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Article History

Received: 5 July 2025

Accepted: 13 November 2025

First Online: 17 November 2025

<!--Emphasis Type='Bold' removed-->Declarations

:

: The authors secured written ethical approval from Mekelle University’s Research and Community Services Directorate (RCSD), reference number MU-RCSD-112/22..

: We declare that the manuscript is original, has not been published before, and is currently not being considered for publication elsewhere. All authors have made a significant contribution to the work and agree to be accountable for all aspects of the manuscript. All authors have read and approved the final version of the manuscript before submission. Proper credit has been given to all sources and contributors in the manuscript. We grant the publisher permission to publish, reproduce, distribute, and store the manuscript in all forms and media, now or hereafter known.

: Verbal consent was obtained from study participants before their participation. This is because many of the study participants were illiterate and could not provide written consent. Their consent was recorded using the mobile phone of the enumerators. Participants were fully informed and able to make voluntary decisions. Confidentiality and anonymity were strictly maintained regarding participant identities.

: The authors declare no competing interests.