{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:21:33Z","timestamp":1789586493405,"version":"build-2803163510"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,7,14]],"date-time":"2020-07-14T00:00:00Z","timestamp":1594684800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,7,14]],"date-time":"2020-07-14T00:00:00Z","timestamp":1594684800000},"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":["BMC Infect Dis"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Tuberculosis and intestinal parasites are mostly affecting poor people. They are in a vicious since one is the risk factor for the other. However, the comprehensive report on the burden and co-incidence of intestinal parasites and tuberculosis in Ethiopia is scant. This systematic review and meta-analysis aimed to provide abridge conclusive evidence on the intestinal parasite-tuberculosis co-infection in Ethiopia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 414 articles published in English were searched from both electronic databases (CINAHL, DOAJ, Embase, Emcare, Medline, ProQuest, and PubMed, Science Direct, and Web of Science) and other sources. The qualities of the included studies were assessed using the Joanna Briggs Institute Critical Appraisal tools and the publication bias was measured using the funnel plot and Eggers regression test. Comprehensive meta-analysis (CMA) Version 3.3.07 and Review Manager software were used to estimate pooled prevalence and associations of intestinal parasites and tuberculosis infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eleven articles with a total of 3158 tuberculosis patients included in the analysis based on the eligibility criteria. The estimated pooled prevalence of intestinal parasites co-infection was 33% (95% CI: 23.3, 44.3) using the random-effects model. The most common intestinal parasites were<jats:italic>Ascaris lumbricoides<\/jats:italic>10.5% (95% CI: 6.0, 17.5),<jats:italic>Hookworm<\/jats:italic>9.5% (95% CI: 6.10, 14.4),<jats:italic>Giardia lamblia<\/jats:italic>5.7% (95% CI: 2.90, 10.9) and<jats:italic>Strongyloides sterocoralis<\/jats:italic>5.6% (95% CI: 3.3, 9.5). The odds of intestinal parasites infection was higher among tuberculosis patients compared to tuberculosis free individuals (OR\u2009=\u20091.76; 95% CI: 1.17, 2.63). A significant difference was observed among TB patients for infection with intestinal helminths (OR\u2009=\u20092.01; 95% CI: 1.07, 3.80) but not for intestinal protozoans when compared with their counterparts. The odds of multiple parasitic infections was higher among tuberculosis patients (OR\u2009=\u20092.59, 95% CI: 1.90, 3.55) compared to tuberculosis free individuals. However, intestinal parasites co-infection was not associated with<jats:italic>HIV<\/jats:italic>status among tuberculosis patients (OR\u2009=\u20090.97; 95% CI: 0.71, 1.32).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>One-third of tuberculosis patients are co-infected with one or more intestinal parasites, and they are more likely to be infected with intestinal helminths and multiple intestinal parasitic infections compared to TB free individuals. We recommend routine screening of tuberculosis patients for intestinal parasites. The effect of mass deworming on tuberculosis incidence would be important to be considered in future researches.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration<\/jats:title><jats:p>Registered on PROSPERO with reference number ID:<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.crd.york.ac.uk\/prospero\/#myprospero\">CRD42019135350<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12879-020-05237-7","type":"journal-article","created":{"date-parts":[[2020,7,14]],"date-time":"2020-07-14T14:06:56Z","timestamp":1594735616000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Intestinal parasites co-infection among tuberculosis patients in Ethiopia: a systematic review and meta-analysis"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5307-8774","authenticated-orcid":false,"given":"Ayinalem","family":"Alemu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zebenay Workneh","family":"Bitew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teshager","family":"Worku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,7,14]]},"reference":[{"key":"5237_CR1","volume-title":"Global Tuberculosis Report","author":"WHO","year":"2019","unstructured":"WHO. Global Tuberculosis Report. Geneva: World Health Organization; 2019."