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BACKGROUND: Venipuncture is one of the most commonly performed medical procedures in paediatric care, but it can also be one of the most painful and distressing experiences for patients. Finding effective strategies to manage pain and fear associated with venipuncture is crucial for improving the paediatric patient experience and promoting positive health outcomes. This study aimed to evaluate the efficacy of a combined approach using a topical analgesic cream (TKTX cream) and a distraction technique (Trace Image and Colouring for Kids-Book, TICK-B) in reducing pain intensity and fear levels in children undergoing venipuncture procedures. METHODS: We conducted this randomised controlled trial among 176 children aged 6-12 years undergoing venipuncture. Participants were randomly assigned to four groups: TICK-B, TKTX cream, TICK-B+TKTX cream and a control group. Pain and fear were measured using the Wong-Baker FACES Pain Rating Scale and Children's Fear Scale. The study was carried out from 20 February 2024 to 1 June 2024 at the emergency unit of Heevi paediatric teaching hospital in the Kurdistan region of Iraq. In the intervention groups, TICK-B was applied for 2-3 min before needle insertion, and TKTX cream was applied 20 min before the venipuncture procedure. All outcome measures were evaluated 2-3 min after the completion of the venipuncture procedure. RESULTS: The combined TICK-B (colouring book) and TKTX cream (topical anaesthetic) intervention was the most effective in reducing both pain intensity (mean score 2.80 vs 7.24 in the control, p<0.001) and fear levels (mean score 0.93 vs 2.83 in the control, p<0.001) during and after venipuncture procedures compared with individual interventions and control. CONCLUSIONS: The combined TICK-B distraction and TKTX cream topical anaesthetic intervention was the most effective in reducing pain intensity and fear during and after venipuncture in children, providing a practical strategy for healthcare providers to optimise needle procedure management. TRIAL REGISTRATION NUMBER: NCT06326125.

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BACKGROUND: Thalassemias are genetic disorders of globin chain synthesis. In Iraq, ß-thalassemia is more prevalent than α-thalassemia. This study identifies two unpredicted globin gene mutations, a rare α-globin gene mutation (Hb SKMC) and a novel γδß-thalassemia deletion. METHODS: Over 2 years, the Genetics unit at PAR hospital in Erbil, northern Iraq processed 137 ß-thalassemia and 97 α-thalassemia genetic testing requests. Three symptomatic thalassemia cases with unreported genotypes were identified. Proband-1α and proband-2α had Hb H disease, while proband-1ß had severe transfusion-dependent ß-thalassemia (TDT). Molecular studies included multiplex PCR, reverse hybridization, multiplex ligation-dependent probe amplification (MLPA), and globin gene sequencing. RESULTS: The α-thalassemia probands exhibited moderate microcytic hypochromic anemia with irregular transfusions and splenomegaly. Hb H disease was confirmed by positive Hb H tests and high-performance liquid chromatography (HPLC). Molecular analysis revealed heterozygous -MED deletion in proband-1α and α2Poly-A2 mutation in proband-2α. Sequencing identified the Hb SKMC (HBA1:c.283_300+3dup) mutation in both probands. The ß-thalassemia proband showed anemia and regular transfusions. Molecular studies detected the IVS1.110 G>A mutation and a novel γδß-thalassemia deletion in compound heterozygous form. The maternal sample showed the IVS1.110 G>A mutation, and MLPA confirmed the γδß-thalassemia deletion in the paternal sample. CONCLUSION: These findings highlight the genetic diversity of thalassemias in the region and emphasize the importance of advanced molecular diagnostics in detecting rare mutations.

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Accurate inflow forecasting is an essential non-engineering strategy to guarantee flood management and boost the effectiveness of the water supply. As inflow is the primary reservoir input, precise inflow forecasting may also offer appropriate reservoir design and management assistance. This study aims to generalize the machine learning model using the support vector machine (SVM), which is support vector regression (SVR), to predict the discharges of the Euphrates River upstream of the Haditha Dam reservoir in Anbar province West of Iraq. Time series data were collected for the period (1986-2024) for the river's daily, monthly, and seasonal flow. Different kernel functions of SVR were applied in this study. The kernels are linear, Quadratic, and Gaussian (RBF). The results showed that the daily time scale is better than the monthly and seasonal performance. In contrast, the linear kernel outperformed the other SVR kernel with a time delay of one day based on the value of the coefficient of determination (R2 = 0.95) and the root mean square error (RMSE = 53.29) m3/sec for predicting daily river flow. The results showed that the proposed machine learning model performed well in predicting the daily flow of the Euphrates River upstream of the Haditha Dam reservoir; this indicates that the model might effectively forecast flows, which helps improve water resource management and dam operations.

