{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T12:38:52Z","timestamp":1740141532131,"version":"3.37.3"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,11,27]],"date-time":"2021-11-27T00:00:00Z","timestamp":1637971200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,11,27]],"date-time":"2021-11-27T00:00:00Z","timestamp":1637971200000},"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":["Trop Med Health"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Artemisinin based combination therapies (ACTs) have been a cornerstone in the treatment of malaria in the world. A rapid decline in dihydroartemisinin piperaquine (DHP) and artemether lumefantrine (ALU) efficacies has been reported in some parts of South East Asia, the historical epicenter for the antimalarial drug resistance. Prolonged drug use is associated with selection of resistant parasites due to exposure to inadequate drug levels hence effects on treatment outcomes in malaria. ALU and DHP are used as first line and alternative first line, respectively, in Tanzania. This study was carried in Igombe, Tanzania to assess the efficacies of ALU and DHP in routine treatment of uncomplicated malaria among children.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This was a prospective study involving children up to 10 years and followed up for 28 and 35\u00a0days as per the WHO protocol, 2015 for monitoring antimalarial drug efficacy. The primary end points were crude and adjusted Adequate Clinical and Parasitological Response (ACPR), parasite clearance rate and reported adverse events.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 205 children with uncomplicated malaria were enrolled. One hundred and sixteen participants were treated with ALU, while 89 participants were treated with DHP. Two participants in the ALU group were lost within the 24\u00a0h of follow-up. The PCR unadjusted ACPR was108 (94.7%) for ALU and 88 (98.9%) for DHP, while the PCR adjusted ACPR was 109(95.6%) and 88(98.9%) for ALU and DHP, respectively, at 28\u00a0day follow-up. No treatment failure was observed in both groups. Cumulative risk of recurrent parasitemia was similar in both groups (<jats:italic>p<\/jats:italic>\u2009=\u20090.32). Age and parasite density were strong predictors for persistent day 1 parasitemia (<jats:italic>p<\/jats:italic>\u2009=\u20090.034 and 0.026, respectively). Nausea and vomiting, abdominal pain and headache were the most clinical adverse events reported in both groups of patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The present study shows that ALU and DHP are still efficacious after more than a decade of use with PCR corrected efficacies greater than 95% implying a failure rate less than 5% which is below the WHO minimum threshold requirement for recommendation of a change in the treatment policy. Both drugs were well tolerated with no major adverse events reported.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s41182-021-00383-3","type":"journal-article","created":{"date-parts":[[2021,11,27]],"date-time":"2021-11-27T09:02:41Z","timestamp":1638003761000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Artemether\u2013lumefantrine and dihydroartemisinin\u2013piperaquine treatment outcomes among children infected with uncomplicated Plasmodium falciparum malaria in Mwanza, Tanzania"],"prefix":"10.1186","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5237-2904","authenticated-orcid":false,"given":"Karol J.","family":"Marwa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eveline T.","family":"Konje","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Kapesa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erasmus","family":"Kamugisha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stanley","family":"Mwita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G\u00f6te","family":"Swedberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,11,27]]},"reference":[{"issue":"1","key":"383_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40249-016-0151-8","volume":"5","author":"RE Cibulskis","year":"2016","unstructured":"Cibulskis RE, Alonso P, Aponte J, Aregawi M, Barrette A, Bergeron L, Fergus CA, Knox T, Lynch M, Patouillard E. Malaria: global progress 2000\u20132015 and future challenges. Infect Dis Poverty. 