{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T13:16:30Z","timestamp":1788009390008,"version":"build-2784847793"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:00:00Z","timestamp":1787961600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:00:00Z","timestamp":1787961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007051","name":"Uppsala University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007051","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The increasing prevalence of Obesity and associated health risks in LMICs underscores the urgent need to adopt an integrated approach to Obesity prevention and management. This systematic review aims to assess the impact of school-based diet and physical activity interventions on weight-related outcomes among children and adolescents in Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This systematic review was registered with PROSPERO (CRD42023450307) and reported according to the PRISMA statement. A comprehensive literature search was conducted across three databases, PubMed, Google Scholar and African Journals Online from January 2000 to December 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      Our search identified a total of 11 eligible studies, with modest to low risk of bias, of which majority of the studies were published within the last decade (63.6%), and conducted in South Africa (72.7%). These studies were predominantly quasi-experimental (70%) or cluster randomized control trail (18.2%) in design. The majority (73%) interventions were delivered in primary school settings and participants were mainly engaged in group activities. The bulk of the interventions were multi-component, comprising physical activity, alongside nutrition, and other health\/behavioural interventions. Overall, the studies reported modest improvements in elevated adiposity and maintenance of normal weight status in the intervention groups. However, this translated into a non-significant effect in the meta-analysis of nine intervention comparisons on BMI-for-age (MD\u2009=\u20090.03, 95% CI: \u22120.24 to 0.29;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.813; I\u00b2 = 69.0%), although combined nutrition and physical activity interventions showed reductions in a few comparisons.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>School-based diet and physical activity interventions show potential to improve adiposity and maintain healthy weight status among African children and adolescents, particularly when combined. However, the overall effect on BMI-for-age was not significant, highlighting the need for more geographically diverse and methodologically robust evidence across Africa.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12889-026-29255-3","type":"journal-article","created":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T12:34:50Z","timestamp":1788006890000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["School-based diet and physical activity interventions and weight-related outcomes among children and adolescents in Africa: a systematic review and meta-analysis"],"prefix":"10.1186","volume":"26","author":[{"given":"Barbara Adimchinobi","family":"Onyeonu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Favour Chiamaka","family":"Kalu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosisochukwu Chidinma","family":"Igbokwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uzoamaka Victoria","family":"Thomspon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Favour Chidinma","family":"Okezie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anuoluwapo Funmilayo","family":"Taiwo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1554-5970","authenticated-orcid":false,"given":"Gideon Onyedikachi","family":"Iheme","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,29]]},"reference":[{"key":"29255_CR1","unstructured":"World Health Organization. Obesity and overweight. World Health Organization (WHO). In: WHO fact sheets; 2024."