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OBJECTIVE: Aim: To understand how vitamin D receptor gene polymorphism (VDR rs2228570) affects blood pressure in Iraqi patients with essential hypertension in Al Diwaniya province. PATIENTS AND METHODS: Materials and Methods: This is a single-center observational cross-sectional descriptive study of 90 patients with essential hypertension. Using the PCRTETRA ARM technique, blood samples were genotyped and examined for the polymorphisms of FOKI (rs2228570) gene. RESULTS: Results: The most frequent allele was A (121, 67%) while the most frequent genotype was AG (55, 61%). There was no statistical difference between the actual and expected frequency distribution, according to Hardy-Weinberg equilibrium. The effect of VDR polymorphism rs 2228570 on blood pressure indicates (the mean systolic blood pressure in AA, AG, and GG carrier patients was 149, 150 and 166 respectively, P=0.29. On the other hand, the mean diastolic blood pressure in AA, AG, and GG carrier patients was 89, 89, and 94 respectively P=0.6) there was no statistically significant effect on systolic and diastolic blood pressure. CONCLUSION: Conclusions: there is no statistically significant effect of VDR rs2228570 on SBP and DBP (p = 0.6), vitamin D receptor gene polymorphism rs2228570 was related to vitamin D level.

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OBJECTIVE: Aim: To estimate the differences between patients with celiac disease based on symptoms, diagnosis, treatment, and follow-up. PATIENTS AND METHODS: Materials and Methods: A retrospective cross-sectional study carried out between July 1, 2022 and April 2023, enrolling 200 patients from different provinces of central and south Iraq with Celia disease, whose diagnosis depended on a specialized physician according to WHO guidelines with long-term follow-up. Participants were following up for three to six months in private clinics. Survey was written in English, and the questionnaire form contains 13 fields divided into three sections. Diagnosis of Celia before and after treatment parameters: Tissue Transglutaminase Antibody, IgG, Serum (tTg-Ig G), and tTg-IgA levels the fourth part included a glutin-free diet and symptomatic treatment. RESULTS: Results: Females and ages below 20 were most affected. 176(88%) patients had detectable tTG levels; after 3 months, 72(36.0%) patients had an increase in their body weight but less than 5 kg, while 14(7.0%) of the patients showed an increase of more than 5 kg. But after 6 months, 73(36.5%) patients had an increase in their body weight less than 5 kg, while 45(22.5%) of patients showed an increase of more than 5 kg. CONCLUSION: Conclusions: Celiac patient profile in central Iraq is not different from that in other parts of the world, with typical patient being female and under 30 years of age. The study highlighted to a certain degree that a gluten-free diet can have a modest and promising positive impact on BMI in some patients.

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OBJECTIVE: Aim: To investigate allele frequencies of rs1799983 polymorphism eNOS genes and to determine association between rs1799983 polymorphism of eNOS gene and essential hypertension in Iraqi hypertensive patients. PATIENTS AND METHODS: Materials and Methods: This is an observational cross sectional descriptive single center study. ninety hypertensive patients were recruited by specialist cardiologist and conducted at AL-Diwaniyah teaching hospital and department of pharmacology and therapeutics, college of medicine, university of Al-Qadisiyah, Iraq. DNA samples were genotyped by PCR-tetra-arm method. NO level was measured by using ELISA kit. RESULTS: Results: Regarding rs1799983 the most frequent allele was G (73%) and the most frequent genotype was GG (55%). Our results indicate lack of substantial link between genotype frequencies of rs1799983 polymorphism and NO level (p=0.88) and thereby there is no statistically significant effect on SBP and DBP (p = 0.051). CONCLUSION: Conclusions: our study demonstrated lack of significant association between this polymorphism and essential hypertension in Iraqi hypertensive patients.

