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Background Potentially inappropriate medications (PIM) are associated with adverse health outcomes. The use of PIM among persons living with HIV (PLHIV) could be more problematic due to peculiarities such as antiretroviral toxicity and drug-disease interactions. However, PIM among PLHIV continues to receive little attention. Therefore, we aimed to systematically review and estimate the prevalence of PIM among PLHIV. Methods We searched the PubMed, Scopus, and Web of Science databases to identify relevant studies from 1 January 2014 to 30 June 2024. Studies included were peer-reviewed articles that determined PIM prevalence using validated explicit or implicit tools and provided statistical information on the measured outcomes. Systematic, narrative, and literature reviews as well as case studies, commentaries, and editorials were excluded. Risk of bias was assessed using the Joanna Briggs Institute Prevalence Critical Appraisal Tool. Subgroup analysis was performed for the different geographic regions, PIM criteria, age, study period, and median numbers of medicines. Statistical heterogeneity was assessed using the I2 statistic. Sensitivity analyses, publication bias, and cumulative meta-analysis were conducted. Results A total of 13 articles, including 3200 PLHIV, were included for the systematic review, while meta-analysis was conducted using 8 studies comprising 2546 PLHIV. Most of the studies (46%) employed a cross-sectional study design. 11 out of the 13 studies were conducted in Europe. Most studies reported benzodiazepines as the most common PIM among PLHIV, while hypertension and dyslipidaemia were identified as the most frequent comorbidities. Overall, the pooled prevalence of PIM was 44.8% (95% CI, 32%-58%) using a random-effect model. PIM prevalence among PLHIV was higher among those exposed to polypharmacy (59.3%; CI: 48.9% – 68.9%), those aged > 70 years (44.6%; CI: 24.1–67.1), and post-COVID (48.9%; CI: 39%-59%). Conclusion This study suggests that PIM exposure among PLHIV is a budding issue. Findings from this review advocate for mitigating measures against PIM use. Also, this review contributes data on the use of PIM across different cohorts, creating awareness for policymakers and health managers. Review registration PROSPERO – CRD42024529411.

BackgroundAlthough different educational interventions have been widely used to manage and treat hypertension, alone or in combination with other interventions, there is a significant variation in their claimed effectiveness.Review question/objectiveThe objective of this umbrella review is to determine the effectiveness of educational interventions, alone or in combination with other interventions, for improving blood pressure control and self-management practices among hypertensive patients. The review question is: Do educational interventions, alone or in combination with other interventions, improve self-management practices among patients with hypertension?MethodsWe will conduct a review of systematic reviews involving studies that implemented educational interventions, alone or in combination with other interventions, designed to change self-care practices among hypertensive patients who are 18 years and above, regardless of their sex and ethnicity. Following the guidelines set forth in the Preferred Reporting Items for Systematic Review and Meta-Analysis statement, a comprehensive literature search will be conducted from September to December 2023 on six electronic databases: MEDLINE, Embase, PsycINFO, CINAHL, Web of Science Core Collection and Google Scholar. Search terms will be developed using database-specific indexed terms and text words derived from the review aim. We will present the effects of the educational interventions, alone or in combination with other interventions, on hypertension self-management practices. We will report the outcome data with 95% CIs for each study. Relative risk, mean differences or ORs will be used, depending on the measuring indices in each study.Ethics and disseminationEthical approval is not required as this study will use aggregated data from previously published systematic reviews. However, we have registered the protocol in PROSPERO. We confirm that all methods will be performed following the guidelines of the Declaration of Helsinki. The findings from this study will be disseminated through presentations at academic conferences and publication in peer-reviewed international journals.PROSPERO registration numberCRD42022375581.

