{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T22:10:18Z","timestamp":1793225418298,"version":"4.5.0"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T00:00:00Z","timestamp":1740355200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T00:00:00Z","timestamp":1740355200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Insecticide resistance and outdoor transmission have reduced the effectiveness of existing malaria transmission prevention strategies. As a result, targeted approaches to support continuing malaria control, such as transmission-blocking vaccines, are required. Cross-sectional mass blood screening in children between 5 and 15\u00a0years was conducted in Chulaimbo, Kisumu,\u00a0during the dry and wet seasons in 2018 and 2019.\n                    <jats:italic>Plasmodium falciparum<\/jats:italic>\n                    gametocyte carriers were identified by Microscopy. Subsequently, carriers were used to feed colony bred\n                    <jats:italic>Anopheles gambiae<\/jats:italic>\n                    females in serum replacement and whole blood membrane feeding experiments. The infection prevalence was 19.7% (95% Cl 0.003\u20130.007) with 95% of the infections being caused by\n                    <jats:italic>P. falciparum<\/jats:italic>\n                    . Of all confirmed\n                    <jats:italic>P. falciparum<\/jats:italic>\n                    infections, 16.9% were gametocytes. Thirty-seven paired experiments showed infection rates of 0.9% and 0.5% in the serum replacement and whole blood experiments, respectively, with no significant difference (P\u2009=\u20090.738). Six Pfs47 haplotypes were identified from 24 sequenced infectious blood samples: Hap_1 (E27D and L240I), Hap_2 (S98T); Hap_3 (E27D); Hap_4 (L240I); Hap_5 (E188D); and Hap_6 without mutations. Haplotype 4 had the highest frequency of 29.2% followed by Hap_3 and Hap_6 at 20.8% each then Hap_1 with a frequency of 16.7%, whereas Hap_5 and Hap_2 had frequencies of 8.3% and 4.2% respectively. Varying frequencies of Pfs47 haplotypes observed from genetically heterogeneous parasite populations in endemic regions illuminates vector compatibility to refracting\n                    <jats:italic>P. falciparum<\/jats:italic>\n                    using the hypothesized lock and key analogy. This acts as a bottleneck that increases the frequency of\n                    <jats:italic>P. falciparum<\/jats:italic>\n                    haplotypes that escape elimination by vector immune responses. The interaction can be used as a potential target for transmission blocking through a refractory host.\n                  <\/jats:p>","DOI":"10.1038\/s41598-024-84847-6","type":"journal-article","created":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T03:22:11Z","timestamp":1740367331000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Plasmodium falciparum Pfs47 haplotype compatibility to Anopheles gambiae in Kisumu, a malaria-endemic region of Kenya"],"prefix":"10.1038","volume":"15","author":[{"given":"Shirley A.","family":"Onyango","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxwell G.","family":"Machani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin O.","family":"Ochwedo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin M.","family":"Oriango","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Chieh","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Kokwaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaw A.","family":"Afrane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew K.","family":"Githeko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daibin","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guiyun","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,24]]},"reference":[{"issue":"4","key":"84847_CR1","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1111\/eva.12530","volume":"11","author":"S Huijben","year":"2018","unstructured":"Huijben, S. & Paaijmans, K. P. Putting evolution in elimination: winning our ongoing battle with evolving malaria mosquitoes and parasites. Evol. Appl. 11(4), 415\u2013430 (2018).","journal-title":"Evol. Appl."