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OBJECTIVE: Aim: To assess the impact of BMI and diet control on variation in response to metformin monotherapy in Iraqi people with type 2 DM. PATIENTS AND METHODS: Materials and Methods: a cross-sectional study included 150 patients who met specific criteria, such as being between 30 and 70 years old, diagnosed with type 2 diabetes, and on a daily dose of 1000 mg metformin as a monotherapy for at least three months. Data collected included body mass index (BMI) and glycemic control parameters such as: glycated hemoglobin (HbA1c) levels, fasting blood glucose levels, fasting serum insulin levels, HOMA-IR, and insulin sensitivity. The patients according to their metformin response classified into two groups based on HbA1c as following: poor (HbA1c≥6.5% and good (HbA1c≤6.5%) responder's patients. RESULTS: Results: The statistical analysis suggests that there is no meaningful distinction in glycemic control parameters when comparing good and poor responders within specific BMI subgroups and among individuals practicing diet control. However, in a broader context, it is evident that glycemic control parameters tend to be lower in patients with lower BMI and those who are following a controlled diet. CONCLUSION: Conclusions: The correlation between diet control and BMI with glycemic control in diabetic patients, underscoring the significance of lifestyle adjustments in the management of diabetes.

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OBJECTIVE: Aim: To find any association between specific ABO blood groups and FUT2 secretory status and COVID-19 in a sample of Iraqi dentists. PATIENTS AND METHODS: Materials and Methods: For each participant, a questionnaire including demography, COVID-19 status, blood grouping, and RH factor, with chemo-sensitive symptoms was recorded. The saliva samples were collected and DNA was extracted from leukocytes. Sequencing of molecular detection of the FUT2 gene by real-time PCR and the data was done, whilst drawing the phylogenetic tree. RESULTS: Results: Out of 133, most of the dentists were female 61%, most were just under 35 years of age. The most participants in this study were predominantly with blood group O (40%), followed by B, A, and AB, with (90%) of them were RH+. All blood grouping and RH factor were high significantly associated with COVID-19 infection and its frequency (p<0.001). A significant association between smell dysfunction and infected blood group A and RH+ (p =0.044, 0.038) while taste dysfunction was negatively and significantly correlated with AB group (r=-0.73; p=0.008). The FUT2 secretor showed a significant association with COVID-19 infection and frequency. The majority of COVID-19-infected participants experienced a significant loss of both smell and taste with fast recovery within 2 weeks. CONCLUSION: Conclusions: The COVID-19 infection susceptibility and reinfection are associated with FUT2 secretory status and greatly associated to olfactory and gustatory sense loss.

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INTRODUCTION: Streptococcusmutans and lactobacilli are most important bacteria in the pathogenesis of dental caries. Cariogenic microflora has been associated to the primary caregiver transmission and sugary diets.

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Background: Najaf governorate was recorded as one of the most polluted Iraqi governorates with increased cancer, autoimmune, and abortion cases. Study Groups. A total of 88 adult volunteers from three test groups were divided based on their inhabitance in different geographical regions in Najaf governorate. Group 1 (G1; n, 29) inhabitants of Al-Ansar, Al-Abbaseyeh, and Al-Manathera districts, Group 2 (G2; n, 27) inhabitants of 22 different scattered districts of the governorate, Group 3 (G3; n, 32) inhabitants of Kufa city and center districts in the old Najaf city. According to previous authors' findings, all participants had uranium contamination in their urine and blood samples, and also, they had DNA damage according to the level of urinary 8-OHdG compound. The control group 4 (G4; n, 25) were adult healthy Iraqi volunteers who were residents of the Sulaimaniyah governorate, which has low-level uranium pollution. The present study aims to determine the effect of uranium pollution and DNA damage on the immune system function in terms of estimating the levels of serum interleukin (IL)-6, interferon-gamma (IFN-γ), and IL-1 beta (ß). Method: Enzyme-linked immunosorbent assay (ELISA) (Sandwich method technique) was used for estimating the serum cytokines levels in test and control groups. Results: A significant elevation of cytokines levels was reported as compared with the control groups (p ≤ 0.01). The level of IL-6 was 764.64 ± 24.12 pg/ml, 768.87 ± 19.64 pg/ml, and 735.62 ± 18.47 in G1, G2, and G3, respectively. The level of IFN-γ was 264.55 ± 19.17 pg/ml, 259 ± 18.76 pg/ml, and 261.20 ± 12.99 pg/ml for G1, G2, and G3, respectively. The level of IL-1ß was 99.85 ± 10.81 pg/ml, 116.8 ± 10.71 pg/ml, and 83 ± 19.24 pg/ml in G1, G2, and G3, respectively. The levels of IL-6, IFN-γ, and IL-1ß were 86.5 ± 22.9 pg/ml, 19.4 ± 2.8 pg/ml, and 16.1 ± 3.2 pg/ml in the sera of control (G4). The results showed significant statistical elevation with the corresponding p value cut-off p ≤ 0.01 in IL-6, IFN-γ, and IL-1ß in the sera of three test groups as compared with the results of the control group. Conclusion: The change in the proinflammatory cytokines (IL-6, IFN-γ, and IL-1ß) levels indicates a persistent inflammatory response in the participants and may reflect immune system impairment as a consequence of exposure to long-term low-dose ionizing radiation.

