{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T13:35:26Z","timestamp":1790948126534,"version":"4.1.0"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T00:00:00Z","timestamp":1721347200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T00:00:00Z","timestamp":1721347200000},"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":["Malar J"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Malaria contributes substantially to the persistent burden of child deaths in sub-Saharan Africa. Accurate and comprehensive malaria mortality data are crucial to monitor the progress in reducing malaria incidence and mortality. Verbal Autopsy (VA) ascertains the cause of death despite its limitations leading to misclassification errors. Minimally Invasive Tissue Sampling (MITS) is being conducted in some settings as an alternative to Complete Diagnostic Autopsy (CDA). The present study examines the validity of malaria-related deaths comparing VA diagnoses with those obtained through MITS and\/or CDA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A comprehensive literature search for original studies in English language using Ovid MEDLINE, Ovid Embase, CINAHL via EBSCO, Scopus, The Cochrane Library via Wiley, Google Scholar and searching the MITS Surveillance Alliance papers was carried out. The reference period was January 1, 1990\u2013March 31, 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adopted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 71 articles identified in the databases, 21 matched the eligibility criteria. Qualitative syntheses showed that malaria Cause Specific Mortality Fractions (CSMFs) across various studies ranged from 2 to 31%.<jats:italic>Plasmodium falciparum<\/jats:italic>was mostly responsible for these deaths and the most common complications were anaemia and cerebral malaria. The sensitivity and specificity of the VA validation studies ranged from 18.4% to 33% and from 86.6% to 97%, respectively, and there was a high level of misclassification for both InSilico and Expert Algorithm VA for malaria compared to MITS. The overall concordance rates between MITS and CDA diagnoses ranged from 68 to 90%, with the highest concordance seen in deaths due to infectious diseases and malignant tumours. Clinical data increased diagnostic coincidence between MITS blind to clinical data and the gold standard CDA by 11%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The comprehensive review finds that MITS demonstrated better accuracy compared to VA in diagnosing malaria-attributed deaths, particularly in hospital settings. The high specificity of malaria in VA diagnosis suggests population-based estimates of the proportion of deaths due to malaria are broadly plausible.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12936-024-05035-5","type":"journal-article","created":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T13:02:08Z","timestamp":1721394128000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Validation of malaria-attributed deaths using verbal autopsy studies: a systematic review"],"prefix":"10.1186","volume":"23","author":[{"given":"Ronald","family":"Carshon-Marsh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Bondy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore","family":"Witek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prabhat","family":"Jha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,19]]},"reference":[{"key":"5035_CR1","unstructured":"United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). Levels & Trends in Child Mortality. Report 2021. Estimates developed by the UN Inter-agency Group for Child Mortality Estimation. New York; 2021. https:\/\/childmortality.org\/reports. Accessed Jan 2022."},{"key":"5035_CR2","unstructured":"WHO. World Malaria report 2022. Geneva, World Health Organization, 2022. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/malaria."