Sand Flies Control: A Review of the Knowledge of Health Professionals and the Local Community, Province of El Hajeb, Morocco
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Area
2.2. Study Design and Sampling
2.3. Data Collection
2.4. Data Processing and Analysis
2.5. Ethical Considerations
3. Results
3.1. Health Professionals
3.1.1. Socio-Demographic Characteristics and Levels of Health Professional Knowledge of Sand Flies
3.1.2. Factors Associated with the High Level of Health Professional Knowledge of Sand Flies
3.2. The Local Community
3.2.1. Socio-Demographic Characteristics of the Local Community
3.2.2. Factors Associated with Sufficient Knowledge and Positive Attitudes of the Community Regarding Sand Flies
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- World Health Assembly 70. Global Vector Control Response: An Integrated Approach for the Control of Vector-Borne Diseases. 2017. Available online: https://apps.who.int/iris/handle/10665/275708 (accessed on 25 February 2020).
- Faraj, C.; Adlaoui, E.B.; Ouahabi, S.; El Kohli, M.; El Rhazi, M.; Lakraa, L.; Ameur, B. Distribution and Bionomic of Sand Flies in Five Ecologically Different Cutaneous Leishmaniasis Foci in Morocco; Ramon, J.M., Szmaragd, C., Eds.; Hindawi Publishing Corporation: Cairo, Egypt, 2013; 145031p. [Google Scholar]
- Ministère de la santé Marocaine. Direction de l’Epidémiologie et de Lutte Contre les Maladies. Lutte Contre les Leishmanioses. Guide des activités 2010; Ministère de la santé Marocaine: Rabat, Morocco, 2010. [Google Scholar]
- World HealthOrganization. Bote à Outils Pour Une Gestion Vectorielle Intǧrě En Afrique Subsaharienne; World Health Organization: Geneva, Switzerland, 2017. [Google Scholar]
- Kahime, K.; Sereno, D.; Bounoua, L.; El Hidan, M.A.; Souad, B. Management of Leishmaniases in the Era of Climate Change in Morocco. Int. J. Environ. Res. Public Health 2018, 15, 1542. [Google Scholar]
- Albi, F.Z.; Lalami, A.E.O.; Idrissi, A.J.; Sebti, F.; Faraj, C. Leishmaniasis in Central Morocco: Seasonal Fluctuations of Phlebotomine Sand Fly in Aichoun Locality, from Sefrou Province. Pathol. Res. Int. 2015, 2015, 1–4. [Google Scholar]
- Lalami, A.E.O. Entomological investigations in moulayyaacoub, leishmaniasis focus in the centr of morocco. Asian J. Pharm. Clin. Res. 2016, 9, 340. [Google Scholar] [CrossRef]
- Boussaa, S.; Kahime, K.; Samy, A.M.; Ben Salem, A.; Boumezzough, A. Species composition of sand flies and bionomics of Phlebotomuspapatasi and P. sergenti (Diptera: Psychodidae) in cutaneous leishmaniasis endemic foci, Morocco. Parasites Vectors 2016, 9, 1–11. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- El-Mouhdi, K.; Chahlaoui, A.; Lalami, A.E.-O.; Bouzid, J.; El Omari, H.; Fekhaoui, M. Situation Épidémiologique des Leishmanioses au Niveau de la Ville d’ElHajeb (Centre du Maroc) Durant la Période de 2013 à 2017. Eur. Sci. J. ESJ 2019, 15, 155. [Google Scholar]
- Kholoud, K.; Bounoua, L.; Sereno, D.; El Hidan, M.; Messouli, M. Emerging and Re-Emerging Leishmaniases in the Mediterranean Area: What Can Be Learned from a Retrospective Review Analysis of the Situation in Morocco during 1990 to 2010? Microorganisms 2020, 8, 1511. [Google Scholar]
- Bounoua, L.; Kahime, K.; Houti, L.; Blakey, T.; Ebi, K.L.; Zhang, P.; Imhoff, M.L.; Thome, K.J.; Dudek, C.; Sahabi, S.A.; et al. Linking Climate to Incidence of Zoonotic Cutaneous Leishmaniasis (L. major) in Pre-Saharan North Africa. Int. J. Environ. Res. Public Health 2013, 10, 3172–3191. [Google Scholar] [CrossRef] [PubMed]