},{"issue":"1","key":"5237_CR2","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1186\/1471-2334-13-292","volume":"13","author":"KA Alene","year":"2013","unstructured":"Alene KA, Nega A, Taye BW. Incidence and predictors of tuberculosis among adult people living with human immunodeficiency virus at the University of Gondar Referral Hospital, Northwest Ethiopia. BMC Infect Dis. 2013;13(1):292.","journal-title":"BMC Infect Dis"},{"issue":"4","key":"5237_CR3","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1111\/j.1365-3156.2006.01578.x","volume":"11","author":"D Elias","year":"2006","unstructured":"Elias D, Mengistu G, Akuffo H, Britton S. Are intestinal helminths risk factors for developing active tuberculosis? Tropical Med Int Health. 2006;11(4):551\u20138.","journal-title":"Tropical Med Int Health"},{"issue":"8","key":"5237_CR4","doi-asserted-by":"publisher","first-page":"e42901","DOI":"10.1371\/journal.pone.0042901","volume":"7","author":"E Abate","year":"2012","unstructured":"Abate E, Belayneh M, Gelaw A, Idh J, Getachew A, Alemu S, et al. The impact of asymptomatic helminth co-infection in patients with newly diagnosed tuberculosis in north-West Ethiopia. PLoS One. 2012;7(8):e42901.","journal-title":"PLoS One"},{"issue":"6","key":"5237_CR5","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1590\/S1413-86702009000600008","volume":"13","author":"MS Neto","year":"2009","unstructured":"Neto MS, Totino RP, Sant\u2019Anna MF, Coelho OV, Rolla CV, Zanini MG, et al. Enteroparasitosis prevalence and parasitism influence in clinical outcomes of tuberculosis patients with or without HIV co-infection in a reference Hospital in Rio de Janeiro (2000-2006). Braz J Infect Dis. 2009;13(6):427\u201332.","journal-title":"Braz J Infect Dis"},{"issue":"2","key":"5237_CR6","doi-asserted-by":"publisher","first-page":"e0005342","DOI":"10.1371\/journal.pntd.0005342","volume":"11","author":"F Mhimbira","year":"2017","unstructured":"Mhimbira F, Hella J, Said K, Kamwela L, Sasamalo M, Maroa T, et al. Prevalence and clinical relevance of helminth co-infections among tuberculosis patients in urban Tanzania. PLoS Negl Trop Dis. 2017;11(2):e0005342.","journal-title":"PLoS Negl Trop Dis"},{"issue":"10","key":"5237_CR7","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1111\/j.1365-3024.2006.00909.x","volume":"28","author":"SM Kamal","year":"2006","unstructured":"Kamal SM, El Sayed Khalifa K. Immune modulation by helminthic infections: worms and viral infections. Parasite Immunol. 2006;28(10):483\u201396.","journal-title":"Parasite Immunol"},{"issue":"9","key":"5237_CR8","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1016\/j.it.2016.07.005","volume":"37","author":"S Babu","year":"2016","unstructured":"Babu S, Nutman TB. Helminth-tuberculosis co-infection: an immunologic perspective. Trends Immunol. 2016;37(9):597\u2013607.","journal-title":"Trends Immunol"},{"issue":"8","key":"5237_CR9","doi-asserted-by":"publisher","first-page":"e0003994","DOI":"10.1371\/journal.pntd.0003994","volume":"9","author":"E Abate","year":"2015","unstructured":"Abate E, Belayneh M, Idh J, Diro E, Elias D, Britton S, et al. Asymptomatic Helminth infection in active tuberculosis is associated with increased regulatory and Th-2 responses and a lower sputum smear positivity. PLoS Negl Trop Dis. 2015;9(8):e0003994.","journal-title":"PLoS Negl Trop Dis"},{"issue":"5","key":"5237_CR10","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1590\/S0037-86822002000500020","volume":"35","author":"R Trist\u00e3o-S\u00e1","year":"2002","unstructured":"Trist\u00e3o-S\u00e1 R, Ribeiro-Rodrigues