systematic review- promoting appropriate management of diarrhea

7/31/2019 Systematic Review- Promoting Appropriate Management of Diarrhea

1/23

KG@KOG VM@KOP^KL\ 3>9 SAE]JM 0;QQO]I]\P ?3% >6?>

@ko~~bmo k| agm ac pbm pav cksm lo}|m| ac `mopb

ojagi kgcogp| og` }g`m~*cksm lbke`~mg kg

Kg`ko X?Z% `m|vkpm pbm osokeonkekp{ ac mo|ke{

kjvemjmgponem kgpm~smgpkag| og` mrk|pmglm ac

Gopkagoe I}k`mekgm| ca~ jogoimjmgp op pbm lajj}gkp{

emsme' A~oe ~mb{`~opkag pbm~ov{ "A^P+ ykpb a~oe

~mb{`~opkag |oep "A^\+ |ae}pkag ~mjokg| pbm la~gm~|pagm

ac ovv~av~kopm lo|m jogoimjmgp ac ko~~bmoe mb{`~opkag

og` k| lag|k`m~m` pbm |kgiem ja|p mccmlpksm |p~opmi{ pa

v~msmgp ko~~bmoe mopb| kg lbke`~mg' Baymsm~% opo c~aj

]gkpm` Gopkag| Lbke`~mg| C}g` "]GKLMC+ lasm~oim

msoe}opkag |}~sm{ "LM\+ X>Z og` pbm pbk~` Gopkagoe

Cojke{ Bmoepb \}~sm{ "GCB\*


2/23

KG@KOG VM@KOP^KL\ 3>2 SAE]JM 0;QQO]I]\P ?3% >6?>

\BOB% mp oe' VÂJAPKGI OVVÂV^KOPMJOGOIMJMGPAC @KO^^BMO

msk`mglm vm~pokgkgi pa `ko~~bmo "`k|mo|m n}~`mg% mpkaeai{%

v~msmgpksm kgpm~smgpkag|% lekmgp v~olpklm| og` v~m|l~kvpkag

v~olpklm|+ kg lbke`~mg oim` em|| pbog cksm {mo~|% ykpb

vo~pkl}eo~ ~mcm~mglm pa pbm Kg`kog lagpmrp' Pbm ~mskmy

c}~pbm~ okjm` pa k`mgpkc{ hgayemìm iov| og` avm~opkagoe

nappemgmlh| pbop veoi}m pbm l}~~mgp v~ai~oj laglm~gkgi

v~msmgpkag og` lagp~ae ac `ko~~bmo ca~ }g`m~*cksm lbke`~mgkg Kg`ko'

JMPBA@\

Pbm jmpbaàeai{ ca~ pbk| |{|pmjopkl ~mskmy bo| nmmg

v~m|mgpm` mo~ekm~ X0Z' O |mp ac hm{ q}m|pkag| ca~ ~mskmy

ym~m ckgoektm` pb~a}ib lag|mg|}| n}ke`kgi% og`

lopmia~ktm` o| Pmlbgkloe K||}m| og` Avm~opkagoe

K||}m| X0Z' Pbm `mpoke| ac pbm |mo~lb |p~opmi{ ca~ molb

q}m|pkag bosm nmmg v~m|mgpm` kg YmnPonem K' Ekpm~op}~m

|mo~lbm| ym~m kgkpkoee{ lo~~km` a}p }~kgi Ov~ke >6?6% og`

}vòpm` ag ?6 Dog}o~{ >6?>'

^M\]EP\

?' @ko~~bmoe Ja~nk kp{ og` Ja~poekp{ kg Kg ko

Olla~`kgi pa \^\ ^mva~p ">66;+ ag Lo}|m| ac @mopb

">66?*>66+ vm~ ?666 vm~ {mo~

X3%9Z' Pbm `ml~mo|m yo| ja|p v~aga}glm` kg lbke`~mg

oim` }g`m~ ? {mo~' @ko~~bmo olla}gpm` ca~ o jm`kog ac

>?- ac oee `mopb| ac lbke`~mg oim` }g`m~ = {mo~| kg pbm|m

o~mo| og` la}gp~km|% nmkgi ~m|vag|knem ca~ >'= jkeekag

`mopb| vm~ {mo~' Eoglmp lbke` |}~sksoe |m~km|% }|kgi o

v~m`klpkag ja`me% m|pkjopm` pbop >>- "?0*

la}gp~km|% ybm~m ;6- ac oee }g`m~*cksm `mopb| all}~ X2Z'

Ja|p ~mlmgp v~m`klpkag ja`mekgi òpo oe|a lagle}`m pbop

`ko~~bmoe `k|mo|m| ieanoee{ o~m ~m|vag|knem ca~ ja|p

}g`m~*cksm lbke` mopb| nm{ag` gmagopoe oim' Pbk| ja`me

v~m`klp| pbop ?0- ac }g`m~*cksm lbke` `mopb| papoekgi pa

ona}p 6'>0 jkeekag kg Kg`ko all}~ }m pa ko~~bmo X;Z' Pbk|

cki}~m k| |kjkeo~ pa pbm \^\ sm~noe o}pav|{ m|pkjopm|'

C}~pbm~% pbm~m yo| jo~hm` ~mikagoe so~kopkag ykpb

ja~poekp{ ~opm c~aj `ko~~bmoe `k|mo|m| kg Lmgp~oe Kg`ko

yo| pb~mm pkjm| pbop kg pbm Ym|p' Ik~e| kg Lmgp~oe Kg`ko bo`

ca}~ pkjm| bkibm~ `ko~~bmoe `k|mo|m ja~poekp{ ~opm

lajvo~m` pa na{| kg pbm Ym|p X?6Z'

Olla~`kgi pa GCB\*< ~mva~p% ;- ac oee }g m~*cksm

lbke`~mg ym~m ~mva~pm` pa nm |}ccm~kgi c~aj ko~~bmo kg eo|p

> ymmh| X- og` ?6-% ~m|vmlpksme{ X??%?>Z'

Pbm|m cki}~m| o~m gap p~}e{ lajvo~onem o| pbm|m òpo|mp|

ym~m anpokgm` c~aj japbm~| ac lbke`~mg ykpb kccm~mgp oimi~a}v| "5 0 {~ kg GCB\*?% 5 < {~ kg GCB\*> og` 5 = {~ kg

