I
nte
rna
t
io
na
l J
o
urna
l o
f
P
u
bli
c
H
ea
lt
h Science
(
I
J
P
H
S)
Vo
l.
14
,
No
.
4
,
Dec
em
b
er
20
25
,
p
p
.
1
7
2
0
~
1
7
2
9
I
SS
N:
2
2
5
2
-
8
8
0
6
,
DOI
: 1
0
.
1
1
5
9
1
/ijp
h
s
.
v
14
i
4
.
2
5
9
3
7
1720
J
o
ur
na
l ho
m
ep
a
g
e
:
h
ttp
:
//
ijp
h
s
.
ia
esco
r
e.
co
m
Dete
rmi
na
nt
fact
o
rs o
f
a
nemia
pre
v
ention beha
v
io
r
a
mo
ng
female a
do
lescent
s in border
area
:
a
pa
th
a
na
ly
sis
o
n t
he h
ea
lth
b
eli
ef
mo
del
M
a
ria
P
a
ula
M
a
rla
Na
ha
k
,
P
ius
Alm
ind
u L
ek
i Bere
k
N
u
r
si
n
g
D
e
p
a
r
t
m
e
n
t
,
F
a
c
u
l
t
y
o
f
A
g
r
i
c
u
l
t
u
r
e
S
c
i
e
n
c
e
a
n
d
H
e
a
l
t
h
,
U
n
i
v
e
r
si
t
a
s T
i
m
o
r
,
K
e
f
a
me
n
a
n
u
,
I
n
d
o
n
e
s
i
a
Art
icle
I
nfo
AB
S
T
RAC
T
A
r
ticle
his
to
r
y:
R
ec
eiv
ed
Sep
2
2
,
2
0
2
4
R
ev
is
ed
Sep
1
6
,
2
0
2
5
Acc
ep
ted
No
v
3
,
2
0
2
5
Co
m
b
a
ti
n
g
a
n
e
m
ia
in
fe
m
a
le
a
d
o
les
c
e
n
ts
m
a
y
p
re
v
e
n
t
lo
n
g
term
e
ffe
c
ts
o
f
lo
w
b
irt
h
we
ig
h
t
,
m
a
ln
u
tri
t
io
n
,
a
n
d
g
ro
wt
h
fa
il
u
re
(stu
n
ti
n
g
)
i
n
th
e
i
r
p
ro
g
e
n
y
.
Th
is
st
u
d
y
a
ime
d
t
o
p
a
th
-
a
n
a
ly
z
e
th
e
d
e
term
in
a
n
ts
o
f
a
n
e
m
ia
p
re
v
e
n
ti
o
n
b
e
h
a
v
i
o
r
in
fe
m
a
le
a
d
o
les
c
e
n
ts
wi
th
h
e
a
lt
h
b
e
l
ief
m
o
d
e
l
a
p
p
ro
a
c
h
.
Th
is
wa
s
a
n
o
b
se
rv
a
ti
o
n
a
l
a
n
a
l
y
ti
c
a
l
stu
d
y
,
c
o
n
d
u
c
ted
a
t
S
M
AN
3
Ata
m
b
u
a
,
Eas
t
Nu
sa
Ten
g
g
a
ra
,
In
d
o
n
e
sia
,
fro
m
M
a
y
7
,
2
0
2
4
to
Au
g
u
st
2
,
2
0
2
4
.
A
to
tal
o
f
1
0
3
p
a
rti
c
ip
a
n
ts
we
re
se
lec
ted
b
y
t
o
t
a
l
sa
m
p
li
n
g
.
T
h
e
d
a
ta
c
o
ll
e
c
ted
b
y
a
se
t
o
f
q
u
e
stio
n
n
a
ires
.
T
h
is
stu
d
y
re
v
e
a
led
a
d
irec
t
a
n
d
p
o
sit
iv
e
c
o
rre
latio
n
b
e
twe
e
n
p
e
rc
e
iv
e
d
th
re
a
t
(
b
=
2
.
4
3
;
9
5
%
CI
=
0
.
6
7
t
o
4
.
1
8
;
p
=
0
.
0
0
7
),
p
e
rc
e
iv
e
d
b
e
n
e
fit
s
(b
=
1
.
9
9
;
9
5
%
CI
=
0
.
2
0
to
3
.
7
8
;
p
=
0
.
0
2
9
),
p
e
rc
e
iv
e
d
b
a
rrier
(b
=
2
.
7
4
;
9
5
%
CI
=
0
.
3
4
t
o
5
.
1
4
;
p
=
0
.
0
2
5
),
se
lf
-
e
ffica
c
y
(b
=
1
.
7
6
;
9
5
%
CI
=
0
.
0
6
t
o
3
.
4
6
;
p
=
0
.
0
4
2
),
c
u
e
s
to
a
c
ti
o
n
(
b
=
1
.
9
6
;
9
5
%
CI
=
0
.
2
7
t
o
3
.
6
5
;
p
=
0
.
0
2
2
)
a
n
d
a
n
e
m
ia
p
re
v
e
n
ti
o
n
b
e
h
a
v
io
r.
Kn
o
wle
d
g
e
is
in
d
irec
tl
y
c
o
r
re
late
d
to
a
n
e
m
ia p
re
v
e
n
ti
o
n
b
e
h
a
v
io
r
th
r
o
u
g
h
se
lf
-
e
ff
ica
c
y
(b
=
2
.
2
5
;
9
5
%
CI
=
0
.
9
5
to
3
.
5
4
;
p
=
0
.
0
0
1
)
;
p
e
rc
e
iv
e
d
su
sc
e
p
ti
b
il
it
y
is
in
d
irec
tl
y
c
o
rre
late
d
to
a
n
e
m
ia
p
re
v
e
n
ti
o
n
b
e
h
a
v
i
o
r
th
r
o
u
g
h
p
e
rc
e
iv
e
d
th
re
a
t
(b
=
2
.
0
1
;
9
5
%
CI
=
0
.
7
8
to
3
.
2
4
;
p
=
0
.
0
0
1
);
p
e
rc
e
iv
e
d
se
v
e
rit
y
is
in
d
irec
tl
y
c
o
rre
late
d
to
a
n
e
m
ia
p
re
v
e
n
ti
o
n
b
e
h
a
v
i
o
r
th
r
o
u
g
h
p
e
rc
e
iv
e
d
t
h
re
a
t
(b
=
0
.
9
1
;
9
5
%
CI
=
0
.
0
1
to
1
.
8
1
;
p
=
0
.
0
4
5
).
Th
e
imp
li
c
a
ti
o
n
s
o
f
t
h
is
st
u
d
y
s
u
g
g
e
st
t
h
a
t
m
u
lt
ifac
e
ted
in
terv
e
n
ti
o
n
s
s
h
o
u
ld
b
e
p
u
t
i
n
p
lac
e
th
a
t
c
o
m
b
i
n
e
e
d
u
c
a
ti
o
n
,
e
m
p
o
we
rm
e
n
t,
o
v
e
rc
o
m
in
g
b
a
rriers
,
a
n
d
in
c
re
a
sin
g
t
h
e
p
e
rc
e
iv
e
d
th
re
a
t
a
n
d
se
v
e
rit
y
o
f
a
n
e
m
ia,
a
ll
o
f
wh
ich
c
a
n
imp
ro
v
e
a
n
e
m
ia p
re
v
e
n
ti
o
n
b
e
h
a
v
io
r
a
m
o
n
g
fe
m
a
le ad
o
les
c
e
n
ts.
K
ey
w
o
r
d
s
:
An
em
ia
Fem
ale
ad
o
lescen
t
Hea
lth
b
elief
m
o
d
el
Per
ce
iv
ed
th
r
ea
t a
n
d
b
e
n
ef
its
Self
-
ef
f
icac
y
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Ma
r
ia
Pau
la
Ma
r
la
Nah
ak
Nu
r
s
in
g
Dep
ar
tm
en
t,
Facu
lty
o
f
Ag
r
icu
ltu
r
e
Scien
ce
an
d
Hea
lth
,
Un
iv
er
s
itas
T
im
o
r
Kef
am
en
an
u
,
E
ast
Nu
s
a
T
en
g
g
ar
a,
I
n
d
o
n
esia
E
m
ail:
p
au
lam
ar
la@
u
n
im
o
r
.
a
c.
id
1.
I
NT
RO
D
UCT
I
O
N
T
h
e
p
er
io
d
o
f
a
d
o
l
esce
n
ce
m
a
r
k
s
t
h
e
s
h
i
f
t
f
r
o
m
c
h
il
d
h
o
o
d
t
o
a
d
u
lt
h
o
o
d
[
1
]
.
T
h
e
a
d
o
les
ce
n
t
s
ta
g
e
is
wid
el
y
r
ec
o
g
n
ize
d
as
a
c
r
u
ci
al
ti
m
e
wh
e
n
th
e
d
iet
a
r
y
co
n
d
it
i
o
n
at
t
h
is
l
e
v
el
w
o
u
l
d
d
i
r
ec
tl
y
i
m
p
ac
t
t
h
e
h
ea
lt
h
s
tat
u
s
i
n
t
h
e
s
u
b
s
e
q
u
e
n
t
a
g
e
s
tag
e
[
2
]
,
[
3
]
.
Pu
b
er
t
y
b
r
i
n
g
s
ab
o
u
t
s
ev
er
al
p
h
y
s
io
lo
g
ica
l
ch
an
g
es
t
h
at
m
a
k
e
ad
o
l
esce
n
ts
m
o
r
e
s
u
s
c
ep
ti
b
le
t
o
an
em
ia
.
H
o
we
v
e
r
,
t
h
e
o
c
cu
r
r
e
n
c
e
o
f
a
n
em
i
a
is
m
o
r
e
co
m
m
o
n
i
n
f
e
m
al
e
ad
o
l
esce
n
ts
c
o
m
p
a
r
e
d
t
o
m
al
e
a
d
o
l
esce
n
ts
[
2
]
,
[
3
]
.
I
t
is
d
u
e
to
t
h
e
n
ee
d
f
o
r
r
e
p
r
o
d
u
cti
v
e
d
ev
el
o
p
m
e
n
t
,
w
h
i
ch
r
e
q
u
i
r
es
a
n
ele
v
ate
d
a
m
o
u
n
t
o
f
m
ac
r
o
a
n
d
m
i
c
r
o
n
u
t
r
ie
n
t
s
[
4
]
.
T
h
e
f
r
e
q
u
e
n
c
y
o
f
a
n
e
m
ia
a
m
o
n
g
f
em
al
e
ad
o
l
esce
n
ts
i
n
I
n
d
o
n
esi
a
is
r
el
a
tiv
el
y
h
i
g
h
.
T
h
e
2
0
1
8
B
as
ic
H
ea
lt
h
R
ese
a
r
c
h
s
tu
d
y
r
ev
ea
l
e
d
a
p
r
e
v
al
e
n
ce
r
at
e
o
f
3
2
%
f
o
r
a
n
e
m
i
a,
i
n
d
ic
ati
n
g
th
a
t
3
t
o
4
o
u
t
o
f
e
v
e
r
y
1
0
f
e
m
al
e
ad
o
l
esce
n
ts
i
n
I
n
d
o
n
esia
e
x
p
e
r
ien
ce
a
n
e
m
i
a
[
5
]
.
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
Dete
r
min
a
n
t fa
cto
r
s
o
f a
n
emia
p
r
ev
en
tio
n
b
eh
a
vio
r
a
mo
n
g
fema
le
…
(
Ma
r
ia
P
a
u
la
Ma
r
la
N
a
h
a
k
)
1721
Pre
v
en
tio
n
o
f
an
em
ia
a
m
o
n
g
f
em
ale
ad
o
lescen
ts
r
e
p
r
esen
ts
a
s
p
ec
if
ic
i
n
d
icato
r
with
in
th
e
b
r
o
a
d
e
r
f
r
am
ewo
r
k
o
f
s
tu
n
tin
g
m
itig
at
io
n
ef
f
o
r
ts
in
I
n
d
o
n
esia.
Ho
w
ev
er
,
in
ter
v
e
n
tio
n
s
aim
ed
at
p
r
ev
en
tin
g
an
e
m
ia
in
f
em
ale
ad
o
lescen
ts
r
esid
in
g
in
I
n
d
o
n
esian
b
o
r
d
e
r
r
eg
io
n
s
co
n
tin
u
e
to
f
ac
e
s
ig
n
if
ican
t
ch
alle
n
g
es.
Data
f
r
o
m
th
e
Hea
lth
Dep
ar
tm
en
t
o
f
E
ast
Nu
s
a
T
en
g
g
ar
a
(
E
NT
)
Pro
v
i
n
ce
in
2
0
2
4
in
d
icate
t
h
at
o
n
ly
5
4
.
7
%
o
f
f
em
ale
ad
o
lescen
ts
r
ec
eiv
ed
an
em
ia
s
tatu
s
s
cr
ee
n
in
g
(
h
em
o
g
lo
b
in
test
in
g
)
,
a
f
ig
u
r
e
th
at
r
em
ain
s
s
u
b
s
tan
tially
b
elo
w
th
e
tar
g
et
o
f
9
0
%.
A
d
d
itio
n
all
y
,
th
e
p
r
o
p
o
r
tio
n
o
f
f
em
ale
ad
o
lescen
ts
co
n
s
u
m
in
g
ir
o
n
s
u
p
p
lem
en
tatio
n
tab
lets
was
r
ep
o
r
ted
at
7
3
.
3
%,
wh
ich
s
im
ilar
ly
f
alls
s
h
o
r
t
o
f
th
e
est
ab
lis
h
ed
tar
g
et
o
f
9
0
%.
T
h
e
s
u
b
o
p
tim
al
co
v
e
r
ag
e
o
f
an
em
ia
s
cr
ee
n
in
g
a
n
d
ir
o
n
s
u
p
p
lem
en
tatio
n
am
o
n
g
f
em
ale
ad
o
lescen
ts
m
ay
b
e
attr
i
b
u
ted
to
a
r
an
g
e
o
f
f
ac
to
r
s
,
in
clu
d
in
g
lim
ited
ac
ce
s
s
to
h
ea
lth
ca
r
e
s
er
v
ices,
s
o
cio
-
ec
o
n
o
m
ic
co
n
s
tr
ain
ts
,
an
d
p
o
t
en
tial
g
ap
s
in
h
ea
lth
ed
u
ca
tio
n
a
n
d
awa
r
e
n
ess
[
6
]
.
T
h
ese
s
h
o
r
tco
m
i
n
g
s
ar
e
p
ar
ticu
lar
ly
co
n
ce
r
n
in
g
,
g
iv
e
n
t
h
e
well
-
estab
lis
h
ed
r
elatio
n
s
h
ip
b
etwe
en
a
n
em
ia
a
n
d
ad
v
er
s
e
o
u
tco
m
es
[
7
]
.
Fem
ale
ad
o
lescen
ts
with
an
em
ia
m
ay
e
x
p
er
ien
ce
d
if
f
icu
lties
s
u
ch
as
co
m
p
r
o
m
is
ed
co
g
n
itiv
e
f
u
n
ctio
n
[
8
]
–
[
1
0
]
an
d
r
ed
u
ce
d
ac
a
d
em
ic
p
er
f
o
r
m
an
ce
as
a
r
esu
lt
o
f
r
ed
u
ce
d
lear
n
i
n
g
ca
p
ac
ity
[
1
0
]
.
An
o
th
er
r
ep
o
r
t
in
d
ic
ates
th
at
an
em
ia
in
a
d
o
lescen
ts
is
s
tr
o
n
g
ly
ass
o
ciate
d
with
r
ed
u
ce
d
p
h
y
s
ical
ca
p
ac
ity
an
d
a
h
ig
h
e
r
in
cid
en
ce
o
f
s
y
n
c
o
p
e
(
f
ain
tin
g
)
in
s
ch
o
o
l
s
ettin
g
s
[
1
1
]
.
Gi
v
en
th
e
r
o
le
o
f
f
em
ale
ad
o
le
s
ce
n
ts
as
p
o
ten
tial
m
o
th
er
s
,
it
is
im
p
e
r
ativ
e
to
a
d
d
r
ess
th
is
is
s
u
e
p
r
o
m
p
tl
y
to
av
o
id
th
e
s
ev
e
r
e
co
n
s
eq
u
en
ce
s
o
f
lo
w
b
ir
t
h
weig
h
t,
m
aln
u
tr
itio
n
,
a
n
d
g
r
o
wth
f
ailu
r
e
(
s
tu
n
tin
g
)
in
th
eir
p
r
o
g
en
y
[
1
2
]
,
[
1
3
]
.
Di
f
f
er
en
t
r
esear
ch
f
in
d
in
g
s
h
a
v
e
id
en
tifie
d
d
eter
m
i
n
an
t
f
ac
t
o
r
s
th
at
co
n
tr
ib
u
te
to
th
e
p
r
e
v
en
tio
n
o
f
an
em
ia.
T
h
ese
f
ac
to
r
s
in
clu
d
e
s
o
cio
d
em
o
g
r
ap
h
ic
ch
a
r
ac
ter
is
tics
,
attitu
d
es
[
1
4
]
,
k
n
o
wled
g
e
[
1
5
]
,
f
ea
r
o
f
weig
h
t
g
ain
[
1
6
]
,
p
r
o
tein
c
o
n
s
u
m
p
tio
n
p
atter
n
s
[
1
7
]
,
[
1
8
]
,
f
o
lic
ac
i
d
,
an
d
ir
o
n
tab
le
ts
[
2
]
,
[
1
9
]
,
p
h
y
s
ical
ac
tiv
ity
[
2
0
]
,
[
2
1
]
,
n
u
tr
itio
n
al
s
tatu
s
[
2
2
]
,
[
2
3
]
,
u
p
p
e
r
ar
m
cir
cu
m
f
er
en
ce
(
MU
AC
)
[
6
]
,
[
2
4
]
–
[
2
6
]
,
an
d
m
en
s
tr
u
al
d
u
r
atio
n
[
2
7
]
,
[
2
8
]
.
Prio
r
r
esear
c
h
f
in
d
i
n
g
s
in
d
icate
d
th
at
an
em
ia
in
f
em
ale
ad
o
lescen
ts
is
a
ttrib
u
ted
to
s
o
cio
d
em
o
g
r
ap
h
ic
an
d
b
eh
a
v
io
r
al
v
ar
iab
les,
in
clu
d
in
g
in
ad
e
q
u
ate
f
o
o
d
an
d
c
o
n
s
u
m
p
tio
n
h
a
b
its
.
Nev
er
th
eless
,
to
p
r
o
m
o
te
h
ea
lt
h
y
b
eh
av
io
r
am
o
n
g
ad
o
lescen
ts
in
p
r
ev
en
tin
g
an
em
ia,
it
is
ess
en
tial
to
an
aly
ze
th
e
f
ac
to
r
s
th
at
in
f
lu
en
ce
ad
o
lescen
t
b
eh
av
io
r
u
s
in
g
th
e
h
ea
lth
b
elief
m
o
d
el
(
HB
M)
th
eo
r
etica
l
ap
p
r
o
ac
h
,
p
ar
ticu
lar
ly
in
th
e
b
o
r
d
er
r
e
g
io
n
s
o
f
I
n
d
o
n
esia
an
d
th
e
R
ep
u
b
lic
o
f
Dem
o
cr
atic
T
im
o
r
L
este
(
R
DT
L
)
.
HB
M
i
s
a
th
eo
r
etica
l
f
r
am
ewo
r
k
th
at
elu
cid
ates a
n
d
f
o
r
ec
asts
in
d
iv
id
u
al
h
ea
l
th
b
eh
av
io
r
m
o
d
if
icatio
n
s
[
2
9
]
.
