{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T17:31:43Z","timestamp":1790357503166,"version":"4.1.0"},"reference-count":51,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Malar J"],"DOI":"10.1186\/s12936-025-05409-3","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T13:20:03Z","timestamp":1754054403000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Prevalence and determinants of malaria among children aged 6\u201359 months in Tanzania: a nationwide cross-sectional study"],"prefix":"10.1186","volume":"24","author":[{"given":"Jovinary","family":"Adam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pankras","family":"Luoga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tumaini","family":"Nyamhanga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chijano","family":"Makunenge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meshack","family":"Ayubu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,1]]},"reference":[{"key":"5409_CR1","doi-asserted-by":"publisher","first-page":"6576","DOI":"10.1097\/MS9.0000000000002578","volume":"86","author":"EI Obeagu","year":"2024","unstructured":"Obeagu EI, Obeagu GU. Emerging public health strategies in malaria control: innovations and implications. Ann Med Surg. 2024;86:6576\u201384.","journal-title":"Ann Med Surg"},{"key":"5409_CR2","doi-asserted-by":"crossref","unstructured":"Editorial. Malaria: (still) a global health priority. EClinicalMedicine. 2021;34:100891.","DOI":"10.1016\/j.eclinm.2021.100891"},{"key":"5409_CR3","doi-asserted-by":"publisher","DOI":"10.1093\/jtm\/taab046","volume":"28","author":"Q Liu","year":"2021","unstructured":"Liu Q, Jing W, Kang L, Liu J, Liu M. Trends of the global, regional and national incidence of malaria in 204 countries from 1990 to 2019 and implications for malaria prevention. J Travel Med. 2021;28: taab046.","journal-title":"J Travel Med"},{"key":"5409_CR4","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1186\/s13071-022-05432-2","volume":"15","author":"ST Mirzohreh","year":"2022","unstructured":"Mirzohreh ST, Safarpour H, Pagheh AS, Bangoura B, Barac A, Ahmadpour E. Malaria prevalence in HIV-positive children, pregnant women, and adults: a systematic review and meta-analysis. Parasit Vectors. 2022;15:324.","journal-title":"Parasit Vectors"},{"key":"5409_CR5","first-page":"123","volume":"9","author":"TE Kwenti","year":"2018","unstructured":"Kwenti TE. Malaria and HIV coinfection in sub-Saharan Africa: prevalence, impact, and treatment strategies. Res Rep Trop Med. 2018;9:123\u201336.","journal-title":"Res Rep Trop Med"},{"key":"5409_CR6","unstructured":"WHO.World malaria report 2024: addressing inequity in the global malaria response. Geneva: World Health Organization, 2024. https:\/\/www.wipo.int\/amc\/en\/mediation\/, https:\/\/www.who.int\/teams\/global-malaria-programme\/reports\/world-malaria-report-2023"},{"key":"5409_CR7","unstructured":"WHO, Africa Region. Country diseases outlook, Tanzania. World Health Organization, Regional Office for Africa; 2023."},{"key":"5409_CR8","unstructured":"WHO. World malaria report 2022. Geneva: World Health Organization, 2022. https:\/\/www.who.int\/teams\/global-malaria-programme\/reports\/world-malaria-report-2021"},{"key":"5409_CR9","unstructured":"United Republic of Tanzania, Ministry of Health, Community Development, Gender, Elderly and Children. National Malaria Strategic Plan 2021\u20132025. Transitioning to Malaria Elimination in Phases. Dodoma:Tanzania; 2020. https:\/\/www.moh.go.tz"},{"key":"5409_CR10","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1186\/s12936-021-03950-5","volume":"20","author":"PS Larson","year":"2021","unstructured":"Larson PS, Eisenberg JNS, Berrocal VJ, Mathanga DP, Wilson ML. An urban-to-rural continuum of malaria risk: new analytic approaches characterize patterns in Malawi. Malar J. 2021;20:418.","journal-title":"Malar J"},{"key":"5409_CR11","doi-asserted-by":"publisher","DOI":"10.1016\/j.gpeds.2023.100085","volume":"6","author":"R Ranjha","year":"2023","unstructured":"Ranjha R, Singh K, Baharia RK, Mohan M, Anvikar AR, Bharti PK. Age-specific malaria vulnerability and transmission reservoir among children. Glob Pediatr. 