Document is current

Article History

Received: 23 May 2025

Accepted: 18 August 2025

First Online: 30 September 2025

Declarations

:

: The study protocol was approved by the Institutional Review Committee of the Institute of Medicine, Tribhuvan University (Reference no. 86 [, –]). Written informed consent was obtained from all participants, with thumbprints accepted for those unable to sign. Participation was voluntary, and participants could withdraw at any time without penalty. Confidentiality and anonymity were maintained by using unique participant codes instead of personal identifiers. Data were securely stored on password-protected computers and in locked cabinets accessible only to the research team. For the participants under the age of 16, assent was taken and informed consent was obtained from their parents in accordance with ethical guidelines. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki as revised in 2013.

: No visual andother person details and consent for publication is given.

: The authors declare no competing interests.