y
(
7
7
%)
o
f
t
h
e
p
a
r
ti
ci
p
an
ts
h
a
d
‘
h
i
g
h
r
is
k
’
b
eh
av
io
r
f
o
r
R
T
I
s
.
F
ig
u
r
e
3
is
a
p
ie
d
i
a
g
r
am
th
at
s
h
o
ws
2
5
%
o
f
t
h
e
p
ar
t
ici
p
an
ts
h
ad
‘
h
i
g
h
r
is
k
’
b
e
h
a
v
i
o
r
f
o
r
R
T
I
s
.
1
6
(
4
.
4
%)
s
tu
d
y
s
u
b
jects h
a
d
s
ig
n
s
an
d
s
y
m
p
to
m
s
o
f
R
T
I
s
f
o
r
th
e
last
1
y
ea
r
,
o
u
t
o
f
wh
ich
th
e
m
o
s
t
co
m
m
o
n
ly
r
ep
o
r
ted
was
b
u
r
n
in
g
,
p
ain
f
u
l
m
ictu
r
itio
n
.
Fig
u
r
e
4
th
o
r
o
u
g
h
ly
d
ep
icts
th
ese
f
in
d
in
g
s
.
Fig
u
r
e
2
.
Pie c
h
a
r
t illu
s
tr
atin
g
th
e
d
is
tr
ib
u
tio
n
o
f
p
ar
ticip
an
ts
b
ased
o
n
th
eir
k
n
o
wled
g
e
o
f
R
T
I
s
(
n
=
1
5
8
)
Fig
u
r
e
3
.
Pie c
h
a
r
t illu
s
tr
atin
g
th
e
d
is
tr
ib
u
tio
n
o
f
p
ar
ticip
an
ts
b
ased
o
n
th
eir
r
is
k
b
eh
av
io
r
s
r
elate
d
to
R
T
I
s
(
n
=
1
5
8
)
Fig
u
r
e
4
.
Ho
r
izo
n
tal
b
a
r
ch
ar
t
d
ep
ictin
g
th
e
d
is
tr
ib
u
tio
n
o
f
s
tu
d
y
p
a
r
ticip
an
ts
b
y
c
u
r
r
e
n
tly
r
ep
o
r
ted
R
T
I
s
y
m
p
to
m
s
(
n
₃
=
1
6
)
I
n
a
s
tu
d
y
c
o
n
d
u
cted
b
y
R
elh
an
et
a
l.
[
24
]
in
New
Delh
i,
w
h
ich
r
ec
r
u
ited
1
2
3
g
er
iatr
ic
s
u
b
jects,
th
e
m
o
s
t
co
m
m
o
n
ag
e
g
r
o
u
p
o
f
p
ar
ticip
an
ts
was
6
0
-
6
5
y
ea
r
s
.
5
p
atien
ts
g
av
e
a
h
is
to
r
y
o
f
i
n
jectio
n
d
r
u
g
u
s
e
,
an
d
2
.
4
%
p
atien
ts
g
av
e
a
h
is
to
r
y
o
f
h
o
m
o
s
ex
u
al
co
n
tact.
T
h
e
m
o
s
t
co
m
m
o
n
co
m
p
lain
t
was
a
h
is
to
r
y
o
f
u
lce
r
s
o
v
e
r
th
e
g
en
italia
in
2
8
.
4
%
(
3
5
)
o
f
ca
s
es
,
an
d
n
o
n
e
o
f
th
e
p
atien
ts
wer
e
f
o
u
n
d
to
b
e
HI
V
p
o
s
itiv
e.
On
th
e
o
th
er
h
an
d
,
o
u
r
s
tu
d
y
r
ec
r
u
ited
1
5
8
g
er
ia
tr
ic
p
eo
p
le
,
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d
th
e
m
ea
n
ag
e
was
6
5
y
ea
r
s
.
T
h
e
m
o
s
t
co
m
m
o
n
l
y
r
ep
o
r
ted
s
y
m
p
to
m
was
b
u
r
n
in
g
m
ictu
r
itio
n
,
f
o
llo
wed
b
y
v
a
g
in
al
d
is
ch
ar
g
e.
Ho
wev
er
,
n
o
n
e
o
f
th
e
m
h
ad
a
h
is
to
r
y
o
f
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n
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u
r
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en
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y
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ly
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ltip
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at
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ity
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lin
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tead
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at
o
ld
er
ag
es,
b
u
t
a
g
ain
r
em
ain
s
co
n
s
id
er
ab
le,
p
ar
ticu
l
ar
ly
f
o
r
m
en
.