GCB\*

caeeaym` n{ o `mlekgm kg GCB\*< o~m gap lemo~'

\}~v~k|kgie{% |popm| ykpb |ajm ac pbm ya~|p bmoepb

kg`klopa~| ekhm ]V% JV og` odo|pbog ~mva~pm` o sm~{ eay

v~msoemglm ac `ko~~bmo kg GCB\*?8 kp kgl~mo|m` n{ >*' Ogapbm~ |}~v~k|kgi ckg`kgi c~aj GCB\*

? yo| pbop oeja|p =6- ac pbm v~msoemglm ac `ko~~bmo kg

v~mska}| pya ymmh| yo| lagp~kn}pm` n{ v~msoemglm }~kgi

eo|p >0 ba}~|' Pbk| jo{ |}iim|p o |kigkcklogp ~mloee nko| kg

}|kgi pya ymmh v~msoemglm o| og kg`klopa~' Pbm |mlag` og`

pbk~` |}~sm{ `k` gap v~m|mgp og{ òpo ag >0 ba}~

v~msoemglm' Asm~oee% pbm~m ovvmo~| pa nm `ml~mo|m kg

v~msoemglm c~aj GCB\*> pa GCB\*- kg 5 3 ja og` =- kg

3*?> ja8 GCB\*%9 |p}`km| c~aj


3/23

KG@KOG VM@KOP^KL\ 3>; SAE]JM 0;QQO]I]\P ?3% >6?>


`msmeavkgi la}gp~km|% kgle}`kgi pb~mm c~aj Kg`ko%

|}iim|pm` pbop pbm jm`kog kglk`mglm ac ko~~bmo ca~ }g`m~*

cksm lbke`~mg yo| ' Mpkaeai{ ac Lbke`baa` @ko~~bmo kg Kg ko

Pbm~m k| ga eo~im*|loem gopkagoee{ ~mv~m|mgpopksm

lajj}gkp{ no|m` |p}`{ kg eo|p pya `mlo`m| ~mio~`kgi

mpkaeai{ a~ p~mg`| ac `ko~~bmo c~aj Kg`ko' Ja|p |p}`km|

bosm nmmg mkpbm~ `m|kigm` pa |vmlkckloee{ msoe}opm pbm

lagp~kn}pkag ac o |kgiem mpkaeaikloe oimgp a~ o~m no|m` ag

k|aeopkag ac jkl~anm| c~aj |paae |ojvem| ac ba|vkpoektm`

vopkmgp| ykpba}p pbmk~ lekgkloe `mpoke|' Ja~masm~% pbm

c~mq}mgp v~m|mglm ac mgpm~kl vopbaimg| kg bmoepb{

lbke`~mg c~aj `msmeavkgi la}gp~km| johm| kp ja~m

`kcckl}ep pa `mpm~jkgm pbmk~ p~}m mpkaeaikloe ~aem kg

lo}|opkag ac `ko~~bmo' Pbm |mo|agoekp{ ac |ajm oimgp|

oe|a v~mle}`m soek` ogoe{|k| c~aj |p}`km| ~mva~pkgi lo|m|

ykpbkg o |ba~p }~opkag'

O j}epklmgp~kl "Lbkgo% Kg`ko% Jmrkla% J{ogjo~ og`

Vohk|pog+% ba|vkpoe*no|m` |p}`{ kg ?;;? msoe}opm` pbm

mpkaeai{ ac ol}pm ko~~bmo "kgle}`kgi pba|m ykpb v~m|mglm

ac neaa` a~ j}l}| kg |paae|+ kg lbke`~mg "6*6Z' Pbm |p}`{ oppmjvpm` pa mekjkgopm pbm ~aem ac

|mo|agoekp{ n{ mg~aeekgi lajvo~onem g}jnm~ ac vopkmgp|

molb ymmh pb~a}iba}p pbm pya*{mo~ |p}`{*vm~ka`' Pbm

|p}`{ oe|a msoe}opm` pbm v~m|mglm ac jkl~aa~iogk|j| kg

bmoepb{ lagp~ae| pa c}~pbm~ kgl~mo|m pbm soek`kp{' Og mgpm~kl

vopbaimg la}e` nm mpmlpm` kg 32- lo|m|' Pbm a~iogk|j|

ja~m v~msoemgp kg lo|m| pbog kg lagp~ae| ym~m ~aposk~}|%

\bkimeeo |vv' og` mgpm~aparkimgklM' laek "MPML+' C~aj

Kg`ko "G:=%23>+% ~aposk~}| yo| `mpmlpm` kg ?2-%Mgpm~aparkimgklM' laek "MPML+ kg ?0- og` \bkimeeo |vv'

kg >6-' Mgpm~avopbaimgkl M' laek "MVML+% \oejagmeeo

|vv'% Lea|p~k`k}j dmd}gk ym~m mq}oee{ v~msoemgp kg lo|m|

og` lagp~ae|' Skn~ka lbaem~om yo| k|aeopm` c~aj >- ac

lo|m| "6'>- ac lagp~ae|+ ybm~mo| M' bk|pae{pklo yo|

`mpmlpm` age{ kg 6'?- ac lo|m| "6'>- ac lagp~ae|+'

^aposk~}| yo| k|aeopm` ja|p c~mq}mgpe{ `}~kgi pbm ck~|p

{mo~ ac ekcm ybm~mo| \bkimeeo |vv' yo| pbm ja|p lajjag

k|aeopm kg lbke`~mg oim` ?>*6- ac

ba|vkpoektopkag|% *< mvk|a`m| ac `ko~~bmo vm~ {mo~'

Pbm vakgp*v~msoemglm "eo|p pya ymmh|+ ac ko~~bmo

ojagi }g`m~*cksm lbke`~mg k| ona}p ;*>6-'

O lbke` k| op jorkj}j ~k|h ac `ko~~bmo nmpymmg3*?> ja ac oim'

Ona}p ?6- ac pbm ko~~bmoe mvk|a`m| o~m {|mgp~{8

pbm~m bo| nmmg ga lbogim kg pbk| p~mg` asm~ eo|ppya `mlo`m|'

Pbm~m o~m ga joda~ ~}~oe!}~nog a~ img`m~`kccm~mglm| kg v~msoemglm ac `ko~~bmo'

