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Authors
Biracyaza, Emmanuel https://orcid.org/0000-0001-7494-2779
Habimana, Samuel https://orcid.org/0000-0001-5766-8659
Montgomery, Susanne https://orcid.org/0000-0003-1269-9034
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Article History
Received: 10 November 2025
Accepted: 16 September 2026
First Online: 25 September 2026
Declarations
Competing interests: The authors declare no competing interests.
Ethics approval and consent to participate: Ethical clearance was granted by the Institutional Review Board of the College of Medicine and Health Sciences, University of Rwanda (Approval No. 106/CMHS IRB/2023), on 10 February 2023. Ethical clearance was granted by the ethics committee of the Institutional Review Board of the College of Medicine and Health Sciences of the University of Rwanda (Approval No.: 106/CMHS IRB/2023) on February 6, 2025. Authorisation for data gathering was obtained from district leaders on February 9, 2023, as required by the local governance procedures.Before participation and recording the interviews and focus group discussions, the purpose, procedures, and confidentiality measures were thoroughly explained to all participants. They were informed about their rights to withdraw from this research at any time without providing reasons. They were also guaranteed that their participation or withdrawal could not have any risk of negative consequences, whether legal, psychological, social, or physical. Participants were assured that confidentiality and anonymity would be strictly maintained throughout the entire research process, including reporting, sharing policy-brief, and publication. Each participant offered the oral and written informed consent before we began collecting data. Consent was collected during the data collection period performed from February 15, 2023, to July 31, 2023. Consent was administered and explained by the researcher. Oral consent was documented through audio-recorded confirmations and written field notes. In addition, each participant received 2000 Rwandan Francs (approximately 2 USD) as transport support to facilitate their participation in the study. All data were securely stored in password-protected OneDrive folders to ensure confidentiality and prevent data loss. All the methods were conducted in accordance with the principles and regulations of the Helsinki Declaration.