2016;5(1):1\u20138.","journal-title":"Infect Dis Poverty"},{"issue":"1","key":"383_CR2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12936-017-2006-6","volume":"16","author":"K Kiaco","year":"2017","unstructured":"Kiaco K, Rodrigues AS. The drug transporter ABCB1 c 3435C> T SNP influences artemether\u2013lumefantrine treatment outcome. Malaria J. 2017;16(1):1\u20136.","journal-title":"Malaria J"},{"key":"383_CR3","unstructured":"Organization WH: World malaria report 2015: World Health Organization; 2016."},{"issue":"4","key":"383_CR4","doi-asserted-by":"publisher","first-page":"181","DOI":"10.5694\/j.1326-5377.2005.tb06650.x","volume":"182","author":"TM Davis","year":"2005","unstructured":"Davis TM, Karunajeewa HA, Ilett KF. Artemisinin-based combination therapies for uncomplicated malaria. Med J Aust. 2005;182(4):181\u20135.","journal-title":"Med J Aust"},{"key":"383_CR5","unstructured":"Organization WH: Guidelines for the treatment of malaria; 2006. Document no: WHO. In.: HTM\/MAL; 2006."},{"key":"383_CR6","doi-asserted-by":"publisher","first-page":"201","DOI":"10.2147\/TCRM.S127571","volume":"13","author":"T Deressa","year":"2017","unstructured":"Deressa T, Seid ME, Birhan W, Aleka Y, Tebeje BM. In vivo efficacy of artemether\u2013lumefantrine against uncomplicated Plasmodium falciparum malaria in Dembia District, northwest ethiopia. Ther Clin Risk Manag. 2017;13:201.","journal-title":"Ther Clin Risk Manag"},{"issue":"1","key":"383_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12936-017-1817-9","volume":"16","author":"AO Mohamed","year":"2017","unstructured":"Mohamed AO, Hamid MMA, Mohamed OS, Elkando NS, Suliman A, Adam MA, Elnour FAA, Malik EM. Efficacies of DHA\u2013PPQ and AS\/SP in patients with uncomplicated Plasmodium falciparum malaria in an area of an unstable seasonal transmission in Sudan. Malar J. 2017;16(1):1\u20136.","journal-title":"Malar J"},{"issue":"1","key":"383_CR8","doi-asserted-by":"publisher","first-page":"75","DOI":"10.2165\/00003495-200565010-00004","volume":"65","author":"TM Davis","year":"2005","unstructured":"Davis TM, Hung T-Y, Sim K, Karunajeewa HA, Ilett KF. Piperaquine. Drugs. 2005;65(1):75\u201387.","journal-title":"Drugs"},{"issue":"1","key":"383_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12936-017-1680-8","volume":"16","author":"NV Thanh","year":"2017","unstructured":"Thanh NV, Thuy-Nhien N, Tuyen NTK, Tong NT, Nha-Ca NT, Quang HH, Farrar J, Thwaites G, White NJ, Wolbers M. Rapid decline in the susceptibility of Plasmodium falciparum to dihydroartemisinin\u2013piperaquine in the south of Vietnam. Malar J. 2017;16(1):1\u201310.","journal-title":"Malar J"},{"issue":"1","key":"383_CR10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1475-2875-5-34","volume":"5","author":"F Ariey","year":"2006","unstructured":"Ariey F, Fandeur T, Durand R, Randrianarivelojosia M, Jambou R, Legrand E, Ekala MT, Bouchier C, Cojean S, Duchemin JB. Invasion of Africa by a single pfcrt allele of South East Asian type. Malar J. 2006;5(1):1\u20135.","journal-title":"Malar J"},{"issue":"12","key":"383_CR11","doi-asserted-by":"publisher","first-page":"1980","DOI":"10.1093\/infdis\/jir664","volume":"204","author":"T Mita","year":"2011","unstructured":"Mita T, Venkatesan M, Ohashi J, Culleton R, Takahashi N, Tsukahara T, Ndounga M, Dysoley L, Endo H, Hombhanje F. Limited geographical origin and global spread of sulfadoxine-resistant dhps alleles in Plasmodium falciparum populations. J Infect Dis. 2011;204(12):1980\u20138.","journal-title":"J Infect Dis"},{"issue":"5687","key":"383_CR12","doi-asserted-by":"publisher","first-page":"1124","DOI":"10.1126\/science.1098876","volume":"305","author":"C Roper","year":"2004","unstructured":"Roper C, Pearce R, Nair S, Sharp B, Nosten F, Anderson T. Intercontinental spread of pyrimethamine-resistant malaria. Science. 