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1.
Sci Rep ; 13(1): 17108, 2023 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-37816836

RESUMEN

Cyberphysical systems connect physical devices and large private network environments in modern communication systems. A fundamental worry in the establishment of large private networks is mitigating the danger of transactional data privacy breaches caused by adversaries using a variety of exploitation techniques. This study presents a privacy-preserving architecture for ensuring the privacy and security of transaction data in large private networks. The proposed model employs digital certificates, RSA-based public key infrastructure, and the blockchain to address user transactional data privacy concerns. The model also guarantees that data in transit remains secure and unaltered and that its provenance remains authentic and secure during node-to-node interactions within a large private network. The proposed model has increased the encryption speed by about 17 times, while the decryption process is expedited by 4 times. Therefore, the average overall acceleration obtained was 16.5. Both the findings of the security analysis and the performance analysis demonstrate that the proposed model can safeguard transactional data during communications on large private networks more effectively and securely than the existing solutions.

2.
Malar J ; 22(1): 255, 2023 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-37661263

RESUMEN

BACKGROUND: Rapid urbanization in Nigerian cities may lead to localized variations in malaria transmission, particularly with a higher burden in informal settlements and slums. However, there is a lack of available data to quantify the variations in transmission risk at the city level and inform the selection of appropriate interventions. To bridge this gap, field studies will be undertaken in Ibadan and Kano, two major Nigerian cities. These studies will involve a blend of cross-sectional and longitudinal epidemiological research, coupled with longitudinal entomological studies. The primary objective is to gain insights into the variation of malaria risk at the smallest administrative units, known as wards, within these cities. METHODS/RESULTS: The findings will contribute to the tailoring of interventions as part of Nigeria's National Malaria Strategic Plan. The study design incorporates a combination of model-based clustering and on-site visits for ground-truthing, enabling the identification of environmental archetypes at the ward-level to establish the study's framework. Furthermore, community participatory approaches will be utilized to refine study instruments and sampling strategies. The data gathered through cross-sectional and longitudinal studies will contribute to an enhanced understanding of malaria risk in the metropolises of Kano and Ibadan. CONCLUSIONS: This paper outlines pioneering field study methods aimed at collecting data to inform the tailoring of malaria interventions in urban settings. The integration of multiple study types will provide valuable data for mapping malaria risk and comprehending the underlying determinants. Given the importance of location-specific data for microstratification, this study presents a systematic process and provides adaptable tools that can be employed in cities with limited data availability.


Asunto(s)
Malaria , Proyectos de Investigación , Humanos , Estudios Transversales , Nigeria/epidemiología , Ciudades/epidemiología , Malaria/epidemiología , Malaria/prevención & control
3.
Sci Rep ; 13(1): 11571, 2023 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-37463960

RESUMEN

Due to the significance of trust in Social Internet of Things (SIoT)-based smart marketplaces, several research have focused on trust-related challenges. Trust is necessary for a smooth connection, secure systems, and dependable services during trade operations. Recent SIoT-based trust assessment approaches attempt to solve smart marketplace trust evaluation difficulties by using a variety of direct and indirect trust evaluation techniques and other local trust rating procedures. Nevertheless, these methodologies render trust assessment very sensitive to seller dishonesty, and a dishonest seller may influence local trust scores and at the same time pose a significant trust related threats in the system. In this article, a MarketTrust model is introduced, which is a blockchain-based method for assessing trust in an IoT-based smart marketplace. It has three parts: familiarity, personal interactions, and public perception. A conceptual model, assessment technique, and a global trust evaluation system for merging the three components of a trust value are presented and discussed. Several experiments were conducted to assess the model's security, viability, and efficacy. According to results, the MarketTrust model scored a 21.99% higher trust score and a 47.698% lower average latency than both benchmark models. Therefore, this illustrates that using the proposed framework, a potential buyer can efficiently choose a competent and trustworthy resource seller in a smart marketplace and significantly reduce malicious behavior.