A
h
ig
h
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cid
en
ce
o
f
u
n
s
af
e
s
e
x
u
al
p
r
ac
tices
am
o
n
g
th
e
eld
e
r
ly
,
s
u
ch
as
a
d
ec
r
ea
s
ed
r
ate
o
f
co
n
d
o
m
u
s
ag
e,
co
n
tact
with
m
ale/f
e
m
ale
s
ex
wo
r
k
er
s
,
r
ec
r
ea
tio
n
al
d
r
u
g
u
s
e,
an
d
m
u
ltip
le
s
ex
u
al
p
ar
t
n
er
s
,
was
o
b
s
er
v
ed
,
an
d
s
u
ch
b
e
h
av
io
r
s
m
a
y
b
e
att
r
ib
u
ted
to
th
e
f
ac
t
th
at
th
e
g
e
r
iatr
ic
p
o
p
u
latio
n
d
o
es
n
o
t
p
er
c
eiv
e
th
em
s
elv
es
as
b
ein
g
s
u
s
ce
p
tib
le
to
th
e
ac
q
u
i
s
itio
n
o
f
STDs
[2
5
]
.
C
o
n
tact
with
a
r
eg
u
la
r
p
a
r
tn
er
,
m
en
o
p
au
s
e,
an
d
s
u
b
s
eq
u
en
t
in
f
er
tili
ty
also
co
n
tr
ib
u
te
to
r
e
d
u
ce
d
co
n
d
o
m
u
s
ag
e
[2
5
],
[2
6
]
.
T
h
e
eld
er
ly
in
g
en
e
r
al
ar
e
n
o
t
co
n
s
id
er
ed
at
r
is
k
f
o
r
ac
q
u
ir
in
g
R
T
I
s
,
lead
in
g
to
a
d
elay
in
d
iag
n
o
s
is
an
d
m
an
a
g
em
en
t
[2
6
]
.
R
T
I
s
ar
e
th
e
ca
u
s
e
o
f
s
ev
er
e
g
y
n
ae
co
lo
g
ical
an
d
m
ater
n
al
m
o
r
b
id
ity
in
I
n
d
ia,
ac
co
r
d
in
g
to
a
s
tu
d
y
b
y
T
h
o
m
as
an
d
Nar
ay
a
n
[
27
]
.
In
m
ar
g
in
alize
d
c
o
m
m
u
n
ities
,
wo
m
en
p
er
s
ev
e
r
e
q
u
ietly
wh
en
f
a
ce
d
with
a
c
u
ltu
r
ally
s
en
s
itiv
e
h
ea
lth
is
s
u
e
s
u
ch
as
an
R
T
I
.
An
ex
p
l
o
r
ato
r
y
s
tu
d
y
in
a
co
astal
f
is
h
er
m
en
c
o
m
m
u
n
ity
in
So
u
th
I
n
d
ia
was
co
n
d
u
cted
.
Pu
b
lic
h
ea
lth
p
r
ac
titi
o
n
er
s
an
d
s
o
cial
wo
r
k
e
r
s
s
h
o
u
ld
d
elv
e
in
to
r
ec
o
m
m
e
n
d
atio
n
s
r
elev
a
n
t
to
ad
d
r
ess
in
g
h
ea
lth
is
s
u
es
in
m
ar
g
in
alize
d
co
m
m
u
n
ities
.
An
o
th
er
s
tu
d
y
d
o
n
e
b
y
Z
en
g
et
a
l.
[
28
]
r
ev
ea
led
th
a
t
C
h
la
myd
ia
in
f
ec
tio
n
r
ate
was
th
e
h
ig
h
est
in
p
eo
p
le
u
n
d
er
2
0
y
ea
r
s
o
ld
,
an
d
th
e
in
f
ec
tio
n
s
h
o
wed
a
ten
d
en
cy
to
war
d
y
o
u
n
g
in
d
iv
id
u
als.
T
h
e
cu
r
r
en
t stu
d
y
r
ev
ea
led
th
at
2
9
.
4
% a
n
d
2
1
.
9
% d
id
n
o
t c
lean
th
eir
in
tim
ate
ar
ea
s
d
u
r
in
g
b
ath
i
n
g
an
d
af
ter
s
ex
u
al
in
ter
co
u
r
s
e
,
r
esp
ec
tiv
el
y
,
wh
ile
th
o
s
e
eld
er
l
y
p
eo
p
le
wh
o
h
ad
a
n
y
k
n
o
wn
co
m
o
r
b
i
d
ity
an
d
d
id
n
o
t
a
v
ail
an
y
s
o
cial
s
ec
u
r
ity
s
ch
em
es
h
ad
h
i
g
h
er
o
d
d
s
o
f
in
a
d
eq
u
ate
k
n
o
wled
g
e
an
d
p
r
esen
ce
o
f
r
is
k
b
eh
a
v
io
r
f
o
r
an
y
R
T
I
.
T
h
er
e
f
o
r
e,
th
e
p
u
b
licity
o
f
s
ex
u
al
h
ea
lth
k
n
o
wled
g
e
m
u
s
t
b
e
s
tr
en
g
th
en
ed
,
an
d
th
e
p
r
e
v
en
t
io
n
an
d
tr
ea
tm
e
n
t
o
f
v
en
er
ea
l
d
is
ea
s
es
am
o
n
g
y
o
u
n
g
an
d
m
id
d
le
-
ag
ed
p
e
o
p
le
m
u
s
t b
e
im
p
r
o
v
ed
.
