{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T06:27:39Z","timestamp":1768458459070,"version":"3.49.0"},"reference-count":55,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2019,2,7]],"date-time":"2019-02-07T00:00:00Z","timestamp":1549497600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["Cooperative Agreement No. AID-OAA-A-14-00028"],"award-info":[{"award-number":["Cooperative Agreement No. AID-OAA-A-14-00028"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Negative experiences of care may act as a deterrent to current and\/or future utilization of facility-based health services. To examine the situation in Tanzania, we conducted a sub-analysis of a cross-sectional household survey conducted in April 2016 in the Mara and Kagera regions of Tanzania. The sample included 732 women aged 15\u201349 years who had given birth in a health facility during the previous two years. Log binomial regression models were used to investigate the association between women\u2019s experiences of care during childbirth and the receipt of early postnatal checks before discharge. Overall, 73.1% of women reported disrespect and abuse, 60.1% were offered a birth companion, 29.1% had a choice of birth position, and 85.5% rated facility cleanliness as good. About half of mothers (46.3%) and newborns (51.4%) received early postnatal checks before discharge. Early postnatal checks for both mothers and newborns were associated with no disrespect and abuse (RR: 1.23 and 1.14, respectively) and facility cleanliness (RR: 1.29 and 1.54, respectively). Early postnatal checks for mothers were also associated with choice of birth position (RR: 1.18). The results suggest that a missed opportunity in providing an early postnatal check is an indication of poor quality of the continuum of care for mothers and newborns. Improved quality of care at one stage can predict better care in subsequent stages.<\/jats:p>","DOI":"10.3390\/ijerph16030481","type":"journal-article","created":{"date-parts":[[2019,2,7]],"date-time":"2019-02-07T11:50:33Z","timestamp":1549540233000},"page":"481","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Women\u2019s Experience of Facility-Based Childbirth Care and Receipt of an Early Postnatal Check for Herself and Her Newborn in Northwestern Tanzania"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5970-6604","authenticated-orcid":false,"given":"Dunstan R.","family":"Bishanga","sequence":"first","affiliation":[{"name":"Jhpiego Tanzania, Dar es Salaam, Tanzania"},{"name":"Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4262-1038","authenticated-orcid":false,"given":"Joseph","family":"Massenga","sequence":"additional","affiliation":[{"name":"Jhpiego Tanzania, Dar es Salaam, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0702-3304","authenticated-orcid":false,"given":"Amasha H.","family":"Mwanamsangu","sequence":"additional","affiliation":[{"name":"Jhpiego Tanzania, Dar es Salaam, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young-Mi","family":"Kim","sequence":"additional","affiliation":[{"name":"Jhpiego, Baltimore, MD 21231, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"George","sequence":"additional","affiliation":[{"name":"USAID\u2019s Maternal and Child Survival Program\/Jhpiego Tanzania, Dar es Salaam, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ntuli A.","family":"Kapologwe","sequence":"additional","affiliation":[{"name":"President\u2019s Office\u2014Regional Administration and Local Government, Dodoma, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6099-1841","authenticated-orcid":false,"given":"Jeremie","family":"Zoungrana","sequence":"additional","affiliation":[{"name":"Jhpiego Tanzania, Dar es Salaam, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Rwegasira","sequence":"additional","affiliation":[{"name":"Jhpiego Tanzania, Dar es Salaam, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7423-1504","authenticated-orcid":false,"given":"Adrienne","family":"Kols","sequence":"additional","affiliation":[{"name":"Jhpiego, Baltimore, MD 21231, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen","family":"Hill","sequence":"additional","affiliation":[{"name":"USAID\u2019s Maternal and Child Survival Program\/Jhpiego, Baltimore, MD 21231, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0914-5508","authenticated-orcid":false,"given":"Marcus J.","family":"Rijken","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Woman and Baby, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"},{"name":"Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jelle","family":"Stekelenburg","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands"},{"name":"Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, 8934 AD Leeuwarden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,2,7]]},"reference":[{"key":"ref_1","unstructured":"Tanzania Bureau of Statistics (2016). Tanzania Demographic and Health Survey 2016."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1016\/S0140-6736(06)69384-7","article-title":"Maternal health in poor countries: The broader context and a call for action","volume":"368","author":"Filippi","year":"2006","journal-title":"Lancet"},{"key":"ref_3","unstructured":"Tanzania Ministry of Health, National Bureau of Statistics, ICF (2016). Tanzania Demographic and Health Survey and Malaria Indicator Survey 2015\u20132016."