4.
Nat Commun ; 14(1): 2666, 2023 05 09.
Artículo en Inglés | MEDLINE | ID: mdl-37160867

RESUMEN

Pneumococcal conjugate vaccines (PCVs) protect against invasive pneumococcal disease (IPD) among vaccinees. However, at population level, this protection is driven by indirect effects. PCVs prevent nasopharyngeal acquisition of vaccine-serotype (VT) pneumococci, reducing onward transmission. Each disease episode is preceded by infection from a carrier, so vaccine impacts on carriage provide a minimum estimate of disease reduction in settings lacking expensive IPD surveillance. We documented carriage prevalence and vaccine coverage in two settings in Nigeria annually (2016-2020) following PCV10 introduction in 2016. Among 4,684 rural participants, VT carriage prevalence fell from 21 to 12% as childhood (<5 years) vaccine coverage rose from 7 to 84%. Among 2,135 urban participants, VT carriage prevalence fell from 16 to 9% as uptake rose from 15 to 94%. Within these ranges, carriage prevalence declined with uptake. Increasing PCV10 coverage reduced pneumococcal infection at all ages, implying at least a comparable reduction in IPD.


Asunto(s)
Infecciones Neumocócicas , Vacunas Neumococicas , Humanos , Niño , Nigeria/epidemiología , Streptococcus pneumoniae , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/prevención & control , Vacunas Conjugadas
5.
J Neurosci Rural Pract ; 13(2): 246-253, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35694056

RESUMEN

Background Depression is a common psychological disorder in women with infertility, which causes significant morbidity and mortality. Little attention is currently given to depression by health care providers who manage infertility, and there is a scarcity of studies on depression among women with infertility in northern Nigeria. Objective This study aimed at assessing the association between family functionality, sociodemographic factors, and depression severity in women with infertility attending a gynecology clinic in northwest Nigeria. Methods This was a cross-sectional study involving 415 females systematically selected from women with infertility attending a gynecology clinic in a Nigerian hospital. They were interviewed using Beck's Depression Inventory and Family APGAR (Adaptability, Partnership, Growth, Affection, Resolve) questionnaires over 12 weeks. Data regarding participants' sociodemographic and infertility characteristics were also collected. The association between categorical variables was assessed using the chi-square or Fisher's exact test. The determinants of depression severity were assessed using logistic regression analysis. A p -value of < 0.05 was considered significant. Results The mean age of respondents was 30.9 ± 6.6 years; the prevalence of depression was 44.6% (32.5% were of mild severity). Most families (73.5%) were highly functional. Association between family functionality and depression severity was not statistically significant (chi-square =5.143, p = 0.259). Respondents' religion (chi-square = 10.813, p = 0.029), education (chi-square = 36.835, p = 0.001), and monthly income (chi-square = 9.261, p = 0.010) were associated with depression severity. Being a Muslim (odds ratio [OR] = 2.9, 95% confidence interval [CI] = 1.8-5.6, p = 0.001) and having formal education (OR = 10.2, 95% CI = 4.7-16.5, p = 0.001) were determinants of depression severity. Conclusion The prevalence of depression was high among the respondents. Although no association was found between family functionality and depression severity, respondents who are Muslims or had formal education were at increased risk of depression. Therefore, a high index of suspicion for depression and holistic care is required to manage women with infertility.

