Ukufikelela kwiisibulali zinambuzane-iinethi zokulala ezinyangwayo kunye nokuphunyezwa kwinqanaba lekhaya le-IRS negalelo ekunciphiseni okubonakalayo kokuxhaphaka kwesifo seengcongconi phakathi kwabasetyhini abakwiminyaka yokuzala eGhana. Oku kufunyanisiweyo komeleza imfuno yempendulo ebanzi yolawulo lwemalariya ukufaka isandla ekupheliseni isifo seengcongconi eGhana.
Idatha yolu phononongo ithathwe kuPhando lweSalathi seMalaria yaseGhana (GMIS). I-GMIS luphando olumele ilizwe lonke olwenziwe yiNkonzo yezeNgcaciso yaseGhana ukususela ngo-Oktobha ukuya kuDisemba 2016. Kolu phononongo, kuphela ngabasetyhini ababudala bokuzala ababudala buphakathi kwe-15-49 leminyaka bathathe inxaxheba kuphando. Abasetyhini ababenedatha kuzo zonke iinguqu bafakwe kuhlalutyo.
Kuphononongo luka-2016, i-MIS yaseGhana yasebenzisa inkqubo yesampulu yeqela elidibanisa amanqanaba ngamanqanaba kuzo zonke iingingqi ezili-10 zelizwe. Ilizwe lihlulwe kwiiklasi ze-20 (imimandla ye-10 kunye nohlobo lwendawo yokuhlala - idolophu / yasemaphandleni). Iqela lichazwa njengendawo yobalo-bantu (CE) ebandakanya malunga nama-300–500 amakhaya. Kwinqanaba lokuqala lesampulu, amaqela akhethiweyo kwisitramu ngasinye esinokubakho ngokomlinganiselo wobungakanani. Kwakhethwa amaqela angama-200 ewonke. Kwinqanaba lesibini lesampulu, inani elimiselweyo lamakhaya angama-30 akhethwe ngokungenamkhethe kwiqela ngalinye elikhethiweyo ngaphandle kokutshintshwa. Nanini na kunokwenzeka, siye sadlana indlebe nabasetyhini abaneminyaka eyi-15-49 kwikhaya ngalinye [8]. Uvavanyo lokuqala ludlan' indlebe nabasetyhini abangama-5,150. Nangona kunjalo, ngenxa yokungaphenduli kwezinye izinto eziguquguqukayo, inani labasetyhini be-4861 lifakwe kolu cwaningo, olumele i-94.4% yabasetyhini kwisampuli. Idatha ibandakanya ulwazi ngezindlu, amakhaya, iimpawu zabasetyhini, uthintelo lwemalariya, nolwazi lwemalariya. Idatha yaqokelelwa kusetyenziswa inkqubo yodliwano-ndlebe lomntu oncediswa yikhompyutha (CAPI) kwiipilisi kunye namaphepha emibuzo. Abaphathi beenkcukacha basebenzisa inkqubo yoBalo-bantu kunye noPhando (CSPro) ukuhlela nokulawula idatha .
Esona siphumo siphambili solu phononongo yayikukuxhaphaka kwesifo seengcongconi phakathi kwabasetyhini abaneminyaka yobudala eyi-15 ukuya kwengama-49, echazwa njengabasetyhini abathe banesiqendu esinye semalariya kwiinyanga ezili-12 ezandulela isifundo. Oko kukuthi, ukuxhaphaka kwesifo seengcongconi phakathi kwabasetyhini abaneminyaka eyi-15-49 kwasetyenziswa njenge-proxy ye-RDT yokwenyani yemalariya okanye i-microscopy positivity phakathi kwabasetyhini kuba olu vavanyo belungafumaneki phakathi kwabasetyhini ngexesha lophononongo.
Amanyathelo okungenelela abandakanya ukufikelela kwamakhaya kwiinethi ezinezibulali zinambuzane (ITN) kunye nokusetyenziswa kwe-IRS ekhaya kwiinyanga ezili-12 ezandulela uphando. Iintsapho ezithe zafumana ungenelelo omabini zajongwa njengezinye. Amakhaya anokufikelela kwiinetha zokulala ezihlanjululwe ngamayeza ezinambuzane achazwa njengabasetyhini abahlala kwimizi enenethi yokulala efakwe isibulali zinambuzane, ngelixa amakhaya ane-IRS achazwa njengabasetyhini abahlala kwimizi enyangwa ngamayeza okubulala izinambuzane ngaphakathi kweenyanga ezili-12 ngaphambi kovavanyo. yabafazi.