Healthcare access remains a challenge in developing countries and could be a drawback to the attainment of Objective 3 of the Sustainable Development Goals. Digital interventions such as telemedicine have been identified as an effective tool to improve healthcare access. However, evidence suggests that the impact of telemedicine is not uniform globally due to variances in barriers and facilitators. Thus, we conducted a systematic review to identify the barriers and facilitators of telemedicine in Nigeria. The systematic review was pre-registered on PROSPERO (Identification Number: CRD42024609405). Search was conducted on PubMed, Scopus, and the Cumulative Index of Nursing and Allied Health Literature databases. We included studies that reported on the estimates of barriers and facilitators of telemedicine in Nigeria as well as the factors associated with telemedicine implementation, provision, or operation in Nigeria. The outcome was the reportage of barriers and facilitators of telemedicine in Nigeria. A total of 384 studies were identified from the search. After the application of eligibility criteria and deletion of duplicates, 29 studies were included in the review. The most reported barriers were technical and institutional-related while the most reported facilitators were human-resource-related. Technical barriers frequently reported were power outages, poor internet connectivity, and paucity of health professionals with technical expertise while institutional barriers were lack of regulation and poor organizational policies. Formal telemedicine training and education were the most reported human resource facilitators while the use of low-tech educational networks and internet accessibility were the most reported technical facilitators. Findings from this review suggest that technical barriers are a challenge to adopting telemedicine in Nigeria. Evidence shows that education and training are critical in addressing these technical challenges. Thus, this review provides a background for interventions towards the effective implementation of telemedicine in Nigeria.

Background This study aimed to assess the impact of an educational intervention on knowledge, acceptability, and willingness to pay (WTP) for dapivirine vaginal ring (DPV-VR) by undergraduate female students at the University of Nigeria (UNN). Methods A cross-sectional design was adopted to obtain responses from the respondents using a validated 23-item questionnaire. A sample size of 1500 was estimated from five systematically sampled faculties. Their acceptability was accessed before and after educating them on the dapivirine vaginal ring (DPV-VR). WTP was determined in Naira (N490/$1) using contingent valuation. Descriptive statistics were used to summarize the findings, with inter-faculty comparison done with the Chi-squared test. Results 1017 students responded to the questionnaire. The modal age was 18–24 years (754 [74.1%]), and most of them (886 [87.1%]) were unmarried. More than half of the respondents had tested for HIV (531 [52.2%])), with 3 (1.5%), 3 (1.7%), 2 (0.6%), 2 (1.8%) and 1 (0.5%) student from Arts, Biological Sciences, Pharmaceutical Sciences, Social Sciences, and Veterinary Medicine, respectively, having positive results. Only 304 (29.9%) of the students had prior knowledge of DPV-VR. There was about a two-fold increase in the acceptability of the dapivirine vaginal ring (DPV-VR) (294 to 596) after the intervention ( p  ≤ 0.001). Most of the students (466 [45.8%]) indicated that they would be willing to pay < N410.00 for a single dapivirine vaginal ring (DPV-VR). Conclusions Many of the female students at UNN were willing to use the dapivirine vaginal ring (DPV-VR); even more after they were informed of its importance. Most of the students were willing to pay less than one dollar out-of-pocket for the ring.

Despite the global scale up of dolutegravir (DTG)-based regimens as the preferred first-line therapy for persons living with HIV (PLHIV), no comprehensive evidence exists on its effect on patient-reported outcomes such as Quality of Life (QoL) and patient satisfaction (PS). We conducted a systematic review and meta-analysis to provide the first comprehensive quantitative synthesis of the effect of DTG-based regimens on QoL and PS among PLHIV. We conducted literature search on PubMed, Scopus, Embase and Cochrane Library databases for peer-reviewed, primary studies published from January 2015 to January 2025. Studies using validated tools to evaluate QoL and PS among PLHIV exposed to DTG were eligible. Standardised Mean Differences (SMD) were computed using DerSimonian-Laird random-effects model. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The study protocol was registered on PROSPERO (CRD42025643301). Seventeen out of the 214 (n = 4064) identified studies met the inclusion criteria, with six contributing to the QoL meta-analysis and four to the PS meta-analysis. The pooled QoL estimate showed a small improvement favoring DTG-based regimens compared to other antiretroviral therapy (ART) though not statistically significant (SMD: 0.094, 95% CI: -0.034-0.223; p = 0.15; GRADE: Very Low). With the WHOQOL-HIV BREF tool subgroup, a positive directional effect was also observed (SMD: 0.09, 95% CI: -0.042-0.22, p = 0.18; I2 = 0.0%) compared to other ART, though not statistically significant. DTG-based regimens were associated with a statistically significant improvement in PS (SMD = 0.3; 95% CI: 0.2-0.4; p < 0.001; I2 = 10.7; GRADE: Low). Among studies that used the HIV Treatment Satisfaction Questionnaire to evaluate PS, the effect of DTG-based regimens was also statistically significant (SMD: 0.32, 95% CI: 0.2-0.45, p < 0.001; I2 = 34%). This review identified a directional improvement in QoL and a statistically significant small improvement in PS among PLHIV on DTG-based regimens. Findings from this study were supported by low between-study heterogeneity. However, findings should be interpreted in the context of low and very low certainty of evidence for both outcomes. Additionally, results from this study are best characterized as hypothesis-generating and supportive of person-centered HIV care, underscoring the need for more well-designed trials to generate high-certainty evidence on patient-reported outcomes among PLHIV. Not applicable.

