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Article History

Received: 20 August 2022

Accepted: 16 February 2023

First Online: 4 April 2023

Declarations

:

: No ethical approval was needed for this study, because it is based on secondary data taken from four waves of PDHS. For primary data collection, ethical approvals were obtained: The ICF Institutional Review Board (132989.<0.010.PK.DHS.01) and the National Bioethics Committee of Pakistan (4–87/NBC-285/17/1438) reviewed and approved PDHS 2017-18. The Institutional Review Board of ICF Macro reviewed and approved the MEASURE Demographic and Health Surveys Project Phase III. The PDHS 2012-13 is categorized under that approval (31406.0<0.012.12). The Institutional Review Board of Macro International, Inc. reviewed and approved the MEASURE Demographic and Health Surveys Project Phase II. The PDHS 2006-07 is categorized under that approval. The Institutional Review Board of Macro International, Inc. reviewed and approved the MEASURE Demographic and Health Surveys + Project, which includes the PDHS 1990-9. Written informed consent was obtained from participants or from legally authorized representatives in case of minors.

: The DHS Program maintains ethical standards and ethical reviews to protect the privacy of respondents and household members for all DHS. Furthermore, all questionnaires and procedures for DHS were reviewed and approved by ICF Institutional Review Board (IRB) to comply with the U.S. Department of Health and Human Services regulations for the protection of human subjects (45 CFR 46), as well as by country-specific IRB to ensure compliance of the survey with local laws and norms. You may kindly refer to the following link: ExternalRef removed.

: All procedures were taken in respect of the Declaration of Helsinki.

: Not applicable.

: The authors declare no conflict of interest. RZ and FF serve on the Editorial Board of BMC Public Health as Associate Editors.