Uphononongo luphonononge iindidi ezimbini ezibanzi zeenguqu ezibhidayo, ezizezi, iimpawu zosapho kunye neempawu zomntu ngamnye. Ibandakanya iimpawu zekhaya; ummandla, uhlobo lwendawo yokuhlala (yasemaphandleni-edolophini), isini sentloko yekhaya, ubukhulu bendlu, ukusetyenziswa kombane wasekhaya, uhlobo lwamafutha okupheka (oluqilima okanye olungaqinanga), imathiriyeli yomgangatho ongundoqo, imathiriyeli eludongeni, imathiriyeli yophahla, umthombo wamanzi okusela. (iphuculwe okanye ayiphucukanga), uhlobo lwendlu yangasese (ephuculweyo okanye engaphucukanga) kunye nodidi lobutyebi bekhaya (abangathathi ntweni, abaphakathi nabatyebileyo). Iindidi zeempawu zekhaya zihlaziywa ngokwemigangatho yokunika ingxelo ye-DHS kwi-GMIS ye-2016 kunye ne-2014 yaseGhana ye-Demographic Health Survey (GDHS) iingxelo [8, 9]. Iimpawu zobuqu eziqwalaselweyo zibandakanya iminyaka yangoku yomfazi, inqanaba eliphezulu lemfundo, imeko yokukhulelwa ngexesha lodliwano-ndlebe, imeko yeinshorensi yezempilo, inkolo, ulwazi malunga nokuchanabeka kwimalariya kwiinyanga ezi-6 ngaphambi kodliwano-ndlebe, kunye nenqanaba lolwazi lomfazi malunga nesifo seengcongconi. imiba. . Imibuzo emihlanu yolwazi yasetyenziswa ukuhlola ulwazi lwabasetyhini, kuquka ulwazi lwabasetyhini ngoonobangela besifo seengcongconi, iimpawu zesifo seengcongconi, iindlela zokuthintela isifo seengcongconi, unyango lwesifo seengcongconi, nokwazisa ukuba imalariya igutyungelwe yi-Ghana National Health Insurance Scheme (NHIS). Abasetyhini abafumene amanqaku e-0-2 bathathwa ngokuba banolwazi oluphantsi, abafazi abafumene i-3 okanye i-4 babethathwa njengabanolwazi oluphakathi, kwaye abafazi abafumene i-5 bathathwa njengabanolwazi olupheleleyo malunga ne-malaria. Izinto eziguquguqukayo zomntu ngamnye ziye zadibaniswa nokufikelela kwiinetha eziphathwe nge-insecticide, i-IRS, okanye ukuxhaphaka kwe-malaria kwiincwadi.
Iimpawu zemvelaphi yabasetyhini zashwankathelwa kusetyenziswa iifrikhwensi kunye neepesenti zoguquguquko ngokweendidi, ngelixa iinguqu eziqhubekayo zashwankathelwa kusetyenziswa iindlela kunye nokutenxa okusemgangathweni. Ezi mpawu ziye zadityaniswa yimeko yongenelelo ukuhlola ukungalingani okunokubakho kunye nolwakhiwo lwedemografi ebonisa ukuthambekela okunokubakho okubhidayo. Iimephu zecontour zisetyenziselwe ukuchaza ukuzixela ngokwakho isifo seengcongconi phakathi kwabasetyhini kunye nokugubungela ungenelelo olubini ngokwendawo. I-Scott Rao chi-square test statistic, echaza iimpawu zoyilo lwesaveyi (oko kukuthi, ukuhlelwa, ukuhlanganisana, kunye nemilinganiselo yesampuli), yasetyenziselwa ukuvavanya umbutho phakathi kokuxhaphaka kwesifo seengcongconi kunye nokufikelela kuzo zombini ungenelelo kunye neempawu zomxholo. Ukuxhaphaka kwesifo seengcongconi esizixelayo kubalwa njengenani labasetyhini abaye bafumana ubuncinci isiqendu esinye semalariya kwiinyanga ezili-12 ngaphambi kokuba uphando luhlulwe ngenani elipheleleyo labasetyhini abafanelekileyo abahlolwe.