},{"issue":"1","key":"84847_CR2","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1186\/s13071-017-2361-8","volume":"10","author":"BM Ondeto","year":"2017","unstructured":"Ondeto, B. M. et al. Current status of insecticide resistance among malaria vectors in Kenya. Parasit. Vect. 10(1), 429 (2017).","journal-title":"Parasit. Vect."},{"issue":"1","key":"84847_CR3","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1186\/s13071-021-04833-z","volume":"14","author":"PW Orondo","year":"2021","unstructured":"Orondo, P. W. et al. Insecticide resistance status of Anopheles arabiensis in irrigated and non-irrigated areas in western Kenya. Parasit. Vect. 14(1), 335 (2021).","journal-title":"Parasit. Vect."},{"issue":"4","key":"84847_CR4","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1111\/eva.12501","volume":"11","author":"ED Sternberg","year":"2018","unstructured":"Sternberg, E. D. & Thomas, M. B. Insights from agriculture for the management of insecticide resistance in disease vectors. Evolut. Appl. 11(4), 404\u2013414 (2018).","journal-title":"Evolut. Appl."},{"issue":"1","key":"84847_CR5","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1186\/s12936-021-03650-0","volume":"20","author":"M Ke\u00efta","year":"2021","unstructured":"Ke\u00efta, M. et al. Indoor and outdoor malaria transmission in two ecological settings in rural Mali: implications for vector control. Malar. J. 20(1), 127 (2021).","journal-title":"Malar. J."},{"key":"84847_CR6","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1186\/s12936-016-1286-6","volume":"15","author":"JI Meyers","year":"2016","unstructured":"Meyers, J. I. et al. Increasing outdoor host-seeking in Anopheles gambiae over 6 years of vector control on Bioko Island. Malar. J. 15, 239 (2016).","journal-title":"Malar. J."},{"issue":"2","key":"84847_CR7","doi-asserted-by":"publisher","first-page":"219","DOI":"10.4269\/ajtmh.2006.75.219","volume":"75","author":"PE Okello","year":"2006","unstructured":"Okello, P. E. et al. Variation in malaria transmission intensity in seven sites throughout Uganda. Am. J. Trop. Med. Hyg. 75(2), 219\u2013225 (2006).","journal-title":"Am. J. Trop. Med. Hyg."},{"issue":"30","key":"84847_CR8","doi-asserted-by":"publisher","first-page":"15086","DOI":"10.1073\/pnas.1820646116","volume":"116","author":"E Sherrard-Smith","year":"2019","unstructured":"Sherrard-Smith, E. et al. Mosquito feeding behavior and how it influences residual malaria transmission across Africa. Proc. Natl. Acad. Sci. U. S. A. 116(30), 15086\u201315095 (2019).","journal-title":"Proc. Natl. Acad. Sci. U. S. A."},{"issue":"49","key":"84847_CR9","doi-asserted-by":"publisher","first-page":"15178","DOI":"10.1073\/pnas.1520426112","volume":"112","author":"A Molina-Cruz","year":"2015","unstructured":"Molina-Cruz, A. et al. Plasmodium evasion of mosquito immunity and global malaria transmission: The lock-and-key theory. Proc. Natl. Acad. Sci. U. S. A. 112(49), 15178\u201315183 (2015).","journal-title":"Proc. Natl. Acad. Sci. U. S. A."},{"issue":"4","key":"84847_CR10","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1016\/j.dci.2009.12.005","volume":"34","author":"CM Cirimotich","year":"2010","unstructured":"Cirimotich, C. M. et al. Mosquito immune defenses against Plasmodium infection. Dev. Comp. Immunol. 34(4), 387\u2013395 (2010).","journal-title":"Dev. Comp. Immunol."},{"issue":"7","key":"84847_CR11","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1016\/j.ibmb.2005.02.009","volume":"35","author":"K Michel","year":"2005","unstructured":"Michel, K. & Kafatos, F. C. Mosquito immunity against Plasmodium. Insect. Biochem. Mol. Biol. 35(7), 677\u2013689 (2005).","journal-title":"Insect. Biochem. Mol. Biol."},{"issue":"6","key":"84847_CR12","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1004871","volume":"11","author":"SK Nilsson","year":"2015","unstructured":"Nilsson, S. K. et al. Targeting human transmission biology for malaria elimination. PLoS Pathog. 