6.
EClinicalMedicine ; 47: 101411, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35518118

RESUMEN

Background: The WHO in collaboration with the Nigeria Federal Ministry of Health, established a nationwide electronic data platform across referral-level hospitals. We report the burden of maternal, foetal and neonatal complications and quality and outcomes of care during the first year. Methods: Data were analysed from 76,563 women who were admitted for delivery or on account of complications within 42 days of delivery or termination of pregnancy from September 2019 to August 2020 across the 54 hospitals included in the Maternal and Perinatal Database for Quality, Equity and Dignity programme. Findings: Participating hospitals reported 69,055 live births, 4,498 stillbirths and 1,090 early neonatal deaths. 44,614 women (58·3%) had at least one pregnancy complication, out of which 6,618 women (8·6%) met our criteria for potentially life-threatening complications, and 940 women (1·2%) died. Leading causes of maternal death were eclampsia (n = 187,20·6%), postpartum haemorrhage (PPH) (n = 103,11·4%), and sepsis (n = 99,10·8%). Antepartum hypoxia (n = 1455,31·1%) and acute intrapartum events (n = 913,19·6%) were the leading causes of perinatal death. Predictors of maternal and perinatal death were similar: low maternal education, lack of antenatal care, referral from other facility, previous caesarean section, latent-phase labour admission, operative vaginal birth, non-use of a labour monitoring tool, no labour companion, and non-use of uterotonic for PPH prevention. Interpretation: This nationwide programme for routine data aggregation shows that maternal and perinatal mortality reduction strategies in Nigeria require a multisectoral approach. Several lives could be saved in the short term by addressing key predictors of death, including gaps in the coverage of internationally recommended interventions such as companionship in labour and use of labour monitoring tool. Funding: This work was funded by MSD for Mothers; and UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization (WHO).

7.
BMJ Glob Health ; 7(1)2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-35101861

RESUMEN

BACKGROUND: Pneumococcal disease contributes significantly to childhood morbidity and mortality and treatment is costly. Nigeria recently introduced the pneumococcal conjugate vaccine (PCV) to prevent pneumococcal disease. The aim of this study is to estimate health provider and household costs for the treatment of pneumococcal disease in children aged <5 years (U5s), and to assess the impact of these costs on household income. METHODS: We recruited U5s with clinical pneumonia, pneumococcal meningitis or pneumococcal septicaemia from a tertiary level hospital and a secondary level hospital in Kano, Nigeria. We obtained resource utilisation data from medical records to estimate costs of treatment to provider, and household expenses and income loss data from caregiver interviews to estimate costs of treatment to households. We defined catastrophic health expenditure (CHE) as household costs exceeding 25% of monthly household income and estimated the proportion of households that experienced it. We compared CHE across tertiles of household income (from the poorest to least poor). RESULTS: Of 480 participants recruited, 244 had outpatient pneumonia, and 236 were hospitalised with pneumonia (117), septicaemia (66) and meningitis (53). Median (IQR) provider costs were US$17 (US$14-22) for outpatients and US$272 (US$271-360) for inpatients. Median household cost was US$51 (US$40-69). Overall, 33% of households experienced CHE, while 53% and 4% of the poorest and least poor households, experienced CHE, respectively. The odds of CHE increased with admission at the secondary hospital, a diagnosis of meningitis or septicaemia, higher provider costs and caregiver having a non-salaried job. CONCLUSION: Provider costs are substantial, and households incur treatment expenses that considerably impact on their income and this is particularly so for the poorest households. Sustaining the PCV programme and ensuring high and equitable coverage to lower disease burden will reduce the economic burden of pneumococcal disease to the healthcare provider and households.


Asunto(s)
Infecciones Neumocócicas , Neumonía , Niño , Preescolar , Costo de Enfermedad , Gastos en Salud , Humanos , Nigeria/epidemiología , Infecciones Neumocócicas/prevención & control
8.
PeerJ Comput Sci ; 8: e801, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35111911

RESUMEN

The increasing number of rice product safety issues and the potential for contamination have established an enormous need for an effective strategy for the traceability of the rice supply chain. Tracing the origins of a rice product from raw materials to end customers is very complex and costly. Existing food supply chain methods (for example, rice) do not provide a scalable and cost-effective means of agricultural food supply. Besides, consumers lack the capability and resources required to check or report on the quality of agricultural goods in terms of defects or contamination. Consequently, customers are forced to decide whether to utilize or discard the goods. However, blockchain is an innovative framework capable of offering a transformative solution for the traceability of agricultural products and food supply chains. The aim of this paper is to propose a framework capable of tracking and monitoring all interactions and transactions between all stakeholders in the rice chain ecosystem through smart contracts. The model incorporates a system for customer satisfaction feedback, which enables all stakeholders to get up-to-date information on product quality, enabling them to make more informed supply chain decisions. Each transaction is documented and stored in the public ledger of the blockchain. The proposed framework provides a safe, efficient, reliable, and effective way to monitor and track rice products safety and quality especially during product purchasing. The security and performance analysis results shows that the proposed framework outperform the benchmark techniques in terms of cost-effectiveness, security and scalability with low computational overhead.