Healthcare access remains a challenge in developing countries and could be a drawback to the attainment of Objective 3 of the Sustainable Development Goals. Digital interventions such as telemedicine have been identified as an effective tool to improve healthcare access. However, evidence suggests that the impact of telemedicine is not uniform globally due to variances in barriers and facilitators. Thus, we conducted a systematic review to identify the barriers and facilitators of telemedicine in Nigeria. The systematic review was pre-registered on PROSPERO (Identification Number: CRD42024609405). Search was conducted on PubMed, Scopus, and the Cumulative Index of Nursing and Allied Health Literature databases. We included studies that reported on the estimates of barriers and facilitators of telemedicine in Nigeria as well as the factors associated with telemedicine implementation, provision, or operation in Nigeria. The outcome was the reportage of barriers and facilitators of telemedicine in Nigeria. A total of 384 studies were identified from the search. After the application of eligibility criteria and deletion of duplicates, 29 studies were included in the review. The most reported barriers were technical and institutional-related while the most reported facilitators were human-resource-related. Technical barriers frequently reported were power outages, poor internet connectivity, and paucity of health professionals with technical expertise while institutional barriers were lack of regulation and poor organizational policies. Formal telemedicine training and education were the most reported human resource facilitators while the use of low-tech educational networks and internet accessibility were the most reported technical facilitators. Findings from this review suggest that technical barriers are a challenge to adopting telemedicine in Nigeria. Evidence shows that education and training are critical in addressing these technical challenges. Thus, this review provides a background for interventions towards the effective implementation of telemedicine in Nigeria.

The COVID-19 vaccine is essential to reduce the global impact of the pandemic. Understanding its acceptance is key to Nigeria’s national COVID-19 control strategies. Between the 6th and 22nd of January 2021, we conducted a non-probability convenience sampling of 3076 respondents using online and in-person interviews to assess the prevalence and predictors of the COVID-19 vaccine acceptance in Nigeria. Of the 3076 recruited participants, 74.7% (n = 2300/3076) had tertiary education. The median age group was 30–39 years (35.1%, n = 1097/3076) whereas 31% (n = 952/3076) of all respondents had a monthly income<30,000 Naira (65 USD). The survey results indicated that a wide range of the respondents were in government employment (34.1%, n = 1050/3076). The majority of our study participants (92.2%, n = 2835/3076) believe that COVID-19 is real and not a hoax. Only 27.9% (n = 858/3076) of the study participants have been tested for COVID-19 and 17.8 % (n = 152/858) of the tested respondents were COVID-19 positive by PCR. Half (50.7%; n = 1560/3076) of the study participants were willing to take the vaccine once available. The majority of the respondents (81.1%, n = 2496/3076) were not willing to pay for the vaccine. Only 15.9% (n = 483/3076) of the respondents rated the government’s handling of the pandemic above average. The potential acceptance of the COVID-19 vaccine was significantly affected by the age and the monthly income of the respondents. Respondents older than 60 years old (OR: 3.02, 95% CI: 1.69,5.41; p < 0.001) and those that earn between 250,000–500,000 Naira monthly (OR: 1.38; 95% CI: 1.11,1.70; p < 0.001) were more likely to accept the COVID-19 vaccine respectively. In addition, the respondents’ perception of the existence of the disease (OR: 1.45; 95% CI: 0.99,2.18; p > 0.05), the need for a COVID-19 vaccine (OR: 16; 95% CI: 11.63,22.10; p < 0.001), the willingness to pay (OR: 1.68; 95% CI: 1.39,2.01; p < 0.001) and the rating of the government handling of the pandemic (OR: 2.25; 95% CI: 1.57,3.23; p < 0.001) were critical to the acceptance of the COVID-19 vaccine. With 50.7% vaccine acceptance, Nigeria’s public health policymakers must prioritize and develop strategies that will effectively increase COVID-19 vaccine acceptance across the country with emphasis on trust, transparency and strong leadership.