R, Johnson LT, Pereira FEL, Dietze R. Intestinal nematodes and pulmonary tuberculosis. Rev Soc Bras Med Trop. 2002;35(5):533\u20135.","journal-title":"Rev Soc Bras Med Trop"},{"issue":"1","key":"5237_CR11","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1186\/s12879-019-4009-0","volume":"19","author":"A Alemu","year":"2019","unstructured":"Alemu A, Kebede A, Dagne B, Amare M, Diriba G, Yenew B, et al. Intestinal parasites co-infection and associated factors among active pulmonary tuberculosis patients in selected health centers, Addis Ababa, Ethiopia: unmatched case control study. BMC Infect Dis. 2019;19(1):407.","journal-title":"BMC Infect Dis"},{"issue":"3","key":"5237_CR12","first-page":"1092","volume":"5","author":"AW Hailu","year":"2015","unstructured":"Hailu AW, Merid Y, Gebru AA, Ayene YY, Asefa MK. The case control studies of HIV and intestinal parasitic infections rate in active pulmonary tuberculosis patients in Woldia General Hospital and Health Center in North Wollo, Amhara Region, Ethiopia. Int J Pharma Sci. 2015;5(3):1092\u20139.","journal-title":"Int J Pharma Sci"},{"issue":"1","key":"5237_CR13","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1186\/1471-2458-13-151","volume":"13","author":"T Wegayehu","year":"2013","unstructured":"Wegayehu T, Tsalla T, Seifu B, Teklu T. Prevalence of intestinal parasitic infections among highland and lowland dwellers in Gamo area, South Ethiopa. BMC Public Health. 2013;13(1):151.","journal-title":"BMC Public Health"},{"issue":"1","key":"5237_CR14","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1186\/s12890-019-0953-0","volume":"19","author":"BE Feleke","year":"2019","unstructured":"Feleke BE, Feleke TE, Biadglegne F. Nutritional status of tuberculosis patients, a comparative cross-sectional study. BMC Pulm Med. 2019;19(1):182.","journal-title":"BMC Pulm Med"},{"issue":"4","key":"5237_CR15","doi-asserted-by":"publisher","first-page":"179","DOI":"10.4172\/1948-5948.1000140","volume":"6","author":"M Alemayehu","year":"2014","unstructured":"Alemayehu M, Birhan W, Belyhun Y, Sahle M, Tessema B. Prevalence of smear positive tuberculosis, intestinal parasites and their co-infection among tuberculosis suspects in Gondar University hospital and Gondar poly clinic, north West Ethiopia. J Microbial Biochem Technol. 2014;6(4):179\u201384.","journal-title":"J Microbial Biochem Technol"},{"issue":"6\u20137","key":"5237_CR16","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1080\/00365540500525187","volume":"38","author":"JM Ramos","year":"2006","unstructured":"Ramos JM, Reyes F, Tesfamariam A. Intestinal parasites in adults admitted to a rural ethiopian hospital: relationship to tuberculosis and malaria. Scand J Infect Dis. 2006;38(6\u20137):460\u20132 Date of Publication: July 2006.; 2006.","journal-title":"Scand J Infect Dis"},{"key":"5237_CR17","doi-asserted-by":"publisher","first-page":"9372145","DOI":"10.1155\/2018\/9372145","volume":"2018","author":"Y Tegegne","year":"2018","unstructured":"Tegegne Y, Wondmagegn T, Worku L, Jejaw Zeleke A. Prevalence of intestinal parasites and associated factors among pulmonary tuberculosis suspected patients attending University of Gondar Hospital, Gondar, Northwest Ethiopia. J Parasitol Res. 2018;2018:9372145.","journal-title":"J Parasitol Res"},{"issue":"1","key":"5237_CR18","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1097\/XEB.0000000000000152","volume":"17","author":"Z Munn","year":"2019","unstructured":"Munn Z, Aromataris E, Tufanaru C, Stern C, Porritt K, Farrow J, et al. The development of software to support multiple systematic review types: the Joanna Briggs institute system for the unified management, assessment and review of information (JBI SUMARI). Int J Evid Based Healthc. 