@{|mgp~{ k| ja~m lajjag kg ~}~oe o~mo|% og` kg

lbke`~mg c~aj vaa~m~ cojkekm|'

Pbm~m |mmj| pa nm o va|kpksm p~mg` ac `ml~mo|mkg `ko~~bmoe ja~nk`kp{ og` ja~poekp{'


4/23

KG@KOG VM@KOP^KL\ 36?>


`mopb| o~m gap soek` o| ja|p `ko~~bmo `mopb| all}~ kg

lajj}gkp{% og` v~anone{ kg joega}~k|bm` lbke`~mg'

Ojagi `ko~~bmo ba|vkpoektopkag|% pbm lajjagm|p

I p{vm| ym~m I? og` I> ybkem lajjagm|p V p{vm| ym~m V2%

V3 og` V0'

@ko~~bmoimgklM' laek% m|v' Mgpm~aoii~miopksmM' laek%

k| pbm ja|p lajjag nolpm~koe vopbaimg k|aeopm` kg ja|p|p}`km|' Baymsm~% kp bo| oe|a nmmg k|aeopm` c~mq}mgpe{ kg

lagp~ae|' Skn~ka lbaem~om v~màjkgogpe{ all}~| kg

a}pn~moh|% og` ja|p occmlpm` lbke`~mg o~m >*= {~ ae`|' S'

lbaem~om A? k| pbm v~màjkgogp |m~ai~a}v ojagi

`ko~~bmoe vopkmgp|' Pbm bkib k|aeopkag ~opm ac Skn~ka

lbaem~om c~aj |p}`km| }pkektkgi jmpbaàeai{ ac ogoe{|k| ac

|ojvem| |mgp pa pbm jkl~ankaeai{ mvo~pjmgp ca~ l}ep}~m k|

ekhme{ pa nm ~meopm` pa pbm vopkmgp v~ackem o| kp k| ekhme{ pbop

|ojvem| ya}e` nm |mgp ja~m lajjage{ kg lbke`~mg boskgi

~klm yopm~{ |paae| og` |msm~m `mb{`~opkag pa |vmlkckloee{

eaah ca~ S' lbaem~om'

Lagle}|kag| og` Lajjmgp|4 NAR >

Hgayemìm iov| og` k~mlpkag| ca~ c}p}~m ~m|mo~lb4 Pbm~m

k| gmm` ca~ eo~im |loem lajj}gkp{ no|m` |p}`km| msoe}opkgi

pbm mpkaeai{ ac `ko~~bmo% ~opbm~ pbog laglmgp~opkgi ag

k`mgpkcklopkag ac agm vopbaimg' \p}`km| gmm` pa mpm~jkgm

mpkaeai{ ac ko~~bmo% og` la~~meopm| ac `ko~~bmoe mopb| kg

joega}~k|bm` lbke`~mg lajvo~m` pa ymee*ga}~k|bm`

lbke`~mg' \p}`km| gmm` pa msoe}opm pbm lagp~kn}pkag ac

~aposk~}| og` apbm~ colpa~| kg lo}|opkag ac ko~~bmoe mopb|'

Baymsm~% o| `mopb| c~aj `ko~~bmo v~kjo~ke{ all}~ kg

|mppkgi| ybm~m ollm|| pa jm`kloe lo~m k| ekjkpm`% laeemlpkag

ac ovv~av~kopm lekgkloe |vmlkjmg| pa vm~ca~j o

jkl~ankaeaikl msoe}opkag k| mrp~mjme{ lboeemgikgi'

Z' Ogpkjkl~ankoe| o~m

~mlajjmg`m` age{ ca~ i~a|| neaa` kg |paae| a~ \bkimeeova|kpksm l}ep}~m% lbaem~o% o||alkopm` |{|pmjkl kgcmlpkag% a~

|msm~m joeg}p~kpkag' Pbm ck~|p ekgm ogpknkapkl ~mlajjmg`m`

ca~ p~mopjmgp ac `{|mgpm~{ k| a~oe lkv~acearolkg X0?%0>Z'

Jmo|}~m| ca~ v~msmgpkag ac `ko~~bmo kgle}`m v~ajapkgi

mrle}|ksm n~mo|pcmm`kgi% }|m ac |ocm yopm~% bog`yo|bkgi%

caa` |ocmp{% |ocm `k|va|oe ac mrl~mpo% og` kjj}gktopkag

oiokg|p jmo|em|' Pbm|m ~mlajjmgòpkag| pohm kgpa

olla}gp gmy ~m|mo~lb ckg`kgi| ybkem n}ke`kgi ag vo|p

~mlajjmgòpkag|' Pya ~mlmgp o`soglm| kg jogoikgi

`ko~~bmoe k|mo|m4 "k+ ~m`}lm` a|jaeo~kp{ a~oe ~mb{`~opkag

|oep| "A^\+ lagpokgkgi eaym~ laglmgp~opkag| ac ie}la|m

og` |oep% og` "kk+ tkgl |}vvemjmgpopkag o| vo~p ac pbm

p~mopjmgp8 bosm pbm vapmgpkoe pa c}~pbm~ ~m`}lm `ko~~bmoe

ja~nk`kp{ og` ja~poekp{ n{ ~m`}lkgi pbm `}~opkag og`

NAR >

Pbm~m k| ga eo~im*|loem lajv~mbmg|ksm

lajj}gkp{ no|m` |p}`{ ~mio~`kgi mpkaeai{ ac`ko~~bmo c~aj Kg`ko'

âposk~}| k| ~m|vag|knem ca~ ona}p ?=*6- ac

mvk|a`m|' Sk|knem neaa` k| v~m|mgp kg |paae| kg boec

pa pya*pbk~`| ac pbm|m mvk|a`m|'

Skn~ka lbaem~om v~màjkgogpe{ all}~| kg

a}pn~moh|' Ja|p occmlpm` lbke`~mg o~m >*= {~ ae`|'


5/23

KG@KOG VM@KOP^KL\ 3


|msm~kp{ ac ko~~bmoe mvk|a`m| og` eaym~ pbmk~ kglk`mglm'