},{"key":"ref_4","unstructured":"National Bureau of Statistics (2010). Tanzania Demographic and Health Survey 2010."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"McMahon, S.A., George, A.S., Chebet, J.J., Mosha, I.H., Mpembeni, R.N.M., and Winch, P.J. (2014). Experiences of and responses to disrespectful maternity care and abuse during childbirth; a qualitative study with women and men in Morogoro Region, Tanzania. BMC Pregnancy Childbirth, 14.","DOI":"10.1186\/1471-2393-14-268"},{"key":"ref_6","unstructured":"World Health Organization (WHO) (2015). Postnatal Care for Mothers and Newborns: Highlights from the World Health Organization 2013 Guidelines, WHO."},{"key":"ref_7","unstructured":"World Health Organization (WHO) (2013). Postnatal Care of the Mother and Newborn, WHO."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1016\/S0140-6736(05)71048-5","article-title":"4 million neonatal deaths: When? Where? Why?","volume":"365","author":"Lawn","year":"2005","journal-title":"Lancet"},{"key":"ref_9","unstructured":"De Graft-Johnson, J., Kerber, K., Tinker, A., Otchere, S., Narayanan, I., and Shoo, R. (2006). The continuum of care\u2014Reaching mothers and babies at the crucial time and place. Opportunities for Africa\u2019s Newborns, WHO."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Iqbal, S., Maqsood, S., Zakar, R., Zakar, M.Z., and Fischer, F. (2017). Continuum of care in maternal, newborn and child health in Pakistan: Analysis of trends and determinants from 2006 to 2012. BMC Health Serv. Res., 17.","DOI":"10.1186\/s12913-017-2111-9"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s12978-015-0041-8","article-title":"Birth preparedness and complication readiness among recently delivered women in chamwino district, central Tanzania: A cross sectional study \u201cObstetrics\u201d","volume":"12","author":"Bintabara","year":"2015","journal-title":"Reprod. Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.12688\/gatesopenres.12756.1","article-title":"Advancing a conceptual model to improve maternal health quality: The Person-Centered Care Framework for Reproductive Health Equity","volume":"1","author":"Sudhinaraset","year":"2017","journal-title":"Gates Open Res."},{"key":"ref_13","first-page":"11","article-title":"Predictors of Antenatal Care, Skilled Birth Attendance, and Postnatal Care Utilization among the Remote and Poorest Rural Communities of Zambia: A Multilevel Analysis","volume":"5","author":"Jacobs","year":"2017","journal-title":"Front. Public Heal"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"7095352","DOI":"10.1155\/2016\/7095352","article-title":"Postnatal Care Service Utilization and Associated Factors among Women Who Gave Birth in the Last 12 Months prior to the Study in Debre Markos Town, Northwestern Ethiopia: A Community-Based Cross-Sectional Study","volume":"2016","author":"Limenih","year":"2016","journal-title":"Int. J. Reprod. Med."},{"key":"ref_15","first-page":"1","article-title":"Early Postnatal Care Service Utilization and Associated Factors among Mothers Who Gave Birth in the Last 12 Months in Aseko District, Arsi Zone, South East Ethiopia in 2016","volume":"6","author":"Teklehaymanot","year":"2017","journal-title":"J. Women\u2019s Heal Care"},{"key":"ref_16","unstructured":"World Health Organization (WHO) (2016). Standards for Improving Quality of Maternal and Newborn Care in Health Facilities, WHO."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.wombi.2010.06.004","article-title":"Joy, struggle and support: Postpartum experiences of first-time mothers in a Tanzanian suburb","volume":"24","author":"Mbekenga","year":"2011","journal-title":"Women Birth"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1093\/intqhc\/mzw002","article-title":"Using mixed methods to evaluate perceived quality of care in southern Tanzania","volume":"28","author":"Tancred","year":"2016","journal-title":"Int. J. Qual. Heal Care"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Lugina, H., Mlay, R., and Smith, H. (2004). Mobility and maternal position during childbirth in Tanzania: An exploratory study at four government hospitals. BMC Pregnancy Childbirth, 4.","DOI":"10.1186\/1471-2393-4-3"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1093\/heapol\/czu079","article-title":"Disrespectful and abusive treatment during facility delivery in Tanzania: A facility and community survey","volume":"33","author":"Kruk","year":"2018","journal-title":"Health Policy Plan."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Sando, D., Ratcliffe, H., McDonald, K., Spiegelman, D., Lyatuu, G., Mwanyika-Sando, M., Emil, F., Wegner, M.N., Chalamilla, G., and Langer, A. (2016). The prevalence of disrespect and abuse during facility-based childbirth in urban Tanzania. BMC Pregnancy Childbirth, 16.","DOI":"10.1186\/s12884-016-1019-4"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"28567","DOI":"10.3402\/gha.v8.28567","article-title":"Women\u2019s perceptions of antenatal, delivery, and postpartum services in rural Tanzania","volume":"8","author":"Mahiti","year":"2015","journal-title":"Glob. Health Action"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"51","DOI":"10.11604\/pamj.2015.21.51.6347","article-title":"Prevalence and predictors of institutional delivery among pregnant mothers in Biharamulo district, Tanzania: A cross-sectional study","volume":"21","author":"Mageda","year":"2015","journal-title":"Pan Afr. Med. