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СпутникиРНSpaceXРоскосмосNASASouth Africa has the highest rate of non-communicable diseases in the Southern African Development Community. The South African government has developed sports and recreation legislation to provide infrastructure that addresses non-communicable diseases and promotes healthy lifestyles. Despite significant progress in establishing national sports and recreation policies and structures to meet population needs and ensure equitable access to facilities, South Africa remains among the countries with the highest rates of non-communicable diseases. This study explores Indigenous Games as culturally grounded, decolonial spaces for physical activity that promote holistic well-being among youth in selected rural communities in the Vhembe District, Limpopo Province. Trustworthiness will be ensured through measures of credibility, confirmability, transferability, and dependability. Qualitative data will be collected through focus groups and in-depth interviews. Quantitative data will be collected using a structured self-administered questionnaire. The study will adopt an exploratory sequential mixed-methods design in three phases. Phase one will employ both qualitative and quantitative approaches. In Phase two, meta-inferences will be conducted, and, in collaboration with youth and community stakeholders, a culturally relevant framework for promoting Indigenous Games as a strategy to enhance youth well-being in rural communities will be conceptualized and co-developed using community-based practice, decolonial theory, the BOEM model, and SWOT analysis. Phase three will use the Delphi Technique to validate the developed framework for promoting Indigenous Games. The study will use multi-stage random sampling and simple random sampling to assess how Indigenous Games can help prevent and manage non-communicable diseases. Ethical principles of informed consent, anonymity, privacy, confidentiality, and the avoidance of harm will be upheld throughout the research process. Qualitative data will be analyzed using ATLAS. ti, whereas the Statistical Package for the Social Sciences version 30.0 will be used to analyse the quantitative data.
Non-communicable diseases (NCDs) are a global public health challenge, accounting for 41 million deaths worldwide, equivalent to 71% of all global deaths (Budreviciute, Damiati, Sabir, Onder, Schuller-Goetzburg, Plakys, & Kodzius, 2020). This societal concern affects both developed and developing countries and is linked to lifestyle and genetics (Abdullahi, Kingsley, Yusuf, Otutu, & Nwose, 2025). In India, the government developed the National Program for Non-Communicable Diseases to prevent and manage non-infectious diseases (Sharma, Gaidhane, & Choudhari, 2024). However, an estimated 4.7 million people lost their lives due to NCDs in the country (Ramesh & Kosalram, 2023). This issue requires urgent attention to preserve life while promoting a healthy lifestyle. Although this problem affects all people, children and youth are particularly prone to conditions associated with overweight and obesity because of a sedentary lifestyle.
Globally, the prevalence of childhood obesity has risen rapidly in recent years, placing children at higher risk for cardiovascular diseases and other preventable NCDs (Abdullahi, Kingsley, Yusuf, Otutu & Nwose, 2025). A study conducted in Nigeria indicated that NCDs contribute to 30% of the total deaths in the country. Although these challenges affect people of all ages, people between 15 and 49 years are prone to non-communicable diseases in Nigeria (Imadojiemu, Oladele & Olufadewa, 2026). Some of the factors that contribute to this challenge include lifestyle behaviours such as consumption of unhealthy food, alcohol and substance abuse, and physical inactivity.
In Sub-Saharan Africa, non-communicable diseases account for about 33.7% of deaths (Imadojiemu, Oladele & Olufadewa, 2026). The South African government spends a significant amount of money on health and education to preserve life and support social development. However, South Africa is among the countries with the highest rates of non-communicable diseases, with an estimated 12 million people who are obese or overweight (Boachie, Thsehla, Immurana, Kohli-Lynch, & Hofman, 2022). These conditions can be mitigated through participation in traditional indigenous games, which serve as culturally grounded, decolonial spaces for physical activity that promote holistic well-being. Traditional indigenous games have been used to promote a healthy lifestyle and create a conducive environment for sharing experiences (Munyangane, Matshidze, Lekgothwane, Mokwena & Negota, 2026).
The United Nations has developed and adopted Sustainable Development Goal 3 to reduce the burden of NCDs in both developed and developing countries (Winkel, Galloway, Colfer, de Jong, Katila, and Pacheco, 2019). Despite the development of legislation aimed at addressing this crisis, about 86% of premature deaths from NCDs occur in low- and middle-income countries, including South Africa (Li, Pandian, Davidson, Song, Chen, N., & Fong, 2025). This is a serious problem that affects the social well-being of people across various countries.