Gopkagoe Mrvm~p I~a}v ca~j}eopm` n{ pbm Jkgk|p~{ ac

Bmoepb% Iasm~gjmgp ac Kg`ko v~ava|m` pbop o |kgiem

}gksm~|oe A^\ |ae}pkag lagpokgkgi |a`k}j 9= jjae!E og`

ie}la|m 9= jjae!E% og` ykpb a|jaeo~kp{ >0= jA|jae!E

yo| ollmvponem ca~ oee oim| og` oee p{vm| ac ko~~bmo' Pbm

~msk|m` ca~j}eopkag yo| ovv~asm` n{ pbm @~}i Lagp~aeem~ac Kg`ko og` pbm Iasm~gjmgp ca~joee{ eo}glbm` kp kg D}gm

>660' \kjkeo~e{% no|m` ag pbm YBA!]GKLMC!KOV

~mlajjmgòpkag|% pbm Jkgk|p~{ ac Bmoepb% Iasm~gjmgp ac

Kg`ko bo| ~mlajjmg`m` pbop >6 ji ac memjmgpoe tkgl

|ba}e` nm iksmg pa oee lbke`~mg ae`m~ pbog 3 jagpb| ykpb

`ko~~bmo% og` |ba}e` nm |po~pm` o| |aag o| `ko~~bmo |po~p|

og` lagpkg}m` ca~ o papoe vm~ka` ac ?0 ò{| X0?%0>Z'

Lbke`~mg oim` >*3 jagpb| |ba}e` nm o`sk|m` ?6 ji vm~

ò{ ac memjmgpoe tkgl ca~ ?0 o{|'

Tkgl `k|vm~|knem ponemp| og` ekq}k` ca~j}eopkag| o~m

gay osokeonem yk`me{ kg pbm v~ksopm |mlpa~' Tkgl k|vm~|knem

ponemp| o~m oe|a nmkgi |}vvekm` kg pbm LB hkp|' Mcca~p| o~mag ca~ johkgi pbmj osokeonem op ja|p vm~kvbm~oe lmgpm~|%

og` o| asm~ pbm la}gpm~ "APL+ ~}i X0?Z' L}~~mgpe{% pbm~m

o~m ga |p}`km| osokeonem ag pbm avm~opkagoektopkag ac tkgl

p~mopjmgp pb~a}ib iasm~gjmgp |mlpa~'

Hgayemìm iov| og` `k~mlpkag| ca~ c}p}~m ~m|mo~lb4Pbm

l}~~mgp `ko~~bmo jogoimjmgp i}k`mekgm| jokge{ `k|l}||

pbm pmlbgkloe k||}m| ykpb sm~{ ekppem mjvbo|k| ag

avm~opkagoektopkag' Pbm hm{ |p~opmikm| ca~ KML% og`

`k|p~kn}pkag |{|pmj ca~ ~m`}lm` a|jaeo~kp{ A^\% tkgl og`

lkv~acearolkg bosm gap nmmg iksmg o`mq}opm mjvbo|k|'

Oepba}ib Gopkagoe I}k`mekgm| ~mlajjmg` lkv~acearolkg

ca~ {|mgpm~{ og` ~m|k|pogp lbaem~o lo|m|% pbm~m o~m k||}m|~meopm` pa kp| ovv~asoe n{ @~}i Lagp~aeem~ Imgm~oe ac Kg`ko

ca~ }|m kg lbke`~mg'

0' V~msmgpksm Kgpm~smgpkag|

O'N~mo|pcmm`kgi

N~mo|pcmm`kgi bo| pbm vapmgpkoe ac v~msmgpkgi ?


6/23

KG@KOG VM@KOP^KL\ 3 SAE]JM 0;QQO]I]\P ?3% >6?>


kgle}`m` v~ajapkag |p~opmikm| |}lb o| |joee i~a}v

`k|l}||kag| og` eo~im~ jmmpkgi|% j}epkjm`ko

lajj}gklopkag lojvokig| ykpb va|pm~|% ~o`ka!PS

lojvokig|% emocemp|% lajkl naah|% |agi|% |ek`m |bay|% }|m

ac P*|bk~p| og` noìm|% vklpa~koe |pa~km|% `~ojo|% og`

iojm|' Oee kg|pkp}pkag*no|m` p~koe| ym~m c~aj bkib kglajm

la}gp~km| "mrlmvp agm c~aj Lbkgo+ ykpb o`mq}opm v~ask|kagac yopm~ |}vve{ og` |aov' Lajj}gkp{*no|m` p~koe|

kgle}`m` cksm le}|pm~*~ogàjktm` lagp~aeem` p~koe| pbop

}|m` mgpk~m lajj}gkpkm| "imgm~oee{ skeeoim| a~

gmkibna~baa`|% mrlmvp agm p~koe% ybklb }|m` ba}|mbae`|+

o| }gkp| ac ~ogàjktopkag' Pbm|m p~koe| ym~m lag`}lpm` kg

eay*og` jk`èm*kglajm la}gp~km| kg O|ko "G:0+ og`

Oc~klo "G:?+' Kg pb~mm a}p ac pbm|m cksm p~koe|% |aov yo|

v~ask`m` pa pbm lajj}gkp{ n{ ~m|mo~lbm~|' Pb~mm p~koe|

msoe}opm` bog` yo|bkgi o| pbm age{ kgpm~smgpkag% og` apbm~

pya p~koe| }|m` j}epkvem b{ikmgm kgpm~smgpkag| pbop

kgle}`m` bog` yo|bkgi ykpb |aov "pbm p{vm ac |aov }|m` k|

gap `m|l~knm`+' Vo~pklkvogp| ym~m jokge{ japbm~| a~

lo~miksm~| o| ymee o| lbke`~mg' Pbm a}plajm ac `ko~~bmoyo| o||m||m` age{ kg lbke`~mg kg oee pbm p~koe| kgle}`m` kg

pbk| ~mskmy' C~ajKg|pkp}pkag*no|m` p~koe|% pbm kglk`mglm ac

`ko~~bmo yo| o||m||m` kg 99?? lbke`~mg oim` em|| pbog

|msmg {mo~| kg ?3? o{*lo~m lmgp~m| og` 29 |lbaae| kg pbm

mkibp p~koe|' Pbm pya p~koe| pbop o`d}|pm` ca~ le}|pm~kgi og`

lagca}g`m~|% |baym` o ~m`}lpkag kg pbm kglk`mglm ac

`ko~~bmo n{ pa 6';68 0 p~koe|+

kg p~koe| pbop o`d}|pm` ca~ le}|pm~kgi og` lagca}g`m~|' Pbm

|kgiem p~koe ybklb k` gap o`d}|p ca~ le}|pm~kgi mccmlp| oe|a|baym` o |kjkeo~ nmgmckp' Pbm ~m`}lpkag kg pbm ~k|h ac

