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Article History

Received: 20 October 2025

Accepted: 22 December 2025

First Online: 30 December 2025

Declarations

:

: All methods of this research were conducted in accordance with the Declaration of Helsinki. Ethics approval for this study was granted from Deakin University (No- 2023 − 342), and the copy was submitted to Haramaya University. The broader KHDSS project has ethical approval from the Ethiopian Public Health Association (EPHA), the Centres for Disease Control and Prevention (CDC), the Ethiopian Science and Technology Agency, and the Haramaya University Health Research Ethical Review Committee (HRERC). Informed verbal consent was obtained from all participants after explaining the objectives and purpose of the study prior to data collection. Verbal consent was used for several reasons. First, a substantial proportion of the population in this area is illiterate and unable to read or write. Second, in the Ethiopian context, written consent is typically required for studies involving laboratory procedures, blood sample collection, or clinical trials, which carry greater risk compared to conventional interview-based data collection. All information obtained from each study participant is kept confidential throughout the process of study and kept in approved secure data storage.

: Not applicable.

: The authors declare no competing interests.