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Article History

Received: 20 March 2026

Revised: 31 July 2026

Accepted: 7 August 2026

First Online: 12 August 2026

Declarations

Ethics approval and consent to participate: The need for ethics approval was waived by the institutional review committee of the Nepal Health Research Council (NHRC) as the study did not involve sensitive personal data, clinical investigation, or vulnerable populations. The study was conducted in full accordance with the National Ethical Guidelines for Health Research in Nepal as issued by NHRC. All data collection activities; field observation, O&D survey, semi-structured interviews, and acceptance survey, were conducted with the knowledge and consent of participants. Participants who declined to be identified are anonymised in Table 3; two participants who declined to engage at all are recorded as such without further identification. Informed consent was obtained from all participants involved in the study prior to data collection. Each participant was clearly informed of: the purpose and scope of the research; the voluntary nature of participation and the right to withdraw at any time without consequence; the manner in which responses would be recorded, used, and stored; and the anonymisation policy applied to participants who requested it. No personally identifying information was recorded without explicit participant permission. Participants who declined to provide consent are recorded as having declined, without further identification.

Consent for publication: Not applicable.

Competing interests: The authors declare no competing interests.