2004;305(5687):1124\u20131124.","journal-title":"Science"},{"issue":"7","key":"383_CR13","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.1093\/infdis\/jiy637","volume":"219","author":"A Yeka","year":"2019","unstructured":"Yeka A, Wallender E, Mulebeke R, Kibuuka A, Kigozi R, Bosco A, Kyambadde P, Opigo J, Kalyesubula S, Senzoga J. Comparative efficacy of artemether-lumefantrine and dihydroartemisinin-piperaquine for the treatment of uncomplicated malaria in Ugandan children. J Infect Dis. 2019;219(7):1112\u201320.","journal-title":"J Infect Dis"},{"issue":"1","key":"383_CR14","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1128\/AAC.04181-14","volume":"59","author":"MM Plucinski","year":"2015","unstructured":"Plucinski MM, Talundzic E, Morton L, Dimbu PR, Macaia AP, Fortes F, Goldman I, Lucchi N, Stennies G, MacArthur JR. Efficacy of artemether-lumefantrine and dihydroartemisinin-piperaquine for treatment of uncomplicated malaria in children in Zaire and U\u00edge Provinces Angola. Antimicrob Agents Chemother. 2015;59(1):437\u201343.","journal-title":"Antimicrob Agents Chemother"},{"issue":"1","key":"383_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12936-021-03585-6","volume":"20","author":"A Gansan\u00e9","year":"2021","unstructured":"Gansan\u00e9 A, Moriarty LF, M\u00e9nard D, Yerbanga I, Ouedraogo E, Sondo P, Kinda R, Tarama C, Soulama E, Tapsoba M. Anti-malarial efficacy and resistance monitoring of artemether\u2013lumefantrine and dihydroartemisinin\u2013piperaquine shows inadequate efficacy in children in Burkina Faso, 2017\u20132018. Malar J. 2021;20(1):1\u201312.","journal-title":"Malar J"},{"issue":"1","key":"383_CR16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12936-018-2524-x","volume":"17","author":"MA Kakolwa","year":"2018","unstructured":"Kakolwa MA, Mahende MK, Ishengoma DS, Mandara CI, Ngasala B, Kamugisha E, Kataraihya JB, Mandike R, Mkude S, Chacky F. Efficacy and safety of artemisinin-based combination therapy, and molecular markers for artemisinin and piperaquine resistance in Mainland Tanzania. Malar J. 2018;17(1):1\u201310.","journal-title":"Malar J"},{"issue":"1","key":"383_CR17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12936-018-2635-4","volume":"18","author":"DS Ishengoma","year":"2019","unstructured":"Ishengoma DS, Mandara CI, Francis F, Talundzic E, Lucchi NW, Ngasala B, Kabanywanyi AM, Mahende MK, Kamugisha E, Kavishe RA. Efficacy and safety of artemether\u2013lumefantrine for the treatment of uncomplicated malaria and prevalence of Pfk13 and Pfmdr1 polymorphisms after a decade of using artemisinin-based combination therapy in mainland Tanzania. Malar J. 2019;18(1):1\u201313.","journal-title":"Malar J"},{"issue":"1","key":"383_CR18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12936-019-2740-z","volume":"18","author":"CI Mandara","year":"2019","unstructured":"Mandara CI, Francis F, Chiduo MG, Ngasala B, Mandike R, Mkude S, Chacky F, Molteni F, Njau R, Mohamed A. High cure rates and tolerability of artesunate\u2013amodiaquine and dihydroartemisinin\u2013piperaquine for the treatment of uncomplicated falciparum malaria in Kibaha and Kigoma Tanzania. Malaria J. 2019;18(1):1\u201312.","journal-title":"Malaria J"},{"issue":"1","key":"383_CR19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1475-2875-13-376","volume":"13","author":"A Shayo","year":"2014","unstructured":"Shayo A, Mandara CI, Shahada F, Buza J, Lemnge MM, Ishengoma DS. Therapeutic efficacy and safety of artemether-lumefantrine for the treatment of uncomplicated falciparum malaria in North-Eastern Tanzania. Malar J. 2014;13(1):1\u201310.","journal-title":"Malar J"},{"issue":"1","key":"383_CR20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1475-2875-11-58","volume":"11","author":"E Kamugisha","year":"2012","unstructured":"Kamugisha E, Jing S, Minde M, Kataraihya J, Kongola G, Kironde F, Swedberg G. Efficacy of artemether-lumefantrine in treatment of malaria among under-fives and prevalence of drug resistance markers in Igombe-Mwanza, north-western Tanzania. Malar J. 2012;11(1):1\u20138.","journal-title":"Malar J"},{"key":"383_CR21","unstructured":"Organization WH: Methods for surveillance of antimalarial drug efficacy. 