2023;6: 100085.","journal-title":"Glob Pediatr"},{"key":"5409_CR12","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0285265","volume":"18","author":"D Chilot","year":"2023","unstructured":"Chilot D, Mondelaers A, Alem AZ, Asres MS, Yimer MA, Toni AT, et al. Pooled prevalence and risk factors of malaria among children aged 6\u201359 months in 13 sub-Saharan African countries: a multilevel analysis using recent malaria indicator surveys. PLoS ONE. 2023;18: e0285265.","journal-title":"PLoS ONE"},{"key":"5409_CR13","unstructured":"Ministry of Health (MoH) [Tanzania Mainland], Ministry of Health (MoH) [Zanzibar], National Bureau of Statistics (NBS) O of the CGS (OCGS). Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS) 2022 Final Report. Dodoma, Tanzania, and Rockville, USA: 2022."},{"key":"5409_CR14","volume-title":"National Guidelines for Integrated Malaria Vector Control","author":"United Republic of Tanzania, NMCP","year":"2016","unstructured":"United Republic of Tanzania, NMCP. National Guidelines for Integrated Malaria Vector Control. Dar es Salaam: United Republic of Tanzania; 2016."},{"key":"5409_CR15","unstructured":"United Republic of Tanzania. National Malaria Strategic Plan 2015\u20132020. Dar es Salaam: 2014."},{"key":"5409_CR16","unstructured":"Revolutionary Government of Zanzibar, Ministry of Health (MoH). Zanzibar Malaria Elimination Programme: Strategic Plan IV 2018\/19\u20132022\/23. Zanzibar: 2017."},{"key":"5409_CR17","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1172\/JCI21682","volume":"113","author":"NJ White","year":"2004","unstructured":"White NJ. Antimalarial drug resistance. J Clin Invest. 2004;113:1084\u201392.","journal-title":"J Clin Invest"},{"key":"5409_CR18","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1186\/s12936-023-04508-3","volume":"22","author":"P Tungu","year":"2023","unstructured":"Tungu P, Kabula B, Nkya T, Machafuko P, Sambu E, Batengana B, et al. Trends of insecticide resistance monitoring in mainland Tanzania, 2004\u20132020. Malar J. 2023;22:100.","journal-title":"Malar J"},{"key":"5409_CR19","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1186\/s13071-024-06315-4","volume":"17","author":"JO Odero","year":"2024","unstructured":"Odero JO, Nambunga IH, Masalu JP, Mkandawile G, Bwanary H, Hape EE, et al. Genetic markers associated with the widespread insecticide resistance in malaria vector Anopheles funestus populations across Tanzania. Parasit Vectors. 2024;17:230.","journal-title":"Parasit Vectors"},{"key":"5409_CR20","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/s13071-024-06639-1","volume":"18","author":"GA Chacha","year":"2025","unstructured":"Chacha GA, Francis F, Mandai SS, Seth MD, Madebe RA, Challe DP, et al. Prevalence and drivers of malaria infection among asymptomatic and symptomatic community members in five regions with varying transmission intensity in mainland Tanzania. Parasit Vectors. 2025;18:24.","journal-title":"Parasit Vectors"},{"key":"5409_CR21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0260785","volume":"16","author":"RO Mwaiswelo","year":"2021","unstructured":"Mwaiswelo RO, Mmbando BP, Chacky F, Molteni F, Mohamed A, Lazaro S, et al. Malaria infection and anemia status in under-five children from Southern Tanzania where seasonal malaria chemoprevention is being implemented. PLoS ONE. 2021;16: e0260785.","journal-title":"PLoS ONE"},{"key":"5409_CR22","first-page":"1","volume":"4","author":"K Gillian","year":"2023","unstructured":"Gillian K. Factors influencing prevalence of malaria among children under five years attending pediatric ward at Hoima Regional Referral Hospital in Hoima District, Western Uganda. Student J Health Res Africa. 