9.
Curr HIV Res ; 19(6): 488-496, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34109911

RESUMEN

BACKGROUND: In line with global standards and progress made in Prevention of Motherto- Child Transmission (PMTCT), an assessment of the outcome of Early Infant Diagnosis in northern Nigeria is necessary to evaluate progress towards zero Human immunodeficiency Virus (HIV) infection among children. OBJECTIVES: This study assessed the infection rate and risk factors for mother-to-child HIV transmission among HIV-exposed children in Kano, northwest Nigeria. METHODS: Using a retrospective cohort design, pregnant HIV-positive women and their exposed infants were recruited over a period of six years (2010 to 2016). Participants were enrolled during pregnancy or at delivery in the PMTCT clinic of a tertiary health facility in Kano, Nigeria. The main outcomes for the study were Early infant diagnosis positivity for HIV at 6 weeks and risk factors for positivity. RESULTS: Of the 1,514 infants studied, early infant diagnosis was positive for HIV among 13 infants (0.86%). Infants whose mothers did not have antiretroviral therapy (adjusted Prevalence Ratio aPR = 2.58, 95%CI (1.85- 3.57)), who had mixed feeding (aPR = 12.06, 95%CI (9.86- 14.70)), and those not on antiretroviral prophylaxis (aPR = 20.39, 95%CI (16.04- 25.71)) were more likely to be infected with HIV. HIV-exposed infants on nevirapine and zidovudine prophylaxis were 95% and 74%, respectively, less likely to be infected with HIV. CONCLUSION: HIV infection rate remains high among HIV-exposed infants whose mothers did not receive PMTCT services. Scaling up proven interventions of early commencement of antiretroviral treatment for mothers, adherence to antiretroviral prophylaxis, and avoidance of mixed feeding among HIV-exposed infants would protect future generations from HIV infection.


Asunto(s)
Infecciones por VIH , Complicaciones Infecciosas del Embarazo , Antirretrovirales/uso terapéutico , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Instituciones de Salud , Humanos , Lactante , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Madres , Nigeria/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Estudios Retrospectivos
10.
Int J MCH AIDS ; 10(1): 55-65, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33442492

RESUMEN

BACKGROUND: Human Immunodeficiency Virus (HIV)-exposed and HIV-infected infants are at increased risk of vaccine-preventable diseases. However, little is known about health care workers' knowledge and immunization counseling practices in this population. We determined the predictors of health care workers' knowledge of vertical transmission risks, HIV exposed/infected infant immunization, and counseling practices in a tertiary center in Northern Nigeria. METHODS: A cross-section of 297 health workers were interviewed using a structured, validated questionnaire. Knowledge and HIV-exposed infant immunization counseling practices were analyzed, and adjusted odds ratios for predictors were derived from logistic regression models. RESULTS: Of the 297 participating health care workers, (32.3%, n=96) had adequate knowledge of HIV-exposed/infected infant immunization. Two-thirds (67%, n=199) of the participants appropriately identified the timing of infant diagnosis, while (73%, n=217) and (56.2%, n=167) correctly categorized infants as HIV-exposed and HIV-infected, respectively. Only (19.5%, n=58) participants had ever counselled a HIV-positive mother on infant immunization. Knowledge was predicted by work unit (HIV clinic vs. Obstetrics & Gynecology clinic), (Adjusted Odds Ratio (AOR) =3.78, 95% CI: 1.27-5.54), age (30-39 vs. <30 years), (AOR=2.24, 95% CI:1.19-5.67), years of experience (≥10 vs. <5), (AOR=1.76, 95% CI: 1.15-6.04), number of children (1 vs. 0), (AOR=1.73, 95% CI:1.14-4.23), infant immunization training (yes vs. no), (AOR=1.57, 95% CI:1.12-5.43), female sex (AOR = 1.17, 95% CI:1.06-2.21), profession (nurse/midwife vs. physician), (AOR=0.44, 95% CI:0.21-0.94) and previous HIV test (no vs. yes), (AOR=0.67, 95% CI:0.21-0.83). CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Knowledge of HIV-exposed infant immunization was low and counseling practices were sub-optimal. Both immunization knowledge and counseling practices were predicted by demographic, professional, and training variables. Our findings indicate the need for educating health care workers on HIV exposed/infected infant immunization policy and improving counseling skills through capacity-building programs.

