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Traffic, training, and turnover: Experiences of research personnel in collecting road safety data in Hyderabad, India. 交通、培训和周转:印度海得拉巴研究人员收集道路安全数据的经验。
Q2 Medicine Pub Date : 2021-01-01 DOI: 10.4103/WHO-SEAJPH.WHO-SEAJPH_37_21
Josyula K Lakshmi, Shailaja Tetali, Dane Moran, Shirin Wadhwaniya, Shivam Gupta, Gopalkrishna Gururaj, Adnan A Hyder

We describe the experiences of research personnel in collecting road safety data, using a range of quantitative and qualitative methods to collect primary and secondary data, in the course of monitoring and evaluating the impact of road safety interventions under the Bloomberg Philanthropies Global Road Safety Program, in Hyderabad, India. We detail environmental, administrative, and operational barriers encountered, and individual, systemic, and technical enablers pertaining to the conduct of road safety research in Hyderabad, India, but bearing relevance to broader public health research and practice and the implementation and evaluation of projects. From our experiences of the challenges and the solutions developed to address them, we set out recommendations for research teams and for administrators in road safety as well as in various other streams of public health research and practice. We propose actionable strategies to enhance data-collectors' safety; build effective partnerships with various stakeholders, including research collaborators, administrators, and communities; and strengthen data quality and streamlining systems, particularly in similar geo-political settings.

我们描述了研究人员在印度海得拉巴的彭博慈善全球道路安全计划下,在监测和评估道路安全干预措施影响的过程中,使用一系列定量和定性方法收集第一手和第二手数据的经验。我们详细介绍了在印度海德拉巴进行道路安全研究时遇到的环境、行政和操作障碍,以及与更广泛的公共卫生研究和实践以及项目的实施和评估相关的个人、系统和技术促成因素。根据我们在挑战方面的经验和为解决这些挑战而制定的解决办法,我们为道路安全以及各种其他公共卫生研究和实践领域的研究小组和管理人员提出了建议。我们提出切实可行的策略,以加强资料收集者的安全;与各种利益相关者建立有效的伙伴关系,包括研究合作者、管理人员和社区;加强数据质量和精简系统,特别是在类似的地缘政治环境中。
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引用次数: 0
Public health challenges in Asia: Complex multifaceted challenges require transformative leadership. 亚洲的公共卫生挑战:复杂的多方面挑战需要变革的领导。
Q2 Medicine Pub Date : 2021-01-01 DOI: 10.4103/2224-3151.334414
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引用次数: 0
The trend of emergency department visits among the elderly in Thailand. 泰国老年人急诊科就诊趋势
Q2 Medicine Pub Date : 2021-01-01 DOI: 10.4103/WHO-SEAJPH.WHO-SEAJPH_67_21
Methasit Lumjeaksuwan, Suparada Patcharasopit, Chanatip Seksanpanit, Natchaya Sritharo, Apichat Aeampuck, Borwon Wittayachamnankul

Emergency department (ED) usage by older adults tends to be a major health issue due to increase in aging population and their health fragility. Currently, there is no study comparing ED data of older adults with those of younger population in Southeast Asia. The aim of this study was to explore the epidemiologic data of elderly who visited the ED from 2016 to 2018 and compare them with data from younger group. Data on ED visits from 2016 to 2018 were extracted from the electronic medical database. Descriptive statistics were used for analyzing the collected data and compared with the data of the age group of 15-59 years. A total of 27,871 elderly patients were found eligible and included. The mean age was 72.69 years (95% confidence interval 72.6-72.8). Patients aged 60-69 years have the highest ED visits rate (45.4%). From the total visits, 58.06% were discharged from ED, while 40.82% were admitted to hospital with 11.22% death rate after the admission. The most diagnosed condition was injury, poisoning, or other consequence from an external cause, with a head injury as the leading cause (20.74%). Compared with patients aged 15-59 years, elderly patients had a higher visit rate per 1000 population (21.99 vs. 30.91; P < 0.001), more admissions (15% vs. 40.8%; P < 0.001), and more re-visits within 7 days (1.81% vs. 4.07%; P < 0.001). These results showed that older adult patients tend to have higher ED visits rate, ED re-visits rate, and admissions rate compared to younger age groups.