11(6), e1004871 (2015).","journal-title":"PLoS Pathog."},{"issue":"20","key":"84847_CR13","doi-asserted-by":"publisher","first-page":"6114","DOI":"10.1093\/emboj\/16.20.6114","volume":"16","author":"AM Richman","year":"1997","unstructured":"Richman, A. M. et al. Plasmodium activates the innate immune response of Anopheles gambiae mosquitoes. Embo J. 16(20), 6114\u20136119 (1997).","journal-title":"Embo J."},{"key":"84847_CR14","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1186\/1471-2148-8-274","volume":"8","author":"DJ Obbard","year":"2008","unstructured":"Obbard, D. J. et al. The evolution of TEP1, an exceptionally polymorphic immunity gene in Anopheles gambiae. BMC Evol. Biol. 8, 274 (2008).","journal-title":"BMC Evol. Biol."},{"issue":"2","key":"84847_CR15","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1159\/000353602","volume":"6","author":"AM Clayton","year":"2014","unstructured":"Clayton, A. M., Dong, Y. & Dimopoulos, G. The Anopheles innate immune system in the defense against malaria infection. J. Innate Immunity 6(2), 169\u2013181 (2014).","journal-title":"J. Innate Immunity"},{"issue":"5","key":"84847_CR16","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1016\/S0092-8674(04)00173-4","volume":"116","author":"SA Blandin","year":"2004","unstructured":"Blandin, S. A. et al. Complement-like protein TEP1 is a determinant of vectorial capacity in the malaria vector Anopheles gambiae. Cell 116(5), 661\u2013670 (2004).","journal-title":"Cell"},{"issue":"5949","key":"84847_CR17","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1126\/science.1175241","volume":"326","author":"SA Blandin","year":"2009","unstructured":"Blandin, S. A. et al. Dissecting the genetic basis of resistance to malaria parasites in Anopheles gambiae. Science 326(5949), 147\u2013150 (2009).","journal-title":"Science"},{"issue":"5","key":"84847_CR18","doi-asserted-by":"publisher","first-page":"2597","DOI":"10.1073\/pnas.1917042117","volume":"117","author":"A Molina-Cruz","year":"2020","unstructured":"Molina-Cruz, A. et al. Plasmodium falciparum evades immunity of anopheline mosquitoes by interacting with a Pfs47 midgut receptor. Proc. Natl. Acad. Sci. 117(5), 2597\u20132605 (2020).","journal-title":"Proc. Natl. Acad. Sci."},{"issue":"6135","key":"84847_CR19","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1126\/science.1235264","volume":"340","author":"A Molina-Cruz","year":"2013","unstructured":"Molina-Cruz, A. et al. The human malaria parasite Pfs47 gene mediates evasion of the mosquito immune system. Science 340(6135), 984\u2013987 (2013).","journal-title":"Science"},{"key":"84847_CR20","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1186\/1756-3305-3-117","volume":"3","author":"ME Sinka","year":"2010","unstructured":"Sinka, M. E. et al. The dominant Anopheles vectors of human malaria in Africa, Europe and the Middle East: occurrence data, distribution maps and bionomic pr\u00e9cis. Parasites Vectors 3, 117 (2010).","journal-title":"Parasites Vectors"},{"issue":"4","key":"84847_CR21","doi-asserted-by":"publisher","first-page":"e0266394","DOI":"10.1371\/journal.pone.0266394","volume":"17","author":"KO Ochwedo","year":"2022","unstructured":"Ochwedo, K. O. et al. Signatures of selection and drivers for novel mutation on transmission-blocking vaccine candidate Pfs25 gene in western Kenya. PLoS One 17(4), e0266394 (2022).","journal-title":"PLoS One"},{"key":"84847_CR22","doi-asserted-by":"publisher","first-page":"36958","DOI":"10.1038\/srep36958","volume":"6","author":"ZM Idris","year":"2016","unstructured":"Idris, Z. M. et al. High and heterogeneous prevalence of asymptomatic and sub-microscopic malaria infections on islands in Lake Victoria, Kenya. Sci. Rep. 6, 36958 (2016).","journal-title":"Sci. Rep."