Kupinda kumushonga wezvipembenene-mambure emubhedha akarapwa uye kushandiswa kweIRS pamhuri kwakabatsira mukuderedza kukuru kupararira kwemarariya kwakaonekwa nemukadzi ari pazera rekubereka muGhana. Izvi zvinosimbisa kudiwa kwemhinduro yakakwana yekudzora marariya kuti ibatsire mukubvisa marariya muGhana.
Data rekudzidza uku rakatorwa kubva kuGhana Malaria Indicator Survey (GMIS). GMIS iongororo inomiririrwa nenyika yese yakaitwa neGhana Statistical Service kubva muna Gumiguru kusvika Zvita 2016. Mukudzidza uku, vakadzi vane makore ekubereka vana vane makore ari pakati pe15-49 chete ndivo vakapinda muongororo iyi. Vakadzi vaiva nedata rezvinhu zvese zvakachinja-chinja vakaverengerwa muongororo iyi.
Pachidzidzo cha2016, MIS yeGhana yakashandisa nzira yekuunganidza sampuli dzemapoka akawanda munzvimbo dzese gumi dzenyika. Nyika yakakamurwa kuita mapoka makumi maviri (nzvimbo gumi nerudzi rwekugara - muguta/kumaruwa). Chikamu chinotsanangurwa senzvimbo yekuverengera vanhu (CE) ine mhuri dzinosvika 300-500. Muchikamu chekutanga chekutora sampuli, mapoka anosarudzwa pachikamu chimwe nechimwe chine mukana wakaenzana nehukuru. Maboka ese mazana maviri akasarudzwa. Muchikamu chechipiri chekutora sampuli, nhamba yakatarwa yemhuri makumi matatu yakasarudzwa zvisina kurongeka kubva muchikwata chimwe nechimwe chakasarudzwa pasina kuchitsiva. Pose pazvaikwanisika, takabvunzurudza vakadzi vane makore 15-49 mumhuri yega yega [8]. Ongororo yekutanga yakabvunzurudza vakadzi 5,150. Zvisinei, nekuda kwekusapindura pane zvimwe zvinhu, vakadzi vanosvika 4861 vakaverengerwa muchidzidzo ichi, vachimiririra 94.4% yevakadzi mumuenzaniso. Data rinosanganisira ruzivo nezvedzimba, dzimba, hunhu hwevakadzi, kudzivirira malaria, uye ruzivo rwemalaria. Data rakaunganidzwa pachishandiswa sisitimu yekukurukurirana kwevanhu inobatsirwa nekombiyuta (CAPI) pamapiritsi nemibvunzo yepepa. Vatariri vedata vanoshandisa sisitimu yeCensus and Survey Processing (CSPro) kugadzirisa nekutarisira data.
Mhedzisiro huru yechidzidzo ichi yaive kupararira kwemarariya pakati pevakadzi vane makore ekubereka vana vane makore 15-49, vanotsanangurwa sevakadzi vakataura kuti vakamborwara nemarariya kamwe chete mumwedzi gumi nemiviri yapfuura. Kureva kuti, kupararira kwemarariya pakati pevakadzi vane makore 15-49 kwakashandiswa senzira yekuratidza kuti vane malaria chaiyo RDT kana microscopy positive pakati pevakadzi nekuti bvunzo idzi dzakanga dzisipo pakati pevakadzi panguva yechidzidzo.
Kupindira kwaisanganisira kuwanikwa kwemidziyo yekudzivirira zvipembenene (ITN) mumhuri uye kushandiswa kweIRS mumhuri mumwedzi gumi nemiviri ongororo isati yaitwa. Mhuri dzakagamuchira rubatsiro rwese urwu dzakaonekwa sedzakabatana. Mhuri dzaive nemidziyo yekudzivirira zvipembenene dzakatsanangurwa sevakadzi vanogara mumhuri dzaive nemidziyo yekudzivirira zvipembenene imwe chete, nepo mhuri dzine IRS dzakatsanangurwa sevakadzi vanogara mudzimba dzaive nemidziyo yekudzivirira zvipembenene mukati memwedzi gumi nemiviri ongororo yevakadzi isati yaitwa.