Kaid
a
et
a
l.
[
29
]
r
ep
o
r
ted
a
h
i
g
h
p
r
e
v
alen
ce
o
f
asy
m
p
to
m
ati
c
R
T
I
s
an
d
n
o
ted
th
at
th
e
l
o
w
s
en
s
itiv
ity
o
f
s
y
m
p
t
o
m
-
b
ased
r
ep
o
r
tin
g
li
m
its
th
e
ef
f
ec
tiv
en
ess
o
f
s
y
n
d
r
o
m
ic
R
T
I
m
a
n
ag
em
en
t
,
th
er
e
b
y
wea
k
e
n
in
g
HI
V
p
r
ev
en
tio
n
s
tr
ateg
ies
am
o
n
g
y
o
u
n
g
p
eo
p
le.
T
h
is
ap
p
r
o
ac
h
f
a
ils
to
ad
e
q
u
ately
a
d
d
r
ess
th
e
s
ex
u
al
h
ea
lth
n
ee
d
s
o
f
y
o
u
th
,
h
ig
h
lig
h
tin
g
th
e
n
ee
d
f
o
r
p
o
licy
r
ef
o
r
m
s
th
at
in
c
o
r
p
o
r
ate
ad
v
an
ce
d
d
iag
n
o
s
tic
in
n
o
v
atio
n
s
f
o
r
g
en
ital
tr
ac
t
in
f
ec
tio
n
s
(
GT
I
s
)
to
r
ed
u
ce
R
T
I
s
an
d
HI
V
-
r
elate
d
r
is
k
s
.
Similar
ly
,
s
tu
d
ies
b
y
Ma
n
jate
et
a
l.
[
30
]
an
d
Z
h
o
u
et
a
l.
[
31
]
i
d
en
tifie
d
a
h
ig
h
p
r
ev
alen
ce
o
f
ch
lam
y
d
ia
,
tr
ich
o
m
o
n
iasi
s
,
an
d
HI
V
-
1
/
2
am
o
n
g
w
o
m
en
o
f
r
ep
r
o
d
u
ctiv
e
ag
e
p
r
esen
tin
g
with
u
r
o
g
en
ital
co
m
p
lain
ts
.
Sy
n
d
r
o
m
ic
m
a
n
ag
em
e
n
t
o
f
v
ag
in
al
d
is
ch
ar
g
e
d
em
o
n
s
tr
ated
p
o
o
r
d
iag
n
o
s
tic
ac
cu
r
ac
y
,
p
a
r
ticu
lar
ly
lo
w
s
p
ec
if
icity
,
l
ea
d
in
g
to
u
n
d
er
-
t
r
e
atm
en
t
o
f
tr
u
e
R
T
I
ca
s
es
an
d
u
n
n
ec
ess
ar
y
tr
ea
tm
en
t
o
f
wo
m
en
wh
o
test
ed
n
eg
ativ
e
f
o
r
n
o
n
-
v
ir
al
STI
s
.
I
n
So
n
g
jian
g
,
Sh
an
g
h
ai,
Ur
ea
p
lasma
in
f
ec
tio
n
was
f
o
u
n
d
to
b
e
co
m
m
o
n
am
o
n
g
m
e
n
o
f
r
ep
r
o
d
u
ctiv
e
ag
e,
wh
er
ea
s
HPV
p
r
ev
alen
ce
was
r
elativ
ely
lo
w.
E
n
h
an
ce
d
s
cr
ee
n
in
g
is
r
ec
o
m
m
en
d
e
d
f
o
r
m
e
n
in
th
is
ag
e
g
r
o
u
p
,
p
a
r
ticu
lar
ly
s
m
o
k
er
s
an
d
t
h
o
s
e
with
lo
wer
ed
u
ca
tio
n
al
attain
m
en
t
.
T
h
e
c
u
r
r
e
n
t
s
tu
d
y
r
ev
e
aled
th
at
2
9
.
4
%
an
d
2
1
.
9
%
d
id
n
o
t
clea
n
th
eir
in
tim
ate
ar
ea
s
d
u
r
in
g
b
ath
in
g
an
d
af
te
r
s
ex
u
al
in
ter
co
u
r
s
e
,
r
esp
ec
tiv
ely
,
wh
ile
th
o
s
e
eld
er
ly
p
eo
p
le
wh
o
h
a
d
an
y
k
n
o
wn
co
m
o
r
b
id
ity
an
d
d
i
d
n
o
t
av
ail
a
n
y
s
o
cial
s
ec
u
r
ity
s
ch
em
es
h
ad
h
ig
h
er
o
d
d
s
o
f
i
n
a
d
eq
u
ate
k
n
o
wled
g
e
an
d
p
r
esen
ce
o
f
r
is
k
b
eh
av
i
o
r
f
o
r
an
y
R
T
I
.
