Mambure emubhedha ane pyrethroid clofenpyr (CFP) uye pyrethroid piperonyl butoxide (PBO) ari kukurudzirwa munyika dziri munzvimbo iyi kuti pave nekudzora marariya inoparadzirwa neumhutu hunodzivirira pyrethroid. CFP mushonga wezvipembenene unoda kushandiswa neumhutu hunonzi cytochrome P450 monooxygenase (P450), uye PBO inowedzera kushanda kwe pyrethroids nekudzivirira kushanda kwema enzymes aya muumhutu hunodzivirira pyrethroid. Saka, kudziviswa kweP450 nePBO kunogona kuderedza kushanda kwe pyrethroid-CFP mambure kana akashandiswa mumba mumwe chete ne pyrethroid-PBO mambure.
Miedzo miviri yekuyedza yemukamuri yemudhudhudhu yakaitwa kuti iongorore mhando mbiri dzakasiyana dzepyrethroid-CFP ITN (Interceptor® G2, PermaNet® Dual) chete uye pamwe chete nepyrethroid-PBO ITN (DuraNet® Plus, PermaNet® 3.0). Zvinokonzera kushandiswa kwePyrethroid resistance Vector populations kumaodzanyemba kweBenin. Muzvidzidzo zvese zviri zviviri, mhando dzese dzema mesh dzakaedzwa mukurapa kwe single ne double mesh. Bioassays dzakaitwawo kuti dziongorore kuramba kwemishonga kwevector populations muhut uye kuti dzidzidze kudyidzana kuripo pakati peCFP nePBO.
Huwandu hwemabhakitiriya aya hwainzwa CFP asi hwakaratidza kusasimba kwakanyanya kumishonga yepyrethroid, asi kusasimba uku kwakakundwa nekusangana nePBO isati yatanga. Kufa kwemasero aya kwakadzikira zvakanyanya mudzimba dzakashandiswa musanganiswa wemambure epyrethroid-CFP nemambure epyrethroid-PBO zvichienzaniswa nedzimba dzakashandisa mambure maviri epyrethroid-CFP (74% yeInterceptor® G2 vs. 85%, PermaNet® Dual 57% vs. 83%), p < 0.001). Kusangana nePBO isati yatanga kwakaderedza chepfu yeCFP muongororo dzemabhodhoro, zvichiratidza kuti mhedzisiro iyi inogona kunge yakakonzerwa nekusawirirana pakati peCFP nePBO. Kufa kwemasero aya kwakakwira mudzimba dzakashandisa musanganiswa wemambure ane mambure epyrethroid-CFP zvichienzaniswa nedzimba dzisina mambure epyrethroid-CFP, uye kana mambure epyrethroid-CFP akashandiswa ega semambure maviri. Kana akashandiswa pamwe chete, kufa kwacho kwakanyanya (83-85%).
Chidzidzo ichi chakaratidza kuti kushanda kwe pyrethroid-CFP meshes kwakadzikira kana ikashandiswa pamwe chete ne pyrethroid-PBO ITN zvichienzaniswa nekushandiswa chete, nepo kushanda kwe mesh combinations ine pyrethroid-CFP meshes kwakakwira. Izvi zvinoratidza kuti kuisa pamberi kugoverwa kwe pyrethroid-CFP networks pane mamwe marudzi e networks kuchawedzera mhedzisiro yekudzora vector mumamiriro ezvinhu akafanana.
Mambure emubhedha ane mishonga yezvipembenene inonzi pyrethroid (ITNs) ave chinhu chikuru chekudzora malaria mumakore makumi maviri apfuura. Kubva muna 2004, mambure emubhedha ane mishonga yezvipembenene angangoita mabhiriyoni 2.5 akaendeswa kuSub-Saharan Africa [1], zvichikonzera kuwedzera kwehuwandu hwevanhu vanorara pasi pemambure ane mishonga yezvipembenene kubva pa4% kusvika pa47% [2]. Mhedzisiro yekushandiswa uku yaive yakakosha. Zvinofungidzirwa kuti nyaya dzemarariya dzinosvika mabhiriyoni maviri nerufu rwemamiriyoni 6.2 dzakadziviswa pasi rose pakati pa2000 na2021, nekuongorora kwemuenzaniso kuchiratidza kuti mambure ane mishonga yezvipembenene ndiwo akanyanya kukonzera izvi [2, 3]. Zvisinei, kufambira mberi uku kunouya nemutengo: kukurumidza kushanduka kwekusagona kurwisa pyrethroid muhuwandu hwevanokonzera malaria. Kunyangwe mambure emubhedha ane mishonga yezvipembenene anonzi pyrethroid achiri kupa dziviriro yemunhu kubva kumalaria munzvimbo dzine vanodzivirira malaria [4], zvidzidzo zvemuenzaniso zvinofanotaura kuti pamazinga akakwirira ekusagona kurwisa, mambure ane mishonga yezvipembenene achaderedza kukanganiswa kwezvirwere [5]. Saka, kusakwanisa kurwisa malaria ne pyrethroid ndeimwe yenjodzi huru kumatambudziko ekufambira mberi kwenguva refu mukurwisa malaria.