2009. In.; 2015."},{"key":"383_CR22","unstructured":"Organization WH: Methods for surveillance of antimalarial drug efficacy. 2009."},{"key":"383_CR23","volume-title":"Basic malaria microscopy: Part I","author":"WH Organization","year":"2010","unstructured":"Organization WH. Basic malaria microscopy: Part I. Learner\u2019s guide: World Health Organization; 2010."},{"issue":"1","key":"383_CR24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13071-018-2895-4","volume":"11","author":"AF Som\u00e9","year":"2018","unstructured":"Som\u00e9 AF, Bazi\u00e9 T, Zongo I, Yerbanga RS, Niki\u00e9ma F, Neya C, Taho LK, Ou\u00e9draogo J-B. Plasmodium falciparum msp 1 and msp 2 genetic diversity and allele frequencies in parasites isolated from symptomatic malaria patients in Bobo-Dioulasso Burkina Faso. Parasites Vectors. 2018;11(1):1\u20138.","journal-title":"Parasites Vectors"},{"key":"383_CR25","unstructured":"Organization WH: Methods and techniques for clinical trials on antimalarial drug efficacy: genotyping to identify parasite populations: informal consultation organized by the Medicines for Malaria Venture and cosponsored by the World Health Organization, 29-31 May 2007, Amsterdam, The Netherlands: World Health Organization; 2008."},{"key":"383_CR26","unstructured":"Tanzania N: National guidelines for malaria diagnosis and treatment. Dar es Salaam 2006."},{"issue":"2","key":"383_CR27","doi-asserted-by":"publisher","first-page":"526","DOI":"10.4269\/ajtmh.16-0780","volume":"97","author":"R Mwaiswelo","year":"2017","unstructured":"Mwaiswelo R, Ngasala B, Gil JP, Malmberg M, Jovel I, Xu W, Premji Z, Mmbando BP, Bj\u00f6rkman A, M\u00e5rtensson A. Sustained high cure rate of artemether\u2013lumefantrine against uncomplicated Plasmodium falciparum malaria after 8 years of its wide-scale use in Bagamoyo District, Tanzania. Am J Trop Med Hyg. 2017;97(2):526\u201332.","journal-title":"Am J Trop Med Hyg"},{"issue":"3","key":"383_CR28","doi-asserted-by":"publisher","first-page":"649","DOI":"10.4269\/ajtmh.18-0115","volume":"99","author":"JC Ebenebe","year":"2018","unstructured":"Ebenebe JC, Ntadom G, Ambe J, Wammanda R, Jiya N, Finomo F, Emechebe G, Mokuolu O, Akano K, Agomo C. Efficacy of artemisinin-based combination treatments of uncomplicated falciparum malaria in under-five-year-old Nigerian children ten years following adoption as first-line antimalarials. Am J Trop Med Hyg. 2018;99(3):649\u201364.","journal-title":"Am J Trop Med Hyg"},{"issue":"4","key":"383_CR29","doi-asserted-by":"publisher","first-page":"715","DOI":"10.3201\/eid2304.161872","volume":"23","author":"BQ Phuc","year":"2017","unstructured":"Phuc BQ, Rasmussen C, Duong TT, Dong LT, Loi MA, M\u00e9nard D, Tarning J, Bustos D, Ringwald P, Galappaththy GL. Treatment failure of dihydroartemisinin\/piperaquine for Plasmodium falciparum malaria Vietnam. Emerg Infect Dis. 2017;23(4):715.","journal-title":"Emerg Infect Dis"},{"key":"383_CR30","unstructured":"Organization WH: Global plan for artemisinin resistance containment (GPARC): World Health Organization; 2011."},{"issue":"1","key":"383_CR31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1475-2875-10-339","volume":"10","author":"JA Flegg","year":"2011","unstructured":"Flegg JA, Guerin PJ, White NJ, Stepniewska K. Standardizing the measurement of parasite clearance in falciparum malaria: the parasite clearance estimator. Malar J. 2011;10(1):1\u201313.","journal-title":"Malar J"},{"issue":"1","key":"383_CR32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1475-2875-10-1","volume":"10","author":"N White","year":"2011","unstructured":"White N. The parasite clearance curve. Malar J. 2011;10(1):1\u20138.","journal-title":"Malar J"},{"key":"383_CR33","doi-asserted-by":"crossref","unstructured":"org WPCSGksw: Baseline data of parasite clearance in patients with falciparum malaria treated with an artemisinin derivative: an individual patient data meta-analysis. Malaria J 2015, 