Iinethi zokulala ezine-pyrethroid clofenpyr (CFP) kunye ne-pyrethroid piperonyl butoxide (PBO) ziyakhuthazwa kumazwe ahlala abantu abaninzi ukuphucula ulawulo lwemalariya edluliselwa ziingcongconi ezimelana ne-pyrethroid. I-CFP sisibulali-zinambuzane esifuna ukusebenza yi-mosquito cytochrome P450 monooxygenase (P450), kwaye i-PBO iphucula ukusebenza kwe-pyrethroids ngokuthintela ukusebenza kwezi enzymes kwiingcongconi ezimelana ne-pyrethroid. Ngoko ke, ukuthintela i-P450 yi-PBO kunokunciphisa ukusebenza kwe-pyrethroid-CFP inethi xa zisetyenziswa kwikhaya elinye nee-pyrethroid-PBO nethi.
Uvavanyo lwe-cockpit oluphindwe kabini lwenziwe ukuze kuvavanywe iintlobo ezimbini ezahlukeneyo ze-pyrethroid-CFP ITN (Interceptor® G2, PermaNet® Dual) zodwa kwaye zidibene ne-pyrethroid-PBO ITN (DuraNet® Plus, PermaNet® 3.0). Impembelelo ye-entomological yokusetyenziswa kwe-Pyrethroid resistance Vector populations kumazantsi eBenin. Kuzo zombini ezi zifundo, zonke iintlobo ze-mesh zavavanywa kunyango lwe-single kunye ne-double mesh. Ii-bioassays zenziwa kwakhona ukuvavanya ukumelana namayeza kwi-vector populations kwi-hut kunye nokufunda ukusebenzisana phakathi kwe-CFP kunye ne-PBO.
Inani leentsholongwane ezibangela isifo lalinovelwano kwi-CFP kodwa labonisa amanqanaba aphezulu okuxhathisa kwi-pyrethroids, kodwa olu xhathiso loyiswa kukuvezwa kwangaphambili kwi-PBO. Ukufa kwe-vector kwehle kakhulu kwiindlwana ezisebenzisa indibaniselwano ye-pyrethroid-CFP ne-pyrethroid-PBO ne-huts ezisebenzisa indibaniselwano ye-pyrethroid-CFP ne-pyrethroid-PBO ne-huts ezisebenzisa i-pyrethroid-CFP ne-huts ezimbini (74% kwi-Interceptor® G2 vs. 85%, i-PermaNet® Dual 57% vs. 83%), p < 0.001). Ukuvezwa kwangaphambili kwi-PBO kunciphisa ubuthi be-CFP kwiimvavanyo zebhotile, nto leyo ebonisa ukuba esi siphumo sinokubangelwa yingxabano phakathi kwe-CFP ne-PBO. Ukufa kwe-vector kwakuphezulu kwiindlwana ezisebenzisa indibaniselwano ye-nets eziqulethe i-pyrethroid-CFP ne-huts xa kuthelekiswa neendlwana ezingenayo i-pyrethroid-CFP ne-huts, kwaye xa i-pyrethroid-CFP ne-huts zisetyenziswa zodwa njenge-huts ezimbini. Xa zisetyenziswa kunye, ukufa kuphezulu (83-85%).
Olu phononongo lubonise ukuba ukusebenza kakuhle kwe-pyrethroid-CFP meshes kunciphile xa kusetyenziswa kunye ne-pyrethroid-PBO ITN xa kuthelekiswa nokusetyenziswa kodwa, ngelixa ukusebenza kakuhle kweendibaniselwano ze-mesh ezine-pyrethroid-CFP meshes kwakuphezulu. Ezi ziphumo zibonisa ukuba ukubeka phambili ukusasazwa kwenethiwekhi ze-pyrethroid-CFP kunezinye iintlobo zenethiwekhi kuya kwandisa iziphumo zolawulo lwe-vector kwiimeko ezifanayo.