Imodeli elungisiweyo ye-Poisson regression model isetyenziselwe ukuqikelela isiphumo sofikelelo kungenelelo lolawulo lwemalariya kwi-prevalence yabasetyhini abazixelayo ngokwabo kwimalariya16, emva kokulungelelaniswa kwe-inverse probability of treatment weights (IPTW) kunye novavanyo lovavanyo kusetyenziswa imodeli "svy-linearization" kwi-Stata. NDIYABONA . (Stata Corporation, College Station, Texas, USA). I-inverse enokwenzeka yobunzima bonyango (IPTW) yokungenelela "i" kunye nomfazi "j" kuqikelelwa njenge:
Izinto eziguquguqukayo zokugqibela ezisetyenziswe kwimodeli yokubuyisela iPoisson zihlengahlengiswa ngolu hlobo lulandelayo:
Phakathi kwazo, \(fw_{ij}\) ngumlinganiselo wokugqibela wobunzima bomntu ngamnye j kunye nongenelelo i, \(sw_{ij}\) yisampuli yobunzima bomntu j kunye nongenelelo i kwi-GMIS ka-2016.
Umyalelo we-post-estimation "margins, dydx (intervention_i)" kwi-Stata emva koko wasetyenziselwa ukuqikelela umahluko we-marginal (isiphumo) songenelelo "i" kwi-self-reported malaria prevalence phakathi kwabasetyhini emva kokufaka imodeli yokunciphisa i-Poisson yokulawula ukulawula. zonke iinguqu ezibonwayo ezibhidayo.
Iimodeli ezintathu ezahlukeneyo zokuhlehla zikwasetyenziswa njengohlahlelo lovakalelo: ukuhlehla kokubini, ukuhlehla okunokwenzeka, kunye neemodeli zokuhlehla ngomgca ukuqikelela impembelelo yongenelelo lolawulo lwemalariya ekuchazeni ukuxhaphaka kwemalariya phakathi kwabasetyhini baseGhana. I-95% yamaxesha okuzithemba aqikelelwa kuzo zonke iingqikelelo zokuxhaphaka, umlinganiselo wokuxhaphaka, kunye noqikelelo lwesiphumo. Lonke uhlalutyo lwamanani kolu phononongo luthathwa njengento ebalulekileyo kwinqanaba le-alpha le-0.050. I-Stata IC version 16 (i-StataCorp, eTexas, e-USA) yayisetyenziselwa uhlalutyo lwamanani.
Kwiimodeli ezine zokuhlehla, ukuxhaphaka kwesifo seengcongconi akubanga sezantsi kakhulu phakathi kwabasetyhini abafumana zombini i-ITN kunye ne-IRS xa kuthelekiswa nabasetyhini abafumana i-ITN bodwa. Ngaphaya koko, kwimodeli yokugqibela, abantu abasebenzisa zombini i-ITN kunye ne-IRS khange babonise kuncipha kakhulu kwisifo seengcongconi xa kuthelekiswa nabantu abasebenzisa i-IRS kuphela.
Impembelelo yokufikelela kwi-anti-malaria ungenelelo kwi-malaria exelwe ngabasetyhini ukuxhaphaka kweempawu zekhaya
Impembelelo yokufikelela kungenelelo lokulawula isifo seengcongconi kwi-self-reported report ye-malaria phakathi kwabasetyhini, ngeempawu zabasetyhini.
Ipakethe yeendlela zokuthintela isifo seengcongconi incede ukunciphisa kakhulu ukuxhaphaka okuxeliweyo kwesifo seengcongconi phakathi kwabasetyhini abakwiminyaka yokuzala eGhana. Ukuchazwa kwesifo seengcongconi kwehle ngama-27% phakathi kwabasetyhini abasebenzisa iinethi zokunyanga izibulala-zinambuzane kunye ne-IRS. Oku kufunyaniswayo kuhambelana neziphumo zovavanyo olulawulwa ngokungahleliwe olubonisa amazinga aphantsi kakhulu e-malaria DT positivity phakathi kwabasebenzisi be-IRS xa kuthelekiswa nabasebenzisi abangewona i-IRS kwindawo ene-malaria ephezulu kodwa imigangatho ephezulu yokufikelela kwe-ITN eMozambique [19]. Kumantla eTanzania, iminatha yokulala efakwe amayeza okubulala izinambuzane kunye ne-IRS zadityaniswa ukuze zinciphise kakhulu ingxinano ye-Anopheles kunye namazinga okugonywa kwezinambuzane [20]. Izicwangciso ezidityanisiweyo zolawulo lwezityalo zikwaxhaswa luvavanyo lwabemi kwiphondo laseNyanza kwintshona yeKenya, olufumanise ukuba ukutshiza kwangaphakathi kunye neinethi ezityatyelwe ngezibulali zinambuzane zisebenza ngakumbi kunezitshabalalisi. Indibaniselwano inokubonelela ngokhuseleko olongezelelweyo kwimalariya. uthungelwano ziqwalaselwa ngokwahlukeneyo [21].
