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Approval to conduct the research in secondary schools has been granted by Regional Administrative Secretary (RAS) of the respective regions in Tanzania. Permission has been granted by respective secondary school authorities.Participants were informed about the purpose of the study, and they were assured that their answers would only be used anonymously for research purposes on a voluntary basis.All participants aged 18 and above were given information about the study, and they were asked for their voluntary participation. A written informed consent was administered to each participant; all participants read and signed written consent forms before being enrolled in the study.For students under 18\u00a0years old, consent (agreement to participate in study) was sought and obtained from their parents or guardian.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Publisher\u2019s Note"}}],"article-number":"35"}}