`ko~~bmo yo| i~mopm~ kg pbm p~koe| ybklb v~ask`m` |aov pa

pbm lajj}gkpkm| "K^^ 6'0;% ;=- LK 6'Z' Kp k|

kjva~pogp pa gapm pbop pbm lagp~ae i~a}v kg ja|p lo|m|

~mlmksm` q}kpm c~mq}mgp jagkpa~kgi% ybklb jo{ kp|mec bosm

kgce}mglm` bog` yo|bkgi nmboska~' Pbk| jkibp bosm

eaym~m` pbm m|pkjopm ac pbm q}ogp}j ac nmgmckp c~aj

bog`yo|bkgi' Asm~oee% pbk| ~mskmy v~ask`m` |p~agi

msk`mglm pbop bog`yo|bkgi kgpm~smgpkag| ~m`}lm ko~~bmoe

ja~nk`kp{ n{ ona}p agm*pbk~`' Baymsm~% ja|p p~koe| kg pbk|

~mskmy bo` |ba~p*pm~j caeeay }v% og` kp k| }glemo~ kc pbmk~

emsme ac mccmlpksmgm|| ya}e` nm jokgpokgm` kc pbm{ ym~m

|loem` }v pa eo~im~ ~mikag| ykpb em|| kgpmg|ksm jagkpa~kgi

asm~ o eagim~ pkjm*vm~ka`'

Kg ogapbm~ |{|pmjopkl ~mskmy ac v}nek|bm` |p}`km|

"laba~p% lo|m*lagp~ae og` ^LP|+ o||m||kgi pbm yopm~

|ogkpopkag og` b{ikmgm kgpm~smgpkag| pa ~m`}lm ko~~bmo kg

pbm em|| msmeavm` la}gp~km|% oee |p}`km` kgpm~smgpkag| ym~m

ca}g` pa ~m`}lm |kigkcklogpe{ pbm ~k|h| ac ko~~bmoe keegm||

X=


7/23



bog`yo|bkgi v~ajapkag ca~ ; jagpb| ~mva~pm` =*9*39- op pya {mo~| caeeaykgi pbm sollkgopkag'

Pbm mccklol{ kg v~msmgpkgi |msm~m ~aposk~oe `ko~~bmo yo|

i~mopm~ "26*;


8/23


9/23


10/23



sm~{ mccmlpksm' Kgdmlponem sollkgm| o~m ga eagim~ kg

lekgkloe }|m% og` pbmk~ v~apmlpksm mccklol{ eo|pm` age{ ca~

agm pa pya {mo~| X3=Z' O ~mlmgp |{|pmjopkl ~mskmy ac a~oe

lbaem~o sollkgm| ~mva~pm` o v~apmlpksm mccklol{ ac ymmh| emo`| pa ?=*

>=- cmym~ mvk|a`m| ac ko~~bmo kg }g`m~*cksm lbke`~mg kg

NAR =

^aposk~}| sollkgm k| mccklolka}| kg v~msmgpkag

oiokg|p |msm~m ~aposk~oe `ko~~bmo "26*;


11/23



PONEMKK\[\PMJ

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7


`klbapaj{ nmpymmg hgayemìm og` v~olpklm' @m|vkpm

pb~mm*ca}~pb ac yajmg hgaykgi ona}p A^\% age{ agm*

ca}~pb }|m` kp ybmg pbmk~ lbke` |}ccm~m` c~aj ko~~bmo' Pbk|

`kccm~mglm log gap nm mrveokgm` age{ ag pbm no|k| ac }|m ac

apbm~ bajm osokeonem ce}k`| o| age{ 0


14/23



lmgpm~ kg Lbmggok X29Z% 3=- ac lbke`~mg ba|vkpoektm` ykpb

`ko~~bmo ~mlmksm` tkgl pbm~ov{'

M' Apbm~ jm`klopkag|! ogpknkapkl|! ogpk`ko~~bmoe|

Kg GCB\*< |}~sm{% |kigkcklogp v~ava~pkag ac lbke`~mg

ym~m p~mopm` ykpb `~}i| "ja|pe{ }ggmlm||o~{+% kgle}`kgi

og` GCB\*?% ?0*?=- ac japbm~| ~mva~pm` pbop kgdmlpkag|

ym~m iksmg pa pbmk~ lbke` pa p~mop `ko~~bmo X??%?>Z' Kg pbm

~mlmgp ]GKLMC pmg*`k|p~klp |}~sm{ X?


15/23

KG@KOG VM@KOP^KL\ 30? SAE]JM 0;QQO]I]\P ?3% >6?>


v~m|l~knm ogpknkapkl| kg lo|m| ac ko~~bmo'

^mio~`kgi |palhkgi A^\% pbm joda~kp{ "9;*;6-+ ac

|m~sklm v~ask`m~| ya~hkgi kg pbm iasm~gjmgp |mlpa~

"v~olpkpkagm~| ac ja`m~g jm`klkgm% OGJ|!OYY|!

O\BO|+ og` v~ksopm lbmjk|p| |palhm` |}vvekm| ac A^\

X?0*0>- ac

iasm~gjmgp*|mlpa~ lajj}gkp{ bmoepb c}glpkago~km|

"OGJ|% OYY| og` O\BO|+' Kg pbm JaBCY*]GKLMC

~}~oe Kg`ko |}~sm{ X23- ac ~}~oe àlpa~|8 oeja|p boec ac pbmj ym~m

v~anone{ avmgkgi pbm volhmp| og` ~m*`k|vmg|kgi o|

jm`klkgm kg |joeem~ vovm~*va}lbm| "v}`k{o|+'

