Ukufikelela kwiisibulali-zinambuzane-inethi zokulala ezinyangiweyo kunye nokusetyenziswa kwe-IRS kumakhaya kunegalelo ekunciphiseni okukhulu ukuxhaphaka kwemalariya okuxeliweyo phakathi kwabasetyhini abakwiminyaka yokuzala eGhana. Oku kufunyanisiweyo kuqinisa imfuneko yempendulo epheleleyo yokulawula imalariya ukuze kuncediswe ekuphelisweni kwemalariya eGhana.
Idatha yolu phononongo ithathwe kwiGhana Malaria Indicator Survey (GMIS). I-GMIS luphando olumele ilizwe lonke oluqhutywe yiGhana Statistical Service ukusuka ngo-Okthobha ukuya kuDisemba 2016. Kolu phononongo, ngabafazi abaneminyaka eli-15-49 kuphela abathathe inxaxheba kolu phando. Abafazi ababenedatha kuzo zonke izinto eziguquguqukayo babandakanyiwe kuhlalutyo.
Kwisifundo sika-2016, i-MIS yaseGhana isebenzise inkqubo yokuvavanya amaqela amaninzi kuzo zonke iindawo ezili-10 zelizwe. Eli lizwe lahlulwe laba ziiklasi ezingama-20 (imimandla eli-10 kunye nohlobo lwendawo yokuhlala - ezidolophini/emaphandleni). Iqela lichazwa njengendawo yokubala abantu (CE) equka malunga nemizi engama-300-500. Kwinqanaba lokuqala lokuvavanya, amaqela akhethwa kwi-stratum nganye enomlinganiselo ofanelekileyo ngokobukhulu. Kukhethwe amaqela angama-200. Kwinqanaba lesibini lokuvavanya, inani elimiselweyo lemizi engama-30 likhethwe ngokungacwangciswanga kwiqela ngalinye elikhethiweyo ngaphandle kokutshintshwa. Nanini na xa kunokwenzeka, sidlane udliwanondlebe nabafazi abaneminyaka eli-15-49 kwikhaya ngalinye [8]. Uphando lokuqala ludlane udliwanondlebe nabafazi abangama-5,150. Nangona kunjalo, ngenxa yokungaphenduli kwezinye izinto eziguquguqukayo, abafazi abangama-4861 bafakiwe kolu phononongo, bemele ama-94.4% abafazi kwisampulu. Idatha ibandakanya ulwazi malunga nezindlu, imizi, iimpawu zabasetyhini, ukuthintela imalariya, kunye nolwazi lwemalariya. Idatha iqokelelwe kusetyenziswa inkqubo yodliwanondlebe lomntu ngamnye oluncediswa yikhompyutha (i-CAPI) kwiitablethi kunye nephepha lemibuzo. Abaphathi bedatha basebenzisa inkqubo yeCensus and Survey Processing (CSPro) ukuhlela nokulawula idatha.
Isiphumo esiphambili solu phononongo yayikukusasazeka kwemalariya okuzixelileyo phakathi kwabasetyhini abaneminyaka eli-15-49 ubudala, abachazwa njengabasetyhini ababike ukuba babe nesinye isiganeko semalariya kwiinyanga ezili-12 ngaphambi kolu phononongo. Oko kukuthi, ukusasazeka kwemalariya okuzixelileyo phakathi kwabasetyhini abaneminyaka eli-15-49 ubudala kwasetyenziswa njenge-proxy ye-RDT yemalariya okanye i-microscopy positivity phakathi kwabasetyhini kuba olu vavanyo lwalungekho phakathi kwabasetyhini ngexesha lophononongo.
Ungenelelo luquka ukufikelela kwiinethi ezinyangwa yizinambuzane (i-ITN) kumakhaya kunye nokusetyenziswa kwe-IRS kwiinyanga ezili-12 ngaphambi kophando. Iintsapho ezifumana zombini ezi ngenelelo zithathwe njengezidibeneyo. Amakhaya anokufikelela kwiinethi ezinyangwa yizinambuzane achazwe njengabafazi abahlala kumakhaya anenethi enye ubuncinane enyangwa yizinambuzane, ngelixa amakhaya ane-IRS achazwa njengabafazi abahlala kumakhaya anyangwa yizinambuzane kwiinyanga ezili-12 ngaphambi kophando lwabasetyhini.