由于人口老龄化和老年人健康脆弱性的增加,老年人急诊科的使用往往是一个主要的健康问题。目前,没有研究比较东南亚老年人和年轻人的ED数据。本研究的目的是探讨2016年至2018年访问急诊科的老年人的流行病学数据,并将其与年轻人的数据进行比较。从电子医疗数据库中提取2016 - 2018年的急诊科就诊数据。采用描述性统计方法对收集的资料进行分析,并与15 ~ 59岁年龄组的资料进行比较。共有27,871名老年患者被纳入研究。平均年龄72.69岁(95%可信区间72.6 ~ 72.8)。60-69岁患者急诊科就诊率最高(45.4%)。出院率为58.06%,住院率为40.82%,入院后死亡率为11.22%。诊断最多的疾病是外伤、中毒或其他外因造成的后果,其中头部损伤是主要原因(20.74%)。与15-59岁的患者相比,老年患者每1000人的就诊率更高(21.99比30.91;P < 0.001),更多的入院率(15% vs. 40.8%;P < 0.001),且7天内复诊率较高(1.81% vs. 4.07%;P < 0.001)。这些结果表明,与年轻年龄组相比,老年成年患者往往有更高的ED就诊率、ED复诊率和入院率。
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引用次数: 2
Multimorbidity patterns among rural adults with Type-2 diabetes mellitus: A cross-sectional study in Kerala, India. 印度喀拉拉邦农村成人2型糖尿病的多发病模式:一项横断面研究
Q2 Medicine Pub Date : 2021-01-01 DOI: 10.4103/WHO-SEAJPH.WHO-SEAJPH_73_21
D J Soji, J Lordson, G K Mini

Objectives: The study evaluated the prevalence and pattern of multi-morbidity among rural adults with type-2 diabetes mellitus and explored the factors associated with multi-morbidity among 400 adult diabetic patients from rural areas of Thiruvananthapuram district in the Kerala state of India.

Materials and methods: The presence of multi-morbidity was assessed using a semi-structured interview schedule based on the physician's confirmation. The reported chronic diseases were classified as concordant (conditions with a similar pathophysiologic risk profile as diabetes) and discordant (conditions whose treatments are not directly related to the pathogenesis for diabetes) co-morbidity. Multivariate analysis was done to find the factors associated with multi-morbidity.

Results: Prevalence of multi-morbidity among diabetic patients was 74% (95% Confidence Interval (CI): 69-77), around 66% reported at least one concordant co-morbidity, 30% reported at least one discordant co-morbidity and 21% reported both concordant and discordant co-morbidity with diabetes. Hypertension (59%) was the most frequent co-morbidity. Older adults (above 60 years of age) [Odds Ratio (OR):3.42, 95% CI:1.97-5.94] and women (OR:2.16, CI:1.13-3.51) were more likely to have multi-morbidity compared to their counterparts. Those using insulin and/or oral medication were more likely to have multi-morbidity compared to those using oral medication only (OR: 2.19, CI: 1.07-4.09).

Conclusion: Multi-morbidity among diabetic patients needs to be addressed by a comprehensive and integrated approach rather than a diabetes specific approach.

目的:本研究对印度喀拉拉邦蒂鲁万南塔普兰地区400例农村成人2型糖尿病的患病率和多重发病模式进行了评估,并探讨了与多重发病相关的因素。材料和方法:根据医生的确认,使用半结构化的访谈时间表来评估多发病的存在。报告的慢性疾病被分类为一致性(与糖尿病具有相似的病理生理风险状况)和非一致性(其治疗与糖尿病的发病机制没有直接关系)共发病。通过多因素分析发现与多发病相关的因素。结果:糖尿病患者中多重发病的患病率为74%(95%可信区间(CI): 69-77),约66%报告至少有一种一致性合并症,30%报告至少有一种不一致性合并症,21%报告糖尿病的一致性和不一致性合并症。高血压(59%)是最常见的合并症。老年人(60岁以上)[比值比(OR):3.42, 95% CI:1.97-5.94]和女性(OR:2.16, CI:1.13-3.51)与同行相比更容易出现多重发病。与仅使用口服药物的患者相比,使用胰岛素和/或口服药物的患者更容易发生多重发病(or: 2.19, CI: 1.07-4.09)。结论:糖尿病患者的多发病需要采取综合、综合的治疗方法,而不是针对糖尿病的治疗方法。
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引用次数: 3
Impact of COVID-19 on the global supply chain of antiretroviral drugs: a rapid survey of Indian manufacturers. 2019冠状病毒病对全球抗逆转录病毒药物供应链的影响:对印度制造商的快速调查
Q2 Medicine Pub Date : 2020-09-01 DOI: 10.4103/2224-3151.294306
Bharat Bhushan Rewari, Nabeel Mangadan-Konath, Mukta Sharma