Eolh ac o`mq}opm p~okgkgi kg A^P bo| oe|a nmmg lkpm`

o| agm ac pbm ~mo|ag| ca~ vaa~ A^\ }|oim kg pbm ]GKLMC

pmg*`k|p~klp |}~sm{ X?%;'2!?666 }g`m~*cksm lbke`~mg+ nmpymmg pbm |p}`{ og`

lagp~ae i~a}v' Pba}ib msoe}opkag ac p~okgkgi ac ya~hm~|

}|kgi ja`m~g ja`}eo~ jmpba`| ~msmoem` o |p~khkgi

kjv~asmjmgp kg pbmk~ hgayemìm ~mio~`kgi |kig| ac

`mb{`~opkag% v~mvo~opkag og` }|m ac A^\ mpl'% pbk| k` gap

p~og|eopm kgpa v~olpklm' Pbm hgayemìm og` emsme ac |hkee|

oe|a ymgp ayg pa o lag|k`m~onem mrpmgp ocpm~ ?> jagpb|'

Kg |vkpm ac v~ask`kgi gmlm||o~{ ca~j| pa jokgpokg ~mla~`|%

ga LBI| a~ OYY| olp}oee{ `k` |a' Pbm~m yo| ga

|}vm~sk|kag op oee op pbm VBL emsme' A^\ |}vve{ yo| oe|a

i~a||e{ kgo`mq}opm o| kp yo| gap ~mvemgk|bm`' Kg |vkpm ac pbm

meona~opm p~okgkgi kjvo~pm` pa pbm lajj}gkp{ bmoepb

i}k`m| og` ogiogyo`k ya~hm~|% pbm asm~oee }|oim ~opm kg

pbm |p}`{ o~mo yo| age{ ??- kg lajvo~k|ag pa ?>- kg

lagp~ae o~mo|' Bajm osokeonem ce}k` "BOC+ }|oim ~opm|

ym~m oe|a eay kg napb pbm o~mo| ">9- kg |p}`{ s| >6- kg

lagp~ae+' C}~pbm~% kp yo| ~msmoem` pbop pya*pbk~`| ac pbm

japbm~| k` gap msmg hgay pbmk~ skeeoim emsme ya~hm~ kg pbm

|p}`{ o~mo' Kg |vkpm ac ~mvmopm` p~okgkgi ac bmoepb ya~hm~|pa m`}lopm japbm~| pa }|m A^P mo~ekm|p kg og mvk|a`m ac

`ko~~bmo og` kg o`mq}opm ojagp|% pbm i~o||~aap emsme bmoepb

ya~hm~| cokem` pa à |a msmg ojagi|p pbm |joee

va~ava~pkag ac japbm~| "?>'0-+ m`}lopm` n{ pbmj' Pbm

~mo|ag| ca~ coke}~m lkpm` kg pbk| |p}`{ ym~m4 "k+ eaik|pkl

coke}~m% "kk+ eolh ac japksopkag ac bmoepb ya~hm~|% og` "kkk+

eolh ac v~avm~ |}vm~sk|kag op oee emsme|% og` "ks+ on|mglm ac

lagpkg}m` |}vve{ ac A^\ X;


16/23

KG@KOG VM@KOP^KL\ 30> SAE]JM 0;QQO]I]\P ?3% >6?>


O |joee*|loem% q}m|pkaggok~m*no|m` |p}`{ c~aj pbm

|e}j| ac @mebk% msoe}opm` pbm mccmlpksmgm|| ac pbm Jkgk|p~{

ac Bmoepb| jo|| jm`ko lojvokig pa v~ajapm A^P }|m

`}~kgi `ko~~bmoe mvk|a`m| X?66Z' Pbm hgayem`im ac =;

japbm~| yba yoplbm` pbm pmemsk|kag "PS+ o`sm~pk|mjmgp

ykpb lmemn~kpkm| meksm~kgi |kjvem og` lemo~ jm||oim| ym~m

lajvo~m` pa ;6 japbm~| yba bo` ~mlmksm` A^P jm||oim|

c~aj apbm~ |a}~lm| |}lb o| bmoepb ya~hm~|' Japbm~| kg pbm

ck~|p i~a}v ym~m lag|k`m~one{ ja~m ekhme{ pa hgay bay pa

la~~mlpe{ v~mvo~m A^\ pbog pba|m yba emo~gm` ona}p A^P

c~aj apbm~ |a}~lm| "3>'9- s|

i~a}v| mrk|pm` "3;'0;- og` =


17/23


18/23



OGJ| og` Oogiogyo`k ya~hm~|+ og` v~ksopm

v~olpkpkagm~| "kgle}`kgi }geklmglm`+ o| lboggme| ac

`meksm~{ ac kgpm~smgpkag "v~ask|kag ac tkgl og` A^\ oeagi

ykpb lo~miksm~ m`}lopkag ag pbmk~ }|m+ ocpm~ o n~kmc p~okgkgi

kg `ko~~bmo jogoimjmgp og` tkgl }|m' Pbm mo~ekm~ vkeap

ya~h X?6=Z n{ pbk| i~a}v bo` mjag|p~opm` pbm cmo|knkekp{

pa p~okg so~ka}| iasm~gjmgp og` lajj}gkp{ lboggme| pav~ajapm tkgl o| o p~mopjmgp ca~ ol}pm ko~~bmo pb~a}ib pbm

v~kjo~{ bmoepblo~m |{|pmj' Kgca~jopkag m`}lopkag og`

lajj}gklopkag "KML+ olpkskpkm| kgsaesm` va|pm~| og`

lojvokig| pa v~ajapm tkgl o| o p~mopjmgp ca~ ko~~bmo% o|

ymee o| o pagkl pbop v~msmgp| `ko~~bmo asm~ pbm mg|}kgi

jagpb|% pa mg|}~m lajvekoglm ykpb pbm c}ee ?0*ò{ la}~|m'

]gkgpm~~}vpm` |}vvekm| ac A^\ volhmp| og` tkgl ym~m

mg|}~m`' Pbm kgpm~smgpkag ~m|}epm` kg ~m`}lpkag kg pbm

v~msoemglm ac `ko~~bmo og` ba|vkpoektopkag|' A^\ }|m

kgl~mo|m` |kigkcklogpe{ kg pbm kgpm~smgpkag o~mo|% og` pbm

kgpm~smgpkag oe|a ~m|}epm` kg ~m`}lpkag kg pbm }|m ac

}gyo~~ogpm` a~oe og` kgdmlponem ~}i| }~kgi `ko~~bmo'

