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Article History

Received: 30 June 2025

Accepted: 29 January 2026

First Online: 13 February 2026

Declarations

:

: The Demographic and Health Survey (DHS) data used in this study from Kenya, Madagascar, Mozambique, Rwanda, and Tanzania were collected in accordance with both national and international ethical guidelines. Ethical approval was granted by ICF International and the Institutional Review Board of the U.S. Centers for Disease Control and Prevention (CDC). At the time of data collection, informed consent was obtained from all participants. For individuals under the age of 18, consent was obtained from a parent or legal guardian, and assent was obtained from the minors, following standard DHS ethical procedures. The purpose of the study and the voluntary nature of participation were clearly explained to all participants by trained data collectors. Data were collected anonymously, and no personally identifiable information was used in this analysis. Ethical guidelines were strictly followed to ensure participant privacy and confidentiality, with minimal risk involved. Further information on DHS data collection procedures and ethical standards is available at .

: Not applicable.

: The authors declare no competing interests.