In the United States, non-communicable diseases are closely linked to lifestyle factors and the consumption of unhealthy food (Lyun et al., 2024). One in every five children in America is obese, and this number is increasing annually, exposing them to non-infectious diseases that can be mitigated through lifestyle modifications (Lyum et al., 2021). Another study reported that approximately 18.5% of American children and adolescents aged 2 to 19 years are obese (Cheryl, Fryar, Margaret D., Carroll, and Cynthia, 2018). Although this issue affects all genders, it is more prevalent among women; in South Africa in 2016, 68% of women were either obese or overweight, compared to only 31% of men (Lyum et al., 2021). This may be influenced by the fact that the majority of men actively participate in socio-economic activities such as work and various sports, which promote a healthy lifestyle. This is a global health issue, primarily caused by an imbalance between energy intake and energy expenditure, leading to excessive accumulation of body fat (Lyum et al., 2021). Although this challenge exists worldwide, it is particularly prevalent in higher- and middle-income countries such as South Africa (Budreviciute, Damiati, Sabir, Onder, Schuller-Goetzburg, Plakys, & Kodzius, 2020). This is a serious concern that requires an interdisciplinary approach to prevent and manage non-communicable diseases through participation in indigenous physical games.
In South Africa, the government provides sports and recreation facilities to enable communities to participate in sports and recreational activities, aiming to promote a healthy lifestyle and reduce mortality from non-communicable diseases. However, non-communicable diseases, particularly cardiovascular diseases, chronic respiratory diseases, metabolic diseases, and various types of cancer, are prevalent and affect people’s health (Jebeile, Kelly, O'Malley, & Baur, 2022). This health issue leaves the government with no choice but to spend a significant amount of money on healthcare rather than on other basic services such as social development, sanitation, and road infrastructure (Kranjac & Kranjac, 2023). Another study shows that African countries spend about 13.2% of total health expenditure on non-communicable diseases (Boachie et al., 2022). It is estimated that obesity and overweight cost R4400 in South Africa in the 2017 financial year (Boachie, Tshehla, Mustapha, Kohli-Lynch, & Hofman, 2022). This puts the Department of Health in a crisis because about 80% of the South African population does not have medical aid and depends on public health care services (Maphumulo & Bhengu, 2019). These issues may be influenced by the fact that most low-income individuals cannot afford healthy food, leading them to purchase whatever is accessible and affordable at the time. Therefore, there is a need to develop a framework to improve the effectiveness of the indigenous Games in preventing and managing non-communicable diseases among youth in selected villages in the Vhembe district of Limpopo Province.
A conceptual framework is a collection of theories or models that guide a study (Du Plooy, Davis, and Bezuidenhout, 2014). The study is underpinned by decolonial theory, which challenges the dominance of Western sport and health paradigms and foregrounds indigenous Games as legitimate knowledge systems and spaces for physical activity. The theory is characterised by indigenous people engaging in activities to resist the practice of Western sport solely for self-determination, health, and wellbeing (Mukavetz, 2018). The main objective of decolonial theory is to create, sustain, and maintain a space for future generations. The study will further adopt a community-based participatory research framework to ensure equitable involvement of community members, including teenagers, youth, community elders, Indigenous Games Facilitators, Sport and Recreation Facilitators, parents, and guardians as co-creators.
This study stems from ongoing observations and reports highlighting significant gaps in youth health and well-being, particularly in rural South Africa, including the Vhembe District. The rising burden of non-communicable diseases and related health conditions, unbalanced diets, and psychosocial challenges among youth has raised concerns among health professionals and sports and recreation practitioners. Existing approaches to youth recreation and wellness programs have been fragmented, with limited integration of health promotion and preventive strategies tailored to youth. These approaches often privilege Western biomedical frameworks and overlook Indigenous knowledge systems, including Indigenous Games, which historically served as culturally grounded physical activity spaces that supported holistic health and social cohesion among rural youth. Addressing these gaps requires a community-based participatory approach that recognizes youth, elders, and community members as knowledge holders and partners in revitalizing Indigenous Games within their sociocultural context. In this study, youth well-being is understood holistically, encompassing physical health alongside cultural identity, psychosocial well-being, and meaningful participation in community life.