Most people living with HIV in low- and middle-income countries are treated with generic antiretroviral (ARV) drugs produced by manufacturers in India - the "pharmacy of the developing world". India's nationwide lockdown in March 2020 in response to the coronavirus disease 2019 (COVID-19) pandemic therefore prompted concerns about disruption to this essential supply. A preliminary assessment of ARV drug manufacturers in India in March 2020 indicated a range of concerns. This prompted a rapid questionnaire-based survey in May 2020 of eight manufacturers that account for most of India's ARV drug exports. The greatest challenges reported were in international shipping, including delays, increased lead times and rising costs. Contrary to expectations, lack of access to the active pharmaceutical ingredients (APIs) required for ARV drug manufacture was not a major hindrance, as manufacturers reported that their reliance on China for API supplies had reduced in recent years. However, their reliance on overseas markets for the raw materials required for local API synthesis was a major challenge. The findings from this survey have implications for addressing some of the immediate and medium-term concerns about the production and supply of generic ARV drugs. Long-term orders to support multi-month dispensing and buffer stocks need to be in place, together with computerized inventory management systems with real-time information from the lowest-level dispensation unit. Manufacturers and industry associations should have regular, formal interaction with the key ministries of the Government of India regarding these issues. Measures to improve the resilience of the generic ARV drug supply system are essential to minimize ongoing supply shocks resulting from the COVID-19 pandemic and to prepare for future emergencies.

低收入和中等收入国家的大多数艾滋病毒感染者使用印度制造商生产的非专利抗逆转录病毒(ARV)药物治疗——印度是“发展中国家的药房”。因此,为应对2019年冠状病毒病(COVID-19)大流行,印度于2020年3月在全国范围内实施封锁,引发了人们对这一基本供应中断的担忧。2020年3月对印度抗逆转录病毒药物制造商的初步评估表明了一系列担忧。这促使人们在2020年5月对占印度大部分抗逆转录病毒药物出口的八家制造商进行了快速问卷调查。报告中最大的挑战是国际航运,包括延误、交货时间延长和成本上升。与预期相反,缺乏ARV药物生产所需的活性药物成分(API)并不是主要障碍,因为制造商报告说,近年来他们对中国原料药供应的依赖有所减少。然而,他们依赖海外市场获得本地原料药合成所需的原材料是一个重大挑战。这项调查的结果对解决非专利抗逆转录病毒药物生产和供应方面的一些近期和中期关切具有影响。需要有支持多个月配药和缓冲库存的长期订单,以及具有来自最低一级配药单位实时信息的计算机库存管理系统。制造商和行业协会应就这些问题与印度政府的主要部委进行定期的正式互动。采取措施提高非专利抗逆转录病毒药物供应系统的复原力,对于最大限度地减少COVID-19大流行造成的持续供应冲击并为未来的紧急情况做好准备至关重要。
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引用次数: 17
Mitigating the impact of the COVID-19 pandemic on progress towards ending tuberculosis in the WHO South-East Asia Region. 减轻COVID-19大流行对世卫组织东南亚区域终止结核病进展的影响。
Q2 Medicine Pub Date : 2020-09-01 DOI: 10.4103/2224-3151.294300
Vineet Bhatia, Partha Pratim Mandal, Srinath Satyanarayana, Tjandra Yoga Aditama, Mukta Sharma

