{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:58:26Z","timestamp":1781614706762,"version":"3.54.5"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"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 Endocr Disord"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Erectile dysfunction (ED) is the inability to achieve or sustain an erection adequate for satisfactory sexual activity. The prevalence of ED varies widely among diabetic patients worldwide, mainly due to disparities in healthcare access and diabetes management between low-income and high-income countries. ED significantly impacts the quality of life for affected men, potentially leading to frustration, despair, and sometimes separation from an intimate partner. This study aimed to assess the prevalence, severity patterns, and factors associated with erectile dysfunction among diabetic men attending clinics in three selected sites in Western Uganda.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The clinic-based cross-sectional study was conducted involving 236 diabetic men from three clinics: Fort Portal Regional Referral Hospital, Hoima Regional Referral Hospital, and Kampala International University (KIU) Teaching Hospital in Western Uganda from June to September 2024. The number of patients was proportionally assigned depending on the number of diabetic men receiving care at the selected facilities. For each clinic, the patients were enrolled consecutively. The IIEF-5 questionnaire was used. Descriptive statistics and bivariate and multivariable logistic regression were done with SPSS version 20.0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      The prevalence of erectile dysfunction was 79.2%, whereby 21.95%, 36.4%, 22.4% and 19.3% had mild, mild to moderate, moderate, and severe erectile dysfunction, respectively, at 95% CI. Multivariable logistic regression identified increasing age, HbA1c (aOR\u2009=\u20092.44, 95%CI:1.067\u20135.569,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.035), fasting blood sugar (aOR\u2009=\u20092.50, 95%CI:1.106\u20135.657,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.028), and BMI (aOR\u2009=\u200915.1833, 95%CI: 1.168\u201319.739) to be significantly associated with ED. No behavioural characteristic was associated with ED.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The prevalence of erectile dysfunction was very high. Increasing age, obesity, and inadequate control of blood sugar were significantly associated with ED. Future studies should focus on qualitative data and causal and therapeutic interventions. We also recommend routine screening and timely addressing of blood sugars.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12902-025-02048-2","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T01:54:20Z","timestamp":1761184460000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Erectile dysfunction among diabetic patients in Western Uganda: prevalence and associated factors in a multicentre study across three selected clinics"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9362-9943","authenticated-orcid":false,"given":"Venance Emmanuel","family":"Mswelo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afizi","family":"Kibuuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tijjani Salihu","family":"Shinkafi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5689-5461","authenticated-orcid":false,"given":"Wardat Rashid","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7379-0441","authenticated-orcid":false,"given":"Elias Joseph","family":"Xwatsal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8454-7967","authenticated-orcid":false,"given":"Abdisamad Guled","family":"Hersi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5661-215X","authenticated-orcid":false,"given":"Zakarie