Ethical approval and consent to participate
The study received ethical approval (reference number. IHRPG/938/20) from Jimma University’s Institute of Health Research and Postgraduate Office, Institutional Review board. Administrative permission was acquired from Maji Woreda Administrative offices, and formal letters to the research area were obtained from Maji Woreda Health Office. All participants provided written informed consent. Participation was voluntary with the right to withdraw at any time.