Usi
n
g
HB
M
as
a
th
eo
r
etica
l
f
r
am
ewo
r
k
th
at
elu
cid
ates
a
n
d
f
o
r
ec
asts
in
d
iv
id
u
al
h
ea
lth
b
eh
a
v
io
r
m
o
d
if
icatio
n
s
is
ess
en
tial
[
2
9
]
.
T
h
e
HB
M
th
eo
r
y
h
ig
h
lig
h
ts
th
at
th
e
ex
is
ten
ce
o
r
ab
s
en
ce
o
f
h
ea
lth
b
eh
av
i
o
r
ca
n
b
e
ex
p
lain
ed
b
y
in
d
i
v
id
u
al
v
alu
es
o
f
p
er
ce
iv
ed
v
u
l
n
er
ab
ilit
y
,
p
e
r
ce
iv
ed
s
ev
er
ity
,
p
er
ce
iv
ed
th
r
ea
t,
p
er
ce
iv
ed
b
en
e
f
it,
p
er
ce
iv
ed
b
ar
r
ier
,
cu
es
to
ac
tio
n
,
an
d
s
elf
-
ef
f
icac
y
.
T
h
is
s
tu
d
y
u
n
iq
u
ely
p
r
esen
ts
ex
ten
s
iv
e
d
ata
an
d
in
f
o
r
m
atio
n
u
s
in
g
th
e
HB
M
th
eo
r
y
ap
p
r
o
ac
h
an
d
p
a
th
an
aly
s
is
to
ex
am
in
e
th
e
p
r
i
m
ar
y
p
r
e
d
icto
r
s
an
d
in
ter
m
ed
iate
v
ar
ia
b
les
ass
o
ciat
ed
with
ad
o
lescen
t
b
eh
av
io
r
in
p
r
ev
en
ti
n
g
an
e
m
ia.
Path
an
aly
s
is
f
u
r
th
er
h
elp
s
i
n
id
en
tify
in
g
h
o
w
th
ese
f
ac
to
r
s
ar
e
in
ter
r
elate
d
,
p
r
o
v
id
in
g
a
clea
r
er
p
ictu
r
e
o
f
w
h
at
n
ee
d
s
to
b
e
a
d
d
r
ess
ed
in
in
ter
v
en
tio
n
s
.
T
h
is
an
aly
s
is
is
th
e
f
o
u
n
d
atio
n
f
o
r
co
m
m
u
n
i
ca
t
in
g
b
eh
a
v
io
r
al
ch
a
n
g
e
t
o
m
o
d
if
y
i
n
ter
n
al
a
n
d
ex
ter
n
al
d
eter
m
i
n
an
ts
.
T
o
a
d
d
r
ess
th
e
is
s
u
e
o
f
an
em
ia
in
f
em
ale
ad
o
lescen
ts
,
it
is
n
ec
ess
ar
y
to
im
p
lem
en
t
b
eh
av
io
r
al
m
o
d
if
icatio
n
s
f
r
o
m
th
e
p
er
s
p
ec
tiv
e
o
f
th
e
f
em
ale
ad
o
lescen
ts
.
T
h
er
ef
o
r
e,
th
is
s
tu
d
y
is
cr
u
cial
as
u
tili
zin
g
HB
M
as
a
p
r
ed
icto
r
o
f
ad
o
lescen
t
b
eh
a
v
io
r
ca
n
p
r
o
v
id
e
p
r
ac
tical
s
o
lu
tio
n
s
th
at
ca
n
b
e
im
p
lem
en
ted
to
r
em
ed
y
th
e
id
e
n
tifie
d
r
o
o
t
c
au
s
e
o
f
th
e
p
r
o
b
lem
.
T
h
er
ef
o
r
e
,
th
is
s
tu
d
y
aim
s
to
p
ath
-
an
aly
ze
th
e
d
eter
m
in
an
ts
o
f
an
em
ia
p
r
ev
e
n
tio
n
b
e
h
av
io
r
in
f
em
ale
ad
o
lescen
ts
in
th
e
I
n
d
o
n
esia
–
T
im
o
r
L
este b
o
r
d
e
r
ar
ea
.
2.
M
E
T
H
O
D
T
h
is
was
an
o
b
s
er
v
atio
n
al
an
aly
tical
r
esear
ch
m
eth
o
d
o
lo
g
y
to
ac
cu
r
ately
i
d
en
tify
th
e
f
ac
to
r
s
th
at
in
f
lu
en
ce
an
e
m
ia
p
r
e
v
en
tiv
e
b
eh
av
io
r
in
f
em
ale
ad
o
lescen
ts
at
a
p
u
b
lic
s
en
io
r
h
ig
h
s
c
h
o
o
l
(
SMAN
3
Atam
b
u
a)
.
C
o
n
s
id
er
in
g
th
e
lack
o
f
s
tu
d
ie
s
th
at
m
ea
s
u
r
e
th
e
d
ir
ec
t
an
d
i
n
d
ir
ec
t
ef
f
ec
t
o
f
HB
M
co
n
s
tr
u
cts
to
war
d
an
em
ia
p
r
ev
en
tiv
e
b
eh
a
v
io
r
i
n
ad
o
lescen
ts
,
p
ar
ticu
lar
ly
in
f
e
m
ale
a
d
o
lescen
ts
r
esid
in
g
in
b
o
r
d
er
l
an
d
,
a
q
u
a
n
titativ
e
s
tu
d
y
em
p
lo
y
in
g
g
en
er
alize
d
s
tr
u
ctu
r
al
eq
u
atio
n
m
o
d
ellin
g
(G
-
SEM
)
,
a
m
u
ltiv
ar
iate
m
eth
o
d
f
o
r
a
n
aly
zin
g
n
o
n
-
co
n
tin
u
o
u
s
d
ep
en
d
en
t
v
a
r
iab
le
s
.
T
h
e
s
tu
d
y
was
co
n
d
u
cted
at
SMAN
3
Atam
b
u
a,
s
itu
ated
o
n
th
e
b
o
r
d
er
b
etwe
en
I
n
d
o
n
esia
an
d
R
DT
L
,
f
r
o
m
Ma
y
7
to
Au
g
u
s
t
2
,
2
0
2
4
.
Ar
i
d
co
n
d
itio
n
s
an
d
m
in
im
al
p
r
ec
ip
itatio
n
c
h
ar
ac
ter
i
ze
th
e
ar
ea
.
T
h
ese
en
v
ir
o
n
m
en
tal
co
n
d
itio
n
s
in
cr
ea
s
e
th
e
s
u
s
ce
p
tib
ilit
y
o
f
f
em
ale
ad
o
lescen
ts
to
ac
q
u
ir
in
g
an
em
ia.
T
h
e
p
ar
ticip
an
ts
in
th
is
s
tu
d
y
co
n
s
is
ted
o
f
1
0
3
f
em
ale
a
d
o
lescen
ts
f
r
o
m
SMAN
3
Atam
b
u
a,
s
elec
ted
f
r
o
m
an
y
o
f
th
e
7
class
es
r
an
g
in
g
f
r
o
m
X
t
o
XI
I
class
es
u
s
in
g
to
tal
s
am
p
l
in
g
.
T
h
e
d
ata
co
llectio
n
p
r
o
ce
d
u
r
e
was
co
n
d
u
cted
th
r
o
u
g
h
th
e
co
m
p
letio
n
o
f
q
u
e
s
tio
n
n
air
es.
T
h
e
s
tu
d
y
em
p
lo
y
ed
k
n
o
wled
g
e,
p
er
ce
iv
e
d
s
u
s
c
ep
tib
ilit
y
,
p
er
ce
iv
e
d
s
ev
er
ity
,
p
er
ce
iv
e
d
th
r
ea
t,
p
er
ce
iv
ed
b
e
n
ef
it,
p
er
ce
iv
ed
b
ar
r
ier
,
c
u
es
to
ac
tio
n
,
an
d
s
elf
-
ef
f
icac
y
as
th
e
in
d
ep
en
d
en
t v
ar
ia
b
les.
I
n
th
is
s
tu
d
y
,
th
e
an
e
m
ia
p
r
e
v
en
tiv
e
b
eh
av
io
r
s
er
v
e
d
as th
e
d
e
p
en
d
e
n
t v
ar
iab
le.
Data
co
llectio
n
co
m
m
en
ce
d
w
ith
a
v
is
it
to
SMAN
3
Atam
b
u
a,
I
n
d
o
n
esia,
d
u
r
in
g
wh
ich
th
e
r
esear
ch
team
m
et
with
th
e
s
ch
o
o
l
p
r
i
n
cip
al.
T
h
e
team
o
u
tlin
ed
t
h
e
p
u
r
p
o
s
e
a
n
d
o
b
jectiv
es
o
f
th
e
s
tu
d
y
a
n
d
s
o
u
g
h
t
th
e
p
r
in
cip
al’
s
co
n
s
en
t
t
o
s
er
v
e
a
s
th
e
leg
al
g
u
ar
d
ian
f
o
r
th
e
f
e
m
ale
ad
o
lescen
t
p
ar
ticip
an
ts
.
T
h
is
p
r
o
ce
d
u
r
e
was
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
7
2
0
-
1
7
2
9
1722
r
eq
u
ir
ed
b
ec
a
u
s
e,
u
n
d
er
I
n
d
o
n
esian
laws
an
d
r
eg
u
latio
n
s
,
th
e
p
ar
ticip
an
ts
wer
e
c
o
n
s
id
er
ed
m
in
o
r
s
an
d
th
e
r
ef
o
r
e
n
ee
d
ed
g
u
ar
d
ian
a
p
p
r
o
v
al,
wh
ich
in
t
h
is
co
n
tex
t
was
o
b
tain
ed
th
r
o
u
g
h
th
e
p
r
i
n
cip
al.
Fo
ll
o
win
g
th
e
r
ec
eip
t
o
f
in
s
titu
tio
n
al
co
n
s
en
t,
t
h
e
r
ese
ar
ch
team
v
is
ited
ea
ch
class
r
o
o
m
t
o
m
ee
t
th
e
p
o
ten
tial
p
ar
ticip
an
ts
.
T
h
e
team
p
r
o
v
id
e
d
a
d
etailed
ex
p
la
n
atio
n
o
f
th
e
s
tu
d
y
'
s
aim
s
an
d
p
r
o
c
ed
u
r
es
an
d
s
u
b
s
eq
u
en
tly
r
eq
u
ested
th
e
s
tu
d
e
n
ts
’
ass
en
t
to
p
ar
ticip
ate.
Up
o
n
o
b
tain
in
g
ass
en
t,
th
e
r
esea
r
c
h
er
s
d
is
tr
ib
u
ted
a
s
et
o
f
q
u
e
s
tio
n
n
air
es
f
o
r
th
e
p
ar
ticip
an
ts
to
co
m
p
lete.
Data
co
llectio
n
was
ca
r
r
ied
o
u
t
d
u
r
in
g
r
eg
u
lar
in
s
tr
u
ctio
n
al
h
o
u
r
s
.
T
o
e
n
s
u
r
e
th
at
p
ar
ticip
an
ts
’
ed
u
ca
tio
n
al
r
ig
h
t
s
wer
e
f
u
lly
u
p
h
eld
,
all
d
ata
c
o
llectio
n
ac
tiv
ities
wer
e
s
ch
ed
u
le
d
in
co
o
r
d
in
atio
n
with
th
e
s
ch
o
o
l
tim
etab
le,
m
i
n
im
izin
g
d
is
r
u
p
tio
n
s
t
o
th
e
le
ar
n
in
g
p
r
o
ce
s
s
.
Fo
llo
win
g
th
e
co
m
p
letio
n
o
f
d
ata
co
llectio
n
,
th
e
r
esear
c
h
er
s
p
r
o
ce
ed
ed
with
d
ata
a
n
aly
s
is
u
s
in
g
StataMP
1
3
s
o
f
twar
e.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
Respo
nd
ent
cha
ra
ct
er
is
t
ics
T
ab
le
1
s
h
o
ws
th
at
8
0
ad
o
lescen
ts
(
7
7
.
6
7
%)
h
ad
a
h
ig
h
lev
e
l
o
f
k
n
o
wled
g
e
r
e
g
ar
d
in
g
an
e
m
ia,
wh
ile
2
3
(
2
2
.
3
%)
h
ad
a
lo
wer
k
n
o
wled
g
e
lev
el.
A
to
tal
o
f
2
0
f
em
ale
ad
o
lescen
ts
,
ac
co
u
n
tin
g
f
o
r
1
9
.
4
2
%
o
f
th
e
s
am
p
le,
co
n
s
id
er
th
em
s
elv
es p
r
o
n
e
t
o
an
e
m
ia.
I
n
co
n
tr
ast,
8
3
f
em
ale
a
d
o
lescen
ts
,
r
ep
r
esen
ti
n
g
8
0
.
5
8
%,
d
o
n
o
t
p
o
s
s
ess
th
is
p
er
ce
p
tio
n
.
Am
o
n
g
th
e
a
d
o
lescen
ts
,
4
5
(
4
3
.
6
9
%)
co
n
s
id
er
an
em
ia
a
s
ev
er
e
co
n
d
itio
n
,
w
h
er
ea
s
5
8
(
5
6
.
3
1
%)
d
o
n
o
t.
Am
o
n
g
t
h
e
f
em
ale
ad
o
lescen
ts
,
4
0
(
3
8
.
8
3
)
co
n
s
id
er
an
em
ia
a
c
o
n
ce
r
n
,
wh
er
ea
s
6
3
(
6
1
.
1
7
)
d
o
n
o
t
r
ec
o
g
n
ize
it.
Of
th
e
f
e
m
ale
ad
o
lescen
ts
,
6
1
(
5
9
.
2
2
%)
id
en
tify
t
h
e
ad
v
an
tag
es
o
f
e
n
g
ag
in
g
in
a
n
em
ia
p
r
ev
en
tio
n
b
eh
av
io
r
,
wh
er
ea
s
4
2
(
4
0
.
7
8
)
d
o
n
o
t p
er
ce
iv
e
an
y
b
e
n
ef
its
.
5
1
(
4
9
.
5
1
%)
f
em
al
e
ad
o
lescen
ts
d
o
n
o
t
s
ee
b
ar
r
ier
s
to
an
em
ia
p
r
ev
e
n
tio
n
b
eh
a
v
io
r
,
wh
er
ea
s
5
2
(
5
0
.
4
9
)
f
em
ale
ad
o
lescen
ts
en
c
o
u
n
ter
ch
allen
g
es
in
s
u
ch
b
eh
a
v
io
r
.
T
h
ir
ty
-
th
r
ee
(
3
2
.
0
4
%)
f
em
ale
ad
o
lescen
ts
r
ec
eiv
e
ex
p
licit
in
s
tr
u
ctio
n
s
to
ac
t,
wh
ile
s
ev
en
t
y
(
6
7
.
9
6
%)
f
em
ale
ad
o
lescen
ts
lack
s
u
ch
in
s
tr
u
ctio
n
s
.
A
to
tal
o
f
5
0
(
4
8
.
5
4
%)
f
e
m
ale
ad
o
le
s
ce
n
ts
ex
h
ib
it
h
ig
h
s
elf
-
ef
f
icac
y
,
wh
er
ea
s
5
3
(
5
1
.
4
6
%)
f
e
m
ale
ad
o
lescen
ts
d
em
o
n
s
tr
ate
lo
w
s
elf
-
ef
f
icac
y
.
Am
o
n
g
f
em
al
e
ad
o
lescen
ts
,
3
1
(
3
0
.
1
0
%)
ex
h
i
b
it
g
o
o
d
a
n
em
ia
p
r
e
v
en
tio
n
b
eh
av
io
r
,
wh
ile
7
1
(
6
9
.
9
0
%)
d
i
s
p
lay
p
o
o
r
a
n
e
m
ia
p
r
ev
en
tio
n
b
eh
a
v
io
r
.
T
ab
le
1
.
R
esp
o
n
d
e
n
t c
h
ar
ac
ter
is
tics
No
V
a
r
i
a
b
l
e
s
n
%
No
V
a
r
i
a
b
l
e
s
n
%
1
K
n
o
w
l
e
d
g
e
6
P
e
r
c
e
p
t
i
o
n
o
f
b
a
r
r
i
e
r
s
P
o
o
r
23
2
2
.
3
B
a
r
r
i
e
r
s
52
5
0
.
4
9
G
o
o
d
80
7
7
.
6
7
N
o
b
a
r
r
i
e
r
s
51
4
9
.
5
1
2
P
e
r
c
e
p
t
i
o
n
o
f
v
u
l
n
e
r
a
b
i
l
i
t
y
7
C
u
e
s t
o
a
c
t
i
o
n
I
n
v
u
l
n
e
r
a
b
l
e
83
8
0
.
5
8
No
70
6
7
.
9
6
V
u
l
n
e
r
a
b
l
e
20
1
9
.
4
2
Y
e
s
33
3
2
.
0
4
3
P
e
r
c
e
p
t
i
o
n
o
f
se
v
e
r
i
t
y
8
S
e
l
f
–
e
f
f
i
c
a
c
y
U
n
se
v
e
r
a
b
l
e
58
5
6
.
3
1
P
o
o
r
53
5
1
.
4
6
S
e
v
e
r
a
b
l
e
45
4
3
.
6
9
G
o
o
d
50
4
8
.
5
4
4
Th
r
e
a
t
p
e
r
c
e
p
t
i
o
n
9
A
n
e
m
i
a
p
r
e
v
e
n
t
i
o
n
b
e
h
a
v
i
o
r
U
n
t
h
r
e
a
t
e
n
e
d
63
6
1
.
1
7
P
o
o
r
71
6
9
.
9
0
Th
r
e
a
t
e
n
40
3
8
.
8
3
G
o
o
d
31
3
0
.
1
0
5
P
e
r
c
e
p
t
i
o
n
o
f
b
e
n
e
f
i
t
s
N
o
b
e
n
e
f
i
t
s
42
4
0
.
7
8
B
e
n
e
f
i
t
s
61
5
9
.
2
2
3
.
2
.
P
a
t
h a
na
ly
s
is
3
.
2
.
1
.
M
o
del sp
ec
if
ica
t
io
n
An
ex
p
licit
m
o
d
el
f
o
r
m
u
latio
n
elu
cid
ates
th
e
co
r
r
elatio
n
b
e
twee
n
th
e
v
ar
iab
les
u
n
d
er
in
v
esti
g
atio
n
.
T
h
e
p
r
esen
t
s
tu
d
y
ex
am
i
n
es
n
in
e
v
ar
iab
les:
k
n
o
wled
g
e,
p
er
c
eiv
ed
s
u
s
ce
p
tib
ilit
y
,
p
er
ce
iv
ed
s
ev
er
ity
,
p
er
ce
iv
e
d
th
r
ea
t,
p
er
ce
iv
e
d
b
e
n
ef
its
,
p
er
ce
iv
ed
b
ar
r
ier
s
,
cu
es to
ac
tio
n
,
s
elf
-
ef
f
icac
y
,
an
d
an
em
ia
p
r
e
v
en
tio
n
b
eh
av
io
r
.
3
.
2
.
2
.
M
o
del ident
if
ica
t
io
n
Ob
s
er
v
ed
v
ar
ia
b
les:
i.
Nu
m
b
er
o
f
o
b
s
er
v
ed
v
a
r
iab
les
ii.
Dir
ec
t e
f
f
ec
ts
iii.
I
n
d
ir
ec
t e
f
f
ec
ts
iv
.
Nu
m
b
er
o
f
p
ar
a
m
eter
s
v.