Abdullahi","family":"Hussein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4887-1346","authenticated-orcid":false,"given":"David Elia","family":"Saria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0050-9461","authenticated-orcid":false,"given":"Wisdom","family":"Njumwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2161-7290","authenticated-orcid":false,"given":"Hanan Asad","family":"Hassan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8710-8421","authenticated-orcid":false,"given":"Abukar Ali","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adan Abdi","family":"Hassan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7328-3195","authenticated-orcid":false,"given":"Abdisalam Ahmed","family":"Sandeyl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1294-2981","authenticated-orcid":false,"given":"Theoneste","family":"Hakizimana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6485-1774","authenticated-orcid":false,"given":"David Mumbere","family":"Mayani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2606-571X","authenticated-orcid":false,"given":"Josiah J.","family":"Mkojera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4507-0518","authenticated-orcid":false,"given":"Feisal Dahir","family":"Kahie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalton Kambale","family":"Munyambalu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacinto","family":"Amandua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"issue":"April","key":"2048_CR1","first-page":"1","volume":"28","author":"AL Burnett","year":"2018","unstructured":"Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, et al. AUA guideline ED. AUA Clin Guidel. 2018;28(April):1\u201336.","journal-title":"AUA Clin Guidel"},{"key":"2048_CR2","doi-asserted-by":"publisher","unstructured":"NIH, Impotence. NIH Consensus Development Panel on Impotence. JAMA J Am Med Assoc [Internet]. 1993;270(1):83\u201390. Available from: https:\/\/doi.org\/10.1001\/jama.1993.03510010089036.","DOI":"10.1001\/jama.1993.03510010089036"},{"key":"2048_CR3","unstructured":"WHO. GLOBAL REPORT ON DIABETES [Internet]. 2016. Available from: https:\/\/www.who.int\/publications\/i\/item\/9789241565257"},{"key":"2048_CR4","unstructured":"WHO. Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population- representative studies with 141 million participants [Internet]. Vol. 404. 2024. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/diabetes#"},{"key":"2048_CR5","doi-asserted-by":"publisher","unstructured":"NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants. Lancet. 2024 Nov 23;404(10467):2077\u201393. https:\/\/doi.org\/10.1016\/S0140-6736(24)02317-1. Epub 2024 Nov 13. Erratum in: Lancet. 2025 Apr 5;405(10485):1146. https:\/\/doi.org\/10.1016\/S0140-6736(25)00620-8. PMID: 39549716; PMCID: PMC7616842. CopyDownload. nbib","DOI":"10.1016\/S0140-6736(24)02317-1"},{"key":"2048_CR6","unstructured":"IDFUganda. Annual Report [Internet]. 2021. Available from: https:\/\/idf.org\/our-network\/regions-and-members\/africa\/members\/uganda\/"},{"key":"2048_CR7","unstructured":"Region IDFA, Region IDFA, Tolerance IG, Region IDFA, Region IDFA. Diabetes Afr. 2021;0\u20131."},{"key":"2048_CR8","unstructured":"IDF Africa. IDF Africa Members [Internet]. 2021. Available from: https:\/\/diabetesatlas.org\/data-by-location\/region\/africa"},{"issue":"1","key":"2048_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12902-017-0167-5","volume":"17","author":"A Seid","year":"2017","unstructured":"Seid A, Gerensea H, Tarko S, Zenebe Y, Mezemir R. Prevalence and determinants of erectile dysfunction among diabetic patients attending in hospitals of central and northwestern zone of Tigray, Northern Ethiopia: a cross-sectional study. BMC Endocr Disord. 