},{"key":"29255_CR2","unstructured":"United Nations Children\u2019s Fund (UNICEF). UNICEF, New York. Feeding Profit. How food environments are failing children. Child Nutrition Report. 2025. Available from: https:\/\/blogs.worldbank.org\/en\/impactevaluations\/how-leverage-time-children-spend-out-school-learning."},{"key":"29255_CR3","unstructured":"World Health Organization. World Health Organization. 202. Obesity. In: Health topics. Available from: https:\/\/www.who.int\/health-topics\/obesity#tab=tab_1. Cited 23 Jun 2025."},{"issue":"3","key":"29255_CR4","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1016\/j.maturitas.2011.08.005","volume":"70","author":"AM Craigie","year":"2011","unstructured":"Craigie AM, Lake AA, Kelly SA, Adamson AJ, Mathers JC. Tracking of obesity-related behaviours from childhood to adulthood: A systematic review. Maturitas. 2011;70(3):266\u201384. https:\/\/doi.org\/10.1016\/j.maturitas.2011.08.005.","journal-title":"Maturitas"},{"issue":"16","key":"29255_CR5","first-page":"7700","volume":"27","author":"YS Alanazi","year":"2023","unstructured":"Alanazi YS. Implications of lifestyle changes on the incidence of childhood obesity - a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2023;27(16):7700\u20139. PubMed PMID: 37667948.","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"29255_CR6","unstructured":"World Bank. World Bank Blogs. 2017. How to leverage the time children spend out of school for learning. Available from: https:\/\/blogs.worldbank.org\/en\/impactevaluations\/how-leverage-time-children-spend-out-school-learning."},{"key":"29255_CR7","unstructured":"World Health Organization. World Health Organization (WHO). 2022. WHO acceleration plan to stop obesity. Available from: https:\/\/iris.who.int\/bitstream\/handle\/10665\/370281\/9789240075634-eng.pdf?sequence=1. Cited 23 Jun 2025."},{"key":"29255_CR8","unstructured":"United Nations Children\u2019s Fund (UNICEF). New York: UNICEF. 2020. UNICEF advocacy strategy guidance for the prevention of overweight and obesity in children and adolescents. Available from: https:\/\/www.unicef.org\/media\/92331\/file\/Advocacy-Guidance-Overweight-Prevention.pdf."},{"key":"29255_CR9","doi-asserted-by":"publisher","first-page":"105775","DOI":"10.1016\/j.worlddev.2021.105775","volume":"151","author":"KA Abay","year":"2022","unstructured":"Abay KA, Ibrahim H, Breisinger C. Food policies and obesity in low- and middle-income countries. World Dev. 2022;151:105775. https:\/\/doi.org\/10.1016\/j.worlddev.2021.105775.","journal-title":"World Dev"},{"key":"29255_CR10","doi-asserted-by":"publisher","unstructured":"Lan X, Sulaiman N. Public Policies on Obesity: A Literature Review of Global Challenges and Response Strategies. Cureus 2024 Jun 20. https:\/\/doi.org\/10.7759\/cureus.62758","DOI":"10.7759\/cureus.62758"},{"issue":"2","key":"29255_CR11","doi-asserted-by":"publisher","first-page":"415","DOI":"10.3945\/ajcn.112.035378","volume":"96","author":"R Verstraeten","year":"2012","unstructured":"Verstraeten R, Roberfroid D, Lachat C, Leroy JL, Holdsworth M, Maes L, et al. Effectiveness of preventive school-based obesity interventions in low- and middle-income countries: a systematic review. Am J Clin Nutr. 2012;96(2):415\u201338. https:\/\/doi.org\/10.3945\/ajcn.112.035378.","journal-title":"Am J Clin Nutr"},{"issue":"7","key":"29255_CR12","doi-asserted-by":"publisher","first-page":"1212","DOI":"10.3390\/ijerph16071212","volume":"16","author":"S Klingberg","year":"2019","unstructured":"Klingberg S, Draper CE, Micklesfield LK, Benjamin-Neelon SE, van Sluijs EMF. Childhood Obesity Prevention in Africa: A Systematic Review of Intervention Effectiveness and Implementation. Int J Environ Res Public Health. 