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Article History

Received: 22 November 2024

Accepted: 19 May 2025

First Online: 29 May 2026

Declarations

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: The data used in our study are publicly available. It does not use personal identifiers (anonymous) and therefore do not pose an ethical risk to participants. Each country was responsible for collecting and managing the STEPS data, and the World Health Organization provided technical support to the implementing agencies in each country. Each implementing agency in each country obtained consent from participants to collect the information needed for the survey.WHO requested the STEPS databases, and the principal investigator agreed to (1) acknowledge the source of the data. (2) Inform WHO of any planned publication before publication. (3) Offer co-authorship of any report or publication using the survey results to the survey coordinator. (4) Use the data only for non-commercial, non-profit public health purposes. In addition, only authorized personnel had access to the database.Consent to collect information was obtained from each adult (18 years and over). In the case of minors (17 years and under), the consent form was read to a parent or legal guardian to allow for the assessment of the minor. There were two consent forms for participants to sign. One is for STEP 1 and 2 and the other is for STEP 3. All signed forms will be kept on file at WHO's Centre for Public Health and Reform.This study did not require approval from an ethics committee as it involved a secondary data analysis of the publicly available WHO STEPS database. The authors had no contact with the study participants, and the accessed data were anonymized, posing no ethical risk for evaluation. Our study adhered to international research ethics standards outlined in the Declaration of Helsinki.

: Not applicable.

: The authors declare no competing interests.