{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T14:12:41Z","timestamp":1788876761550,"version":"build-2803163510"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":76,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Australian National Health and Medical Research Council","award":["1099655"],"award-info":[{"award-number":["1099655"]}]},{"name":"Australian National Health and Medical Research Council","award":["1195716"],"award-info":[{"award-number":["1195716"]}]},{"name":"WA Future Health Research and Innovation Fund","award":["WANMAEL2024-25\/22"],"award-info":[{"award-number":["WANMAEL2024-25\/22"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Reprod Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adolescents and young adults (AYAs) in Ethiopia face multiple challenges in accessing sexual and reproductive health (SRH) services. Understanding the barriers and facilitators to SRH service uptake is essential for designing tailored interventions. Therefore, this study aimed to explore barriers and facilitators to SRH service uptake from the perspectives of AYAs and stakeholders in southern Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a qualitative study in the Sidama region, Southern Ethiopia using focus group discussions (FGDs) with AYAs recruited from schools, communities, and a non-governmental organisation. A supplemental FGD was conducted with government officials, clinicians and SRH experts to capture stakeholder perspectives. The FGD was conducted in the national language (\n                      <jats:italic>Amharic<\/jats:italic>\n                      ), which was then transcribed and translated into English for analysis. A thematic content analysis was used to present emerging themes in the FGDs. A ranking of barriers and facilitators was conducted to identify the most influential factors for SRH service uptake. NVivo 15 was used for data management and organisation for the thematic analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nine FGDs were conducted with 56 AYAs and seven experts, with each FGD comprising 6\u20138 participants. We identified four major themes: 1) health system and policy environment, 2) service access and delivery, 3) user experience and outcomes, and 4) sociocultural and economic determinants. Participants ranked service quality, cost, and privacy higher in their influence on determining SRH service uptake. Stigma, religious beliefs, poverty, and urban migration were also identified as barriers to SRH service access among AYAs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>SRH service uptake among AYAs was shaped by their interconnected health system and policy environment; service access and delivery; user experiences and outcomes, and sociocultural and economic determinants. Barriers and facilitators from service access and delivery theme such as service quality, privacy and health system factors such as cost emerged as the most influential drivers shaping service uptake. Policy and programme efforts should consider improving service quality, strengthening confidentiality, and reducing financial barriers. The findings may also inform future quantitative research examining AYAs\u2019 preferences for SRH service.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12978-026-02400-2","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T11:51:31Z","timestamp":1782301891000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers and facilitators to sexual and reproductive health services among adolescents and young adults in Sidama region, Ethiopia: a qualitative study"],"prefix":"10.1186","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1768-6689","authenticated-orcid":false,"given":"Melaku Birhanu","family":"Alemu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0625-4330","authenticated-orcid":false,"given":"Jaya AR","family":"Dantas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5350-6334","authenticated-orcid":false,"given":"Zohra S","family":"Lassi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3112-3893","authenticated-orcid":false,"given":"Richard","family":"Norman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3740-8117","authenticated-orcid":false,"given":"Gavin","family":"Pereira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4784-8151","authenticated-orcid":false,"given":"Gizachew A","family":"Tessema","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"2400_CR1","unstructured":"UN. DEFINITION OF YOUTH Accessed in 03\/29\/2023 [Available from: https:\/\/www.un.org\/esa\/socdev\/documents\/youth\/fact-sheets\/youth-definition.pdf."