Olu phononongo luhlolisise iindidi ezimbini ezibanzi zezinto eziguquguqukayo ezididayo, ezizezi: iimpawu zosapho kunye neempawu zomntu ngamnye. Zibandakanya iimpawu zosapho; ummandla, uhlobo lwendawo yokuhlala (yasemaphandleni-yasezidolophini), isini sentloko yekhaya, ubungakanani bendlu, ukusetyenziswa kombane wendlu, uhlobo lwepetroli yokupheka (eqinileyo okanye engaqinileyo), izinto eziphambili zomgangatho, izinto eziphambili zodonga, izinto zophahla, umthombo wamanzi okusela (ophuculweyo okanye ongaphuculwanga), uhlobo lwendlu yangasese (ephuculweyo okanye engaphuculwanga) kunye nodidi lobutyebi bendlu (abahlwempuzekileyo, abaphakathi nabatyebileyo). Iindidi zeempawu zendlu zaphinda zabhalwa ngokwemigangatho yengxelo ye-DHS kwiingxelo ze-GMIS zika-2016 kunye ne-2014 zeGhana Demographic Health Survey (GDHS) [8, 9]. Iimpawu zomntu eziqwalaselweyo ziquka ubudala bomfazi ngoku, inqanaba eliphezulu lemfundo, imeko yokukhulelwa ngexesha lodliwanondlebe, imeko ye-inshurensi yezempilo, unqulo, ulwazi malunga nokuchaphazeleka kwi-malaria kwiinyanga ezi-6 ngaphambi kodliwanondlebe, kunye nenqanaba lolwazi lomfazi malunga nemiba ye-malaria. Imibuzo emihlanu yolwazi isetyenziswe ukuvavanya ulwazi lwabasetyhini, kuquka ulwazi lwabasetyhini ngezizathu zemalariya, iimpawu zemalariya, iindlela zokuthintela malariya, unyango lwemalariya, kunye nokuqonda ukuba imalariya igutyungelwe yiGhana National Health Insurance Scheme (NHIS). Abafazi abafumene amanqaku angama-0-2 bathathwa njengabanolwazi oluphantsi, abafazi abafumene amanqaku ama-3 okanye ama-4 bathathwa njengabanolwazi oluphakathi, kwaye abafazi abafumene amanqaku ama-5 bathathwa njengabanolwazi olupheleleyo malunga nemalariya. Izinto ezahlukeneyo ziye zanxulunyaniswa nokufikelela kwiinethi ezinyangwa yizinambuzane, i-IRS, okanye ukuxhaphaka kwemalariya kwiincwadi.
Iimpawu zemvelaphi yabasetyhini zishwankathelwe kusetyenziswa amaza kunye neepesenti zezinto eziguquguqukayo ngokweendidi, ngelixa izinto eziguquguqukayo eziqhubekayo zishwankathelwe kusetyenziswa iindlela kunye nokuphambuka okuqhelekileyo. Ezi mpawu zihlanganiswe ngokwesimo songenelelo ukuze kuhlolwe ukungalingani okunokwenzeka kunye nesakhiwo sedemografi esibonisa ukukhetha okunokubangela ukudideka. Iimephu ze-contour zisetyenziselwe ukuchaza ukuxhaphaka kwemalariya okuxeliweyo phakathi kwabasetyhini kunye nokugubungela iindlela ezimbini zokungenelela ngokwendawo. I-Scott Rao chi-square test statistic, echaza iimpawu zoyilo lophando (oko kukuthi, ukwahlulwahlulwa, ukuqokelelana, kunye nobunzima besampulu), yasetyenziswa ukuvavanya unxulumano phakathi kokuxhaphaka kwemalariya okuxeliweyo kunye nokufikelela kuzo zombini iindlela zokungenelela kunye neempawu zemeko. Ukuxhaphaka kwemalariya okuxeliweyo kubalwe njengenani labasetyhini abaye bafumana ubuncinane isiqendu esinye semalariya kwiinyanga ezili-12 ngaphambi kophando olwahlulwe linani lilonke labasetyhini abafanelekileyo abahlolweyo.
