{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T23:25:15Z","timestamp":1793057115461,"version":"4.5.0"},"reference-count":56,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"DOI":"10.1038\/s41598-025-20342-w","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T08:59:38Z","timestamp":1761037178000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Menstrual irregularity and associated factors among female adolescents in Somali region high schools Ethiopia 2023"],"prefix":"10.1038","volume":"15","author":[{"given":"Nasir","family":"Hussein","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasiye","family":"Shiferaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arega Abebe","family":"Lonsako","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahir Yousuf","family":"Nour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haymanot","family":"Mezmur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,21]]},"reference":[{"key":"20342_CR1","unstructured":"Dutta, D. Textbook of DC Dutta\u2019s Gynecology 6th edn (Jaypee Brothers Medical Publishers (P) Ltd, 2013)."},{"key":"#cr-split#-20342_CR2.1","unstructured":"ACOG. The Menstrual cycle: Menstruation, ovulation, and how pregnancy occurs. [cited 2024 1 January]"},{"key":"#cr-split#-20342_CR2.2","unstructured":"(2022). Available from: https:\/\/www.acog.org\/womens-health\/infographics\/the-menstrual-cycle"},{"issue":"4","key":"20342_CR3","doi-asserted-by":"publisher","first-page":"263","DOI":"10.5005\/jp-journals-10006-1603","volume":"10","author":"G Jyothi","year":"2018","unstructured":"Jyothi, G., Kumar, A. & Murthy, N. S. Correlation of anthropometry and nutritional assessment with menstrual cycle patterns. J. South. Asian Federation Obstet. Gynecol. 10 (4), 263\u2013269 (2018).","journal-title":"J. South. Asian Federation Obstet. Gynecol."},{"issue":"10","key":"20342_CR4","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1055\/s-0041-1736143","volume":"43","author":"H Gomes","year":"2021","unstructured":"Gomes, H. et al. Abnormal uterine bleeding in adolescence: when menarche reveals other surprises. Rev. Bras Ginecol E Obstet. 43 (10), 789\u2013792 (2021).","journal-title":"Revista Brasileira De Ginecol. E Obstetr\u00edcia"},{"key":"20342_CR5","unstructured":"BANK, W. Menstrual Health and Hygiene (2022). Available from: https:\/\/www.worldbank.org\/en\/topic\/water\/brief\/menstrual-health-and-hygiene"},{"issue":"3","key":"20342_CR6","first-page":"462","volume":"6","author":"D Tewari","year":"2020","unstructured":"Tewari, D. & Tewari, P. Assessment of menstrual disorders among adolescent girls. Int. J. Home Sci. 6 (3), 462\u2013465 (2020).","journal-title":"Int. J. Home Sci."},{"key":"20342_CR7","doi-asserted-by":"publisher","first-page":"e2020494","DOI":"10.1590\/1984-0462\/2022\/40\/2020494","volume":"40","author":"P Marques","year":"2022","unstructured":"Marques, P., Madeira, T. & Gama, A. Menstrual cycle among adolescents: Girls\u2019 awareness and influence of age at menarche and overweight. Rev. Paul. Pediatr. 40, e2020494 (2022).","journal-title":"Revista Paulista De Pediatria"},{"issue":"8","key":"20342_CR8","first-page":"2307","volume":"38","author":"S Latif","year":"2022","unstructured":"Latif, S. et al. Junk food consumption in relation to menstrual abnormalities among adolescent girls: A comparative cross sectional study. Pak. J. Med. Sci. 38 (8), 2307 (2022).","journal-title":"Pakistan J. Med. Sci."},{"issue":"5","key":"20342_CR9","doi-asserted-by":"publisher","first-page":"e04018","DOI":"10.1016\/j.heliyon.2020.e04018","volume":"6","author":"CC Anikwe","year":"2020","unstructured":"Anikwe, C. C. et al. Age at menarche, menstrual characteristics, and its associated morbidities among secondary school students in abakaliki, Southeast Nigeria. Heliyon 6 (5), e04018 (2020).","journal-title":"Heliyon"},{"key":"20342_CR10","doi-asserted-by":"crossref","unstructured":"Ali, A., Khalafala, H. & Fadlalmola, H. Menstrual Disorders among Nursing Students at Al Neelain University, Khartoum State (Sudan Journal of Medical Sciences (SJMS), 2020).","DOI":"10.18502\/sjms.v15i2.7067"},{"key":"20342_CR11","unstructured":"UNISCO. Menstrual Hygiene Management. [cited 