Access tomushonga wezvipembenene-mambure emubhedha akarapwa uye kushandiswa kwepaimba-pamwero weIRS zvakabatsira mukudzikisira kukuru mukuzvitaura kwemarariya kuwanda pakati pevakadzi vezera rekubereka muGhana. Kuwana uku kunosimbisa kukosha kwemhinduro yakazara yekudzora marariya kuti ibatsire mukupedza marariya muGhana.
Mashoko echidzidzo ichi akatorwa kubva kuGhana Malaria Indicator Survey (GMIS). GMIS iwongororo inomiririra nyika yose yakaitwa neGhana Statistical Service kubva muna Gumiguru kusvika Zvita 2016. Muongororo iyi, vakadzi chete vezera rekuberekwa vana vane makore 15-49 ekuberekwa ndivo vakapinda muongororo iyi. Vakadzi vaive nedata pane zvese zvakasiyana vakaverengerwa mukuongorora.
Pachidzidzo cha2016, MIS yekuGhana yakashandisa maitiro esampling yematanho akawanda mumatunhu gumi enyika. Nyika yakakamurwa kuva makirasi makumi maviri (matunhu gumi uye rudzi rwekugara - mumaguta / kumaruwa). Cluster inotsanangurwa senzvimbo yekuverengera vanhu (CE) inosanganisira dzimba dzinosvika mazana matatu kusvika mazana mashanu. Muchikamu chekutanga chekuenzanisira, masumbu anosarudzwa kune imwe neimwe stratum ine mukana wakaenzana nehukuru. Hwerengedzo yemasumbu mazana maviri akasarudzwa. Muchikamu chechipiri chekuenzanisira, nhamba yakatarwa yedzimba dze30 dzakasarudzwa kubva kune imwe neimwe yakasarudzwa yakasarudzwa pasina kutsiva. Pese pazvaikwanisika, takabvunzurudza vakadzi vane makore 15–49 emakore mumhuri yega yega [8]. Ongororo yekutanga yakabvunzurudza vakadzi 5,150. Zvisinei, nekuda kwekusapindura pane zvimwe zvakasiyana-siyana, huwandu hwevakadzi ve4861 vakaiswa muchidzidzo ichi, vachimiririra 94.4% yevakadzi mumuenzaniso. Mashoko anosanganisira ruzivo pamusoro pedzimba, dzimba, maitiro evakadzi, kudzivirira marariya, uye ruzivo rwemalaria. Data yakaunganidzwa pachishandiswa computer-assisted personal interview (CAPI) system pamahwendefa uye mapepa emibvunzo. Mamaneja edata anoshandisa Census uye Survey Processing (CSPro) system kugadzirisa nekugadzirisa data.
Mhedzisiro yekutanga yechidzidzo ichi yaive yekuzvishuvira kwemarariya kuwanda pakati pevakadzi vezera rekuzvarwa makore 15-49, inotsanangurwa sevakadzi vakashuma kuti vane chikamu chimwe chemalaria mumwedzi gumi nemiviri isati yaitwa. Kureva kuti, kuzvishuvira kwechirwere chemalaria pakati pevakadzi vane makore 15–49 ekuberekwa kwakashandiswa semumiriri wemarariya RDT chaiyo kana microscopy positivity pakati pevakadzi nekuti ongororo idzi dzainge dzisipo pakati pevakadzi panguva yechidzidzo.
Kupindira kwaisanganisira kuwanikwa kwemhuri kune mambure ane mishonga yezvipembenene (ITN) uye kushandiswa kwepamba kwe IRS mumwedzi gumi nemiviri yakatangira ongororo. Mhuri dzakagamuchira zvose zviri zviviri kupindira dzakarangarirwa dzakabatanidzwa. Mhuri dzine mukana wekuwana mambure ane mishonga yezvipembenene vaitsanangurwa sevakadzi vanogara mudzimba dzinenge dzine mambure akaiswa mushonga wezvipembenene, nepo dzimba dzine IRS dzichitsanangurwa semadzimai aigara mudzimba dzainge dzarapwa nemishonga mukati memwedzi gumi nemiviri isati yaitwa ongororo. zvevakadzi.