Almost half of the deaths worldwide caused by tuberculosis in 2018 occurred in the World Health Organization (WHO) South-East Asia Region, home to around a quarter of the global population. Maintaining robust progress in this region is therefore essential if the global goal of ending the tuberculosis epidemic is to be realized. Substantial gains have been made in the region, but the threat to health worldwide posed by the coronavirus disease 2019 (COVID-19) pandemic includes not only the direct effects of the pandemic but also the potential eclipsing of the global tuberculosis emergency. The results of modelling studies present stark warnings of a reversal of years of progress and a significant resurgence in deaths from tuberculosis. The COVID-19 pandemic has had variable impacts in the WHO South-East Asia Region to date, but in the countries most affected there has been targeted diversion and repurposing of tuberculosis services, health-care workers and diagnostic equipment. The combined effects of COVID-19, containment measures and fragmentation of tuberculosis services have resulted in delays in diagnosis or non-diagnosis and disruption in treatment resulting in increased morbidity, mortality, transmission and drug resistance. Countries of the region have made attempts to ensure continuity of services and civil society and nongovernmental organizations have instituted a range of innovative mechanisms to support national programmes. However, a comprehensive approach - including scaling up successful initiatives, empowering community leadership, harnessing digital tools, and implementing easily accessible cash transfers and nutrition support - will be critical to success. As COVID-19 recedes, countries will need "catch-up plans" to deploy supplementary measures to address the increased tuberculosis burden. Urgent, targeted and agile responses have the potential to mitigate and reverse the impact of the COVID-19 pandemic on tuberculosis in South-East Asia.

2018年,全球近一半的结核病死亡发生在世界卫生组织(世卫组织)东南亚区域,该区域人口约占全球人口的四分之一。因此,如果要实现消灭结核病流行的全球目标,就必须保持本区域的强劲进展。该区域取得了重大进展,但2019年冠状病毒病(COVID-19)大流行对全球健康构成的威胁不仅包括大流行的直接影响,还包括全球结核病紧急情况的潜在影响。模拟研究的结果发出了严峻的警告,表明多年来取得的进展出现逆转,结核病死亡人数大幅回升。迄今为止,COVID-19大流行对世卫组织东南亚区域产生了不同的影响,但在受影响最严重的国家,结核病服务、卫生保健工作者和诊断设备已被有针对性地转移和重新利用。COVID-19、遏制措施和结核病服务分散的综合影响导致诊断延误或未诊断以及治疗中断,导致发病率、死亡率、传播和耐药性增加。本区域各国已作出努力,确保服务的连续性,民间社会和非政府组织设立了一系列创新机制,以支持国家方案。然而,全面的方法——包括扩大成功的倡议、增强社区领导能力、利用数字工具以及实施易于获得的现金转移支付和营养支持——将是成功的关键。随着COVID-19的消退,各国将需要“追赶计划”来部署补充措施,以应对日益增加的结核病负担。紧急、有针对性和灵活的应对措施有可能减轻和扭转2019冠状病毒病大流行对东南亚结核病的影响。
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引用次数: 21
Protecting sex workers in Thailand during the COVID-19 pandemic: opportunities to build back better. 2019冠状病毒病大流行期间保护泰国性工作者:更好重建的机会
Q2 Medicine Pub Date : 2020-09-01 DOI: 10.4103/2224-3151.294301
Surang Janyam, Dusita Phuengsamran, Jamrong Pangnongyang, Wutikan Saripra, Ladda Jitwattanapataya, Chalidaporn Songsamphan, Patchara Benjarattanaporn, Deyer Gopinath

