{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:51:28Z","timestamp":1787507488489,"version":"build-2736575974"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2024,3,28]],"date-time":"2024-03-28T00:00:00Z","timestamp":1711584000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,3,28]],"date-time":"2024-03-28T00:00:00Z","timestamp":1711584000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001713","name":"European & Developing Countries Clinical Trials Partnership","doi-asserted-by":"crossref","award":["DRIA2014-308 SOLID"],"award-info":[{"award-number":["DRIA2014-308 SOLID"]}],"id":[{"id":"10.13039\/501100001713","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100013699","name":"Bundesministerium f\u00fcr Bildung, Wissenschaft und Forschung","doi-asserted-by":"publisher","award":["01KA1617"],"award-info":[{"award-number":["01KA1617"]}],"id":[{"id":"10.13039\/501100013699","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurol Sci"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Epilepsy is a multifactorial neurological disorder, including parasitic infections of the brain such as neurocysticercosis (NCC). People with epileptic seizures (PWES) in low and middle-income countries often do not receive appropriate treatment, which besides epileptic seizures, may also lead to reduced quality of life and possibly death. The objective of this study was to describe gaps in treatment of epileptic seizures in a Zambian rural area.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted in Sinda district of Zambia between August and October 2018. PWES identified from clinic records and with the help of community healthcare workers were recruited. Two questionnaires, one to PWES and the other to local healthcare workers, were administered to describe the treatment gap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 146 PWES and 43 healthcare workers were interviewed. Of the 146 PWES, 131 had taken anti-seizure medication (ASM) at some point since their seizure onset, of which 49.6% were on current treatment. Only 18.3% were on continuous ASM, an overall treatment gap of 83.6%. Over 55% of healthcare workers did not know the relationship between epilepsy and NCC. The risk factors associated with lack of appropriate treatment were stock-outs of ASMs, lack of diagnostic equipment, poor patient follow-up, and PWES opting for traditional medicine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The treatment gap is substantial in Sinda district. The causes are multifactorial, involving shortcomings at the level of healthcare facilities, communities, and individuals. Directed training of healthcare workers and significant improvements in the supply and dispensing of ASMs will be key in substantially reducing the gap.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10072-024-07456-1","type":"journal-article","created":{"date-parts":[[2024,3,28]],"date-time":"2024-03-28T01:43:00Z","timestamp":1711590180000},"page":"4529-4538","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Gaps in treatment of epileptic seizures in a Zambian rural area"],"prefix":"10.1007","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5716-7775","authenticated-orcid":false,"given":"Richard","family":"Mambo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Phiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Trevisan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gideon","family":"Zulu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chishimba M.","family":"Mubanga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chembensofu","family":"Mwelwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac K.","family":"Phiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronika","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Magnussen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Dorny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Gabri\u00ebl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea S.","family":"Winkler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kabemba