is increasingly detected in sugarcane fields, but its infection biology and effective chemical control options remain unclear. We isolated the causal fungus from symptomatic sugarcane leaves and identified it using morphology and ITS phylogeny. Pathogenicity was tested on cultivar ROC22 using wounded and unwounded inoculations (mycelial plugs and spore suspensions). We assessed fungal growth across temperatures and pH, quantified host chlorophyll and defense-related responses (POD, SOD, PAL, and MDA), and evaluated sensitivity to commonly used fungicides using growth-inhibition assays. The isolate (MF1) clustered with and caused lesions only on mechanically wounded leaves. Infection reduced chlorophyll content and increased POD, SOD, PAL activities and MDA accumulation. Optimal growth occurred around 25-30°C and near neutral pH. Among tested fungicides, pyraclostrobin + metiram and difenoconazole showed the strongest inhibition (lowest EC ), whereas several others were weak or ineffective. These results indicate acts as a wound-dependent opportunistic pathogen of sugarcane. The sensitivity profile provides baseline guidance for integrated management and resistance-aware fungicide selection.

Main conclusion Silicon application at a concentration of 2 mM induced sugarcane resistance to Nigrospora oryzae by upregulating pathogen recognition and defense genes, thus increasing plant metabolic activities and productivity. Sugarcane is an important global food and industrial crop, but numerous pathogens threaten its productivity. Our team recently identified the fungus Nigrospora oryzae as a pathogen affecting sugarcane’s growth and productivity. Although silicon supplementation is active against most fungi, it remains unclear if it would enhance the resilience of sugarcane to N. oryzae , and molecular mechanisms underlying this process are yet to be explored. In this study, we explored the effects of four silicon concentrations (control, 1 mM, 2 mM, and 4 mM) on the growth and disease resistance of seedlings of the sugarcane variety ROC22 under fungal stress. Employing an integrative approach combining detailed phenotypic analysis with transcriptomic and metabolomic profiling, we elucidated the underlying molecular mechanisms of silicon’s protective effects. Results indicated that optimal concentrations (2 mM) of silicon enhanced disease resistance and significantly improved plant height, root characteristics, and enzymatic activities. Transcriptomic analysis revealed an upregulation of genes (826) involved in pathogen recognition and defensive response, while metabolomic analysis highlighted alterations in metabolic pathways pertinent to stress response. These findings suggest that silicon supplementation could effectively bolster sugarcane’s defense against fungal diseases, offering new insights into its role in plant pathology and paving the way for developing more resilient crop varieties. Graphical abstract

The treatment method of natural fiber is one of the factors that influences its properties. There are several reports on sodium hydroxide (NaOH) treatment of many natural fiber. Though there are works on NaOH treatment of the fruits fiber, however, works on Borassus flabellifer Leaf fiber (BFLF) is sparsely reported. Hence no report on the optimum conditions for sodium hydroxide treatment of Borassus Flabellifer Leaf fiber. Therefore, this study aimed at establishing the optimum concentration and time for alkaline treatment on the properties of BFLF. The fiber extraction was carried out using water retting method for 24 h. Experimental design was carried out using Design Expert 12.0 adopting Central composite design in response surface methodology. NaOH concentration of 0–5 wt% and time of 1–12 h were used as the independent variables. The responses were water absorption, elongation (%), modulus of elasticity and tensile strength. The surface morphology of the fiber was studied using scanning electron microscope (SEM) and the functional group changes established using Fourier transform infrared (FTIR) spectroscopy to indicate effect of NaOH treatment (FTIR) spectroscopy to show the functional group changes due to NaOH treatment. The optimum concentration and treatment time was established as 2 wt% NaOH and 4 h, respectively, with corresponding responses of water absorption, tensile strength, modulus of elasticity and elongation (%) were 2.07%, 977.378 MPa, 6971.02 MPa, 5.178%, respectively. Using these optimum treatment conditions of time and NaOH concentration, the responses were validated to be 1.88%, 920.019 MPa, 6943.73 MPa, 4.99 mm having a desirability of 0.963. The SEM revealed rough surfaces and increased porosity for the treated fiber compared to the untreated. The FTIR spectra showed reduction in peaks representing lignin at wavelength of 3321.1 cm −1 to 3306.1 cm −1 , which indicated that the NaOH treatment resulted to decrease in lignin in the fiber. The properties of the BFLF obtained at the optimum treatment conditions were within range of other fibers used in composite materials development, hence, BFLF treated at these conditions is suitable for composite development.