2024 May 2024]; (2014). https:\/\/pacificdata.org\/data\/dataset\/b08f10df-3115-4beb-980c-e761eb176c1b\/resource\/eebe0ff0-4e9a-48d5-b00e-21bed26d5df5\/download\/mhm-in-kiribati-schools-10pt-1.pdf"},{"key":"20342_CR12","doi-asserted-by":"crossref","unstructured":"Mittiku, Y. M. et al. Menstrual Irregularity and its Associated Factors among College Students in Ethiopia, 2021 3 (Frontiers in Global Women\u2019s Health, 2022).","DOI":"10.3389\/fgwh.2022.917643"},{"issue":"1","key":"20342_CR13","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1186\/s12978-021-01156-1","volume":"18","author":"AB Zeru","year":"2021","unstructured":"Zeru, A. B., Gebeyaw, E. D. & Ayele, E. T. Magnitude and associated factors of menstrual irregularity among undergraduate students of Debre Berhan university, Ethiopia. Reproduct. Health. 18 (1), 101 (2021).","journal-title":"Reproductive Health"},{"issue":"1","key":"20342_CR14","doi-asserted-by":"publisher","first-page":"e0262295","DOI":"10.1371\/journal.pone.0262295","volume":"17","author":"B Sahiledengle","year":"2022","unstructured":"Sahiledengle, B. et al. Menstrual hygiene practice among adolescent girls in ethiopia: A systematic review and meta-analysis. PloS One. 17 (1), e0262295 (2022).","journal-title":"PloS One"},{"issue":"4","key":"20342_CR15","first-page":"1","volume":"3","author":"A Aber","year":"2018","unstructured":"Aber, A. Prevalence of menstrual disturbances among female students of fourth and fifth classes of curative medicine faculty. IJRDO\u2014J Health Sci. Nurs. 3 (4), 1\u201314 (2018).","journal-title":"IJRDO\u2014J Health Sci. Nurs."},{"issue":"1","key":"20342_CR16","doi-asserted-by":"publisher","first-page":"e0280356","DOI":"10.1371\/journal.pone.0280356","volume":"18","author":"E Demeke","year":"2023","unstructured":"Demeke, E. et al. Effect of menstrual irregularity on academic performance of undergraduate students of Debre Berhan university: A comparative cross sectional study. Plos One. 18 (1), e0280356 (2023).","journal-title":"Plos One"},{"issue":"1","key":"20342_CR17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12905-019-0730-5","volume":"19","author":"E Ansong","year":"2019","unstructured":"Ansong, E. et al. Menstrual characteristics, disorders and associated risk factors among female international students in Zhejiang province, china: a cross-sectional survey. BMC Women\u2019s Health. 19 (1), 1\u201310 (2019).","journal-title":"BMC Women\u2019s Health"},{"issue":"11","key":"20342_CR18","doi-asserted-by":"publisher","first-page":"2415","DOI":"10.1007\/s00125-021-05531-2","volume":"64","author":"YX Wang","year":"2021","unstructured":"Wang, Y. X. et al. Pre-pregnancy menstrual cycle regularity and length and the risk of gestational diabetes mellitus: Prospective cohort study. Diabetologia 64 (11), 2415\u20132424 (2021).","journal-title":"Diabetologia"},{"key":"20342_CR19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40738-020-00070-7","volume":"6","author":"S Musa","year":"2020","unstructured":"Musa, S. & Osman, S. Risk profile of Qatari women treated for infertility in a tertiary hospital: A case-control study. Fertil. Res. Pract. 6, 1\u201317 (2020).","journal-title":"Fertility Res. Pract."},{"issue":"12","key":"20342_CR20","doi-asserted-by":"publisher","first-page":"e0168402","DOI":"10.1371\/journal.pone.0168402","volume":"11","author":"M Rostami Dovom","year":"2016","unstructured":"Rostami Dovom, M. et al. Menstrual cycle irregularity and metabolic disorders: A population-based prospective study. PLoS One. 11 (12), e0168402 (2016).","journal-title":"PLoS One"},{"issue":"3","key":"20342_CR21","first-page":"p917643","volume":"2022","author":"YM Mittiku","year":"2021","unstructured":"Mittiku, Y. M. et al. Menstrual irregularity and its associated factors among college students in Ethiopia. Front. Glob. Women\u2019s Health. 2022 (3), 917643 (2021).","journal-title":"Front. Global Women\u2019s Health"},{"issue":"4","key":"20342_CR22","doi-asserted-by":"publisher","first-page":"1271","DOI":"10.18203\/2320-1770.ijrcog20190980","volume":"8","author":"U Sreelakshmi","year":"2019","unstructured":"Sreelakshmi, U. et al. Impact of dietary and lifestyle choices on menstrual patterns in medical students. Int. J. Reprod. Contracept. Obstet. Gynecol. 