2017;17(1):1\u20137.","journal-title":"BMC Endocr Disord"},{"issue":"4","key":"2048_CR10","doi-asserted-by":"publisher","first-page":"215","DOI":"10.4103\/aam.aam_3_18","volume":"17","author":"FO Ugwumba","year":"2018","unstructured":"Ugwumba FO, Okafor CI, Nnabugwu II, Udeh EI, Echetabu KN, Okoh AD, et al. Prevalence of, and risk factors for erectile dysfunction in male type 2 diabetic outpatient attendees in Enugu, South East Nigeria. Ann Afr Med. 2018;17(4):215\u201320.","journal-title":"Ann Afr Med"},{"key":"2048_CR11","doi-asserted-by":"publisher","unstructured":"Shiferaw WS, Akalu TY, Petrucka PM, Areri HA, Aynalem YA. Risk factors of erectile dysfunction among diabetes patients in Africa: A systematic review and meta-analysis. J Clin Transl Endocrinol [Internet]. 2020;21(July):100232. Available from: https:\/\/doi.org\/10.1016\/j.jcte.2020.100232.","DOI":"10.1016\/j.jcte.2020.100232"},{"key":"2048_CR12","doi-asserted-by":"publisher","unstructured":"Atnafu N, Melese M, Dagnaw K, Solomon Y, Ambaw G, Asmamaw M et al. Global prevalence of sexual dysfunction among diabetic patients from 2008 to 2022: Systematic review and meta-analysis. Metab Open [Internet]. 2023;18(May):100247. Available from: https:\/\/doi.org\/10.1016\/j.metop.2023.100247.","DOI":"10.1016\/j.metop.2023.100247"},{"key":"2048_CR13","doi-asserted-by":"crossref","unstructured":"Sayadi M, Elmafshar R, Razeghian-Jahromi I, Zibaeenezhad MJ. Detection of Coronary Artery Disease by an Erectile Dysfunction Questionnaire. Cardiol Res Pract. 2021;2021.","DOI":"10.1155\/2021\/6647995"},{"key":"2048_CR14","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-022-07673-z","author":"H Zakumumpa","year":"2022","unstructured":"Zakumumpa H, Kiguba R, Ndagije HB, Ategeka G, Ssanyu JN, Kitutu FE. Patient experiences of sexual dysfunction after transition to dolutegravir-based HIV treatment in mid-Western Uganda: a qualitative study. BMC Infect Dis. 2022. https:\/\/doi.org\/10.1186\/s12879-022-07673-z.","journal-title":"BMC Infect Dis"},{"key":"2048_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.11604\/pamj.2014.17.227.2695","volume":"17","author":"RK Mutagaywa","year":"2014","unstructured":"Mutagaywa RK, Lutale J, Muhsin A, Kamala BA. Prevalence of erectile dysfunction and associated factors among diabetic men attending diabetic clinic at Muhimbili National Hospital in Dar-es-Salaam, Tanzania. Pan Afr Med J. 2014;17:1\u20138.","journal-title":"Pan Afr Med J"},{"key":"2048_CR16","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/9988841","author":"DG Massi","year":"2021","unstructured":"Massi DG, Mountap GN, Moby HE, Ngalle FGE, Mouliom S, Doumbe J, et al. Poststroke erectile dysfunction in Cameroon: prevalence, associated factors, and quality of life. Stroke Res Treat. 2021. https:\/\/doi.org\/10.1155\/2021\/9988841.","journal-title":"Stroke Res Treat"},{"issue":"7","key":"2048_CR17","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1038\/nrurol.2013.124","volume":"10","author":"Capogrosso","year":"2013","unstructured":"Capogrosso. Erectile dysfunction\u2014surprisingly common in young men. Nat Rev Urol. 2013;10(7):369\u2013369.","journal-title":"Nat Rev Urol"},{"issue":"June","key":"2048_CR18","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.ejphar.2017.03.024","volume":"804","author":"LN Leite","year":"2017","unstructured":"Leite LN, do Vale GT, Simplicio JA, De Martinis BS, Carneiro FS, Tirapelli CR. Ethanol-induced erectile dysfunction and increased expression of pro-inflammatory proteins in the rat cavernosal smooth muscle are mediated by NADPH oxidase-derived reactive oxygen species. Eur J Pharmacol. 2017;804(June):82\u201393.","journal-title":"Eur J Pharmacol"},{"key":"2048_CR19","doi-asserted-by":"publisher","unstructured":"Furukawa S, Sakai T, Niiya T, Miyaoka H, Miyake T, Yamamoto S, Maruyama K, Ueda T, Tanaka K, Senba H, Todo Y, Torisu M, Minami H, Onji M, Tanigawa T, Matsuura B, Hiasa Y, Miyake Y. Alcohol consumption and prevalence of erectile dysfunction in Japanese patients with type 2 diabetes mellitus: Baseline data from the Dogo Study. Alcohol. 