The Impact of Text Message Reminders on Adherence to Antimalarial Treatment in Northern Ghana: A Randomized Trial
Identifieur interne : 000225 ( Pmc/Checkpoint ); précédent : 000224; suivant : 000226The Impact of Text Message Reminders on Adherence to Antimalarial Treatment in Northern Ghana: A Randomized Trial
Auteurs : Julia R. G. Raifman [États-Unis] ; Heather E. Lanthorn [États-Unis] ; Slawa Rokicki [États-Unis] ; Günther Fink [États-Unis]Source :
- PLoS ONE [ 1932-6203 ] ; 2014.
Abstract
Low rates of adherence to artemisinin-based combination therapy (ACT) regimens increase the risk of treatment failure and may lead to drug resistance, threatening the sustainability of current anti-malarial efforts. We assessed the impact of text message reminders on adherence to ACT regimens.
Health workers at hospitals, clinics, pharmacies, and other stationary ACT distributors in Tamale, Ghana provided flyers advertising free mobile health information to individuals receiving malaria treatment. The messaging system automatically randomized self-enrolled individuals to the control group or the treatment group with equal probability; those in the treatment group were further randomly assigned to receive a simple text message reminder or the simple reminder plus an additional statement about adherence in 12-hour intervals. The main outcome was self-reported adherence based on follow-up interviews occurring three days after treatment initiation. We estimated the impact of the messages on treatment completion using logistic regression.
1140 individuals enrolled in both the study and the text reminder system. Among individuals in the control group, 61.5% took the full course of treatment. The simple text message reminders increased the odds of adherence (adjusted OR 1.45, 95% CI [1.03 to 2.04], p-value 0.028). Receiving an additional message did not result in a significant change in adherence (adjusted OR 0.77, 95% CI [0.50 to 1.20], p-value 0.252).
The results of this study suggest that a simple text message reminder can increase adherence to antimalarial treatment and that additional information included in messages does not have a significant impact on completion of ACT treatment. Further research is needed to develop the most effective text message content and frequency.
ClinicalTrials.gov
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DOI: 10.1371/journal.pone.0109032
PubMed: 25350546
PubMed Central: 4211682
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The Impact of Text Message Reminders on Adherence to Antimalarial Treatment in Northern Ghana: A Randomized Trial</title><author><name sortKey="Raifman, Julia R G" sort="Raifman, Julia R G" uniqKey="Raifman J" first="Julia R. G." last="Raifman">Julia R. G. Raifman</name><affiliation wicri:level="2"><nlm:aff id="aff1"><addr-line>Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Global Health and Population, Harvard School of Public Health, Boston, MA</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Lanthorn, Heather E" sort="Lanthorn, Heather E" uniqKey="Lanthorn H" first="Heather E." last="Lanthorn">Heather E. Lanthorn</name><affiliation wicri:level="2"><nlm:aff id="aff2"><addr-line>Harvard School of Public Health, Boston, MA, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Harvard School of Public Health, Boston, MA</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Rokicki, Slawa" sort="Rokicki, Slawa" uniqKey="Rokicki S" first="Slawa" last="Rokicki">Slawa Rokicki</name><affiliation wicri:level="2"><nlm:aff id="aff3"><addr-line>Department of Health Policy, Harvard Graduate School of Arts and Sciences, Cambridge, MA, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Health Policy, Harvard Graduate School of Arts and Sciences, Cambridge, MA</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Fink, Gunther" sort="Fink, Gunther" uniqKey="Fink G" first="Günther" last="Fink">Günther Fink</name><affiliation wicri:level="2"><nlm:aff id="aff1"><addr-line>Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Global Health and Population, Harvard School of Public Health, Boston, MA</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25350546</idno><idno type="pmc">4211682</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4211682</idno><idno type="RBID">PMC:4211682</idno><idno type="doi">10.1371/journal.pone.0109032</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000489</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000489</idno><idno type="wicri:Area/Pmc/Curation">000488</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000488</idno><idno type="wicri:Area/Pmc/Checkpoint">000225</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000225</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Impact of Text Message Reminders on Adherence to Antimalarial Treatment in Northern Ghana: A Randomized Trial</title><author><name sortKey="Raifman, Julia R G" sort="Raifman, Julia R G" uniqKey="Raifman J" first="Julia