},{"key":"2400_CR2","unstructured":"Bureau UC. Population estimates and projections 2025 [Available from: https:\/\/www.census.gov\/data-tools\/demo\/idb\/#\/dashboard?dashboard_page=country&COUNTRY_YR_ANIM=2025&CCODE_SINGLE=ET&subnat_map_admin=ADM1&CCODE=ET."},{"key":"2400_CR3","unstructured":"UNFPA. Seeing the Unseen: The case for action in the neglected crisis of unintended pregnancy 2022 [Available from: https:\/\/www.unfpa.org\/sites\/default\/files\/pub-pdf\/EN_SWP22%20report_0.pdf."},{"issue":"11","key":"2400_CR4","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0259262","volume":"16","author":"J Merga","year":"2021","unstructured":"Merga J, Wirtu D, Bekuma TT, Regasa MT. Unintended pregnancy and the factors among currently pregnant married youths in Western Oromia, Ethiopia: a mixed method. PLoS ONE. 2021;16(11):e0259262.","journal-title":"PLoS ONE"},{"issue":"2","key":"2400_CR5","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-087224","volume":"15","author":"TL Dadi","year":"2025","unstructured":"Dadi TL, Medhin G, Fentaye FW, Tadesse D, Tassew ST, Wakene TU, et al. The state of youth sexual and reproductive health problems and service utilisation in major towns of Ethiopia: a cross-sectional study. BMJ Open. 2025;15(2):e087224.","journal-title":"BMJ Open"},{"issue":"6","key":"2400_CR6","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1016\/j.jadohealth.2017.12.015","volume":"62","author":"E Sully","year":"2018","unstructured":"Sully E, Dibaba Y, Fetters T, Blades N, Bankole A. Playing it safe: legal and clandestine abortions among adolescents in Ethiopia. J Adolesc Health. 2018;62(6):729\u201336.","journal-title":"J Adolesc Health"},{"issue":"7","key":"2400_CR7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0271221","volume":"17","author":"T Gelibo","year":"2022","unstructured":"Gelibo T, Lulseged S, Eshetu F, Abdella S, Melaku Z, Ajiboye S, et al. Spatial distribution and determinants of HIV prevalence among adults in urban Ethiopia: Findings from the Ethiopia Population-based HIV Impact Assessment Survey (2017\u20132018). PLoS ONE. 2022;17(7):e0271221.","journal-title":"PLoS ONE"},{"issue":"1","key":"2400_CR8","doi-asserted-by":"publisher","first-page":"1976","DOI":"10.1186\/s12889-024-19548-w","volume":"24","author":"EK Bogale","year":"2024","unstructured":"Bogale EK, Anagaw TF, Tiruneh MG, Fenta ET, Endeshaw D, Delie AM, et al. Prevalence of sexually transmitted infections, and its associated factors among students in Ethiopia: a systematic review and meta-analysis study. BMC Public Health. 2024;24(1):1976.","journal-title":"BMC Public Health"},{"issue":"1","key":"2400_CR9","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-018-0501-z","volume":"15","author":"W Binu","year":"2018","unstructured":"Binu W, Marama T, Gerbaba M, Sinaga M. Sexual and reproductive health services utilization and associated factors among secondary school students in Nekemte town, Ethiopia. Reprod Health. 2018;15(1):64.","journal-title":"Reprod Health"},{"issue":"1","key":"2400_CR10","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-12634-x","volume":"22","author":"A Habte","year":"2020","unstructured":"Habte A, Dessu S, Bogale B, Lemma L. Disparities in sexual and reproductive health services utilization among urban and rural adolescents in southern Ethiopia, 2020: a comparative cross-sectional study. BMC Public Health. 2020;22(1):203.","journal-title":"BMC Public Health"},{"issue":"2","key":"2400_CR11","first-page":"59","volume":"2","author":"A Jaleta","year":"2017","unstructured":"Jaleta A, Assefa A, Amentie M. Youth friendly reproductive health service utilization and associated factors among youths in Metekel zone, north west Ethiopia. International Journal of Ophthalmology & Visual Science. 