14:1\u201312.","DOI":"10.1186\/s12936-015-0874-1"},{"issue":"4","key":"383_CR34","doi-asserted-by":"publisher","first-page":"898","DOI":"10.2478\/s11686-019-00115-y","volume":"64","author":"JMN Ngomo","year":"2019","unstructured":"Ngomo JMN, Megnie GJO, Ditombi BM, Lengongo JVK, M\u2019Bondoukw\u00e9 NP, Offouga CL, Mawili-Mboumba DP, Lekana-Douki JB, Ringwald P, Fandeur T. Persistence of high in vivo efficacy and safety of artesunate-amodiaquine and artemether\u2013lumefantrine as the first-and second-line treatments for uncomplicated Plasmodium falciparum malaria 10 years after their implementation in Gabon. Acta Parasitol. 2019;64(4):898\u2013902.","journal-title":"Acta Parasitol"},{"issue":"1","key":"383_CR35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12936-018-2290-9","volume":"17","author":"E Davlantes","year":"2018","unstructured":"Davlantes E, Dimbu PR, Ferreira CM, Joao MF, Pode D, F\u00e9lix J, Sanhangala E, Andrade BN, dos Santos SS, Talundzic E. Efficacy and safety of artemether\u2013lumefantrine, artesunate\u2013amodiaquine, and dihydroartemisinin\u2013piperaquine for the treatment of uncomplicated Plasmodium falciparum malaria in three provinces in Angola, 2017. Malar J. 2018;17(1):1\u201311.","journal-title":"Malar J"},{"issue":"1","key":"383_CR36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1475-2875-10-369","volume":"10","author":"Q Bassat","year":"2011","unstructured":"Bassat Q, Gonz\u00e1lez R, Machevo S, Nahum A, Lyimo J, Maiga H, M\u00e5rtensson A, Bashraheil M, Ouma P, Ubben D. Similar efficacy and safety of artemether\u2013lumefantrine (Coartem\u00ae) in African infants and children with uncomplicated falciparum malaria across different body weight ranges. Malar J. 2011;10(1):1\u20139.","journal-title":"Malar J"},{"issue":"1","key":"383_CR37","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.trstmh.2011.09.006","volume":"106","author":"DO Simba","year":"2012","unstructured":"Simba DO, Kakoko D, Tomson G, Premji Z, Petzold M, Mahindi M, Gustafsson LL. Adherence to artemether\/lumefantrine treatment in children under real-life situations in rural Tanzania. Trans R Soc Trop Med Hyg. 2012;106(1):3\u20139.","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"1","key":"383_CR38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1475-2875-8-204","volume":"8","author":"DJ Bell","year":"2009","unstructured":"Bell DJ, Wootton D, Mukaka M, Montgomery J, Kayange N, Chimpeni P, Hughes DA, Molyneux ME, Ward SA, Winstanley PA. Measurement of adherence, drug concentrations and the effectiveness of artemether\u2013lumefantrine, chlorproguanil-dapsone or sulphadoxine\u2013pyrimethamine in the treatment of uncomplicated malaria in Malawi. Malar J. 2009;8(1):1\u201311.","journal-title":"Malar J"}],"container-title":["Tropical Medicine and Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s41182-021-00383-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s41182-021-00383-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s41182-021-00383-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,27]],"date-time":"2021-11-27T21:28:34Z","timestamp":1638048514000},"score":1,"resource":{"primary":{"URL":"https:\/\/tropmedhealth.biomedcentral.com\/articles\/10.1186\/s41182-021-00383-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,27]]},"references-count":38,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["383"],"URL":"https:\/\/doi.org\/10.1186\/s41182-021-00383-3","relation":{},"ISSN":["1349-4147"],"issn-type":[{"type":"electronic","value":"1349-4147"}],"subject":[],"published":{"date-parts":[[2021,11,27]]},"assertion":[{"value":"4 June 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 November 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical and study approval was granted by the joint Catholic University of Health and Allied Sciences (CUHAS)\/Bugando Medical Centre (BMC) Institutional Review Board. All parent\/guardian signed a written informed consent.","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 that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"94"}}