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Article History

Received: 3 April 2024

Accepted: 3 September 2024

First Online: 12 September 2024

Competing interests

: The authors declare no competing interests.

: The study was conducted with complete adherence to ethical standards expressed in the Declaration of Helsinki. Before the commencement of the study, ethical approval was obtained from the University of Malawi Research Ethics Committee (No: P.11/21/101), district commissioners in the four districts where data was collected, and community leaders in the respective areas.

: Participation in the study was voluntary. Participants were informed of this and could withdraw at any time of the study. The study obtained written informed consent from participants 18 years old and above. Due to various challenges, participants unable to sign their consent forms were asked to use their fingerprints to give consent. Verbal consent was not allowed. Participants were also informed that there is no monetary reward for their participation in the study. Responses from participants were treated with strict confidence. Each participant was assigned a participation number; only the participant number appeared with their responses. Participants were notified that they could skip it or withdraw from the study if they felt uncomfortable with a question.