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Authors
Sharma, Indra Prasad https://orcid.org/0000-0001-8815-794X
Naidoo, Kovin Shunmugam https://orcid.org/0000-0001-8261-9779
Mashige, Khathutshelo Percy https://orcid.org/0000-0001-8199-0891
Lepcha, Nor Tshering https://orcid.org/0000-0001-8034-3860
Wangmo, Dechen
Peldon, Sonam
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Article History
Received: 8 November 2025
Accepted: 13 March 2026
First Online: 19 March 2026
Declarations
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: Ethical approval for the study was granted by the Research Ethics Board of Health (REBH), Ministry of Health, Bhutan (Ref: REBH/Approval/2023/003), and the Biomedical Research Ethics Committee (BREC) of the University of KwaZulu-Natal, South Africa (Approval No: BREC/00004482/2022). In addition, administrative clearance was secured from the Policy and Planning Division of the Ministry of Health, Bhutan. The study methodology was guided by WHO standards. Although the RESAT typically exempts non-clinical assessments from formal ethical clearance, all applicable national and institutional protocols were strictly adhered to. Informed consent was obtained from all participants prior to data collection. Participation was entirely voluntary and had the option to withdraw anytime without any consequences. Data confidentiality was strictly maintained: no personal identifiers were recorded, and datasets were anonymized. No monetary or non-monetary incentives were provided to participants. Our study adhered to the Declaration of Helsinki.
: Not applicable.
: The authors declare no competing interests.