The study will use a community-based participatory mixed approach comprising qualitative and quantitative methods. The researcher will collaborate with youth and community stakeholders to co-develop a framework to promote Indigenous Games as a strategy to enhance youth well-being in rural communities. The approach will assist in measuring participants’ body composition, cardiorespiratory endurance, muscular strength, muscular endurance, and flexibility. ( Table 1).
The study will employ an exploratory sequential mixed-methods design. The design is characterised by collecting qualitative data and using the data to build a quantitative data collection instrument. The researcher will collect qualitative data and use it to develop a quantitative data collection instrument.
The purpose of this study is to explore Indigenous Games as culturally grounded, decolonial physical activity spaces that promote holistic well-being among youth in selected rural communities of the Vhembe District, Limpopo Province. Using a community-based participatory mixed-methods approach, the study seeks to examine the physical, psychosocial, and cultural significance of Indigenous Games and to co-develop a contextually relevant framework to enhance youth participation and well-being.
Phase one (empirical study: qualitative and quantitative approach)
Phase one, stage one: Qualitative approach
❖ To explore youths’ and community members’ perceptions of the physical, psychosocial, and cultural wellbeing benefits associated with participation in Indigenous Games.
❖ To examine Indigenous Games as decolonial physical activity practices that embody Indigenous knowledge, cultural values, and community understandings of youth wellbeing.
Phase one, stage two: quantitative approach
The researcher will use phase one, stage one, to develop and revise the quantitative objective. The researcher will use the qualitative objectives to confirm that Indigenous Games are culturally grounded, decolonial physical activity spaces that promote holistic well-being among participants in the Vhembe district of Limpopo Province.
❖ To assess selected physical health indicators, including body composition, cardiorespiratory endurance, muscular strength, muscular endurance, and flexibility, among youth participating in Indigenous Games in selected rural communities of the Vhembe District.
❖ To examine patterns and levels of participation in Indigenous Games among youth in selected rural communities of the Vhembe District.
Phase two: Meta-inferences
❖ In Phase two, a Meta-inference will be conducted in collaboration with youth and community stakeholders.
Phase three: framework development and validation to promote Indigenous Games
❖ To co-develop, in collaboration with youth and community stakeholders, a culturally relevant framework for promoting Indigenous Games as a strategy for enhancing youth wellbeing in rural communities.
❖ To validate the proposed framework with relevant community stakeholders, practitioners, and youth participants to ensure contextual relevance, cultural appropriateness, and sustainability.
The study will be conducted in the selected rural villages in the Vhembe district of Limpopo Province. Vhembe District is a rural-based district located in the north-west part of Limpopo Province. The district is one of the five districts in Limpopo Province, where many people are still participating in indigenous Games. There are 8 hospitals, 115 clinics, and 8 community health centres in the Vhembe District (Ntuli & Maboya, 2017). There are Venda, Tsonga, Pedi, and Afrikaner-speaking people in the area. The community members are rooted in cultural dance, where Malende and Tshikona are among the popular cultural dances in the area. One of the practices highly recommended in the area is respecting elders.
Study population
The target population refers to people or entities that share similar characteristics, such as principles, cultural values, and geographical area (Creswell, 2013). In this study, the target population will be children, teenagers, and youth aged 10 years and older who participate in indigenous games in selected rural villages within the Vhembe District of Limpopo Province.
Sampling, sampling procedure, and sampling size
Sampling is the process of selecting a portion of the population to represent the entire population (Du Plooy-Cilliers, Davis, and Bezuidenhout, 2014). The study will use a multi-stage random sampling design, in which children, teenagers, youth, community elders, Indigenous Games facilitators, parents, and sports and recreation facilitators will be sampled. Multi-stage random sampling is cost-effective when collecting data from a large population (Du Plooy-Cilliers, Davis, and Bezuidenhout, 2014). The researcher will include children, teenagers, youth, community elders, Indigenous Games facilitators, sports and recreation facilitators, parents, and guardians from five selected villages in the Vhembe district. After categorizing the participants into clusters, the researcher will use simple random sampling to select participants for the study. Those who have completed a written consent form and are willing to participate in the study will be selected. The researcher will cut small pieces of paper, write “yes” on some of the papers, and write “no” on the remaining papers. The researcher will fold the pieces of paper and put them in a box. Each participant will be allowed to pick one piece of paper. Those who pick a piece of paper labelled “yes” will be allowed to participate in the study, and those who pick a piece of paper labelled “no” will be excluded from the study.