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BACKGROUND AND OBJECTIVES: Bacterial meningitis is a common serious infectious diseases in children with tough therapy due to resistance to commonly indicated antibacterial therapy. We sought to characterize the bacterial resistance spectrum of Bacterial meningitis in Iraqi pediatric patients. METHODS: Fifty-seven patients' CSF (cerebrospinal fluid) microbiological data were reviewed before enrollment of children (less than 4 years old), Gram-stain identification, white blood cells, protein, and glucose assays, and growing the bacterial pathogen from CSF or blood samples. A probable case of bacterial meningitis was determined by leukocytosis (>100 cells/mm 3), turbidity, decreased glucose (<40 mg/dl), and raised protein levels (>100 mg/dl), which provided enough evidence to start antibiotic regimen. RESULTS: Three quarters of the patients diagnosed with meningitis 71.9 % were males, although there was no significant association neither between gender nor age group and drug resistance. There was a significant association between the level of hemoglobin (low level of Hb) and drug resistance (single 68.3%, multiple 29.3%, P value 0.004). Also, there was a significant association between vaccination (unvaccinated patient) and drug resistance (multiple drug resistance) (100%, P value 0.001). CONCLUSION: This study offers valuable new insights into the characteristics and prognoses of individuals with varying degrees of therapy resistance.

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BACKGROUND: Gestational diabetes mellitus (GDM) traditionally refers to abnormal glucose tolerance with onset or first recognition during pregnancy. The objectives: The study is designed to measure vaspin in the serum of women with GDM and estimate its association with insulin resistance, HbA1c, HDL, LDL, triglyceride and total cholesterol. METHODS: This study was a case-control study conducted on 90 pregnant women (26 weeks and more), 60 of them patients with GDM, and 30 normal pregnant women as the control group, The blood sample was taken from participating women, and an interview was carried out with them using questionnaire form. vaspin and insulin were measured by ELISA technique, HbA1c was measured by ichroma™, lipid profile, and fasting blood glucose was measured by colourimetric method. RESULT: Vaspin was increased significantly in the patient group in comparison to control (268.98±154.02) ng/ml. Insulin level increased significantly in the patient group (27.88±19.69) ng/ml, HbA1c and blood glucose also increased significantly in the patient group in comparison to the control respectively (5.08±0.613) (126.47±29.05) mg/dl. However, there was no significant difference in insulin resistance, HDL, LDL, TG, and TC. CONCLUSION: The study shows that vaspin was increased in GDM but there is no negative correlation with HbA1c, insulin resistance, and lipid profile.

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Toxoplasmosis is one of the most widespread zoonotic diseases in the world. Human infection rates range from 10% to 80% in many countries. Female cancer patients receiving chemotherapy are more susceptible to developing acute forms of toxoplasmosis, which can cause brain defects, neurological damage, and encephalitis. The aim of the present study was to investigate the effect of Toxoplasma gondii infection on the induction of interferon-gamma in breast cancer patients from Iraq. This descriptive cross-sectional study was performed on women had breast cancer in Al-Haboubi Teaching Hospital in Nasiriya City-Thi-Qar Province (Iraq) during the period from January to September 2022. Approximately three ml of blood was drawn from all participants and sera were collected. The Sera were then tested for Toxoplasma IgM, IgG, and IFN-γ (Nova Tec Immunodiagnostica GmbH, Germany) using the enzyme-linked immunosorbent assay (ELISA) kits according to the protocols of the manufacturer. Before blood collection, participants completed a printed questionnaire with some demographic information, such as age and place of residence. The total number of positive T. gondii infections from breast cancer patients in the current study was 60 (85.7%). The results of sample analysis by ELISA assay showed that 85.7% and 74.2% of patients were positive for IgG and IgM, respectively. The mean IFN-γ levels in breast cancer patients with toxoplasmosis, without toxoplasmosis, and in the control group were 47.66, 0.00, and 0.57 pg/ ml, respectively. Higher IgG and interferon gamma levels were detected in the group of breast cancer patients with toxoplasmosis than in the group without toxoplasmosis. According to the ELISA findings, T. gondii was the most common parasite in female cancer patients.

