{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T04:20:55Z","timestamp":1772166055100,"version":"3.50.1"},"reference-count":48,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T00:00:00Z","timestamp":1748908800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T00:00:00Z","timestamp":1748908800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["224834"],"award-info":[{"award-number":["224834"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Health Passports (HPs) are paper-based, patient-held records used in Malawi to document key details about the health condition of a patient and the care provided during medical visits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This paper assessed their use and effectiveness within the health data ecosystem, and their potential impact on patient care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The study setting was health facilities under the District Health Office in the Zomba District, Malawi.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We undertook a qualitative study to determine the practices for data recording used by health care professionals and the importance placed on HPs by patients and professionals. We conducted an in-depth Focus Group Discussion with healthcare practitioners. Pages from completed HPs were analysed to extract practices for recording case presentation, diagnosis, and medication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>HPs were perceived to be beneficial to healthcare professionals as a means of transmitting information and communicate to each other the patient record history and treatment. Patients saw HPs solely as means of accessing services rather than as sources of personal health information with intrinsic value to them. Practices in recording patient notes varied considerably and we found many instances of illegible handwriting, and the use of abbreviations and shorthand that could be interpreted differently by clinicians and were not understood by patients. Language and communication barriers, low patient literacy and a general lack of privacy during consultations also had a significant negative effect on the use and effectiveness of HPs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>There are significant gaps between the intended use and effectiveness of HPs in a clinical setting and the actual use by healthcare professionals and patients. Efforts to make sure that HPs can effectively fulfil the primary purpose of medical records are long overdue.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Contribution<\/jats:title>\n                    <jats:p>This study contributes to an under-researched area for understanding the use and effectiveness of patient-held records in LMICs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12913-025-12844-0","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T12:42:14Z","timestamp":1748954534000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Revisiting the use and effectiveness of patient-held records in rural Malawi"],"prefix":"10.1186","volume":"25","author":[{"given":"Amelia","family":"Taylor","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Kazembe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"key":"12844_CR1","unstructured":"Malawi Ministry of Health. Malawi National Health Information System Policy. 2015. [cited 2025 Feb 1]. Available from:\u00a0https:\/\/www.healthdatacollaborative.org\/fileadmin\/uploads\/hdc\/Documents\/Country_documents\/September_2015_Malawi_National_Health_Information_System_Policy.pdf."},{"key":"12844_CR2","doi-asserted-by":"crossref","unstructured":"Chaulagai CN, Moyo CM, Pendame RB. Health Management Information System in Malawi: Issues and Innovations. 2005. [cited 2025 Feb 1]. Available from: https:\/\/www.academia.edu\/27471436\/Health_Management_Information_System_in_Malawi_Issues_and_Innovations.","DOI":"10.1093\/heapol\/czi044"},{"issue":"1","key":"12844_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-024-10922-3","volume":"24","author":"L Mndala","year":"2024","unstructured":"Mndala L, Kondoni C, Gadama L, Bamuya C, Kuyere A, Maseko B. Developing comprehensive woman hand-held case notes to improve quality of antenatal care in low-income settings: participatory approach with maternal health stakeholders in Malawi. BMC Health Serv Res. 2024;24(1):1\u201314 [Cited 2025 Jan 31]. Available from: https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-024-10922-3.","journal-title":"BMC Health Serv Res"},{"key":"12844_CR4","doi-asserted-by":"crossref","unstructured":"Aukrust CG, Kamalo PD, Finyiza G, Mula C, Chapweteka BA, Fjeld HE, et al. \u2018It is the child with the big head\u2019\u2013Primary healthcare providers\u2019 perceptions of paediatric hydrocephalus in Blantyre, Malawi: A qualitative study. Glob Public Health. 