Olu phononongo luqikelela ukuba i-34% yabasetyhini bebenesifo seengcongconi kwiinyanga ezili-12 ezandulela uphando, kunye noqikelelo lwexesha lokuzithemba lwama-95% lwama-32-36%. Amakhosikazi ahlala kumakhaya anofikelelo kwiinatha zokulala amayeza okubulala izinambuzane (33%) abenezinga elisezantsi kakhulu lezehlo zesifo seengcongconi kunabasetyhini abahlala ezindlini ngaphandle kokufikelela kwiinethi ezityatyelwe izitshabalalisi (39%) . Ngokufanayo, abasetyhini abahlala kumakhaya atshiziweyo babenezinga lokuxhaphaka kwesifo seengcongconi esizichaze ngokwabo ngama-32%, xa kuthelekiswa nama-35% kumakhaya angatshizwanga. Izindlu zangasese azikaphuculwa kwaye neemeko zococeko zimbi. Uninzi lwazo lungaphandle kwaye amanzi amdaka aqokelelana kuwo. La manzi amileyo namdaka ayindawo efanelekileyo yokuzala kweengcongconi ezibizwa ngokuba yi-Anopheles, eyona ndawo ithwala isifo seengcongconi eGhana. Ngenxa yoko, izindlu zangasese kunye neemeko zococeko azizange ziphucuke, nto leyo eyakhokelela ngokuthe ngqo ekosulelweni kwesifo seengcongconi phakathi kwabemi. Iinzame kufuneka ziqiniswe ukuphucula izindlu zangasese kunye neemeko zogutyulo emakhayeni kunye noluntu.
Olu phononongo lunemida emininzi ebalulekileyo. Okokuqala, uphando lusebenzise idatha yophando lwamacandelo, okwenza kube nzima ukulinganisa i-causality. Ukoyisa lo mda, iindlela zezibalo ze-causality zazisetyenziselwa ukuqikelela umphumo wonyango wokungenelela. Uhlalutyo lulungelelanisa isabelo sonyango kwaye lusebenzisa ukuguquguquka okuphawulekayo ukuqikelela iziphumo ezinokuthi zibe khona kubasetyhini abanemizi yabo bafumana ukungenelela (ukuba kwakungekho ngenelelo) kunye nabasetyhini abanemizi yabo engazange bafumane ukungenelela.
Okwesibini, ukufikelela kwiinatha ezihlanjululwe ngamayeza okubulala izinambuzane akuthethi ukuba kusetyenziswe iminatha enezibulali zinambuzane, ngoko ke kufuneka kuqwalaselwe xa kutolikwa iziphumo kunye nezigqibo zolu phononongo. Okwesithathu, iziphumo zolu phononongo malunga nemalariya ezixelwe ngokuzimeleyo phakathi kwabasetyhini zingummeli wokuxhaphaka kwesifo seengcongconi phakathi kwabasetyhini kwiinyanga ezili-12 ezidlulileyo kwaye ke ngoko banokuthambekela kwinqanaba lolwazi lwabasetyhini malunga nesifo seengcongconi, ngakumbi iimeko ezintle ezingabonwayo.
Ekugqibeleni, uphononongo aluzange luphendule kwiimeko ezininzi ze-malaria kumntu ngamnye ngexesha lokubhekisela kunyaka omnye, okanye ixesha elichanekileyo leziganeko ze-malaria kunye nokungenelela. Ukunikezelwa kwemida yophononongo lokuphonononga, ulingo olomelele ngakumbi olulawulwa ngokungahleliwe luya kuba yingqwalasela ebalulekileyo kuphando lwexesha elizayo.
Amakhaya afumene zombini i-ITN kunye ne-IRS aye anengxelo ephantsi yobukho besifo seengcongconi xa kuthelekiswa namakhaya angazange afumane ncedo. Oku kufunyaniswayo kuxhasa iifowuni zokudityaniswa kwemizamo yokulawula isifo seengcongconi ukufaka isandla ekupheliseni isifo seengcongconi eGhana.
Ixesha lokuposa: Oct-15-2024