- Chan, E.Y.Y.; Sham, T.S.T.; Shahzada, T.S.; Dubois, C.; Huang, Z.; Liu, S.; Hung, K.K.C.; Tse, L.A.; Kwok, K.O.; Chung, P.-H.; et al. Narrative Review on Health-EDRM Primary Prevention Measures for Vector-Borne Diseases. Int. J. Environ. Res. Public Health 2020, 17, 5981. [Google Scholar] [CrossRef] [PubMed]
- Organisation Mondiale de la santé. Relevé Epidémiologique Hebdomadaire; OMS: Geneva, Switzerland, 2016; ISSN 0049-8114. [Google Scholar]
- Ministère de la santé Marocaine. Bulletin D’épidémiologie et de Santé Publique (Juillet 2018); Ministère de la santé Marocaine: Rabat, Morocco, 2018; Volume 56, ISSN 08518238. [Google Scholar]
- El-Mouhdi, K.; Fekhaoui, M.; Elhamdaoui, F.; Guessioui, H.; Chahlaoui, A. Knowledge and Experiences of Health Professionals in the Peripheral Management of Leishmaniasis in Morocco (ELHajeb). J. Parasitol. Res. 2020, 2020, 1–9. [Google Scholar]
- De Amorim, C.F.; Amóra, S.S.A.; Kazimoto, T.A.; Costa, K.F.D.L.; Silva, L.F.; De Sousa, M.L.R.; Freitas, Y.B.N.; Alves, N.D.; Feijó, F.M.C. Knowledge of the Population about Visceral Leishmaniasis Transmission in Endemic Areas near the Banks of the Mossoró River in Northeastern Brazil. Int. J. Environ. Res. Public Health 2015, 12, 3343–3357. [Google Scholar] [CrossRef] [PubMed]
- Boussaa, S.; Pesson, B.; Boumezzough, A. Faunistic study of the sandflies (Diptera: Psychodidae) in an emerging focus of cutaneous leishmaniasis in Al Haouz province, Morocco. Ann. Trop. Med. Parasitol. 2009, 103, 73–83. [Google Scholar] [CrossRef] [PubMed]
- Kahime, K.; Boussaa, S.; Bounoua, L.; Fouad, O.; Messouli, M.; Boumezzough, A. Leishmaniasis in Morocco: Diseases and vectors. Asian Pac. J. Trop. Dis. 2014, 4, S530–S534. [Google Scholar] [CrossRef]
- Fontenille, D.; Lagneau, C.; Lecollinet, S.; Robin, R.L.; Setbon, M.; Tirel, B.; Yébakima, A. La eishmaniose humaine et canine en France. In La Lutte Antivectorielle en France; IRD, Ed.; Expertise Collégiale: Marseille, France, 2013; pp. 166–177. Available online: http://books.openedition.org/irdeditions/1318 (accessed on 18 May 2020).
- Haut Commissariat au Plan. Population Legale des Regions, Provinces, Prefectures, Municipalites, Arrondissements et Communes du Royaume D’apres les Resultats du Rgph 2014 (12 Regions); Haut Commissariatau Plan du Maroc: Rabat, Morocco, 2014; Available online: http://www.hcp.ma/Etudes_r161.html (accessed on 25 February 2020).
- Moroccan Agency for Sustainable Energy. Etude D’impact Environnemental et Social de la Centrale Solaire PhotovoltaiqueNoor el Hajeb. Conseil IngnerieDevelopement. 2018. Available online: http://www.masen.ma/sites/default/files/documents_rapport/El%20Hajeb_FESIA_27_07_2018.pdf (accessed on 13 June 2020).
- Hmamouch, A.; El Alem, M.M.; Hakkour, M.; Amarir, F.; Daghbach, H.; Habbari, K.; Fellah, H.; Bekhti, K.; Sebti, F. Circulating species of Leishmania at microclimate area of Boulemane Province, Morocco: Impact of environmental and human factors. Parasites Vectors 2017, 10, 1–10. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ministère de la Santé Marocaine. Offre de Soins de Santé. 2019. Available online: http://cartesanitaire.sante.gov.ma/dashboard/pages2/rh_med.html (accessed on 6 May 2020).