I
n
a
s
tu
d
y
d
o
n
e
b
y
Z
h
an
g
et
a
l.
[
32
]
,
4
7
%
o
f
wo
m
en
h
ad
l
o
wer
g
en
ital
tr
ac
t
in
f
ec
tio
n
s
(
L
GT
I
s
)
.
UU
was
th
e
m
o
s
t
co
m
m
o
n
in
f
ec
tio
n
(
3
5
.
5
%),
f
o
llo
wed
b
y
b
a
cter
ial
v
ag
in
o
s
is
(
B
V)
(
1
0
.
5
%),
y
ea
s
t
in
f
ec
tio
n
(
3
.
7
%)
,
C
T
(
2
.
2
%),
an
d
T
r
ic
h
o
m
o
n
as
v
ag
in
alis
(
1
.
7
%).
B
V
was
as
s
o
ci
ated
with
an
in
cr
ea
s
ed
r
is
k
o
f
HR
-
HPV.
An
o
th
er
s
tu
d
y
d
o
n
e
b
y
J
u
n
g
an
d
B
r
u
b
ak
er
[
33
]
in
p
o
s
tm
en
o
p
au
s
al
wo
m
en
with
f
r
eq
u
e
n
t
R
T
I
,
th
e
d
iag
n
o
s
is
o
f
ac
u
te
R
T
I
s
h
o
u
ld
b
e
m
ad
e
u
s
in
g
a
co
m
b
in
atio
n
o
f
th
e
s
y
m
p
to
m
ass
ess
m
en
t
an
d
u
r
in
e
d
iag
n
o
s
tic
s
tu
d
ies.
T
h
e
cu
r
r
en
t
s
tu
d
y
r
ev
e
aled
th
at
2
9
.
4
%
a
n
d
2
1
.
9
%
d
id
n
o
t
clea
n
th
eir
in
tim
ate
ar
ea
s
d
u
r
in
g
b
at
h
in
g
an
d
af
ter
s
ex
u
al
in
ter
co
u
r
s
e
,
r
esp
ec
tiv
ely
,
wh
il
e
th
o
s
e
eld
er
l
y
p
e
o
p
le
wh
o
h
a
d
an
y
k
n
o
wn
c
o
m
o
r
b
id
ity
a
n
d
d
id
n
o
t
a
v
ail
an
y
s
o
cial
s
ec
u
r
ity
s
ch
em
es
h
ad
h
i
g
h
er
o
d
d
s
o
f
in
ad
e
q
u
ate
k
n
o
w
led
g
e
an
d
p
r
esen
ce
o
f
r
is
k
b
eh
av
io
r
f
o
r
an
y
R
T
I
.
T
h
e
ch
o
ice
o
f
R
T
I
an
tib
io
tic
s
h
o
u
ld
i
n
clu
d
e
c
o
n
s
id
er
ati
o
n
o
f
ef
f
icac
y
,
c
o
llater
al
ef
f
ec
ts
,
an
d
s
id
e
ef
f
ec
ts
.
I
n
th
e
cu
r
r
e
n
t
s
tu
d
y
,
T
a
b
le
2
s
h
o
ws
B
in
ar
y
L
o
g
is
tic
R
eg
r
e
s
s
io
n
an
aly
s
es
th
at
r
ev
ea
led
p
ar
ticip
an
ts
wh
o
wer
e
m
ar
r
ie
d
(
aOR
=
4
.
1
1
,
9
5
%
C
I
,
1
.
9
5
-
7
.
6
5
;
p
<0
.
0
0
1
)
,
em
p
lo
y
e
d
(
aOR
=
7
.
5
5
,
9
5
%
C
I
,
3
.
4
6
-
1
0
.
4
5
;
p
<0
.
0
0
1
)
,
h
ad
n
o
k
n
o
w
n
co
m
o
r
b
id
ities
(
aOR
=
2
.
1
9
,
9
5
%
C
I
,
1
.
0
2
-
7
.
3
2
;
p
<0
.
0
0
1
)
an
d
d
i
d
n
o
t
av
ail
an
y
s
o
cial
s
ec
u
r
ity
s
ch
em
e
(
aOR
=
5
.
1
8
,
9
5
%
C
I
,
2
.
5
0
-
8
.
2
2
;
p
<0
.
0
0
1
)
,
h
ad
s
tatis
tically
s
ig
n
if
ican
t
h
ig
h
er
o
d
d
s
o
f
in
ad
eq
u
ate
k
n
o
wled
g
e
o
n
R
T
I
s
,
as
co
m
p
ar
ed
to
th
o
s
e
wh
o
w
er
e
u
n
m
ar
r
ie
d
/
d
iv
o
r
c
ed
,
u
n
em
p
lo
y
ed
/r
etir
e
d
,
h
ad
k
n
o
wn
co
m
o
r
b
i
d
ities
an
d
av
ailed
an
y
s
o
cial
s
ec
u
r
ity
s
ch
em
e
r
esp
ec
tiv
ely
.