2023;18(1):2276242.","DOI":"10.1080\/17441692.2023.2276242"},{"key":"12844_CR5","doi-asserted-by":"crossref","unstructured":"Tough AG. The Scope and Appetite for Technology-Assisted Sensitivity Reviewing of Born-Digital Records in a Resource Poor Environment: A Case Study From Malawi. 2018;175\u201382. [Cited 2025 Jan 31]. Available from: https:\/\/www.igi-global.com\/chapter\/the-scope-and-appetite-for-technology-assisted-sensitivity-reviewing-of-born-digital-records-in-a-resource-poor-environment\/196847.","DOI":"10.4018\/978-1-5225-3137-1.ch009"},{"issue":"3","key":"12844_CR6","doi-asserted-by":"publisher","first-page":"247","DOI":"10.4314\/mmj.v29i3.4","volume":"29","author":"KEM Msiska","year":"2017","unstructured":"Msiska KEM, Kumitawa A, Kumwenda B. Factors affecting the utilisation of electronic medical records system in Malawian central hospitals. Malawi Med J. 2017;29(3):247 [Cited 2025 Feb 3]. Available from: https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC5811997\/.","journal-title":"Malawi Med J"},{"key":"12844_CR7","doi-asserted-by":"crossref","unstructured":"Tweya H, Feldacker C, Gadabu OJ, Ng\u2019ambi W, Mumba SL, Phiri D, et al. Developing a point-of-care electronic medical record system for TB\/HIV co-infected patients: experiences from lighthouse trust, Lilongwe, Malawi. BMC Res Notes. 2016;9(1):146.","DOI":"10.1186\/s13104-016-1943-4"},{"key":"12844_CR8","doi-asserted-by":"crossref","unstructured":"Weston W, Smedley J, Bennett A, Mortimer K. The cooking and pneumonia study (CAPS) in Malawi: implementation of remote source data verification. PLoS ONE. 2016;11(6):e0155966.","DOI":"10.1371\/journal.pone.0155966"},{"issue":"3","key":"12844_CR9","doi-asserted-by":"publisher","first-page":"145","DOI":"10.5588\/pha.14.0015","volume":"4","author":"OJ Gadabu","year":"2014","unstructured":"Gadabu OJ, Manjomo RC, Mwakilama SG, Douglas GP, Harries AD, Moyo C, et al. An electronic register for vital registration in a rural village with no electricity in Malawi. Public Health Act. 2014;4(3):145\u20139.","journal-title":"Public Health Act"},{"key":"12844_CR10","doi-asserted-by":"crossref","unstructured":"Allain TJ, van Oosterhout JJ, Douglas GP, Joukes S, Gadabu OJ, Darts C, et al. Applying lessons learnt from the DOTS tuberculosis model to monitoring and evaluating persons with diabetes mellitus in Blantyre, Malawi. Trop Med Int Health. 2011;16(9):1077\u201384.","DOI":"10.1111\/j.1365-3156.2011.02808.x"},{"issue":"1","key":"12844_CR11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12911-024-02802-x","volume":"24","author":"MB Aron","year":"2024","unstructured":"Aron MB, Nkhomah WE, Dullie L, Matanje B, Kachimanga C, Ndarama E, et al. Towards improving district health information system data consistency, report completeness and timeliness in Neno district, Malawi. BMC Med Inform Decis Mak. 2024;24(1):1\u201311 [Cited 2025 Feb 3]. Available from: https:\/\/bmcmedinformdecismak.biomedcentral.com\/articles\/10.1186\/s12911-024-02802-x.","journal-title":"BMC Med Inform Decis Mak"},{"key":"12844_CR12","doi-asserted-by":"crossref","unstructured":"Mauluka C, Kazanga Chiumia I, Maliwichi L, Stones W. Assessing the impact of client knowledge and demand on service provision from antenatal to postnatal Care - An implementation science design. J Womens Health Dev. 2022;05(04):287\u2013302.","DOI":"10.26502\/fjwhd.2644-28840101"},{"key":"12844_CR13","doi-asserted-by":"crossref","unstructured":"Malpass A, Chinkhumba J, Davlantes E, Munthali J, Wright K, Ramsey, K et al. Malaria knowledge and experiences with community health workers among recently pregnant women in Malawi. Malar J. 2020;19(1). [Cited 2025 Feb 3]. Available