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Article History

Received: 23 July 2025

Accepted: 19 January 2026

First Online: 25 February 2026

Declarations

:

: None.

: All authors certify that they meet the ICMJE criteria for authorship.

: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

: The data and STATA code for the analysis are available at Curtin University's data repositories and can be made available upon reasonable request.

: We obtained ethical approval from the University of Gondar Institutional Review Board (approval number CMHSSH-UOG IRERC/03/03/2024) and subsequently received reciprocal approval from the Curtin University Human Research Ethics Committee (HREC) (HRE2024-0191). Following this, we first obtained formal support letters from the Sidama Institute of Public Health (SPHI). Then, we approached each district health office individually and provided them with support letters from the SPHI. In response, each district health office issued its support letters to proceed with data collection activities within the health facilities under its district. The hospital director and the health centre officer acted as key liaisons between the research team, health facilities, and communities. Written informed consent was obtained for every study participant for both participation and publication.