Om
n
ib
u
s
T
est
o
f
m
o
d
el
co
ef
f
icien
ts
was
s
ig
n
if
ican
t
(
p
<0
.
0
0
1
)
,
a
n
d
Ho
s
m
er
-
L
em
esh
o
w
g
o
o
d
n
ess
o
f
f
it
test
wa
s
n
o
t
s
ig
n
if
ican
t
(
p
=0
.
9
3
6
)
,
s
u
g
g
esti
n
g
a
g
o
o
d
f
it o
f
th
e
m
o
d
el.
T
ab
le
3
s
h
o
ws
m
u
ltiv
ar
iab
l
e
b
in
ar
y
lo
g
is
tic
r
eg
r
ess
io
n
an
aly
s
is
,
wh
ich
r
ev
ea
led
t
h
at
f
em
ale
p
ar
ticip
an
ts
,
(
aOR
=
2
.
3
5
,
9
5
%
C
I
,
1
.
0
5
-
5
.
2
1
;
p
=
0
.
0
3
6
)
e
m
p
lo
y
ed
(
aOR
=
3
.
8
8
,
9
5
%
C
I
,
1
.
7
6
-
6
.
5
2
;
p
=
0
.
0
0
1
)
an
d
th
o
s
e
wh
o
d
id
n
o
t
av
ail
an
y
s
o
cial
s
ec
u
r
ity
s
ch
em
e
(
a
OR
=
2
.
0
5
,
9
5
%
C
I
,
1
.
2
2
-
5
.
4
3
;
p
=
0
.
0
4
3
)
,
h
ad
s
tatis
t
ically
s
ig
n
if
ican
t h
ig
h
er
o
d
d
s
o
f
th
e
p
r
esen
ce
o
f
h
ig
h
-
r
is
k
b
eh
av
i
o
u
r
f
o
r
R
T
I
s
,
as c
o
m
p
ar
ed
t
o
th
o
s
e
wh
o
wer
e
m
ales,
u
n
em
p
lo
y
e
d
/r
etir
ed
,
an
d
th
o
s
e
wh
o
a
v
ailed
o
f
s
o
cial
s
ec
u
r
ity
s
ch
em
es
r
esp
ec
tiv
ely
.
Om
n
ib
u
s
T
est
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
R
ep
r
o
d
u
ctive
tr
a
ct
in
fectio
n
s
a
mo
n
g
g
eria
tr
ic
p
o
p
u
la
tio
n
in
a
b
lo
ck
o
f West B
en
g
a
l
…
(
K
u
n
ta
la
R
a
y
)
1681
o
f
Mo
d
el
c
o
ef
f
icien
ts
was
s
ig
n
if
ican
t
(
p
<
0
.
0
0
1
)
,
an
d
H
o
s
m
er
-
L
em
esh
o
w
g
o
o
d
n
ess
o
f
f
it
test
was
n
o
t
s
ig
n
if
ican
t
(
p
=
0
.
9
9
4
)
,
s
u
g
g
esti
n
g
a
g
o
o
d
f
it
o
f
th
e
m
o
d
el.
Sp
ea
r
m
an
’
s
r
an
k
co
r
r
e
latio
n
test
r
ev
ea
le
d
‘
m
o
d
er
ately
p
o
s
itiv
e
c
o
r
r
elati
o
n
’
(
Sp
ea
r
m
an
’
s
r
h
o
v
alu
e
=
+0
.
3
3
;
2
-
tailed
)
b
etwe
en
t
h
e
k
n
o
wled
g
e
an
d
r
is
k
b
eh
av
io
u
r
s
co
r
es,
as illu
s
tr
ated
in
Fig
u
r
e
5
.
T
ab
le
2
.
Mu
ltiv
ar
ia
b
le
b
in
ar
y
lo
g
is
tic
r
eg
r
ess
io
n
an
aly
s
is
o
f
th
e
ass
o
ciatio
n
b
etwe
en
p
ar
tic
ip
an
ts
’
s
o
cio
d
em
o
g
r
ap
h
ic
c
h
ar
ac
ter
is
tics
an
d
th
eir
k
n
o
wled
g
e
o
f
R
T
I
s
(
n
=
1
5
8
)
S
l
.
N
o
.
S
o
c
i
o
d
e
m
o
g
r
a
p
h
i
c
c
h
a
r
a
c
t
e
r
i
st
i
c
s
I
n
a
d
e
q
u
a
t
e
k
n
o
w
l
e
d
g
e
o
n
R
TI
s (n
1
=
4
8
)
N
u
mb
e
r
(
%)
a
O
R
(
9
5
%
C
I
)
p
-
v
a
l
u
e
1.
O
c
c
u
p
a
t
i
o
n
o
f
t
h
e
st
u
d
y
su
b
j
e
c
t
Emp
l
o
y
e
d
9
4
(
8
5
.
5
)
7
.