2019;17(1):36\u201343.","journal-title":"Int J Evid Based Healthc"},{"key":"5237_CR19","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s12879-017-2195-1","volume":"17","author":"A Getaneh","year":"2017","unstructured":"Getaneh A, Mama M. Intestinal helminth co-infection and associated factors among tuberculosis patients in Arba Minch, Ethiopa. BMC Infect Dis. 2017;17:68.","journal-title":"BMC Infect Dis"},{"issue":"4","key":"5237_CR20","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1258\/004947507782333026","volume":"37","author":"A Kassu","year":"2007","unstructured":"Kassu A, Mengistu G, Ayele B, Diro E, Mekonnen F, Ketema D, et al. HIV and intestinal parasites in adult TB patients in a teaching hospital in Northwest Ethiopia. Trop Dr. 2007;37(4):222\u20134.","journal-title":"Trop Dr"},{"key":"5237_CR21","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1186\/s40249-019-0600-2","volume":"8","author":"F Gashaw","year":"2019","unstructured":"Gashaw F, Bekele S, Mekonnen Y, Medhin G, Ameni G, Erko B. High helminthic co-infection in tuberculosis patients with undernutritional status in northeastern Ethiopia. Infect Dis Poverty. 2019;8:88.","journal-title":"Infect Dis Poverty"},{"issue":"6","key":"5237_CR22","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1097\/01.NAJ.0000450430.97383.64","volume":"114","author":"K Porritt","year":"2014","unstructured":"Porritt K, Gomersall J, Lockwood C. JBI\u2019s systematic reviews: study selection and critical appraisal. Am J Nurs. 2014;114(6):47\u201352.","journal-title":"Am J Nurs"},{"issue":"10","key":"5237_CR23","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1016\/S0895-4356(01)00377-8","volume":"54","author":"JA Sterne","year":"2001","unstructured":"Sterne JA, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol. 2001;54(10):1046\u201355.","journal-title":"J Clin Epidemiol"},{"key":"5237_CR24","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1002\/0470870168.ch6","volume-title":"Publication bias in meta-analysis: Prevention, assessment and adjustments","author":"JA Sterne","year":"2005","unstructured":"Sterne JA, Egger M. Regression methods to detect publication and other bias in meta-analysis. In: Publication bias in meta-analysis: Prevention, assessment and adjustments; 2005. p. 99\u2013110."},{"key":"5237_CR25","volume-title":"The nordic cochrane centre, the cochrane collaboration. Book [computer program]","author":"R RevMan","year":"2014","unstructured":"RevMan R. The nordic cochrane centre, the cochrane collaboration. Book [computer program]; 2014."},{"issue":"3","key":"5237_CR26","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1016\/j.parint.2014.02.002","volume":"63","author":"B Taye","year":"2014","unstructured":"Taye B, Desta K, Ejigu S, Dori GU. The magnitude and risk factors of intestinal parasitic infection in relation to human immunodeficiency virus infection and immune status, at ALERT hospital, Addis Ababa, Ethiopa. Parasitol Int. 2014;63(3):550\u20136.","journal-title":"Parasitol Int"},{"issue":"4","key":"5237_CR27","doi-asserted-by":"publisher","first-page":"e93429","DOI":"10.1371\/journal.pone.0093429","volume":"9","author":"D Gebreegziabiher","year":"2014","unstructured":"Gebreegziabiher D, Desta K, Desalegn G, Howe R, Abebe M. The effect of maternal helminth infection on maternal and neonatal immune function and immunity to tuberculosis. PLoS One. 2014;9(4):e93429.","journal-title":"PLoS One"},{"key":"5237_CR28","doi-asserted-by":"publisher","first-page":"598605","DOI":"10.1155\/2015\/598605","volume":"2015","author":"B Amare","year":"2015","unstructured":"Amare B, Moges B, Mulu A, Yifru S, Kassu A. Quadruple burden of HIV\/AIDS, tuberculosis, chronic intestinal parasitoses, and multiple micronutrient deficiency in Ethiopia: a summary of available findings. Biomed Res Int. 2015;2015:598605.","journal-title":"Biomed Res Int"},{"key":"5237_CR29","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1046\/j.1365-2249.2001.01446.x","volume":"123","author":"D Elias","year":"2001","unstructured":"Elias D, Wolday D, Akuffo H, Petros B, Bronneru BS. Effect of deworming on human T cell responses to mycobacterial antigens in helminth-exposed individuals before and after Bacille Calmette Gue\u00c2rin (BCG) vaccination. Clin Exp Immunol. 