2019;16(7):1212. https:\/\/doi.org\/10.3390\/ijerph16071212.","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"29255_CR13","doi-asserted-by":"publisher","first-page":"95","DOI":"10.3390\/nu12010095","volume":"12","author":"T Adom","year":"2019","unstructured":"Adom T, De Villiers A, Puoane T, Kengne AP. School-Based Interventions Targeting Nutrition and Physical Activity, and Body Weight Status of African Children: A Systematic Review. Nutrients. 2019;12(1):95. https:\/\/doi.org\/10.3390\/nu12010095.","journal-title":"Nutrients"},{"issue":"10","key":"29255_CR14","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1016\/j.jclinepi.2009.06.005","volume":"62","author":"D Moher","year":"2009","unstructured":"Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. J Clin Epidemiol. 2009;62(10):1006\u201312. https:\/\/doi.org\/10.1016\/j.jclinepi.2009.06.005.","journal-title":"J Clin Epidemiol"},{"issue":"3","key":"29255_CR15","doi-asserted-by":"publisher","first-page":"378","DOI":"10.11124\/JBIES-23-00268","volume":"22","author":"TH Barker","year":"2024","unstructured":"Barker TH, Habibi N, Aromataris E, Stone JC, Leonardi-Bee J, Sears K, et al. The revised JBI critical appraisal tool for the assessment of risk of bias for quasi-experimental studies. JBI Evid Synth. 2024;22(3):378\u201388. https:\/\/doi.org\/10.11124\/JBIES-23-00268.","journal-title":"JBI Evid Synth"},{"issue":"3","key":"29255_CR16","doi-asserted-by":"publisher","first-page":"494","DOI":"10.11124\/JBIES-22-00430","volume":"21","author":"TH Barker","year":"2023","unstructured":"Barker TH, Stone JC, Sears K, Klugar M, Tufanaru C, Leonardi-Bee J, et al. The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. JBI Evid Synth. 2023;21(3):494\u2013506. https:\/\/doi.org\/10.11124\/JBIES-22-00430.","journal-title":"JBI Evid Synth"},{"key":"29255_CR17","unstructured":"IBM Corp. IBM SPSS Statistics for Windows. IBM Corp. IBM Corp. 2021. Available from: https:\/\/www.ibm.com\/products\/spss-statistics."},{"key":"29255_CR18","unstructured":"R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing. 2024. Available from: https:\/\/www.r-project.org."},{"key":"29255_CR19","doi-asserted-by":"publisher","unstructured":"Naidoo R, Coopoo Y, Lambert E, Draper C. Impact of a primary school-based nutrition and physical activity intervention on learners in KwaZulu-Natal, South Africa: A pilot study. South Afr J Sport Med. 2009;21(1). https:\/\/doi.org\/10.17159\/2078-516X\/2009\/v21i1a301.","DOI":"10.17159\/2078-516X\/2009\/v21i1a301"},{"issue":"1","key":"29255_CR20","doi-asserted-by":"publisher","first-page":"12","DOI":"10.17159\/2078-516X\/2010\/v22i1a320","volume":"22","author":"C Draper","year":"2010","unstructured":"Draper C, De Kock L, Grimsrud A, Rudolph M, Nemutandani S, Kolbe-Alexander T, et al. Evaluation of a school-based physical activity intervention in Alexandra Township. South Afr J Sport Med. 2010;22(1):12. https:\/\/doi.org\/10.17159\/2078-516X\/2010\/v22i1a320.","journal-title":"South Afr J Sport Med"},{"key":"29255_CR21","doi-asserted-by":"publisher","unstructured":"Kemp C, Pienaar A. The effect of a physical activity, diet and behaviour modification intervention on the self-perception of 9 to 12 year old overweight and obese children. Afr J Phys Heal Educ Recreat Danc. 2010;16(1). https:\/\/doi.org\/10.4314\/ajpherd.v16i1.53316.","DOI":"10.4314\/ajpherd.v16i1.53316"},{"issue":"12","key":"29255_CR22","first-page":"241","volume":"18","author":"MA Monyeki","year":"2012","unstructured":"Monyeki MA, De Ridder JH, Du Preez SM, Toriola ALMD. The effect of a ten-month physical activity intervention programme on body composition of 9\u201313 year-old boys. Afr J Phys Heal Educ Recreat Danc. 2012;18(12):241\u201350.","journal-title":"Afr J Phys Heal Educ Recreat Danc"},{"issue":"6","key":"29255_CR23","doi-asserted-by":"publisher","first-page":"1040","DOI":"10.4103\/2230-8210.122619","volume":"17","author":"S Regaieg","year":"2013","unstructured":"Regaieg S, Charfi N, Kamoun M, Ghroubi S, Rebai H, Elleuch H, et al. The effects of an exercise training program on body composition and aerobic capacity parameters in Tunisian obese children. Indian J Endocrinol Metab. 