Chidzidzo ichi chakaongorora zvikamu zviviri zvakafara zvezvakasiyana zvinovhiringa, zvinoti hunhu hwemhuri uye hunhu hwemunhu. Inosanganisira maitiro emumba; dunhu, rudzi rwekugara (kumaruwa-mudhorobha), murume kana mukadzi wemusoro wemba, ukuru hwemba, magetsi epamba, rudzi rwemafuta ekubikisa (akasimba kana asina kuomarara), main floor material, main wall material, padenga remba, manyuko emvura yekunwa. (yakavandudzwa kana kuti isina kuvandudzwa), rudzi rwechimbuzi (chakavandudzwa kana chisina kuvandudzwa) uye chikamu chehupfumi hwemhuri (varombo, vepakati uye vakapfuma). Zvikamu zvehutano hwemhuri zvakadzokororwa maererano nemitemo yeDHS yekuzivisa mu2016 GMIS uye 2014 Ghana Demographic Health Survey (GDHS) inoshuma [8, 9]. Hunhu hwemunhu hunorangarirwa hunosanganisira zera remukadzi iyezvino, mwero wepamusoro wedzidzo, mamiriro epamuviri panguva yekubvunzurudzwa, mamiriro einishuwarenzi yehutano, chitendero, ruzivo rwekusangana nemarariya mumwedzi mitanhatu isati yaitwa bvunzurudzo, uye ruzivo rwemukadzi nezve marariya. nyaya. . Mibvunzo mishanu yeruzivo yakashandiswa kuongorora ruzivo rwevakadzi, kusanganisira ruzivo rwevakadzi rwezvinokonzeresa marariya, zviratidzo zvemalaria, nzira dzekudzivirira marariya, kurapwa kwemalaria, nekuziva kuti marariya inovharwa neGhana National Health Insurance Scheme (NHIS). Vakadzi vaiwana 0–2 vaionekwa sevane ruzivo rwakaderera, vakadzi vakapasa 3 kana 4 vaionekwa vaine ruzivo rwune mwero, uye vakadzi vakawana 5 vaionekwa sevane ruzivo rwakakwana nezvemalaria. Kusiyana kwakasiyana-siyana kwakave kwakabatanidzwa nekuwana mambure akabatwa nemishonga, IRS, kana kuwanda kwemarariya mumabhuku.
Mamiriro ezvinhu evakadzi akapfupikiswa pachishandiswa mafambiro nezvikamu zvezvikamu zvakasiyana-siyana, nepo zvinoramba zvichipesana zvakapfupikiswa pachishandiswa nzira uye misiyano. Aya maitiro akaunganidzwa nechimiro chekupindira kuti uongorore kusaenzana kunogona kuitika uye chimiro chedemographic chinoratidza zvinogona kukanganisa kusarura. Mamepu emucontour akashandiswa kutsanangura kuzvishuvira kwemarariya pakati pevakadzi uye kuvharirwa kwekupindira kuviri uku nenzvimbo. Iyo Scott Rao chi-square test statistics, iyo inoverengera maitiro ekuongorora dhizaini (kureva, stratification, clustering, uye sampling uremu), yakashandiswa kuongorora hukama pakati pekuzvishuvira kwemarariya kuwanda uye kuwana kune zvese kupindira uye mamiriro emamiriro. Chirwere chemalaria chakazvizivisa chakaverengerwa sehuwandu hwevakadzi vakambosangana nechikamu chimwe chemalaria mumwedzi gumi nemiviri isati yaitwa ongororo yakakamurwa nehuwandu hwevakadzi vanokodzera vakaongororwa.
