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Article History

Received: 12 January 2026

Accepted: 24 March 2026

First Online: 11 April 2026

Declarations

:

: The study protocol was approved by the Institutional Ethics Committee of Government Medical College, Thiruvananthapuram (IEC No. 01/32/2020/MCT), with reciprocal approval from the Ethics Committee of the Faculty of Medicine, University of Freiburg. Written informed consent was obtained from all participants or their legal guardians, as appropriate. Surveillance data were anonymised prior to analysis. All procedures were conducted in accordance with the Declaration of Helsinki (2013 revision) and national ethical guidelines for biomedical and health research.

: Not applicable.

: AI-based language tools were used solely for grammatical editing and improvement of readability. No AI tools were used to generate scientific content, interpret data, perform statistical analyses, or construct scientific arguments. All study design decisions, analyses, and conclusions are the work of the authors.

: The authors declare no competing interests.