{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T21:22:03Z","timestamp":1789680123978,"version":"4.0.1"},"reference-count":54,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2024,7,16]],"date-time":"2024-07-16T00:00:00Z","timestamp":1721088000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Childhood vision impairment (VI) has a significantly harmful effect on both health and social outcomes.\n\nAim:\u00a0To assess the causes of childhood VI, to determine obstacles to accessing eye care services and to develop a strategy for the childhood eye care system in African nations.\n\nMethod:\u00a0This systematic review was conducted by searching several online databases, including; Scopus, PubMed, ProQuest, Web of Science, Google Scholar, Ebsco and Medline. They focussed on articles available between 2003 and 2023. These studies were conducted to evaluate the causes of childhood VI and to assess obstacles to accessing eye care services in African countries.\n\nResults:\u00a0The main causes of childhood VI in African nations can be avoided with timely diagnosis and an appropriate management strategy. The leading obstacles to accessing childhood eye care services were a lack of availability, accessibility and affordability. In addition to these barriers, we found that there are concerns with quality of services, primary health care system, geographic barriers, incorrect health beliefs, inappropriate parental perception, a lack of knowledge, attitudes and inadequate practices related to paediatric eye care.\n\nConclusion:\u00a0The main causes of childhood VI were uncorrected refractive error (RE), amblyopia, cataract and corneal opacities that can be avoided with timely diagnosis and an appropriate management strategy. While the main obstacles to accessing childhood eye care services were a lack of availability, accessibility, affordability and healthcare system.\n\nContribution:\u00a0The recommended strategy for childhood eye-care services includes models for delivery and training.<\/jats:p>","DOI":"10.4102\/phcfm.v16i1.4556","type":"journal-article","created":{"date-parts":[[2024,7,16]],"date-time":"2024-07-16T19:14:05Z","timestamp":1721157245000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Childhood visual impairment causes and barriers to accessing eye care: A suggested approach for Africa"],"prefix":"10.4102","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0247-8780","authenticated-orcid":false,"given":"Saif H.","family":"Alrasheed","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01wsfe280","id-type":"ROR","asserted-by":"publisher"}],"name":"Qassim University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9197-4748","authenticated-orcid":false,"given":"Zoelfigar D.","family":"Mohamed","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01q0sjp54","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Buraimi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5829-1398","authenticated-orcid":false,"given":"Muhammed S.","family":"Alluwimi","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01wsfe280","id-type":"ROR","asserted-by":"publisher"}],"name":"Qassim University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2024,7,16]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"DeCarlo DK, McGwin Jr G, Bixler ML, Wallander J, Owsley C. Impact of paediatric vision impairment on daily life: Results of focus groups. Optometry Vis Sci. 2012;89(9):1409\u20131416. https:\/\/doi.org\/10.1097\/OPX.0b013e318264f1dc","DOI":"10.1097\/OPX.0b013e318264f1dc"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Casta\u00f1eda YS, Cheng-Patel CS, Leske DA, et al. Quality of life and functional vision concerns of children with cataracts and their parents. Eye. 2016;30(9):1251\u20131259. https:\/\/doi.org\/10.1038\/eye.2016.134","DOI":"10.1038\/eye.2016.134"},{"key":"ref2","unstructured":"World Health Organization (WHO). Blindness and vision impairment. World Health Organization; 2023 [cited 2024 Feb 07]. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/blindness-and-visual-impairment"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Solebo AL, Rahi J. Epidemiology, aetiology and management of visual impairment in children. Arch Dis Childhood. 2014;99:375\u2013379. https:\/\/doi.org\/10.1136\/archdischild-2012-303002","DOI":"10.1136\/archdischild-2012-303002"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Zelalem M, Abebe Y, Adamu Y, Getinet T. Prevalence of visual impairment among school children in three primary schools of Sekela Woreda, Amhara regional state, north-west Ethiopia. SAGE Open Med. 2019;7:2050312119849769. https:\/\/doi.org\/10.1177\/2050312119849769","DOI":"10.1177\/2050312119849769"},{"key":"ref5","unstructured":"Gilbert C, Foster A. Childhood blindness in the context of vision 2020: The right to sight. Bull World Health Organ. 2001;79(3):227\u2013232."},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Kong L, Fry M, Al-Samarraie M, Gilbert C, Steinkuller PG. An update on progress and the changing epidemiology of causes of childhood blindness worldwide. J Am Assoc Paediatr Ophthalmol Strabismus. 2012;16(6):501\u2013507. https:\/\/doi.org\/10.1016\/j.jaapos.2012.09.004","DOI":"10.1016\/j.jaapos.2012.09.004"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Yekta A, Hooshmand E, Saatchi M, et al. Global prevalence and causes of visual impairment and blindness in children: A systematic review and meta-analysis. J Curr Ophthalmol. 2022;34(1):1\u201315. https:\/\/doi.org\/10.4103\/joco.joco_135_21","DOI":"10.4103\/joco.joco_135_21"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Naidoo KS, Raghunandan A, Mashige KP, et al. Refractive error and visual impairment in African children in South Africa. Invest Ophthalmol Vis Sci. 2003;44(9):3764\u20133770. https:\/\/doi.org\/10.1167\/iovs.03-0283","DOI":"10.1167\/iovs.03-0283"},{"key":"ref9","unstructured":"Zeidan Z, Hashim K, Muhit MA, Gilbert C. Prevalence and causes of childhood blindness in camps for displaced persons in Khartoum: Results of a household survey. East Mediterr Health J. 2007;13(3):580\u2013585."},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Mehari ZA, Yimer AW. Prevalence of refractive errors among schoolchildren in rural central Ethiopia. Clin Exp Optom. 2013;96(1):65\u201369. https:\/\/doi.org\/10.1111\/j.1444-0938.2012.00762.x","DOI":"10.1111\/j.1444-0938.2012.00762.x"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Solebo AL, Teoh L, Rahi J. Epidemiology of blindness in children. Arch Dis Childhood. 2017;102(9):853\u2013857. https:\/\/doi.org\/10.1136\/archdischild-2016-310532","DOI":"10.1136\/archdischild-2016-310532"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Mohamed ZD, Abdu M, Alrasheed SH. Management plan for childhood visual impairment in traditional Quranic boarding schools in Al-Gazira state of Sudan. Albasar Int J Ophthalmol. 2018;5(1):1\u20135. https:\/\/doi.org\/10.4103\/bijo.bijo_8_18","DOI":"10.4103\/bijo.bijo_8_18"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Alrasheed SH, Naidoo KS, Clarke-Farr PC. Childhood eye care services in South Darfur State of Sudan: Learner and parent perspectives. Afr Vision Eye Health. 2016;75(1):a315. https:\/\/doi.org\/10.4102\/aveh.v75i1.315","DOI":"10.4102\/aveh.v75i1.315"},{"key":"ref14","unstructured":"Resnikoff S, Pascolini D, Etya\u2019Ale D, et al. Global data on visual impairment in the year 2002. Bull World Health Organ. 2004;82(11):844\u2013851."},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Muma S, Obonyo S. The prevalence and causes of visual impairment among children in Kenya\u2013the Kenya eye study. BMC Ophthalmol. 2020;20:1\u20135. https:\/\/doi.org\/10.1186\/s12886-020-01665-w","DOI":"10.1186\/s12886-020-01665-w"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Sharma A, Congdon N, Patel M, Gilbert C. School-based approaches to the correction of refractive error in children. Survey Ophthalmol. 2012;57(3):272\u2013283. https:\/\/doi.org\/10.1016\/j.survophthal.2011.11.002","DOI":"10.1016\/j.survophthal.2011.11.002"},{"key":"ref17","unstructured":"Muhit MA, Shahjahan M, Hassan A, Wazed A, Ahmed N. Parental knowledge, attitude and practice related to blindness of children in some selected Upazilla of Bangladesh. Mymensingh Med J. 2011;20:671\u2013679."