Deg
r
ee
o
f
f
r
ee
d
o
m
(
d
f
)
d
f
=
d
eg
r
ee
o
f
f
r
ee
d
o
m
=
#
o
b
s
er
v
atio
n
-
#
p
a
r
am
eter
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
Dete
r
min
a
n
t fa
cto
r
s
o
f a
n
emia
p
r
ev
en
tio
n
b
eh
a
vio
r
a
mo
n
g
fema
le
…
(
Ma
r
ia
P
a
u
la
Ma
r
la
N
a
h
a
k
)
1723
Nu
m
b
er
o
f
o
b
s
er
v
atio
n
s
#
o
b
s
er
v
atio
n
=
(
k
*
(
k
-
1
)
)
/ 2
k
=
o
b
s
er
v
e
d
v
ar
ia
b
les
Nu
m
b
er
o
f
p
ar
a
m
eter
s
#
p
ar
am
eter
=
(
#
r
e
g
r
ess
io
n
p
at
h
+
#
co
r
r
elatio
n
p
ath
+
#
r
esid
u
al
er
r
o
r
)
Ob
s
er
v
ed
v
ar
ia
b
les =
8
x
(
8
-
1
)
)
/2
=
2
8
Nu
m
b
er
o
f
p
ar
a
m
eter
s
=
Nu
m
b
er
o
f
r
e
g
r
ess
io
n
p
at
h
+c
o
r
r
elatio
n
p
ath
/co
v
ar
ian
ce
+r
esid
u
al
er
r
o
r
=
8
+0
+0
=
8
d
f
=
(
5
6
/2
)
–
(
8
)
d
f
=
2
8
–
8
d
f
=
2
0
df
v
alu
e
is
2
0
(
>0
=
o
v
er
-
id
e
n
tifie
d
)
s
o
th
at
p
ath
an
aly
s
is
ca
n
b
e
ca
r
r
ied
o
u
t.
T
h
e
s
tr
u
ct
u
r
al
m
o
d
el
o
f
p
ath
an
aly
s
is
ca
n
b
e
s
ee
n
in
Fig
u
r
e
1
.
Fig
u
r
e
1
.
Stru
ctu
r
al
m
o
d
el
o
f
p
ath
an
aly
s
is
T
h
e
d
ata
in
T
a
b
le
2
s
h
o
ws
a
d
ir
ec
t
a
n
d
p
o
s
itiv
e
ef
f
ec
t
of
p
er
ce
iv
e
d
th
r
ea
t
an
d
an
e
m
ia
p
r
ev
e
n
tio
n
b
eh
av
io
r
.
Am
o
n
g
ad
o
lescen
ts
wh
o
v
iew
an
e
m
ia
as
a
th
r
e
at,
th
e
lo
g
odds
lik
elih
o
o
d
o
f
ad
o
p
tin
g
an
em
ia
p
r
ev
en
tio
n
b
e
h
av
io
r
is
2
.
4
3
tim
es
h
ig
h
er
(
b
=
2
.
4
3
;
9
5
%
C
I
=
0
.
6
7
to
4
.
1
8
;
p
=
0
.
0
0
7
)
co
m
p
ar
ed
t
o
ad
o
lescen
ts
wh
o
d
o
n
o
t
v
iew
an
em
ia
as
a
th
r
ea
t.
A
d
ir
ec
t
an
d
p
o
s
itiv
e
ef
f
ec
t
ex
is
ts
b
etwe
en
p
er
ce
iv
ed
b
en
ef
its
an
d
th
e
im
p
lem
en
tatio
n
o
f
a
n
em
ia
p
r
e
v
en
tio
n
ac
tiv
it
y
.
Ad
o
lescen
ts
wh
o
r
ec
o
g
n
ize
t
h
e
b
e
n
ef
its
o
f
an
em
ia
p
r
ev
en
ti
o
n
co
n
d
u
ct
h
av
e
a
lo
g
o
d
d
s
lik
elih
o
o
d
o
f
en
g
ag
in
g
in
s
u
ch
b
eh
a
v
io
r
th
at
is
1
.
9
9
tim
es h
ig
h
e
r
(
b
=
1
.
9
9
; 9
5
% C
I
=
0
.
2
0
t
o
3
.
7
8
;
p
=
0
.
0
2
9
)
c
o
m
p
ar
ed
to
ad
o
lescen
ts
wh
o
d
o
n
o
t
r
ec
o
g
n
ize
th
e
ad
v
a
n
tag
es
o
f
an
em
ia
p
r
ev
e
n
tio
n
b
eh
av
io
r
.
Per
ce
iv
ed
b
a
r
r
ier
d
ir
ec
tly
an
d
p
o
s
i
tiv
ely
co
r
r
el
ates
with
ac
tiv
ity
aim
ed
at
p
r
ev
en
tin
g
an
em
ia.
Ad
o
lescen
ts
wh
o
d
o
n
o
t
s
ee
an
y
b
ar
r
ier
s
to
p
r
ev
en
tin
g
an
e
m
ia
h
av
e
a
lo
g
o
d
d
s
r
atio
o
f
2
.
7
4
tim
es
h
ig
h
er
(
b
=
2
.
7
4
;
9
5
%
C
I
=
0
.
3
4
to
5
.
1
4
;
p
=
0
.
0
2
5
)
to
e
n
g
ag
e
in
an
em
ia
p
r
ev
en
tio
n
b
eh
a
v
io
r
co
m
p
ar
e
d
t
o
ad
o
lescen
ts
wh
o
d
o
p
er
ce
iv
e
o
b
s
tacle
s
.
A
d
ir
ec
t
an
d
p
o
s
itiv
e
co
r
r
elatio
n
ex
i
s
ts
b
etwe
en
s
elf
-
ef
f
icac
y
an
d
an
em
ia
p
r
e
v
en
tio
n
b
eh
av
io
r
.
Hig
h
s
elf
-
ef
f
icac
y
i
n
f
em
ale
a
d
o
lescen
ts
is
ass
o
ciate
d
with
a
lo
g
-
o
d
d
lik
elih
o
o
d
o
f
en
g
ag
in
g
in
an
em
ia
p
r
e
v
en
tio
n
b
eh
a
v
io
r
t
h
at
is
1
.
7
6
tim
es
h
ig
h
e
r
(
b
=
1
.
7
6
;
9
5
%
C
I
=
0
.
0
6
to
3
.
4
6
;
p
=
0
.
0
4
2
)
c
o
m
p
a
r
ed
to
lo
w
s
elf
-
ef
f
icac
y
in
ad
o
lescen
ts
.
C
u
es
to
ac
tio
n
ar
e
d
ir
ec
tly
an
d
p
o
s
itiv
ely
co
r
r
elate
d
with
b
eh
av
io
r
aim
e
d
at
p
r
ev
en
tin
g
an
e
m
ia.
Ad
o
lescen
ts
wh
o
g
et
c
u
es
to
ac
tio
n
h
a
d
a
lo
g
o
d
d
s
o
f
1
.
9
6
(
b
=
1
.
9
6
;
9
5
%
C
I
=
0
.
2
7
t
o
3
.
6
5
;
p
=
0
.
0
2
2
)
to
ad
o
p
t
an
e
m
ia
p
r
ev
en
tio
n
b
e
h
av
io
r
co
m
p
ar
ed
to
a
d
o
lescen
ts
wh
o
d
o
n
o
t
ac
q
u
ir
e
d
ir
ec
tio
n
s
to
ac
t.
Kn
o
wled
g
e
is
in
d
ir
ec
tly
co
r
r
elate
d
to
a
n
em
ia
p
r
ev
en
ti
o
n
b
e
h
av
io
r
th
r
o
u
g
h
s
elf
-
ef
f
ic
ac
y
.
T
h
e
lo
g
o
d
d
f
o
r
ad
o
lescen
ts
with
a
g
o
o
d
u
n
d
e
r
s
tan
d
in
g
o
f
a
n
em
ia
to
h
a
v
e
h
ig
h
s
elf
-
ef
f
icac
y
is
2
.
2
5
tim
es
g
r
ea
ter
(
b
=
2
.
2
5
;
9
5
%
C
I
=
0
.
9
5
to
3
.
5
4
;
p
=
0
.
0
0
1
)
c
o
m
p
ar
e
d
to
ad
o
le
s
ce
n
ts
with
p
o
o
r
k
n
o
wled
g
e
ab
o
u
t
a
n
em
ia.
T
h
e
p
h
en
o
m
en
o
n
o
f
p
e
r
ce
iv
ed
s
u
s
ce
p
tib
ilit
y
i
s
in
d
ir
ec
tly
ass
o
ciate
d
with
an
em
ia
p
r
ev
e
n
tio
n
b
eh
a
v
io
r
th
r
o
u
g
h
p
er
ce
iv
ed
t
h
r
ea
t.
T
h
e
lo
g
o
d
d
s
o
f
ad
o
lescen
ts
wh
o
co
n
s
id
e
r
th
em
s
elv
es
s
u
s
ce
p
tib
le
to
a
n
em
ia
,
co
n
s
id
er
in
g
an
em
ia
as
a
th
r
ea
t
,
ar
e
2
.
0
1
tim
es
h
ig
h
er
(
b
=
2
.
0
1
;
9
5
%
C
I
=
0
.
7
8
to
3
.
2
4
;
p
=
0
.
0
0
1
)
c
o
m
p
ar
ed
to
ad
o
lescen
ts
wh
o
d
o
n
o
t
r
e
g
ar
d
th
em
s
elv
es
as
s
u
s
ce
p
tib
le
to
an
e
m
ia.
T
h
e
p
er
ce
iv
e
d
s
ev
er
ity
o
f
a
n
em
ia
is
in
d
ir
ec
tly
K
n
o
wl
e
d
g
e
b
i
n
o
m
i
a
l
l
o
g
i
t
P
e
r
c
e
i
v
e
d
S
u
s
c
e
p
t
i
b
i
l
i
t
y
b
i
n
o
m
i
a
l
l
o
g
i
t
P
e
r
c
e
i
v
e
d
T
h
r
e
a
t
b
i
n
o
m
i
a
l
l
o
g
i
t
-
1.3
A
n
e
m
i
a
P
r
e
v
e
n
t
i
o
n
B
e
h
a
v
i
o
r
b
i
n
o
m
i
a
l
l
o
g
i
t
-
7.6
P
e
r
c
e
i
v
e
d
B
e
n
e
f
i
t
s
b
i
n
o
m
i
a
l
l
o
g
i
t
P
e
r
c
e
i
v
e
d
B
a
r
r
i
e
r
s
b
i
n
o
m
i
a
l
l
o
g
i
t
S
e
l
f
-
E
f
f
i
c
a
c
y
b
i
n
o
m
i
a
l
l
o
g
i
t
-
1.9
Cu
e
s
t
o
A
c
t
i
o
n
b
i
n
o
m
i
a
l
l
o
g
i
t
P
e
r
c
e
i
v
e
d
S
e
v
e
r
i
t
y
b
i
n
o
m
i
a
l
l
o
g
i
t
2
.92
2.4
2
2.7
1.8
2
2.3
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
7
2
0
-
1
7
2
9
1724
ass
o
ciate
d
with
an
em
ia
p
r
ev
e
n
tio
n
ac
tiv
ity
th
r
o
u
g
h
p
er
ce
iv
ed
th
r
ea
t.
T
h
e
l
o
g
odds
o
f
p
er
ce
iv
in
g
an
e
m
ia
as
a
th
r
ea
t
ar
e
0
.
9
1
tim
es
h
ig
h
er
f
o
r
ad
o
lescen
ts
wh
o
v
iew
an
em
ia
as
a
s
ev
er
ity
co
m
p
ar
ed
to
ad
o
lescen
ts
wh
o
d
o
n
o
t v
iew
an
em
ia
as a
s
ev
er
ity
(
b
=
0
.
9
1
; 9
5
% C
I
=
0
.
0
1
to
1
.
8
1
; p
=
0
.
0
4
5
)
.
T
ab
le
2
.
Path
an
al
y
s
is
r
esu
lts
:
d
eter
m
in
an
ts
f
ac
to
r
s
o
f
an
em
i
a
p
r
ev
en
tio
n
b
e
h
av
io
r
in
f
em
al
e
a
d
o
lescen
ts
u
s
in
g
th
e
h
ea
lth
b
elief
m
o
d
el
ap
p
r
o
ac
h
D
e
p
e
n
d
e
n
t
v
a
r
i
a
b
l
e
s
I
n
d
e
p
e
n
d
e
n
t
v
a
r
i
a
b
l
e
s
b
C
I
9
5
%
p
U
p
p
e
r
l
i
mi
t
Lo
w
e
r
l
i
m
i
t
D
i
r
e
c
t
e
f
f
e
c
t
s
A
n
e
m
i
a
p
r
e
v
e
n
t
i
o
n
b
e
h
a
v
i
o
r
P
e
r
c
e
i
v
e
d
t
h
r
e
a
t
s
2
.
4
3
0
.
6
7
4
.
1
8
0
.
0
0
7
A
n
e
m
i
a
p
r
e
v
e
n
t
i
o
n
b
e
h
a
v
i
o
r
P
e
r
c
e
i
v
e
d
b
e
n
e
f
i
t
s
1
.
9
9
0
.
2
0
3
.
7
8
0
.
0
2
9
A
n
e
m
i
a
p
r
e
v
e
n
t
i
o
n
b
e
h
a
v
i
o
r
P
e
r
c
e
i
v
e
d
b
a
r
r
i
e
r
s
2
.
7
4
0
.
3
4
5
.
1
4
0
.
0
2
5
A
n
e
m
i
a
p
r
e
v
e
n
t
i
o
n
b
e
h
a
v
i
o
r
S
e
l
f
-
e
f
f
i
c
a
c
y
1
.
7
6
0
.
0
6
3
.
4
6
0
.
0
4
2
A
n
e
m
i
a
p
r
e
v
e
n
t
i
o
n
b
e
h
a
v
i
o
r
C
u
e
s t
o
a
c
t
i
o
n
1
.
9
6
0
.
2
7
3
.
6
5
0
.
0
2
2
I
n
d
i
r
e
c
t
e
f
f
e
c
t
s
S
e
l
f
-
e
f
f
i
c
a
c
y
K
n
o
w
l
e
d
g
e
2
.
2
5
0
.
9
5
3
.
5
4
0
.
0
0
1
P
e
r
c
e
i
v
e
d
t
h
r
e
a
t
s
P
e
r
c
e
i
v
e
d
su
sc
e
p
t
i
b
i
l
i
t
y
2
.
0
1
0
.
7
8
3
.
2
4
0
.
0
0
1
P
e
r
c
e
i
v
e
d
t
h
r
e
a
t
s
P
e
r
c
e
i
v
e
d
se
v
e
r
i
t
y
0
.
9
1
0
.
0
1
1
.
8
1
0
.
0
4
5
N
o
b
serv
a
t
i
o
n
=
1
0
3
d
f
=
1
1
A
I
C
=
3
1
0
.
1
9
B
I
C
=
3
3
9
.
1
7
T
h
is
s
tu
d
y
ex
p
an
d
s
th
e
HB
M,
a
th
eo
r
etica
l
f
r
am
ewo
r
k
to
elu
cid
ate
an
d
f
o
r
ec
ast
h
ea
lth
-
r
elat
ed
b
eh
av
io
r
.
HB
M
o
r
ig
in
ated
f
r
o
m
th
e
r
ec
o
g
n
itio
n
th
at
h
ea
lth
is
s
u
es
ar
e
d
ef
in
ed
b
y
th
e
in
a
b
ilit
y
o
f
p
eo
p
le
o
r
co
m
m
u
n
ities
to
p
r
ev
en
t
o
r
tr
ea
t
d
is
ea
s
es
ef
f
e
ctiv
ely
.
W
i
th
in
th
e
f
r
am
ewo
r
k
o
f
th
is
r
esear
ch
,
th
e
HB
M
is
em
p
lo
y
ed
t
o
f
o
r
ec
ast
th
e
co
n
d
u
ct
o
f
f
em
ale
a
d
o
lescen
ts
in
av
o
id
in
g
an
em
ia.
T
h
e
p
ath
way
an
aly
s
is
r
ev
ea
led
b
o
t
h
d
ir
ec
t
an
d
in
d
ir
ec
t
ef
f
ec
ts
o
f
HB
M
co
m
p
o
n
en
ts
o
n
th
e
b
e
h
av
io
r
o
f
f
e
m
ale
ad
o
le
s
ce
n
ts
in
p
r
ev
en
tin
g
an
em
ia.
3
.
3
.
Dire
ct
e
f
f
ec
t
s
3
.
3
.
1
.
Co
rr
ela
t
io
n bet
wee
n per
ce
iv
ed
t
hrea
t
a
nd
a
nem
ia
prev
ent
io
n beha
v
io
r
in f
em
a
le
a
do
lescent
s
T
h
is
s
tu
d
y
s
h
o
ws
a
d
ir
ec
t
a
n
d
p
o
s
itiv
e
ef
f
ec
t
of
p
er
ce
iv
e
d
th
r
ea
t
an
d
an
em
ia
p
r
ev
e
n
tio
n
b
eh
av
io
r
.
T
h
e
th
r
ea
t
p
er
ce
p
tio
n
will
m
o
tiv
ate
an
in
d
iv
id
u
al
to
ad
o
p
t
p
r
ev
en
tiv
e
m
ea
s
u
r
es
o
r
th
er
a
p
eu
ti
c
ac
tio
n
s
[
3
0
]
.
T
h
e
p
er
ce
p
tio
n
o
f
th
r
ea
t
ca
n
also
s
tim
u
late
th
e
d
ev
elo
p
m
en
t
o
f
h
ea
lth
m
o
tiv
atio
n
in
in
d
i
v
id
u
al
s
.
Similar
ly
,
a
lac
k
o
f
awa
r
en
ess
o
f
th
e
d
a
n
g
er
p
o
s
ed
b
y
an
illn
ess
will
r
esu
lt
in
in
ad
eq
u
ate
in
d
iv
id
u
al
ac
ti
o
n
s
co
n
ce
r
n
i
n
g
th
e
p
r
ev
en
tio
n
an
d
tr
ea
tm
en
t
o
f
t
h
e
d
is
ea
s
e
[
3
1
]
.
T
h
r
ea
t
p
er
ce
p
tio
n
in
th
is
s
tu
d
y
p
er
tain
s
to
th
e
p
er
s
p
ec
tiv
e
o
f
f
em
ale
ad
o
lescen
ts
ab
o
u
t
th
e
id
en
tifie
d
th
r
ea
t
ass
o
ciate
d
w
ith
an
em
ia.
T
h
e
f
in
d
in
g
s
in
d
i
ca
ted
a
d
im
in
is
h
ed
p
er
ce
p
tio
n
o
f
th
r
ea
t,
lead
in
g
to
in
ad
eq
u
ate
co
n
d
u
ct
in
p
r
e
v
en
tin
g
an
em
ia,
b
ec
au
s
e
it
r
ed
u
ce
s
th
e
s
en
s
e
o
f
u
r
g
en
c
y
o
r
im
p
o
r
tan
ce
ad
o
lescen
ts
attac
h
to
en
g
a
g
in
g
in
p
r
ev
en
tiv
e
b
eh
av
io
r
s
.
W
h
en
ad
o
lescen
ts
d
o
n
'
t
f
u
lly
ap
p
r
ec
iate
th
e
r
is
k
s
an
d
s
er
io
u
s
n
ess
o
f
an
em
ia,
th
ey
a
r
e
less
lik
ely
to
tak
e
p
r
o
ac
tiv
e
s
tep
s
t
o
av
o
id
o
r
m
an
ag
e
th
e
co
n
d
itio
n
.