11.
Sci Total Environ ; 705: 135869, 2020 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-31837877

RESUMEN

The intent of the present study was to evaluate the effect of chromium (Cr3+) as chromium propionate on growth performance, organ index, immune response, intestinal morphology and nutrient transporter gene expression in broilers. One-day-old broiler chicks (n = 756) were divided into six experimental groups of 126 chicks; each group was further divided into 7 replicates (18 chicks/replicate). All birds were offered corn-soybean diets supplemented with Cr3+ at 0, 0.10, 0.15, 0.20, 0.25 or 0.30 mg/kg. Dietary inclusion of Cr3+ at various levels yielded significantly better growth performance and organ index in birds. Similarly, antibody titre against Newcastle disease and avian influenza H5 at various ages was found to be significantly higher in birds that received 0.15 mg/kg Cr3+ in the diet. Significant results with respect to villus height (VH), crypt depth (CD) and VH:CD were observed in all groups that received Cr3+ in the diet compared to control. Moreover, it was observed that different levels of Cr3+ supplementation of the diet also increased the expression of the nutrient transporter genes SGLT1, GLUT2, rBAT and CAT1 in broilers. The findings of the present study suggest that dietary inclusion of Cr3+ at various levels may have beneficial effects on growth performance, immunity, intestinal morphology and nutrient transporter gene expression in broilers. Supplementation of the diet with Cr3+ at a level of 0.15 mg/kg could yield better performance in broiler production.


Asunto(s)
Alimentación Animal , Pollos , Animales , Dieta , Suplementos Dietéticos , Nutrientes , Propionatos
12.
BMC Infect Dis ; 17(1): 170, 2017 02 23.
Artículo en Inglés | MEDLINE | ID: mdl-28231851

RESUMEN

BACKGROUND: Tuberculosis (TB) remains a leading cause of death in much of sub-Saharan Africa despite available effective treatment. Prompt initiation of TB treatment and access to antiretroviral therapy (ART) remains vital to the success of TB control. We assessed time to mortality after treatment onset using data from a large treatment centre in Nigeria. METHODS: We analysed a retrospective cohort of TB patients that commenced treatment between January 2010 and December 2014 in Aminu Kano Teaching Hospital. We estimated mortality rates per person-months at risk (pm). Cox proportional hazards model was used to determine risk factors for mortality. RESULTS: Among 1,424 patients with a median age of 36.6 years, 237 patients (16.6%) died after commencing TB treatment giving a mortality rate of 3.68 per 100 pm of treatment in this cohort. Most deaths occurred soon after treatment onset with a mortality rate of 37.6 per 100 pm in the 1st week of treatment. Risk factors for death were being HIV-positive but not on anti-retroviral treatment (ART) (aHR 1.39(1 · 04-1 · 85)), residence outside the city (aHR 3 · 18(2.28-4.45)), previous TB treatment (aHR 3.48(2.54-4.77)), no microbiological confirmation (aHR 4.96(2.69-9.17)), having both pulmonary and extra-pulmonary TB (aHR 1.45(1.03-2.02), and referral from a non-programme linked clinic/centre (aHR 3.02(2.01-4.53)). CONCLUSIONS: We attribute early deaths in this relatively young cohort to delay in diagnosis and treatment of TB, inadequate treatment of drug-resistant TB, and poor ART access. Considerable expansion and improvement in quality of diagnosis and treatment services for TB and HIV are needed to achieve the sustainable development goal of reducing TB deaths by 95% by 2035.