Children, teenagers, youth, community elders, and sport and recreation facilitators aged 10 years and above who participate in indigenous games in the Vhembe district and are willing to take part in the study will be recruited.
Those who don’t come from villages in the Vhembe district will be excluded from participating in the project. Those who come from rural villages in the Vhembe district and don’t complete a written consent/assent form will be excluded from participating in the study.
The study will use focus group discussions and semi-structured interviews for data collection. The interview guide was developed in English. Participants will be asked probing questions. The interview guide will consist of the following questions: May you kindly share with me your perception about the physical, psychosocial, and cultural well-being benefits associated with participation in indigenous Games? The interview will be recorded using a digital recorder. The purpose of recording the interviews will be explained to the participants.
Pretesting of the Interview guide will be conducted before actual data collection on those who meet the inclusion criteria. The purpose of conducting pretesting is to correct problems that will be encountered when designing the data collection instrument. Questions found to be unclear will be clarified before data collection. Participants who will participate in pretesting will never form part of the actual study.
People who participate in Indigenous Games will be approached to be recruited for the study. The researcher will provide participants with full information about the study to allow them to decide whether they want to participate in the study or not. Those who are willing to engage in the study will be asked to complete a written consent form before they can participate. Participants will be informed that participation is voluntary, and those who wish to withdraw from participating can do so at any time; there will be no consequences for withdrawing from participating in the study. Participants will be assured that their personal details will not be used when writing a report, and their information will only be shared with those who are directly involved in the study.
The researcher will set appointments for data collection based on dates and times suitable for the participants. The focus Group Discussion and In-depth Interviews will be conducted in environments were conducive for participants. Focus group discussions and In-depth interviews will be recorded and stored in a digital voice recorder and transcribed using content thematic data analysis. The researcher will create a good rapport with the participants. Participants will be asked to permit the interview to be recorded. The interview session might last for an hour per participant for clarity-seeking questions. Two research assistants who understand English, Tshivenda, and Xitsonga will be recruited to assist in the data collection process.
Trustworthiness will be ensured through the following elements: (1) credibility, (2) Confirmability, (3) Transferability, and (4) Dependability.
The researcher will ensure credibility by using an appropriate sampling technique to select participants. The researcher will use appropriate data collection and analysis methods. The researcher will further ensure credibility by using prolonged engagement and member checks.
The researcher will spend time with the participants before the data collection process to build rapport and trust. This process will help participants feel at ease during the interview.
The researcher will ensure confirmability by transcribing information recorded during the data collection process without alterations. Additionally, the researcher will review the literature to identify similarities and differences and to verify whether the research findings are supported by the literature.
The study approach, design, setting, target population, inclusion criteria, sampling method and procedure, and conceptual theories used will be fully described. A full description of the study methodology will enable the study to be replicated by other researchers in the future and to conclude.
The researcher will ensure that there is no bias influencing participation. The researcher will apply a code-recode strategy, which involves the researcher coding the same data twice, with a period of two weeks between each coding. Independent coders who are experts in the field of research will be allowed to co-code the data. The results from the two coding will be compared to check if the results are similar.
The researcher will use ATLAS ti to analyse the data. Tape-recorded information will be carefully and repeatedly listened to, then transcribed verbatim. The researcher will transcribe the recorded information. Then similarities and differences will be identified, and similar information will be grouped into themes and sub-themes. Before concluding the data analysis, an independent coder will transcribe the interview for independent data analysis and to establish themes and sub-themes. Then, the themes and sub-themes formulated by the researcher and the independent coder will be discussed to reach a consensus. Then the themes and subthemes will be coded, and the findings will be interpreted.
Phase 1 stage 2: Quantitative approach.
Phase one, stage one findings will be used to develop quantitative objectives.
Study
This phase will use a quantitative research approach. The researcher will use a quantitative approach, collecting data from participants and analysing it using the Statistical Package for the Social Sciences. The quantitative data will assist the researcher in confirming the qualitative findings collected in phase one, stage one.
The study will employ an exploratory sequential mixed-methods design. The researcher will analyse the collected qualitative data and use the exploratory database to build a quantitative data collection instrument.