2023;4:1\u201316.","journal-title":"Student J Health Res Africa"},{"key":"5409_CR23","first-page":"161","volume":"91","author":"SJ Rweyemamu","year":"2014","unstructured":"Rweyemamu SJ, Mtango D. Malaria prevalence in under five children utilising insecticide treated nets through voucher scheme programme in MTWARA municipality. East Afr Med J. 2014;91:161\u20134.","journal-title":"East Afr Med J"},{"key":"5409_CR24","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s12936-023-04484-8","volume":"22","author":"S Anjorin","year":"2023","unstructured":"Anjorin S, Okolie E, Yaya S. Malaria profile and socioeconomic predictors among under-five children: an analysis of 11 sub-Saharan African countries. Malari J. 2023;22:55.","journal-title":"Malari J"},{"key":"5409_CR25","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1186\/s40001-023-01046-1","volume":"28","author":"JO Sarfo","year":"2023","unstructured":"Sarfo JO, Amoadu M, Kordorwu PY, Adams AK, Gyan TB, Osman AG, et al. Malaria amongst children under five in sub-Saharan Africa: a scoping review of prevalence, risk factors and preventive interventions. Eur J Med Res. 2023;28:80.","journal-title":"Eur J Med Res"},{"key":"5409_CR26","doi-asserted-by":"publisher","first-page":"1438218","DOI":"10.3389\/fpara.2024.1438218","volume":"3","author":"A Aliyo","year":"2024","unstructured":"Aliyo A, Golicha W, Fikrie A. Malaria and associated factors among under-five children in Borena pastoral communities, southern Ethiopia. Front Parasitol. 2024;3:1438218.","journal-title":"Front Parasitol"},{"key":"5409_CR27","doi-asserted-by":"publisher","first-page":"7975","DOI":"10.3390\/ijerph17217975","volume":"17","author":"F Habyarimana","year":"2020","unstructured":"Habyarimana F, Ramroop S. Prevalence and risk factors associated with malaria among children aged six months to 14 years old in Rwanda: evidence from 2017 Rwanda Malaria Indicator Survey. Int J Environ Res Public Health. 2020;17:7975.","journal-title":"Int J Environ Res Public Health"},{"key":"5409_CR28","doi-asserted-by":"publisher","first-page":"1687","DOI":"10.1186\/s12889-024-19206-1","volume":"24","author":"JV Mbishi","year":"2024","unstructured":"Mbishi JV, Chombo S, Luoga P, Omary HJ, Paulo HA. Malaria in under-five children: prevalence and multi-factor analysis of high-risk African countries. BMC Public Health. 2024;24:1687.","journal-title":"BMC Public Health"},{"key":"5409_CR29","unstructured":"INSD and ICF. Enqu\u00eate D\u00e9mographique et de Sant\u00e9 du Burkina Faso 2021. Ouagadougou, Burkina Faso et Rockville, USA; 2023. http:\/\/www.coraf.org\/burkina-faso\/?lang=fr"},{"key":"5409_CR30","unstructured":"Ghana Statistical Service (GSS) and ICF. Ghana Demographic and Health Survey 2022. Accra, Ghana, and Rockville, USA; 2024."},{"key":"5409_CR31","unstructured":"Institut National de la Statistique Abidjan C\u00f4te d\u2019Ivoire. Enqu\u00eate D\u00e9mographique et de Sant\u00e9. Rockville, USA: INS\/C\u00f4te d\u2019Ivoire; 2023."},{"key":"5409_CR32","unstructured":"National Institute of Statistics of Rwanda (NISR) [Rwanda], Ministry of Health, ICF. Rwanda Demographic and Health Survey 2019\u201320 Final Report. Kigali, Rwanda, and Rockville, USA: 2021."},{"key":"5409_CR33","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1186\/s12936-020-03382-7","volume":"19","author":"E Chilanga","year":"2020","unstructured":"Chilanga E, Collin-V\u00e9zina D, MacIntosh H, Mitchell C, Cherney K. Prevalence and determinants of malaria infection among children of local farmers in Central Malawi. Malar J. 2020;19:308.","journal-title":"Malar J"},{"key":"5409_CR34","unstructured":"Institut National de la Statistique (INSTAT) et ICF. Enqu\u00eate D\u00e9mographique et de Sant\u00e9 \u00e0 Madagascar. Antananarivo, Madagascar and Rockville, USA: INSTAT et ICF; 2021."},{"key":"5409_CR35","unstructured":"United Republic of Tanzania, Tabora Master Plan (2015\u20132035). 2018."