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Article History

Received: 8 April 2025

Accepted: 13 May 2026

First Online: 22 May 2026

Declarations

Ethics approval and consent to participate: The DHS program maintains appropriate ethical standards in all the surveys it conducts. In line with this, the 2004–20222 BDHS data sets that are used in this study got ethical approval from the respective authorities of Bangladesh and the Institutional Review Board of ICF International. Informed written consent was obtained from each participant, and for adolescents less than 18 years, consent was obtained from their parents/guardian and assent from them. Prior to conducting each interview, an informed consent statement is read to the respondent, who may accept or decline to participate. Most importantly, the informed consent statement highlights the voluntary nature of participation, emphasizing that the respondent has the right to refuse to answer any question, decline any biomarker test, or discontinue participation at any point in the interview. Furthermore, the statement emphasizes that the identity and information of the respondent will be maintained in strict confidentiality. The DHS Program maintains rigorous standards to protect the privacy of respondents and household members in all DHS surveys. This comprehensive protocol ensures that neither the individual nor the household can be identified. Details of this protocol can be found on the DHS website [ ]. Authors got access to the DHS database after registering and obtaining permission from DHS authorities, and ethical approval was also obtained from the Swinburne University of Technology, Melbourne, Australia, Ethics Committee (Ref. No.: 20237065-15642, approved 26 May 2023).

Consent for publication: All authors approved the final manuscript and gave consent for publication.

Competing interests: The authors declare no competing interests.