},{"key":"84847_CR23","doi-asserted-by":"publisher","DOI":"10.3791\/221","author":"S Das","year":"2007","unstructured":"Das, S., Garver, L. & Dimopoulos, G. Protocol for mosquito rearing (A. gambiae). JoVE https:\/\/doi.org\/10.3791\/221 (2007).","journal-title":"JoVE"},{"issue":"2","key":"84847_CR24","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1086\/431152","volume":"192","author":"FE McKenzie","year":"2005","unstructured":"McKenzie, F. E. et al. White blood cell counts and malaria. J. Infect. Dis. 192(2), 323\u2013330 (2005).","journal-title":"J. Infect. Dis."},{"key":"84847_CR25","unstructured":"NMCP\/Kenya, N.M.C.P. National Guidelines for the Diagnosis, Treatment and Prevention of Malaria in Kenya, Fifth Edition (2016)."},{"issue":"8","key":"84847_CR26","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0042821","volume":"7","author":"T Bousema","year":"2012","unstructured":"Bousema, T. et al. Mosquito feeding assays to determine the infectiousness of naturally infected Plasmodium falciparum gametocyte carriers. PLoS One 7(8), e42821 (2012).","journal-title":"PLoS One"},{"issue":"10","key":"84847_CR27","doi-asserted-by":"publisher","first-page":"1533","DOI":"10.3201\/eid1410.070781","volume":"14","author":"YA Afrane","year":"2008","unstructured":"Afrane, Y. A. et al. Deforestation and vectorial capacity of Anopheles gambiae Giles mosquitoes in malaria transmission, Kenya. Emerg. Infect. Dis. 14(10), 1533\u20131538 (2008).","journal-title":"Emerg. Infect. Dis."},{"issue":"1","key":"84847_CR28","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1186\/s12936-022-04256-w","volume":"21","author":"SA Onyango","year":"2022","unstructured":"Onyango, S. A. et al. Molecular characterization and genotype distribution of thioester-containing protein 1 gene in Anopheles gambiae mosquitoes in western Kenya. Malar. J. 21(1), 235 (2022).","journal-title":"Malar. J."},{"key":"84847_CR29","doi-asserted-by":"publisher","first-page":"249","DOI":"10.4269\/ajtmh.2005.72.249","volume":"72","author":"S Bereczky","year":"2005","unstructured":"Bereczky, S. et al. Short report: rapid DNA extraction from archive blood spots on filter paper for genotyping of Plasmodium falciparum. Am. J. Trop. Med. Hyg. 72, 249\u2013251 (2005).","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"84847_CR30","doi-asserted-by":"crossref","unstructured":"Onyango, S.A., et al. Genetic diversity and population structure of the human malaria parasite Plasmodium falciparum surface protein Pfs47 in isolates from the lowlands in Western Kenya. 16(11), e0260434 (2021).","DOI":"10.1371\/journal.pone.0260434"},{"issue":"12","key":"84847_CR31","doi-asserted-by":"publisher","first-page":"3299","DOI":"10.1093\/molbev\/msx248","volume":"34","author":"J Rozas","year":"2017","unstructured":"Rozas, J. et al. DnaSP 6: DNA sequence polymorphism analysis of large data sets. Mol. Biol. Evol. 34(12), 3299\u20133302 (2017).","journal-title":"Mol. Biol. Evol."},{"key":"84847_CR32","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1146\/annurev-genet-120215-035211","volume":"50","author":"A Molina-Cruz","year":"2016","unstructured":"Molina-Cruz, A. et al. Mosquito vectors and the globalization of Plasmodium falciparum malaria. Annu. Rev. Genet. 50, 447\u2013465 (2016).","journal-title":"Annu. Rev. Genet."},{"key":"84847_CR33","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs-1660930\/v1","volume-title":"Anopheles Merus Distribution and TEP1 Genotypes Along the Kenyan Coast","author":"B Bartilol","year":"2022","unstructured":"Bartilol, B. et al. Anopheles Merus Distribution and TEP1 Genotypes Along the Kenyan Coast (Research Square, 2022)."},{"key":"84847_CR34","volume-title":"Variation in the Anopheles gambiae TEP1 Gene Shapes Local Population Structures of Malaria Mosquitoes","author":"KE Rono","year":"2017","unstructured":"Rono, K. E. Variation in the Anopheles gambiae TEP1 Gene Shapes Local Population Structures of Malaria Mosquitoes (University of Berlin, 2017)."},{"key":"84847_CR35","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1016\/j.mib.2017.11.029","volume":"40","author":"A Molina-Cruz","year":"2017","unstructured":"Molina-Cruz, A., Canepa, G. E. & Barillas-Mury, C. Plasmodium P47: a key gene for malaria transmission by mosquito vectors. Curr. Opin. Microbiol. 