Ethical clearance was obtained from the Institution Review Board (IRB) of institute of health of Jimma University. Written permission was obtained from the Dire Dawa administrative city Health Bureau. Then, heads of hospitals and health centers were communicated through formal letters from the city health office in addition to personal communication by the investigator. Informed written consent was obtained from each study participant before the interview. The interview was held in a separate room to maintain privacy and Answers to any questions were made completely confidential.

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