},{"key":"5409_CR36","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1186\/s12936-018-2450-y","volume":"17","author":"EW Kaindoa","year":"2018","unstructured":"Kaindoa EW, Finda M, Kiplagat J, Mkandawile G, Nyoni A, Coetzee M, et al. Housing gaps, mosquitoes and public viewpoints: a mixed methods assessment of relationships between house characteristics, malaria vector biting risk and community perspectives in rural Tanzania. Malar J. 2018;17:298.","journal-title":"Malar J"},{"key":"5409_CR37","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/s12936-023-04499-1","volume":"22","author":"RM Bofu","year":"2023","unstructured":"Bofu RM, Santos EM, Msugupakulya BJ, Kahamba NF, Swilla JD, Njalambaha R, et al. The needs and opportunities for housing improvement for malaria control in southern Tanzania. Malar J. 2023;22:69.","journal-title":"Malar J"},{"key":"5409_CR38","doi-asserted-by":"publisher","DOI":"10.1016\/j.parepi.2020.e00162","volume":"11","author":"AH Beavogui","year":"2020","unstructured":"Beavogui AH, Delamou A, Camara BS, Camara D, Kourouma K, Camara R, et al. Prevalence of malaria and factors associated with infection in children aged 6 months to 9 years in Guinea: results from a national cross-sectional study. Parasite Epidemiol Control. 2020;11: e00162.","journal-title":"Parasite Epidemiol Control"},{"key":"5409_CR39","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1186\/s12936-024-04939-6","volume":"23","author":"I Isiko","year":"2024","unstructured":"Isiko I, Nyegenye S, Bett DK, Asingwire JM, Okoro LN, Emeribe NA, et al. Factors associated with the risk of malaria among children: analysis of 2021 Nigeria Malaria Indicator Survey. Malar J. 2024;23:109.","journal-title":"Malar J"},{"key":"5409_CR40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/nu16010001","volume":"16","author":"F Morales","year":"2023","unstructured":"Morales F, Montserrat-de la Paz S, Leon MJ, Rivero-Pino F. Effects of malnutrition on the immune system and infection and the role of nutritional strategies regarding improvements in children\u2019s health status: a literature review. Nutrients. 2023;16:1.","journal-title":"Nutrients"},{"key":"5409_CR41","doi-asserted-by":"publisher","first-page":"236","DOI":"10.3390\/nu12010236","volume":"12","author":"AF Gombart","year":"2020","unstructured":"Gombart AF, Pierre A, Maggini S. A review of micronutrients and the immune system-working in harmony to reduce the risk of infection. Nutrients. 2020;12:236.","journal-title":"Nutrients"},{"key":"5409_CR42","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1186\/s12889-015-1932-x","volume":"15","author":"LEG Mboera","year":"2015","unstructured":"Mboera LEG, Bwana VM, Rumisha SF, Malima RC, Mlozi MRS, Mayala BK, et al. Malaria, anaemia and nutritional status among schoolchildren in relation to ecosystems, livelihoods and health systems in Kilosa District in central Tanzania. BMC Public Health. 2015;15:553.","journal-title":"BMC Public Health"},{"key":"5409_CR43","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1186\/s13071-018-3026-y","volume":"11","author":"AL Wilson","year":"2018","unstructured":"Wilson AL, Bradley J, Kandeh B, Salami K, D\u2019Alessandro U, Pinder M, et al. Is chronic malnutrition associated with an increase in malaria incidence? A cohort study in children aged under 5 years in rural Gambia. Parasit Vectors. 2018;11:451.","journal-title":"Parasit Vectors"},{"key":"5409_CR44","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s12936-025-05289-7","volume":"24","author":"T Mhelembe","year":"2025","unstructured":"Mhelembe T, Ramroop S, Habyarimana F. Assessing the influence of socioeconomic and environmental variables on malaria risk in Nigerian children under 5 years: a GLMM approach. Malar J. 2025;24:55.","journal-title":"Malar J"},{"key":"5409_CR45","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2020.e03946","volume":"6","author":"RT Gaston","year":"2020","unstructured":"Gaston RT, Ramroop S. Prevalence of and factors associated with malaria in children under five years of age in Malawi, using malaria indicator survey data. Heliyon. 