Document is current

Article History

Received: 14 September 2025

Accepted: 20 March 2026

First Online: 27 May 2026

Declarations

:

: This activity was classified as a quality assurance/quality improvement initiative conducted in response to a public health intervention and therefore did not meet the regulatory definition of human subjects’ research requiring full IRB oversight. Accordingly, we received a RASCAL correspondence confirming “Not Human Subjects Research” under 45 CFR 46, Protocol IRB AAAV6532 (Y01M00), Columbia University.In Sierra Leone, the study protocol underwent independent ethical review by the Sierra Leone Ethics and Scientific Review Committee (SLESRC), which determined that the study posed minimal risk to participants and granted approval for its implementation. All procedures were conducted in accordance with the ethical principles outlined in the Declaration of Helsinki (2013 revision) and the Council for International Organizations of Medical Sciences (CIOMS) International Ethical Guidelines for health-related research involving humans.Prior to each interview, verbal informed consent was obtained after participants were provided with a clear explanation of the study’s purpose, procedures, and their rights. Participation was entirely voluntary, and participants were informed that refusal to answer specific questions or withdrawal at any time would not result in any adverse consequences. To ensure confidentiality, all personally identifying information was de-identified during data analysis. Completed interview forms were stored in locked cabinets, and only the research team had access to the data.

: All authors have approved this manuscript for publication.

: The authors declare no competing interests.