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Article History

Received: 9 February 2026

Accepted: 8 July 2026

First Online: 14 July 2026

Declarations

:

: Ethical clearance for this study was obtained from the Jimma University Institute of Health Institutional Review Board (IRB) (Reference No. JUIH/IRB/076/25). The IRB reviewed and approved all study procedures, including the informed consent process for illiterate participants, whereby the participant information sheet and consent form were read aloud in the local language by trained data collectors, and informed consent was documented using the participant’s thumbprint. Administrative permission was also obtained from the Jimma and Agaro Town Health Offices. Written informed consent was obtained from all participants aged 18 years or older. For participants who were unable to read or write, the study information and consent form were read aloud in the local language, sufficient time was provided for questions and consideration, and voluntary informed consent was documented by a thumbprint, in accordance with the IRB-approved protocol. Participation was entirely voluntary, and participants could decline or withdraw at any time without any consequences. The study did not involve minors or individuals lacking decision-making capacity; therefore, consent from legal guardians or proxies was not required. Participant confidentiality was maintained by using coded identifiers, and all study procedures were conducted in accordance with the Declaration of Helsinki.

: Not applicable. This manuscript does not contain any individual person’s identifiable data in any form.

: The authors declare no competing interests.