- Gouvernement du Canada SC, Gouvernement du Canada SC. Les Statistiques: Le Pouvoir Des Données! Échantillonnage non Probabiliste. 2011. Available online: https://www150.statcan.gc.ca/n1/edu/power-pouvoir/ch13/nonprob/5214898-fra.htm (accessed on 1 February 2020).
- Khan, H.A.A.; Akram, W.; Shad, S.A.; Razaq, M.; Naeem-Ullah, U.; Zia, K. A cross sectional survey of knowledge, attitude and practices related to house flies among dairy farmers in Punjab, Pakistan. J. Ethnobiol. Ethnomed. 2013, 9, 18. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Frary, R.B. A Brief Guide to Questionnaire Development. 1998. Available online: http://www.ericae.net/ft/tamu/vpiques3.htm (accessed on 1 February 2020).
- Fortin, M.F.; Côté, J.; Filion, F. Fondements et Etapes du Processus de Recherche. Available online: http://www.asso-arsi.fr/images/Doc_PJ/Ouvrages/Recherche_Fortin.pdf (accessed on 2 November 2020).
- Matthews, G. Attitudes and behaviours regarding use of crop protection products—A survey of more than 8500 smallholders in 26 countries. Crop. Prot. 2008, 27, 834–846. [Google Scholar] [CrossRef]
- Shiferaw, B.B.; Modiba, L.M. Women’s Perspectives on Influencers to the Utilisation of Skilled Delivery Care: An Explorative Qualitative Study in North West Ethiopia. Obstet. Gynecol. Int. 2020, 2020, 8207415. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bennis, I.; Belaid, L.; De Brouwere, V.; Filali, H.; Sahibi, H.; Boelaert, M. “The mosquitoes that destroy your face”. Social impact of Cutaneous Leishmaniasis in South-eastern Morocco, A qualitative study. PLoS ONE 2017, 12, e0189906. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738074/ (accessed on 20 April 2020). [CrossRef] [PubMed] [Green Version]
- Ministère de la santé Marocaine. Bulletin D’épidémiologie et de Santé Publique (Février 2018); Ministère de la santé Marocaine: Rabat, Morocco, 2018; Volume 40, ISSN 08518238. [Google Scholar]
- Ruoti, M.; Oddone, R.; Lampert, N.; Orué, E.; Miles, M.A.; Alexander, N.; Rehman, A.M.; Njord, R.; Shu, S.; Brice, S.; et al. MucocutaneousLeishmaniasis: Knowledge, Attitudes, and Practices Among Paraguayan Communities, Patients, and Health Professionals. J. Trop. Med. 2013, 2013, 1–10. [Google Scholar] [CrossRef] [PubMed]
- Akram, A.; Khan, H.A.A.; Qadir, A.; Sabir, A.M. A Cross-Sectional Survey of Knowledge, Attitude and Practices Related to Cutaneous Leishmaniasis and Sand Flies in Punjab, Pakistan. PLoS ONE 2015, 10, e0130929. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4474799/ (accessed on 16 May 2020). [CrossRef] [PubMed]
Variables | Total | Doctors | Nurses | Health Technicians | Midwives | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
n = 143 | %100 | n = 41 | %28.7 | n = 73 | %51.0 | n = 8 | %5.6 | n = 21 | %14.7 | ||
