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Article History

Received: 1 October 2025

Accepted: 22 January 2026

First Online: 14 February 2026

Declarations

:

: Informed consent was obtained from all participants 18 years old or older to participate in the study. For all individuals younger than 18 years, informed consent was obtained from their parents and guardians for their children and assent was obtained from individuals 12–17 years old. Consent of household heads was obtained for household participation. This study was conducted in accordance with the Declaration of Helsinki, and was approved by Emory University Institutional Review Board (approval number 00105630), Yale University (reliance agreement approval number 2000026911), UT Southwestern (reliance agreement approval number STU-2023-1107), and review boards at Christian Medical College Vellore (Approval #12065), Universidad del Valle de Guatemala (Protocol #223-12-2020) and the National Ethics Committee from the Ministry of Public Health and Social Assistance in Guatemala (Protocol #31-2020), Manhiça Health Research Institute Internal Scientific Committee (CCI/03/2020) and Internal Ethical Review Board (initial approval CIBS-CISM/011/2020), and The Aga Khan University (Approval #2022-7912-23648).

: Not applicable.

: The authors declare no competing interests.