{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T20:48:00Z","timestamp":1792615680295,"version":"4.5.0"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,9,11]],"date-time":"2021-09-11T00:00:00Z","timestamp":1631318400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,11]],"date-time":"2021-09-11T00:00:00Z","timestamp":1631318400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100015815","name":"Consortium of International Agricultural Research Centers","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100015815","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p><jats:italic>Toxoplasma gondii<\/jats:italic>is a zoonotic protozoan parasite infecting warm-blooded animals. Infection in people can occur through ingestion of oocysts passed in the faeces of the definitive hosts; ingestion of bradyzoites in the tissue of infected intermediate hosts; or exposure to tachyzoites in raw milk and eggs. Slaughterhouse workers are considered a high-risk group for<jats:italic>T. gondii<\/jats:italic>exposure because of their contact with raw meat, although a positive relationship between handling raw meat and<jats:italic>T. gondii<\/jats:italic>seropositivity has not been demonstrated in all studies. This study aimed to determine the seroprevalence of antibodies to<jats:italic>T. gondii<\/jats:italic>in slaughterhouse workers in Kenya and identify risk factors associated with seropositivity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A survey of slaughterhouse workers was conducted in 142 slaughter facilities in the study area. Information regarding demographics, contact with livestock, meat consumption, and practices in the slaughterhouse was collected using structured questionnaires. Commercial ELISAs were used to detect IgM and IgG antibodies against<jats:italic>T. gondii<\/jats:italic>and a multi-level logistic regression model was used to identify potential risk factors for seropositivity in slaughterhouse workers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The apparent prevalence of antibodies to<jats:italic>T. gondii<\/jats:italic>was 84.0% (95% Confidence Interval (CI) 81.2\u201386.5%) for IgG and 2.2% (95% CI 1.3\u20133.5%) for IgM antibodies. All IgM positive individuals were IgG positive. Risk factors for exposure to<jats:italic>T. gondii<\/jats:italic>were: increasing age (Odds Ratio (OR) 1.03; 95% CI 1.01\u20131.05); owning poultry (OR 2.00; 95% CI 1.11\u20133.62); and consuming animal blood (OR 1.92; 95% CI 1.21\u20133.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The seroprevalence of antibodies to<jats:italic>T. gondii<\/jats:italic>was very high in this population and considerably higher than published values in the general population. Risk factors included age, owning poultry and drinking animal blood which were consistent with previous reports but none were specifically associated with working in the slaughterhouse. In this instance slaughterhouse workers may represent a useful sentinel for the general population where the level of exposure is also likely to be high and may signify an unidentified public health risk to vulnerable groups such as pregnant women. A detailed understanding of the epidemiology of infection is required, which should include an assessment of incidence, mortality, and burden since<jats:italic>T. gondii<\/jats:italic>infection is likely to have life-long sequelae.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12879-021-06658-8","type":"journal-article","created":{"date-parts":[[2021,9,12]],"date-time":"2021-09-12T12:04:18Z","timestamp":1631448258000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Prevalence and risk factors for exposure to Toxoplasma gondii in slaughterhouse workers in western Kenya"],"prefix":"10.1186","volume":"21","author":[{"given":"Elizabeth Anne Jessie","family":"Cook","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nduhiu","family":"Gitahi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William Anson","family":"de Glanville","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lian