R. G." last="Raifman">Julia R. G. Raifman</name><affiliation wicri:level="2"><nlm:aff id="aff1"><addr-line>Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Global Health and Population, Harvard School of Public Health, Boston, MA</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Lanthorn, Heather E" sort="Lanthorn, Heather E" uniqKey="Lanthorn H" first="Heather E." last="Lanthorn">Heather E. Lanthorn</name><affiliation wicri:level="2"><nlm:aff id="aff2"><addr-line>Harvard School of Public Health, Boston, MA, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Harvard School of Public Health, Boston, MA</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Rokicki, Slawa" sort="Rokicki, Slawa" uniqKey="Rokicki S" first="Slawa" last="Rokicki">Slawa Rokicki</name><affiliation wicri:level="2"><nlm:aff id="aff3"><addr-line>Department of Health Policy, Harvard Graduate School of Arts and Sciences, Cambridge, MA, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Health Policy, Harvard Graduate School of Arts and Sciences, Cambridge, MA</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Fink, Gunther" sort="Fink, Gunther" uniqKey="Fink G" first="Günther" last="Fink">Günther Fink</name><affiliation wicri:level="2"><nlm:aff id="aff1"><addr-line>Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Global Health and Population, Harvard School of Public Health, Boston, MA</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Low rates of adherence to artemisinin-based combination therapy (ACT) regimens increase the risk of treatment failure and may lead to drug resistance, threatening the sustainability of current anti-malarial efforts. We assessed the impact of text message reminders on adherence to ACT regimens.</p></sec><sec><title>Methods</title><p>Health workers at hospitals, clinics, pharmacies, and other stationary ACT distributors in Tamale, Ghana provided flyers advertising free mobile health information to individuals receiving malaria treatment. The messaging system automatically randomized self-enrolled individuals to the control group or the treatment group with equal probability; those in the treatment group were further randomly assigned to receive a simple text message reminder or the simple reminder plus an additional statement about adherence in 12-hour intervals. The main outcome was self-reported adherence based on follow-up interviews occurring three days after treatment initiation. We estimated the impact of the messages on treatment completion using logistic regression.</p></sec><sec><title>Results</title><p>1140 individuals enrolled in both the study and the text reminder system. Among individuals in the control group, 61.5% took the full course of treatment. The simple text message reminders increased the odds of adherence (adjusted OR 1.45, 95% CI [1.03 to 2.04], p-value 0.028). Receiving an additional message did not result in a significant change in adherence (adjusted OR 0.77, 95% CI [0.50 to 1.20], p-value 0.252).</p></sec><sec><title>Conclusion</title><p>The results of this study suggest that a simple text message reminder can increase adherence to antimalarial treatment and that additional information included in messages does not have a significant impact on completion of ACT treatment. Further research is needed to develop the most effective text message content and frequency.</p></sec><sec><title>Trial Registration</title><p>ClinicalTrials.gov <ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT01722734?term=NCT01722734&rank=1">NCT01722734</ext-link></p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Murray, Cj" uniqKey="Murray C">CJ Murray</name></author><author><name sortKey="Rosenfield, Lc" uniqKey="Rosenfield L">LC Rosenfield</name></author><author><name sortKey="Lim, Ss" uniqKey="Lim S">SS Lim</name></author><author><name sortKey="Andrews, Kg" uniqKey="Andrews K">KG Andrews</name></author><author><name sortKey="Foreman, Kj" uniqKey="Foreman K">KJ Foreman</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="White, N" uniqKey="White N">N White</name></author><author><name sortKey="Pongtavornpinyo, W" uniqKey="Pongtavornpinyo W">W Pongtavornpinyo</name></author><author><name sortKey="Maude, R" uniqKey="Maude R">R Maude</name></author><author><name sortKey="Saralamba, S" uniqKey="Saralamba S">S Saralamba</name></author><author><name sortKey="Aguas, R" uniqKey="Aguas R">R Aguas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tougher, S" uniqKey="Tougher S">S Tougher</name></author><author><name sortKey="Ye, Y" uniqKey="Ye Y">Y Ye</name></author><author><name sortKey="Amuasi, Jh" uniqKey="Amuasi J">JH Amuasi</name></author><author><name sortKey="Kourgueni, Ia" uniqKey="Kourgueni I">IA Kourgueni</name></author><author><name sortKey="Thomson, R" uniqKey="Thomson R">R Thomson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Laxminarayan, R" uniqKey="Laxminarayan R">R Laxminarayan</name></author><author><name sortKey="Arrow, K" uniqKey="Arrow