},{"key":"5035_CR3","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1186\/s12936-017-2071-x","volume":"16","author":"S Herrera","year":"2017","unstructured":"Herrera S, Enuameh Y, Adjei G, Ae-Ngibise KA, Asante KP, Sankoh S, et al. A systematic review and synthesis of the strengths and limitations of measuring malaria mortality through verbal autopsy. Malar J. 2017;16:421.","journal-title":"Malar J"},{"key":"5035_CR4","unstructured":"WHO. Verbal Autopsy Reference Group Revision of the 2016 WHO Verbal Autopsy Instrument. Geneva, World Health Organization, 2022. https:\/\/cdn.who.int\/media\/docs\/default-source\/classification\/other-classifications\/autopsy\/2022-va-instrument\/report---revision-of-the-2016-who-va-instrument_2022.pdf. Accessed 22 Aug 2022."},{"key":"5035_CR5","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2017-000639","volume":"3","author":"LM Thomas","year":"2018","unstructured":"Thomas LM, D\u2019Ambruoso L, Balabanova D. Verbal autopsy in health policy and systems: a literature review. BMJ Glob Health. 2018;3: e000639.","journal-title":"BMJ Glob Health"},{"key":"5035_CR6","doi-asserted-by":"publisher","first-page":"318","DOI":"10.11604\/pamj.2019.33.318.16405","volume":"33","author":"CJ Uneke","year":"2019","unstructured":"Uneke CJ, Uro-Chukwu HC, Chukwu OE. Validation of verbal autopsy methods for assessment of child mortality in sub-Saharan Africa and the policy implication: a rapid review. Pan Afr Med J. 2019;33:318.","journal-title":"Pan Afr Med J"},{"key":"5035_CR7","doi-asserted-by":"publisher","first-page":"e114","DOI":"10.1016\/S2214-109X(21)00459-9","volume":"10","author":"R Carshon-Marsh","year":"2021","unstructured":"Carshon-Marsh R, Aimone A, Ansumana R, Swaray IB, Assalif A, Musa A, et al. Child, maternal, and adult mortality in Sierra Leone: nationally representative mortality survey 2018\u201320. Lancet Glob Health. 2021;10:e114\u201323.","journal-title":"Lancet Glob Health"},{"key":"5035_CR8","doi-asserted-by":"publisher","first-page":"1090","DOI":"10.1093\/ije\/26.5.1090","volume":"26","author":"M Anker","year":"1997","unstructured":"Anker M. The effect of misclassification error on reported cause-specific mortality fractions from verbal autopsy. Int J Epidemiol. 1997;26:1090\u20136.","journal-title":"Int J Epidemiol"},{"key":"5035_CR9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003814","volume":"18","author":"RF Breiman","year":"2021","unstructured":"Breiman RF, Blau DM, Mutevedzi P, Akelo V, Mandomando I, Ogbuanu IU, et al. Postmortem investigations and identification of multiple causes of child deaths: an analysis of findings from the Child Health and Mortality Prevention Surveillance (CHAMPS) network. PLoS Med. 2021;18: e1003814.","journal-title":"PLoS Med"},{"key":"5035_CR10","doi-asserted-by":"publisher","first-page":"1792682","DOI":"10.1080\/16549716.2020.1792682","volume":"13","author":"CR Paganelli","year":"2020","unstructured":"Paganelli CR, Goco NJ, McClure EM, Banke KK, Blau DM, Breiman RF, et al. The evolution of minimally invasive tissue sampling in postmortem examination: a narrative review. Glob Health Action. 2020;13:1792682.","journal-title":"Glob Health Action"},{"key":"5035_CR11","doi-asserted-by":"publisher","first-page":"1768","DOI":"10.1016\/S0140-6736(10)60831-8","volume":"376","author":"N Dhingra","year":"2010","unstructured":"Dhingra N, Jha P, Sharma VP, Cohen AA, Jotkar RM, Rodriguez PS, et al. Adult and child malaria mortality in India: a nationally representative mortality survey. Lancet. 2010;376:1768\u201374.","journal-title":"Lancet"},{"key":"5035_CR12","doi-asserted-by":"publisher","first-page":"25369","DOI":"10.3402\/gha.v7.25369","volume":"7","author":"PK Streatfield","year":"2014","unstructured":"Streatfield PK, Khan WA, Bhuiya A, Hanifi SM, Alam N, Diboulo E, et al. Malaria mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites. Glob Health Action. 