F.","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Kariuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erastus","family":"Kang\u2019ethe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric Maurice","family":"F\u00e8vre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,11]]},"reference":[{"key":"6658_CR1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.05013-11","author":"F Robert-Gangneux","year":"2012","unstructured":"Robert-Gangneux F, Dard\u00e9 ML. Epidemiology of and diagnostic strategies for toxoplasmosis. Clin Microbiol Rev. 2012. https:\/\/doi.org\/10.1128\/CMR.05013-11.","journal-title":"Clin Microbiol Rev"},{"issue":"12\u201313","key":"6658_CR2","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.1016\/S0020-7519(00)00124-7","volume":"30","author":"AM Tenter","year":"2000","unstructured":"Tenter AM, Heckeroth AR, Weiss LM. Toxoplasma gondii: From animals to humans. Int J Parasitol. 2000;30(12\u201313):1217\u201358.","journal-title":"Int J Parasitol"},{"issue":"7254","key":"6658_CR3","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1136\/bmj.321.7254.142","volume":"321","author":"A Cook","year":"2000","unstructured":"Cook A, Gilbert R, Buffolano W, Zufferey J, Petersen E, Jenum P, et al. Sources of toxoplasma infection in pregnant women: European multicentre case-control study. European Research Network on Congenital Toxoplasmosis. BMJ. 2000;321(7254):142\u20137.","journal-title":"BMJ"},{"issue":"4","key":"6658_CR4","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1093\/oxfordjournals.aje.a008942","volume":"144","author":"G Kapperud","year":"1996","unstructured":"Kapperud G, Jenum P, Sray-Pedersen B, Melby K, Esklin A, Eng J. Risk factors for Toxoplasma gondii infection in pregnancy. Results of a prospective case-control study in Norway. Am J Epidemiol. 1996;144(4):405\u201312.","journal-title":"Am J Epidemiol"},{"issue":"3","key":"6658_CR5","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1080\/00365549950163626","volume":"31","author":"L Baril","year":"1999","unstructured":"Baril L, Ancelle T, Goulet V, Thulliez P, Tirard-Fluery V, Carme B. Risk factors for Toxoplasma infection in pregnancy: a case-control study in France. Scand J Infect Dis. 1999;31(3):305\u20139.","journal-title":"Scand J Infect Dis"},{"issue":"6","key":"6658_CR6","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1016\/j.ajo.2008.06.027","volume":"146","author":"E Delair","year":"2008","unstructured":"Delair E, Monnet D, Grabar S, Dupouy-Camet J, Yera H, Br\u00e9zin AP. Respective roles of acquired and congenital infections in presumed ocular toxoplasmosis. Am J Ophthalmol. 2008;146(6):851\u20135.","journal-title":"Am J Ophthalmol"},{"issue":"11","key":"6658_CR7","doi-asserted-by":"publisher","first-page":"1375","DOI":"10.3201\/eid0911.030143","volume":"9","author":"EF Torrey","year":"2003","unstructured":"Torrey EF, Yolken RH. Toxoplasma gondii and Schizophrenia. Emerg Infect Dis. 2003;9(11):1375\u201380.","journal-title":"Emerg Infect Dis"},{"issue":"10","key":"6658_CR8","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1046\/j.1469-0691.2002.00485.x","volume":"8","author":"D Hill","year":"2002","unstructured":"Hill D, Dubey JP. Toxoplasma gondii: Transmission, diagnosis, and prevention. Clin Microbiol Infect. 2002;8(10):634\u201340.","journal-title":"Clin Microbiol Infect"},{"issue":"1","key":"6658_CR9","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1080\/01971528108062991","volume":"2","author":"R Mondesire","year":"1981","unstructured":"Mondesire R, Charlton D, Tizard I. A standardized enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies to Toxoplasma gondii. J Immunoassay. 1981;2(1):45\u201357.","journal-title":"J Immunoassay"},{"issue":"May","key":"6658_CR10","first-page":"1","volume":"10","author":"RHD Yba\u00f1ez","year":"2020","unstructured":"Yba\u00f1ez RHD, Yba\u00f1ez AP, Nishikawa Y. Review on the current trends of toxoplasmosis serodiagnosis in humans. Front Cell Infect Microbiol. 