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Article History

Received: 3 November 2025

Accepted: 15 December 2025

First Online: 30 December 2025

Declarations

:

: Ethical approval was obtained from two institutional ethics committees: University of Douala Institutional Ethics Committee: approval number 1679/CEI-UDo/02/2019/T and Douala Gyneco-Obstetric and Pediatric Hospital Ethics Committee: approval number 2018/0005/DGOPH/DG/CEI.For the retrospective component, a consent waiver was granted given the observational nature of the study using existing medical records with no additional risk to patients. For the prospective component, written informed consent was obtained from parents or legal guardians of all participating children before enrollment.Confidentiality was maintained through: (1) data coding with unique patient identifiers, (2) secure storage of paper forms in locked cabinets, (3) password-protected electronic databases, (4) restricted access to identifiable data, and (5) presentation of only aggregate anonymized data in publications.The study was purely observational with no additional costs to participants beyond standard care. All procedures were conducted according to the Declaration of Helsinki principles for medical research involving human subjects.

: Not applicable. This manuscript contains no individual person’s data in any form.

: The authors declare no competing interests.