On
th
e
c
o
n
tr
ar
y
,
a
p
r
ev
i
o
u
s
s
tu
d
y
h
as
p
r
o
v
en
th
at
p
er
ce
iv
e
d
t
h
r
ea
t
d
o
es
n
o
t
f
u
lly
c
o
r
r
elate
with
an
em
ia
p
r
ev
en
tio
n
b
eh
a
v
io
r
d
u
e
to
a
lim
ited
s
en
s
e
o
f
u
r
g
en
cy
,
wh
ich
lead
s
to
a
lack
o
f
u
r
g
e
n
cy
to
ad
o
p
t
h
ea
lth
y
b
eh
av
io
r
[
3
2
]
.
Ad
d
itio
n
ally
,
f
ea
r
o
f
m
e
d
ical
in
ter
v
en
tio
n
ca
n
also
p
r
ev
en
t
ad
o
lescen
ts
f
r
o
m
en
g
ag
in
g
in
ef
f
ec
tiv
e
p
r
ev
en
tio
n
b
eh
av
i
o
r
s
,
as
well
as
c
u
ltu
r
al
a
n
d
s
o
cial
n
o
r
m
s
,
wh
ich
ar
e
also
r
e
g
ar
d
ed
as
a
f
ac
t
o
r
t
h
at
m
ak
es
it d
if
f
icu
lt f
o
r
ad
o
lesce
n
ts
to
p
r
io
r
itize
an
em
ia
p
r
ev
e
n
t,
ev
en
if
th
e
y
r
ec
o
g
n
ize
a
n
em
ia
as a
th
r
ea
t
[
3
3
]
.
3
.
3
.
2
.
Co
rr
ela
t
io
n bet
wee
n per
ce
iv
ed
benef
it
s
a
nd
a
nem
ia
prev
ent
io
n beha
v
io
r
in f
e
m
a
le
a
do
lescent
s
T
h
is
s
tu
d
y
s
h
o
ws a
d
ir
ec
t a
n
d
p
o
s
itiv
e
ef
f
ec
t
of
p
er
ce
iv
e
d
b
e
n
ef
its
an
d
th
e
im
p
lem
en
tatio
n
o
f
an
em
i
a
p
r
ev
en
tio
n
b
e
h
av
io
r
.
Per
ce
iv
e
d
b
e
n
ef
its
in
d
icate
a
n
in
d
iv
id
u
al'
s
s
u
b
jectiv
e
ass
es
s
m
en
t
o
f
th
e
a
d
v
an
tag
es
o
r
b
en
ef
its
ex
p
er
ien
ce
d
wh
e
n
m
itig
atin
g
th
e
r
is
k
o
f
a
d
is
ea
s
e
[
3
4
]
.
T
h
is
p
er
s
p
ec
tiv
e
m
o
tiv
ates
in
d
iv
id
u
als
to
co
n
tem
p
late
th
e
ad
v
a
n
tag
es
o
f
im
p
lem
en
tin
g
s
tr
ateg
ies
to
av
o
id
an
em
ia.
An
in
d
iv
id
u
al
wil
l
ex
ec
u
te
a
c
o
u
r
s
e
o
f
ac
tio
n
if
th
ey
p
er
ce
iv
e
th
e
b
en
ef
its
o
f
s
u
ch
an
ac
tiv
ity
.
I
n
th
e
ca
s
e
o
f
p
r
ev
e
n
tin
g
an
em
ia,
if
ad
o
lescen
ts
d
o
n
’
t
r
ec
o
g
n
ize
th
e
b
e
n
ef
its
o
f
p
r
ev
e
n
tio
n
,
th
ey
m
ay
n
o
t
b
e
m
o
tiv
at
ed
to
tak
e
th
e
n
ec
ess
ar
y
s
tep
s
t
o
av
o
id
o
r
m
a
n
ag
e
th
e
co
n
d
itio
n
.
T
h
is
h
ap
p
en
s
as
ad
o
lescen
ts
m
ay
n
o
t
s
ee
th
e
v
alu
e
in
m
a
k
in
g
ch
an
g
es
to
t
h
e
ir
d
iet,
life
s
ty
le,
o
r
h
ea
lth
b
eh
av
io
r
s
.
Per
ce
iv
ed
b
en
ef
its
in
th
is
s
tu
d
y
p
er
tain
to
f
em
ale
ad
o
lescen
ts
'
p
e
rc
e
p
ti
o
n
s
r
eg
ar
d
in
g
th
e
ad
v
an
tag
es
o
f
ad
o
p
tin
g
h
ea
lth
y
b
eh
av
io
r
s
to
p
r
ev
en
t
an
em
i
a.
T
h
e
f
in
d
in
g
s
in
d
icate
d
th
at
f
em
ale
ad
o
lescen
ts
lack
ed
awa
r
en
ess
o
f
th
e
b
en
ef
its
o
f
en
g
ag
in
g
i
n
an
em
ia
p
r
ev
en
tio
n
b
eh
a
v
io
r
.
I
t
s
ig
n
i
f
ican
tly
in
f
lu
en
ce
s
in
ad
eq
u
ate
b
eh
av
i
o
r
in
av
o
id
i
n
g
an
em
ia
.
T
h
e
lik
elih
o
o
d
o
f
f
em
ale
ad
o
lescen
ts
in
g
esti
n
g
ir
o
n
tab
lets
is
h
ig
h
e
r
wh
en
th
ey
p
er
ce
iv
e
t
h
e
ad
v
an
t
ag
es
o
f
s
u
ch
ta
b
lets
co
m
p
ar
e
d
to
ad
o
lescen
ts
wh
o
d
o
n
o
t
s
h
ar
e
th
is
p
er
ce
p
tio
n
.
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
Dete
r
min
a
n
t fa
cto
r
s
o
f a
n
emia
p
r
ev
en
tio
n
b
eh
a
vio
r
a
mo
n
g
fema
le
…
(
Ma
r
ia
P
a
u
la
Ma
r
la
N
a
h
a
k
)
1725
Ho
wev
er
,
p
r
e
v
io
u
s
s
tu
d
y
s
u
g
g
ests
th
at
m
er
ely
u
n
d
er
s
tan
d
i
n
g
th
e
b
en
ef
its
o
f
p
r
ev
e
n
tio
n
is
n
o
t e
n
o
u
g
h
,
v
ar
io
u
s
s
o
cial,
p
s
y
ch
o
lo
g
ical,
a
n
d
s
tr
u
ctu
r
al
f
ac
to
r
s
m
u
s
t a
ls
o
b
e
a
d
d
r
ess
ed
to
tr
an
s
late
it in
to
ac
tio
n
[
3
5
]
.
3
.
3
.
3
.
Co
rr
ela
t
io
n bet
wee
n per
ce
iv
ed
ba
rr
ier
a
nd
a
nem
ia
prev
ent
io
n beha
v
io
r
in f
ema
le
a
do
lescent
s
Per
ce
iv
ed
b
ar
r
ier
d
ir
ec
tly
a
n
d
p
o
s
itiv
ely
co
r
r
elate
s
with
ac
t
iv
ity
aim
ed
at
p
r
ev
en
tin
g
a
n
e
m
ia.
T
h
e
p
er
ce
p
tio
n
o
f
b
ar
r
ier
s
is
d
er
iv
ed
f
r
o
m
p
er
s
o
n
al
v
iewp
o
in
ts
o
f
o
b
s
tacle
s
to
ad
o
p
tin
g
h
ea
lt
h
y
life
s
ty
le
p
r
ac
tices
[
3
4
]
.
Po
ten
tial
o
b
s
tacle
s
to
tak
in
g
ac
tio
n
m
a
y
m
an
if
est
as
u
n
p
leasan
t
em
o
tio
n
s
o
r
d
is
co
m
f
o
r
t
ex
p
er
ien
ce
d
d
u
r
in
g
t
r
ea
tm
en
t
an
d
s
en
tim
e
n
ts
o
f
r
ejec
tio
n
.
Fu
r
th
er
m
o
r
e,
o
b
s
tacle
s
m
ig
h
t
m
an
if
est
as
f
in
an
cial
h
u
r
d
les
(
s
u
ch
as
tr
ea
tm
en
t
ex
p
e
n
s
es)
an
d
te
m
p
o
r
al
o
b
s
tacle
s
(
s
u
ch
as
th
e
t
im
e
s
p
en
t
u
n
d
er
g
o
in
g
tr
ea
tm
e
n
t
o
r
ac
ce
s
s
in
g
h
ea
lth
s
er
v
ices
th
at
h
in
d
er
p
r
o
d
u
ctiv
ity
)
.
B
ar
r
ier
s
m
ay
s
o
m
etim
es
m
an
if
est
a
s
ac
u
te
em
o
tio
n
al
d
is
tr
ess
ex
p
er
ien
ce
d
d
u
r
in
g
m
ed
ical
tr
ea
tm
en
t
[
3
6
]
.
T
h
is
s
tu
d
y
'
s
p
er
ce
p
tio
n
o
f
b
a
r
r
ier
s
r
elate
s
to
h
o
w
f
em
ale
a
d
o
lescen
ts
p
er
ce
iv
e
f
ac
to
r
s
h
in
d
er
in
g
th
e
im
p
lem
en
tatio
n
o
f
an
em
ia
p
r
e
v
en
tio
n
b
eh
av
io
r
.
T
h
e
id
en
tifie
d
b
ar
r
ier
s
co
m
p
r
is
e
b
o
t
h
s
itu
atio
n
al
an
d
em
o
tio
n
al
ch
allen
g
es
r
elate
d
t
o
th
e
co
n
s
u
m
p
tio
n
o
f
ir
o
n
s
u
p
p
lem
e
n
ts
an
d
p
a
r
ticip
atio
n
in
p
h
y
s
ical
ac
tiv
ity
,
as
well
as
s
tr
u
ctu
r
al
co
n
s
tr
ain
ts
,
in
clu
d
in
g
lim
ited
tim
e,
in
s
u
f
f
icien
t
f
in
an
cial
r
eso
u
r
ce
s
to
ac
c
ess
h
o
s
p
ital
-
b
ased
h
em
o
g
lo
b
in
test
in
g
,
an
d
t
h
e
co
n
s
id
er
ab
le
d
is
tan
ce
b
etwe
en
p
ar
ticip
an
ts
’
r
esid
en
ce
s
a
n
d
h
ea
lth
ca
r
e
f
ac
ilit
ies
.
A
lack
o
f
p
er
ce
iv
e
d
b
ar
r
ier
s
ca
n
p
ar
ad
o
x
ically
lead
to
in
ad
eq
u
ate
co
n
d
u
ct
in
p
r
e
v
en
tin
g
a
n
e
m
ia
b
ec
au
s
e
it
m
ay
f
o
s
ter
a
s
en
s
e
o
f
c
o
m
p
lace
n
cy
,
o
v
er
co
n
f
id
en
ce
,
an
d
a
n
u
n
d
er
esti
m
atio
n
o
f
th
e
e
f
f
o
r
t
r
eq
u
i
r
ed
.
W
ith
o
u
t
r
ec
o
g
n
izin
g
th
e
ch
allen
g
es
an
d
co
m
p
lex
ities
in
v
o
l
v
ed
in
c
o
n
s
is
ten
t
p
r
ev
en
tio
n
b
e
h
av
io
r
s
,
ad
o
lescen
ts
m
ay
f
ail
to
en
g
a
g
e
with
th
e
ac
tio
n
s
n
e
ed
ed
to
m
ain
tain
ir
o
n
lev
els,
u
ltima
tely
n
eg
lectin
g
cr
itical
s
tep
s
in
m
an
ag
i
n
g
an
em
ia.
Ho
wev
e
r
,
cu
ltu
r
al
an
d
f
am
ilial
p
r
ac
tices
an
d
p
r
e
f
er
en
ce
s
ca
n
also
p
lay
a
s
ig
n
i
f
ican
t
r
o
le
in
d
eter
m
in
i
n
g
b
eh
av
io
r
[
3
7
]
.
E
v
e
n
wh
e
n
a
d
o
lescen
ts
p
er
ce
iv
e
t
h
e
b
ar
r
ier
s
,
th
ey
m
ay
n
o
t
h
av
e
th
e
p
o
wer
o
r
au
to
n
o
m
y
to
ch
an
g
e
th
eir
b
eh
a
v
io
r
s
,
esp
ec
i
ally
if
th
eir
f
am
ilies
d
o
n
o
t p
r
i
o
r
itize
o
r
u
n
d
er
s
tan
d
an
em
ia
p
r
ev
en
tio
n
.
3
.
3
.
4
.
Co
rr
ela
t
io
n
bet
wee
n
s
elf
-
ef
f
ica
cy
a
nd
eng
a
g
em
ent
in
a
nem
ia
prev
ent
io
n
beha
v
io
r
a
m
o
ng
f
e
m
a
le
a
do
lescent
s
T
h
is
s
tu
d
y
s
h
o
ws
a
d
ir
ec
t
a
n
d
p
o
s
itiv
e
co
r
r
elatio
n
b
etwe
en
s
elf
-
ef
f
icac
y
a
n
d
a
n
em
ia
p
r
ev
en
tio
n
b
eh
av
io
r
.
Self
-
ef
f
icac
y
r
e
f
er
s
to
an
in
d
iv
id
u
al'
s
co
n
f
id
en
ce
in
ac
co
m
p
lis
h
in
g
a
task
[
3
8
]
.
M
o
s
t
in
d
iv
id
u
als
will
n
o
t
tak
e
ac
tio
n
o
r
attem
p
t
to
ac
co
m
p
lis
h
s
o
m
eth
in
g
n
o
v
el
with
o
u
t
co
n
f
id
e
n
ce
in
th
eir
ab
ilit
y
.
I
f
an
in
d
iv
id
u
al
o
r
g
r
o
u
p
b
eliev
es
t
h
at
ad
o
p
tin
g
a
n
ew
h
ab
it
will
y
ield
f
a
v
o
r
a
b
le
o
r
ad
v
a
n
tag
eo
u
s
o
u
tco
m
es
,
b
u
t
t
h
ey
e
x
p
er
ien
ce
a
s
en
s
e
o
f
in
ca
p
ac
ity
,
t
h
e
tr
an
s
f
o
r
m
atio
n
p
r
o
ce
s
s
will r
em
ain
elu
s
iv
e
[
3
4
]
.
T
h
is
s
tu
d
y
d
ef
in
es
s
elf
-
e
f
f
ica
cy
as
th
e
co
n
f
id
en
ce
lev
el
a
m
o
n
g
f
em
ale
ad
o
lescen
ts
in
co
n
s
is
ten
tly
ea
tin
g
b
r
ea
k
f
ast,
ex
er
cisi
n
g
r
e
g
u
lar
ly
,
c
o
n
s
u
m
in
g
p
r
o
tei
n
-
r
ic
h
f
o
o
d
s
,
tak
in
g
ir
o
n
tab
lets
s
u
p
p
lied
b
y
th
e
h
ea
lth
ce
n
ter
,
m
o
n
ito
r
in
g
t
h
eir
a
n
em
ia
s
tatu
s
,
an
d
in
d
ep
e
n
d
en
tly
p
u
r
ch
asin
g
ir
o
n
p
ills
.
T
h
e
s
tu
d
y
f
in
d
in
g
s
in
d
icate
d
th
at
f
em
ale
ad
o
lescen
ts
h
ad
l
o
w
s
elf
-
co
n
f
id
e
n
ce
,
lead
in
g
t
o
in
ad
eq
u
ate
b
eh
a
v
io
r
i
n
p
r
e
v
en
tin
g
an
em
ia.
L
o
w
s
elf
-
co
n
f
id
en
ce
ca
n
s
ig
n
if
ica
n
tly
im
p
ac
t
an
ad
o
lescen
t’
s
ab
ilit
y
to
en
g
ag
e
in
b
eh
av
io
r
s
t
h
at
p
r
ev
en
t
an
em
ia
b
ec
au
s
e
it
u
n
d
er
m
i
n
es
th
eir
b
elief
in
th
eir
o
wn
ab
ilit
y
to
s
u
cc
ee
d
.
T
h
is
lack
o
f
s
elf
-
b
elief
lead
s
to
av
o
id
an
ce
,
in
ac
tio
n
,
f
ea
r
o
f
f
ailu
r
e,
an
d
d
i
f
f
icu
lty
in
o
v
e
r
co
m
in
g
ch
allen
g
es,
all
o
f
wh
ich
co
n
tr
ib
u
te
to
in
ad
eq
u
ate
ef
f
o
r
ts
in
p
r
e
v
en
tin
g
an
em
ia.
Stre
n
g
th
en
in
g
s
elf
-
c
o
n
f
id
e
n
ce
,
th
r
o
u
g
h
ed
u
ca
tio
n
,
s
u
p
p
o
r
t,
an
d
en
c
o
u
r
ag
em
en
t,
ca
n
h
elp
ad
o
lescen
ts
tak
e
m
o
r
e
p
r
o
ac
ti
v
e
an
d
c
o
n
s
is
ten
t
s
tep
s
in
m
an
ag
in
g
a
n
d
p
r
ev
en
tin
g
an
em
i
a.
On
th
e
co
n
tr
ar
y
,
wh
ile
s
elf
-
ef
f
icac
y
is
im
p
o
r
tan
t
f
o
r
m
o
tiv
atin
g
h
ea
lth
b
eh
a
v
io
r
,
it
d
o
es
n
o
t
alwa
y
s
g
u
ar
an
te
e
th
at
a
n
a
d
o
lescen
t
will
f
o
llo
w
th
r
o
u
g
h
o
n
p
r
e
v
e
n
tiv
e
ac
tio
n
s
lik
e
m
an
ag
in
g
an
em
ia.
E
x
ter
n
al
f
ac
to
r
s
s
u
ch
as
en
v
ir
o
n
m
e
n
tal
in
f
lu
en
ce
s
,
s
o
cial
p
r
ess
u
r
es,
co
g
n
itiv
e
ch
allen
g
es,
an
d
lack
o
f
s
u
p
p
o
r
t
[
3
9
]
ca
n
all
p
lay
a
r
o
le
in
h
in
d
er
in
g
th
e
tr
an
s
latio
n
o
f
s
elf
-
ef
f
icac
y
in
t
o
b
eh
a
v
io
r
.
3
.
3
.
5
.
Co
rr
ela
t
io
n bet
wee
n c
ues
t
o
a
ct
io
n a
nd
a
nem
ia
pre
v
ent
iv
e
beha
v
io
r
in
f
ema
le
a
do
lescent
s
C
u
es to
ac
tio
n
ar
e
d
ir
ec
tly
an
d
p
o
s
itiv
ely
ass
o
ciate
d
with
b
eh
av
io
r
aim
ed
at
p
r
e
v
en
tin
g
a
n
e
m
ia.
C
u
es
to
ac
tio
n
ar
is
e
f
r
o
m
in
d
iv
id
u
a
ls
o
r
s
itu
atio
n
s
th
at
s
er
v
e
as
th
e
p
r
im
ar
y
m
o
tiv
atio
n
f
o
r
in
d
iv
id
u
als
to
m
o
d
if
y
th
eir
h
ab
its
[
3
6
]
.
Un
d
e
r
th
e
co
n
tex
t
o
f
th
is
s
tu
d
y
,
cu
es
to
ac
tio
n
ar
e
g
iv
en
r
e
g
ar
d
in
g
th
e
f
a
cto
r
s
th
at
m
o
tiv
ate
f
em
ale
ad
o
lescen
ts
to
en
g
ag
e
in
an
em
ia
p
r
ev
en
tio
n
b
e
h
av
i
o
r
.
T
h
e
cu
es
to
ac
tio
n
ar
e
d
er
iv
ed
f
r
o
m
p
a
r
en
ts
,
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als,
an
d
p
ee
r
s
.