The Government of Thailand was prompt to launch social and economic measures to mitigate the effects on the general population following lockdown measures to counter coronavirus disease 2019 (COVID-19). However, sex workers were one of the vulnerable groups who were unable to access state support. A rapid survey of sex workers in Thailand showed that almost all had become unemployed and lost their income as a consequence of the lockdown, restrictions on international flights into the country and the closure of entertainment venues. Most were unable to cover the costs of food and shelter for themselves and their dependents. COVID-19 had also disrupted testing and treatment for sexually transmitted infections and HIV services for sex workers. As in other countries, community-based organizations were essential to providing an immediate, short-term COVID-19 response for sex workers. Also as in other countries, the pandemic has demonstrated that many people's health and well-being depends on very fragile foundations. This presents a clear opportunity to build back better by committing to a longer-term vision for the overall societal inclusion of sex workers. Thailand should advocate for decriminalization of sex work and ensure sex workers are entitled to equal labour rights and inclusion in the government social protection programme. Progress in innovative government initiatives aimed at ending HIV stigma and discrimination show how structural change can come about through harnessing community-based organizations. In turn, HIV services for sex workers need to expand and incorporate targeted interventions to reduce sex workers' occupational susceptibility to COVID-19.

在采取封锁措施应对2019冠状病毒病(COVID-19)后,泰国政府迅速采取了社会和经济措施,以减轻对普通民众的影响。然而,性工作者是无法获得国家支持的弱势群体之一。一项针对泰国性工作者的快速调查显示,由于封锁、限制国际航班进入泰国以及娱乐场所关闭,几乎所有人都失业了,失去了收入。大多数人无力支付自己及其家属的食物和住所费用。COVID-19还中断了性传播感染的检测和治疗以及为性工作者提供的艾滋病毒服务。与其他国家一样,社区组织在为性工作者提供COVID-19即时短期应对措施方面发挥了至关重要的作用。正如在其他国家一样,这场大流行病表明,许多人的健康和福祉依赖于非常脆弱的基础。这提供了一个明确的机会,通过致力于对性工作者的整体社会包容的长期愿景,更好地重建。泰国应提倡将性工作除罪化,并确保性工作者享有平等的劳动权利,并被纳入政府的社会保障计划。旨在消除艾滋病毒污名化和歧视的政府创新举措取得的进展表明,如何通过利用社区组织实现结构性变革。反过来,为性工作者提供的艾滋病毒服务需要扩大并纳入有针对性的干预措施,以降低性工作者在职业上对COVID-19的易感性。
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引用次数: 28
Community action for people with HIV and sex workers during the COVID-19 pandemic in India. 印度2019冠状病毒病大流行期间为艾滋病毒感染者和性工作者采取的社区行动。
Q2 Medicine Pub Date : 2020-09-01 DOI: 10.4103/2224-3151.294302
Sushena Reza-Paul, Lisa Lazarus, Partha Haldar, Manisha Reza Paul, Bhagya Lakshmi, Manjula Ramaiah, Akram Pasha, Syed Hafeez Ur Rahman, K T Venukumar, M S Venugopa, Bharat Bhushan Rewari, Robert Lorway

Sex workers have been one of the marginalized groups that have been particularly affected by India's stringent lockdown in response to the coronavirus disease 2019 (COVID-19) pandemic. The sudden loss of livelihood and lack of access to health care and social protection intensified the vulnerabilities of sex workers, especially those living with HIV. In response, Ashodaya Samithi, an organization of more than 6000 sex workers, launched an innovative programme of assistance in four districts in Karnataka. Since access to antiretroviral therapy (ART) was immediately disrupted, Ashodaya adapted its HIV outreach programme to form an alternative, community-led system of distributing ART at discreet, private sites. WhatsApp messaging was used to distribute information on accessing government social benefits made available in response to the COVID-19 pandemic. Other assistance included advisory messages posted in WhatsApp groups to raise awareness, dispel myths and mitigate violence, and regular, discreet phone check-ins to follow up on the well-being of members. The lessons learnt from these activities represent an important opportunity to consider more sustainable approaches to the health of marginalized populations that can enable community organizations to be better prepared to respond to other public health crises as they emerge.