5
5
(
3
.
4
6
-
1
0
.
4
5
)
<
0
.
0
0
1
U
n
e
m
p
l
o
y
e
d
a
n
d
o
t
h
e
r
s
(
H
o
mema
k
e
r
s
,
r
e
t
i
r
e
e
s)
1
6
(
1
4
.
5
)
R
e
f
.
2.
G
e
n
d
e
r
o
f
t
h
e
st
u
d
y
su
b
j
e
c
t
F
e
mal
e
1
1
8
(
7
4
.
6
)
1
.
6
1
(
0
.
8
8
-
9
.
4
1
)
0
.
7
4
7
M
a
l
e
4
0
(
2
5
.
4
)
R
e
f
.
3.
M
a
r
i
t
a
l
s
t
a
t
u
s
M
a
r
r
i
e
d
7
0
(
6
3
.
6
)
4
.
1
1
(
1
.
9
5
-
7
.
6
5
)
<
0
.
0
0
1
U
n
marr
i
e
d
6
(
5
.
5
)
1
.
7
5
(
0
.
4
0
-
5
.
6
7
)
0
.
4
4
9
W
i
d
o
w
e
d
3
4
(
3
0
.
9
)
R
e
f
.
-
4.
W
h
e
t
h
e
r
a
v
a
i
l
i
n
g
o
f
a
n
y
s
o
c
i
a
l
s
e
c
u
r
i
t
y
sch
e
me
Y
e
s
8
5
(
7
7
.
3
)
5
.
1
8
(
2
.
5
0
-
8
.
2
2
)
<
0
.
0
0
1
No
2
5
(
2
2
.
7
)
R
e
f
.
5.
A
n
y
k
n
o
w
n
c
o
mo
r
b
i
d
i
t
i
e
s
o
f
t
h
e
st
u
d
y
su
b
j
e
c
t
Y
e
s
9
(
8
.
2
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2
.
1
9
(
1
.
0
2
-
7
.
3
2
)
<
0
.
0
0
1
No
1
0
1
(
9
1
.
8
)
R
e
f
.
6.
N
u
mb
e
r
o
f
c
h
i
l
d
r
e
n
N
o
n
e
o
r
1
3
6
(
2
2
.
7
)
3
.
3
8
(
1
.
2
2
-
6
.
4
1
)
0
.
5
1
2
≥ 2
1
1
2
(
7
0
.
8
)
R
e
f
.
(
R
e
f
.
c
a
t
.
=
‘
a
d
e
q
u
a
t
e
k
n
o
w
l
e
d
g
e
’
r
e
g
a
r
d
i
n
g
R
TI
s;
C
o
x
a
n
d
S
n
e
l
l
R
-
S
q
u
a
r
e
=
0
.
4
3
0
,
N
a
g
e
l
k
e
r
k
e
R
-
S
q
u
a
r
e
=
0
.
6
5
3
)
T
ab
le
3
.
Mu
ltiv
ar
ia
b
le
b
in
ar
y
lo
g
is
tic
r
eg
r
ess
io
n
tab
le
s
h
o
wi
n
g
th
e
ass
o
ciatio
n
o
f
s
o
cio
d
e
m
o
g
r
ap
h
ic
ch
ar
ac
ter
is
tics
o
f
th
e
s
tu
d
y
p
o
p
u
latio
n
with
th
eir
r
is
k
b
eh
a
v
io
u
r
f
o
r
R
T
I
s
(
n
=
1
5
8
)
S
l
.
N
o
.
S
o
c
i
o
d
e
m
o
g
r
a
p
h
i
c
c
h
a
r
a
c
t
e
r
i
st
i
c
s
H
i
g
h
r
i
s
k
b
e
h
a
v
i
o
u
r
f
o
r
R
TI
s (n
2
=
1
2
2
)
N
u
mb
e
r
(
%)
a
O
R
(
9
5
%
C
I
)
p
-
v
a
l
u
e
1.
A
g
e
o
f
s
t
u
d
y
p
a
r
t
i
c
i
p
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n
t
(
i
n
c
o
mp
l
e
t
e
d
y
e
a
r
s)
60
-
70
8
0
(
6
5
.
6
)
1
.
7
3
(
0
.
7
2
-
4
.
1
4
)
0
.
2
1
9
71
-
80
4
1
(
3
3
.
6
)
0
.
3
3
(
0
.
0
2
-
5
.
5
8
)
0
.
4
4
8
≥
8
1
1
(
0
.
8
)
R
e
f
.
-
2.
G
e
n
d
e
r
o
f
p
a
r
t
i
c
i
p
a
n
t
F
e
mal
e
9
6
(
7
8
.
7
)
2
.
3
5
(
1
.
0
5
-
5
.
2
1
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0
.
0
3
6
M
a
l
e
2
6
(
2
1
.
3
)
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e
f
.
3.
O
c
c
u
p
a
t
i
o
Emp
l
o
y
e
d
9
7
(
7
9
.