Sex | Male | 67 | 46.9 | 24 | 58.5 | 37 | 50.7 | 6 | 75 | 0 | 0 |
Female | 76 | 53.1 | 17 | 41.5 | 36 | 49.3 | 2 | 25 | 21 | 100 | |
Age | (20–30) | 14 | 9.8 | 4 | 9.8 | 7 | 9.6 | 0 | 0 | 3 | 14.3 |
(31–40) | 68 | 47.6 | 11 | 26.8 | 37 | 50.7 | 5 | 62.5 | 15 | 71.4 | |
(41–50) | 41 | 28.7 | 19 | 46.3 | 16 | 21.9 | 3 | 37.5 | 3 | 14.3 | |
(+50) | 20 | 14 | 7 | 46.3 | 13 | 21.9 | 0 | 37.5 | 0 | 14.3 | |
<5 years old | 6 | 4.2 | 3 | 7.3 | 3 | 4.1 | 0 | 0 | 0 | 0 | |
Seniority in the health service | (5–10) | 41 | 28.7 | 8 | 39 | 17 | 41.1 | 3 | 37.5 | 13 | 23.8 |
(10–15) | 54 | 37.8 | 16 | 24.4 | 30 | 15.1 | 3 | 12.5 | 5 | 14.3 | |
(15–20) | 25 | 17.5 | 10 | 24.4 | 11 | 15.1 | 1 | 12.5 | 3 | 14.3 | |
>20 years old | 17 | 11.9 | 4 | 9.8 | 12 | 16.4 | 1 | 12.5 | 0 | 0 | |
Working structure | Hospital | 53 | 37.1 | 15 | 36.6 | 26 | 35.6 | 6 | 75 | 6 | 28.6 |
Urban Health Centre | 23 | 16.1 | 17 | 41.5 | 31 | 42.5 | 1 | 12.5 | 13 | 61.9 | |
Rural Health Centre | 62 | 43.4 | 8 | 34.8 | 12 | 52.2 | 1 | 4.3 | 2 | 8.7 | |
rural dispensary | 5 | 3.5 | 1 | 2.4 | 4 | 5.5 | 0 | 0 | 0 | 0 | |
Continuing Training on Vector-Borne Diseases | No | 119 | 83.2 | 32 | 78 | 59 | 80.8 | 7 | 87.5 | 21 | 100 |
Yes | 24 | 16.8 | 9 | 22 | 14 | 19.2 | 1 | 12.5 | 0 | 0 | |
High knowledge (score ≥ at 4) | 15 | 9.8 | 6 | 14.6 | 7 | 9.6 | 1 | 12.5 | 1 | 4.8 | |
Levels of general knowledge about sand flies | Average knowledge (score from 2 to 3) | 51 | 35.7 | 16 | 39 | 26 | 35.6 | 3 | 37.5. | 6 | 28.6 |
Low knowledge (score < to 2) | 74 | 51.7 | 19 | 46.3 | 37 | 50.7 | 4 | 50 | 14 | 66.7 |
Knowledge of the Sand Flies as a Vector of Cutaneous Leishmaniases | Knowledge of Sand Flies Breeding Grounds | Knowledge of Sand Flies Biting Times | Knowledge of Protection Methods | Total | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | n | % | |||
Population (n = 281) | Yes | 107 | 38.1 | 84 | 29.9 | 36 | 12.8 | 107 | 38.1 | 89 | 31.7 | |
No | 174 | 61.9 | 197 | 70.1 | 245 | 87.2 | 174 | 61.9 | 192 | 68.3 | ||
Health Care Professionals | Doctors (n = 41) | Y | 28 | 19.6 | 9 | 6.3 | 11 | 7.7 | 29 | 20.3 | 19 | 47.0 |
No | 13 | 9.1 | 32 | 22.4 | 30 | 21.0 | 12 | 8.4 | 22 | 53.0 | ||
Nurses (n = 73) | Yes | 36 | 25.2 | 30 | 21.0 | 14 | 9.8 | 40 | 28.0 | 30 | 41.0 | |
No | 37 | 25.9 | 43 | 30.1 | 59 | 41.3 | 33 | 23.1 | 43 | 59.0 | ||
Health technicians (n = 8) | Yes | 3 | 2.1 | 3 | 2.1 | 2 | 1.4 | 4 | 2.8 | 3 | 38.0 | |
No | 5 | 3.5 | 5 | 3.5 | 6 | 4.2 | 4 | 2.8 | 5 | 63.0 | ||
Midwives (n = 21) | Yes | 6 | 4.2 | 10 | 7.0 | 1 | 0.7 | 7 | 4.9 | 6 | 29.0 | |
No | 15 | 10.5 | 11 | 7.7 | 20 | 14.0 | 14 | 9.8 | 15 | 71.0 | ||
Total (n = 143) | Yes | 73 | 51.0 | 52 | 36.4 | 28 | 19.6 | 80 | 55.9 | |||
No | 70 | 49.0 | 91 | 63.6 | 115 | 80.4 | 63 | 44.1 |