E.","family":"Mwape","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,3,28]]},"reference":[{"issue":"11","key":"7456_CR1","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1016\/S1474-4422(17)30299-5","volume":"16","author":"VL Feigin","year":"2017","unstructured":"Feigin VL, Abajobir AA, Abate KH, Abd-Allah F, Abdulle AM, Abera SF, Abyu GY, Ahmed MB, Aichour AN, Aichour I, Aichour MT (2017) Global, regional, and national burden of neurological disorders during 1990\u20132015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol 16(11):877\u2013897","journal-title":"Lancet Neurol"},{"key":"7456_CR2","unstructured":"World Health Organization (2023) Intersectoral global action plan on epilepsy and other neurological disorders 2022\u20132031"},{"issue":"1","key":"7456_CR3","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/S0001-706X(03)00038-X","volume":"87","author":"AG Diop","year":"2003","unstructured":"Diop AG, de Boer HM, Mandlhate C, Prilipko L, Meinardi H (2003) The global campaign against epilepsy in Africa. Acta Trop 87(1):149\u2013159","journal-title":"Acta Trop"},{"issue":"1","key":"7456_CR4","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/S1474-4422(04)00963-9","volume":"4","author":"PM Preux","year":"2005","unstructured":"Preux PM, Druet-Cabanac M (2005) Epidemiology and aetiology of epilepsy in sub-Saharan Africa. Lancet Neurol 4(1):21\u201331","journal-title":"Lancet Neurol"},{"issue":"10","key":"7456_CR5","doi-asserted-by":"publisher","first-page":"2310","DOI":"10.1111\/j.1528-1167.2009.02184.x","volume":"50","author":"AS Winkler","year":"2009","unstructured":"Winkler AS, Kerschbaumsteiner K, Stelzhammer B, Meindl M, Kaaya J, Schmutzhard E (2009) Prevalence, incidence, and clinical characteristics of epilepsy\u2014a community-based door-to-door study in northern Tanzania. Epilepsia 50(10):2310\u20132313","journal-title":"Epilepsia"},{"issue":"1","key":"7456_CR6","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1046\/j.1365-3156.2003.01149.x","volume":"9","author":"GL Birbeck","year":"2004","unstructured":"Birbeck GL, Kalichi EM (2004) Epilepsy prevalence in rural Zambia: a door-to-door survey. Tropical Med Int Health 9(1):92\u201395","journal-title":"Tropical Med Int Health"},{"key":"7456_CR7","doi-asserted-by":"crossref","unstructured":"Annegers JF, Rocca WA, Hauser WA (1996) Causes of epilepsy: contributions of the Rochester epidemiology project. In: Mayo Clinic Proceedings, vol 71, no 6. Elsevier, p 570\u2013575","DOI":"10.4065\/71.6.570"},{"issue":"165","key":"7456_CR8","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.actatropica.2015.10.018","volume":"1","author":"YA Assane","year":"2017","unstructured":"Assane YA, Trevisan C, Schutte CM, Noormahomed EV, Johansen MV, Magnussen P (2017) Neurocysticercosis in a rural population with extensive pig production in Angonia district, Tete Province. Mozambique Acta Tropica 1(165):155\u2013160","journal-title":"Mozambique Acta Tropica"},{"issue":"8","key":"7456_CR9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0003972","volume":"9","author":"KE Mwape","year":"2015","unstructured":"Mwape KE, Blocher J, Wiefek J, Schmidt K, Dorny P, Praet N, Chiluba C, Schmidt H, Phiri IK, Winkler AS, Gabri\u00ebl S (2015) Prevalence of neurocysticercosis in people with epilepsy in the Eastern Province of Zambia. PLoS Negl Trop Dis 9(8):e0003972","journal-title":"PLoS Negl Trop Dis"},{"key":"7456_CR10","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1590\/0004-282X20140024","volume":"72","author":"A Carpio","year":"2014","unstructured":"Carpio A, Romo ML (2014) The relationship between neurocysticercosis and epilepsy: an endless debate. Arq Neuropsiquiatr 72:383\u2013390","journal-title":"Arq Neuropsiquiatr"},{"key":"7456_CR11","first-page":"307","volume-title":"Novel aspects on cysticercosis and neurocysticercosis","author":"AS Winkler","year":"2013","unstructured":"Winkler AS (2013) Epilepsy and neurocysticercosis in sub-Saharan Africa. In: Foyaca Sibat H (ed) Novel aspects on cysticercosis and neurocysticercosis. InTech, p 