2013;17(6):1040\u20135. https:\/\/doi.org\/10.4103\/2230-8210.122619.","journal-title":"Indian J Endocrinol Metab"},{"key":"29255_CR24","doi-asserted-by":"publisher","unstructured":"Maatoug J, Fredj S, Ben, Msakni Z, Dendana E, Sahli J, Harrabi I, et al. Challenges and results of a school-based intervention to manage excess weight among school children in Tunisia 2012\u20132014. Int J Adolesc Med Health. 2017;29(2). https:\/\/doi.org\/10.1515\/ijamh-2015-0035.","DOI":"10.1515\/ijamh-2015-0035"},{"issue":"2","key":"29255_CR25","doi-asserted-by":"publisher","first-page":"232","DOI":"10.3390\/ijerph16020232","volume":"16","author":"I M\u00fcller","year":"2019","unstructured":"M\u00fcller I, Schindler C, Adams L, Endes K, Gall S, Gerber M, et al. Effect of a Multidimensional Physical Activity Intervention on Body Mass Index, Skinfolds and Fitness in South African Children: Results from a Cluster-Randomised Controlled Trial. Int J Environ Res Public Health. 2019;16(2):232. https:\/\/doi.org\/10.3390\/ijerph16020232.","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"29255_CR26","doi-asserted-by":"publisher","first-page":"9","DOI":"10.5334\/aogh.3147","volume":"87","author":"J Grace","year":"2021","unstructured":"Grace J, Biggs C, Naicker A, Moss S. Effect of Physical Activity and Nutrition Education on Body Mass Index, Blood Pressure and Biochemical Variables in Overweight and Obese Adolescents. Ann Glob Heal. 2021;87(1):9. https:\/\/doi.org\/10.5334\/aogh.3147.","journal-title":"Ann Glob Heal"},{"issue":"4","key":"29255_CR27","first-page":"e4309","volume":"14","author":"GI Wanghi","year":"2021","unstructured":"Wanghi GI, Lytle L, Zakayi P, Rudahaba KBA, Sumaili EK. Effect of diet alone or combined with physical activity on obesity and overweight among adolescents in Kinshasa, DR Congo. Ann Africaines M\u00e9decine. 2021;14(4):e4309\u201318.","journal-title":"Ann Africaines M\u00e9decine"},{"issue":"2","key":"29255_CR28","doi-asserted-by":"publisher","first-page":"89","DOI":"10.7196\/SAJCH.2021.v15i2.01762","volume":"15","author":"S Nqweniso","year":"2021","unstructured":"Nqweniso S, DuRandt R, Adams L, Degen J, Gall S, Gerber M, et al. Effect of school-based interventions on body composition of grade-4 children from lower socioeconomic communities in Gqeberha, South Africa. South Afr J Child Heal. 2021;15(2):89. https:\/\/doi.org\/10.7196\/SAJCH.2021.v15i2.01762.","journal-title":"South Afr J Child Heal"},{"issue":"3","key":"29255_CR29","doi-asserted-by":"publisher","first-page":"1762","DOI":"10.3390\/ijerph20031762","volume":"20","author":"M Idamokoro","year":"2023","unstructured":"Idamokoro M, Pienaar AE, Gerber B, van Gent MM. The Influence of a 9-Week Movement Program on the Body Composition of 7- to 8-Year-Old Schoolchildren in the Eastern Cape of South Africa. Int J Environ Res Public Health. 2023;20(3):1762. https:\/\/doi.org\/10.3390\/ijerph20031762.","journal-title":"Int J Environ Res Public Health"},{"key":"29255_CR30","doi-asserted-by":"publisher","unstructured":"Faiz A, Nawaz S, Raza Q, Imran K, Batool R, Firyal S et al. Effectiveness of Nutrition Education on Weight Loss and Body Metrics Among Obese Adults: An Interventional Study. Cureus. 