Asunto(s)
Antituberculosos/uso terapéutico , Tuberculosis/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Tardío/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológico , Adulto Joven
13.
Anim Reprod Sci ; 172: 164-72, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27477115

RESUMEN

Melatonin (N-acetyl-5-methoxytryptamine) is documented as a hormone involved in the circadian regulation of physiological and neuroendocrine function in mammals. Herein, the effects of melatonin on the functions of porcine granulosa cells in vitro were investigated. Porcine granulosa cells were cultivated with variable concentrations of melatonin (0, 0.001, 0.01, 0.1, 1.0, and 10ng/mL) for 48h. Melatonin receptor agonist (IIK7) and antagonist (Luzindole, 4P-PDOT) were used to further examine the action of melatonin. The results showed optimum cell viability and colony-forming efficiency of porcine granulosa cells at 0.01ng/mL melatonin for 48-h incubation period. The percentage of apoptotic granulosa cells was significantly reduced by 0.01 and 0.1ng/mL melatonin within the 48-h incubation period as compared with the rest of the treatments. Estradiol biosynthesis was significantly stimulated by melatonin supplementation and suppressed for the progesterone secretion; the minimum ratio of progesterone to estradiol was 1.82 in 0.01ng/mL melatonin treatment after 48h of cultivation. Moreover, the expression of BCL-2, CYP17A1, CYP19A1, SOD1, and GPX4 were up-regulated by 0.01ng/mL melatonin or combined with IIK7, but decreased for the mRNA levels of BAX, P53, and CASPASE-3, as compared with control or groups treated with Luzindole or 4P-PDOT in the presence of melatonin. In conclusion, the study demonstrated that melatonin mediated proliferation, apoptosis, and steroidogenesis in porcine granulosa cells predominantly through the activation of melatonin receptor MT2 in vitro, which provided evidence of the beneficial role of melatonin as well as its functional mechanism in porcine granulosa cells in vitro.


Asunto(s)
Células de la Granulosa/fisiología , Melatonina/farmacología , Receptor de Melatonina MT2/metabolismo , Porcinos/fisiología , Animales , Apoptosis , Células Cultivadas , Femenino , Regulación de la Expresión Génica , Isoindoles/farmacología , Receptor de Melatonina MT2/genética , Triptaminas/farmacología
14.
J Trop Med ; 2015: 189232, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26161095

RESUMEN

Adherence to artemisinin-based combination therapy (ACT) is not clearly defined. This meta-analysis determines the prevalence and predictors of adherence to ACT. Twenty-five studies and six substudies met the inclusion criteria. The prevalence of ACT adherence in the public sector was significantly higher compared to retail sector (76% and 45%, resp., P < 0.0001). However, ACT adherence was similar across different ACT dosing regimens and formulations. In metaregression analysis prevalence estimates of adherence significantly decrease with increasing year of study publication (P = 0.046). Factors found to be significant predictors of ACT adherence were years of education ≥ 7 {odds ratio (OR) (95% CI) = 1.63 (1.05-2.53)}, higher income {2.0 (1.35-2.98)}, fatty food {4.6 (2.49-8.50)}, exact number of pills dispensed {4.09 (1.60-10.7)}, and belief in traditional medication for malaria {0.09 (0.01-0.78)}. The accuracy of pooled estimates could be limited by publication bias, and differing methods and thresholds of assessing adherence. To improve ACT adherence, educational programs to increase awareness and understanding of ACT dosing regimen are interventions urgently needed. Patients and caregivers should be provided with an adequate explanation at the time of prescribing and/or dispensing ACT.

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