2014;7:25369.","journal-title":"Glob Health Action"},{"key":"5035_CR13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2024.01.006","volume":"88","author":"IU Ogbuanu","year":"2024","unstructured":"Ogbuanu IU, Otieno K, Varo R, Sow SO, Ojulong J, Duduyemi B, et al. Burden of child mortality from malaria in high endemic areas: results from the CHAMPS network using minimally invasive tissue sampling. J Infect. 2024;88: 106107.","journal-title":"J Infect"},{"key":"5035_CR14","doi-asserted-by":"crossref","unstructured":"Carshon-Marsh R, Bondy S, Witek T, Jha P. Validation of malaria-attributed deaths using verbal autopsy studies. A systematic review protocol. PROSPERO 2023 CRD42023452940. https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42023452940","DOI":"10.1186\/s12936-024-05035-5"},{"key":"5035_CR15","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1016\/j.jclinepi.2009.10.002","volume":"63","author":"NP Lucas","year":"2010","unstructured":"Lucas NP, Macaskill P, Irwig L, Bogduk N. The development of a quality appraisal tool for studies of diagnostic reliability (QAREL). J Clin Epidemiol. 2010;63:854\u201361.","journal-title":"J Clin Epidemiol"},{"key":"5035_CR16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-005218","volume":"6","author":"N Rakislova","year":"2021","unstructured":"Rakislova N, Jordao D, Ismail MR, Mayor A, Cister\u00f3 P, Marimon L, et al. Accuracy of verbal autopsy, clinical data and minimally invasive autopsy in the evaluation of malaria-specific mortality: an observational study. BMJ Glob Health. 2021;6: e005218.","journal-title":"BMJ Glob Health"},{"key":"5035_CR17","doi-asserted-by":"publisher","first-page":"55","DOI":"10.12688\/gatesopenres.13132.2","volume":"4","author":"C Men\u00e9ndez","year":"2021","unstructured":"Men\u00e9ndez C, Quint\u00f3 L, Castillo P, Carrilho C, Ismael MR, Lorenzoni C, et al. Limitations to current methods to estimate cause of death: a validation study of a verbal autopsy model. Gates Open Res. 2021;4:55.","journal-title":"Gates Open Res"},{"issue":"5 Suppl","key":"5035_CR18","doi-asserted-by":"publisher","first-page":"78","DOI":"10.4269\/ajtmh.22-0319","volume":"108","author":"B Gilbert","year":"2023","unstructured":"Gilbert B, Fiksel J, Wilson E, Kalter H, Kante A, Akum A, et al. Multi-cause calibration of verbal autopsy-based cause-specific mortality estimates of children and neonates in Mozambique. Am J Trop Med Hyg. 2023;108(5 Suppl):78\u201389.","journal-title":"Am J Trop Med Hyg"},{"issue":"5 Suppl","key":"5035_CR19","doi-asserted-by":"publisher","first-page":"66","DOI":"10.4269\/ajtmh.22-0318","volume":"108","author":"J Fiksel","year":"2023","unstructured":"Fiksel J, Gilbert B, Wilson E, Kalter H, Kante A, Akum A, et al. Correcting for verbal autopsy misclassification bias in cause-specific mortality estimates. Am J Trop Med Hyg. 2023;108(5 Suppl):66\u201377.","journal-title":"Am J Trop Med Hyg"},{"key":"5035_CR20","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1186\/s12889-022-13081-4","volume":"22","author":"CDS de Andr\u00e9","year":"2022","unstructured":"de Andr\u00e9 CDS, Bierrenbach AL, Barroso LP, de Andr\u00e9 PA, Justo LT, Pereira LAA, et al. Validation of physician certified verbal autopsy using conventional autopsy: a large study of adult non-external causes of death in a metropolitan area in Brazil. BMC Public Health. 2022;22:748.","journal-title":"BMC Public Health"},{"key":"5035_CR21","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1007\/s00428-019-02602-z","volume":"475","author":"AEM Palhares","year":"2019","unstructured":"Palhares AEM, Ferreira L, Freire M, Castillo P, Mart\u00ednez MJ, Hurtado JC, et al. Performance of the minimally invasive autopsy tool for cause of death determination in adult deaths from the Brazilian Amazon: an observational study. Virchows Arch. 2019;475:649\u201358.","journal-title":"Virchows Arch"},{"key":"5035_CR22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002171","volume":"13","author":"P Castillo","year":"2016","unstructured":"Castillo