Imodeli yohlengahlengiso lwePoisson eguqulweyo isetyenzisiwe ukuqikelela impembelelo yokufikelela kwiindlela zokungenelela zokulawula imalariya kwingxelo yokuxhaphaka kwemalariya kwabasetyhini16, emva kokulungelelanisa amathuba okufumana ubunzima bonyango (IPTW) kunye nokuhlola ubunzima kusetyenziswa imodeli "ye-svy-linearization" kwiStata IC. (Stata Corporation, College Station, Texas, USA). Amathuba okufumana ubunzima bonyango (IPTW) kwi-intervention "i" kunye ne-woman "j" aqikelelwa ngolu hlobo:
Iinguqu zokugqibela zokulinganisa ezisetyenzisiweyo kwimodeli yokuguqulwa kwePoisson emva koko zilungiswa ngolu hlobo lulandelayo:
Phakathi kwazo, \(fw_{ij}\) yi-final weight variable ye-individual j kwaye i-intervention i, \(sw_{ij}\) yi-sample weight ye-individual j kunye ne-intervention i kwi-2016 GMIS.
Umyalelo we-post-estimation othi “margins, dydx (intervention_i)” kwi-Stata wasetyenziswa ukuqikelela umahluko ongaphantsi (isiphumo) songenelelo “i” kwingxelo yokuxhaphaka kwemalariya phakathi kwabasetyhini emva kokufaka imodeli yohlengahlengiso lwePoisson eguquliweyo ukulawula. Zonke ezi zinto zibone izinto ezididayo.
Iimodeli ezintathu ezahlukeneyo zokubuyela umva zisetyenzisiwe njengohlalutyo lovakalelo: ukujikeleza kwe-binary logistic, ukujikeleza okunokwenzeka, kunye neemodeli zokubuyela umva ezithe ngqo ukuqikelela impembelelo yongenelelo ngalunye lolawulo lwe-malaria kwingxelo yokusasazeka kwe-malaria phakathi kwabasetyhini baseGhana. Izithuba zokuzithemba ezingama-95% ziqikelelwe kuzo zonke iingqinisiso zokusasazeka kwamanqaku, ii-ratios zokusasazeka, kunye noqikelelo lweziphumo. Zonke iingqinisiso zezibalo kolu phononongo zithathwe njengezibalulekileyo kwinqanaba le-alpha le-0.050. Inguqulelo ye-Stata IC 16 (StataCorp, eTexas, e-USA) isetyenziselwe uhlalutyo lwezibalo.
Kwiimodeli ezine zokubuyela umva, ukusasazeka kwemalariya okuzixelileyo bekungephantsi kakhulu phakathi kwabasetyhini abafumana i-ITN kunye ne-IRS xa kuthelekiswa nabasetyhini abafumana i-ITN yodwa. Ngaphezu koko, kwimodeli yokugqibela, abantu abasebenzisa i-ITN kunye ne-IRS abazange babonise ukwehla okukhulu kokusasazeka kwemalariya xa kuthelekiswa nabantu abasebenzisa i-IRS yodwa.
Impembelelo yokufikelela kwiindlela zokulwa nemalariya kukwanda kwemalariya okuxelwe ngabasetyhini ngokweempawu zasekhaya
Impembelelo yokufikelela kwiindlela zokungenelela zokulawula imalariya kwingxelo yokuxhaphaka kwemalariya phakathi kwabasetyhini, ngokweempawu zabasetyhini.
Iphakheji yeendlela zokuthintela i-malaria vector control incede kakhulu ekunciphiseni ukusasazeka kwe-malaria okwabikwayo phakathi kwabasetyhini abakwiminyaka yokuzala eGhana. Ukusasazeka kwe-malaria okwabikwayo kwehla ngama-27% phakathi kwabasetyhini abasebenzisa ii-bed nets eziphathwe ngee-insecticide kunye ne-IRS. Olu phando luhambelana neziphumo zovavanyo olulawulwa ngokungacwangciswanga olubonise amazinga aphantsi kakhulu e-malaria DT positivity phakathi kwabasebenzisi be-IRS xa kuthelekiswa nabasebenzisi abangengabo i-IRS kwindawo enesifo se-malaria esiphezulu kodwa imigangatho ephezulu yokufikelela kwi-ITN eMozambique [19]. Kumantla eTanzania, ii-bed nets eziphathwe ngee-insecticide kunye ne-IRS zadityaniswa ukunciphisa kakhulu ubuninzi be-Anopheles kunye namazinga okugonywa kwezinambuzane [20]. Amaqhinga okulawula ii-vector adibeneyo axhaswa luphando lwabantu kwiphondo laseNyanza kwintshona yeKenya, olufumanise ukuba ukutshiza ngaphakathi kunye nee-bed nets eziphathwe ngee-insecticide zazisebenza ngakumbi kune-insecticide. Le ndibaniselwano inokubonelela ngokhuseleko olongezelelweyo kwi-malaria. iinethiwekhi zithathwa ngokwahlukeneyo [21].