T
h
e
s
tu
d
y
f
i
n
d
in
g
s
in
d
icate
d
a
d
ef
icien
cy
in
p
r
o
m
p
ts
f
o
r
ac
tio
n
,
wh
ich
r
esu
lted
in
i
n
ad
eq
u
ate
co
n
d
u
ct
d
u
r
i
n
g
t
h
e
p
r
ev
en
tio
n
o
f
a
n
e
m
ia
am
o
n
g
f
e
m
ale
ad
o
lescen
ts
.
A
lack
o
f
p
r
o
m
p
ts
f
o
r
ac
tio
n
ca
n
r
esu
lt
in
in
ad
e
q
u
ate
b
eh
av
i
o
r
in
p
r
e
v
en
tin
g
an
em
ia
am
o
n
g
f
e
m
ale
ad
o
lescen
ts
b
ec
au
s
e
th
ese
p
r
o
m
p
ts
ac
t
as
im
p
o
r
tan
t
m
o
tiv
ato
r
s
,
r
em
in
d
er
s
,
an
d
s
u
p
p
o
r
t
s
y
s
tem
s
f
o
r
tak
in
g
n
ec
ess
ar
y
h
ea
lth
ac
tio
n
s
.
W
ith
o
u
t
r
em
in
d
er
s
o
r
cu
es,
a
d
o
lescen
ts
ar
e
less
lik
ely
to
r
e
m
em
b
er
o
r
p
r
io
r
itize
p
r
e
v
en
ti
v
e
b
eh
a
v
io
r
s
s
u
ch
as
ea
tin
g
ir
o
n
-
r
ich
f
o
o
d
s
o
r
tak
i
n
g
s
u
p
p
lem
e
n
ts
,
wh
ich
ca
n
le
ad
to
m
is
s
ed
o
p
p
o
r
tu
n
ities
f
o
r
an
em
ia
p
r
ev
e
n
tio
n
an
d
in
ad
e
q
u
ate
co
n
d
u
ct
i
n
m
a
n
ag
in
g
t
h
e
co
n
d
itio
n
.
Ho
wev
er
,
th
e
p
r
e
v
io
u
s
s
tu
d
y
h
as
f
o
u
n
d
t
h
at
wh
ile
cu
es
t
o
ac
tio
n
,
lik
e
h
ea
lth
r
e
m
in
d
er
s
o
r
ex
ter
n
al
tr
ig
g
er
s
,
h
a
v
e
th
e
p
o
te
n
tial
to
p
r
o
m
p
t
b
eh
a
v
io
r
al
c
h
an
g
e
,
th
e
y
d
o
n
’
t
alwa
y
s
lead
to
a
n
em
ia
p
r
ev
en
tio
n
b
e
h
av
io
r
in
ad
o
lescen
ts
d
u
e
to
a
v
ar
iet
y
o
f
f
ac
to
r
s
.
T
h
ese
f
ac
to
r
s
in
clu
d
e
lim
ited
p
er
s
o
n
al
r
elev
a
n
ce
,
en
v
ir
o
n
m
e
n
tal
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
7
2
0
-
1
7
2
9
1726
b
ar
r
ier
s
,
s
o
cial
in
f
lu
en
ce
s
,
lac
k
o
f
u
n
d
er
s
tan
d
i
n
g
,
an
d
th
e
a
d
o
lescen
t’
s
d
ev
el
o
p
m
en
tal
s
tag
e
[
3
4
]
,
[
3
7
]
.
T
o
b
e
ef
f
ec
tiv
e,
cu
es
to
ac
tio
n
n
ee
d
to
b
e
well
-
tim
ed
,
p
er
s
o
n
alize
d
,
an
d
ac
co
m
p
an
ied
b
y
s
u
p
p
o
r
t
iv
e
s
tr
u
ctu
r
es
(
lik
e
ac
ce
s
s
to
r
eso
u
r
ce
s
an
d
s
o
cial
s
u
p
p
o
r
t)
t
h
at
h
elp
a
d
o
lescen
ts
ac
t o
n
th
em
.
3
.
4
.
I
nd
irec
t
e
f
f
ec
t
3
.
4
.
1
.
Co
rr
ela
t
io
n bet
wee
n kno
wledg
e
a
nd
a
nem
ia
prev
e
ntiv
e
beha
v
io
r
in f
em
a
le
a
do
lescent
s
Kn
o
wled
g
e
is
in
d
ir
ec
tly
co
r
r
elate
d
to
an
e
m
ia
p
r
e
v
en
tio
n
b
eh
av
io
r
th
r
o
u
g
h
s
elf
-
ef
f
icac
y
.
An
em
ia
k
n
o
wled
g
e
with
in
th
e
co
n
te
x
t
o
f
f
em
ale
ad
o
lescen
ts
p
er
tain
s
to
th
eir
co
m
p
r
eh
en
s
io
n
o
f
th
e
d
ef
in
itio
n
,
in
d
icatio
n
s
,
an
d
m
an
if
estatio
n
s
o
f
an
em
ia
an
d
th
e
n
ec
ess
ar
y
m
ea
s
u
r
es
to
av
o
id
an
em
ia.
T
h
e
p
r
e
v
io
u
s
s
tu
d
y
in
d
icate
d
th
at
a
h
ig
h
lev
el
o
f
k
n
o
wled
g
e
will
en
h
a
n
ce
s
elf
-
ef
f
icac
y
[
4
0
]
.
T
h
is
s
tu
d
y
'
s
f
in
d
in
g
s
s
h
o
w
t
h
at
ac
q
u
ir
in
g
a
co
m
p
r
eh
en
s
iv
e
u
n
d
er
s
tan
d
i
n
g
o
f
an
em
ia
co
r
r
elate
s
with
th
e
lev
el
o
f
s
el
f
-
ass
u
r
an
ce
am
o
n
g
ad
o
lescen
ts
to
en
g
a
g
e
in
an
e
m
ia
p
r
ev
e
n
tio
n
ac
tiv
ities
.
I
t
p
r
o
v
id
es
ad
o
lescen
ts
with
th
e
k
n
o
wled
g
e
an
d
to
o
ls
th
ey
n
ee
d
to
ta
k
e
p
r
o
ac
tiv
e
s
tep
s
to
war
d
p
r
ev
en
tio
n
.
T
h
is
lev
el
o
f
u
n
d
e
r
s
tan
d
in
g
f
o
s
ter
s
s
elf
-
ass
u
r
an
ce
b
y
b
o
o
s
tin
g
th
eir
c
o
n
f
i
d
en
ce
in
th
eir
ab
ilit
y
to
tak
e
ac
tio
n
,
o
v
e
r
c
o
m
e
o
b
s
tac
les,
an
d
m
a
k
e
in
f
o
r
m
ed
d
ec
is
io
n
s
.
As
th
ey
g
ai
n
in
s
ig
h
t
in
to
h
o
w
an
em
ia
d
ev
elo
p
s
,
h
o
w
to
p
r
e
v
e
n
t
it,
an
d
wh
y
it
m
atter
s
,
ad
o
lescen
ts
f
ee
l
m
o
r
e
em
p
o
wer
ed
a
n
d
ca
p
ab
le
o
f
m
a
n
ag
in
g
th
ei
r
h
ea
lth
,
wh
ic
h
lead
s
to
a
g
r
ea
ter
co
m
m
itm
en
t
to
p
r
ev
en
tiv
e
b
eh
av
io
r
s
an
d
a
h
i
g
h
er
lev
el
o
f
s
elf
-
ef
f
icac
y
.
Ho
wev
er
,
wh
ile
k
n
o
wled
g
e
is
ess
en
tial
f
o
r
an
em
ia
p
r
ev
e
n
tio
n
,
it
d
o
es
n
o
t
au
to
m
atica
lly
le
ad
to
h
ig
h
s
elf
-
ef
f
icac
y
.
Self
-
ef
f
icac
y
is
s
h
ap
ed
b
y
a
co
m
b
in
atio
n
o
f
p
er
s
o
n
al
co
n
f
id
en
ce
,
e
n
v
ir
o
n
m
en
tal
f
ac
to
r
s
,
s
o
cial
in
f
lu
en
ce
s
,
an
d
e
m
o
tio
n
al
wel
l
-
b
ein
g
[3
9
]
,
[
4
1
]
.
Ad
o
lescen
t
s
m
ay
p
o
s
s
ess
th
e
k
n
o
wled
g
e
to
p
r
ev
en
t
a
n
em
ia,
b
u
t
th
eir
b
elief
in
th
eir
a
b
ilit
y
to
ac
t
o
n
th
at
k
n
o
wled
g
e
i
s
in
f
lu
en
ce
d
b
y
f
ac
to
r
s
s
u
ch
as
lack
o
f
s
u
p
p
o
r
t,
em
o
tio
n
al
s
tate,
an
d
p
er
s
o
n
al
cir
cu
m
s
tan
ce
s
.
3
.
4
.
2
.
Co
rr
ela
t
i
o
n
bet
wee
n
perc
eiv
ed
s
us
ce
pti
bil
it
y
a
nd
a
nem
ia
prev
ent
iv
e
be
ha
v
io
r
in
f
ema
le
a
do
lescent
s
T
h
is
s
tu
d
y
s
h
o
ws
th
at
p
er
ce
iv
ed
s
u
s
ce
p
tib
ilit
y
is
in
d
ir
ec
tly
ass
o
ciate
d
with
an
em
ia
p
r
ev
en
tio
n
b
eh
av
io
r
th
r
o
u
g
h
p
er
ce
iv
e
d
th
r
ea
t.
Per
ce
p
tio
n
o
f
v
u
ln
er
ab
ilit
y
is
th
e
p
er
s
o
n
al
ass
ess
m
en
t
m
ad
e
b
y
an
in
d
iv
id
u
a
l
r
eg
ar
d
in
g
a
d
eter
io
r
atio
n
in
th
eir
h
ea
lth
s
tatu
s
o
r
th
e
lik
elih
o
o
d
o
f
ac
q
u
ir
in
g
a
d
is
ea
s
e
[
2
9
]
,
[
3
4
]
.
T
h
er
e
is
a
p
o
s
itiv
e
co
r
r
elatio
n
b
etwe
en
t
h
e
p
er
ce
iv
e
d
th
r
ea
t
an
d
t
h
e
wi
llin
g
n
ess
o
f
an
i
n
d
iv
id
u
al
to
p
ar
ticip
ate
in
ac
tio
n
aim
ed
at
r
ed
u
cin
g
t
h
at
r
is
k
.
An
d
co
n
v
er
s
ely
.
T
h
er
e
ex
is
ts
an
i
n
v
er
s
e
r
elatio
n
s
h
ip
b
etwe
en
th
e
p
er
ce
iv
e
d
v
u
ln
er
ab
ilit
y
o
f
a
d
is
ea
s
e
an
d
th
e
lev
el
o
f
p
r
ev
e
n
tiv
e
m
eth
o
d
s
im
p
lem
en
ted
[
2
9
]
,
[
3
4
]
.
T
h
is
s
tu
d
y
'
s
f
in
d
in
g
s
s
u
g
g
est
t
h
at
f
em
ale
ad
o
lescen
ts
’
p
er
c
eiv
ed
v
u
ln
e
r
ab
ilit
y
af
f
ec
ts
th
eir
p
er
ce
p
tio
n
o
f
th
e
th
r
ea
t
ass
o
ciate
d
with
a
n
em
ia.
Ad
o
lescen
ts
wh
o
v
iew
th
em
s
elv
es
as su
s
ce
p
tib
le
to
a
n
em
ia
will
h
eig
h
ten
th
eir
im
p
r
ess
io
n
o
f
th
e
th
r
ea
t
r
elate
d
to
an
em
ia.
I
n
co
n
tr
ast,
f
em
ale
ad
o
lescen
ts
wh
o
d
o
n
o
t
s
ee
th
em
s
elv
es
as
s
u
s
ce
p
tib
le
to
a
n
em
ia
will
s
h
a
p
e
th
eir
b
elief
th
at
an
em
ia
is
n
o
t
a
d
an
g
er
o
u
s
co
n
d
itio
n
,
s
u
b
s
eq
u
en
tly
af
f
ec
tin
g
th
eir
ten
d
en
cy
t
o
en
g
a
g
e
in
i
n
ad
eq
u
ate
a
n
em
ia
p
r
e
v
en
tio
n
m
ea
s
u
r
es.
W
h
en
f
em
ale
ad
o
lescen
ts
d
o
n
o
t
s
ee
th
em
s
elv
es
as
s
u
s
ce
p
tib
le
to
a
n
em
i
a,
th
ey
ar
e
less
lik
ely
to
p
er
ce
iv
e
th
e
co
n
d
itio
n
as
a
s
e
r
io
u
s
h
ea
lth
th
r
ea
t,
lead
in
g
th
em
t
o
u
n
d
er
esti
m
ate
its
r
is
k
s
an
d
f
ail
to
tak
e
p
r
ev
en
tiv
e
ac
tio
n
s
.
T
h
is
b
elief
s
h
a
p
es
th
eir
b
eh
a
v
io
r
,
r
esu
ltin
g
in
in
ad
eq
u
ate
co
n
d
u
ct
in
an
em
ia
p
r
e
v
en
tio
n
.
I
n
c
r
e
asin
g
a
war
en
ess
o
f
s
u
s
ce
p
tib
il
ity
,
ed
u
ca
tin
g
th
em
ab
o
u
t
th
e
r
is
k
s
,
an
d
p
r
o
v
id
i
n
g
co
n
s
is
ten
t
r
em
in
d
er
s
o
f
h
o
w
p
r
ev
en
tiv
e
m
ea
s
u
r
es
ca
n
p
r
o
tect
th
eir
h
ea
lth
ar
e
k
ey
s
tr
ateg
ies in
en
co
u
r
ag
i
n
g
ad
e
q
u
ate
ac
tio
n
an
d
en
g
a
g
em
en
t in
p
r
ev
en
tio
n
b
e
h
av
io
r
s
.
On
th
e
o
th
e
r
h
a
n
d
,
p
r
io
r
r
ese
ar
ch
f
o
u
n
d
th
at
p
e
r
ce
iv
ed
s
u
s
ce
p
tib
ilit
y
d
o
es
n
o
t
alwa
y
s
c
o
r
r
elate
to
p
er
ce
iv
ed
th
r
ea
t
i
n
a
n
em
ia
p
r
ev
en
tio
n
b
eh
a
v
io
r
in
a
d
o
lescen
ts
.
W
h
ile
ad
o
lescen
ts
m
ay
ac
k
n
o
wled
g
e
th
eir
s
u
s
ce
p
tib
ilit
y
to
an
em
ia,
th
e
y
m
ay
n
o
t
alwa
y
s
p
er
ce
iv
e
it
as
a
s
ig
n
if
ican
t
t
h
r
ea
t
b
ec
au
s
e
o
f
v
ar
io
u
s
p
s
y
ch
o
lo
g
ical,
s
o
cial,
an
d
e
n
v
ir
o
n
m
e
n
tal
f
ac
to
r
s
.
T
h
ese
in
clu
d
e
a
lack
o
f
im
m
e
d
iate
s
y
m
p
to
m
s
,
co
m
p
etin
g
p
r
io
r
ities
,
em
o
tio
n
al
d
is
tan
ce
f
r
o
m
t
h
e
co
n
s
eq
u
en
ce
s
,
p
ee
r
in
f
lu
en
ce
s
,
c
o
n
f
lictin
g
in
f
o
r
m
a
tio
n
,
an
d
a
g
en
er
al
u
n
d
er
esti
m
atio
n
o
f
h
ea
lth
r
is
k
s
[
4
1
]
–
[
4
3
]
.
W
ith
o
u
t
a
s
tr
o
n
g
s
en
s
e
o
f
p
er
ce
iv
e
d
th
r
ea
t,
ad
o
le
s
ce
n
ts
m
ay
n
o
t
f
ee
l
m
o
tiv
ated
to
e
n
g
ag
e
i
n
an
em
ia
p
r
ev
en
tio
n
b
e
h
av
io
r
s
,
e
v
en
if
th
ey
k
n
o
w
th
ey
a
r
e
at
r
is
k
.
3
.
4
.
3
.
Co
rr
ela
t
i
o
n bet
wee
n per
ce
iv
ed
s
ev
er
it
y
a
nd
a
nemia
prev
ent
iv
e
beha
v
io
r
in f
e
m
a
le
a
do
lescent
s
T
h
e
p
er
ce
iv
ed
s
ev
er
ity
o
f
an
e
m
ia
is
in
d
ir
ec
tly
ass
o
ciate
d
with
an
em
ia
p
r
ev
en
tio
n
ac
tiv
i
ty
th
r
o
u
g
h
p
er
ce
iv
ed
th
r
ea
t.
Per
ce
iv
ed
s
e
v
er
ity
r
ef
er
s
to
th
e
s
u
b
jectiv
e
ass
e
s
s
m
en
t
m
ad
e
b
y
an
in
d
iv
i
d
u
al
r
e
g
ar
d
i
n
g
t
h
e
s
er
io
u
s
n
ess
o
f
an
illn
ess
[
3
6
]
.
T
h
is
co
n
ce
p
t
is
d
er
iv
ed
f
r
o
m
t
h
e
in
d
iv
id
u
al'
s
p
r
esu
m
p
tio
n
th
at
th
e
s
ev
er
ity
o
f
an
u
n
tr
ea
ted
s
ick
n
ess
d
ir
ec
tly
co
r
r
elate
s
with
th
e
m
ag
n
itu
d
e
o
f
t
h
e
th
r
ea
t th
at
m
u
s
t b
e
co
n
f
r
o
n
ted
[
3
8
]
.
Per
ce
iv
ed
s
ev
er
ity
in
th
is
s
tu
d
y
r
ef
er
s
to
th
e
d
e
g
r
ee
o
f
s
er
io
u
s
n
ess
ex
p
er
ien
ce
d
b
y
f
em
ale
a
d
o
lescen
ts
wh
en
th
ey
f
ail
to
a
d
o
p
t
a
n
em
i
a
p
r
ev
en
tio
n
b
eh
a
v
io
r
.
T
h
e
s
tu
d
y
f
in
d
i
n
g
s
in
d
icate
d
th
at
f
e
m
ale
ad
o
lescen
ts
wh
o
d
id
n
o
t
co
n
s
id
er
a
n
em
ia
a
s
er
io
u
s
ailm
en
t
h
ad
a
less
s
ev
er
e
ass
es
s
m
en
t
o
f
an
em
ia
as
a
th
r
ea
ten
in
g
illn
ess
.
C
o
n
s
eq
u
en
tly
,
th
is
r
esu
lted
in
in
ad
eq
u
ate
m
ea
s
u
r
es
to
p
r
ev
e
n
t
an
em
ia.
Fem
ale
ad
o
lescen
ts
w
h
o
d
o
n
o
t
c
o
n
s
id
er
an
em
ia
a
s
er
io
u
s
ailm
en
t ty
p
ically
h
av
e
a
less
s
ev
er
e
ass
e
s
s
m
en
t o
f
th
e
co
n
d
itio
n
b
e
ca
u
s
e
o
f
a
co
m
b
in
atio
n
o
f
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
Dete
r
min
a
n
t fa
cto
r
s
o
f a
n
emia
p
r
ev
en
tio
n
b
eh
a
vio
r
a
mo
n
g
fema
le
…
(
Ma
r
ia
P
a
u
la
Ma
r
la
N
a
h
a
k
)
1727
f
ac
to
r
s
s
u
ch
as
lac
k
o
f
v
is
ib
le
s
y
m
p
to
m
s
,
m
is
u
n
d
er
s
tan
d
in
g
o
f
its
lo
n
g
-
ter
m
co
n
s
eq
u
e
n
ce
s
,
lack
o
f
ex
p
er
ien
ce
with
s
er
io
u
s
illn
ess
,
an
d
s
o
c
ia
l
in
f
lu
en
ce
s
.