Chidzidzo ichi chakaongorora mapoka maviri makuru ezvinhu zvinokanganisa, zvinoti hunhu hwemhuri nehunhu hwemunhu. Zvinosanganisira hunhu hwemhuri; dunhu, rudzi rwekugara (kumaruwa-kumaguta), murume kana mukadzi wemusoro wemhuri, hukuru hwemhuri, kushandiswa kwemagetsi emhuri, rudzi rwemafuta ekubikisa (akasimba kana asina kusimba), zvinhu zvepasi, zvinhu zvemadziro, zvinhu zvedenga, mvura yekunwa (yakagadziridzwa kana isina kusimba), rudzi rwechimbuzi (yakagadziridzwa kana isina kusimba) uye chikamu chehupfumi hwemhuri (varombo, vepakati nevapfumi). Mapoka ehunhu hwemhuri akagadziriswazve zvichienderana nemitemo yeDHS mumishumo ye2016 GMIS ne2014 Ghana Demographic Health Survey (GDHS) [8, 9]. Hunhu hwemunhu hwakatariswa hwaisanganisira zera remukadzi parizvino, dzidzo yepamusoro, mamiriro epamuviri panguva yekubvunzurudzwa, mamiriro einishuwarenzi yehutano, chitendero, ruzivo nezvekusangana nemalaria mumwedzi mitanhatu kubvunzurudzwa kusati kwaitwa, uye ruzivo rwemukadzi nezvenyaya dzemalaria. Mibvunzo mishanu yeruzivo yakashandiswa kuongorora ruzivo rwevakadzi, kusanganisira ruzivo rwevakadzi nezvezvikonzero zvemarariya, zviratidzo zvemarariya, nzira dzekudzivirira marariya, kurapwa kwemarariya, uye kuziva kuti marariya inofukidzwa neGhana National Health Insurance Scheme (NHIS). Vakadzi vakawana 0-2 vaionekwa sevasina ruzivo rwakawanda, vakadzi vakawana 3 kana 4 vaionekwa sevane ruzivo rwakaringana, uye vakadzi vakawana 5 vaionekwa sevane ruzivo rwakakwana nezvemarariya. Zvimwe zvinhu zvakabatana nekuwana mambure anorapwa zvipembenene, IRS, kana kuwanda kwemarariya mumabhuku.
Hunhu hwevakadzi hwakapfupikiswa uchishandisa ma frequency nema percentages e categorical variables, nepo continuous variables dzakapfupikiswa uchishandisa means uye standard deviations. Hunhu uhwu hwakaunganidzwa ne intervention status kuti vaongorore kusawirirana kunogona kuitika uye demographic structure inoratidza rusaruro runogona kukanganisa. Contour maps akashandiswa kutsanangura kupararira kwemalaria kwakaziviswa pakati pevakadzi uye kufukidzwa kwezvirongwa zviviri izvi zvichienderana nenzvimbo. Scott Rao chi-square test statistics, iyo inotsanangura hunhu hwekugadzira ongororo (kureva, stratification, clustering, uye sampling weights), yakashandiswa kuongorora hukama huripo pakati pehuwandu hwemalaria hwakaziviswa uye mukana wekuwana zvese zvirongwa uye hunhu hwemamiriro ezvinhu. Kupararira kwemalaria kwakaziviswa wega kwakaverengerwa sehuwandu hwevakadzi vakambosangana nekanenge kamwe chete kemalaria mumwedzi gumi nemiviri ongororo isati yaitwa ikakamurwa nehuwandu hwevakadzi vakakodzera vakaongororwa.