},{"key":"ref18","unstructured":"Borrel A, Dabideen R, Mekonen Y, Overland L. Child eye health in Africa: The status and way forward. Cape Town: African Child Policy Forum, ORBIS Africa; 2013, p. 1\u201337."},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Balasubramaniam SM, Kumar DS, Kumaran SE, Ramani KK. Factors affecting eye care\u2013seeking behaviour of parents for their children. Optometry Vis Sci. 2013;90(10):1138\u20131142. https:\/\/doi.org\/10.1097\/OPX.0000000000000010","DOI":"10.1097\/OPX.0000000000000010"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Ntsoane MD, Oduntan OA. A review of factors influencing the utilization of eye care services. Afr Vision Eye Health. 2010;69(4):182\u2013192. https:\/\/doi.org\/10.4102\/aveh.v69i4.143","DOI":"10.4102\/aveh.v69i4.143"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Alrasheed SH. A systemic review of barriers to accessing paediatric eye care services in African countries. Afr Health Sci. 2021;21(4):1887\u20131897. https:\/\/doi.org\/10.4314\/ahs.v21i4.47","DOI":"10.4314\/ahs.v21i4.47"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Int J Surg. 2021;88:18. https:\/\/doi.org\/10.1016\/j.ijsu.2021.105906","DOI":"10.1016\/j.ijsu.2021.105906"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Ekpenyong BN, Naidoo K, Ndep A, Akpan M, Ekanem E. Prevalence, and determinants of visual impairment amongst school-aged children in Southern Nigeria. Afr Vision Eye Health. 2020;79(1):a534. https:\/\/doi.org\/10.4102\/aveh.v79i1.534","DOI":"10.4102\/aveh.v79i1.534"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Ebri AE, Govender P, Naidoo KS. Prevalence of vision impairment and refractive error in school learners in Calabar, Nigeria. Afr Vision Eye Health. 2019;78(1):a487. https:\/\/doi.org\/10.4102\/aveh.v78i1.487","DOI":"10.4102\/aveh.v78i1.487"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Alrasheed SH, Naidoo KS, Clarke-Farr PC. Prevalence of visual impairment and refractive error in schoolaged children in South Darfur State of Sudan. Afr Vision Eye Health. 2016;75(1):a355. https:\/\/doi.org\/10.4102\/aveh.v75i1.355","DOI":"10.4102\/aveh.v75i1.355"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Mohamed ZD, Binnawi KH, Abdu M. Prevalence and causes of childhood blindness and visual impairment in Quranic boarding schools in Al-Gazira state of Sudan. Sudanese J Ophthalmol 2017;9(2):44\u201349. https:\/\/doi.org\/10.4103\/sjopthal.sjopthal_1_18","DOI":"10.4103\/sjopthal.sjopthal_1_18"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Bezabih L, Abebe TW, Fite RO. Prevalence and factors associated with childhood visual impairment in Ethiopia. Clin Ophthalmol. 2017;2017:1941\u20131948. https:\/\/doi.org\/10.2147\/OPTH.S135011","DOI":"10.2147\/OPTH.S135011"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Kedir J, Girma A. Prevalence of refractive error and visual impairment among rural school-age children of Goro District, Gurage Zone, Ethiopia. Ethiopian J Health Sci. 2014;24(4):353\u2013358. https:\/\/doi.org\/10.4314\/ejhs.v24i4.11","DOI":"10.4314\/ejhs.v24i4.11"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Darge HF, Shibru G, Mulugeta A, Dagnachew YM. The prevalence of visual acuity impairment among school children at Arada Subcity primary schools in Addis Ababa, Ethiopia. J Ophthalmol. 