from:\u00a0https:\/\/msh.org\/resources\/malaria-knowledge-and-experiences-with-community-health-workers-among-recently-pregnant\/.","DOI":"10.1186\/s12936-020-03228-2"},{"key":"12844_CR14","doi-asserted-by":"crossref","unstructured":"Simbeye AJ, Kumwenda S, Cohee LM, Omondi D, Masibo PK, Wao H, et al. Factors associated with malaria vaccine uptake in Nsanje district, Malawi. Malar J. 2024;23(1):105.","DOI":"10.1186\/s12936-024-04938-7"},{"key":"12844_CR15","doi-asserted-by":"crossref","unstructured":"Stones W. Malawi: Findings from a National census of health facilities. Malawi Med J. 2018;30(3):140\u20135.","DOI":"10.4314\/mmj.v30i3.2"},{"issue":"11","key":"12844_CR16","doi-asserted-by":"publisher","first-page":"768","DOI":"10.2471\/BLT.14.145623","volume":"93","author":"AN Dasgupta","year":"2015","unstructured":"Dasgupta AN, Ngwalo R, Branson K, Gondwe L, Taulo F, Ngwira B, et al. Using patient-held records to evaluate contraceptive use in Malawi. Bull World Health Organ. 2015;93(11):768\u201374 [Cited 2025 Feb 4]. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/26549904\/.","journal-title":"Bull World Health Organ"},{"issue":"3","key":"12844_CR17","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1108\/RMJ-02-2018-0004","volume":"28","author":"AG Tough","year":"2018","unstructured":"Tough AG, Lihoma P. Medical record keeping systems in Malawi: is there a case for hybrid systems and intermediate technologies? Records Manage J. 2018;28(3):265\u201377.","journal-title":"Records Manage J"},{"key":"12844_CR18","doi-asserted-by":"crossref","unstructured":"Chikumba PA. Management of health information in Malawi: role of technology. Adv Sci Technol Eng Syst. 2017;2(1):157\u201366.","DOI":"10.25046\/aj020118"},{"key":"12844_CR19","doi-asserted-by":"crossref","unstructured":"Ye J, Xiong S, Wang T, Li J, Cheng N, Tian M, et al. The roles of electronic health records for clinical trials in Low- and Middle-Income countries: scoping review. JMIR Med Inform. 2023;22(11):e47052.","DOI":"10.2196\/47052"},{"issue":"3","key":"12844_CR20","doi-asserted-by":"publisher","first-page":"367","DOI":"10.9745\/GHSP-D-17-00177","volume":"5","author":"R O\u2019Hagan","year":"2017","unstructured":"O\u2019Hagan R, Marx MA, Finnegan KE, Naphini P, Ng\u2019ambi K, Laija K, et al. National Assessment of Data Quality and Associated Systems-Level Factors in Malawi. Glob Health Sci Pract. 2017;5(3):367\u201381 [Cited 2025 Feb 4]. Available from: https:\/\/www.ghspjournal.org\/content\/5\/3\/367.","journal-title":"Glob Health Sci Pract"},{"issue":"1","key":"12844_CR21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-024-11901-4","volume":"24","author":"A Taylor","year":"2024","unstructured":"Taylor A, Kazembe P. Assessing language barriers in health facilities in Malawi. BMC Health Serv Res. 2024;24(1):1\u201326 [Cited 2025 Feb 3]. Available from: https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-024-11901-4.","journal-title":"BMC Health Serv Res"},{"key":"12844_CR22","unstructured":"World Health Organization. WHO recommendations on home-based records for maternal, newborn and child health. World Health Organization; 2018. p. 56. Available from:\u00a0http:\/\/www.who.int\/immunization\/monitoring_surveillance\/routine\/homebasedrecords\/en\/."},{"key":"12844_CR23","doi-asserted-by":"crossref","unstructured":"Brown DW, Tabu C, Sergon K, Shendale S, Mugoya I, Machekanyanga Z, et al. Home-based record (HBR) ownership and use of HBR recording fields in selected Kenyan communities: results from the Kenya missed opportunities for vaccination assessment. PLoS ONE. 2018;13(8):e0201538.","DOI":"10.1371\/journal.pone.0201538"},{"key":"12844_CR24","doi-asserted-by":"crossref","unstructured":"Mahomed K, Mason E, Warndorf T. Home-Based Mother\u2019s Record: Operational Feasibility, Understanding and Usage in a Rural Community in Zimbabwe. 2000;30(3):155\u20139. [Cited 2025 Feb 4]. Available from:\u00a0https:\/\/journals.sagepub.com\/doi\/10.1177\/004947550003000314.","DOI":"10.1177\/004947550003000314"},{"key":"12844_CR25","unstructured":"Zambia Ministry of Health. National Maternal and Neonatal Services Referral Guidelines. 2018. [Cited 2025 Feb 5]. Available from: https:\/\/www.moh.gov.zm\/?wpfb_dl=6."