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Although a large number of Muslim refugees have resettled in the United States for the last decades, few studies have looked into maternal healthcare access and utilization among Muslim refugee women in the country. This qualitative study was conducted to explore the factors influencing maternal healthcare access and utilization among Muslim refugee women resettled in the United States. In-depth interviews were conducted among Afghan, Iraqi, and Syrian refugee women (n = 17) using an interview guide informed by Social Cognitive Theory and its key constructs. The interviews were recorded and transcribed verbatim, imported into MAXQDA 2020 (VERBI Software), and analyzed based on qualitative content analysis. Data analysis revealed several themes at the micro, meso, and macro-levels. Micro-level factors included women's attitudes toward hospitals and prenatal care, as well as their life skills and language proficiency. Meso-level factors, such as cultural norms and practices, social support and network, as well as health care provider characteristics, were also identified. Macro-level factors, such as the complex healthcare system and access to insurance, also appeared to influence maternal healthcare access and utilization. This study revealed the complex contextual factors that refugee populations face. Given the population's heterogeneity, a more nuanced understanding of refugee maternal health is required, as are more tailored programs for the most vulnerable groups of refugee women.

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Background: The methylenetetrahydrofolate reductase (MTHFR) gene is an essential gene in the metabolism of folate-homocysteine. Recently, the level of homocysteine was found to be a significant marker in the follow-up of COVID-19 infection. Thus, this study aimed to detect the effect of genetic polymorphisms for single nucleotide polymorphisms (SNPs) (c.66A>G, c.1298A>C, and c.677CT) on COVID-19 infection. Methods: Blood samples were collected from 270 patients with COVID-19 in the medical center of Al-Shifa (Baghdad, Iraq) from November 2020 to March 2021. Tetra-primer amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) technique was used for the detection of genotypes of SNPs. The odds ratio (OR) was used to detect the relationship between SNPs and COVID-19 infections. Haplotype analysis was performed by SHEsis software. Results: There was a significant difference between mild/moderate cases and severe/critical cases for ages (35-45), (46-55), and (56-65) years (P<0.0001, P=0.01, and P=0.006, respectively). The results showed significant differences in the T allele for SNP c.677>C (P<0.0001 and OR=4.58). The C allele for SNP c.1298A>C indicated significant differences (P<0.001 and OR=3.15). Besides, the G allele for SNP c.677C>T showed significant differences (P<0.001 and OR=6.64). Consequently, these SNPs showed a predisposition to the development of COVID-19 infection. With regard to the C-A-A, T-A-A and T-C-G haplotypes indicated significant differences between the control and patient groups. The C-A-A was related to a decreased risk and indicated a protective effect against COVID-19 infection development (P<0.0001 and OR=0.218). The increased risk was associated with T-A-A and T-C-G haplotypes and indicated the risk impact on COVID-19 infection development (P<0.0001, P=0.004, and OR=15.5, OR=6.772, respectively). Furthermore, the linkage disequilibrium (LD) for SNPs was studied, and the complete D' value was 99. Conclusion: The genetic polymorphisms of SNPs (c.66A>G, c.1298A>C, and c.677C>T) in the Iraqi population were associated with COVID-19 infection.