Logistic Regression | Cœf. | OR 1 | CI 2 à 95% | p-Value < 0.05 |
---|---|---|---|---|
Doctors (n = 41) | ||||
Age (41–50 years) | −0.54 | 2.006 | 0.18–1.87 | 0.291 |
Sex (Male) | −2.21 | 2.060 | −1.54–1.94 | 0.003 |
Type of work structure (Rural Health Centre) | 2.28 | 2.411 | 1.55–4.18 | 0.000 |
Seniority in the health service (15–20 years) | −3.5 | 2.297 | −5.7–1.93 | 0.059 |
History of caring for people with cutaneous leishmaniasis | 0.26 | 2.171 | 0.26–1.54 | 0.007 |
Continuing training on VBD 3 | 1.35 | 2.173 | 0.16–1.55 | 0.003 |
Knowledge of the sand flies | −2.51 | 2.202 | 1.38–2.11 | 0.006 |
Nurses (n = 73) | ||||
Age (41–50 years) | 0.99 | 1.104 | 0.67–1.8 | 0.000 |
Sex (Female) | 2.78 | 1.072 | 1.70–4.69 | 0.007 |
Work structure (Rural Health Centre) | −1.15 | 1.190 | 0.74–1.91 | 0.000 |
Seniority in the health service (15–20 years) | 0.67 | 1.069 | −0.19–1.16 | 0.046 |
History of caring for people with cutaneous leishmaniasis | 1.79 | 1.109 | −0.32–0.60 | 0.002 |
Continuing training on VBD 3 | 2.22 | 0.511 | −0.37–0.63 | 0.010 |
Knowledge of the sand flies | −0.65 | 0.517 | 0.33–0.80 | 0.003 |
Midwives (n = 21) | ||||
Age (41–50 years) | −0.96 | 0.499 | −0.12–2.30 | 0.035 |
Sex (Female) | 2.43 | 0.486 | 0.43–5.10 | 0.014 |
Working structure | −0.17 | 0.415 | 0.52–1.35 | 0.473 |
Seniority in the health service (15–20 years) | 0.83 | 0.435 | −0.70–0.51 | 0.124 |
History of caring for people with cutaneous leishmaniasis | −0.10 | 0.461 | 0.55–1.46 | 0.676 |
Continuing training on VBD 3 | −0.07 | 0.468 | 0.45–1.88 | 0.839 |
Knowledge of the sand flies | 1.43 | 0.454 | 0.26–0.88 | 0.020 |
Health technicians (n = 8) | ||||
Age (41–50 years) | −0.12 | 1.143 | 0.47–2.30 | 0.910 |
Sex (Male) | −2.81 | 0.950 | −1.23–0.34 | 0.021 |
Work structure (Rural Health Centre) | −0.57 | 1.245 | 0.94–2.86 | 0.026 |
Seniority in the health service (15–20 years) | −2.21 | 0.410 | −1.54–3.09 | 0.061 |
History of caring for people with cutaneous leishmaniasis | −0.07 | 1.031 | 0.45–1.88 | 0.839 |
Continuing training on VBD 3 | 0.69 | 1.016 | −0.96–1.22 | 0.008 |
Knowledge of the sand flies | −0.77 | 0.470 | 0.21–0.99 | 0.049 |
n | % | ||
---|---|---|---|
Age (Year) | Age (Year) (Mean 38.84 ± 11.89 SD. Median 39 Years) | ||
<20 | 17 | 6.0 | |
(20–30) | 64 | 22.8 | |
(31–40) | 70 | 24.9 | |
(41–50) | 76 | 27.0 | |
>50 | 54 | 19.2 | |
Sex | Female | 191 | 68.0 |
Male | 90 | 32.0 | |
Family situation | Single | 46 | 16.4 |
Married | 210 | 74.7 | |
Widower | 16 | 5.7 | |
Divorced | 9 | 3.2 | |
Education | Illiterate | 88 | 31.3 |
Primary | 91 | 32.4 | |
Secondary | 79 | 28.1 | |
Over | 23 | 8.2 | |
Activity/Occupation | Farming and husbandry | 97 | 34.5 |
Civil servant | 19 | 6.8 | |
Daily/Employ | 52 | 18.5 | |
Housewife | 107 | 38.1 | |
Shopkeeper | 6 | 2.1 | |