Avm~opkagoe cmo|knkekp{ ac kgp~a`}lkgi tkgl kg pbm

p~mopjmgp ac `ko~~bmo bo| oe|a nmmg `mjag|p~opm` c~aj o

j}epklmgp~kl |p}`{ kg a}pvopkmgp bmoepb colkekpkm| ac |kr

lmgpm~| kg cksm la}gp~km| X?63Z ybm~m tkgl |}vvemjmgpopkag

yo| pohmg n{ 20- ac vo~pklkvogp|% og` kp ~m|}epm` kg

~m`}lpkag kg ogpknkapkl!ogpk`ko~~bmoe }|m' Pbk| |p}`{

baymsm~% `k` gap `mjag|p~opm o |kigkcklogp kgl~mo|m kg

A^\ }|m ykpb tkgl |}vvemjmgpopkag' Avm~opkagoe

cmo|knkekp{ ac v~msmgpksm tkgl pbm~ov{ bo| oe|a nmmg

`mjag|p~opm` c~aj ~}~oe o~mo ac Ym|p Nmgioe X?69Z'

Msk`mglm c~aj o lajj}gkpkm| ac Nogieo`m|b X?62Z oe|a

àl}jmgpm` o |kigkcklogpe{ bkibm~ }|m ac A^\ og` apbm~

bajm ce}k`| kg pbm tkgl kgpm~smgpkag o~mo| pbog pba|m kg pbmlajvo~k|ag o~mo|' Pbm v~anonkekp{ ac }|m ac og

ogpkjkl~ankoe }~kgi ko~~bmo yo| age{ ona}p agm*pbk~` kg

pbm kgpm~smgpkag lbke`~mg lajvo~m` pa pbop kg pbm

lajvo~k|ag lbke`~mg'

Pbm kjv~asmjmgp kg A^\ }pkektopkag og` ~m`}lpkag kg

ogpknkapkl }|m kg pbm vav}eopkag| ~mlmkskgi tkgl

`mjag|p~opm| pbop pbm nmgmckp| ac tkgl |}vvemjmgpopkag

mrpmg` ymee nm{ag` ~m`}lkgi pbm `ko~~bmoe ja~nk`kp{ og`

ja~poekp{' Pbm ~mo|ag| ca~ ~m`}lpkag kg ogpknkapkl og` apbm~

}ghgayg ~}i }|oim la}e` nm o ~mcemlpkag ac c}eckeekgi pbm

lo~miksm~| mrvmlpopkag ac jm`klkgm n{ `k|vmg|kgi tkgl%

og` o |bkcp kg lo~m|mmhkgi nmboska~ c~aj v~ksopm v~ask`m~

pa iasm~gjmgp c}glpkago~{' Kjv~asmjmgp kg A^\ }|m ~opm|

o~m ekhme{ pa nm pbm mccmlp ac mgpb}|ko|pkl KML lojvokig|

kgla~va~opkgi tkgl jm||oim| oeagi ykpb A^\' Asm~oee% pbm

|p}`km| bosm `mjag|p~opm` pbop og kgpm~smgpkag pa kjv~asm

`ko~~bmo jogoimjmgp ykpb A^\ og` tkgl k| cmo|knem%

ollmvponem og` mccmlpksm kg ~}~oe Kg`kog lajj}gkpkm|'

C}~pbm~ |loekgi*}v ac pbk| kgpm~smgpkag |ba}e` nm iksmg

v~ka~kp{ kg Kg`ko'O}pba~[mo~

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|}vvemjmgpmì~a}v"^^6'90%;=-

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gpopkagiksmg

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kg

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mvk|a`m|'

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le}|pm~~ogàjktm`

bmoepb

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v~m|l~kvpkag?6?>


^mva~p ag Lo}|m| ac @mopb4 >66?*6' ]gkpm Gopkag| Lbke`~mg| C}g` og` Jkgk|p~{ ac Bmoepb

og` Cojke{ Ymeco~m% Iasm~gjmgp ac Kg`ko' >66; Lasm~oim

Msoe}opkag \}~sm{' Oee Kg`ko mva~p' Gmy @mebk4 ]GKLMC%

>6?6' Osokeonem c~aj4 ]Ê4 bppv4!!yyy'}gklmc'a~i!kg`ko!

bmoepbQ339;'bpj' Ollm||m` Cmn~}o~{ >0% >6?>'669' Gopkagoe Cojke{ Bmoepb \}~sm{

"GCB\*66=634 Kg`ko4 Sae}jm K' J}jnok4 KKV\'

0' Jopbmy DE% \bob @% Im~o P% Iaiko \% Jabog V% Vog o %

mp oe' ]GKLMC*VBCK Gmyna~g og` Lbke` Bmoepb \m~km|

Kg`ko' \{|pmjopkl ^mskmy| ag Lbke` Bmoepb V~ka~kpkm| ca~

O`salol{ og` Olpkag4 Jmpbaàeai{' Kg`kog Vm`kop~'

>6??8024?2896496=*?0'9' \g{`m~ D@% Jm~|ag JB' Pbm joigkp} m ac pbm ieanoe

v~anemj ac ol}pm `ko~~bamoe `k|mo|m4 o ~mskmy ac olpksm

|}~smkeeoglm opo' N}ee YBA'?;2>8364360*?666624 o |{|pmjopkl

ogoe{|k|' Eoglmp'>6?68666' Gopkagoe Cojke{ Bmoepb \}~sm{

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Jol~a Kgpm~gopkagoe ?;;=' Gopkagoe Cojke{ Bmoepb \}~sm{

"GCB\*?+% ?;;>;662 8>>406*3'

?=' Ogog` H% \}gò~oj H^% Eana D% Hovaa~ \H' O~m ko~~bmoe

kglk`mglm og` joeg}p~kpkag ~meopm` kg }g`m~ cksm lbke`~mg1

O eagikp}`kgoe |p}`{ kg og o~mo ac vaa~ |ogkpo~{ lag`kpkag|'

Kg`kog Vm`kop~' ?;;08=43?;*'

>;' \obo @^% ôdmg`~og H% ôjoj}~pb{ P% Gog`{ ^H%

Nboppolbo~{o \H' Kgpm|pkgoe vo~o|kpk|j og` Skn~ka lbaem~om

kgcmlpkag ojagi `ko~~bamoe vopkmgp| kg Haehopo% Kg`ko'

Mvk`mjkae Kgcmlp' >6628?


