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Article History

Received: 14 April 2025

Accepted: 2 December 2025

First Online: 7 February 2026

Declarations

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: Ethical considerations: The study received ethical approval from the South Sudan Ministry of Health Research and Ethics Review Board (MOH/RERB/24/2020) and the Strathmore University Institutional Ethics and Research Committee. All participants gave informed consent, and participation was entirely voluntary, with assurances of anonymity and privacy throughout the study. Consent for minors [ , – ] was obtained from their caregivers, while emancipated minors [ – ] provided their own verbal consent. Caregivers and emancipated adolescents aged 15–17 received thorough information on the study’s goal, procedures, benefits, risks to participate right of withdrawal of consent at any time, and privacy and confidentiality. All individuals provided informed consent before data collection during the baseline assessment. A workshop was conducted to go over the study procedures and information contained in the consent/assent forms. The process included: (1) oral and written information to consider participation; and (2) a version for illiterate participants, who could provide consent through the signature of a literate witness (not a member of the research team). Each participant was given complete information about the study before giving their consent (written or oral, as indicated above). To illiterate participants, the information was read aloud in front of an impartial witness who was not associated with the study to ensure that potential participants fully understood what it meant to participate and that they could withdraw their consent at any time without explanation. It was also made clear that refusing to continue in the study would not affect the type of support they received. The research assistants provided ample time to address all of the participants’ questions and concerns. The informed consent method for the participation of young adolescents (10–14 years of age) was a two-step process: First, carer approval was gained for their child’s participation in the study as part of the informed consent process, which involved the same caregivers and procedures as described above. Second, if caretaker approval was acquired, children’s verbal assent to participate in the study would be obtained before tool delivery. This study followed the ethical guidelines outlined in the Helsinki Declaration of 1964, as revised in 2024. In this regard, the study ensured that the health and well-being of the adolescents and their caregivers involved in the study were safe from any harm. Before the study, the Research Assistants signed a confidentiality agreement and a child safeguarding policy statement. Any breach of confidentiality and abuse of children was monitored during the study by the principal investigator.

: Not applicable.

: The authors report no competing interests.