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Article History

Received: 5 November 2025

Accepted: 21 November 2025

First Online: 29 November 2025

Declarations

:

: Permission to access surveillance data was granted by the Nangarhar Public Health Directorate following an official request from Nangarhar University Medical Faculty. The study was approved by the Research and Ethics Committee of Nangarhar University Medical Faculty (NMF REC-04) and the Ethical Committee of the Faculty of Tropical Medicine, Mahidol University, Thailand (TMPSS ECF-034-02). No personal identifiers were used, and data confidentiality was strictly maintained. All procedures adhered to national and institutional ethical guidelines and complied with the Declaration of Helsinki and its subsequent amendments.

: Not applicable.

: Not applicable.

: The authors declare no competing interests.