Iyo yakagadziridzwa huremu yePoisson regression modhi yakashandiswa kufungidzira mhedzisiro yekuwana nzira dzekudzivirira marariya pahuwandu hwevakadzi vanozviti marariya16, mushure mekugadzirisa kune inverse mukana wehuremu hwekurapa (IPTW) uye maremu ekuongorora vachishandisa "svy-linearization" modhi muStata. IC . (Stata Corporation, College Station, Texas, USA). Iyo inverse mukana wekurapa uremu (IPTW) yekupindira "i" uye mukadzi "j" inofungidzirwa se:
Iwo ekupedzisira huremu akasiyana anoshandiswa muPoisson regression modhi anozogadziriswa sezvizvi:
Pakati pavo, \(fw_{ij}\) ndiyo yekupedzisira kushanduka kwehuremu hwemunhu j uye kupindira i, \(sw_{ij}\) ndiyo muenzaniso wehuremu hwemunhu j uye kupindira i muGMIS ya2016.
The post-estimation command "margins, dydx (intervention_i)" muStata yakabva yashandiswa kuenzanisa mutsauko wepamucheto (mugumisiro) wekupindira "i" pakuzvitaura kwemarariya kupararira pakati pevakadzi mushure mekugadzirisa yakagadziridzwa inorema Poisson regression modhi yekudzora. zvese zvakacherechedzwa zvinokanganisa zvakasiyana.
Mhando nhatu dzakasiyana dzekudzoreredza dzakashandiswawo sekuongorora kwekunzwa: bhinary logistic regression, probabilistic regression, uye linear regression modhi yekufungidzira kukanganisa kwega kwega kwemarariya kupindira pakuzvitaura kwemarariya pakati pevakadzi vekuGhana. 95% nguva dzekuvimba dzakafungidzirwa kune ese mapoinzi fungidziro yehuwandu, huwandu hwehuwandu, uye mhedzisiro fungidziro. Yese ongororo yenhamba muchidzidzo ichi yakaonekwa seyakakosha pane alpha level ye0.050. Stata IC version 16 (StataCorp, Texas, USA) yakashandiswa kuongorora nhamba.
Mumhando ina dzekudzoreredza, huwandu hwemarariya hwekuzvitaura hwakanga husina kuderera zvakanyanya pakati pevakadzi vaiwana zvese ITN neIRS zvichienzaniswa nevakadzi vanowana ITN chete. Zvakare, mumuenzaniso wekupedzisira, vanhu vanoshandisa zvese ITN neIRS havana kuratidza kuderera kukuru kwemarariya kana zvichienzaniswa nevanhu vanoshandisa IRS chete.
Mhedzisiro yekuwana kupindira kwekurwisa marariya pavakadzi-inoshumwa kuwanda kwemalaria nemaitiro emumba
Mhedzisiro yekuwana kupindira kwekudzivirira marariya pakuzvitaura kwemarariya kupararira pakati pevakadzi, nehunhu hwevakadzi.
Pasuru yenzira dzekudzivirira marariya vector yekudzivirira yakabatsira zvakanyanya kudzikisira kuzvitaura kupararira kwemarariya pakati pevakadzi vezera rekubereka muGhana. Kuzvitaura kwemarariya kwakadzikira nechikamu che27% pakati pevakadzi vanoshandisa mambure ane mishonga yekuuraya zvipembenene neIRS. Kuwana uku kunopindirana nemigumisiro yekuedza kusingatarisirwi kwakaratidza kuderera kwakanyanya kwemarariya DT positivity pakati pevashandisi ve IRS vachienzaniswa nevasiri vashandisi veIRS munzvimbo ine chirwere chemalaria yakakura asi maitiro epamusoro ekuwana ITN muMozambique [19]. Kuchamhembe kweTanzania, mambure ane mishonga yekuuraya zvipembenene uye IRS zvakabatanidzwa kuti zvideredze zvakanyanya kuwanda kweAnopheles uye mwero wekudzivirira zvipembenene [20]. Matanho akabatanidzwa ekudzora mavhairasi anotsigirwawo neongororo yehuwandu hwevanhu mudunhu reNyanza kumadokero kweKenya, iyo yakaratidza kuti kupfapfaidza mumba uye mambure ane mishonga yezvipembenene aibatsira kudarika mishonga yezvipembenene. Iko kusanganiswa kunogona kupa imwe dziviriro kubva kumarariya. network inoonekwa zvakasiyana [21].