2020;10(May):1\u201318.","journal-title":"Front Cell Infect Microbiol"},{"issue":"3","key":"6658_CR11","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1017\/S0950268803001948","volume":"132","author":"L Gras","year":"2004","unstructured":"Gras L, Gilbert RE, Wallon M, Peyron F, Cortina-Borja M. Duration of the IgM response in women acquiring Toxoplasma gondii during pregnancy: implications for clinical practice and cross-sectional incidence studies. Epidemiol Infect. 2004;132(3):541\u20138.","journal-title":"Epidemiol Infect"},{"key":"6658_CR12","doi-asserted-by":"publisher","DOI":"10.1186\/s13071-015-0902-6","author":"Q Liu","year":"2015","unstructured":"Liu Q, Wang ZD, Huang SY, Zhu XQ. Diagnosis of toxoplasmosis and typing of Toxoplasma gondii. Parasites Vectors. 2015. https:\/\/doi.org\/10.1186\/s13071-015-0902-6.","journal-title":"Parasites Vectors."},{"issue":"6","key":"6658_CR13","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1016\/0035-9203(83)90283-3","volume":"77","author":"L Griffin","year":"1983","unstructured":"Griffin L, Williams KAB. Serological and parasitological survey of blood donors in Kenya for toxoplasmosis. Trans R Soc Trop Med Hyg. 1983;77(6):763\u20136.","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"10","key":"6658_CR14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pone.0204867","volume":"13","author":"AI Nisbet","year":"2018","unstructured":"Nisbet AI, Omuse G, Revathi G, Adam RD. Seroprevalence data at a private teaching hospital in Kenya: an examination of Toxoplasma gondii, cytomegalovirus, rubella, hepatitis A, and Entamoeba histolytica. PLoS ONE. 2018;13(10):1\u201311.","journal-title":"PLoS ONE"},{"key":"6658_CR15","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1016\/0035-9203(86)90336-6","volume":"80","author":"T Bowry","year":"1986","unstructured":"Bowry T, Camargo M, Kinyanjui M. Sero-epidemiology of Toxoplasma gondii infection in young children in Nairobi, Kenya. Trans R Soc Trop Med Hyg. 1986;80:439\u201341.","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"4","key":"6658_CR16","doi-asserted-by":"publisher","first-page":"417","DOI":"10.7196\/SAMJ.2016.v106i4.8777","volume":"106","author":"SK Thiongo","year":"2016","unstructured":"Thiongo SK, Ichagichu JM, Ngotho M, Aboge GO, Kagira JM, Karanja SM, et al. Use of the nested polymerase chain reaction for detection of Toxoplasma gondii in slaughterhouse workers in Thika District, Kenya. S Afr Med J. 2016;106(4):417\u20139.","journal-title":"S Afr Med J"},{"issue":"3","key":"6658_CR17","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1590\/S0036-46652006000300004","volume":"48","author":"DD Gon\u00e7alves","year":"2006","unstructured":"Gon\u00e7alves DD, Teles PS, Dos Reis CR, Lopes FMR, Freire RL, Navarro IT, et al. Seroepidemiology and occupational and environmental variables for leptospirosis, brucellosis and toxoplasmosis in slaughterhouse workers in the Paran\u00e1 State, Brazil. Rev Inst Med Trop Sao Paulo. 2006;48(3):135\u201340.","journal-title":"Rev Inst Med Trop Sao Paulo"},{"issue":"4","key":"6658_CR18","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1093\/occmed\/kqr032","volume":"61","author":"C Alvarado-Esquivel","year":"2011","unstructured":"Alvarado-Esquivel C, Liesenfeld O, Estrada-Mart\u00ednez S, F\u00e9lix-Huerta J. Toxoplasma gondii infection in workers occupationally exposed to raw meat. Occup Med. 2011;61(4):265\u20139.","journal-title":"Occup Med"},{"key":"6658_CR19","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-017-2559-6","author":"EM F\u00e8vre","year":"2017","unstructured":"F\u00e8vre EM, de Glanville WA, Thomas LF, Cook EAJ, Kariuki S, Wamae CN. An integrated study of human and animal infectious disease in the Lake Victoria crescent small-holder crop-livestock production system Kenya. BMC Infect Dis. 2017. https:\/\/doi.org\/10.1186\/s12879-017-2559-6.","journal-title":"BMC Infect Dis"},{"key":"6658_CR20","doi-asserted-by":"publisher","unstructured":"Speybroeck N, Devleesschauwer B, Joseph L, Berkvens D. Misclassification errors in prevalence estimation: Bayesian handling with care. Int J Public Health. 2013;58(5):791\u201395. https:\/\/doi.org\/10.1007\/s00038-012-0439-9.","DOI":"10.1007\/s00038-012-0439-9"},{"key":"6658_CR21","doi-asserted-by":"crossref","unstructured":"Lumley T. Analysis of complex survey samples. J Stat Softw. 