Sampling is the process of selecting a portion of the population to represent the entire population (Du Plooy-Cilliers, Davis, and Bezuidenhout, 2014). The study will use a multi-stage random sampling design, in which children, teenagers, youth, community elders, Indigenous Games facilitators, parents, and sports and recreation facilitators will be sampled. Multi-stage random sampling is cost-effective when collecting data from a large population (Du Plooy-Cilliers, Davis, and Bezuidenhout, 2014). The researcher will include children, teenagers, youth, community elders, Indigenous Games facilitators, sports and recreation facilitators, parents, and guardians from five selected villages in the Vhembe district. After categorizing the participants into clusters, the researcher will use simple random sampling to select participants for the study. Those who have completed a written consent form and are willing to participate in the study will be selected. The researcher will cut small pieces of paper, write “yes” on some of the papers, and write “no” on the remaining papers. The researcher will fold the pieces of paper and put them in a box. Each participant will be allowed to pick one piece of paper. Those who pick pieces of paper with “yes” will be allowed to participate in the study, and those who pick pieces of paper with “no” will be excluded from the study.
Children, teenagers, youth, community elders, and sport and recreation facilitators aged 10 years and above who participate in indigenous games in the Vhembe district and are willing to participate in the study will be recruited to participate in the study.
Those who don’t come from villages in the Vhembe district will be excluded from participating in the project. Those who come from rural villages in the Vhembe district and don’t complete a written consent/assent form will be excluded from participating in the study.
A structured self-administered questionnaire will be used for data collection. The questionnaire will consist of questions that address the WHO-5 Wellbeing Index and culturally adapted wellbeing measures. The questionnaire will consist of closed-ended questions. The data collection instrument will be developed in English. The questionnaire will comprise a demographic section, cardiorespiratory endurance, muscular strength, muscular endurance, flexibility, and indigenous Games participation patterns. Anthropometric measurements will be used to assess participants’ height and weight. The sit-and-reach test will measure flexibility, and the sprint test will assess participants’ speed. Research assistants will assist in taking the participants’ measurements. The mentor and statistician will be permitted to review the data-collection instrument to ensure its validity before data collection.
The mentor and a statistician will be allowed to examine the data collection instrument to ensure content is appropriate and to advise if there is any need for modification to ensure that the instrument is aligned with the study objectives. The researcher will further administer the data collection instrument to the participants to ensure validity.
The research instrument will be given to the mentors, who are experts in the field of study, to check if it appears to be valid. Based on the feedback from the promoters’ responses, the questionnaire will be modified. The modified questionnaire will be administered to participants who express interest and provide consent to participate in the study.
A statistician will be allowed to review the questionnaire for confirmation. This process will improve the presentation of the data collection instrument’s content. The anthropometric measurements, sit-and-reach test, and sprint test will be administered to participants who express interest and provide consent to participate in the study.
Reliability is defined as the process of assessing a study’s credibility (Du Plooy-Cilliers, Davis, and Bezuidenhout, 2014). This study will assess internal consistency reliability by conducting various tests designed to explore Indigenous Games as culturally grounded, decolonial physical activity spaces that promote holistic well-being among youth in selected rural communities of the Vhembe District. The study will also apply the inter-rater reliability standard procedure. The data collection instruments will be provided to the mentor, an expert in the field, to evaluate their effectiveness in gathering data that other researchers can replicate.
The researcher will pretest the data collection instrument before the actual data collection process. The results from the instrument pretesting will be used to modify the questionnaire to ensure it adequately measures the study variables. Pretesting of the data collection instrument will be conducted on ten percent of the total number of people who participate in indigenous games in the Vhembe area. Questions that are found to be unclear will be clarified before the data collection process. Participants who participated in pre-testing will not participate in the actual study because they have already participated in pre-testing of the data collection instrument.
Appointments for data collection will be scheduled at times and dates convenient for the participants. The researcher will provide participants with comprehensive information about the study, enabling them to make an informed decision regarding their participation. Those who choose to participate will be asked to provide written consent before data collection begins. The researcher will collaborate with the participants throughout the research process. The researcher and the participants will work together to develop and revise the data collection instrument. Participants will be informed that their participation is voluntary and that they may withdraw from the study at any time without any consequences. Participants who are under 18 years of age will be provided with a consent form for their parents or guardians before they can participate in the study. After parents or guardians have signed the written consent form, they will be provided with an assent form to sign before they can participate in the study. The researcher will assure participants that the information they provide will be shared only with individuals directly involved in the study, which includes the researcher, research assistant, mentor, and statistician.