5
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3
.
8
8
(
1
.
7
6
-
6
.
5
2
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0
.
0
0
1
U
n
e
m
p
l
o
y
e
d
a
n
d
o
t
h
e
r
s
2
5
(
2
0
.
5
)
R
e
f
.
4.
A
n
y
k
n
o
w
n
c
o
mo
r
b
i
d
i
t
i
e
s
Y
e
s
9
8
(
8
0
.
3
)
0
.
6
3
(
0
.
2
7
-
1
.
4
9
)
0
.
3
0
1
No
2
4
(
1
9
.
7
)
R
e
f
.
5.
W
h
e
t
h
e
r
a
v
a
i
l
i
n
g
a
n
y
so
c
i
a
l
s
e
c
u
r
i
t
y
s
c
h
e
me(s
)
Y
e
s
8
5
(
6
9
.
7
)
2
.
0
5
(
1
.
2
2
-
5
.
4
3
)
0
.
0
4
3
No
3
7
(
3
0
.
3
)
R
e
f
.
(
R
e
f
.
C
a
t
=
‘
l
o
w
r
i
sk
’
b
e
h
a
v
i
o
r
f
o
r
R
T
I
s;
C
o
x
a
n
d
S
n
e
l
l
R
-
S
q
u
a
r
e
=
0
.
4
2
3
,
N
a
g
e
l
k
e
r
k
e
R
-
S
q
u
a
r
e
=
0
.
6
4
3
)
B
r
u
n
h
am
an
d
Paav
o
n
en
[
34
]
e
m
p
h
asized
g
y
n
ec
o
lo
g
ical
an
d
o
b
s
tetr
ical
in
f
ec
tio
u
s
d
is
ea
s
es
as
a
cr
itical
asp
ec
t
o
f
wo
m
en
’
s
h
ea
lth
.
T
h
e
ir
s
tu
d
y
r
ec
o
m
m
en
d
e
d
ad
o
p
tin
g
a
s
y
s
tem
ic
ap
p
r
o
ac
h
to
th
ese
in
f
ec
tio
n
s
,
en
ab
lin
g
th
e
class
if
icatio
n
o
f
m
icr
o
b
i
al
etio
lo
g
y
an
d
p
ath
o
g
e
n
esis
with
in
a
cli
n
ical
a
n
ato
m
ica
l
f
r
am
ewo
r
k
th
at
d
is
tin
g
u
is
h
es b
etwe
en
lo
wer
a
n
d
u
p
p
er
g
en
ital tr
ac
t sy
n
d
r
o
m
es.
T
h
e
f
em
ale
r
ep
r
o
d
u
ctiv
e
s
y
s
tem
en
co
m
p
ass
es
th
e
v
u
lv
a,
v
a
g
in
a,
ce
r
v
i
x
,
u
ter
u
s
,
f
allo
p
ian
tu
b
es,
an
d
o
v
ar
ies.
I
n
an
o
th
e
r
in
v
esti
g
atio
n
,
L
illi
s
et
a
l.
[
35
]
r
e
p
o
r
ted
lo
w
test
in
g
r
ates
f
o
r
R
T
I
s
,
e
v
en
am
o
n
g
p
atien
ts
p
r
esen
tin
g
with
co
m
p
licatio
n
s
co
m
m
o
n
ly
lin
k
ed
to
th
ese
in
f
ec
tio
n
s
,
alo
n
g
s
id
e
a
h
ig
h
p
r
ev
alen
ce
o
f
p
o
ten
tially
in
ap
p
r
o
p
r
iate
p
r
esu
m
p
tiv
e
tr
ea
tm
e
n
ts
.
I
n
c
o
n
tr
ast,
th
e
cu
r
r
en
t
s
tu
d
y
n
o
ted
th
at
two
eld
er
ly
m
ale
p
ar
ticip
an
ts
r
ep
o
r
t
ed
m
u
ltip
le
s
ex
u
al
p
ar
tn
er
s
with
in
th
e
p
ast
y
ea
r
.
T
h
is
s
u
g
g
ests
th
at
wh
ile
s
ex
u
al
ac
tiv
ity
ten
d
s
to
d
ec
lin
e
with
ag
e,
it
r
em
ain
s
s
ig
n
if
ica
n
t,
p
ar
ticu
lar
ly
a
m
o
n
g
m
en
.
T
h
ese
f
in
d
in
g
s
u
n
d
er
s
co
r
e
th
e
im
p
o
r
tan
ce
o
f
tim
ely
an
d
ac
cu
r
ate
R
T
I
d
ia
g
n
o
s
is
,
co
u
p
le
d
with
ap
p
r
o
p
r
iate
tr
ea
tm
en
t stra
teg
ies
.
Xu
et
a
l.
[
7
]
f
o
u
n
d
th
at
3
.
2
%
o
f
p
ar
ticip
an
ts
lack
ed
k
n
o
wled
g
e
ab
o
u
t
id
en
tify
i
n
g
R
T
I
s
,
wh
ile
2
2
.
