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Article History

Received: 8 April 2025

Accepted: 23 May 2025

First Online: 13 August 2025

Declarations

:

: This manuscript is based on secondary data analysis from a cross-sectional survey and a clinical trial for which ethical clearance was obtained during the primary data collection. This study adhered to the principles outlined in the Declaration of Helsinki concerning ethical research involving human subjects. Prior to participation in the original study, both children and their parents were thoroughly informed about the trial's objectives and procedures. Parents or guardians of eligible children provided their consent for participation, while children aged 11 years and older were given the opportunity to assent to participate in the study.The study acquired regulatory approval from the Medical Research Coordination Committee (MRCC) of the National Institute of Medical Research (NIMR), Tanzania. The initial approval based on the protocol was granted on 20 th July 2018. The study protocol was amended, reviewed by the committee, and approved on 19 th March 2019 with validity date on 19 th July 2019. However, based on the progress report of July 2019, the ethical clearance committee granted study extension until 20 th July 2020. The study approval numbers were NIMR/HQ/R.8a/Vol.IX/2818 and NIMR/HQ/R.8c/Vol.I/668 (for amendment) also NIMR/HQ/R.8c/Vol.I/1276 for ethical clearance extension.

: Not applicable.

: The authors declare no competing interests.