307\u2013340"},{"key":"7456_CR12","unstructured":"World Health Organization. Department of Mental Health, Substance Abuse, World Health Organization. Mental Health Evidence, & Research Team (2005) Mental health atlas 2005. World Health Organization"},{"issue":"12","key":"7456_CR13","doi-asserted-by":"publisher","first-page":"2178","DOI":"10.1111\/epi.12002","volume":"53","author":"AC Meyer","year":"2012","unstructured":"Meyer AC, Dua T, Boscardin WJ, Escarce JJ, Saxena S, Birbeck GL (2012) Critical determinants of the epilepsy treatment gap: a cross-national analysis in resource-limited settings. Epilepsia 53(12):2178\u20132185","journal-title":"Epilepsia"},{"key":"7456_CR14","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1046\/j.1528-1157.43.s.6.13.x","volume":"43","author":"R Kale","year":"2002","unstructured":"Kale R (2002) The treatment gap. Epilepsia 43:31\u201333","journal-title":"Epilepsia"},{"key":"7456_CR15","first-page":"378","volume":"80","author":"R Coleman","year":"2002","unstructured":"Coleman R, Loppy L, Walraven G (2002) The treatment gap and primary health care for people with epilepsy in rural Gambia. Bull World Health Organ 80:378\u2013383","journal-title":"Bull World Health Organ"},{"issue":"8","key":"7456_CR16","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1016\/S1474-4422(12)70155-2","volume":"11","author":"CK Mbuba","year":"2012","unstructured":"Mbuba CK, Ngugi AK, Fegan G, Ibinda F, Muchohi SN, Nyundo C (2012) Risk factors associated with the epilepsy treatment gap in Kilifi, Kenya: a cross-sectional study. Lancet Neurol 11(8):688\u2013696","journal-title":"Lancet Neurol"},{"issue":"3","key":"7456_CR17","doi-asserted-by":"publisher","first-page":"571","DOI":"10.4269\/ajtmh.2010.10-0100","volume":"83","author":"EN Chomba","year":"2010","unstructured":"Chomba EN, Haworth A, Mbewe E, Atadzhanov M, Ndubani P, Kansembe H (2010) The current availability of antiepileptic drugs in Zambia: implications for the ILAE\/WHO \u201cout of the shadows\u201d campaign. Am J Trop Med Hyg 83(3):571","journal-title":"Am J Trop Med Hyg"},{"issue":"6","key":"7456_CR18","doi-asserted-by":"publisher","first-page":"1174","DOI":"10.3889\/oamjms.2018.235","volume":"6","author":"I Ernawati","year":"2018","unstructured":"Ernawati I, Wardah Rahmatul Islamiyah S (2018) How to improve clinical outcome of epileptic seizure control based on medication adherence? A literature review. Open Access Macedonian J Med Sci 6(6):1174","journal-title":"Open Access Macedonian J Med Sci"},{"issue":"7","key":"7456_CR19","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1016\/j.seizure.2007.04.008","volume":"16","author":"K Das","year":"2007","unstructured":"Das K, Banerjee M, Mondal GP, Devi LG, Singh OP, Mukherjee BB (2007) Evaluation of socio-economic factors causing discontinuation of epilepsy treatment resulting in seizure recurrence: a study in an urban epilepsy clinic in India. Seizure 16(7):601\u2013607","journal-title":"Seizure"},{"issue":"3","key":"7456_CR20","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1016\/j.yebeh.2010.08.017","volume":"19","author":"M Atadzhanov","year":"2010","unstructured":"Atadzhanov M, Haworth A, Chomba EN, Mbewe EK, Birbeck GL (2010) Epilepsy-associated stigma in Zambia: what factors predict greater felt stigma in a highly stigmatized population? Epilepsy Behav 19(3):414\u2013418","journal-title":"Epilepsy Behav"},{"issue":"10","key":"7456_CR21","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1016\/S1474-4422(06)70528-2","volume":"5","author":"D Ding","year":"2006","unstructured":"Ding D, Wang W, Wu J, Ma G, Dai X, Yang B, Wang T, Yuan C, Hong Z, de Boer HM, Prilipko L (2006) Premature mortality in people with epilepsy in rural China: a prospective study. Lancet Neurol 5(10):823\u2013827","journal-title":"Lancet Neurol"},{"issue":"3","key":"7456_CR22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0003570","volume":"9","author":"S Thys","year":"2015","unstructured":"Thys S, Mwape KE, Lefevre P, Dorny P, Marcotty T, Phiri AM, Phiri IK, Gabri\u00ebl S (2015) Why latrines are not