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Article History

Received: 17 October 2024

Accepted: 9 December 2024

First Online: 24 February 2025

Declarations

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: Ethical approval for this study was obtained from the University of Zambia Biomedical Research Ethics Committee (Ref-1346-2020) and the University of Maryland Institutional Review Board (Ref: HP-00094612). Additional approvals were obtained from the Zambian National Health Research Authority, and the Ministry of Health at both provincial, district, and clinic levels. Written informed consent was obtained from all participants as per the local Research Ethics Committee guidelines. All participants in interviews and focus group discussions provided written informed consent. Non-literate participants provided witnessed thumb-printed informed consent. Prior to conducting observations, all household members provided verbal consent and approval. Participants were interviewed in private venues of their choice. Data transcripts were anonymized by removing personal identifiable information such as home addresses and phone numbers. Additionally, the names of study communities and participants were anonymized.

: Participants gave written consent to participate in the study including giving consent to the following statement: “I agree that anonymized direct quotes from interviews, group discussions, and field notes in public reporting of findings from this study.”

: The authors declare no competing interests.