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Article History

Received: 18 September 2025

Accepted: 9 November 2025

First Online: 18 December 2025

Declarations

:

: No additional ethical approval was required for this study as it utilized secondary data from the MEASURE DHS Program. The researchers did not conduct any primary data collection or interact directly with study participants. All data were obtained through authorized access from the DHS Program website ( ) after completing the standard data request procedure. The dataset is anonymized and contains no personally identifiable information. The original DHS surveys received ethical approval from both ICF International’s Institutional Review Board and the relevant ethics committees in participating countries. The DHS Program maintains strict protocols to protect respondent confidentiality and privacy. Detailed information about these ethical safeguards can be found at: .

: Not applicable.

: The authors declare no competing interests.