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Article History

Received: 5 July 2024

Accepted: 26 May 2025

First Online: 5 June 2025

Declarations

:

: The current study was based on an analysis of publicly available secondary data that had all identification information removed. ICF Macro’s Institutional Review Board (IRB) in Fairfax, Virginia, USA, reviewed and approved the MEASURE DHS Project Phase 3. That approval covers the DHS from 2010 to 2018. ICF Macro’s IRB met the United States Department of Health and Human Services’ criteria for “Protection of Human Subjects” (45 CFR 46). The IRB-approved processes for DHS public use datasets do not identify respondents, households, or sample communities. The data files contain no names or household addresses. The geographic identifiers only extend to the regional level. Each enumeration region (Primary Sampling Unit) has a PSU number in the data file, but there are no labels indicating their names or locations. In surveys that collect GIS coordinates in the field, the coordinates are only for the entire enumeration area (EA), not for individual houses, and the measured coordinates are randomly shifted within a vast geographic area, making it impossible to identify specific enumeration areas. In addition, for participants under the age of 16, a parent or guardian provided written informed consent. The DHS Program has consistently maintained confidentiality and informed consent over the years. We have express permission to utilize the data from ICF Macro. This study did not require any further permission. The data owners can be contacted at , and data can be found at . Further documentations on ethical issues relating to the surveys are available at . We confirm that all methods were carried out in accordance with the relevant guidelines and regulation.

: Not applicable.

: The authors declare no competing interests.

: Authors declare that there was no conflict of interest among authors or between authors and institutions.