2004;9(1):1\u201319. R package verson 2.2.","DOI":"10.18637\/jss.v009.i08"},{"key":"6658_CR22","doi-asserted-by":"publisher","unstructured":"Bates D, M\u00e4chler M, Bolker B, Walker S. Fitting Linear Mixed-Effects Models Using lme4. J Stat Softw. 2015;67(1):1\u201348. https:\/\/doi.org\/10.18637\/jss.v067.i01.","DOI":"10.18637\/jss.v067.i01"},{"issue":"5","key":"6658_CR23","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1093\/oxfordjournals.aje.a112177","volume":"102","author":"HP Riemann","year":"1975","unstructured":"Riemann HP, Brant PC, Behymer DE, Franti CE. Toxoplasma gondii and Coxiella burneti antibodies among Brazilian slaughterhouse employees. Am J Epidemiol. 1975;102(5):386\u201393.","journal-title":"Am J Epidemiol"},{"key":"6658_CR24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2008.05.1014","author":"M Galv\u00e1n-Ram\u00edrez","year":"2008","unstructured":"Galv\u00e1n-Ram\u00edrez M, Flores Orozco C, Soto MJ. Seroepidemiology of toxoplasma gondii in workers of slaughterhouse in Zapopan, Jalisco. Int J Infect Dis. 2008. https:\/\/doi.org\/10.1016\/j.ijid.2008.05.1014.","journal-title":"Int J Infect Dis"},{"key":"6658_CR25","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.4103\/njcp.njcp_44_18","volume":"21","author":"U Ekanem","year":"2018","unstructured":"Ekanem U, Moses A, Abraham E, Motilewa O, Umo A, Itina E. Seroprevalence of anti-toxoplasma gondii igg antibody and risk factors among abattoir workers in Uyo, Southern Nigeria. Niger J Clin Pract. 2018;21:1662\u20139.","journal-title":"Niger J Clin Pract"},{"issue":"6","key":"6658_CR26","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1007\/BF00383252","volume":"65","author":"S Lings","year":"1994","unstructured":"Lings S, Lander F, Lebech M. Antimicrobial antibodies in Danish slaughterhouse workers and greenhouse workers. Int Arch Occup Environ Health. 1994;65(6):405\u20139.","journal-title":"Int Arch Occup Environ Health"},{"key":"6658_CR27","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0003040","author":"Y Fujii","year":"2014","unstructured":"Fujii Y, Kaneko S, Nzou SM, Mwau M, Njenga SM, Tanigawa C, et al. Serological surveillance development for tropical infectious diseases using simultaneous microsphere-based multiplex assays and finite mixture models. PLoS Negl Trop Dis. 2014. https:\/\/doi.org\/10.1371\/journal.pntd.0003040.","journal-title":"PLoS Negl Trop Dis"},{"issue":"2","key":"6658_CR28","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.pt.2016.10.007","volume":"33","author":"S Rougier","year":"2017","unstructured":"Rougier S, Montoya JG, Peyron F. Lifelong persistence of toxoplasma cysts: a questionable Dogma? Trends Parasitol. 2017;33(2):93\u2013101. https:\/\/doi.org\/10.1016\/j.pt.2016.10.007.","journal-title":"Trends Parasitol"},{"issue":"6","key":"6658_CR29","doi-asserted-by":"publisher","first-page":"878","DOI":"10.1086\/605433","volume":"49","author":"JL Jones","year":"2009","unstructured":"Jones JL, Dargelas V, Roberts J, Press C, Remington JS, Montoya JG. Risk factors for Toxoplasma gondii infection in the United States. Clin Infect Dis. 2009;49(6):878\u201384.","journal-title":"Clin Infect Dis"},{"issue":"1","key":"6658_CR30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-016-3923-y","volume":"17","author":"EAJ Cook","year":"2017","unstructured":"Cook EAJ, De Glanville WA, Thomas LF, Kariuki S, de Bronsvoort BMC, F\u00e8vre EM. Working conditions and public health risks in slaughterhouses in western Kenya. BMC Public Health. 2017;17(1):1\u201312.","journal-title":"BMC Public Health"},{"key":"6658_CR31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2016\/7589278","volume":"2016","author":"JM Mose","year":"2016","unstructured":"Mose JM, Kagira JM, Karanja SM, Ngotho M, Kamau DM, Njuguna AN, et al. Detection of natural Toxoplasma gondii Infection in chicken in Thika Region of Kenya using nested polymerase chain reaction. Biomed Res Int. 2016;2016:1\u20135.","journal-title":"Biomed Res Int"},{"issue":"1","key":"6658_CR32","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1111\/j.1863-2378.2009.01274.x","volume":"57","author":"JP Dubey","year":"2010","unstructured":"Dubey JP. Toxoplasma gondii infections in chickens (Gallus domesticus): prevalence, clinical disease, diagnosis and public health significance. Zoonoses Public Health. 