8 (4), 1271\u20131277 (2019).","journal-title":"Int. J. Reprod. Contracept. Obstet. Gynecol."},{"key":"20342_CR23","doi-asserted-by":"crossref","unstructured":"Alhammadi, M. et al. Menstrual Cycle Irregularity and Examination Stress Among Female Medical Students at King Abdulaziz University, Jeddah, Saudi Arabia. (2022).","DOI":"10.21203\/rs.3.rs-1330421\/v1"},{"issue":"2","key":"20342_CR24","doi-asserted-by":"publisher","first-page":"225","DOI":"10.4103\/JCMRP.JCMRP_28_19","volume":"4","author":"AA Abd Elwadood","year":"2019","unstructured":"Abd Elwadood, A. A. et al. The effect of hormonal contraception and intrauterine device on the pattern of menstrual cycle. J. Curr. Med. Res. Pract. 4 (2), 225 (2019).","journal-title":"J. Curr. Med. Res. Pract."},{"issue":"3","key":"20342_CR25","doi-asserted-by":"publisher","first-page":"259","DOI":"10.3329\/ajmbr.v4i3.38464","volume":"4","author":"LC Sen","year":"2018","unstructured":"Sen, L. C. et al. Study on relationship between obesity and menstrual disorders. Asian J. Med. Biol. Res. 4 (3), 259\u2013266 (2018).","journal-title":"Asian J. Med. Biol. Res."},{"issue":"1","key":"20342_CR26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12905-018-0552-x","volume":"18","author":"AA Muluneh","year":"2018","unstructured":"Muluneh, A. A. et al. Prevalence and associated factors of dysmenorrhea among secondary and preparatory school students in Debremarkos town, North-West Ethiopia. BMC Women\u2019s Health 18 (1), 1\u20138 (2018).","journal-title":"BMC Women\u2019s Health"},{"key":"20342_CR27","unstructured":"Rahayu, E. P. The Relationship nutritional status with the menstrual cycle and dismenorea incident in midwifery diploma Unusa, in Proceeding Surabaya International Health Conference 2017 (2017)."},{"key":"20342_CR28","doi-asserted-by":"crossref","unstructured":"Liu, X. et al. Early menarche and menstrual problems are associated with sleep disturbance in a large sample of Chinese adolescent girls. Sleep 40 (9) (2017).","DOI":"10.1093\/sleep\/zsx107"},{"issue":"1","key":"20342_CR29","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.sleh.2014.12.010","volume":"1","author":"M Hirshkowitz","year":"2015","unstructured":"Hirshkowitz, M. et al. National sleep foundation\u2019s sleep time duration recommendations: Methodology and results summary. Sleep Health. 1 (1), 40\u201343 (2015).","journal-title":"Sleep. Health"},{"key":"20342_CR30","unstructured":"WHO. Physical activity. [cited 2024 November]; (2024). Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/physical-activity"},{"key":"20342_CR31","unstructured":"WHO. Global status report on physical activity 2022. [cited 2024 16 January 2024]; (2022). Available from: https:\/\/www.who.int\/teams\/health-promotion\/physical-activity\/global-status-report-on-physical-activity-2022"},{"key":"20342_CR32","unstructured":"Cohen, S. & Williamson, G. Perceived stress in a probability sample of the US In S. Oskamp & S. Spacapam, in The Social Psychology of Health: Claremont Symposium on Applied Social Psychology (Sage Publications, 1988)."},{"issue":"12","key":"20342_CR33","doi-asserted-by":"publisher","first-page":"7769","DOI":"10.4103\/jfmpc.jfmpc_1201_22","volume":"11","author":"P Bhardwaj","year":"2022","unstructured":"Bhardwaj, P., Yadav, S. K. & Taneja, J. Magnitude and associated factors of menstrual irregularity among young girls: A cross-sectional study during COVID-19 second wave in India. J. Fami. Med. Prim. Care 11 (12), 7769 (2022).","journal-title":"J. Family Med. Prim. Care"},{"key":"20342_CR34","doi-asserted-by":"crossref","unstructured":"Erye, E. et al. The relationship between food consumption patterns and the menstrual cycle in aldoscent girls. MIKIA: Mimbar Ilmiah Kesehatan Ibu dan Anak (Maternal and Neonatal Health Journal)  40\u201348 (2021).","DOI":"10.36696\/mikia.v5i2.91"},{"key":"20342_CR35","doi-asserted-by":"crossref","unstructured":"Ali, A., Khalafala, H. & Fadlalmola, H. Menstrual disorders among nursing students at al Neelain university, Khartoum state. Sudan. J. Med. Sci. (SJMS) 199\u2013214 (2020).","DOI":"10.18502\/sjms.v15i2.7067"},{"key":"20342_CR36","unstructured":"Chhetri, D. D. & Singh, M. S. Menstrual characteristics among the nepali adolescent girls. Indian J. Public Health Res. Dev. 11(7) (2020)."