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Article History

Received: 6 March 2026

Accepted: 29 May 2026

First Online: 2 June 2026

Declarations

:

: In accordance with the Declaration of Helsinki which mandates key ethical principles focused on protecting participants' well-being and rights, primarily requiring an independent ethics committee approval and robust informed consent; ethical approval from the Addis Ababa University College of Development Studies IRB (No = 0004/2022) was secured. Data collection was supported through a series of cooperation letters, starting from the Amhara Regional State Public Health Institute to the Machakel Woreda Health Office, which coordinated with local schools. Informed written consent was obtained from school directors, Parent-Teacher Associations, and all adult study participants as well as guardian/parents of minors, while assent was taken from students less than 18 years. Participants were informed about the study's purpose, procedures, risks, and benefits, and were assured of their right to withdraw at any time. Confidentiality and anonymity were strictly maintained throughout the study.

: Not applicable.

: The authors declare no competing interests.