2016 Sep 55:17-22. https:\/\/doi.org\/10.1016\/j.alcohol.2016.07.006. Epub 2016 Aug 25. PMID: 27788774.","DOI":"10.1016\/j.alcohol.2016.07.006"},{"key":"2048_CR20","doi-asserted-by":"publisher","unstructured":"Zeleke M, Hailu D, Daka D. Erectile dysfunction and associated factors among diabetic patients at, Hawassa, Southern, Ethiopia. BMC Endocr Disord. 2021;21:139. https:\/\/doi.org\/10.1186\/s12902-021-00807-5.","DOI":"10.1186\/s12902-021-00807-5"},{"issue":"4","key":"2048_CR21","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1093\/aje\/kwi052","volume":"161","author":"NM Gades","year":"2005","unstructured":"Gades NM, Nehra A, Jacobson DJ, McGree ME, Girman CJ, Rhodes T, et al. Association between smoking and erectile dysfunction: A population-based study. Am J Epidemiol. 2005;161(4):346\u201351.","journal-title":"Am J Epidemiol"},{"key":"2048_CR22","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3494","volume":"38","author":"G CiteDefeudis","year":"2022","unstructured":"CiteDefeudis G, Mazzilli R, Tenuta M, Rossini G, Zamponi V, Olana S, Faggiano A, Pozzilli P, Isidori AM, Gianfrilli D. Erectile dysfunction and diabetes: A melting pot of circumstances and treatments. Diabetes Metab Res Rev. 2022 Feb 38(2):e3494.https:\/\/doi.org\/10.1002\/dmrr.3494. Epub 2021 Sep 21. PMID: 34514697; PMCID: PMC9286480.","journal-title":"Diabetes Metab Res Rev"},{"key":"2048_CR23","unstructured":"Leslie SW, Sooriyamoorthy T. Erectile Dysfunction. 2025."},{"key":"2048_CR24","unstructured":"Salonia A, Bettocchi C, Capogrosso P, Carvalho J, Jones TH, Kadioglu A et al. EAU Guidelines on Sexual and Reproductive Health. 2024."},{"key":"2048_CR25","doi-asserted-by":"crossref","unstructured":"Shiferaw WS, Akalu TY, Aynalem YA. Prevalence of Erectile Dysfunction in Patients with Diabetes Mellitus and Its Association with Body Mass Index and Glycated Hemoglobin in Africa: A Systematic Review and Meta-Analysis. Int J Endocrinol. 2020;2020.","DOI":"10.1155\/2020\/5148370"},{"issue":"1","key":"2048_CR26","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-018-3211-2","volume":"11","author":"B Walle","year":"2018","unstructured":"Walle B, Lebeta KR, Fita YD, Abdissa HG. Prevalence of erectile dysfunction and associated factors among diabetic men attending the diabetic clinic at Felege Hiwot Referral Hospital, Bahir Dar, North West Ethiopia, 2016. BMC Res Notes. 2018;11(1):130. https:\/\/doi.org\/10.1186\/s13104-018-3211-2.","journal-title":"BMC Res Notes"},{"issue":"10140","key":"2048_CR27","doi-asserted-by":"publisher","first-page":"2642","DOI":"10.1016\/S0140-6736(18)30293-9","volume":"391","author":"AM Starrs","year":"2018","unstructured":"Starrs AM, Ezeh AC, Barker G, Basu A, Bertrand JT, Blum R, et al. Accelerate progress\u2014sexual and reproductive health and rights for all: report of the Guttmacher\u2013Lancet commission. Lancet. 2018;391(10140):2642\u201392.","journal-title":"Lancet"},{"issue":"7","key":"2048_CR28","doi-asserted-by":"publisher","first-page":"1078","DOI":"10.1016\/j.jsxm.2019.04.010","volume":"16","author":"KI Neijenhuijs","year":"2019","unstructured":"Neijenhuijs KI, Holtmaat K, Aaronson NK, Holzner B, Terwee CB, Cuijpers P, et al. The international index of erectile function (IIEF)\u2014a systematic review of measurement properties. J Sex Med. 2019;16(7):1078\u201391. https:\/\/doi.org\/10.1016\/j.jsxm.2019.04.010.","journal-title":"J Sex Med"},{"key":"2048_CR29","doi-asserted-by":"publisher","unstructured":"Campbell NRC, Burnens MP, Whelton PK, Angell SY, Jaffe MG, Cohn J et al. Health Policy 2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the region of the Americas. Lancet Reg Heal - Am [Internet]. 