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Article History

Received: 30 January 2026

Accepted: 19 August 2026

First Online: 21 August 2026

Declarations

Ethics approval and consent to participate: This study was conducted in accordance with the ethical principles set out in the Declaration of Helsinki. This study used publicly available, de-identified secondary data from the 2024 Zambia Demographic and Health Survey (ZDHS). Ethical approval for the original ZDHS data collection was granted by the Zambia Ministry of Health National Health Research Ethics Committee and the Institutional Review Board (IRB) of ICF International (IRB approval number: FWA00000845). Informed consent to participate was obtained by trained DHS field interviewers from all respondents prior to data collection, following the DHS Program’s standard ethical protocol, which includes additional consent procedures for respondents younger than 18 years as approved by the relevant IRB. As the present study involved only secondary analysis of anonymized, publicly available data, no additional consent was required for this analysis. Permission to access and use the dataset for this secondary analysis was granted by the DHS Program ( ). No individual identifiers were accessed or reported in this study.

Consent for publication: Not applicable. This study does not contain any individual person’s data, images, or other identifying information.

Competing interests: The authors declare no competing interests.