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Authors
Chandru, B Aravind https://orcid.org/0009-0005-3954-9580
Sandra, K N
Joshua, Jomy
Boopathy, K.
Emmanuel, Catherine Suresh
Haritha, C S
Varma, Ravi Prasad https://orcid.org/0000-0002-1147-9622
Ravindran, Rekha Melathuparambil https://orcid.org/0000-0001-7932-3352
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Article History
Received: 12 July 2024
Accepted: 29 November 2025
First Online: 7 January 2026
Declarations
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: The authors have no relevant financial or non-financial interests to disclose.
: The protocol and tools were reviewed and cleared by the Institutional Ethics Committee of the Department of Health Services, Government General Hospital, Thiruvananthapuram. (Registration number EC/NEW/INST/2021/1590, vide letter number 33/03/02/21-GHEC dated 03 February 2021). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.co
: Participants were informed of the purpose of the survey or interview, the lack of benefits, potential risks, and autonomy to withdraw at any stage without any effect on usual services they received. Participants of cross-sectional survey gave informed witnessed verbal consent and participants of qualitative interviews gave electronically recorded informed consent. Gatekeeper consent was obtained from Manickal panchayat before under taking data collection.