Ongororo iyi inofungidzira kuti chikamu che34% chevakadzi vakarwara nemalaria mumwedzi gumi nemiviri yakatangira ongororo iyi, paine 95% yenguva yekuvimbana ye32-36%. Madzimai anogara mudzimba dzine mambure ane mishonga yekuuraya zvipembenene (33%) vaive nechirwere chemalaria chakaderera zvikuru pane vakadzi vanogara mudzimba vasingawane mambure ane mishonga yekuuraya zvipembenene (39%) . Zvakadai, madzimai anogara mudzimba dzakapfapfaidzwa vaive nechikamu che32% chechirwere chemalaria chakazvitsvakira chega, zvichienzaniswa ne35% mudzimba dzisina kumwaya. Zvimbuzi hazvina kuvandudzwa uye utsanana hwakashata. Vazhinji vavo vari kunze uye mvura yakasviba inoungana mavari. Iyi mvura isingayerere, ine tsvina inoita nzvimbo yakanaka yokuberekera mosquitoes anonzi Anopheles, uhwo hunonyanya kuparadzira marariya muGhana. Nekuda kweizvozvo, zvimbuzi uye mamiriro ehutsanana hazvina kunaka, izvo zvakakonzera zvakananga kuwedzera kutapurira kwemarariya mukati mehuwandu hwevanhu. Nhamburiko dzinofanirwa kusimbaradzwa kuvandudza zvimbuzi uye utsanana mudzimba nenharaunda.
Ichi chidzidzo chine zvipingamupinyi zvakati wandei zvakakosha. Kutanga, chidzidzo chacho chakashandisa data-sectional survey data, zvichiita kuti zvive zvakaoma kuyera causality. Kuti akunde muganhu uyu, nhamba dzenzira dzechikonzero dzakashandiswa kuenzanisa muvhareji wehutano hwehutano hwekupindira. Kuongorora kunogadzirisa basa rekurapa uye kunoshandisa zvakasiyana-siyana zvekufungidzira zvingangoitika kune vakadzi vane mhuri dzakagamuchira kupindira (kana pasina kupindira) uye kune vakadzi vane mhuri dzisina kugamuchira kupindira.
Chechipiri, kuwana mambure ane mishonga yezvipembenene hazvireve kushandisa mambure ane mishonga yezvipembenene, saka kuchenjerera kunofanira kushandiswa pakududzira zvakabuda nemhedziso yeongororo iyi. Chechitatu, zvakabuda muongororo iyi pamusoro pekuzvitsvakira marariya kumadzimai ndiwo ari kutsigira kupararira kwemarariya pakati pemadzimai mumwedzi gumi nemiviri yadarika nekudaro inogona kunge yakarerekera paruzivo rwemadzimai pamusoro pemalaria, zvikuru vanhu vasina kuonekwa.
Pakupedzisira, chidzidzo chacho hachina kuverenga nyaya dzakawanda dzemarariya kune mumwe mubati panguva yereferensi yegore rimwe chete, kana nguva chaiyo yezvikamu zvemarariya uye kupindira. Tichifunga nezvekuganhurirwa kwezvidzidzo zvekutarisa, mamwe akasimba akasarudzika akadzorwa miedzo ichave yakakosha kutariswa kwekutsvaga mune ramangwana.
Mhuri dzakagamuchira zvese ITN neIRS dzaive dzakadzikira dzemarariya dzakazvitaura dzichienzaniswa nedzimba dzisina kupindira. Kuwana uku kunotsigira kubatanidzwa kwekuedza kwekudzivirira marariya kubatsira mukupedza marariya muGhana.
Nguva yekutumira: Oct-15-2024