},{"key":"20342_CR37","doi-asserted-by":"crossref","unstructured":"Alhammadi, M. H. et al. Menstrual Cycle Irregularity during Examination among Female Medical Students at King Abdulaziz University, Jeddah, Saudi Arabia, Vol. 367, 22  (BMC Women\u2019s Health, 2022).","DOI":"10.1186\/s12905-022-01952-2"},{"key":"20342_CR38","doi-asserted-by":"crossref","unstructured":"Shiferaw, M. T., Wubshet, M. & Tegabu, D. Menstrual problems and associated factors among students of Bahir Dar university, Amhara National regional state, Ethiopia: A cross-sectional survey. Pan Afr. Med. J. 17 (2014).","DOI":"10.11604\/pamj.2014.17.246.2230"},{"issue":"1","key":"20342_CR39","first-page":"57","volume":"12","author":"A Osonuga","year":"2018","unstructured":"Osonuga, A. & Ekor, M. N. The menstrual characteristics of undergraduate students in a Ghanaian public university. Jos J. Med. 12 (1), 57\u201363 (2018).","journal-title":"Jos J. Med."},{"key":"20342_CR40","doi-asserted-by":"crossref","unstructured":"Varghese, L., Prakash, P. J. & Lekha, V. A study to identify the menstrual problems and related practices among adolescent girls in selected higher secondary school in Thiruvananthapuram, Kerala, India. J SAFOG (South Asian Federation of Obstetrics and Gynaecology) 11 (1), 13\u201316 (2019).","DOI":"10.5005\/jp-journals-10006-1642"},{"key":"20342_CR41","unstructured":"Derseh, B. et al. Prevalence of Dysmenorrhea and its Effects on School Performance: A Cross-sectional Study., Vol. 6, 6 (2017)."},{"key":"20342_CR42","doi-asserted-by":"publisher","first-page":"2158","DOI":"10.18203\/2320-1770.ijrcog20221929","volume":"11","author":"L Varghese","year":"2022","unstructured":"Varghese, L., Saji, A. & Bose, P. Menstrual irregularities and related risk factors among adolescent girls. Int. J. Reprod. Contracept. Obstet. Gynecol. 11, 2158 (2022).","journal-title":"Int. J. Reprod. Contracept. Obstet. Gynecol."},{"key":"20342_CR43","unstructured":"Zafar, M. et al. Pattern and prevalence of menstrual disorders in adolescents. Int. J. Pharm. Sci. Res., 9(5) (2017)."},{"issue":"1","key":"20342_CR44","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s12902-025-01839-x","volume":"25","author":"BT Guzha","year":"2025","unstructured":"Guzha, B. T. et al. Assessment of the impact of HIV infection on the hypothalamic-pituitary-ovarian axis and pubertal development among adolescent girls at a tertiary centre in zimbabwe: A cross-sectional study. BMC Endocr. Disorders. 25 (1), 16 (2025).","journal-title":"BMC Endocr. Disorders"},{"key":"20342_CR45","doi-asserted-by":"crossref","unstructured":"Karout, N., Hawai, S. & Altuwaijri, S. Prevalence and pattern of menstrual disorders among Lebanese nursing students. EMHJ-East. Mediterr. Health J. 18 (4), 346\u2013352 (2012).","DOI":"10.26719\/2012.18.4.346"},{"issue":"1","key":"20342_CR46","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1089\/jwh.2015.5634","volume":"26","author":"AN Jung","year":"2017","unstructured":"Jung, A. N. et al. Detrimental effects of higher body mass index and smoking habits on menstrual cycles in Korean women. J. Womens Health (Larchmt). 26 (1), 83\u201390 (2017).","journal-title":"J. Womens Health (Larchmt)"},{"issue":"6","key":"20342_CR47","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1111\/j.1479-828X.2009.01097.x","volume":"49","author":"PJ Chang","year":"2009","unstructured":"Chang, P. J. et al. Risk factors on the menstrual cycle of healthy Taiwanese college nursing students. Aust. N. Z. J. Obstet. Gynaecol. 49 (6), 689\u2013694 (2009).","journal-title":"Aust N Z. J. Obstet. Gynaecol."},{"issue":"Suppl 1","key":"20342_CR48","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1007\/s12098-018-2822-x","volume":"86","author":"V De Sanctis","year":"2019","unstructured":"De Sanctis, V. et al. Age at menarche and menstrual abnormalities in adolescence: does it matter? The evidence from a large survey among Italian secondary schoolgirls. Indian J. Pediatr. 86 (Suppl 1), 34\u201341 (2019).","journal-title":"Indian J. Pediatr."