Modhi yePoisson regression yakagadziriswa yakashandiswa kufungidzira mhedzisiro yekuwana nzira dzekudzivirira malaria pahuwandu hwevakadzi vakazviti vane malaria16, mushure mekugadzirisa mukana wekurapa we inverse probability (IPTW) uye kuongorora huremu uchishandisa modhi ye "svy-linearization" muStata IC. (Stata Corporation, College Station, Texas, USA). Inverse probability yekurapwa kwehuremu (IPTW) yekupindira "i" uye mukadzi "j" inofungidzirwa se:
Zvimiro zvekupedzisira zvehuremu zvinoshandiswa muPoisson regression model zvinozogadziriswa seizvi:
Pakati pavo, \(fw_{ij}\) ndiyo yekupedzisira huremu hwemunhu j uye intervention i, \(sw_{ij}\) ndiyo sample weight yemunhu j uye intervention i mu2016 GMIS.
Murairo we post-estimation unoti "margins, dydx (intervention_i)" muStata wakazoshandiswa kufungidzira musiyano wepakati (mhedzisiro) wekupindira "i" pakupararira kwemarariya kwakaonekwa nega pakati pevakadzi mushure mekuisa modhi yakagadziriswa yePoisson regression kuti idzore. Vese vakaona zvinhu zvinokanganisa.
Mamodheru matatu akasiyana eregression akashandiswawo sekuongorora kwekunzwa: binary logistic regression, probabilistic regression, uye linear regression models kufungidzira kukanganisa kwega kwega kupindira kwekudzivirira malaria pahuwandu hwemarariya hwakataurwa nemukadzi wekuGhana. 95% confidence intervals yakafungidzirwa pafungidziro dzese dzekupararira kwemarariya, huwandu hwekupararira, uye fungidziro yemhedzisiro. Kuongororwa kwese kwenhamba muchidzidzo ichi kwakaonekwa sekukosha pa alpha level ye0.050. Stata IC version 16 (StataCorp, Texas, USA) yakashandiswa pakuongorora kwenhamba.
Mumamodheru mana ekudzoka kwechirwere chemalaria, huwandu hwemarariya hwakazvitaura hwakanga husina kuderera zvakanyanya pakati pevakadzi vaigamuchira ITN neIRS zvichienzaniswa nevakadzi vaigamuchira ITN chete. Uyezve, mumodheru yekupedzisira, vanhu vanoshandisa ITN neIRS havana kuratidza kudzikira kukuru kwehuwandu hwemarariya zvichienzaniswa nevanhu vaishandisa IRS chete.
Kukanganiswa kwekuwana rubatsiro rwekurwisa malaria pahuwandu hwemarariya hunoshumwa nevakadzi zvichienderana nehupenyu hwemhuri.
Kukanganiswa kwekuwana nzira dzekudzivirira malaria pahuwandu hwemarariya hwakataurwa nemukadzi, zvichienderana nehunhu hwevakadzi.
Pakeji yenzira dzekudzivirira malaria dzakabatsira zvikuru kuderedza kuwanda kwemalaria kwakaonekwa nemukadzi ari pazera rekubereka muGhana. Kuwanda kwemalaria kwakaonekwa nemukadzi ari pazera rekubereka kwakadzikira ne27% pakati pevakadzi vanoshandisa mambure emubhedha ane mushonga wezvipembenene neIRS. Izvi zvinoenderana nemigumisiro yeongororo yakarongwa nemaitiro yakaratidza mwero wakaderera wezvirwere zvemalaria DT pakati pevashandisi veIRS zvichienzaniswa nevasiri vashandisi veIRS munzvimbo ine chirwere chemalaria chakanyanya asi mwero wepamusoro wekuwana ITN muMozambique [19]. Kuchamhembe kweTanzania, mambure emubhedha ane mushonga wezvipembenene neIRS zvakabatanidzwa kuderedza zvakanyanya kuwanda kweAnopheles uye mwero wekubaiwa zvipembenene [20]. Nzira dzakabatanidzwa dzekudzivirira malaria dzinotsigirwawo neongororo yevanhu mudunhu reNyanza kumadokero kweKenya, iyo yakawana kuti kupfapfaidza mumba nemambure emubhedha ane mushonga wezvipembenene zvaive zvinoshanda kupfuura mishonga yezvipembenene. Musanganiswa uyu unogona kupa dziviriro yekuwedzera kubva kumalaria. network dzinoonekwa zvakasiyana [21].