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2243","DOI":"10.1007\/s10995-015-1743-9","article-title":"Association between disrespect and abuse during childbirth and women\u2019s confidence in health facilities in Tanzania","volume":"19","author":"Kujawski","year":"2015","journal-title":"Matern. Child Health J."},{"key":"ref_25","unstructured":"Bowser, D., and Hill, K. (2019, January 01). Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth Report of a Landscape Analysis. Available online: http:\/\/www.urc-chs.com\/uploads\/resourceFiles\/Live\/RespectfulCareatBirth9-20-101Final.pdf."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.2105\/AJPH.2008.146209","article-title":"Women\u2019s preferences for place of delivery in rural Tanzania: A population-based discrete choice experiment","volume":"99","author":"Kruk","year":"2009","journal-title":"Am. J. Public Health"},{"key":"ref_27","unstructured":"Ministry of Health, United Republic of Tanzania (2016). National Road Map Strategic Plan to Improve Health in Tanzania (2016\u20132020)."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e396","DOI":"10.1016\/S2214-109X(15)00059-5","article-title":"Tanzania\u2019s Countdown to 2015: An analysis of two decades of progress and gaps for reproductive, maternal, newborn, and child health, to inform priorities for post-2015","volume":"3","author":"Magoma","year":"2015","journal-title":"Lancet Glob. Health"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Bishanga, D.R., Drake, M., Kim, Y.-M., Mwanamsangu, A.H., Makuwani, A.M., Zoungrana, J., Lemwayi, R., Rijken, M.J., and Stekelenburg, J. (2018). Factors associated with institutional delivery: Findings from a cross-sectional study in Mara and Kagera regions in Tanzania. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0209672"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Ishola, F., Owolabi, O., and Filippi, V. (2017). Disrespect and abuse of women during childbirth in Nigeria: A systematic review. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0174084"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1751-0473-3-17","article-title":"Purposeful selection of variables in logistic regression","volume":"3","author":"Bursac","year":"2008","journal-title":"Source Code Biol. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12978-017-0449-4","article-title":"Service providers\u2019 experiences of disrespectful and abusive behavior towards women during facility based childbirth in Addis Ababa, Ethiopia","volume":"15","author":"Asefa","year":"2018","journal-title":"Reprod. Health"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Creanga, A.A., Gullo, S., Kuhlmann, A.K.S., Msiska, T.W., and Galavotti, C. (2017). Is quality of care a key predictor of perinatal health care utilization and patient satisfaction in Malawi?. BMC Pregnancy Childbirth, 17.","DOI":"10.1186\/s12884-017-1331-7"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Sialubanje, C., Massar, K., Hamer, D.H., and Ruiter, R.A.C. (2015). Reasons for home delivery and use of traditional birth attendants in rural Zambia: A qualitative study. BMC Pregnancy Childbirth, 15.","DOI":"10.1186\/s12884-015-0652-7"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12978-017-0448-5","article-title":"Modeling the relationship between women\u2019s perceptions and future intention to use institutional maternity care in the Western Highlands of Guatemala","volume":"15","author":"Peca","year":"2018","journal-title":"Reprod. Health"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"McMahon, S., George, A., Chebet, J., Mosha, I., Mpembeni, R., and Winch, P. (2014). Experiences of and responses to disrespectful maternity care and abuse during childbirth. BMC Pregnancy Childbirth, 14.","DOI":"10.1186\/1471-2393-14-268"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12978-015-0024-9","article-title":"Status of respectful and non-abusive care during facility-based childbirth in a hospital and health centers in Addis Ababa, Ethiopia","volume":"12","author":"Asefa","year":"2015","journal-title":"Reprod. Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12978-017-0323-4","article-title":"Respectful maternity care in Ethiopian public health facilities Prof. Suellen Miller","volume":"14","author":"Sheferaw","year":"2017","journal-title":"Reprod. Health"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Rosen, H.E., Lynam, P.F., Carr, C., Reis, V., Ricca, J., Bazant, E.S., Bartlett, L.A., and on behalf of the Quality of Maternal and Newborn Care Study Group of the Maternal and Child Health Integrated Program (2015). Direct observation of respectful maternity care in five countries: A cross-sectional study of health facilities in East and Southern Africa. BMC Pregnancy Childbirth, 15.","DOI":"10.1186\/s12884-015-0728-4"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Kambala, C., Lohmann, J., Mazalale, J., Brenner, S., Sarker, M., Muula, A.S., and De Allegri, M. (2017). Perceptions of quality across the maternal care continuum in the context of a health financing intervention: Evidence from a mixed methods study in rural Malawi. BMC Health Serv. Res., 17.","DOI":"10.1186\/s12913-017-2329-6"},{"key":"ref_41","first-page":"1","article-title":"Perceptions and experiences of the mistreatment of women during childbirth in health facilities in Guinea: A qualitative study with women and service providers","volume":"14","author":"Balde","year":"2017","journal-title":"Reprod. Health"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2017\/7938371","article-title":"Experience of facility based childbirth in rural Ethiopia: An exploratory study of women\u2019s perspective","volume":"2017","author":"Adinew","year":"2017","journal-title":"J. Pregnancy"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/1742-4755-9-30","article-title":"Do Malawian women critically assess the quality of care? A qualitative study on women\u2019s perceptions of perinatal care at a district hospital in Malawi","volume":"9","author":"Kumbani","year":"2012","journal-title":"Reprod. Health"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12978-017-0370-x","article-title":"The prevalence of disrespect and abuse during facility-based maternity care in Malawi: Evidence from direct observations of labor and delivery","volume":"14","author":"Sethi","year":"2017","journal-title":"Reprod. Health"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Behruzi, R., Hatem, M., Fraser, W., Goulet, L., Ii, M., and Misago, C. (2010). Facilitators and barriers in the humanization of childbirth practice in Japan. BMC Pregnancy Childbirth, 10.","DOI":"10.1186\/1471-2393-10-25"},{"key":"ref_46","first-page":"CD003766","article-title":"Continuous support for women during childbirth (Review)","volume":"7","author":"Bohren","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_47","first-page":"S1","article-title":"Social inequalities and women\u2019s satisfaction with childbirth care in Brazil: A national hospital-based survey","volume":"30","author":"Diniz","year":"2014","journal-title":"Cad. Saude Publica"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Ndirima, Z., Neuhann, F., and Beiersmann, C. (2018). Listening to their voices: Understanding rural women\u2019s perceptions of good delivery care at the Mibilizi District Hospital in Rwanda. BMC Womens Health, 18.","DOI":"10.1186\/s12905-018-0530-3"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s12978-016-0138-8","article-title":"Utilization of maternal health care services and their determinants in Karnataka State, India","volume":"13","author":"Vidler","year":"2016","journal-title":"Reprod. Health"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1016\/S0140-6736(07)61578-5","article-title":"Continuum of care for maternal, newborn, and child health: From slogan to service delivery","volume":"370","author":"Kerber","year":"2007","journal-title":"Lancet"},{"key":"ref_51","unstructured":"Sines, E., Syed, U., Wall, S., and Worley, H. (2007). Postnatal Care: A Critical Opportunity to Save Mothers and Newborns, Save the Children, PRB."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Kikuchi, K., Yasuoka, J., Nanishi, K., Ahmed, A., Nohara, Y., Nishikitani, M., Yokota, F., Mizutani, T., and Nakashima, N. (2018). Postnatal care could be the key to improving the continuum of care in maternal and child health in Ratanakiri, Cambodia. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0198829"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Mohan, D., Gupta, S., LeFevre, A., Bazant, E., Killewo, J., and Baqui, A.H. (2015). Determinants of postnatal care use at health facilities in rural Tanzania: Multilevel analysis of a household survey. BMC Pregnancy Childbirth, 15.","DOI":"10.1186\/s12884-015-0717-7"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Bwalya, B.B., Mulenga, M.C., and Mulenga, J.N. (2017). Factors associated with postnatal care for newborns in Zambia: Analysis of the 2013\u20132014 Zambia demographic and health survey. BMC Pregnancy Childbirth, 17.","DOI":"10.1186\/s12884-017-1612-1"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Kant\u00e9, A.M., Chung, C.E., Larsen, A.M., Exavery, A., Tani, K., and Phillips, J.F. (2015). Factors associated with compliance with the recommended frequency of postnatal care services in three rural districts of Tanzania. BMC Pregnancy Childbirth, 15.","DOI":"10.1186\/s12884-015-0769-8"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/3\/481\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:31:28Z","timestamp":1760185888000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/3\/481"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2,7]]},"references-count":55,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2019,2]]}},"alternative-id":["ijerph16030481"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16030481","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,2,7]]}}}