},{"issue":"1","key":"20342_CR49","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1186\/1824-7288-38-38","volume":"38","author":"F Rigon","year":"2012","unstructured":"Rigon, F. et al. Menstrual pattern and menstrual disorders among adolescents: An update of the Italian data. Ital. J. Pediatr. 38 (1), 38 (2012).","journal-title":"Ital. J. Pediatr."},{"key":"20342_CR50","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1007\/s00737-018-0872-8","volume":"21","author":"T Kim","year":"2018","unstructured":"Kim, T. et al. Associations of mental health and sleep duration with menstrual cycle irregularity: A population-based study. Arch. Women Ment. Health. 21, 619\u2013626 (2018).","journal-title":"Arch. Women Ment. Health"},{"key":"20342_CR51","doi-asserted-by":"crossref","unstructured":"Shechter, A. & Boivin, D. B. Sleep, hormones, and circadian rhythms throughout the menstrual cycle in healthy women and women with premenstrual dysphoric disorder. Int. J. Endocrinol. 259345 (2010).","DOI":"10.1155\/2010\/259345"},{"issue":"12","key":"20342_CR52","doi-asserted-by":"publisher","first-page":"7769","DOI":"10.4103\/jfmpc.jfmpc_1201_22","volume":"11","author":"P Bhardwaj","year":"2022","unstructured":"Bhardwaj, P., Yadav, S. K. & Taneja, J. Magnitude and associated factors of menstrual irregularity among young girls: A cross-sectional study during COVID-19 second wave in India. J. Family Med. Prim. Care. 11 (12), 7769\u20137775 (2022).","journal-title":"J. Family Med. Prim. Care"},{"key":"20342_CR53","doi-asserted-by":"crossref","unstructured":"Nillni, Y. I. et al. Mental health, psychotropic medication use, and menstrual cycle characteristics. Clin. Epidemiol.  1073\u20131082 (2018).","DOI":"10.2147\/CLEP.S152131"},{"issue":"3","key":"20342_CR54","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1080\/0167482X.2017.1321631","volume":"39","author":"EK Jung","year":"2018","unstructured":"Jung, E. K. et al. Prevalence and related factors of irregular menstrual cycles in Korean women: The 5th Korean National health and nutrition examination survey (KNHANES-V, 2010\u20132012). J. Psychosom. Obstet. Gynecol. 39 (3), 196\u2013202 (2018).","journal-title":"J. Psychosom. Obstet. Gynecol."},{"issue":"4","key":"20342_CR55","doi-asserted-by":"publisher","first-page":"468","DOI":"10.35946\/arcr.v34.4.11","volume":"34","author":"MA Stephens","year":"2012","unstructured":"Stephens, M. A. & Wand, G. Stress and the HPA axis: Role of glucocorticoids in alcohol dependence. Alcohol Res. 34 (4), 468\u2013483 (2012).","journal-title":"Alcohol Res."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-20342-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-20342-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-20342-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T08:59:48Z","timestamp":1761037188000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-20342-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,21]]},"references-count":56,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["20342"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-20342-w","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,21]]},"assertion":[{"value":"4 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical clearance was obtained from the Institutional Health Research Ethics Review Committee of the College of Health and Medical Sciences, Haramaya University, (Reference Number: IHRERC\/087\/2023). and was subsequently delivered to the Somali Regional Education Bureau (SREB) and Jigjiga city administrations for their official approval. Letters were prepared and submitted to the local authorities of the selected schools. Signed, voluntary, written, Informed consent was obtained from each participant. For participants under the age of 18 years, informed, voluntary, written, and signed consent was obtained from their parents or guardians. Confidentiality was maintained at all levels of the study. Participant selection was based on their willingness to participate, and they were fully informed of the voluntary nature of the study, including their right to withdraw at any time.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"36591"}}