K">K Arrow</name></author><author><name sortKey="Jamison, D" uniqKey="Jamison D">D Jamison</name></author><author><name sortKey="Bloom, Br" uniqKey="Bloom B">BR Bloom</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pyae Phyo, A" uniqKey="Pyae Phyo A">A Pyae Phyo</name></author><author><name sortKey="Standwell, N" uniqKey="Standwell N">N Standwell</name></author><author><name sortKey="Stepniewska, K" uniqKey="Stepniewska K">K Stepniewska</name></author><author><name sortKey="Ashley, Ea" uniqKey="Ashley E">EA Ashley</name></author><author><name sortKey="Nair, S" uniqKey="Nair S">S Nair</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jambou, R" uniqKey="Jambou R">R Jambou</name></author><author><name sortKey="Legrand, E" uniqKey="Legrand E">E Legrand</name></author><author><name sortKey="Niang, M" uniqKey="Niang M">M Niang</name></author><author><name sortKey="Khim, N" uniqKey="Khim N">N Khim</name></author><author><name sortKey="Lim, P" uniqKey="Lim P">P Lim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Banek, K" uniqKey="Banek K">K Banek</name></author><author><name sortKey="Lalani, M" uniqKey="Lalani M">M Lalani</name></author><author><name sortKey="Staedke, S" uniqKey="Staedke S">S Staedke</name></author><author><name sortKey="Chandramohan, D" uniqKey="Chandramohan D">D Chandramohan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cohen, Jm" uniqKey="Cohen J">JM Cohen</name></author><author><name sortKey="Smith, Dl" uniqKey="Smith D">DL Smith</name></author><author><name sortKey="Cotter, C" uniqKey="Cotter C">C Cotter</name></author><author><name sortKey="Ward, A" uniqKey="Ward A">A Ward</name></author><author><name sortKey="Yamey, G" uniqKey="Yamey G">G Yamey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lemma, H" uniqKey="Lemma H">H Lemma</name></author><author><name sortKey="Lofgren, C" uniqKey="Lofgren C">C Lofgren</name></author><author><name sortKey="San Sebastian, M" uniqKey="San Sebastian M">M San Sebastian</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Tomlinson, M" uniqKey="Tomlinson M">M Tomlinson</name></author><author><name sortKey="Rotheram Borus, Mj" uniqKey="Rotheram Borus M">MJ Rotheram-Borus</name></author><author><name sortKey="Swartz, L" uniqKey="Swartz L">L Swartz</name></author><author><name sortKey="Tsai, Ac" uniqKey="Tsai A">AC Tsai</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Lester, Rt" uniqKey="Lester R">RT Lester</name></author><author><name sortKey="Ritvo, P" uniqKey="Ritvo P">P Ritvo</name></author><author><name sortKey="Mills, Ej" uniqKey="Mills E">EJ Mills</name></author><author><name sortKey="Kariri, A" uniqKey="Kariri A">A Kariri</name></author><author><name sortKey="Karanja, S" uniqKey="Karanja S">S Karanja</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pop Eleches, C" uniqKey="Pop Eleches C">C Pop-Eleches</name></author><author><name sortKey="Thirumurthy, H" uniqKey="Thirumurthy H">H Thirumurthy</name></author><author><name sortKey="Habyarimana, Jp" uniqKey="Habyarimana J">JP Habyarimana</name></author><author><name sortKey="Zivin, Jg" uniqKey="Zivin J">JG Zivin</name></author><author><name sortKey="Goldstein, Mp" uniqKey="Goldstein M">MP Goldstein</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zurovac, D" uniqKey="Zurovac D">D Zurovac</name></author><author><name sortKey="Sudoi, Rk" uniqKey="Sudoi R">RK Sudoi</name></author><author><name sortKey="Akhwale, Ws" uniqKey="Akhwale W">WS Akhwale</name></author><author><name sortKey="Ndiritu, M" uniqKey="Ndiritu M">M Ndiritu</name></author><author><name sortKey="Hamer, Dh" uniqKey="Hamer D">DH Hamer</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Farmer, Kc" uniqKey="Farmer K">KC Farmer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Turner, Bj" uniqKey="Turner B">BJ Turner</name></author><author><name sortKey="Hecht, Fm" uniqKey="Hecht F">FM Hecht</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25350546</article-id><article-id pub-id-type="pmc">4211682</article-id><article-id pub-id-type="publisher-id">PONE-D-14-05137</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0109032</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine and Health Sciences</subject><subj-group><subject>Infectious Diseases</subject></subj-group><subj-group><subject>Parasitic Diseases</subject><subj-group><subject>Malaria</subject></subj-group></subj-group><subj-group><subject>Public and Occupational Health</subject><subj-group><subject>Global Health</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>The Impact of Text Message Reminders on Adherence to Antimalarial Treatment in Northern Ghana: A Randomized Trial</article-title><alt-title alt-title-type="running-head">Randomized Trial on Text Reminders for Antimalarial Adherence</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Raifman</surname><given-names>Julia R. G.</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lanthorn</surname><given-names>Heather E.