T
h
is
p
er
ce
p
tio
n
o
f
an
em
ia
as
a
m
ild
o
r
n
o
n
-
th
r
ea
ten
in
g
c
o
n
d
itio
n
d
im
in
is
h
es th
e
lik
elih
o
o
d
th
at
th
ey
will tak
e
p
r
ev
en
tiv
e
ac
tio
n
s
o
r
s
ee
k
tr
ea
tm
en
t,
as th
ey
d
o
n
’
t f
ee
l a
s
en
s
e
o
f
u
r
g
en
c
y
o
r
d
an
g
er
r
elate
d
to
th
e
co
n
d
itio
n
.
I
m
p
r
o
v
in
g
awa
r
en
e
s
s
an
d
ed
u
ca
tio
n
ab
o
u
t
an
em
ia’
s
r
is
k
s
an
d
co
n
s
eq
u
en
ce
s
is
ess
en
tial
in
s
h
if
tin
g
th
is
m
in
d
s
et
an
d
en
c
o
u
r
ag
in
g
m
o
r
e
p
r
o
ac
tiv
e
h
ea
l
th
b
eh
a
v
io
r
am
o
n
g
ad
o
lescen
ts
.
E
v
en
th
o
u
g
h
ad
o
lescen
ts
m
ay
r
ec
o
g
n
ize
t
h
e
s
ev
er
ity
o
f
an
e
m
ia,
it
d
o
es
n
o
t
alwa
y
s
lead
to
a
h
eig
h
t
en
ed
p
er
ce
p
tio
n
o
f
th
r
ea
t
o
r
m
o
tiv
at
e
th
em
to
en
g
a
g
e
in
p
r
e
v
en
tiv
e
b
eh
av
i
o
r
,
d
u
e
t
o
a
r
an
g
e
o
f
f
a
cto
r
s
,
in
clu
d
in
g
th
e
ab
s
en
ce
o
f
im
m
ed
iate
s
y
m
p
t
o
m
s
,
co
n
f
u
s
io
n
a
b
o
u
t
lo
n
g
-
ter
m
co
n
s
eq
u
en
ce
s
,
an
d
a
f
o
c
u
s
o
n
s
h
o
r
t
-
ter
m
co
n
ce
r
n
[
3
7
]
,
[
4
4
]
.
Sin
ce
a
n
em
ia
is
o
f
t
en
a
g
r
a
d
u
al
c
o
n
d
itio
n
,
ad
o
les
ce
n
ts
m
ay
n
o
t
ex
p
er
ie
n
ce
th
e
d
r
am
atic
ef
f
ec
ts
th
at
wo
u
ld
r
ei
n
f
o
r
ce
th
eir
b
elief
in
th
e
s
ev
er
ity
o
f
th
e
co
n
d
itio
n
.
W
ith
o
u
t
tan
g
ib
le
s
ig
n
s
o
f
t
h
e
c
o
n
d
itio
n
,
th
ey
m
ig
h
t
f
ail
to
p
er
ce
iv
e
a
n
em
ia
as a
n
u
r
g
en
t o
r
s
er
io
u
s
h
ea
lth
th
r
ea
t.
4.
CO
NCLU
SI
O
N
T
h
e
p
ath
a
n
aly
s
is
r
ev
ea
led
a
d
ir
ec
t
an
d
p
o
s
itiv
e
co
r
r
elati
o
n
b
etwe
en
p
er
ce
iv
ed
th
r
ea
t,
p
er
ce
iv
ed
b
en
ef
its
,
p
er
ce
iv
e
d
b
a
r
r
ier
s
,
s
elf
-
ef
f
icac
y
,
c
u
es
to
ac
tio
n
,
an
d
an
em
ia
p
r
ev
e
n
tio
n
b
eh
av
io
r
.
Acq
u
ir
in
g
k
n
o
wled
g
e
in
d
ir
ec
tly
i
n
f
lu
en
c
es
b
eh
av
io
r
t
o
p
r
e
v
en
t
an
e
m
ia
t
h
r
o
u
g
h
s
elf
-
ef
f
icac
y
.
Per
ce
iv
ed
s
u
s
ce
p
tib
ilit
y
in
d
ir
ec
tly
in
f
lu
e
n
ce
s
b
eh
a
v
io
r
to
p
r
ev
e
n
t
an
em
ia
t
h
r
o
u
g
h
t
h
e
p
er
ce
iv
e
d
th
r
ea
t.
Per
ce
i
v
e
d
s
ev
er
ity
in
d
ir
ec
tly
in
f
lu
en
ce
s
b
eh
a
v
io
r
to
p
r
e
v
en
t
an
em
ia
th
r
o
u
g
h
p
er
ce
iv
e
d
th
r
ea
t.
T
h
is
s
tu
d
y
co
n
tr
ib
u
tes
to
ad
v
a
n
cin
g
th
e
u
n
d
er
s
tan
d
in
g
o
f
th
e
u
n
d
er
ly
in
g
f
ac
to
r
s
in
f
lu
e
n
cin
g
an
em
ia
p
r
ev
en
tio
n
am
o
n
g
f
em
ale
ad
o
l
escen
ts
in
b
o
r
d
e
r
r
e
g
io
n
s
,
co
n
s
id
er
in
g
th
e
in
t
r
icate
ch
allen
g
es
in
h
er
en
t
to
th
ese
s
ettin
g
s
.
T
h
e
im
p
licatio
n
s
o
f
th
is
s
tu
d
y
s
u
g
g
est
th
at
m
u
ltif
ac
eted
in
ter
v
e
n
tio
n
s
s
h
o
u
l
d
b
e
p
u
t
in
p
lace
th
at
co
m
b
in
e
ed
u
ca
tio
n
,
em
p
o
wer
m
en
t,
o
v
er
co
m
in
g
b
ar
r
ier
s
,
an
d
in
cr
ea
s
in
g
th
e
p
er
ce
iv
ed
th
r
ea
t
an
d
s
ev
er
ity
o
f
an
em
ia,
all
o
f
wh
ich
ca
n
im
p
r
o
v
e
an
e
m
ia
p
r
ev
e
n
tio
n
b
e
h
av
io
r
am
o
n
g
f
em
ale
ad
o
lescen
ts
in
th
is
r
eg
io
n
.
Ad
d
itio
n
ally
,
f
u
tu
r
e
s
t
u
d
ies
ar
e
ex
p
ec
ted
to
u
s
e
m
ix
ed
ap
p
r
o
ac
h
es
in
m
u
ltil
ev
el
s
ettin
g
s
to
in
v
esti
g
ate
in
-
d
e
p
th
an
d
co
m
p
r
eh
e
n
s
iv
e
f
in
d
in
g
s
o
n
s
ev
er
al
f
ac
to
r
s
p
r
e
d
ictin
g
an
em
ia
p
r
ev
e
n
tiv
e
b
e
h
av
io
r
in
f
e
m
ale
ad
o
lescen
ts
in
th
e
R
I
-
R
DT
L
b
o
r
d
er
r
eg
io
n
.
ACK
NO
WL
E
DG
M
E
N
T
S
T
h
e
au
th
o
r
s
wo
u
ld
lik
e
to
th
an
k
th
e
Min
is
tr
y
o
f
Hig
h
er
E
d
u
ca
tio
n
,
Scien
ce
an
d
T
ec
h
n
o
lo
g
y
f
o
r
s
u
p
p
o
r
tin
g
th
is
s
tu
d
y
v
ia
th
e
n
o
v
ice
lectu
r
er
r
esear
ch
s
ch
em
e.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
T
h
is
s
tu
d
y
was
f
u
n
d
e
d
b
y
th
e
Min
is
tr
y
o
f
Hig
h
e
r
E
d
u
ca
tio
n
,
Scien
ce
an
d
T
ec
h
n
o
lo
g
y
(
I
DR
1
5
,
8
0
2
,
0
0
0
)
.
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
M
E
N
T
T
h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
tr
ib
u
to
r
R
o
les
T
ax
o
n
o
m
y
(
C
R
ed
iT)
to
r
ec
o
g
n
ize
in
d
iv
id
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
th
o
r
s
h
ip
d
is
p
u
tes,
an
d
f
ac
ilit
ate
co
llab
o
r
atio
n
.
Na
m
e
o
f
Aut
ho
rs
C
M
So
Va
Fo
I
R
D
O
E
Vi
Su
P
Fu
Ma
r
ia
Pau
la
Ma
r
la
Nah
ak
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Piu
s
Alm
in
d
u
L
ek
i
B
er
ek
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
C
:
C
o
n
c
e
p
t
u
a
l
i
z
a
t
i
o
n
M
:
M
e
t
h
o
d
o
l
o
g
y
So
:
So
f
t
w
a
r
e
Va
:
Va
l
i
d
a
t
i
o
n
Fo
:
Fo
r
mal
a
n
a
l
y
s
i
s
I
:
I
n
v
e
s
t
i
g
a
t
i
o
n
R
:
R
e
so
u
r
c
e
s
D
:
D
a
t
a
C
u
r
a
t
i
o
n
O
:
W
r
i
t
i
n
g
-
O
r
i
g
i
n
a
l
D
r
a
f
t
E
:
W
r
i
t
i
n
g
-
R
e
v
i
e
w
&
E
d
i
t
i
n
g
Vi
:
Vi
su
a
l
i
z
a
t
i
o
n
Su
:
Su
p
e
r
v
i
s
i
o
n
P
:
P
r
o
j
e
c
t
a
d
mi
n
i
st
r
a
t
i
o
n
Fu
:
Fu
n
d
i
n
g
a
c
q
u
i
si
t
i
o
n
CO
NF
L
I
C
T
O
F
I
N
T
E
R
E
S
T
ST
A
T
E
M
E
NT
Au
th
o
r
s
s
tate
n
o
co
n
f
lict o
f
in
t
er
est.
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
7
2
0
-
1
7
2
9
1728
I
NF
O
RM
E
D
CO
NS
E
N
T
W
e
h
av
e
o
b
tain
ed
in
f
o
r
m
ed
c
o
n
s
en
t f
r
o
m
all
in
d
iv
id
u
als in
c
lu
d
ed
in
t
h
is
s
tu
d
y
.
E
T
H
I
CAL AP
P
RO
V
AL
T
h
is
s
tu
d
y
h
as
s
u
cc
ess
f
u
lly
u
n
d
er
g
o
n
e
t
h
e
h
ea
lt
h
r
esear
ch
eth
ics
ass
es
s
m
en
t
co
n
d
u
cted
b
y
th
e
Hea
lth
R
esear
ch
E
th
ics C
o
m
m
is
s
io
n
f
r
o
m
STRADA
I
n
s
titu
te
o
f
He
alth
Scien
ce
s
,
No
.
0
0
1
9
0
6
/EC
/KE
PK/I/1
2
/2
0
2
4
.
DATA AV
AI
L
AB
I
L
I
T
Y
T
h
e
au
th
o
r
s
co
n
f
ir
m
th
at
th
e
d
ata
s
u
p
p
o
r
tin
g
th
e
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
ar
e
av
ailab
le
with
in
th
e
ar
ticle
[
an
d
/o
r
its
s
u
p
p
lem
en
tar
y
m
ater
ials
]
.
RE
F
E
R
E
NC
E
S
[
1
]
W
H
O
,
O
ri
e
n
t
a
t
i
o
n
Pr
o
g
r
a
m
m
e
o
n
A
d
o
l
e
sce
n
t
H
e
a
l
t
h
f
o
r H
e
a
l
t
h
-
c
a
re
Pro
v
i
d
e
rs
.
G
e
n
e
v
a
:
W
H
O
,
2
0
1
4
.
[
2
]
W
o
r
l
d
H
e
a
l
t
h
O
r
g
a
n
i
z
a
t
i
o
n
,
“
P
r
e
v
e
n
t
i
o
n
o
f
i
r
o
n
d
e
f
i
c
i
e
n
c
y
a
n
a
e
m
i
a
i
n
a
d
o
l
e
sc
e
n
t
s,
”
R
o
l
e
o
f
We
e
k
l
y
I
ro
n
a
n
d
Fo
l
i
c
A
c
i
d
S
u
p
l
e
m
e
n
t
a
t
i
o
n
,
p
.
5
0
,
2
0
1
1
.
[
3
]
M
.
R
.
Tu
r
a
,
G
.
Eg
a
t
a
,
S
.
G
.
F
a
g
e
,
a
n
d
K
.
T.
R
o
b
a
,
“
P
r
e
v
a
l
e
n
c
e
o
f
a
n
e
m
i
a
a
n
d
i
t
s
a
sso
c
i
a
t
e
d
f
a
c
t
o
r
s
a
mo
n
g
f
e
m
a
l
e
a
d
o
l
e
sc
e
n
t
s
i
n
A
mb
o
T
o
w
n
,
W
e
s
t
S
h
e
w
a
,
E
t
h
i
o
p
i
a
,
”
J
o
u
r
n
a
l
o
f
Bl
o
o
d
M
e
d
i
c
i
n
e
,
v
o
l
.
1
1
,
p
p
.
2
7
9
–
2
8
7
,
2
0
2
0
,
d
o
i
:
1
0
.
2
1
4
7
/
J
B
M
.
S
2
6
3
3
2
7
.
[
4
]
J.
V
.
U
p
a
d
h
y
e
a
n
d
J.
J.
U
p
a
d
h
y
e
,
“
A
ssessm
e
n
t
o
f
a
n
a
e
m
i
a
i
n
a
d
o
l
e
sce
n
t
g
i
r
l
s,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
Re
p
r
o
d
u
c
t
i
o
n
,
C
o
n
t
r
a
c
e
p
t
i
o
n
,
O
b
s
t
e
t
r
i
c
s
a
n
d
G
y
n
e
c
o
l
o
g
y
,
v
o
l
.
6
,
n
o
.
7
,
p
p
.
3
1
1
3
–
3
1
1
7
,
J
u
n
.
2
0
1
7
,
d
o
i
:
1
0
.
1
8
2
0
3
/
2
3
2
0
-
1
7
7
0
.
i
j
r
c
o
g
2
0
1
7
2
9
4
4
.
[
5
]
I
n
d
o
n
e
si
a
n
M
i
n
i
s
t
r
y
o
f
H
e
a
l
t
h
,
“
B
a
s
i
c
H
e
a
l
t
h
R
e
s
e
a
r
c
h
2
0
1
8
,
”
I
n
d
o
n
e
si
a
n
M
i
n
i
st
r
y
o
f
H
e
a
l
t
h
,
Ja
k
a
r
t
a
,
2
0
1
8
.
d
o
i
:
1
0
.
1
0
8
8
/
1
7
5
1
-
8
1
1
3
/
4
4
/
8
/
0
8
5
2
0
1
.
[
6
]
R
.
V
a
i
r
a
,
M
e
r
l
i
n
K
a
r
i
n
d
a
,
a
n
d
M
u
f
l
i
h
a
h
,
“
F
a
c
t
o
r
s
r
e
l
a
t
e
d
o
f
a
n
e
m
i
a
i
n
a
d
o
l
e
sce
n
c
e
g
i
r
l
,
”
S
c
i
e
n
c
e
Mi
d
w
i
f
e
ry
,
v
o
l
.
1
0
,
n
o
.
4
,
p
p
.
2
4
9
0
–
2
4
9
5
,
2
0
2
2
,
d
o
i
:
1
0
.
3
5
3
3
5
/
m
i
d
w
i
f
e
r
y
.
v
1
0
i
4
.
6
9
6
.
[
7
]
A
.
F
e
r
i
y
a
n
t
i
,
N
.
S
.
D
e
v
i
a
t
i
n
,
I
.
N
u
r
m
a
l
a
,
S
.
W
i
d
a
t
i
,
a
n
d
D
.
R
.
A
t
ma
k
a
,
“
D
e
t
e
r
m
i
n
a
n
t
o
f
A
d
h
e
r
e
n
c
e
t
o
i
r
o
n
s
u
p
p
l
e
m
e
n
t
a
t
i
o
n
i
n
a
d
o
l
e
sce
n
t
g
i
r
l
i
n
s
p
e
s
i
f
i
c
i
n
t
e
r
v
e
n
t
i
o
n
f
o
r
st
u
n
t
i
n
g
p
r
e
v
e
n
t
i
o
n
:
sy
s
t
e
m
a
t
i
c
r
e
v
i
e
w
,
”
Me
d
i
a
G
i
z
i
I
n
d
o
n
e
s
i
a
(
N
a
t
i
o
n
a
l
N
u
t
ri
t
i
o
n
J
o
u
rn
a
l
)
,
v
o
l
.
1
7
,
n
o
.
1
S
P
,
p
p
.
9
0
–
9
6
,
2
0
2
2
,
d
o
i
:
1
0
.
2
0
4
7
3
/
mg
i
.
v
1
7
i
1
s
p
.
9
0
-
9
6
.
[
8
]
L.
S
h
a
b
a
n
,
A
.
A
l
-
Ta
i
a
r
,
A
.
R
a
h
ma
n
,
R
.
A
l
-
S
a
b
a
h
,
a
n
d
O
.
M
o
j
i
mi
n
i
y
i
,
“
A
n
e
m
i
a
a
n
d
i
t
s
a
ss
o
c
i
a
t
e
d
f
a
c
t
o
r
s
a
m
o
n
g
A
d
o
l
e
sce
n
t
s
i
n
K
u
w
a
i
t
,
”
S
c
i
e
n
t
i
f
i
c
R
e
p
o
r
t
s
,
v
o
l
.
1
0
,
n
o
.
1
,
p
p
.
1
–
9
,
D
e
c
.
2
0
2
0
,
d
o
i
:
1
0
.
1
0
3
8
/
s4
1
5
9
8
-
020
-
6
0
8
1
6
-
7.
[
9
]
O
.
S
.
A
d
e
m
,
K
.
T
a
d
ss
e
,
a
n
d
A
.
G
e
b
r
e
me
d
h
i
n
,
“
I
r
o
n
d
e
f
i
c
i
e
n
c
y
a
n
e
a
mi
a
i
s
mo
d
e
r
a
t
e
p
u
b
l
i
c
h
e
a
l
t
h
p
r
o
b
l
e
m
a
m
o
n
g
sc
h
o
o
l
g
o
i
n
g
a
d
o
l
e
sce
n
t
g
i
r
l
s
i
n
B
e
r
a
h
l
e
D
i
s
t
r
i
c
t
,
A
f
a
r
,
N
o
r
t
h
e
a
st
E
t
h
i
o
p
i
a
,
”
J
o
u
r
n
a
l
o
f
F
o
o
d
a
n
d
N
u
t
ri
t
i
o
n
S
c
i
e
n
c
e
s
,
v
o
l
.
3
,
n
o
.
1
,
p
.
1
0
,
2
0
1
5
,
d
o
i
:
1
0
.
1
1
6
4
8
/
j
.
j
f
n
s.
2
0
1
5
0
3
0
1
.
1
2
.
[
1
0
]
F
.
A
b
r
i
s
h
a
mi
a
n
d
A
.
G
o
l
s
h
a
n
,
“
F
r
e
q
u
e
n
c
y
o
f
i
r
o
n
d
e
f
i
c
i
e
n
c
y
a
n
e
m
i
a
i
n
g
i
r
l
s
st
u
d
y
i
n
g
i
n
M
a
sh
h
a
d
h
i
g
h
s
c
h
o
o
l
s,
”
I
ra
n
i
a
n
J
o
u
r
n
a
l
o
f
Pe
d
i
a
t
r
i
c
H
e
m
a
t
o
l
o
g
y
a
n
d
O
n
c
o
l
o
g
y
,
v
o
l
.