Ongororo iyi yakaratidza kuti 34% yevakadzi vakamborwara nemarariya mumwedzi gumi nemiviri ongororo isati yaitwa, ne95% chivimbo chavo chinofungidzirwa kuva 32–36%. Vakadzi vanogara mumhuri dzine mambure emubhedha anorapwa zvipembenene (33%) vaive nehuwandu hwakaderera hwemarariya hwakataurwa nezvahwo pane vakadzi vanogara mudzimba dzisina mambure emubhedha anorapwa zvipembenene (39%). Saizvozvowo, vakadzi vanogara mumhuri dzakapfapfaidzwa zvipembenene vaive nehuwandu hwakataurwa nezvahwo hwe32%, zvichienzaniswa ne35% mumhuri dzisina kupfapfaidzwa. Zvimbuzi hazvina kugadziriswa uye mamiriro ehutsanana haana kunaka. Mazhinji acho ari panze uye mvura yakasviba inoungana mazviri. Mvura iyi isina kumira, ine tsvina inopa nzvimbo yakanaka yekuberekera umhutu hweAnopheles, inokonzera malaria muGhana. Nekuda kweizvozvo, mamiriro ezvimbuzi neutsanana haana kuvandudzika, izvo zvakakonzera kutapurirana kwemarariya muvanhu. Kuedza kunofanira kusimbiswa kuvandudza mamiriro ezvimbuzi neutsanana mudzimba nemunharaunda.
Chidzidzo ichi chine zvipingamupinyi zvakakosha zvakati wandei. Chekutanga, chidzidzo ichi chakashandisa data reongororo yezvikamu zvakasiyana, zvichiita kuti zviome kuyera chikonzero. Kuti zvikunde dambudziko iri, nzira dzekuverenga dzechikonzero dzakashandiswa kufungidzira avhareji yemhedzisiro yekurapa kwekupindira. Ongororo iyi inogadzirisa basa rekurapa uye inoshandisa shanduko dzakakosha kufungidzira mhedzisiro inogona kuitika kuvakadzi vane mhuri dzakagamuchira rubatsiro (kana pasina rubatsiro) uye kuvakadzi vane mhuri dzisina kugamuchira rubatsiro.
Chechipiri, kuwana mambure emubhedha akarapwa nemishonga yezvipembenene hazvirevi hazvo kuti mambure emubhedha akarapwa nemishonga yezvipembenene, saka kungwarira kunofanira kushandiswa pakududzira mhedzisiro nemhedziso yechidzidzo ichi. Chechitatu, mhedzisiro yechidzidzo ichi pamusoro pemarariya yakazvitaura pakati pevakadzi ndiyo chiratidzo chekupararira kwemarariya pakati pevakadzi mumwedzi gumi nemiviri yapfuura uye nekudaro inogona kukanganiswa neruzivo rwevakadzi nezvemarariya, kunyanya nyaya dzisina kuonekwa.
Chekupedzisira, chidzidzo ichi hachina kutsanangura nyaya dzakawanda dzemarariya pamunhu mumwe nemumwe panguva yegore rimwe chete, kana nguva chaiyo yezviitiko zvemarariya uye kupindira. Zvichienderana nemiganhu yezvidzidzo zvekutarisa, miedzo yakasimba yakadzorwa isina kurongeka ichave pfungwa huru yekutsvagisa mune ramangwana.
Mhuri dzakagamuchira ITN neIRS dzaive nedambudziko rekushaya malaria zvishoma kana tichienzanisa nedzimwe mhuri dzisina kuwana rubatsiro. Izvi zvinotsigira kurudziro yekubatanidzwa kwekuedza kudzora malaria kuti zvibatsire mukubvisa malaria muGhana.
Nguva yekutumira: Gumiguru-15-2024