Ethics approval and consent to participate
All methods were carried out in accordance with relevant guidelines and regulations. Ethical approval to conduct the survey was obtained from the Ethical Review Board of Zanzibar Health Research Institute ZAHREC/03/AUG/2021/19 as well as Harvard T.H Chan School of Public Health IRB (IRB20-1108). Informed consent and assent was obtained from all legal guardians including legal guardians of participants who cannot read or write as well as the participating adolescent (study subject) before the survey. Parent signature was recorded on the consent form, either by signature, or thumbprint, for those who could not write. Assent was provided directly by student adolescents. A copy of the consent form was kept by the parent and the study team. Participants personal information was kept confidential by assigning unique IDs and deidentification prior to analysis and storage.