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Article History

Received: 2 October 2025

Accepted: 20 February 2026

First Online: 26 February 2026

Declarations

:

: The study adhered to the principles of the Declaration of Helsinki and complied with the International Council for Harmonisation Good Clinical Practice (ICH-GCP) and the Malawi National Health Sciences Research Committee General Guidelines on Health Research. Ethical approval was granted by the College of Medicine Research Ethics Committee (COMREC), Malawi (Ref: P.12/24-1298). COMREC approved a waiver of parental consent for mature minors; assent/consent procedures followed national regulations. Written informed consent was obtained from all participants, who were free to withdraw at any time without penalty. Permission to conduct the research was granted by Thyolo district hospital management. All data were de-identified and handled confidentially.

: Not applicable.

: The authors declare no competing interests.