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Article History

Received: 10 September 2025

Accepted: 22 December 2025

First Online: 4 January 2026

Declarations

:

: The study received ethical approval from the Institutional Review and Ethics Review Committee (IRERC) of Debre Markos University, College of Medicine and Health Sciences. The research was conducted in accordance with the ethical principles of the Declaration of Helsinki. All data used in this study were fully anonymized before analysis, and no personally identifiable information was collected. The requirement for informed consent was waived by the Debre Markos University CMHS IRERC due to the retrospective design of the study and the use of de-identified, anonymized data. As no direct patient contact or identifiable information was involved, participant consent was not required.

: Consent to publish was not applicable, as the study used anonymized retrospective data with no personal identifiers. The ethics committee confirmed that publication of the aggregated, de-identified findings does not infringe on patient privacy.

: The authors declare no competing interests.