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Article History

Received: 2 February 2026

Accepted: 19 May 2026

First Online: 19 June 2026

Declarations

:

: Maneesha P. Godakanda Arachchige, Rebekah J. Moles, Sarath Lekamwasam, Margaret Jordan, Benjamin J. Basger, Shukry Zawahir and Timothy F. Chen have no conflicts of interest that are directly relevant to the content of this article.

: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethical Review Committee, Faculty of Medicine, University of Ruhuna, Sri Lanka (2023/P/118 [30/11/2023]).

: Written informed consent was obtained from all participants for participation.

: Written informed consent was obtained from all participants for the publication of anonymised data.

: The de-identified data that support the findings of this study are available from the corresponding author upon reasonable request. Interested researchers should submit a formal request to the corresponding author, outlining the intended use and providing evidence of ethical clearance. Each request will be evaluated on a case-by-case basis. Access to the data will require the signing of a data use agreement.

: Not applicable.

: Conceptualisation: MPGA, RJM, TFC. Funding acquisition: MPGA, SZ, TFC. Methodology: MPGA, RJM, TFC. Data collection: MPGA, RJM, SL, TFC. Project administration: MPGA, SL, TFC. Supervision: RJM, TFC. Formal analysis: MPGA, TFC. Validation: RJM, SL, MJ, BJB, TFC. Visualisation: MJ, BJB, TFC. Writing (original draft): MPGA. Writing (review and editing): MPGA, RJM, SL, MJ, BJB, SZ, TFC.

: While preparing this article, we used Microsoft Copilot and ChatGPT to improve readability and language. After using these tools, we carefully reviewed and edited the content as needed. Microsoft Copilot was also used to generate Fig. . We did not use any AI tools for generating scientific insights, analysing or interpreting data, or drawing scientific conclusions. We take full responsibility for the content of this publication.