},{"issue":"6","key":"12844_CR26","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1007\/s10995-006-0132-9","volume":"10","author":"DO Mukanga","year":"2006","unstructured":"Mukanga DO, Kiguli S. Factors affecting the retention and use of child health cards in a slum community in Kampala, Uganda, 2005. Matern Child Health J. 2006;10(6):545\u201352 [Cited 2025 Feb 4]. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/16850275\/.","journal-title":"Matern Child Health J"},{"key":"12844_CR27","doi-asserted-by":"crossref","unstructured":"Naidoo H, Avenant T, Goga A. Completeness of the Road-to-Health booklet and Road-to-Health card: results of cross-sectional surveillance at a provincial tertiary hospital. South Afr J HIV Med. 2018;19(1):10.","DOI":"10.4102\/sajhivmed.v19i1.765"},{"key":"12844_CR28","doi-asserted-by":"crossref","unstructured":"Joseph L, Lavis A, Greenfield S, Boban D, Humphries C, Jose P, et al. Systematic review on the use of patient-held health records in low-income and middle-income countries. BMJ Open. 2021;11(9):e046965.","DOI":"10.1136\/bmjopen-2020-046965"},{"key":"12844_CR29","doi-asserted-by":"crossref","unstructured":"Van Der Hoek W, Ngoma M, Soeters R. The home-based health passport: A tool for primary health care. Trop Doct. 1994;24(1):21\u20133.","DOI":"10.1177\/004947559402400110"},{"key":"12844_CR30","unstructured":"Henbest PR, Germond DT, Fehrsen PG. I Keep My Health Book with Me: A National survey of 20 years\u2019 experience of Patient- retained medical records Lesotho. South Afr Fam Pract. 1995;16(2). [Cited 2025 Feb 4]. Available from:\u00a0http:\/\/safpj.redbricklibrary.co.za\/index.php\/safpj\/article\/view\/2456."},{"key":"12844_CR31","doi-asserted-by":"crossref","unstructured":"Lumbandali N, Mocumbi A. Retention of patient-held medical records for chronic diseases in Mozambique. Pan Afr Med J. 2021;39:1.","DOI":"10.11604\/pamj.2021.39.1.22504"},{"key":"12844_CR32","doi-asserted-by":"crossref","unstructured":"Madziwa PK, Masuku M. Patient held medical records in public hospitals in Bulawayo. 2024. [Cited 2025 Feb 4]; Available from:\u00a0https:\/\/journals.sagepub.com\/doi\/10.1177\/02666669241262310?icid=int.sj-abstract.citing-articles.1.","DOI":"10.1177\/02666669241262310"},{"issue":"1","key":"12844_CR33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12992-023-01011-x","volume":"20","author":"G Towett","year":"2024","unstructured":"Towett G, Snead RS, Marczika J, Prada I. Discursive framework for a multi-disease digital health passport in Africa: a perspective. Global Health. 2024;20(1):1\u201310 [Cited 2025 Jan 31]. Available from: https:\/\/globalizationandhealth.biomedcentral.com\/articles\/10.1186\/s12992-024-01067-3.","journal-title":"Global Health"},{"key":"12844_CR34","doi-asserted-by":"crossref","unstructured":"Sartain SA, Stressing S, Prieto J. Patients\u2019 views on the effectiveness of patient-held records: A systematic review and thematic synthesis of qualitative studies. Health Expect. 2015;18(6):2666\u201377.","DOI":"10.1111\/hex.12240"},{"key":"12844_CR35","unstructured":"Taylor A. Health Passports. Open Science Foundation; 2025. Available from: https:\/\/osf.io\/f6jgk."},{"issue":"2","key":"12844_CR36","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1080\/03057070.2024.2386650","volume":"50","author":"R Macdonald","year":"2024","unstructured":"Macdonald R. Using Written Consent Forms When Conducting Non-Elite Qualitative Research: Reflections from Zambia. J South Afr Stud. 2024;50(2):195\u2013206 [Cited 2025 Apr 15]. Available from: https:\/\/www.tandfonline.com\/action\/journalInformation?journalCode=cjss20.","journal-title":"J South Afr Stud"},{"key":"12844_CR37","doi-asserted-by":"crossref","unstructured":"Chaulagai CN, Moyo CM, Koot J, Moyo HBM, Sambakunsi TC, Khunga FM, et al. Design and implementation of a health management information system in Malawi: issues, innovations and results. Health Policy Plan. 2005;20(6):375\u201384.","DOI":"10.1093\/heapol\/czi044"},{"key":"12844_CR38","unstructured":"Health MGM of Malawi. Standard Treatment Guidelines. Malawi Government; 2009. [Cited 2025 Feb 3]. Available from:\u00a0http:\/\/nkhokwe.kuhes.ac.mw:8080\/handle\/20.500.12845\/185."},{"key":"12844_CR39","doi-asserted-by":"crossref","unstructured":"Neville R, Neville J. What can health care professionals in the united Kingdom learn from Malawi? Hum Resour Health. 