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Article History

Received: 20 October 2025

Accepted: 20 March 2026

First Online: 31 March 2026

Competing interests

: The authors declare no competing interests.

: Ethical approval for this study was exempted according to local regulations in both China and the African regions where data were collected. In China, the exemption was granted under Article 32 of the Measures for Ethical Review of Life Sciences and Medical Research Involving Humans (National Health Commission of China, Document No. 4, 2023), which allows exemption for anonymous, non-interventional research that does not involve identifiable personal information or vulnerable populations (see ). All procedures involving human participants were conducted in accordance with the ethical standards of the Declaration of Helsinki and relevant institutional and national research ethics guidelines.

: Informed consent was obtained online between 8 October 2023 and 15 October 2024. On the introductory page of the questionnaire, participants were informed that the survey was anonymous and voluntary. By proceeding to fill out and submit the questionnaire, participants provided implied informed consent to participate in the study. No identifying information was collected, and respondents could withdraw at any time before submission.