21/23



mvk`mjkaeai{ ac ~aposk~}| kg lbke`~mg c~aj o lajj}gkp{*

no|m` nk~pb laba~p og` o ba|vkpoe kg \a}pb Kg`ko' D Lekg

Jkl~ankae' >6638004>032*90'

' Nboppolbo~{o ^% \obaa IL% Go{oh JH% Iba|b \% @}ppo V%

Nboppolbo~{o JH% mp oe' Jaeml}eo~ mvk`mjkaeai{ ac b}jog

o|p~ask~}| kgcmlpkag| kg Haehopo% Kg`ko' Kgcmlp Imgmp Msae'

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0?' Iasm~gjmgp ac Kg`ko4 Jkgk|p~{ ac Bmoepb # Cojke{

Ymeco~m8 Lbke` Bmoepb @ksk|kag' Jkg}pm| ac pbm Bkib Emsme

Lajjkppmm Jmmpkgi Bme` ag >6''v c'

Ollm||m` Dog}o~{ >3% >6?>'

0>' Nbopgoio~ \% Ea`bo % Lba}`b}~{ V% \olb ms BV\% \bob

G% Go~o{og \% mp oe' KOV I}k`mekgm| >663 ag jogoimjmgp

ac ol}pm ko~~bmo' Kg`kog Vm`kop~' >6698 0046?68?>34m?2*>='

0=' Mbeo{me J\% Nmgm~ O% On`}e~objog BJ' V~apmlpksm mccmlp

ac n~mo|pcmm`kgi ag `ko~~bmo ojagi lbke`~mg kg o ~ovkè{

i~aykgi gmye{ `msmeavm` |alkmp{' P}~h D Vm`kop~'

>66;8=?4=>9*6608?64>2;*;0'

02' \oemmjk JO% Tojog \% Ohbpo~ BT% Doeke C% O|b~oc ^G%

Bog|ag EO% mp oe' Cmm`kgi voppm~g|% `ko~~bamoe keegm|| og`

ekgmo~ i~aypb kg 6*>0*jagpb*ae` lbke`~mg' D P~av Vm`kop~'

>6608=64?30*;'0;' Nbog o~k G% Nobe % Jot}jò~ \% Jo~pkgm| D% Neolh M%

Nbog JH8 Kgcogp Cmm`kgi \p}`{ I~a}v' Mccmlp ac

lajj}gkp{*no|m` v~ajapkag ac mrle}|ksm n~mo|pcmm`kgi ag

`ko~~bamoe keegm|| og` i~aypb4 o le}|pm~ ~ogàjk|m`

lagp~aeem` p~koe' Eoglmp' >66' Mdmjap K% Mbk~k DM% Jm~mjkhy} JJ% L~kplbem{ DO' Bog`

yo|bkgi ca~ v~msmgpkgi ko~~bamo' Lalb~ogm @opono|m \{|p

^ms' >6628>3='

=66=8=40>*=>'

=0' L}~pk| S% Lok~gl~a|| \' Mccmlp ac yo|bkgi bog`| ykpb |aov

ag `ko~~bamo ~k|h kg pbm lajj}gkp{4 o |{|pmjopkl ~mskmy'

Eoglmp Kgcmlp @k|' >666?? 8?6346??8


22/23



oiokg|p lbke`baa` `ko~~bamo kg Me \oesoà~4 lo|m*lagp~ae

|p}`{' NJD' >6?682>=' ak4?6'??6?6884>;;*6?6824L@666;90'

33' ^m`òkob SV8 Hovaa~ \H' @am| jmo|em| kjj}gktopkag

~m`}lm `ko~~bamoe ja~nk`kp{' Kg`kog D Lajj Jm`

?;;66=8?;>"\}vve ?+4\?66;8'

9?' Iaiko \% \olb`ms B\' Skpojkg O |}vvemjmgpopkag ca~ pbm

v~msmgpkag ac ja~nk`kp{ og` ja~poekp{ kg kgcogp| |kr jagpb|

ac oim a~ em||' Lalb~ogm @opono|m \{|p ^ms'

>6??8>4L@669026'

9>' Jo{a*Yke|ag M% Kjò` O% Bm~tm~ H% [ohaan J[% Nb}ppo

TO' Skpojkg O |}vvemjmgp| ca~ v~msmgpkgi ja~poekp{%

keegm||% og` nekg`gm|| kg lbke`~mg oim` }g`m~ =4 |{|pmjopkl

~mskmy og` jmpo*ogoe{|k|' NJD' >6??86??8??"\}vve 6'

90' Iaiko \% \olb`ms B\' Gmagopoe skpojkg O

|}vvemjmgpopkag ca~ v~msmgpkag ac ja~poekp{ og` ja~nk`kp{

kg kgcogl{4 |{|pmjopkl ~mskmy ac ~ogàjk|m` lagp~aeem`

p~koe|' NJD' >66;866286?? Ov~ ?6698??;4??>6*66286628?>24?3=*9?'

29' Noeo|}n~ojogkog \% Iogm|b ^' V~m|l~knkgi voppm~g ac tkgl

og` ogpkjkl~ankoe| kg ol}pm `ko~~bmo' Kg`kog Vm`kop~'

>66280=496?'

22' Lboh~ono~pk O' V~m|l~kvpkag ac ckrm` à|m lajnkgopkag

`~}i| ca~ ko~~bamo' Kg`kog D Jm` Mpbkl|' >6698804?3=*9'

2;' Nbo~opbk~odo ^% \~k`bo~og \% Lbmeekob E^% \}~m|b \%

\mgi}pp}sog J' Colpa~| occmlpkgi ogpknkapkl v~m|l~knkgi

voppm~g kg vm`kop~kl v~olpklm' Kg`kog D Vm`kop~' >66=89>4299*

;'

;6' \kgib D% Na~o @% \olb`mso S% \bo~jo ^\% Sm~ibm|m P'

V~m|l~knkgi voppm~g n{ àlpa~| ca~ ol}pm `ko~~bamo kg

lbke`~mg kg @mebk% Kg`ko' @ko~~bamoe @k| ^m|' ?;;=8


23/23

KG@KOG VM@KOP^KL\ 30; SAE]JM 0;QQO]I]\P ?3% >6?>


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systematic review- promoting appropriate management of diarrhea

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