2001;123:219\u201325.","journal-title":"Clin Exp Immunol"},{"issue":"6","key":"5237_CR30","first-page":"2010","volume":"2","author":"A Gelaw","year":"2012","unstructured":"Gelaw A, Abate E, Idh J, Mulu A, Anagaw B, Belyhun Y, et al. Plasma IgE level and eosinophil count in smear positive tuberculosis patients with and without helminthic infections at Gondar University Hospital, Northwest Ethiopia. Eur J Exp Biol. 2012;2(6):2010\u20134.","journal-title":"Eur J Exp Biol"},{"issue":"1","key":"5237_CR31","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1111\/j.1365-2249.2004.02597.x","volume":"138","author":"A Kassu","year":"2004","unstructured":"Kassu A, Mohammad A, Fujimaki Y, Moges F, Elias D, Mekonnen F, et al. Serum IgE levels of tuberculosis patients in a tropical setup with high prevalence of HIV and intestinal parasitoses. Clin Exp Immunol. 2004;138(1):122\u20137.","journal-title":"Clin Exp Immunol"},{"issue":"2\u20133","key":"5237_CR32","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.ijpara.2014.09.006","volume":"45","author":"E Abate","year":"2015","unstructured":"Abate E, Elias D, Getachew A, Alemu S, Diro E, Britton S, et al. Effects of albendazole on the clinical outcome and immunological responses in helminth co-infected tuberculosis patients: a double blind randomised clinical trial. Int J Parasitol. 2015;45(2\u20133):133\u201340.","journal-title":"Int J Parasitol"},{"issue":"1","key":"5237_CR33","first-page":"5","volume":"1","author":"A Kassu","year":"2008","unstructured":"Kassu A, Fujino M, Nishizawa M, Mengistu G, Diro E, et al. Levels of serum HIV-1 RNA viral load in tuberculosis patients with or without intestinal parasites during treatment of tuberculosis in Gondar, Ethiopia. Ethiop J Health Biomed Sci. 2008;1(1):5\u201313.","journal-title":"Ethiop J Health Biomed Sci"},{"issue":"Suppl 1","key":"5237_CR34","first-page":"S134","volume":"11","author":"A Taghipour","year":"2018","unstructured":"Taghipour A, Azimi T, Javanmard E, Pormohammad A, Olfatifar M, Rostami A, et al. Immunocompromised patients with pulmonary tuberculosis; a susceptible group to intestinal parasites. Gastroenterol Hepatol Bed Bench. 2018;11(Suppl 1):S134.","journal-title":"Gastroenterol Hepatol Bed Bench"},{"issue":"1","key":"5237_CR35","doi-asserted-by":"publisher","first-page":"106","DOI":"10.4269\/ajtmh.13-0426","volume":"90","author":"XX Li","year":"2014","unstructured":"Li XX, Chen JX, Wang LX, Tian LG, Zhang YP, Dong SP, et al. Intestinal parasite co-infection among pulmonary tuberculosis cases without human immunodeficiency virus infection in a rural county in China. Am J Trop Med Hyg. 2014;90(1):106\u201313.","journal-title":"Am J Trop Med Hyg"},{"issue":"4","key":"5237_CR36","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/j.ijmyco.2015.09.002","volume":"4","author":"AF Hasanain","year":"2015","unstructured":"Hasanain AF, Zayed AA, Mahdy RE, Nafee AM, Attia RA, Mohamed AO. Hookworm infection among patients with pulmonary tuberculosis: impact of co-infection on the therapeutic failure of pulmonary tuberculosis. Int J Mycobacteriol. 2015;4(4):318\u201322.","journal-title":"Int J Mycobacteriol"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-020-05237-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-020-05237-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-020-05237-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T06:45:10Z","timestamp":1696401910000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-020-05237-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,14]]},"references-count":36,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["5237"],"URL":"https:\/\/doi.org\/10.1186\/s12879-020-05237-7","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,14]]},"assertion":[{"value":"19 February 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 July 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 July 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors have declared that no competing interests exist.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"510"}}