used: communities\u2019 perceptions and practices regarding latrines in a Taenia solium endemic rural area in Eastern Zambia. PLoS Negl Trop Dis 9(3):e0003570","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"7456_CR23","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0002142","volume":"7","author":"KE Mwape","year":"2013","unstructured":"Mwape KE, Phiri IK, Praet N, Speybroeck N, Muma JB, Dorny P, Gabri\u00ebl S (2013) The incidence of human cysticercosis in a rural community of Eastern Zambia. PLoS Negl Trop Dis 7(3):e2142","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"7456_CR24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0001594","volume":"6","author":"KE Mwape","year":"2012","unstructured":"Mwape KE, Phiri IK, Praet N, Muma JB, Zulu G, Van den Bossche P, De Deken R, Speybroeck N, Dorny P, Gabri\u00ebl S (2012) Taenia solium Infections in a rural area of Eastern Zambia - a community based study. PLoS Negl Trop Dis 6(3):e1594","journal-title":"PLoS Negl Trop Dis"},{"key":"7456_CR25","unstructured":"Ministry of Health (2017) Standard treatment guidelines. Vol: 04, Lusaka, Zambia. A book"},{"key":"7456_CR26","unstructured":"R Core Team, R (2020) R Core Team R: a language and environment for statistical computing. R Core Team, Vienna"},{"issue":"2","key":"7456_CR27","doi-asserted-by":"publisher","first-page":"186","DOI":"10.4314\/ahs.v12i2.17","volume":"12","author":"JH Chin","year":"2012","unstructured":"Chin JH (2012) Epilepsy treatment in sub-Saharan Africa: closing the gap. Afr Health Sci 12(2):186\u2013192","journal-title":"Afr Health Sci"},{"issue":"80","key":"7456_CR28","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1016\/j.yebeh.2017.10.042","volume":"1","author":"AL Nau","year":"2018","unstructured":"Nau AL, Mwape KE, Wiefek J, Schmidt K, Abatih E, Dorny P, Praet N, Chiluba C, Schmidt H, Phiri IK, Winkler AS (2018) Cognitive impairment and quality of life of people with epilepsy and neurocysticercosis in Zambia. Epilepsy Behav 1(80):354\u2013359","journal-title":"Epilepsy Behav"},{"issue":"1","key":"7456_CR29","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/0920-1211(95)00102-6","volume":"24","author":"R Gillham","year":"1996","unstructured":"Gillham R, Baker G, Thompson P, Birbeck K, McGuire A, Tomlinson L, Eckersley L, Silveira C, Brown S (1996) Standardisation of a self-report questionnaire for use in evaluating cognitive, affective and behavioural side-effects of anti-epileptic drug treatments. Epilepsy Res 24(1):47\u201355","journal-title":"Epilepsy Res"},{"issue":"1","key":"7456_CR30","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1212\/WNL.62.1.23","volume":"62","author":"FG Gilliam","year":"2004","unstructured":"Gilliam FG, Fessler AJ, Baker G, Vahle V, Carter J. Systematic screening allows reduction of adverse antiepileptic drug effects: a randomized trial. Neurology. 2004\u00a0 62(1):23\u20137.","journal-title":"Neurology"},{"issue":"9","key":"7456_CR31","doi-asserted-by":"publisher","first-page":"929","DOI":"10.18553\/jmcp.2018.17337","volume":"24","author":"J Fishman","year":"2018","unstructured":"Fishman J, Kalilani L, Song Y, Swallow E, Wild I (2018) Antiepileptic drug titration and related health care resource use and costs. J Managed Care Special Pharm 24(9):929\u201338","journal-title":"J Managed Care Special Pharm"},{"key":"7456_CR32","doi-asserted-by":"publisher","first-page":"107794","DOI":"10.1016\/j.yebeh.2021.107794","volume":"116","author":"P Mirpuri","year":"2021","unstructured":"Mirpuri P, Chandra PP, Samala R, Agarwal M, Doddamani R, Kaur K, Tripathi M (2021) The development and efficacy of a mobile phone application to improve medication adherence for persons with epilepsy in limited resource settings: a preliminary study. Epil Behav 116:107794","journal-title":"Epil Behav"},{"key":"7456_CR33","unstructured":"CSO M (2013) ICF international. Zambia demographic and health survey, 2014"},{"issue":"1","key":"7456_CR34","doi-asserted-by":"publisher","first-page":"e20","DOI":"10.1111\/j.1528-1167.2012.03695.x","volume":"54","author":"N