3
,
n
o
.
4
,
p
p
.
1
4
3
–
8
,
2
0
1
3
.
[
1
1
]
J.
T
u
r
n
e
r
,
M
.
P
a
r
si
,
a
n
d
M
.
B
a
d
i
r
e
d
d
y
,
“
A
n
e
m
i
a
,
”
S
t
a
t
Pe
a
rl
s
P
u
b
l
i
s
h
i
n
g
,
n
o
.
A
u
g
u
st
8
,
p
.
1
6
,
2
0
2
5
.
[
1
2
]
T.
B
e
a
l
,
A
.
Tu
mi
l
o
w
i
c
z
,
A
.
S
u
t
r
i
s
n
a
,
D
.
I
z
w
a
r
d
y
,
a
n
d
L
.
M
.
N
e
u
f
e
l
d
,
“
A
r
e
v
i
e
w
o
f
c
h
i
l
d
s
t
u
n
t
i
n
g
d
e
t
e
r
mi
n
a
n
t
s
i
n
I
n
d
o
n
e
s
i
a
,
”
Ma
t
e
r
n
a
l
a
n
d
C
h
i
l
d
N
u
t
r
i
t
i
o
n
,
v
o
l
.
1
4
,
n
o
.
4
,
p
p
.
1
–
1
0
,
2
0
1
8
,
d
o
i
:
1
0
.
1
1
1
1
/
mcn
.
1
2
6
1
7
.
[
1
3
]
W
H
O
,
W
e
e
k
l
y
i
ro
n
a
n
d
f
o
l
i
c
a
c
i
d
s
u
p
p
l
e
m
e
n
t
a
t
i
o
n
a
s
a
n
a
n
a
e
m
i
a
-
p
re
v
e
n
t
i
o
n
s
t
ra
t
e
g
y
i
n
w
o
m
e
n
a
n
d
a
d
o
l
e
s
c
e
n
t
g
i
r
l
s:
L
e
sso
n
s
l
e
a
rn
t
f
r
o
m
i
m
p
l
e
m
e
n
t
a
t
i
o
n
o
f
p
r
o
g
r
a
m
m
e
s
a
m
o
n
g
n
o
n
-
p
r
e
g
n
a
n
t
w
o
m
e
n
o
f
rep
r
o
d
u
c
t
i
v
e
a
g
e
.
G
e
n
e
v
a
:
W
o
r
l
d
H
e
a
l
t
h
O
r
g
a
n
i
z
a
t
i
o
n
,
2
0
1
8
.
[
1
4
]
M
.
J.
R
a
h
ma
n
e
t
a
l
.
,
“
P
r
e
v
a
l
e
n
c
e
a
n
d
i
n
f
l
u
e
n
c
i
n
g
f
a
c
t
o
r
s
w
i
t
h
k
n
o
w
l
e
d
g
e
,
a
t
t
i
t
u
d
e
,
a
n
d
p
r
a
c
t
i
c
e
t
o
w
a
r
d
a
n
e
mi
a
a
mo
n
g
sc
h
o
o
l
-
g
o
i
n
g
a
d
o
l
e
sce
n
t
g
i
r
l
s
i
n
r
u
r
a
l
B
a
n
g
l
a
d
e
s
h
,
”
PLo
S
O
N
E
,
v
o
l
.
1
9
,
n
o
.
1
1
N
o
v
e
m
b
e
r
,
p
p
.
1
–
2
0
,
2
0
2
4
,
d
o
i
:
1
0
.
1
3
7
1
/
j
o
u
r
n
a
l
.
p
o
n
e
.
0
3
1
3
0
7
1
.
[
1
5
]
M
.
A
.
W
i
a
f
e
,
J.
A
y
e
n
u
,
a
n
d
D
.
E
l
i
-
C
o
p
h
i
e
,
“
A
R
e
v
i
e
w
o
f
t
h
e
R
i
s
k
F
a
c
t
o
r
s
f
o
r
I
r
o
n
D
e
f
i
c
i
e
n
c
y
A
n
a
e
mi
a
a
m
o
n
g
A
d
o
l
e
sc
e
n
t
s
i
n
D
e
v
e
l
o
p
i
n
g
C
o
u
n
t
r
i
e
s,
”
H
i
n
d
a
w
i
,
v
o
l
.
2
0
2
3
,
p
.
1
1
,
2
0
2
3
,
d
o
i
:
1
0
.
1
1
5
5
/
2
0
2
3
/
6
4
0
6
2
8
6
.
[
1
6
]
C
.
T.
C
o
h
e
n
a
n
d
J.
M
.
P
o
w
e
r
s,
“
N
u
t
r
i
t
i
o
n
a
l
s
t
r
a
t
e
g
i
e
s f
o
r
m
a
n
a
g
i
n
g
i
r
o
n
d
e
f
i
c
i
e
n
c
y
i
n
a
d
o
l
e
s
c
e
n
t
s
:
a
p
p
r
o
a
c
h
e
s
t
o
a
c
h
a
l
l
e
n
g
i
n
g
b
u
t
c
o
mm
o
n
p
r
o
b
l
e
m,
”
A
d
v
a
n
c
e
s
i
n
N
u
t
ri
t
i
o
n
,
v
o
l
.
1
5
,
n
o
.
5
,
p
.
8
,
2
0
2
4
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
a
d
v
n
u
t
.
2
0
2
4
.
1
0
0
2
1
5
.
[
1
7
]
Ju
mi
y
a
t
i
,
T.
W
a
h
y
u
W
,
A
.
K
r
i
sn
a
sar
y
,
a
n
d
R
.
Y
u
l
i
a
n
t
i
,
“
A
n
e
m
i
a
a
m
o
n
g
a
d
o
l
e
sce
n
t
g
i
r
l
s:
i
t
s
a
sso
c
i
a
t
i
o
n
w
i
t
h
p
r
o
t
e
i
n
a
n
d
i
r
o
n
in
t
a
k
e
,
”
Me
d
i
a
G
i
zi
I
n
d
o
n
e
s
i
a
(
N
a
t
i
o
n
a
l
N
u
t
ri
t
i
o
n
J
o
u
rn
a
l
)
,
v
o
l
.
1
8
,
n
o
.
1
S
P
,
p
p
.
1
4
–
2
0
,
2
0
2
3
,
d
o
i
:
1
0
.
2
0
4
7
3
/
m
g
i
.
v
1
8
i
1
s
p
.
1
4
-
2
0
.
[
1
8
]
D
.
R
.
A
t
ma
k
a
,
W
.
I
.
F
.
N
i
n
g
s
i
h
,
a
n
d
R
.
M
a
g
h
r
i
b
i
,
“
D
i
e
t
a
r
y
i
n
t
a
k
e
c
h
a
n
g
e
s
i
n
a
d
o
l
e
sce
n
t
g
i
r
l
a
f
t
e
r
i
r
o
n
d
e
f
i
c
i
e
n
c
y
a
n
e
mi
a
d
i
a
g
n
o
s
i
s,”
H
e
a
l
t
h
S
c
i
e
n
c
e
J
o
u
r
n
a
l
o
f
I
n
d
o
n
e
si
a
,
v
o
l
.
1
1
,
n
o
.
1
,
p
p
.
2
7
–
3
1
,
Ju
n
.
2
0
2
0
,
d
o
i
:
1
0
.
2
2
4
3
5
/
h
s
j
i
.
v
1
1
i
1
.
3
1
4
3
.
[
1
9
]
Y
.
I
.
B
a
l
c
i
,
A
.
K
a
r
a
b
u
l
u
t
,
D
.
G
ü
r
ses
,
a
n
d
I
.
E.
Ç
ö
v
ü
t
,
“
P
r
e
v
a
l
e
n
c
e
a
n
d
r
i
sk
f
a
c
t
o
r
s
o
f
a
n
e
m
i
a
a
mo
n
g
a
d
o
l
e
s
c
e
n
t
s
i
n
D
e
n
i
z
l
i
,
T
u
r
k
e
y
,
”
I
ra
n
i
a
n
J
o
u
r
n
a
l
o
f
Pe
d
i
a
t
ri
c
s
,
v
o
l
.
2
2
,
n
o
.
1
,
p
p
.
7
7
–
8
1
,
2
0
1
2
.
[
2
0
]
J.
S
ł
o
w
i
k
e
t
a
l
.
,
“
N
u
t
r
i
t
i
o
n
a
l
st
a
t
u
s
a
ssessme
n
t
i
n
c
h
i
l
d
r
e
n
a
n
d
a
d
o
l
e
sc
e
n
t
s
w
i
t
h
v
a
r
i
o
u
s
l
e
v
e
l
s
o
f
p
h
y
si
c
a
l
a
c
t
i
v
i
t
y
i
n
a
s
p
e
c
t
o
f
ob
e
si
t
y
,
”
O
b
e
s
i
t
y
F
a
c
t
s
,
v
o
l
.
1
2
,
n
o
.
5
,
p
p
.
5
5
4
–
5
6
3
,
O
c
t
.
2
0
1
9
,
d
o
i
:
1
0
.
1
1
5
9
/
0
0
0
5
0
2
6
9
8
.
[
2
1
]
G
.
H
a
d
u
s
h
,
O
.
S
e
i
d
,
a
n
d
A
.
G
.
W
u
n
e
h
,
“
A
ssessm
e
n
t
o
f
n
u
t
r
i
t
i
o
n
a
l
st
a
t
u
s
a
n
d
a
ss
o
c
i
a
t
e
d
f
a
c
t
o
r
s
a
mo
n
g
a
d
o
l
e
sce
n
t
g
i
r
l
s
i
n
A
f
a
r
,
N
o
r
t
h
e
a
s
t
e
r
n
E
t
h
i
o
p
i
a
:
a
c
r
o
ss
-
s
e
c
t
i
o
n
a
l
s
t
u
d
y
,
”
J
o
u
r
n
a
l
o
f
H
e
a
l
t
h
,
P
o
p
u
l
a
t
i
o
n
a
n
d
N
u
t
r
i
t
i
o
n
,
v
o
l
.
4
0
,
n
o
.
2
,
p
p
.
1
–
1
4
,
D
e
c
.
2
0
2
1
,
d
o
i
:
1
0
.
1
1
8
6
/
s
4
1
0
4
3
-
021
-
0
0
2
2
7
-
0.
[
2
2
]
N
.
A
k
se
e
r
,
S
.
A
l
-
G
a
s
h
m,
S
.
M
e
h
t
a
,
A
.
M
o
k
d
a
d
,
a
n
d
Z
.
A
.
B
h
u
t
t
a
,
“
G
l
o
b
a
l
a
n
d
r
e
g
i
o
n
a
l
t
r
e
n
d
s
i
n
t
h
e
n
u
t
r
i
t
i
o
n
a
l
s
t
a
t
u
s
o
f
y
o
u
n
g
p
e
o
p
l
e
:
a
c
r
i
t
i
c
a
l
a
n
d
n
e
g
l
e
c
t
e
d
a
g
e
g
r
o
u
p
,
”
An
n
a
l
s
o
f
t
h
e
N
e
w
Y
o
rk
A
c
a
d
e
m
y
o
f
S
c
i
e
n
c
es
,
v
o
l
.
1
3
9
3
,
n
o
.
1
.
B
l
a
c
k
w
e
l
l
P
u
b
l
i
s
h
i
n
g
I
n
c
.
,
p
p
.
3
–
2
0
,
A
p
r
.
2
0
1
7
.
d
o
i
:
1
0
.
1
1
1
1
/
n
y
a
s.
1
3
3
3
6
.
[
2
3
]
K
.
D
e
,
“
A
sses
sme
n
t
o
f
n
u
t
r
i
t
i
o
n
a
l
st
a
t
u
s
o
f
a
d
o
l
e
sc
e
n
t
g
i
r
l
s
b
y
m
i
d
-
u
p
p
e
r
a
r
m
c
i
r
c
u
mf
e
r
e
n
c
e
s
o
f
p
a
s
c
h
i
m
m
e
d
i
n
i
p
u
r
,
I
n
d
i
a
,
”
O
M
I
C
S
P
u
b
l
i
s
h
i
n
g
G
r
o
u
p
,
2
0
1
6
.
d
o
i
:
1
0
.
4
1
7
2
/
2
1
6
7
-
1
0
7
9
.
1
0
0
0
2
4
2
.
[
2
4
]
A
.
D
a
s
g
u
p
t
a
,
A
.
B
u
t
t
,
T.
S
a
h
a
,
G
.
B
a
su
,
A
.
C
h
a
t
t
o
p
a
d
h
y
a
y
,
a
n
d
A
.
M
u
k
h
e
r
j
e
e
,
“
A
ss
e
ssm
e
n
t
o
f
m
a
l
n
u
t
r
i
t
i
o
n
a
m
o
n
g
a
d
o
l
e
s
c
e
n
t
s
:
C
a
n
B
M
I
b
e
r
e
p
l
a
c
e
d
b
y
M
U
A
C
,
”
I
n
d
i
a
n
J
o
u
r
n
a
l
o
f
C
o
m
m
u
n
i
t
y
Me
d
i
c
i
n
e
,
v
o
l
.
3
5
,
n
o
.
2
,
p
p
.
2
7
6
–
2
7
9
,
2
0
1
0
,
d
o
i
:
1
0
.
4
1
0
3
/
0
9
7
0
-
0
2
1
8
.
6
6
8
9
2
.
[
2
5
]
P
.
S
a
r
i
,
D
.
M
.
D
.
H
e
r
a
w
a
t
i
,
M
.
D
h
a
m
a
y
a
n
t
i
,
a
n
d
D
.
H
i
l
ma
n
t
o
,
“
A
n
e
mi
a
a
mo
n
g
a
d
o
l
e
sce
n
t
g
i
r
l
s
i
n
W
e
s
t
J
a
v
a
,
I
n
d
o
n
e
s
i
a
:
R
e
l
a
t
e
d
F
a
c
t
o
r
s a
n
d
C
o
n
se
q
u
e
n
c
e
s
o
n
t
h
e
Q
u
a
l
i
t
y
o
f
L
i
f
e
,
”
N
u
t
ri
e
n
t
s
,
v
o
l
.
1
4
,
n
o
.
1
8
,
p
p
.
1
–
1
3
,
2
0
2
2
,
d
o
i
:
1
0
.
3
3
9
0
/
n
u
1
4
1
8
3
7
7
7
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Dete
r
min
a
n
t fa
cto
r
s
o
f a
n
emia
p
r
ev
en
tio
n
b
eh
a
vio
r
a
mo
n
g
fema
le
…
(
Ma
r
ia
P
a
u
la
Ma
r
la
N
a
h
a
k
)
1729
[
2
6
]
B
.
G
.
S
i
sa
y
,
D
.
H
a
i
l
e
,
H
.
Y
.
H
a
ss
e
n
,
a
n
d
S
.
H
.
G
e
b
r
e
y
e
s
u
s,
“
M
i
d
-
u
p
p
e
r
a
r
m
c
i
r
c
u
mf
e
r
e
n
c
e
a
s
a
scre
e
n
i
n
g
t
o
o
l
f
o
r
i
d
e
n
t
i
f
y
i
n
g
a
d
o
l
e
sce
n
t
s wi
t
h
t
h
i
n
n
e
ss
,
”
Pu
b
l
i
c
H
e
a
l
t
h
N
u
t
r
i
t
i
o
n
,
v
o
l
.
2
4
,
n
o
.
3
,
p
p
.
1
–
1
0
,
2
0
2
0
,
d
o
i
:
1
0
.
1
0
1
7
/
S
1
3
6
8
9
8
0
0
2
0
0
0
3
8
6
9
.
[
2
7
]
Y
.
S
e
y
o
u
m
,
C
.
H
u
m
b
l
o
t
,
G
.
N
i
c
o
l
a
s,
M
.
T
h
o
m
a
s,
a
n
d
K
.
B
a
y
e
,
“
I
r
o
n
d
e
f
i
c
i
e
n
c
y
a
n
d
a
n
e
mi
a
i
n
a
d
o
l
e
sc
e
n
t
g
i
r
l
s
c
o
n
s
u
m
i
n
g
p
r
e
d
o
m
i
n
a
n
t
l
y
p
l
a
n
t
-
b
a
se
d
d
i
e
t
s i
n
r
u
r
a
l
E
t
h
i
o
p
i
a
,
”
S
c
i
e
n
t
i
f
i
c
Re
p
o
rt
s
,
v
o
l
.
9
,
n
o
.
1
,
p
p
.
1
–
6
,
D
e
c
.
2
0
1
9
,
d
o
i
:
1
0
.
1
0
3
8
/
s
4
1
5
9
8
-
0
1
9
-
5
3
8
3
6
-
5.
[
2
8
]
K
.
F
e
n
t
i
e
,
T.
W
a
k
a
y
o
,
a
n
d
G
.
G
i
z
a
w
,
“
P
r
e
v
a
l
e
n
c
e
o
f
a
n
e
mi
a
a
n
d
a
ss
o
c
i
a
t
e
d
f
a
c
t
o
r
s
a
m
o
n
g
s
e
c
o
n
d
a
r
y
sc
h
o
o
l
a
d
o
l
e
s
c
e
n
t
g
i
r
l
s
i
n
Ji
mm
a
To
w
n
,
O
r
o
m
i
a
R
e
g
i
o
n
a
l
S
t
a
t
e
,
S
o
u
t
h
w
e
s
t
E
t
h
i
o
p
i
a
,
”
A
n
e
m
i
a
,
v
o
l
.
2
0
2
0
,
p
p
.
1
–
1
1
,
2
0
2
0
,
d
o
i
:
1
0
.
1
1
5
5
/
2
0
2
0
/
5
0
4
3
6
4
6
.
[
2
9
]
I
.
M
.
R
o
se
n
st
o
c
k
,
“
H
i
st
o
r
i
c
a
l
O
r
i
g
i
n
s
o
f
t
h
e
H
e
a
l
t
h
B
e
l
i
e
f
M
o
d
e
l
,
”
H
e
a
l
t
h
E
d
u
c
a
t
i
o
n
Mo
n
o
g
r
a
p
h
s
,
v
o
l
.
2
,
n
o
.
4
,
p
p
.
3
2
8
–
3
3
5
,
1
9
7
4
.
[
3
0
]
H
i
d
a
y
a
t
i
,
N
.
M
u
sn
i
a
t
i
,
A
.
H
i
d
a
y
a
t
,
a
n
d
M
.
I
.
N
u
r
ma
n
s
y
a
h
,
“
U
si
n
g
h
e
a
l
t
h
b
e
l
i
e
f
mo
d
e
l
f
o
r
p
r
e
d
i
c
t
i
n
g
C
O
V
I
D
-
1
9
p
r
e
v
e
n
t
i
o
n
p
r
a
c
t
i
c
e
s
a
mo
n
g
u
n
i
v
e
r
si
t
y
s
t
u
d
e
n
t
a
n
d
st
a
f
f
,
”
I
n
t
e
rn
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
P
u
b
l
i
c
H
e
a
l
t
h
S
c
i
e
n
c
e
(
I
J
PH
S
)
,
v
o
l
.
1
1
,
n
o
.
1
,
p
p
.
2
0
–
2
7
,
2
0
2
2
,
d
o
i
:
1
0
.
1
1
5
9
1
/
i
j
p
h
s.
v
1
1
i
1
.
2
1
0
5
9
.
[
3
1
]
S
.
S
u
b
e
d
i
,
W
.
L.
F
i
l
h
o
,
a
n
d
A
.
