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Article History

Received: 24 August 2025

Accepted: 12 March 2026

First Online: 20 March 2026

Declarations

:

: The ethical approval was obtained from the institutional ethical review board of the University of Gondar (Reference No. Rfe.VP/RTT/05/545/2023). The support letters were obtained from the APHI, Zonal and Woreda health offices. The study was conducted under the principles of the Declaration of Helsinki and the International Ethical Guidelines for Biomedical Research involving human subjects. The institutional ethical review board granted us to take informed consent from participants aged 13–49 years. Written informed consent was obtained after presenting the study’s aims and objectives to all participants, including emancipated minors, in accordance with the national research ethics guideline of the Federal Democratic Republic of Ethiopia, Ministry of Science and Technology, Fifth Edition. These emancipated minors typically under the age of 18 but working, earning their own living, married, or parenting were eligible to provide consent, as approved by the Institutional Review Board [39].

: The data in this study were anonymous and did not contain any identifying information about the participants, such as personal details, images, or videos.

: The authors declare no competing interests.