性工作者是受印度为应对2019年冠状病毒病(COVID-19)大流行而实施的严格封锁影响特别严重的边缘化群体之一。生计的突然丧失以及无法获得保健和社会保护加剧了性工作者,特别是艾滋病毒感染者的脆弱性。作为回应,由6000多名性工作者组成的组织Ashodaya Samithi在卡纳塔克邦的四个地区发起了一项创新的援助方案。由于获得抗逆转录病毒疗法(ART)的机会立即中断,Ashodaya调整了其艾滋病毒外展规划,形成了一个由社区主导的替代系统,在谨慎的私人地点分发抗逆转录病毒疗法。利用WhatsApp即时通讯发布有关获取政府社会福利的信息,这些福利是为应对COVID-19大流行而提供的。其他帮助包括在WhatsApp群组中发布咨询信息,以提高认识、消除误解和减少暴力,以及定期、谨慎的电话检查,以跟进成员的健康状况。从这些活动中吸取的教训是一个重要的机会,可以考虑对边缘化人口的健康采取更可持续的办法,使社区组织能够更好地准备应对出现的其他公共卫生危机。
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引用次数: 23
Safeguarding essential health services during emergencies: lessons learnt from the COVID-19 pandemic. 在紧急情况下保障基本卫生服务:从COVID-19大流行中吸取的教训。
Q2 Medicine Pub Date : 2020-09-01 DOI: 10.4103/2224-3151.293433
Poonam Khetrapal Singh, Manoj Jhalani
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引用次数: 8
Assessing the COVID-19 diagnostic laboratory capacity in Indonesia in the early phase of the pandemic. 评估印度尼西亚在大流行早期的COVID-19诊断实验室能力。
Q2 Medicine Pub Date : 2020-09-01 DOI: 10.4103/2224-3151.294307
Harimat Hendarwan, Syachroni Syachroni, Ni Ketut Aryastami, Amir Su'udi, Made Dewi Susilawati, Mieska Despitasari, Ully Adhie Mulyani, Mimi Sumiarsih, Nelly Puspandari, Agnes Rengga Indrati, Dewi Amila Solikha, Dyah Armi Riana, Indira Rezky Wahyuni

The coronavirus disease 2019 (COVID-19) pandemic has put a great burden on countries as a result of the demand for laboratory diagnostic testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This paper reports our experiences in rapidly assessing Indonesia's COVID-19 laboratory testing capacity in the early phase of the pandemic response. Through a questionnaire-based survey carried out between 23 March and 2 April, we estimated the daily tests that could be done by the 44 facilities, excluding the national referral laboratory, first assigned to be COVID-19 diagnostic laboratories. The capacity constraints were lack of reagents and equipment, and limited human resources; because of these constraints, most of the laboratories were not yet operational. A major hindrance was reliance on imported supplies and the associated procurement time. Expanding real-time polymerase chain reaction testing capacity, through increased numbers of laboratories and optimization of existing facilities, was clearly the main priority. We also assessed the potential yield from using rapid molecular testing machines in the country's referral hospitals. Even assuming this potential could be tapped, several provinces would still be poorly served by diagnostic services in the event of a surge in cases. Since this rapid assessment, the number of designated COVID-19 laboratories has increased and, by 1 July 2020, was 163. On 29 July 2020, for the first time, the number of specimens examined in a day reached more than 30 000, achieving the WHO testing capacity target of 1 in 1000 inhabitants per week.

由于对严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)实验室诊断检测的需求,2019年冠状病毒病(COVID-19)大流行给各国带来了巨大负担。本文报告了我们在大流行应对的早期阶段快速评估印度尼西亚COVID-19实验室检测能力的经验。通过在3月23日至4月2日期间进行的基于问卷的调查,我们估计了44个设施(不包括国家转诊实验室)可完成的每日检测量,这些实验室最初被指定为COVID-19诊断实验室。能力限制是缺乏试剂和设备,人力资源有限;由于这些限制,大多数实验室尚未开始运作。一个主要障碍是依赖进口供应品和相关的采购时间。通过增加实验室数量和优化现有设施,扩大实时聚合酶链反应检测能力显然是主要优先事项。我们还评估了在该国转诊医院使用快速分子检测仪的潜在产量。即使假设这一潜力可以被挖掘出来,在病例激增的情况下,一些省份的诊断服务仍然很差。自这次快速评估以来,指定的COVID-19实验室数量有所增加,到2020年7月1日为163个。2020年7月29日,一天内检测的标本数量首次超过3万个,实现了世卫组织每周每1000名居民检测1例的能力目标。
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引用次数: 23
期刊
WHO South-East Asia journal of public health
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