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The approval letter was formally submitted to the Babile District Health Office and Bisidimo General hospital. Final approval was obtained from health facility head. Informed, voluntary, written and signed consent was obtained from all participants, including those without formal education, and from parents or legal guardians of minors under 18 years of age. The study was conducted in full compliance with the human research Declaration of Helsinki to ensure participants\u2019 rights, safety, and well-being. To ensure confidentiality, all data were anonymized, coded, and stored on a secured computer.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"Not Applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1145"}}