2017;17(1):1\u20135. https:\/\/doi.org\/10.1155\/2017\/9326108","DOI":"10.1155\/2017\/9326108"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Abdi Ahmed Z, Alrasheed SH, Alghamdi W. Prevalence of refractive error and visual impairment among school-age children of Hargesia, Somaliland, Somalia. East Mediterr Health J. 2020;26(11):1362\u20131370. https:\/\/doi.org\/10.26719\/emhj.20.077","DOI":"10.26719\/emhj.20.077"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Kumah BD, Ebri A, Abdul-Kabir M, et al. Refractive error, and visual impairment in private school children in Ghana. Optometry Vis Sci. 2013;90(12):1456\u20131461. https:\/\/doi.org\/10.1097\/OPX.0000000000000099","DOI":"10.1097\/OPX.0000000000000099"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Naidoo KS, Raghunandan A, Mashige KP, et al. Refractive error and visual impairment in African children in South Africa. Invest Ophthalmol Vis Sci. 2003;44(9):3764\u20133770. https:\/\/doi.org\/10.1167\/iovs.03-0283","DOI":"10.1167\/iovs.03-0283"},{"key":"ref33","doi-asserted-by":"crossref","unstructured":"Nallasamy S, Anninger WV, Quinn GE, Kroener B, Zetola NM, Nkomazana O. Survey of childhood blindness and visual impairment in Botswana. Br J Ophthalmol. 2011;1\u20135. https:\/\/doi.org\/10.1136\/bjo.2010.189068","DOI":"10.1016\/j.jaapos.2009.12.098"},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Gyawali R, Bhayal BK, Adhikary R, Shrestha A, Sah RP. Retrospective data on causes of childhood vision impairment in Eritrea. BMC Ophthalmol. 2017;17(1):1\u20138. https:\/\/doi.org\/10.1186\/s12886-017-0609-x","DOI":"10.1186\/s12886-017-0609-x"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Agarwal PK, Bowman R, Courtright P. Child eye health tertiary facilities in Africa. J Am Assoc Paediatr Ophthalmol Strabismus. 2010;14(3):263\u2013266. https:\/\/doi.org\/10.1016\/j.jaapos.2010.02.007","DOI":"10.1016\/j.jaapos.2010.02.007"},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"Sukati VN, Moodley VR, Mashige KP. Knowledge and practices of parents about child eye health care in the public sector in Swaziland. Afr J Prim Health Care Fam Med. 2018;10(1):a1808. https:\/\/doi.org\/10.4102\/phcfm.v10i1.1808","DOI":"10.4102\/phcfm.v10i1.1808"},{"key":"ref37","doi-asserted-by":"crossref","unstructured":"Ugalahi MO, Olusanya BA, Fagbemi OO, Baiyeroju AM. Delays in uptake of surgery for childhood cataract at a child eye health tertiary facility in sub-Saharan Africa. Eur J Ophthalmol. 2020;30(2):280\u2013283. https:\/\/doi.org\/10.1177\/1120672119827770","DOI":"10.1177\/1120672119827770"},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"Chan VF, Minto H, Mashayo E, Naidoo KS. Improving eye health using a child-to-child approach in Bariadi, Tanzania. Afr Vision Eye Health. 2017;76(1):a406. https:\/\/doi.org\/10.4102\/aveh.v76i1.406","DOI":"10.4102\/aveh.v76i1.406"},{"key":"ref39","doi-asserted-by":"crossref","unstructured":"Alrasheed SH, Naidoo KS, Clarke-Farr PC, Binnawi KH. Building consensus for the development of child eye care services in South Darfur State of Sudan using the Delphi technique. Afr J Prim Health Care Fam Med. 2018;10(1):e1\u2013e9. https:\/\/doi.org\/10.4102\/phcfm.v10i1.1767","DOI":"10.4102\/phcfm.v10i1.1767"},{"key":"ref40","unstructured":"Wanyama SP. Knowledge, attitude, and practice of eye diseases in children among pediatricians in Kenya. Doctoral dissertation. University of Nairobi."},{"key":"ref41","unstructured":"Belaynew WT, Berihun MZ, Tadesse AA, Yared AW. Knowledge and practice on childhood blindness among communities in Northwest Ethiopia: Implications to blindness prevention programs. JOECSA. 2014;17(2):50\u201358."},{"key":"ref42","unstructured":"Kotb SA, Gadallah MA, Marzouk SA. Self-esteem and quality of life among visually impaired children in Assiut City, Egypt. J Am Sci. 2011;7(8):47\u201357."},{"key":"ref43","doi-asserted-by":"crossref","unstructured":"Schulze Schwering M, Finger RP, Barrows J, Nyrenda M, Kalua K. Barriers to uptake of free pediatric cataract surgery in Malawi. Ophthalmic Epidemiol. 2014;21(3):138\u2013143. https:\/\/doi.org\/10.3109\/09286586.2014.892139","DOI":"10.3109\/09286586.2014.892139"},{"key":"ref44","doi-asserted-by":"crossref","unstructured":"Kumah BD, Abdulkabir M, Kobia-Acquah E, Amponsah MA, Ablordeppey RK. Knowledge of childhood blindness among mothers visiting a children\u2019s Hospital in the Kumasi Metropolis, Ghana. Adv Ophthalmol Vis Syst. 2017;7(3):00221. https:\/\/doi.org\/10.15406\/aovs.2017.07.0022","DOI":"10.15406\/aovs.2017.07.00221"},{"key":"ref45","doi-asserted-by":"crossref","unstructured":"Chan VF, Singer S, Naidoo KS. Disability-related-distress in primary school learners with vision impairment because of uncorrected refractive error in KwaZulu-Natal Province, South Africa \u2013 A qualitative study. PLoS One. 2020;15(3):e0229108. https:\/\/doi.org\/10.4102\/aveh.v78i1.47","DOI":"10.1371\/journal.pone.0229108"},{"key":"ref46","doi-asserted-by":"crossref","unstructured":"Sukati V, Moodley VR, Mashige KP. Knowledge and practices of eye health professionals about the availability and accessibility of child eye care services in the public sector in Swaziland. Afr Vision Eye Health. 