2017;2(2):59\u201364.","journal-title":"International Journal of Ophthalmology & Visual Science"},{"issue":"5","key":"2400_CR12","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0300151","volume":"19","author":"YK Abdu","year":"2024","unstructured":"Abdu YK. Modern contraceptive utilization and associated factors among younger and older married youth women in Ethiopia: Evidence from Ethiopia Mini Demographic and Health Survey 2019. PLoS ONE. 2024;19(5):e0300151.","journal-title":"PLoS ONE"},{"issue":"1","key":"2400_CR13","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1186\/s12978-024-01794-1","volume":"21","author":"G Zeleke","year":"2024","unstructured":"Zeleke G, Mekonnen A, Abuhay T, Agimas MC. Proportion of early treatment seeking for sexually transmitted infections and associated factors among patients attending youth friendly service in Bahir Dar City health centers, Northwest, Ethiopia. Reprod Health. 2024;21(1):85.","journal-title":"Reprod Health"},{"key":"2400_CR14","volume":"43","author":"D Teferi","year":"2019","unstructured":"Teferi D, Samuel S, Markos M. Utilization of youth friendly reproductive health services and associated factors among secondary school students in Southern Ethiopia, 2019: school-based cross-sectional study. Pan Afr Med J. 2019;43:186.","journal-title":"Pan Afr Med J"},{"key":"2400_CR15","doi-asserted-by":"publisher","DOI":"10.3389\/frph.2024.1361662","volume":"6","author":"AM Delie","year":"2024","unstructured":"Delie AM, Adal O, Tareke AA, Ketema Bogale E, Anagaw TF, Tiruneh MG, et al. Sexual and reproductive health service utilization and associated factors among high school students in Ethiopia: systematic review and meta-analysis. Front Reprod Health. 2024;6:1361662.","journal-title":"Front Reprod Health"},{"key":"2400_CR16","doi-asserted-by":"publisher","DOI":"10.3389\/frph.2024.1356969","author":"NB Sidamo","year":"2024","unstructured":"Sidamo NB, Abebe Kerbo A, Gidebo KD, Wado YD. Adolescent utilization of sexual and reproductive health services in Gamo Zone, Southern Ethiopia. Insights from multilevel and latent class analysis. Front Reprod Health. 2024. https:\/\/doi.org\/10.3389\/frph.2024.1356969.","journal-title":"Front Reprod Health"},{"key":"2400_CR17","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1364058","volume":"12","author":"NB Sidamo","year":"2024","unstructured":"Sidamo NB, Abebe Kerbo A, Gidebo KD, Wado YD. A policy brief: improving access and utilization of adolescent sexual and reproductive health services in Southern Ethiopia. Front Public Health. 2024;12:1364058.","journal-title":"Front Public Health"},{"key":"2400_CR18","doi-asserted-by":"publisher","DOI":"10.1177\/20503121231223660","volume":"12","author":"BD Tilahun","year":"2023","unstructured":"Tilahun BD, Yilak G, Amena S, Abebe GK, Ayele M. Exploring the perceptions of health service providers and adolescents on the utilization of adolescent sexual and reproductive health services in Tikur, 2023: a qualitative study. SAGE Open Med. 2023;12:20503121231223660.","journal-title":"SAGE Open Med"},{"issue":"12","key":"2400_CR19","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0312872","volume":"19","author":"NB Sidamo","year":"2024","unstructured":"Sidamo NB, Kerbo AA, Gidebo KD, Wado YD. Exploring preferences to accessing sexual and reproductive health services: a qualitative study of adolescents\u2019 and service provider perspectives. PLoS ONE. 2024;19(12):e0312872.","journal-title":"PLoS ONE"},{"key":"2400_CR20","volume-title":"Global accelerated action for the health of adolescents (AA-HA!): guidance to support country implementation","author":"Organization WH","year":"2023","unstructured":"Organization WH. Global accelerated action for the health of adolescents (AA-HA!): guidance to support country implementation. World Health Organization; 2023."},{"key":"2400_CR21","unstructured":"Organization WH. Global standards for quality health-care services for adolescents: a guide to implement a standards-driven approach to improve the quality of health care services for adolescents. 2015."},{"key":"2400_CR22","unstructured":"Health EMo. National adolescents and Youth health strategy (2021\u20132025). Addis Ababa: Ministry of Health."},{"issue":"2","key":"2400_CR23","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1177\/1098214005283748","volume":"27","author":"DR Thomas","year":"2006","unstructured":"Thomas DR. A general inductive approach for analyzing qualitative evaluation data. Am J Eval. 2006;27(2):237\u201346.","journal-title":"Am J Eval"},{"key":"2400_CR24","unstructured":"office Ych. Yirgalem city kebele population profile. 