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Ethical Approval for the study was obtained from the Health Research and Ethics committee of the University of Port Harcourt Teaching Hospital, before commencement of the study. The study protocol, including the consent procedure, was reviewed and approved by the Health Research and Ethics Committee (Approval No: UPTH\/ADM\/90\/S.II\/VOL.XI\/1948). Considering the minimal-risk and non-interventional nature of the study, and logistical challenges of obtaining written parental consent, parents were informed through the school head, who obtained verbal consent on their behalf. In addition, all children were provided with age-appropriate explanations of the study and gave verbal assent before participation.To ensure confidentiality, all collected data were securely stored in anonymized systems, adhering to the ethical standards outlined in the Declaration of Helsinki for human subject research.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Ethics approval and consent to participate"}},{"value":"Not applicable since the analyzed data contained only de-identified data.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Competing interests"}}],"article-number":"1631"}}