2024 Nov 24. https:\/\/doi.org\/10.7759\/cureus.74373.","DOI":"10.7759\/cureus.74373"},{"key":"29255_CR31","doi-asserted-by":"publisher","unstructured":"Salem A, Ammar A, Trabelsi K, Boukhris O, Heydenreich J, Ghazzawi HA, et al. Combined diet and physical activity effects on health-related outcomes in people with overweight or obesity: an overview of systematic reviews. Front Nutr. 2026;13. https:\/\/doi.org\/10.3389\/fnut.2026.1821389.","DOI":"10.3389\/fnut.2026.1821389"},{"issue":"12","key":"29255_CR32","doi-asserted-by":"publisher","first-page":"e2452185","DOI":"10.1001\/jamanetworkopen.2024.52185","volume":"7","author":"A Jayedi","year":"2024","unstructured":"Jayedi A, Soltani S, Emadi A, Zargar MS, Najafi A. Aerobic Exercise and Weight Loss in Adults. JAMA Netw Open. 2024;7(12):e2452185. https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.52185.","journal-title":"JAMA Netw Open"},{"issue":"10","key":"29255_CR33","doi-asserted-by":"publisher","first-page":"1755","DOI":"10.1016\/j.jada.2007.07.017","volume":"107","author":"MJ Franz","year":"2007","unstructured":"Franz MJ, VanWormer JJ, Crain AL, Boucher JL, Histon T, Caplan W, et al. Weight-Loss Outcomes: A Systematic Review and Meta-Analysis of Weight-Loss Clinical Trials with a Minimum 1-Year Follow-Up. J Am Diet Assoc. 2007;107(10):1755\u201367. https:\/\/doi.org\/10.1016\/j.jada.2007.07.017.","journal-title":"J Am Diet Assoc"},{"issue":"6","key":"29255_CR34","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1002\/oby.24027","volume":"32","author":"KD Hall","year":"2024","unstructured":"Hall KD. Physiology of the weight-loss plateau in response to diet restriction, <scp\u2009>\u2009GLP\u20101 receptor agonism, and bariatric surgery<\/scp\u2009>. Obesity. 2024;32(6):1163\u20138. https:\/\/doi.org\/10.1002\/oby.24027.","journal-title":"Obesity"},{"issue":"5","key":"29255_CR35","doi-asserted-by":"publisher","first-page":"3677","DOI":"10.3390\/nu7053677","volume":"7","author":"M\u00c8 Riou","year":"2015","unstructured":"Riou M\u00c8, Jomphe-Tremblay S, Lamothe G, Stacey D, Szczotka A, Doucet \u00c9. Predictors of Energy Compensation during Exercise Interventions: A Systematic Review. Nutrients. 2015;7(5):3677\u2013704. https:\/\/doi.org\/10.3390\/nu7053677.","journal-title":"Nutrients"},{"issue":"11","key":"29255_CR36","doi-asserted-by":"publisher","first-page":"2817","DOI":"10.1007\/s40279-024-02070-9","volume":"54","author":"ETC Poon","year":"2024","unstructured":"Poon ETC, Li HY, Little JP, Wong SHS, Ho RST. Efficacy of Interval Training in Improving Body Composition and Adiposity in Apparently Healthy Adults: An Umbrella Review with Meta-Analysis. Sport Med. 2024;54(11):2817\u201340. https:\/\/doi.org\/10.1007\/s40279-024-02070-9.","journal-title":"Sport Med"},{"key":"29255_CR37","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.jclinepi.2017.02.015","volume":"89","author":"H Waddington","year":"2017","unstructured":"Waddington H, Aloe AM, Becker BJ, Djimeu EW, Hombrados JG, Tugwell P, Wells G, Reeves B. Quasi-experimental study designs series-paper 6: risk of bias assessment. J Clin Epidemiol. 2017;89:43\u201352. https:\/\/doi.org\/10.1016\/j.jclinepi.2017.02.015.","journal-title":"J Clin Epidemiol"},{"issue":"8","key":"29255_CR38","doi-asserted-by":"publisher","first-page":"826","DOI":"10.2174\/1573401317666210216114311","volume":"17","author":"GO Iheme","year":"2021","unstructured":"Iheme GO. The Undernutrition Situation of School-age Children in Nigeria: A Systematic Review and Meta-analysis. Curr Nutr Food Sci. 2021;17(8):826\u201332. https:\/\/doi.org\/10.2174\/1573401317666210216114311.","journal-title":"Curr Nutr Food Sci"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12889-026-29255-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-026-29255-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-026-29255-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T12:50:55Z","timestamp":1788007855000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12889-026-29255-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,29]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["29255"],"URL":"https:\/\/doi.org\/10.1186\/s12889-026-29255-3","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,29]]},"assertion":[{"value":"28 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"2484"}}