2024."},{"key":"2400_CR25","volume-title":"Focus groups: a practical guide for applied research","author":"RA Krueger","year":"2009","unstructured":"Krueger RA, Casey MA. Focus groups: a practical guide for applied research. SAGE Publications; 2009."},{"issue":"1","key":"2400_CR26","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.1186\/s12913-022-08888-1","volume":"22","author":"O Arije","year":"2022","unstructured":"Arije O, Madan J, Hlungwani T. Attributes development for a discrete choice experiment on preferences in sexual and reproductive health services for adolescents and young people in Nigeria. BMC Health Serv Res. 2022;22(1):1511.","journal-title":"BMC Health Serv Res"},{"issue":"2","key":"2400_CR27","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","volume":"3","author":"V Braun","year":"2006","unstructured":"Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77\u2013101.","journal-title":"Qual Res Psychol"},{"key":"2400_CR28","unstructured":"NVivo. NVivo 15 Windows 2025 [Available from: https:\/\/techcenter.qsrinternational.com\/Content\/nv15\/nv15_about_nvivo_.htm."},{"key":"2400_CR29","unstructured":"StataCorp. Stata Statistical Software: Release 18. College Station, TX: StataCorp LLC. 2023 [Available from: https:\/\/www.stata.com\/."},{"issue":"12","key":"2400_CR30","doi-asserted-by":"publisher","first-page":"1743","DOI":"10.1001\/jama.1988.03410120089033","volume":"260","author":"A Donabedian","year":"1988","unstructured":"Donabedian A. The quality of care: how can it be assessed? JAMA. 1988;260(12):1743\u20138.","journal-title":"JAMA"},{"key":"2400_CR31","doi-asserted-by":"crossref","unstructured":"Indravudh PP, Sib, a EL, d\u2019Elb\u00e9e M, Kumwenda MK, Ringwald B, et al. 'I will choose when to test, where I want to test': investigating young people's preferences for HIV self-testing in Malawi and Zimbabwe. AIDS (02699370). 2017;31:S203\u2013S12.","DOI":"10.1097\/QAD.0000000000001516"},{"issue":"6","key":"2400_CR32","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1007\/s40271-021-00522-2","volume":"14","author":"JJ Ong","year":"2021","unstructured":"Ong JJ, Nwaozuru U, Obiezu-Umeh C, Airhihenbuwa C, Xian H, Terris-Prestholt F, et al. Designing HIV Testing and Self-Testing Services for Young People in Nigeria: A Discrete Choice Experiment. Patient. 2021;14(6):815\u201326.","journal-title":"Patient"},{"key":"2400_CR33","doi-asserted-by":"publisher","DOI":"10.1186\/s13561-015-0046-6","author":"C Michaels-Igbokwe","year":"2015","unstructured":"Michaels-Igbokwe C, Lagarde M, Cairns J, Terris-Prestholt F. Designing a package of sexual and reproductive health and HIV outreach services to meet the heterogeneous preferences of young people in Malawi: results from a discrete choice experiment. Health Econ Rev. 2015. https:\/\/doi.org\/10.1186\/s13561-015-0046-6.","journal-title":"Health Econ Rev"},{"key":"2400_CR34","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25979","author":"I Eshun-Wilson","year":"2022","unstructured":"Eshun-Wilson I, Akama E, Adhiambo F, Kwena Z, Oketch B, Obatsa S, et al. Adolescent and young adult preferences for financial incentives to support adherence to antiretroviral therapy in Kenya: a mixed methods study. J Int AIDS Soc. 2022. https:\/\/doi.org\/10.1002\/jia2.25979.","journal-title":"J Int AIDS Soc"},{"issue":"Suppl 1","key":"2400_CR35","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1186\/s12978-021-01255-z","volume":"19","author":"SJ Holcombe","year":"2005","unstructured":"Holcombe SJ, Kidanemariam Gebru S. Agenda setting and socially contentious policies: Ethiopia\u2019s 2005 reform of its law on abortion. Reprod Health. 2005;19(Suppl 1):218.","journal-title":"Reprod Health"},{"key":"2400_CR36","doi-asserted-by":"publisher","DOI":"10.1016\/j.actpsy.2022.103801","volume":"232","author":"ML Debele","year":"2023","unstructured":"Debele ML, Tolla TT, Zekiros BK, Abegaz HA, Ayalew MZ. Societal and cultural norms that expose children to early alcohol use in Amhara Region rural community, Ethiopia. Acta Psychol. 2023;232:103801.","journal-title":"Acta Psychol"},{"key":"2400_CR37","unstructured":"Bank W. Current health expenditure (% of GDP) - Ethiopia 2024 [Available from: https:\/\/data.worldbank.org\/indicator\/SH.XPD.CHEX.GD.ZS?locations=ET."