2010;57(1):60\u201373.","journal-title":"Zoonoses Public Health"},{"issue":"1","key":"6658_CR33","first-page":"51","volume":"114","author":"O Justus","year":"2013","unstructured":"Justus O, Owuor G, Bebe BO. Management practices and challenges in smallholder indigenous chicken production in western Kenya. J Agric Rural Dev Trop Subtrop. 2013;114(1):51\u20138.","journal-title":"J Agric Rural Dev Trop Subtrop"},{"issue":"11","key":"6658_CR34","doi-asserted-by":"publisher","first-page":"2387","DOI":"10.1017\/S175173112000110X","volume":"14","author":"C Chaiban","year":"2020","unstructured":"Chaiban C, Robinson TP, F\u00e8vre EM, Ogola J, Akoko J, Gilbert M, et al. Early intensification of backyard poultry systems in the tropics: a case study. Animal. 2020;14(11):2387\u201396.","journal-title":"Animal"},{"issue":"2","key":"6658_CR35","first-page":"21","volume":"15","author":"M El-Setouhy","year":"1997","unstructured":"El-Setouhy M, Hussein H, Abdel Malek M. Toxoplasmosis among married female workers in poultiy slaughter houses in Cairo. A cross sectional study. Egypt J Community Med. 1997;15(2):21\u20136.","journal-title":"Egypt J Community Med."},{"issue":"2","key":"6658_CR36","doi-asserted-by":"publisher","first-page":"129","DOI":"10.4103\/2229-5070.190817","volume":"6","author":"A Basavaraju","year":"2016","unstructured":"Basavaraju A. Toxoplasmosis in HIV infection: an overview. Trop Parasitol. 2016;6(2):129\u201335.","journal-title":"Trop Parasitol"},{"key":"6658_CR37","unstructured":"NASCOP. Preliminary KENPHIA 2018 Report [Internet]. Nairobi; 2020 https:\/\/phia.icap.columbia.edu\/wp-content\/uploads\/2020\/04\/KENPHIA-2018_Preliminary-Report_final-web.pdf. Accessed 18 May 2021."},{"issue":"4","key":"6658_CR38","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1093\/occmed\/49.4.225","volume":"49","author":"CY Li","year":"1999","unstructured":"Li CY, Sung FC. A review of the healthy worker effect in occupational epidemiology. Occup Med. 1999;49(4):225\u20139.","journal-title":"Occup Med"},{"key":"6658_CR39","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fpubh.2019.00025","volume":"7","author":"LEG Mboera","year":"2019","unstructured":"Mboera LEG, Kishamawe C, Kimario E, Rumisha SF. Mortality patterns of toxoplasmosis and its comorbidities in Tanzania: a 10-year retrospective hospital-based survey. Front Public Health. 2019;7:1\u20137.","journal-title":"Front Public Health"},{"issue":"5","key":"6658_CR40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pone.0178282","volume":"12","author":"J Nissen","year":"2017","unstructured":"Nissen J, Jokelainen P, Stensvold CR, Trevisan C, Fuchs J, Burgdorf KS, et al. The disease burden of congenital toxoplasmosis in Denmark, 2014. PLoS ONE. 2017;12(5):1\u201312.","journal-title":"PLoS ONE"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-06658-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-021-06658-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-06658-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T17:52:47Z","timestamp":1699465967000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-021-06658-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,11]]},"references-count":40,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["6658"],"URL":"https:\/\/doi.org\/10.1186\/s12879-021-06658-8","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,11]]},"assertion":[{"value":"26 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 September 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 September 2021","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 approval for this study was granted by the Kenya Medical Research Institute Ethical Review Committee (SCC Protocol 2086). All methods were performed in accordance with the Declaration of Helsinki and each participant gave signed informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests..","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"944"}}