</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Rokicki</surname><given-names>Slawa</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Fink</surname><given-names>Günther</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States of America</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Harvard School of Public Health, Boston, MA, United States of America</addr-line></aff><aff id="aff3"><label>3</label><addr-line>Department of Health Policy, Harvard Graduate School of Arts and Sciences, Cambridge, MA, United States of America</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Slutsker</surname><given-names>Laurence</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>Division of Parasitic Diseases and Malaria, Center for Global Health, United States of America</addr-line></aff><author-notes><corresp id="cor1">* E-mail: <email>JuliaRGoldberg@gmail.com</email></corresp><fn fn-type="conflict"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con"><p>Conceived and designed the experiments: JR GF HL SR. Performed the experiments: JR GF HL SR. Analyzed the data: JR GF HL. Contributed reagents/materials/analysis tools: JR GF HL SR. Wrote the paper: JR GF SR HL.</p></fn></author-notes><pub-date pub-type="collection"><year>2014</year></pub-date><pub-date pub-type="epub"><day>28</day><month>10</month><year>2014</year></pub-date><volume>9</volume><issue>10</issue><elocation-id>e109032</elocation-id><history><date date-type="received"><day>7</day><month>2</month><year>2014</year></date><date date-type="accepted"><day>31</day><month>8</month><year>2014</year></date></history><permissions><copyright-year>2014</copyright-year><copyright-holder>Raifman et al</copyright-holder><license><license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><abstract><sec><title>Background</title><p>Low rates of adherence to artemisinin-based combination therapy (ACT) regimens increase the risk of treatment failure and may lead to drug resistance, threatening the sustainability of current anti-malarial efforts. We assessed the impact of text message reminders on adherence to ACT regimens.</p></sec><sec><title>Methods</title><p>Health workers at hospitals, clinics, pharmacies, and other stationary ACT distributors in Tamale, Ghana provided flyers advertising free mobile health information to individuals receiving malaria treatment. The messaging system automatically randomized self-enrolled individuals to the control group or the treatment group with equal probability; those in the treatment group were further randomly assigned to receive a simple text message reminder or the simple reminder plus an additional statement about adherence in 12-hour intervals. The main outcome was self-reported adherence based on follow-up interviews occurring three days after treatment initiation. We estimated the impact of the messages on treatment completion using logistic regression.</p></sec><sec><title>Results</title><p>1140 individuals enrolled in both the study and the text reminder system. Among individuals in the control group, 61.5% took the full course of treatment. The simple text message reminders increased the odds of adherence (adjusted OR 1.45, 95% CI [1.03 to 2.04], p-value 0.028). Receiving an additional message did not result in a significant change in adherence (adjusted OR 0.77, 95% CI [0.50 to 1.20], p-value 0.252).</p></sec><sec><title>Conclusion</title><p>The results of this study suggest that a simple text message reminder can increase adherence to antimalarial treatment and that additional information included in messages does not have a significant impact on completion of ACT treatment. Further research is needed to develop the most effective text message content and frequency.</p></sec><sec><title>Trial Registration</title><p>ClinicalTrials.gov <ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT01722734?term=NCT01722734&rank=1">NCT01722734</ext-link></p></sec></abstract><funding-group><funding-statement>The Clinton Health Access Initiative funded the study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement></funding-group><counts><page-count count="10"></page-count></counts></article-meta></front></pmc><affiliations><list><country><li>États-Unis</li></country><region><li>Massachusetts</li></region></list><tree><country name="États-Unis"><region name="Massachusetts"><name sortKey="Raifman, Julia R G" sort="Raifman, Julia R G" uniqKey="Raifman J" first="Julia R. G." last="Raifman">Julia R. G. Raifman</name></region><name sortKey="Fink, Gunther" sort="Fink, Gunther" uniqKey="Fink G" first="Günther" last="Fink">Günther Fink</name><name sortKey="Lanthorn, Heather E" sort="Lanthorn, Heather E" uniqKey="Lanthorn H" first="Heather E." last="Lanthorn">Heather E. Lanthorn</name><name sortKey="Rokicki, Slawa" sort="Rokicki, Slawa" uniqKey="Rokicki S" first="Slawa" last="Rokicki">Slawa Rokicki</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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