P, Mart\u00ednez MJ, Ussene E, Jordao D, Lovane L, Ismail MR, et al. Validity of a minimally invasive autopsy for cause of death determination in adults in Mozambique: an observational study. PLoS Med. 2016;13: e1002171.","journal-title":"PLoS Med"},{"key":"5035_CR23","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002431","volume":"14","author":"P Castillo","year":"2017","unstructured":"Castillo P, Hurtado JC, Mart\u00ednez MJ, Jordao D, Lovane L, Ismail MR, et al. Validity of a minimally invasive autopsy for cause of death determination in maternal deaths in Mozambique: an observational study. PLoS Med. 2017;14: e1002431.","journal-title":"PLoS Med"},{"key":"5035_CR24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002317","volume":"14","author":"Q Bassat","year":"2017","unstructured":"Bassat Q, Castillo P, Mart\u00ednez MJ, Jordao D, Lovane L, Hurtado JC, et al. Validity of a minimally invasive autopsy tool for cause of death determination in pediatric deaths in Mozambique: an observational study. PLoS Med. 2017;14: e1002317.","journal-title":"PLoS Med"},{"key":"5035_CR25","first-page":"1095","volume":"8","author":"NM Tanko","year":"2021","unstructured":"Tanko NM, Bakytkaly I, Issanov A, Poddighe D, Terzic M. Validating a Minimally Invasive Tissue Sampling (MITS) method in determining cause of death in stillbirths and neonates. Children (Basel). 2021;8:1095.","journal-title":"Children (Basel)"},{"key":"5035_CR26","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002318","volume":"14","author":"C Menendez","year":"2017","unstructured":"Menendez C, Castillo P, Mart\u00ednez MJ, Jordao D, Lovane L, Ismail MR, et al. Validity of a minimally invasive autopsy for cause of death determination in stillborn babies and neonates in Mozambique: an observational study. PLoS Med. 2017;14: e1002318.","journal-title":"PLoS Med"},{"key":"5035_CR27","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1016\/j.humpath.2018.10.037","volume":"85","author":"F Fernandes","year":"2019","unstructured":"Fernandes F, Castillo P, Bassat Q, Quint\u00f3 L, Hurtado JC. Contribution of the clinical information to the accuracy of the minimally invasive and the complete diagnostic autopsy. Hum Pathol. 2019;85:184\u201393.","journal-title":"Hum Pathol"},{"key":"5035_CR28","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0132057","volume":"10","author":"P Castillo","year":"2015","unstructured":"Castillo P, Ussene E, Ismail MR, Jordao D, Lovane L, Carrilho C, et al. Pathological methods applied to the investigation of causes of death in developing countries: minimally invasive autopsy approach. PLoS ONE. 2015;10: e0132057.","journal-title":"PLoS ONE"},{"key":"5035_CR29","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.22494","volume":"6","author":"Q Bassat","year":"2023","unstructured":"Bassat Q, Blau DM, Ogbuanu IU, Samura S, Kaluma E, Bassey IA, et al. Causes of death among infants and children in the child health and mortality prevention surveillance (CHAMPS) network. JAMA Netw Open. 2023;6: e2322494.","journal-title":"JAMA Netw Open"},{"key":"5035_CR30","doi-asserted-by":"publisher","first-page":"e1032","DOI":"10.1016\/S2214-109X(23)00211-5","volume":"11","author":"L Madrid","year":"2023","unstructured":"Madrid L, Alemu A, Seale AC, Oundo J, Tesfaye T, Marami D, et al. Causes of stillbirth and death among children younger than 5 years in eastern Hararghe, Ethiopia: a population-based post-mortem study. Lancet Glob Health. 2023;11:e1032\u201340.","journal-title":"Lancet Glob Health"},{"key":"5035_CR31","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/S2352-4642(23)00328-0","volume":"8","author":"S Mahtab","year":"2024","unstructured":"Mahtab S, Blau DM, Madewell ZJ, Ogbuanu IU, Ojulong J, Lako S, et al. Post-mortem investigation of pneumonia deaths in children 1\u201359 months in sub-Saharan Africa and South Asia from 2016 to 2022: an observational study. Lancet Child Adolesc Health. 