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This research examines animal teeth from Early Dynastic (2900-2350 BCE) Mesopotamia (Southern Iraq) to assess animal management practices and identify consumption patterns in animal diets. The objective to answer larger questions about food management and environmental resilience in ancient early complex societies in the Near East was achieved by the use of mass spectrometry-based proteomics for dietary reconstruction. Dietary MS, a revolutionary new methodology applying proteomics techniques to archeological sample sets to reconstruct ancient animal diet. A developed protein extraction technique followed by liquid chromatography tandem mass spectrometry allowed for the identification of the specific plant species consumed in order to highlight variable herd management strategies, resource optimization, for each taxon over time. It also provided information about overall health and indications of disease. This is the first study to apply a full suite of analyses to the region and provides the foundations of a necessary long-term view of human interaction within an environment, through both time and space.

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The goal of this study is to measure the uranium concentration levels in the blood of Iraqi workers employed in certain government companies. Assessing the initial level of uranium toxicity in their blood and the possibility of health problems occurring. 184 blood samples from Iraqi government companies and the control group were collected in this study. A solid-state nuclear track detector (CR-39) was used to measure the amount of uranium present. Two drops of blood (100 µl) were placed on CR-39. The CR-39 was irradiated with a thermal neutron using the fission-track technique (241Am-9Be) to determine the uranium concentration in blood samples. The statistical analysis is carried out using the Origin Lab 2024 version. The results show the average of uranium concentration at all locations has a higher level compared to the control group. The blood samples from workers at the phosphate company had the highest amount (1.021 ± 0.050 µg/l), compared to samples from other factories. This result confirms that there is a connection between the concentration of uranium and phosphate substances. The results suggest that there is a slight increase in uranium levels that is related to both age and years of employment.

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A typographical error in the Reference No. 175 appeared erroneously in the References List of the article titled "Anti- SARSCoV- 2 IgG and IgM Levels in Iraqi General Population", 2023; 22(2) [1]. Original: Barassi, A.; Pezzilli, R.; Mondoni, M.; Rinaldo, R.F.; Dav, I.M.; Cozzolino, M. Vitamin D in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients with non-invasive ventilation support. Panminerva Med., 2021, ••• Corrected: Barassi, A.; Pezzilli, R.; Mondoni, M.; Rinaldo, R.F.; Davì, M.; Cozzolino, M. Vitamin D in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients with non-invasive ventilation support. Panminerva Med., 2023, 65(1), 23-29. We apologize to the readers for the inconvenience caused due to this error. The original article can be found online at: https://www.eurekaselect.com/article/135111.

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BACKGROUND: Understanding healthcare-seeking behavior and examining health expenditures can help determine possible barriers to accessing healthcare and direct more effective and inclusive healthcare systems. This study aimed to evaluate healthcare-seeking behavior and out-of-pocket healthcare expenditure in a sample of the population in Erbil, Iraq. METHODS: We conducted this cross-sectional study in Erbil, Kurdistan Region of Iraq, from October to December 2023. A convenience sample of 414 adults completed a self-administered online survey. The following data were collected: recent illness, sociodemographic characteristics, type of healthcare received, and cost of healthcare. RESULTS: The most common health conditions reported were communicable diseases (16.3%), musculoskeletal problems (13.1%), and noncommunicable diseases (12.7%). Approximately 85% of patients with health conditions requiring care sought healthcare; most visited private clinics (46.3%) and private hospitals (18.6%). The median total out-of-pocket healthcare expenditure in US dollars was 117.3 (interquartile range (IQR) = 45.6-410.0). The median total cost was much greater for participants who first visited a private health facility (USD 135.5, IQR = 57.3-405.6) than those who first visited a public facility (USD 76.8, IQR = 16.1-459.7). Participants ≥ 60 years spent significantly more than those < 14 years (USD 332, 95% CI = 211-453, p < 0.001). Evermarried participants spent significantly more than unmarried (USD 97, 95% CI = 1 to 192, p = 0.047). Health expenditures were significantly greater for noncommunicable diseases than infectious diseases (USD 232, 95% CI = 96-368, p = 0.001). After adjusting for covariates, age ≥ 60 years was independently associated with higher spending (USD 305, 95% CI = 153-457, p < 0.001). CONCLUSIONS: Most participants sought care from formal health services, preferring the private sector. Seeking care from private facilities incurred significantly higher costs than seeking care from public ones, which suggests potential barriers to accessing healthcare, particularly affordability. The findings underscore the importance of evaluating existing healthcare policies to enhance effectiveness and identify areas for improvement. This study can help policymakers and healthcare providers design effective interventions, allocate resources efficiently, and improve healthcare delivery.

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