2022;9:100219. Available from:https:\/\/doi.org\/10.1016\/j.lana.2022.100219.","DOI":"10.1016\/j.lana.2022.100219"},{"issue":"1","key":"2048_CR30","doi-asserted-by":"publisher","DOI":"10.1186\/s12902-022-01060-0","volume":"22","author":"SM Omar","year":"2022","unstructured":"Omar SM, Musa IR, Idrees MB, Abdelbagi O, Adam I. Prevalence and associated factors of erectile dysfunction in men with type 2 diabetes mellitus in eastern Sudan. BMC Endocr Disord. 2022;22(1):141. https:\/\/doi.org\/10.1186\/s12902-022-01060-0.","journal-title":"BMC Endocr Disord"},{"key":"2048_CR31","doi-asserted-by":"publisher","first-page":"1131555","DOI":"10.3389\/fendo.2023.1131555","volume":"14","author":"MB Gobena","year":"2023","unstructured":"Gobena MB, Abdosh T, Dheresa M, Dechasa DB. Erectile dysfunctionand associated factors among patients withdiabetes attending follow-up at a publichospital, Harar, Eastern Ethiopia. A crosssectional study design. Front. Endocrinol. 2023;14:1131555. https:\/\/doi.org\/10.3389\/fendo.2023.1131555.","journal-title":"A crosssectional study design. Front. Endocrinol"},{"key":"2048_CR32","first-page":"1","volume":"24","author":"BO Oyelade","year":"2016","unstructured":"Oyelade BO, Jemilohun AC, Aderibigbe SA. Prevalence of erectile dysfunction and possible risk factors among men of South-Western Nigeria: a population based study. Pan Afr Med J. 2016;24:1\u20138.","journal-title":"Pan Afr Med J"},{"key":"2048_CR33","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2020\/5148370","volume":"2020","author":"WS Shiferaw","year":"2020","unstructured":"Shiferaw WS, Akalu TY, Aynalem YA. Prevalence of erectile dysfunction in patients with diabetes mellitus and its association with body mass index and glycated hemoglobin in africa: A systematic review and Meta-Analysis. Int J Endocrinol. 2020;2020:1\u201324.","journal-title":"Int J Endocrinol"},{"key":"2048_CR34","unstructured":"Journal THE, Clinical OF. Standards of care in diabetes \u2014 2023 \u00a9 A m Er Ica nD i Ab et Es Oc Ia t Io n \u00a9 A m Er Ica nD i Ab et Es Ss Oc American diabetes association standards of care in Diabetes d 2023 t. 2023;46(January)."},{"key":"2048_CR35","unstructured":"Atamenta T, Abate BB, Tilahun BD, Yilak G, Rede MB. The global burden of erectile dysfunction and its associated risk factors in diabetic patients: an umbrella reviews. 2024."},{"key":"2048_CR36","doi-asserted-by":"crossref","unstructured":"Dilixiati D, Waili A, Tuerxunmaimaiti A, Tao L, Zebibula A, Rexiati M. Risk factors for erectile dysfunction in diabetes mellitus: a systematic review and. 2024;(April).","DOI":"10.3389\/fendo.2024.1368079"}],"container-title":["BMC Endocrine Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-025-02048-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12902-025-02048-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-025-02048-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:23:55Z","timestamp":1781612635000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12902-025-02048-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,23]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["2048"],"URL":"https:\/\/doi.org\/10.1186\/s12902-025-02048-2","relation":{},"ISSN":["1472-6823"],"issn-type":[{"value":"1472-6823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,23]]},"assertion":[{"value":"15 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 October 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 study was conducted in accordance with the declaration of Helsinki. The study received approval from Kampala International University \u2013 Research ethical committee with KIU-REC (2024\u2009\u2212\u2009311). All participants signed informed consent preceding data collection.","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":"238"}}