2020;6: e03946.","journal-title":"Heliyon"},{"key":"5409_CR46","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1186\/s12889-018-5428-3","volume":"18","author":"C Afoakwah","year":"2018","unstructured":"Afoakwah C, Deng X, Onur I. Malaria infection among children under-five: the use of large-scale interventions in Ghana. BMC Public Health. 2018;18:536.","journal-title":"BMC Public Health"},{"key":"5409_CR47","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1186\/s13071-018-2846-0","volume":"11","author":"K Thi\u00e9vent","year":"2018","unstructured":"Thi\u00e9vent K, Hofer L, Rapp E, Tambwe MM, Moore S, Koella JC. Malaria infection in mosquitoes decreases the personal protection offered by permethrin-treated bednets. Parasit Vectors. 2018;11:284.","journal-title":"Parasit Vectors"},{"key":"5409_CR48","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1186\/s12936-021-03738-7","volume":"20","author":"J Scott","year":"2021","unstructured":"Scott J, Kanyangarara M, Nhama A, Macete E, Moss WJ, Saute F. Factors associated with use of insecticide-treated net for malaria prevention in Manica District, Mozambique: a community-based cross-sectional survey. Malar J. 2021;20:200.","journal-title":"Malar J"},{"key":"5409_CR49","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1186\/s12936-022-04370-9","volume":"21","author":"G Biset","year":"2022","unstructured":"Biset G, Tadess AW, Tegegne KD, Tilahun L, Atnafu N. Malaria among under-five children in Ethiopia: a systematic review and meta-analysis. Malar J. 2022;21:338.","journal-title":"Malar J"},{"key":"5409_CR50","first-page":"1","volume":"4","author":"J Moya","year":"2023","unstructured":"Moya J, Anywar L. Factors contributing to the prevalence of malaria among children under five years attending health care at St Elizabeth Magale Health Center Iv, Namisindwa District: a Cross-Sectional Study. Student J Health Res Africa. 2023;4:1\u201315.","journal-title":"Student J Health Res Africa"},{"key":"5409_CR51","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/s12936-025-05262-4","volume":"24","author":"HM Semakula","year":"2025","unstructured":"Semakula HM, Mugagga F. Predictors of insecticide-treated nets utilization among children under five years in refugee settlements in Uganda: analysis of the 2018\u20132019 Uganda Malaria Indicator Survey. Malar J. 2025;24:20.","journal-title":"Malar J"}],"container-title":["Malaria Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-025-05409-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12936-025-05409-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-025-05409-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T11:18:00Z","timestamp":1757330280000},"score":1,"resource":{"primary":{"URL":"https:\/\/malariajournal.biomedcentral.com\/articles\/10.1186\/s12936-025-05409-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,1]]},"references-count":51,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["5409"],"URL":"https:\/\/doi.org\/10.1186\/s12936-025-05409-3","relation":{},"ISSN":["1475-2875"],"issn-type":[{"value":"1475-2875","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,1]]},"assertion":[{"value":"30 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 August 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":"DHS surveys are conducted in compliance with Helsinki Declaration for biomedical research and with ethical review board from (National Institute of Medical Research (NIMR). The study analysed the collected data from the Tanzania Demographic and Health Survey and Malaria Indicator Survey, which had already obtained ethical clearance from the Tanzanian National Bureau of Statistics (NBS) for data collection; hence, this study did not need additional ethical clearance. However, permission to use the data were requested from the DHS custodian USAID MEASURES.","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":"248"}}