40, 168\u2013174 (2017).","journal-title":"Curr. Opin. Microbiol."},{"issue":"5","key":"84847_CR36","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1073\/pnas.1423586112","volume":"112","author":"UN Ramphul","year":"2015","unstructured":"Ramphul, U. N. et al. Plasmodium falciparum evades mosquito immunity by disrupting JNK-mediated apoptosis of invaded midgut cells. Proc. Natl. Acad. Sci. U. S. A. 112(5), 1273\u20131280 (2015).","journal-title":"Proc. Natl. Acad. Sci. U. S. A."},{"issue":"2","key":"84847_CR37","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1016\/j.immuni.2023.01.009","volume":"56","author":"A Fabra-Garc\u00eda","year":"2023","unstructured":"Fabra-Garc\u00eda, A. et al. Highly potent, naturally acquired human monoclonal antibodies against Pfs48\/45 block Plasmodium falciparum transmission to mosquitoes. Immunity 56(2), 406-419.e7 (2023).","journal-title":"Immunity"},{"issue":"12","key":"84847_CR38","doi-asserted-by":"publisher","first-page":"4377","DOI":"10.1128\/IAI.01056-13","volume":"81","author":"K Miura","year":"2013","unstructured":"Miura, K. et al. Functional comparison of Plasmodium falciparum transmission-blocking vaccine candidates by the standard membrane-feeding assay. Infect. Immunity 81(12), 4377\u20134382 (2013).","journal-title":"Infect. Immunity"},{"issue":"21","key":"84847_CR39","doi-asserted-by":"publisher","first-page":"3367","DOI":"10.1016\/j.vaccine.2023.04.042","volume":"41","author":"LM Simons","year":"2023","unstructured":"Simons, L. M. et al. Extending the range of Plasmodium falciparum transmission blocking antibodies. Vaccine 41(21), 3367\u20133379 (2023).","journal-title":"Vaccine"},{"issue":"1","key":"84847_CR40","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1186\/s12936-021-03725-y","volume":"20","author":"HM Soumare","year":"2021","unstructured":"Soumare, H. M. et al. Maintaining Plasmodium falciparum gametocyte infectivity during blood collection and transport for mosquito feeding assays in the field. Malar. J. 20(1), 191 (2021).","journal-title":"Malar. J."},{"key":"84847_CR41","doi-asserted-by":"publisher","first-page":"e34463","DOI":"10.7554\/eLife.34463","volume":"7","author":"J Bradley","year":"2018","unstructured":"Bradley, J. et al. Predicting the likelihood and intensity of mosquito infection from sex specific Plasmodium falciparum gametocyte density. eLife 7, e34463 (2018).","journal-title":"eLife"},{"issue":"2","key":"84847_CR42","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1128\/CMR.00051-10","volume":"24","author":"T Bousema","year":"2011","unstructured":"Bousema, T. & Drakeley, C. Epidemiology and infectivity of Plasmodium falciparum and Plasmodium vivax gametocytes in relation to malaria control and elimination. Clin. Microbiol. Rev. 24(2), 377\u2013410 (2011).","journal-title":"Clin. Microbiol. Rev."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-84847-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-84847-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-84847-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T14:45:24Z","timestamp":1740408324000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-84847-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,24]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["84847"],"URL":"https:\/\/doi.org\/10.1038\/s41598-024-84847-6","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-4711223\/v1","asserted-by":"object"}]},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,24]]},"assertion":[{"value":"9 July 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 December 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 February 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study was approved by the University of California, Irvine Institutional Review Board (UCI IRB) and Maseno University Ethics Review Committee (MUERC protocol No. 00456) and authorized by the Ministry of Health.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate:"}}],"article-number":"6550"}}