Iinethi zebhedi eziphathwa ngezibulala-zinambuzane (ii-ITN) eziqulethe izibulala-zinambuzane ze-pyrethroid ziye zaba sisiseko solawulo lwe-malaria kwiminyaka engamashumi amabini edlulileyo. Ukusukela ngo-2004, malunga neenethi zebhedi eziphathwa ngezibulala-zinambuzane ezi-2.5 bhiliyoni ziye zanikezelwa kwi-Afrika esemazantsi eSahara [1], nto leyo ebangele ukwanda kwenani labantu abalala phantsi kweenethi zebhedi eziphathwa ngezibulala-zinambuzane ukusuka kwi-4% ukuya kwi-47% [2]. Isiphumo solu setyenziso besibalulekile. Kuqikelelwa ukuba malunga neengxelo ze-malaria ezi-2 bhiliyoni kunye nokufa kwezigidi ezi-6.2 kwathintelwa kwihlabathi liphela phakathi kowama-2000 nowe-2021, uhlalutyo lomzekelo lubonisa ukuba iinethi eziphathwa ngezibulala-zinambuzane zezona ziphambili kule nzuzo [2, 3]. Nangona kunjalo, le nkqubela phambili iza ngexabiso: ukuvela ngokukhawuleza kokuxhathisa kwe-pyrethroid kumaqela e-malaria. Nangona iinethi zebhedi eziphathwa ngezibulala-zinambuzane ze-pyrethroid zisenokubonelela ngokhuseleko lomntu ngamnye kwi-malaria kwiindawo apho iivectors zibonisa ukuxhathisa kwe-pyrethroid [4], izifundo zomzekelo ziqikelela ukuba kumanqanaba aphezulu okuxhathisa, iinethi zebhedi eziphathwa ngezibulala-zinambuzane ziya kunciphisa impembelelo ye-epidemiological [5]. Ngoko ke, ukumelana ne-pyrethroid yenye yezona zinto zibalulekileyo ezisongela inkqubela phambili eqhubekayo ekulawuleni i-malaria.
Kwiminyaka embalwa edlulileyo, isizukulwana esitsha seenethi zokulala eziphathwa zinambuzane, ezidibanisa ii-pyrethroids kunye nekhemikhali yesibini, ziye zaphuhliswa ukuphucula ulawulo lwe-malaria edluliselwa ziingcongconi ezinganyangekiyo yi-pyrethroid. Udidi olutsha lokuqala lwe-ITN luqulathe i-synergist piperonyl butoxide (PBO), ekhuthaza ii-pyrethroids ngokunciphisa ii-enzymes ezikhupha ubuthi ezinxulumene nokumelana ne-pyrethroid, ngakumbi ukusebenza kwe-cytochrome P450 monooxygenases (P450s) [6]. Iinethi zokulala ezinyangwe nge-fluprone (CFP), isibulali-zinambuzane se-azole esinendlela entsha yokusebenza ejolise ekuphefumleni kweseli, nazo ziye zafumaneka kutshanje. Emva kokubonakaliswa kwempembelelo ephuculweyo ye-entomological kwizilingo zovavanyo lwe-hut [7, 8], uthotho lwezilingo ezilawulwayo ezingacwangciswanga (cRCT) lwenziwe ukuvavanya iingenelo zempilo yoluntu zezi nethi xa kuthelekiswa neenethi eziphathwa zinambuzane ezisebenzisa ii-pyrethroids zodwa kwaye zibonelele ngobungqina obufunekayo bokwazisa iingcebiso zomgaqo-nkqubo ezivela kwi-World Health Organisation (WHO) [9]. Ngokusekelwe kubungqina bempembelelo ephucukileyo ye-epidemiological evela kwi-CRCTs e-Uganda [11] naseTanzania [12], i-WHO ivumile iminatha yebhedi ephathwe nge-pyrethroid-PBO zinambuzane [10]. I-pyrethroid-CFP ITN nayo ipapashwe kutshanje emva kokuba ii-RCTs ezifanayo eBenin [13] naseTanzania [14] zibonise ukuba i-prototype ITN (Interceptor® G2) inciphise ukwanda kwe-malaria yabantwana ngama-46% kunye nama-44%, ngokwahlukeneyo. 10].
