Document is current

Article History

Received: 19 May 2025

Accepted: 25 September 2025

First Online: 21 October 2025

Declarations

:

: This study was approved by the University of Pretoria Faculty of Health Sciences Research Ethics Committee (Reference: 342/2024) and the Tshwane District Health Research Committee. As this was a retrospective cohort study using de-identified secondary data from Tier.Net, a waiver of informed consent was granted by both ethics committees. No participants were contacted or recruited for the study.

: Not applicable. This study involved the analysis of de-identified, routinely collected secondary data from the Tier.Net system. No individual-level identifiable information (such as names, photographs, or personal narratives) was included in the manuscript. Therefore, individual consent to publish was not required.

: The authors declare no competing interests.