Olu phononongo luqikelele ukuba ama-34% abafazi babenemalariya kwiinyanga ezili-12 ngaphambi kophando, kunye noqikelelo lwe-95% lokuzithemba oluphakathi kwama-32–36%. Abafazi abahlala kumakhaya afumana iinethi zebhedi eziphathwa zinambuzane (33%) babenezinga eliphantsi kakhulu lokwanda kwemalariya abazixelileyo kunabafazi abahlala kumakhaya angenazo iinethi zebhedi eziphathwa zinambuzane (39%). Ngokufanayo, abafazi abahlala kumakhaya afuthiweyo babenezinga eliphantsi lokwanda kwemalariya elichazwe ngokwabo lama-32%, xa kuthelekiswa nama-35% kumakhaya angafuthwanga. Izindlu zangasese azikaphuculwa kwaye iimeko zococeko azilunganga. Uninzi lwazo zingaphandle kwaye amanzi angcolileyo aqokelelana kuzo. La manzi amileyo, angcolileyo anika indawo efanelekileyo yokuzalela iingcongconi ze-Anopheles, eyona nto ibangela imalariya eGhana. Ngenxa yoko, izindlu zangasese kunye neemeko zococeko azizange ziphucuke, nto leyo ekhokelele ngokuthe ngqo ekwandeni kokusasazeka kwemalariya kubemi. Kufuneka kuqiniswe imizamo yokuphucula izindlu zangasese kunye neemeko zococeko kumakhaya nakwiindawo zokuhlala.
Olu phononongo lunemida emininzi ebalulekileyo. Okokuqala, uphando lusebenzise idatha yophando olunqamlezileyo, okwenza kube nzima ukulinganisa umba. Ukuze koyiswe lo mda, iindlela zezibalo zomba zisetyenzisiwe ukuqikelela isiphumo sonyango esiqhelekileyo songenelelo. Uhlalutyo luhlengahlengisa isabelo sonyango kwaye lusebenzisa izinto eziguquguqukayo ezibalulekileyo ukuqikelela iziphumo ezinokubakho kubafazi abanamakhaya afumene ungenelelo (ukuba bekungekho ngenelelo) nakubafazi abanamakhaya angazange afumane ungenelelo.
Okwesibini, ukufikelela kwiinethi zebhedi ezinyangiweyo akuthethi ukuba kufuneka kusetyenziswe iinethi zebhedi ezinyangiweyoyo, ngoko ke kufuneka kusetyenziswe isilumkiso xa kutolikwa iziphumo kunye nezigqibo zolu phononongo. Okwesithathu, iziphumo zolu phononongo malunga nemalariya ezizixelayo phakathi kwabasetyhini zingumqondiso wokuxhaphaka kwemalariya phakathi kwabasetyhini kwiinyanga ezili-12 ezidlulileyo kwaye ngenxa yoko zinokuthambekela kwinqanaba lolwazi lwabasetyhini malunga nemalariya, ingakumbi iimeko ezingabonakaliyo.
Okokugqibela, olu phononongo aluzange luqwalasele iimeko ezininzi zemalariya ngomthathi-nxaxheba ngamnye ngexesha lonyaka omnye, okanye ixesha elichanekileyo leziganeko zemalariya kunye nokungenelela. Ngenxa yemida yezifundo zokujonga, uvavanyo oluqinileyo olulawulwa ngokungacwangciswanga luya kuba yinto ebalulekileyo kuphando lwexesha elizayo.
Imizi efumene i-ITN kunye ne-IRS ibinengxelo ephantsi yokuxhaphaka kwemalariya xa kuthelekiswa nemizi engakhange ifumane ncedo. Olu phando luxhasa izicelo zokuhlanganiswa kwemizamo yokulawula imalariya ukuze kuncediswe ekuphelisweni kwemalariya eGhana.
Ixesha leposi: Oktobha-15-2024