2009;7:26.","DOI":"10.1186\/1478-4491-7-26"},{"issue":"1","key":"12844_CR40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-022-08087-y","volume":"22","author":"FW Sinyiza","year":"2022","unstructured":"Sinyiza FW, Kaseka PU, Chisale MRO, Chimbatata CS, Mbakaya BC, Kamudumuli PS, et al. Patient satisfaction with health care at a tertiary hospital in Northern Malawi: results from a triangulated cross-sectional study. BMC Health Serv Res. 2022;22(1):1\u20139 [Cited 2025 Apr 21]. Available from: https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-022-08087-y.","journal-title":"BMC Health Serv Res"},{"key":"12844_CR41","unstructured":"Muula AS. Will Health Rights Solve Malawi\u2019s Health Problems? Croat Med J. 2005;46(5):853\u20139."},{"key":"12844_CR42","unstructured":"Government of Malawi M of H and P. Malawi Harmonised Health Facility Assessment (HHFA). 2019. [Cited 2025 Apr 16]. Available from:\u00a0https:\/\/documents1.worldbank.org\/curated\/en\/521421611550618689\/pdf\/Short-Report.pdf."},{"key":"12844_CR43","doi-asserted-by":"crossref","unstructured":"Ritter R, Nkhwalingwa N, Anthonj C, Kistemann T. Coping with ill-health while lacking access to health care: Acceptability of health service provision in rural Malawi\u2013 a qualitative study. Glob Health Action. 2022;15(1). [Cited 2025 Apr 21]. Available from:\u00a0https:\/\/www.tandfonline.com\/doi\/abs\/10.1080\/16549716.2022.2062174.","DOI":"10.1080\/16549716.2022.2062174"},{"key":"12844_CR44","unstructured":"Ministry of Health, Government of Malawi. Malawi National Health Policy: Towards Universal Health Coverage. Report. 2020. [Cited 2025 Feb 3]. Available from: https:\/\/p4h.world\/en\/documents\/malawi-national-health-policy-towards-universal-health-coverage\/."},{"key":"12844_CR45","unstructured":"Health Professions Council of South Africa. Booklet 9: Guidelines on the keeping of patient health records. 2022. [Cited 2025 Feb 5]. Available from:\u00a0https:\/\/www.hpcsa.co.za\/Uploads\/professional_practice\/ethics\/Booklet_9_Keeping_of_Patient_Records_Review%20Draft_vSept_2022.pdf."},{"key":"12844_CR46","unstructured":"Zimbabwe Government. Medical and Dental Practitioners Act. Medical Records Amendment (No.20) Act 2012. Available from: https:\/\/www.mdpcz.co.zw\/Medical%20records%20ammendment.pdf."},{"key":"12844_CR47","doi-asserted-by":"crossref","unstructured":"Howard S. Patients\u2019 access to medical records around the world. BMJ. 2024;386. [Cited 2025 Feb 4]. Available from:\u00a0https:\/\/www.bmj.com\/content\/386\/bmj.q1481.","DOI":"10.1136\/bmj.q1481"},{"issue":"4","key":"12844_CR48","first-page":"126","volume":"26","author":"AC Munthali","year":"2014","unstructured":"Munthali AC, Mannan H, MacLachlan M, Swartz L, Makupe CM, Chilimampunga C. Non-use of formal health services in Malawi: perceptions from Non-users. Malawi Med J. 2014;26(4):126.","journal-title":"Malawi Med J"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-025-12844-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-025-12844-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-025-12844-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T12:42:27Z","timestamp":1748954547000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-025-12844-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,3]]},"references-count":48,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["12844"],"URL":"https:\/\/doi.org\/10.1186\/s12913-025-12844-0","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2025.03.01.25322650","asserted-by":"object"}]},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,3]]},"assertion":[{"value":"22 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 June 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 approved by the Zomba District Heath Office Research Committee (ZA\/DC\/ADMIN\/15\/02\/2024). All procedures were carried out in accordance with the Declaration of Helsinki. All participants to the FGD were given written and verbal explanation regarding the aim of the study, data protection and privacy of individual data. Informed consent was obtained in writing from all participants to the FGD.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All authors have given their consent for publication.","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":"792"}}