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Authors
Remkes, Aaron
Zafinimampera, Alexina
Totofotsy, Olivette
Ratiaharison, Fesia Elveric
Rambeloson, Haingoniavo Garcia
Daus, Elly
Lassmann, Myriam
Schmidt, Alexandra
Franz, Fiona
Rausche, Pia
Hey, Jana
Randrianarisoa, Tiana
Rasamoelina, Tahinamandranto
Kislaya, Irina
Andrianarimanana, Diavolana
May, Jürgen
Marchese, Valentina
Rakotoarivelo, Rivo Andry
Fusco, Daniela
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Funding
Funding for this research was provided by:
Bernhard-Nocht-Institut für Tropenmedizin
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Article History
Received: 27 August 2025
Accepted: 25 November 2025
First Online: 3 December 2025
Declarations
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: The survey was conducted in accordance with the ICH-GCP guidelines in compliance with the Helsinki Declaration and was approved by the Ethics Committee of the Hamburg State Medical Chamber (2023-101064-BO-ff) and the National Ethics Committee of Madagascar (No. 177 MSANP/SG/AMM/CERBM). No person who met the inclusion criteria was excluded from this study on the basis of their sexual orientation, gender identity, political or ethnic affiliation, or socioeconomic position. All participants were asked to sign a consent form before being interviewed by two trained interviewers from each region in French or Malagasy. A participant identifier was given to all participants to ensure data protection through pseudonymisation. Participants had the right to withdraw their informed consent at any time, without providing a reason. No financial incentives were given for study participation.
: Not applicable.
: The authors declare no competing interests.
