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Article History

Received: 9 April 2025

Accepted: 7 April 2026

First Online: 12 May 2026

Declarations

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: Ethical approval was obtained from the Ghana Health Service Ethics Review Committee (Protocol ID NO. GHS-ERC:007/07/18). The study was conducted in accordance with the terms of the Helsinki Declaration. Before each interview, research assistants first reviewed participants’ information sheet and informed consent form with each participant. In particular, the benefits and risks of participation were communicated to each participant. No biological samples were collected, and participants were not exposed to any physical danger. However, a few participants (4) experienced distress when discussing some aspects of their experiences (e.g. physical or sexual abuse). In all such situations, participants were referred for appropriate psychological counselling and support. Appropriate financial support was provided to help pay the cost associated with travel and service. Written informed consent was obtained from each participant either by signing or thumbprinting the informed consent form. All interviews were conducted in places that ensured maximum anonymity, confidentiality and privacy. No third parties were present during interviews, except four visually impaired participants who were accompanied by personal assistants. Neither the name/address of participants nor any voice identifiers were used to identify individual participants in interview transcripts. Transcripts and field notes were entered into access-controlled computers, accessible only to the principal investigator.

: All participants gave consent for the study’s findings to be published. All authors also consented to the publication of this manuscript.

: The authors declare no competing interests.