6
%
wer
e
u
n
awa
r
e
o
f
th
eir
p
r
ev
e
n
tio
n
.
M
o
r
e
th
a
n
8
0
%
o
f
r
e
s
p
o
n
d
en
ts
s
u
p
p
o
r
ted
th
e
estab
lis
h
m
en
t
o
f
R
T
I
s
u
r
v
eillan
ce
s
y
s
tem
s
an
d
th
e
i
n
clu
s
io
n
o
f
R
T
I
-
r
elate
d
co
u
r
s
es.
R
eg
ar
d
in
g
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y
g
ien
e
p
r
ac
tic
es,
4
5
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%
r
ep
o
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ted
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g
in
g
th
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n
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r
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e
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y
2
–
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ay
s
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9
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clea
n
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d
3
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s
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I
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T
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s
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co
n
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ast
to
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u
r
e
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.
Scatter
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o
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ately
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d
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p
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ts
(
n
=
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8
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4.
CO
NCLU
SI
O
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Ver
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f
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k
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eh
a
v
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r
f
o
r
R
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s
.
So
cio
d
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o
g
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ap
h
ic
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h
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ac
ter
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tics
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s
tatis
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ass
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ity
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ased
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f
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in
d
in
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s
.
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ly
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(
ANM
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(
m
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]
am
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RE
F
E
R
E
NC
E
S
[
1
]
P
.
S
.
P
h
i
l
i
p
,
A
.
I
.
B
e
n
j
a
mi
n
,
a
n
d
P
.
S
e
n
g
u
p
t
a
,
“
P
r
e
v
a
l
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n
c
e
o
f
s
y
mp
t
o
m
s
su
g
g
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st
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v
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o
f
r
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p
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t
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v
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r
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n
f
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c
t
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o
n
s/
s
e
x
u
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y
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Lu
d
h
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a
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a
,
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n
d
i
a
n
J
o
u
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T
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sm
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D
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,
v
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3
4
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o
.
2
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p
.
8
3
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8
,
J
u
l
.
2
0
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.
4
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0
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5
3
-
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1
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4
.
1
2
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5
3
7
.
[
2
]
S
.
D
.
C
.
v
,
S
.
S
r
i
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a
m
a
,
a
n
d
S
.
S
.
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u
n
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p
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,
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y
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t
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d
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g
t
h
e
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/
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TI
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l
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n
i
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t
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o
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t
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e
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o
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,
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n
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P
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d
e
s
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–
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c
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o
ss
-
s
e
c
t
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n
a
l
s
t
u
d
y
,
”
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o
u
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n
a
l
o
f
Ev
i
d
e
n
c
e
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s
e
d
Me
d
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c
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n
e
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n
d
H
e
a
l
t
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re
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v
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l
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8
,
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o
.
1
7
,
p
p
.
1
1
2
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–
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1
2
6
,
2
0
2
1
,
d
o
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:
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1
8
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1
0
/
j
e
b
m
h
/
2
0
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1
/
2
1
7
.
[
3
]
N
.
A
g
r
a
w
a
l
,
M
.
R
a
n
a
,
K
.
P
a
t
e
l
,
a
n
d
N
.
B
a
p
a
t
,
“
P
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o
f
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e
o
f
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p
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o
d
u
c
t
i
v
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r
a
c
t
i
n
f
e
c
t
i
o
n
s
a
m
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g
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t
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e
n
d
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e
s
o
f
r
e
p
r
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d
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c
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v
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r
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c
t
i
n
f
e
c
t
i
o
n
/
se
x
u
a
l
l
y
t
r
a
n
smi
t
t
e
d
i
n
f
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c
t
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o
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c
l
i
n
i
c
i
n
a
T
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st
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f
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h
me
d
a
b
a
d
,
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u
j
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t
,
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n
d
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a
n
J
o
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l
o
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m
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Me
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1
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p
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3
,
2
0
1
9
,
d
o
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0
.
4
1
0
3
/
i
j
c
m.I
JC
M
_
3
2
_
1
8
.
[
4
]
K
.
C
h
o
u
d
h
u
r
y
,
S
.
M
a
l
l
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k
,
a
n
d
A
.
S
a
r
k
a
r
,
“
A
S
t
u
d
y
o
n
a
w
a
r
e
n
e
ss
a
n
d
p
r
a
c
t
i
c
e
r
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g
a
r
d
i
n
g
r
e
p
r
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d
u
c
t
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r
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c
t
i
n
f
e
c
t
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o
n
/
se
x
u
a
l
l
y
t
r
a
n
s
mi
t
t
e
d
i
n
f
e
c
t
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o
n
(
R
TI
/
S
TI
)
a
mo
n
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m
o
t
h
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s a
t
t
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n
d
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n
g
i
mm
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n
i
z
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t
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l
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c
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29
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Evaluation Warning : The document was created with Spire.PDF for Python.