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No: JUIH\/IRB\/108\/22; August 11, 2022). Further regional clearance was obtained from the Ethics Review Committee of the City Government of Addis Ababa Health Bureau (Ref. No: A\/H\/2077\/227; December 23, 2023). A formal extension for continuous oversight was granted by the Addis Ababa City Government Health Bureau (Ref. No: A.A.\/25018\/) on November 30, 2024, ensuring valid ethical coverage through December 2, 2025. We confirm that all methods and experiments involving human participants were performed in accordance with the relevant guidelines and regulations, including the Declaration of Helsinki and Good Clinical Practice (GCP) standards.Written informed consent was obtained from all participants, including the pregnant women and their chosen companions, prior to enrollment. In cases of limited literacy, the information sheet was read aloud in the presence of an independent witness, and consent was documented using the participant\u2019s thumbprint and the witness\u2019s signature. Participation was entirely voluntary, and all individuals were informed of their right to withdraw from the study at any time without penalty or loss of access to standard healthcare services (consent to participation see Annex1).","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"2354"}}