Collected quantitative data will be coded, captured, cleaned, and analysed using the Statistical Package for the Social Sciences (SPSS) Version 30.0. Before analysis, data will be screened for missing values, outliers, and violations of the normality assumption. Descriptive statistics will be used to summarize participants’ demographic and study characteristics. A t-test will be used to compare observed data, focusing on actual values presented as proportions, percentages, frequencies, and means. Additionally, the Pearson correlation test will be conducted. The analyzed data will be displayed using tables, graphs, and charts.
In this study, the overall conclusion will be drawn from both the qualitative and quantitative approaches. Commitment to a plan of action will guide the researcher in meta-inference and conceptualization. The researcher in column one will indicate the main themes that will emerge from the qualitative data analysis, and in column two will indicate the findings representing those themes. In column three, confirmatory explanations from the quantitative findings will be outlined. Column four will provide conclusive statements about the findings that will be used to develop the framework.
This phase will focus on developing a framework to improve the effectiveness of Indigenous Games in the prevention and management of non-communicable diseases. The findings will guide the researcher to develop a framework. The researcher will use the BOEM model, the Health Promotion model, and SWOT analysis to develop the framework.
This phase of the study will focus on validating the framework to improve the effectiveness of the Indigenous Games in the prevention and management of non-communicable diseases. The Delphi Technique will be used to guide the validation of the framework. The researcher will seek experts’ opinions on the development of the framework. The researcher will seek the opinions of ten experts. The Delphi technique will assist in ensuring that the developed framework is relevant to the desired goal. The researcher will consult experts who know indigenous games to evaluate whether the framework will address the identified challenges. The researcher will explain the purpose of the study to the experts and outline exactly what is expected. The Delphi technique will consist of several phases or stages through which experts will work until they achieve significant consensus.
The ethical approval will be obtained from the relevant ethics review committees at the University of Venda. A detailed research proposal, along with supporting documentation such as consent forms and data collection tools, will be submitted for ethical review. Approval certificates will be secured and retained for audit purposes.
Before recruiting participants, permission will be obtained from community gatekeepers, including local traditional leaders and ward councillors. Stakeholder meetings will be held to ensure transparency and cultural sensitivity.
Participants will be recruited voluntarily based on inclusion criteria, prioritizing teenagers and youth aged 10 years and older. Written Informed consent will be obtained from each participant before any data collection. For participants under 18 years of age, a written consent form will be provided for their parents or guardians to sign before participation. Additionally, participants under 18 will be required to complete an assent form before taking part in the study. This process will involve explaining the purpose of the study, the benefits, and the potential risks. The researcher will explain to the participants that participating in the study is voluntary, and they can withdraw at any time. The participants will sign a written consent form before participating in the study.
All personal information of the participants will be removed from the collected data to ensure anonymity. The data will be securely stored in password-protected electronic files and locked physical files, with access restricted to authorized personnel only.
The findings will be disseminated through a combination of informal and formal platforms to ensure they reach all relevant stakeholders and to contribute to the promotion of indigenous games among youth in the Limpopo Province of South Africa. The researcher will prepare and submit manuscripts to DHET-accredited journals for publication. Additionally, the findings will be presented at research conferences and seminars. Summary reports and presentations will be shared with district health officials, NGOs, social development officers, and other key partners. Feedback from these sessions will guide the sustainability and scaling of the initiative. Concise, actionable policy briefs will be developed and distributed to provincial sport and recreation authorities and municipal councils to advocate for integrating whole-person wellness models into local health promotion strategies. Local dissemination sessions will be conducted in participating villages to share results with community members and local leaders. The University of Venda’s Department of Biokinetics, Recreation, and Sport Science may incorporate the findings into training modules for students to strengthen wellness efforts beyond the project’s duration. Discussions with local authorities and partners will explore continued support, resource allocation, and the potential institutionalization of the framework.
Mokwena T. J conceptualized the manuscript. Mohlala M and Mukoma G reviewed the manuscript and reached a consensus to approve it for publication. All authors have read and agreed to the published version of the manuscript.
The manuscript did not involve human participants or receive ethical approval.