Emva kwemizamo evuselelweyo yiGlobal Fund kunye nabanye abanikeli abaphambili bemalariya yokujongana nokuchasana nezinambuzane ngokukhawulezisa ukungeniswa kweenethi ezintsha zebhedi [15], inethi zebhedi ze-pyrethroid-PBO kunye ne-pyrethroid-CFP sele zisetyenziswa kwiindawo ezixhaphakileyo. Ithatha indawo yeenethi zebhedi eziphathwayo ezisebenzisa ii-pyrethroid kuphela. Phakathi kowama-2019 nowama-2022, inani leenethi zezinambuzane ze-PBO pyrethroid ezinikezelwa kwi-Afrika esemazantsi eSahara linyuke ukusuka kwi-8% ukuya kwi-51% [1], ngelixa inethi zezinambuzane ze-PBO pyrethroid, kuquka neenethi zezinambuzane ze-CFP pyrethroid, inethi zezinambuzane "ezimbini" kulindeleke ukuba zibandakanye i-56% yokuthunyelwa. Ngena kwimarike yase-Afrika ngo-2025[16]. Njengobungqina bokusebenza kweenethi zezinambuzane ze-pyrethroid-PBO kunye ne-pyrethroid-CFP ziyaqhubeka nokukhula, ezi nethi kulindeleke ukuba zifumaneke ngokubanzi kwiminyaka ezayo. Ngoko ke, kukho imfuneko ekhulayo yokuzalisa izikhewu zolwazi malunga nokusetyenziswa ngokugqibeleleyo kweenethi ezisetyenziswa kwiintshabalalisi zesizukulwana esitsha ukuze kufezekiswe isiphumo esiphezulu xa zikhuliswa ukuze zisetyenziswe ngokupheleleyo.
Ngenxa yokwanda ngaxeshanye kwe-pyrethroid CFP kunye ne-pyrethroid PBO mosquito nets, iNational Malaria Control Program (NMCP) inombuzo omnye wophando olusebenzayo: Ngaba ukusebenza kwayo kuya kuncipha – i-PBO ITN? Isizathu sale nkxalabo kukuba i-PBO isebenza ngokuthintela ii-enzymes ze-mosquito P450 [6], ngelixa i-CFP iyi-proinsecticide efuna ukusebenza nge-P450s [17]. Ke ngoko, kucingelwa ukuba xa i-pyrethroid-CFP ITN kunye ne-pyrethroid-CFP ITN zisetyenziswa kwikhaya elinye, isiphumo sokuthintela i-PBO kwi-P450 sinokunciphisa ukusebenza kwe-pyrethroid-CFP ITN. Izifundo ezininzi zelebhu zibonise ukuba ukuvezwa kwangaphambili kwi-PBO kunciphisa ubuthi be-CFP kwiintsholongwane ze-mosquito kwi-bioassays ethe ngqo [18,19,20,21,22]. Nangona kunjalo, xa kuqhutywa izifundo phakathi kweenethiwekhi ezahlukeneyo kwintsimi, ukusebenzisana phakathi kwezi khemikhali kuya kuba nzima ngakumbi. Izifundo ezingapapashwanga zihlolisise iziphumo zokusebenzisa iintlobo ezahlukeneyo zeenethi eziphathwe ngezinambuzane kunye. Ngoko ke, izifundo zasentsimini ezivavanya impembelelo yokusebenzisa indibaniselwano yeenethi zebhedi ze-pyrethroid-CFP kunye ne-pyrethroid-PBO ezinyangwa yizinambuzane kwikhaya elinye ziya kunceda ekumiseleni ukuba ingaba inkcaso enokubakho phakathi kwezi ntlobo zeenethi ibangela ingxaki yokusebenza kwaye zincede ekumiseleni eyona ndlela ilungileyo yokusebenzisa icebo kwiindawo zayo ezisasazwe ngokulinganayo.
Ixesha lokuthumela: Septemba-21-2023