},{"issue":"1","key":"2400_CR38","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1007\/s10461-016-1602-8","volume":"22","author":"M Strauss","year":"2018","unstructured":"Strauss M, George GL, Rhodes BD. Determining preferences related to HIV counselling and testing services among high school learners in KwaZulu-Natal: a discrete choice experiment. AIDS Behav. 2018;22(1):64\u201376.","journal-title":"AIDS Behav"},{"issue":"1","key":"2400_CR39","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-021-01267-9","volume":"19","author":"E Sedlander","year":"2022","unstructured":"Sedlander E, Yilma H, Emaway D, Rimal RN. If fear of infertility restricts contraception use, what do we know about this fear? An examination in rural Ethiopia. Reprod Health. 2022;19(1):57.","journal-title":"Reprod Health"},{"issue":"9","key":"2400_CR40","doi-asserted-by":"publisher","first-page":"3099","DOI":"10.1007\/s10461-022-03658-w","volume":"26","author":"KM Little","year":"2022","unstructured":"Little KM, Flomen L, Hanif H, Anderson SM, Thurman AR, Clark MR, et al. HIV pre-exposure prophylaxis implant stated preferences and priorities: results of a discrete choice experiment among women and adolescent girls in Gauteng Province, South Africa. AIDS Behav. 2022;26(9):3099\u2013109.","journal-title":"AIDS Behav"},{"key":"2400_CR41","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25528","author":"AM Minnis","year":"2020","unstructured":"Minnis AM, Atujuna M, Browne EN, Ndwayana S, Hartmann M, Sindelo S, et al. Preferences for long-acting Pre-Exposure Prophylaxis (PrEP) for HIV prevention among South African youth: results of a discrete choice experiment. J Int AIDS Soc. 2020. https:\/\/doi.org\/10.1002\/jia2.25528.","journal-title":"J Int AIDS Soc"},{"issue":"1","key":"2400_CR42","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1177\/0272989X17729376","volume":"38","author":"M Quaife","year":"2018","unstructured":"Quaife M, Eakle R, Cabrera Escobar MA, Vickerman P, Kilbourne-Brook M, Mvundura M, et al. Divergent preferences for HIV prevention: a discrete choice experiment for multipurpose HIV prevention products in South Africa. Med Decis Making. 2018;38(1):120\u201333.","journal-title":"Med Decis Making"}],"container-title":["Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12978-026-02400-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12978-026-02400-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12978-026-02400-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T14:03:32Z","timestamp":1788876212000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12978-026-02400-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["2400"],"URL":"https:\/\/doi.org\/10.1186\/s12978-026-02400-2","relation":{},"ISSN":["1742-4755"],"issn-type":[{"value":"1742-4755","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]},"assertion":[{"value":"5 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study received ethical approval from the University of Gondar College of Medicine and Health Sciences Specialized Referral Hospital Institutional Research Ethics Review Committee (IRERC) on 15\/09\/2023 (Ref: CMHSSH-UOG IRERC\/07\/09\/2023). Reciprocal ethical approval was also obtained from the Human Research Ethics Committee of Curtin University (Ref: HRE2024-0030). Formal support letters were also secured from the Central Sidama Zone Administration and the Yirgalem City Administration. The study purpose was explained to participants, and written informed consent was obtained from each participant. Participants were informed of their right to withdraw at any stage of data collection. For participants aged under 18\u00a0years, written informed consent was obtained from a parent and\/or legal guardian, along with the participant\u2019s assent. Confidentiality was maintained throughout the study. Audio-recordings were transferred daily to a password-protected computer and deleted from the recorder. The study data was exported and secured on Curtin University Research Drive server and erased from the data collection tablet. All methods complied with the principles of the Declaration of Helsinki.","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":"167"}}