Carpentier","year":"2013","unstructured":"Carpentier N, Jonas J, Frismand S, Vignal JP, Rikir E, Baumann C, Lapicque F, Saint-Marcoux F, Vespignani H, Maillard L (2013) Direct evidence of nonadherence to antiepileptic medication in refractory focal epilepsy. Epilepsia 54(1):e20\u2013e23","journal-title":"Epilepsia"},{"issue":"2","key":"7456_CR35","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1111\/j.1525-1497.2001.00122.x","volume":"16","author":"RL Cook","year":"2001","unstructured":"Cook RL, Sereika SM, Hunt SC, Woodward WC, Erlen JA, Conigliaro J (2001) Problem drinking and medication adherence among persons with HIV infection. J Gen Intern Med 16(2):83\u201388","journal-title":"J Gen Intern Med"},{"key":"7456_CR36","doi-asserted-by":"crossref","unstructured":"Hegazi A, Bailey RL, Ahadzie B, Alabi A, Peterson K (2010) Literacy, education and adherence to antiretroviral therapy in The Gambia. AIDS care 22(11):1340\u20131345","DOI":"10.1080\/09540121003693514"},{"key":"7456_CR37","first-page":"344","volume":"79","author":"RA Scott","year":"2001","unstructured":"Scott RA, Lhatoo SD, Sander JW (2001) The treatment of epilepsy in developing countries: where do we go from here? Bull World Health Organ 79:344\u2013351","journal-title":"Bull World Health Organ"},{"issue":"9","key":"7456_CR38","doi-asserted-by":"publisher","first-page":"401","DOI":"10.3389\/fneur.2018.00401","volume":"5","author":"M Hamerle","year":"2018","unstructured":"Hamerle M, Ghaeni L, Kowski A, Weissinger F, Holtkamp M (2018) Alcohol use and alcohol-related seizures in patients with epilepsy. Front Neurol 5(9):401","journal-title":"Front Neurol"},{"key":"7456_CR39","doi-asserted-by":"crossref","unstructured":"C\u00f4t\u00e9 J, Beaudet L, Auger P, Rouleau G, Chicoine G, L\u00e9ger V, Nguyen DK (2021) Evaluation of a web-based virtual nursing intervention to support self-management among adults with epilepsy: a mixed-methods study. Epil Behav 114:107581","DOI":"10.1016\/j.yebeh.2020.107581"},{"issue":"4","key":"7456_CR40","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1111\/j.1528-1157.1992.tb02341.x","volume":"33","author":"L Jilek-Aall","year":"1992","unstructured":"Jilek-Aall L, Rwiza HT (1992) Prognosis of epilepsy in a rural African community: a 30-year follow-up of 164 patients in an outpatient clinic in rural Tanzania. Epilepsia 33(4):645\u2013650","journal-title":"Epilepsia"}],"container-title":["Neurological Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10072-024-07456-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10072-024-07456-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10072-024-07456-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T06:29:32Z","timestamp":1723012172000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10072-024-07456-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,28]]},"references-count":40,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2024,9]]}},"alternative-id":["7456"],"URL":"https:\/\/doi.org\/10.1007\/s10072-024-07456-1","relation":{},"ISSN":["1590-1874","1590-3478"],"issn-type":[{"value":"1590-1874","type":"print"},{"value":"1590-3478","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,28]]},"assertion":[{"value":"7 November 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 March 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 March 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical clearance was obtained from Excellence in Research Ethics and Science (ERES) Converge (Ref: 22-mar-2018) in Zambia. Permission was sought from the Ministry of Health of Zambia local District Health Authority in Sinda district. Meetings were held with people in the villages through their leaders (village heads) to explain the purpose of the study, and their permission was sought to conduct the study in their area. Written informed consent was obtained from the participants. Minors had to assent with a parent or a guardian consenting on their behalf. To ensure privacy and confidentiality, all data was coded.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}