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Article History

Received: 30 January 2026

Accepted: 19 May 2026

First Online: 2 June 2026

Declarations

:

: The following ethical clearance was obtained: National Commission for Science, Technology and Innovation clearance (Ref No: 820482). Additional approvals were obtained from The Mount Kenya University Ethics and Review Committee clearance (Ref No: MKU/ISERC/3351) and from the Director of Public Health Research and NCPWD Murang’a County Director (Ref No: 21/12/2023). All study procedures were conducted in accordance with the ethical principles outlined in the WMA Declaration of Helsinki, 2024. Comprehensive information about the study was provided to the participants and their written informed consent was obtained prior to their inclusion in the study. Competent adults and emancipated minors who understood the nature, purpose, risks, and benefits of participating in the study provided informed consent. Non-emancipated minors who participated, gave their informed assent in order to respect their developing autonomy and involve them in decision-making to the extent that they could understand. Additionally, consent from their parents or legal guardians was also obtained. Consent and assent procedures were adapted to participants’ specific disability needs to ensure informed and ethical participation. Where appropriate, caregivers provided supportive clarification bud did not consent on behalf of participants. All research assistants received training on ethical conduct and confidentiality and signed confidentiality agreements to safeguard participants’ sensitive information.

: Not applicable. No individual-level data or identifying information are reported in this manuscript.

: The authors declare no competing interests.