Place of living | Rural | 155 | 55.2 |
Urban | 126 | 44.8 | |
District | Bouderbala | 34 | 12.1 |
Agourai | 27 | 9.6 | |
Bitit | 41 | 14.6 | |
Iqdar | 34 | 12.1 | |
Laqsir | 19 | 6.8 | |
ELHajeb | 43 | 15.3 | |
SabaaAyoune | 22 | 7.8 | |
AinTaoujdate | 61 | 21.7 | |
Monthly family income | No answer | 27 | 9.6 |
≤3000 DHS | 147 | 52.3 | |
(3000–5000DHS) | 69 | 24.6 | |
(5000–7000DHS) | 28 | 10.0 | |
≥7000 DHS | 10 | 3.6 | |
Type of coverage | Without coverage | 62 | 22.1 |
CNOPS | 24 | 8.5 | |
CNSS | 45 | 16.0 | |
RAMED | 150 | 53.4 | |
Type of dwelling | Traditional house | 135 | 48.0 |
Modern house (cement) | 121 | 43.1 | |
Apartment | 23 | 8.2 | |
Villa | 2 | 0.7 | |
Have you ever been informed about insect-borne diseases? | Yes | 182 | 64.8 |
No | 99 | 35.2 | |
Overall knowledge of sand flies Adequate | Sufficient (score > 3) | 86 | 30.6 |
Insufficient (score ≤ 2) | 195 | 69.4 | |
Overall attitudes towards sand flies | Positive (≥11) | 84 | 29.9 |
Negative (<11) | 197 | 70.1 |
Variable | Cœf. | OR 1 | IC 2 à 95% | p-Value < 0.05 | |
---|---|---|---|---|---|
Sufficient knowledge | Age (41–50) years | 1.10 | 1.17 | 0.190–1.980 | 0.011 |
Sex (female) | 0.57 | 1.07 | 0.013–1.037 | 0.021 | |
Level of education (high school) | −0.67 | 1.25 | −1.29–0.09 | 0.030 | |
Living place (rural) | 1.23 | 0.67 | 0.562–0.799 | <0.001 | |
Already had (seen) lesions of cutaneous leishmaniasis | −0.21 | 0.80 | −0.416–0.083 | <0.001 | |
Ability to differentiate between mosquitoes and sand flies | −1.08 | 1.59 | 1.320–1.930 | <0.001 | |
Positive Attitudes | Education level (higher) | −1.45 | 1.04 | −2.24–0.67 | <0.001 |
Be informed about diseases transmitted by insects | −0.25 | 0.77 | 0.65–0.91 | <0.003 | |
Sufficient knowledge and positive attitude | 0.31 | 1.37 | 1.033–1.81 | 0.031 |
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El-Mouhdi, K.; Chahlaoui, A.; Boussaa, S.; Fekhaoui, M. Sand Flies Control: A Review of the Knowledge of Health Professionals and the Local Community, Province of El Hajeb, Morocco. Int. J. Environ. Res. Public Health 2020, 17, 8448. https://doi.org/10.3390/ijerph17228448
El-Mouhdi K, Chahlaoui A, Boussaa S, Fekhaoui M. Sand Flies Control: A Review of the Knowledge of Health Professionals and the Local Community, Province of El Hajeb, Morocco. International Journal of Environmental Research and Public Health. 2020; 17(22):8448. https://doi.org/10.3390/ijerph17228448
Chicago/Turabian StyleEl-Mouhdi, Karima, Abdelkader Chahlaoui, Samia Boussaa, and Mohammed Fekhaoui. 2020. "Sand Flies Control: A Review of the Knowledge of Health Professionals and the Local Community, Province of El Hajeb, Morocco" International Journal of Environmental Research and Public Health 17, no. 22: 8448. https://doi.org/10.3390/ijerph17228448