Mumakore mashoma apfuura, chizvarwa chitsva chemambure emubhedha anorapwa zvipembenene, ayo anosanganisa pyrethroids nekemikari yechipiri, yakagadzirwa kuti ivandudze kudzora malaria inotapurirwa neumhutu husingapindi pyrethroid. Kirasi itsva yekutanga yeITN ine synergist piperonyl butoxide (PBO), iyo inosimbisa pyrethroids nekubvisa detoxifying enzymes dzine chekuita ne pyrethroid resistance, kunyanya kushanda kwe cytochrome P450 monooxygenases (P450s) [6]. Mambure emubhedha anorapwa ne fluprone (CFP), mushonga wezvipembenene weazole une nzira itsva yekushanda inotarisa kufema kwemasero, ave kuwanikwawo munguva pfupi yapfuura. Mushure mekuratidzwa kwekuvandudzwa kwemhedzisiro yezvipembenene mumiedzo yekuongorora hut [7, 8], nhevedzano yemiedzo yakadzorwa yakasarudzika (cRCT) yakaitwa kuti iongorore mabhenefiti ehutano hweveruzhinji emambure aya zvichienzaniswa nemambure akarapwa zvipembenene achishandisa pyrethroids chete uye kupa humbowo hunodiwa kuti hubatsire kurudziro dzemitemo kubva kuWorld Health Organisation (WHO) [9]. Zvichibva pahumbowo hwekuvandudzwa kwemigumisiro yezvirwere kubva kuCRCTs muUganda [11] neTanzania [12], WHO yakatsigira mambure emubhedha ane mushonga wezvipembenene anonzi pyrethroid-PBO [10]. Iyo pyrethroid-CFP ITN yakaburitswawo nguva pfupi yadarika mushure mekunge maRCT akafanana muBenin [13] neTanzania [14] aratidza kuti prototype ITN (Interceptor® G2) yakaderedza kuwanda kwemarariya yevana ne46% ne44%, zvichiteerana. 10].
Zvichitevera kuedza kwakaitwa neGlobal Fund nevamwe vanopa mari yemarariya kugadzirisa kusabatwa kwezvipembenene nekukurumidzisa kuunzwa kwemambure matsva emubhedha [15], mambure emubhedha epyrethroid-PBO nepyrethroid-CFP atove kushandiswa munzvimbo dziripo. Inotsiva mishonga yezvipembenene yechinyakare. mambure emubhedha akarapwa anoshandisa pyrethroid chete. Pakati pa2019 na2022, chikamu chemambure eumhutu ePBO pyrethroid anopihwa kuSub-Saharan Africa chakawedzera kubva pa8% kusvika pa51% [1], nepo mambure eumhutu ePBO pyrethroid, kusanganisira mambure eumhutu eCFP pyrethroid, mambure eumhutu e "dual action" anotarisirwa kuita 56% yekutumira. Pinda mumusika weAfrica panosvika 2025[16]. Sehumbowo hwekushanda kwemambure eumhutu epyrethroid-PBO nepyrethroid-CFP ari kuramba achikura, mambure aya anotarisirwa kuwanikwa zvakanyanya mumakore anotevera. Saka, pane kudiwa kuri kukura kwekuzadza ruzivo rwakashaikwa maererano nekushandiswa kwakanaka kwemambure emubhedha matsva akarapwa zvipembenene kuti awane simba guru kana akawedzerwa kuti ashandiswe zvizere.
Zvichienderana nekuwanda kwe pyrethroid CFP ne pyrethroid PBO mosquito nets, National Malaria Control Program (NMCP) ine mubvunzo mumwe chete wekutsvaga: Kushanda kwayo kuchadzikira here - PBO ITN? Chikonzero chekunetseka uku ndechekuti PBO inoshanda nekudzivisa ma enzymes e mosquito P450 [6], nepo CFP iri proinsecticide inoda kushanda kuburikidza neP450s [17]. Saka, zvinofungidzirwa kuti kana pyrethroid-CFP ITN ne pyrethroid-CFP ITN zvikashandiswa mumba mumwe chete, mhedzisiro yekudzivirira yePBO paP450 inogona kuderedza kushanda kwe pyrethroid-CFP ITN. Zvidzidzo zvakati wandei zverabhoritari zvakaratidza kuti kusangana nePBO nePBO kunoderedza chepfu yeCFP kune mosquito vectors mukuongororwa zvakananga kwe bioassays [18,19,20,21,22]. Zvisinei, pakuita zvidzidzo pakati pema network akasiyana mumunda, kudyidzana pakati pemakemikari aya kuchave kwakaoma. Zvidzidzo zvisina kuburitswa zvakaongorora mhedzisiro yekushandisa marudzi akasiyana emambure akarapwa zvipembenene pamwe chete. Saka, zvidzidzo zvemumunda zvinoongorora kushanda kwekushandisa musanganiswa wemambure emubhedha ane mushonga wezvipembenene anonzi pyrethroid-CFP ne pyrethroid-PBO mumba mumwe chete zvichabatsira kuona kana kusawirirana pakati pemhando idzi dzemambure kuchikonzera dambudziko rekushanda uye kubatsira kuona nzira yakanakisisa yekushandisa.
Nguva yekutumira: Gunyana-21-2023