A
d
e
d
e
j
i
,
“
A
n
a
ssessm
e
n
t
o
f
t
h
e
h
e
a
l
t
h
b
e
l
i
e
f
mo
d
e
l
(
H
B
M
)
p
r
o
p
e
r
t
i
e
s
a
s
p
r
e
d
i
c
t
o
r
s
o
f
C
O
V
I
D
-
1
9
p
r
e
v
e
n
t
i
v
e
b
e
h
a
v
i
o
u
r
,
”
J
o
u
r
n
a
l
o
f
P
u
b
l
i
c
H
e
a
l
t
h
,
n
o
.
O
k
t
o
b
e
r
2
0
2
3
,
p
p
.
1
–
1
1
,
2
0
2
3
,
d
o
i
:
1
0
.
1
0
0
7
/
s1
0
3
8
9
-
0
2
3
-
0
2
1
0
9
-
7.
[
3
2
]
R
.
B
.
A
w
u
a
h
e
t
a
l
.
,
“
P
e
r
c
e
p
t
i
o
n
s
a
n
d
b
e
l
i
e
f
s
a
b
o
u
t
a
n
a
e
m
i
a
:
A
q
u
a
l
i
t
a
t
i
v
e
st
u
d
y
i
n
t
h
r
e
e
a
g
r
o
e
c
o
l
o
g
i
c
a
l
r
e
g
i
o
n
s
o
f
G
h
a
n
a
,
”
M
a
t
e
r
n
a
l
a
n
d
C
h
i
l
d
N
u
t
r
i
t
i
o
n
,
v
o
l
.
1
7
,
n
o
.
4
,
p
p
.
1
–
1
2
,
2
0
2
1
,
d
o
i
:
1
0
.
1
1
1
1
/
mc
n
.
1
3
1
8
1
.
[
3
3
]
R
.
K
.
G
a
r
g
e
t
a
l
.
,
“
C
u
l
t
u
r
a
l
d
e
t
e
r
mi
n
a
n
t
s
i
n
a
n
e
mi
a
p
r
e
v
e
n
t
i
o
n
a
n
d
m
a
n
a
g
e
m
e
n
t
:
I
n
si
g
h
t
s
f
r
o
m
w
o
me
n
a
n
d
c
a
r
e
g
i
v
e
r
s
,
”
I
n
d
i
a
n
J
o
u
rn
a
l
o
f
O
b
st
e
t
r
i
c
s
a
n
d
G
y
n
e
c
o
l
o
g
y
Re
se
a
r
c
h
,
v
o
l
.
1
1
,
n
o
.
3
,
p
p
.
3
0
8
–
3
1
4
,
2
0
2
4
,
d
o
i
:
1
0
.
1
8
2
3
1
/
j
.
i
j
o
g
r
.
2
0
2
4
.
0
6
0
.
[
3
4
]
I
.
M
.
R
o
s
e
n
s
t
o
c
k
,
“
T
h
e
h
e
a
l
t
h
b
e
l
i
e
f
mo
d
e
l
a
n
d
p
r
e
v
e
n
t
i
v
e
h
e
a
l
t
h
b
e
h
a
v
i
o
r
,
”
H
e
a
l
t
h
Ed
u
c
a
t
i
o
n
Mo
n
o
g
ra
p
h
s
,
v
o
l
.
2
,
n
o
.
4
,
p
p
.
3
5
4
–
3
8
6
,
1
9
7
4
,
d
o
i
:
1
0
.
1
1
7
7
/
1
0
9
0
1
9
8
1
7
4
0
0
2
0
0
4
0
5
.
[
3
5
]
S
.
E
.
W
i
l
s
o
n
e
t
a
l
.
,
“
C
o
mp
r
e
h
e
n
s
i
v
e
f
r
a
mew
o
r
k
f
o
r
i
n
t
e
g
r
a
t
e
d
a
c
t
i
o
n
o
n
t
h
e
p
r
e
v
e
n
t
i
o
n
,
d
i
a
g
n
o
s
i
s,
a
n
d
ma
n
a
g
e
me
n
t
o
f
a
n
e
mi
a
:
An
i
n
t
r
o
d
u
c
t
i
o
n
,
”
A
n
n
a
l
s
o
f
t
h
e
N
e
w
Y
o
rk
Ac
a
d
e
m
y
o
f
S
c
i
e
n
c
e
s
,
v
o
l
.
1
5
2
4
,
n
o
.
1
,
p
p
.
5
–
9
,
2
0
2
3
,
d
o
i
:
1
0
.
1
1
1
1
/
n
y
a
s.1
4
9
9
9
.
[
3
6
]
I
.
M
.
R
o
se
n
st
o
c
k
,
V
.
J.
S
t
r
e
c
h
e
r
,
a
n
d
M
.
H
.
B
e
c
k
e
r
,
“
S
o
c
i
a
l
l
e
a
r
n
i
n
g
t
h
e
o
r
y
a
n
d
t
h
e
h
e
a
l
t
h
b
e
l
i
e
f
m
o
d
e
l
,
”
H
e
a
l
t
h
E
d
u
c
a
t
i
o
n
&
Be
h
a
v
i
o
r
,
v
o
l
.
1
5
,
n
o
.
2
,
p
p
.
1
7
5
–
1
8
3
,
1
9
8
8
,
d
o
i
:
1
0
.
1
1
7
7
/
1
0
9
0
1
9
8
1
8
8
0
1
5
0
0
2
0
3
.
[
3
7
]
R
.
K
.
F
a
r
a
j
,
“
U
si
n
g
t
h
e
h
e
a
l
t
h
b
e
l
i
e
f
mo
d
e
l
t
o
u
n
d
e
r
st
a
n
d
a
n
e
m
i
a
p
r
e
v
e
n
t
i
v
e
b
e
h
a
v
i
o
r
a
mo
n
g
s
e
c
o
n
d
a
r
y
sc
h
o
o
l
f
e
mal
e
s
t
u
d
e
n
t
s,”
Af
r.
J
.
Bi
o
m
e
d
.
Re
s
.
,
v
o
l
.
2
7
,
n
o
.
4
s
,
p
p
.
1
3
5
1
–
1
3
5
9
,
2
0
2
4
.
[
3
8
]
N
.
K
.
J
a
n
z
a
n
d
M
.
H
.
B
e
c
k
e
r
,
“
T
h
e
h
e
a
l
t
h
b
e
l
i
e
f
m
o
d
e
l
:
a
d
e
c
a
d
e
l
a
t
e
r
,
”
H
e
a
l
t
h
E
d
u
c
a
t
i
o
n
Q
u
a
rt
e
rl
y
,
v
o
l
.
1
1
,
n
o
.
1
,
p
p
.
1
–
4
7
,
1
9
8
4
,
d
o
i
:
0
1
9
5
-
8
4
0
2
/
8
4
/
0
1
0
0
0
1
-
4
7
5
0
4
.
0
0
.
[
3
9
]
N
.
W
.
M
u
t
u
r
i
e
t
a
l
.
,
“
A
n
e
x
a
m
i
n
a
t
i
o
n
o
f
f
a
c
t
o
r
s
a
ss
o
c
i
a
t
e
d
w
i
t
h
se
l
f
-
e
f
f
i
c
a
c
y
f
o
r
f
o
o
d
c
h
o
i
c
e
a
n
d
h
e
a
l
t
h
y
e
a
t
i
n
g
a
m
o
n
g
l
o
w
-
i
n
c
o
me
a
d
o
l
e
sce
n
t
s
i
n
T
h
r
e
e
U
.
S
.
S
t
a
t
e
s,”
F
ro
n
t
i
e
rs
i
n
C
o
m
m
u
n
i
c
a
t
i
o
n
,
v
o
l
.
1
,
n
o
.
S
e
p
t
e
mb
e
r
,
p
p
.
1
–
6
,
2
0
1
6
,
d
o
i
:
1
0
.
3
3
8
9
/
f
c
o
mm
.
2
0
1
6
.
0
0
0
0
6
.
[
4
0
]
C
.
W
.
M
.
S
a
r
i
,
V
.
N
o
f
r
e
l
,
a
n
d
M
.
Lu
k
man
,
“
C
o
r
r
e
l
a
t
i
o
n
b
e
t
w
e
e
n
k
n
o
w
l
e
d
g
e
a
n
d
s
e
l
f
-
e
f
f
i
c
a
c
y
w
i
t
h
f
a
m
i
l
y
sk
i
l
l
s
i
n
e
x
e
r
c
i
s
i
n
g
r
a
n
g
e
o
f
m
o
t
i
o
n
f
o
r
p
o
st
-
s
t
r
o
k
e
,
”
J
o
u
r
n
a
l
o
f
M
u
l
t
i
d
i
sci
p
l
i
n
a
r
y
H
e
a
l
t
h
c
a
re
,
v
o
l
.
1
6
,
n
o
.
Ja
n
u
a
r
y
,
p
p
.
3
7
7
–
3
8
4
,
2
0
2
3
,
d
o
i
:
1
0
.
2
1
4
7
/
J
M
D
H
.
S
3
8
7
6
8
6
.
[
4
1
]
A
.
L.
K
l
e
p
p
a
n
g
,
A
.
M
.
S
t
e
i
g
e
n
,
a
n
d
H
.
S
.
F
i
n
b
r
å
t
e
n
,
“
E
x
p
l
a
i
n
i
n
g
v
a
r
i
a
n
c
e
i
n
s
e
l
f
-
e
f
f
i
c
a
c
y
a
mo
n
g
a
d
o
l
e
s
c
e
n
t
s:
t
h
e
a
sso
c
i
a
t
i
o
n
b
e
t
w
e
e
n
m
a
st
e
r
y
e
x
p
e
r
i
e
n
c
e
s,
s
o
c
i
a
l
su
p
p
o
r
t
,
a
n
d
s
e
l
f
-
e
f
f
i
c
a
c
y
,
”
BM
C
Pu
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
2
3
,
n
o
.
1
,
p
p
.
1
–
1
0
,
2
0
2
3
,
d
o
i
:
1
0
.
1
1
8
6
/
s
1
2
8
8
9
-
0
2
3
-
1
6
6
0
3
-
w.
[
4
2
]
D
.
L
u
t
f
i
a
sar
i
,
S
.
M
a
r
t
i
n
i
,
a
n
d
S
.
W
i
d
a
t
i
,
“
Th
e
e
f
f
e
c
t
i
v
e
n
e
ss
o
f
p
e
e
r
g
r
o
u
p
o
n
a
d
o
l
e
sc
e
n
t
a
n
e
m
i
a
p
r
e
v
e
n
t
i
o
n
b
e
h
a
v
i
o
r
:
a
s
y
st
e
ma
t
i
c
r
e
v
i
e
w
,
”
J
o
u
r
n
a
l
o
f
P
u
b
l
i
c
H
e
a
l
t
h
i
n
Af
ri
c
a
,
v
o
l
.
1
4
,
n
o
.
S
2
,
p
p
.
7
0
–
7
4
,
2
0
2
3
,
d
o
i
:
1
0
.
4
0
8
1
/
j
p
h
i
a
.
2
0
2
3
.
2
5
4
2
.
[
4
3
]
H
.
Z.
G
.
P
u
s
p
i
t
a
s
a
r
i
,
N
.
K
.
A
.
A
r
mi
n
i
,
R
.
P
r
a
d
a
n
i
e
,
a
n
d
M
.
Tr
i
h
a
r
i
n
i
,
“
A
n
e
mi
a
p
r
e
v
e
n
t
i
o
n
b
e
h
a
v
i
o
r
i
n
f
e
m
a
l
e
a
d
o
l
e
s
c
e
n
t
s
a
n
d
r
e
l
a
t
e
d
f
a
c
t
o
r
s
b
a
se
d
o
n
Th
e
o
r
y
o
f
P
l
a
n
n
e
d
B
e
h
a
v
i
o
r
:
A
c
r
o
ss
-
se
c
t
i
o
n
a
l
s
t
u
d
y
,
”
J
u
r
n
a
l
N
e
rs
,
v
o
l
.
1
7
,
n
o
.
1
,
p
p
.
2
5
–
3
0
,
2
0
2
2
,
d
o
i
:
1
0
.
2
0
4
7
3
/
j
n
.
v
1
7
i
1
.
2
7
7
4
4
.
[
4
4
]
L.
M
u
n
i
r
a
a
n
d
P
.
V
i
w
a
t
t
a
n
a
k
u
l
v
a
n
i
d
,
“
I
n
f
l
u
e
n
c
i
n
g
f
a
c
t
o
r
s
a
n
d
k
n
o
w
l
e
d
g
e
g
a
p
s
o
n
a
n
e
mi
a
p
r
e
v
e
n
t
i
o
n
a
mo
n
g
f
e
mal
e
st
u
d
e
n
t
s
i
n
i
n
d
o
n
e
si
a
,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
rn
a
l
o
f
Ev
a
l
u
a
t
i
o
n
a
n
d
Re
se
a
rc
h
i
n
Ed
u
c
a
t
i
o
n
(
I
J
E
RE)
,
v
o
l
.
1
0
,
n
o
.
1
,
p
p
.
2
1
5
–
2
2
1
,
2
0
2
1
,
d
o
i
:
1
0
.
1
1
5
9
1
/
i
j
e
r
e
.
v
1
0
i
1
.
2
0
7
4
9
.
B
I
O
G
RAP
H
I
E
S O
F
AUTH
O
RS
Ma
r
ia
Pa
u
la
Ma
r
l
a
N
a
h
a
k
is
a
n
a
ss
istan
t
p
ro
fe
ss
o
r
a
n
d
a
n
u
rsin
g
lec
tu
re
r
sp
e
c
ializin
g
in
m
a
tern
a
l
a
n
d
c
h
il
d
h
e
a
lt
h
a
t
Un
i
v
e
rsitas
Ti
m
o
r.
S
i
n
c
e
2
0
1
8
,
sh
e
h
a
s
a
c
ti
v
e
ly
c
o
n
tri
b
u
ted
t
o
e
d
u
c
a
ti
o
n
,
re
se
a
rc
h
,
a
n
d
c
o
m
m
u
n
it
y
se
rv
ice
a
ime
d
a
t
imp
ro
v
in
g
th
e
q
u
a
li
t
y
o
f
li
fe
a
n
d
h
e
a
lt
h
o
u
tco
m
e
s
o
f
m
o
th
e
rs,
c
h
il
d
re
n
,
a
n
d
th
e
ir
fa
m
il
ies
i
n
e
c
o
n
o
m
ica
ll
y
d
isa
d
v
a
n
tag
e
d
re
g
io
n
s.
He
r
re
se
a
rc
h
p
rima
ril
y
a
d
d
re
ss
e
s m
a
tern
a
l
a
n
d
c
h
il
d
h
e
a
lt
h
c
h
a
ll
e
n
g
e
s
in
b
o
rd
e
r
a
re
a
s,
with
a
fo
c
u
s
o
n
c
u
l
tu
ra
l,
p
o
v
e
rt
y
-
re
late
d
,
a
n
d
so
c
i
o
d
e
m
o
g
ra
p
h
ic
d
e
term
in
a
n
ts.
S
h
e
h
a
s
led
n
u
m
e
ro
u
s
stu
d
ies
targ
e
ti
n
g
m
a
t
e
rn
a
l
a
n
d
c
h
i
ld
h
e
a
lt
h
issu
e
s
a
n
d
h
a
s
re
c
e
iv
e
d
n
a
ti
o
n
a
l
re
c
o
g
n
it
i
o
n
th
r
o
u
g
h
c
o
n
se
c
u
ti
v
e
r
e
se
a
rc
h
g
ra
n
ts
a
s
p
rin
c
ip
a
l
in
v
e
sti
g
a
to
r
i
n
2
0
2
3
a
n
d
2
0
2
4
.
S
h
e
is
a
lso
a
n
a
c
ti
v
e
a
u
th
o
r
o
f
p
u
b
l
ic
h
e
a
lt
h
li
tera
tu
re
.
He
r
c
u
rre
n
t
re
se
a
rc
h
in
tere
sts
in
c
lu
d
e
e
x
p
lo
r
in
g
fa
m
il
y
h
e
a
lt
h
b
e
h
a
v
i
o
rs
a
n
d
th
e
c
o
m
p
le
x
so
c
ial
a
n
d
d
e
m
o
g
ra
p
h
ic
fa
c
to
rs
i
n
flu
e
n
c
i
n
g
m
a
tern
a
l
a
n
d
c
h
il
d
h
e
a
lt
h
sta
tu
s.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
p
a
u
lam
a
rla@u
n
imo
r.
a
c
.
id
.
Pi
u
s
Al
m
in
d
u
Le
k
i
Be
r
e
k
is
a
n
a
ss
istan
t
p
ro
fe
ss
o
r
a
n
d
a
se
n
io
r
n
u
rsin
g
lec
tu
re
r
sp
e
c
ializin
g
in
c
a
rd
i
o
l
o
g
y
,
with
e
x
ten
siv
e
e
x
p
e
rien
c
e
i
n
m
e
d
ica
l
-
su
rg
ica
l
a
n
d
e
m
e
rg
e
n
c
y
n
u
rsin
g
d
e
p
a
rtme
n
t.
He
p
o
ss
e
ss
e
s
a
d
v
a
n
c
e
d
e
x
p
e
rti
se
i
n
c
a
rd
iac
n
u
rs
in
g
,
p
a
rti
c
u
larly
in
t
h
e
c
a
re
a
n
d
m
a
n
a
g
e
m
e
n
t
o
f
p
a
ti
e
n
ts wi
th
h
y
p
e
rte
n
sio
n
,
a
lo
n
g
si
d
e
su
b
sta
n
ti
a
l
e
x
p
e
rien
c
e
in
e
m
e
rg
e
n
c
y
c
a
re
.
He
h
a
s
a
c
ti
v
e
ly
c
o
l
lab
o
ra
te
d
wit
h
lo
c
a
l
g
o
v
e
rn
m
e
n
t
a
u
t
h
o
rit
ies
to
d
e
v
e
l
o
p
a
n
d
e
n
h
a
n
c
e
c
o
m
m
u
n
it
y
c
a
p
a
c
it
y
fo
r
th
e
p
re
v
e
n
ti
o
n
a
n
d
m
a
n
a
g
e
m
e
n
t
o
f
c
a
rd
iac
d
ise
a
se
s.
He
lea
d
s
a
re
g
i
o
n
a
l
p
ro
fe
ss
io
n
a
l
n
u
rsi
n
g
a
ss
o
c
iati
o
n
,
d
e
m
o
n
stra
ti
n
g
h
is
d
e
d
ica
ti
o
n
t
o
a
d
v
a
n
c
in
g
n
u
rsin
g
p
ra
c
ti
c
e
a
n
d
e
d
u
c
a
ti
o
n
.
His
c
o
m
p
re
h
e
n
s
iv
e
u
n
d
e
rsta
n
d
in
g
o
f
c
a
rd
i
o
v
a
sc
u
lar
h
e
a
lt
h
,
i
n
c
lu
d
in
g
t
h
e
in
terp
lay
b
e
twe
e
n
h
y
p
e
rten
si
o
n
a
n
d
s
y
ste
m
ic
c
o
n
d
it
i
o
n
s
su
c
h
a
s
a
n
e
m
ia,
p
o
siti
o
n
s
h
im
to
c
o
n
tri
b
u
te
m
e
a
n
in
g
fu
ll
y
t
o
re
se
a
rc
h
o
n
a
n
e
m
ia
p
re
v
e
n
ti
v
e
b
e
h
a
v
i
o
r
a
m
o
n
g
fe
m
a
le
a
d
o
les
c
e
n
ts.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
fra
n
c
isd
o
m
in
2
0
1
8
@
g
m
a
il
.
c
o
m
.
Evaluation Warning : The document was created with Spire.PDF for Python.