2019;78(1), a471. https:\/\/doi.org\/10.4102\/aveh.v78i1.471","DOI":"10.4102\/aveh.v78i1.471"},{"key":"ref47","doi-asserted-by":"crossref","unstructured":"Alrasheed SH, Naidoo KS, Clarke-Farr PC. Attitudes and perceptions of Sudanese high-school students and their parents towards spectacle wear. Afr Vision Eye Health. 2018;77(1):a392. https:\/\/doi.org\/10.4102\/aveh.v77i1.392","DOI":"10.4102\/aveh.v77i1.392"},{"key":"ref48","doi-asserted-by":"crossref","unstructured":"Oguego N, Okoye OI, Okoye O, et al. Eye health myths, misconceptions, and facts: Results of a cross-sectional survey among Nigerian school children. Fam Med Prim Care Rev. 2018;20(2):144\u2013148. https:\/\/doi.org\/10.5114\/fmpcr.2018.76458","DOI":"10.5114\/fmpcr.2018.76458"},{"key":"ref49","doi-asserted-by":"crossref","unstructured":"Wadhwani M, Vashist P, Singh SS, Gupta V, Gupta N, Saxena R. Prevalence and causes of childhood blindness in India: A systematic review. Indian J Ophthalmol. 2020;68(2):311\u2013315. https:\/\/doi.org\/10.4103\/ijo.IJO_2076_18","DOI":"10.4103\/ijo.IJO_2076_18"},{"key":"ref50","doi-asserted-by":"crossref","unstructured":"Bhattarai S. The scenario of childhood blindness and its remedy in Nepal. J Patan Acad Health Sci. 2021;8(2):120\u2013125. https:\/\/doi.org\/10.3126\/jpahs.v8i2.31126","DOI":"10.3126\/jpahs.v8i2.31126"},{"key":"ref51","doi-asserted-by":"crossref","unstructured":"Adugna MB, Nabbouh F, Shehata S, Ghahari S. Barriers, and facilitators to healthcare access for children with disabilities in low and middle income sub-Saharan African countries: A scoping review. BMC Health Serv Res. 2020;20:15. https:\/\/doi.org\/10.1186\/s12913-019-4822-6","DOI":"10.1186\/s12913-019-4822-6"},{"key":"ref52","doi-asserted-by":"crossref","unstructured":"Melese M, Alemayehu W, Friedlander E, Courtright P. Indirect costs associated with accessing eye care services as a barrier to service use in Ethiopia. Trop Med Int Health. 2004;9(3):426\u2013431. https:\/\/doi.org\/10.1111\/j.1365-3156.2004.01205.x","DOI":"10.1111\/j.1365-3156.2004.01205.x"},{"key":"ref53","doi-asserted-by":"crossref","unstructured":"Mashige KP, Martin C. Utilization of eye care services by elderly persons in the northern Ethekwini district of Kwa-Zulu-Natal province, South Africa. Afr Vision Eye Health. 2011;70(4):175\u2013181. https:\/\/doi.org\/10.4102\/aveh.v70i4.113","DOI":"10.4102\/aveh.v70i4.113"}],"container-title":["African Journal of Primary Health Care &amp; Family Medicine"],"original-title":[],"link":[{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/viewFile\/4556\/7372","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/viewFile\/4556\/7373","content-type":"application\/epub+zip","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/viewFile\/4556\/7374","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/viewFile\/4556\/7375","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/view\/4556\/7375","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T12:31:16Z","timestamp":1776947476000},"score":1,"resource":{"primary":{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/view\/4556"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,16]]},"references-count":54,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12,21]]}},"URL":"https:\/\/doi.org\/10.4102\/phcfm.v16i1.4556","relation":{},"ISSN":["2071-2928","2071-2936"],"issn-type":[{"value":"2071-2928","type":"print"},{"value":"2071-2936","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,16]]},"article-number":"a4556"}}