2024;8:201\u201313.","journal-title":"Lancet Child Adolesc Health."},{"key":"5035_CR32","doi-asserted-by":"publisher","first-page":"ofad356","DOI":"10.1093\/ofid\/ofad356","volume":"10","author":"S Mahtab","year":"2023","unstructured":"Mahtab S, Madewell ZJ, Madhi SA, Wise A, Swart PJ, Velaphi S, et al. Stillbirths and neonatal deaths caused by Group B Streptococcus in Africa and South Asia identified through child health and mortality prevention surveillance (CHAMPS). Open Forum Infect Dis. 2023;10:ofad356.","journal-title":"Open Forum Infect Dis"},{"key":"5035_CR33","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0001612","volume":"3","author":"S Mahtab","year":"2023","unstructured":"Mahtab S, Madhi SA, Baillie VL, Els T, Thwala BN, Onyango D, et al. Causes of death identified in neonates enrolled through Child Health and Mortality Prevention Surveillance (CHAMPS), December 2016 \u2013December 2021. PLoS Glob Public Health. 2023;3: e0001612.","journal-title":"PLoS Glob Public Health"},{"key":"5035_CR34","doi-asserted-by":"publisher","first-page":"6","DOI":"10.4103\/0300-1652.149163","volume":"56","author":"A Gupta","year":"2015","unstructured":"Gupta A, Dhume V, Puranik GV, Kavishwar V. Autopsy study of febrile deaths during monsoon at a tertiary care institute in India: Is malaria still a challenge? Niger Med J. 2015;56:6\u201311.","journal-title":"Niger Med J"},{"key":"5035_CR35","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s12936-018-2184-x","volume":"17","author":"NO Amek","year":"2018","unstructured":"Amek NO, Van Eijk A, Lindblade KA, Hamel M, Bayoh N, Gimnig J, et al. Infant and child mortality in relation to malaria transmission in KEMRI\/CDC HDSS, Western Kenya: validation of verbal autopsy. Malar J. 2018;17:37.","journal-title":"Malar J"},{"key":"5035_CR36","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1093\/ije\/dyi087","volume":"34","author":"AK Rowe","year":"2005","unstructured":"Rowe AK. Should verbal autopsy results for malaria be adjusted to improve validity? Int J Epidemiol. 2005;34:712\u20133.","journal-title":"Int J Epidemiol"},{"key":"5035_CR37","unstructured":"Healthy Sierra Leone. Report on causes of death in Sierra Leone 2018\u20132023. www.healsl.org"},{"key":"5035_CR38","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2700","volume":"339","author":"A Liberati","year":"2009","unstructured":"Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339: b2700.","journal-title":"BMJ"},{"key":"5035_CR39","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1046\/j.1365-3024.2001.00364.x","volume":"23","author":"EM Riley","year":"2001","unstructured":"Riley EM, Wagner GE, Akanmori BD, Koram KA. Do maternally acquired antibodies protect infants from malaria infection? Parasite Immunol. 2001;23:51\u20139.","journal-title":"Parasite Immunol"}],"container-title":["Malaria Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-024-05035-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12936-024-05035-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-024-05035-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,24]],"date-time":"2024-11-24T13:03:08Z","timestamp":1732453388000},"score":1,"resource":{"primary":{"URL":"https:\/\/malariajournal.biomedcentral.com\/articles\/10.1186\/s12936-024-05035-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,19]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["5035"],"URL":"https:\/\/doi.org\/10.1186\/s12936-024-05035-5","relation":{},"ISSN":["1475-2875"],"issn-type":[{"value":"1475-2875","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,19]]},"assertion":[{"value":"20 May 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 July 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Unity Health Toronto Research Ethics Board (REB), Statistical Alliance for Vital Events (SAVE) under REB #15-231. No primary data was collected for this review.","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":"217"}}