Ukufinyelela kuisibulala-zinambuzane-manethi alashiwe kanye nokuqaliswa kwe-IRS ezingeni lasekhaya kube nesandla ekwehliseni okukhulu kokuvama komalaleveva okuzibikayo phakathi kwabesifazane abaseminyakeni yokuzala eGhana. Lokhu okutholakele kuqinisa isidingo sempendulo ebanzi yokulawula umalaleveva ukuze kube neqhaza ekuqedeni umalaleveva eGhana.
Idatha yalolu cwaningo ithathwe ocwaningweni lwezinkomba ze-Malaria yaseGhana (GMIS). I-GMIS inhlolovo emele izwe lonke eyenziwe yi-Ghana Statistical Service kusukela ngo-Okthoba kuya kuZibandlela wezi-2016. Kulolu cwaningo, abesifazane kuphela abaneminyaka yobudala yokubeletha abaneminyaka eyi-15-49 ababambe iqhaza ocwaningweni. Abesifazane ababenedatha kukho konke okuguquguqukayo bafakiwe ekuhlaziyeni.
Ocwaningweni lwango-2016, i-MIS yaseGhana yasebenzisa inqubo yesampula yezigaba eziningi kuzo zonke izifunda eziyi-10 zezwe. Izwe lihlukaniswe ngamakilasi angama-20 (izifunda eziyi-10 nohlobo lwezindawo zokuhlala - zasemadolobheni/zasemaphandleni). Iqoqo lichazwa njengendawo yokubalwa kwabantu (CE) ehlanganisa cishe amakhaya angama-300–500. Esigabeni sokuqala samasampula, amaqoqo akhethwa ku-stratum ngayinye namathuba alinganayo nosayizi. Kwakhethwa amaqoqo angama-200. Esigabeni sesibili samasampula, inani elimisiwe lemizi engama-30 lakhethwa ngokungahleliwe kuqoqo ngalinye elikhethiwe ngaphandle kokushintshwa. Noma nini lapho kungenzeka, sasixoxisana nabesifazane abaneminyaka engu-15-49 emndenini ngamunye [8]. Inhlolovo yokuqala yaxoxisana nabesifazane abayizi-5,150. Kodwa-ke, ngenxa yokungaphenduli kwezinye izinto eziguquguqukayo, ingqikithi yabesifazane be-4861 ifakiwe kulolu cwaningo, emele i-94.4% yabesifazane kusampula. Idatha ihlanganisa ulwazi lwezindlu, imindeni, izici zabesifazane, ukuvimbela umalaleveva, nolwazi lwe-malaria. Idatha yaqoqwa kusetshenziswa uhlelo lwe-computer-assisted personal interview (CAPI) kumathebulethi namaphepha emibuzo. Abaphathi bedatha basebenzisa uhlelo lweCensus and Survey Processing (CSPro) ukuze bahlele futhi baphathe idatha .
Umphumela oyinhloko walolu cwaningo kwaba ukuzibika kwesifo sikamalaleveva phakathi kwabesifazane abaneminyaka yobudala engu-15-49, okuchazwa njengabesifazane ababike ukuthi banesiqephu okungenani esisodwa sikamalaleveva ezinyangeni eziyi-12 ezandulele ucwaningo. Okusho ukuthi, ukuvama kukamalaleveva okuzibikayo phakathi kwabesifazane abaneminyaka engu-15-49 kwasetshenziswa njengommeleli we-RDT yangempela kamalaleveva noma i-microscope positivity phakathi kwabesifazane ngenxa yokuthi lezi zivivinyo bezingekho phakathi kwabesifazane ngesikhathi socwaningo.
Ukungenelela kufake phakathi ukufinyelela komndeni emanethi alahlwe izibulala-zinambuzane (ITN) kanye nokusetshenziswa kwasendlini kwe-IRS ezinyangeni eziyi-12 ezandulela inhlolovo. Imindeni ethole kokubili ukungenelela ithathwe njengejoyiniwe. Imindeni ekwazi ukufinyelela amanetha afakwe izibulala-zinambuzane ichazwe njengabesifazane abahlala emizini enenethi okungenani eyodwa efakwe isibulala-zinambuzane, kuyilapho imizi ene-IRS ichazwa njengabesifazane abahlala emakhaya abelashwe ngezibulala-zinambuzane phakathi nezinyanga ezingu-12 ngaphambi kocwaningo. zabesifazane.
Ucwaningo luhlole izigaba ezimbili ezibanzi zezinhlobonhlobo ezididayo, okuyizici zomndeni nezici zomuntu ngamunye. Kufaka phakathi izici zasekhaya; isifunda, uhlobo lwendawo yokuhlala (yasemaphandleni-emadolobheni), ubulili benhloko yekhaya, ubukhulu bendlu, ukusetshenziswa kukagesi wasendlini, uhlobo lwamafutha okupheka (okuqinile noma okungaqinile), impahla yaphansi eyinhloko, impahla yodonga olukhulu, impahla yophahla, umthombo wamanzi okuphuza (ethuthukisiwe noma engathuthukisiwe), uhlobo lwendlu yangasese (ethuthukisiwe noma engathuthukisiwe) kanye nesigaba sengcebo yasekhaya (empofu, ephakathi kanye necebile). Izigaba zezici zendlu zabhalwa kabusha ngokuvumelana nezindinganiso zokubika ze-DHS kumbiko we-GMIS ka-2016 kanye no-2014 we-Ghana Demographic Health Survey (GDHS) [8, 9]. Izici zomuntu siqu ezicatshangelwayo zihlanganisa iminyaka yamanje yowesifazane, izinga eliphezulu lemfundo, isimo sokukhulelwa ngesikhathi senhlolokhono, isimo somshuwalense wezempilo, inkolo, ulwazi mayelana nokuchayeka kumalaleveva ezinyangeni ezingu-6 ngaphambi kwengxoxo, kanye nezinga lolwazi lowesifazane mayelana nomalaleveva. izindaba. . Kusetshenziswe imibuzo yolwazi emihlanu ukuhlola ulwazi lwabesifazane, okuhlanganisa nolwazi lwabesifazane ngezimbangela zikamalaleveva, izimpawu zikamalaleveva, izindlela zokuvimbela umalaleveva, ukwelashwa kukamalaleveva, kanye nokuqwashisa ngokuthi umalaleveva umbozwa iSikimu Somshuwalense Wezempilo Kazwelonke waseGhana (NHIS). Abesifazane abathole amaphuzu angu-0–2 babebhekwa njengabanolwazi oluncane, abesifazane abathole amaphuzu angu-3 noma angu-4 babebhekwa njengabanolwazi olulinganiselwe, kanti abesifazane abathole angu-5 babebhekwa njengabanolwazi oluphelele mayelana nomalaleveva. Ukuguquguquka komuntu ngamunye kuye kwahlotshaniswa nokufinyelela kwamanetha alashwe izibulala-zinambuzane, i-IRS, noma ukwanda komalaleveva ezincwadini.
Izici zangemuva zabesifazane zafingqwa kusetshenziswa amaza kanye namaphesenti okuguquguquka kwezigaba, kuyilapho okuguquguqukayo okuqhubekayo kwafingqwa kusetshenziswa izindlela nokuchezuka okujwayelekile. Lezi zici zihlanganiswe yisimo sokungenelela ukuze kuhlolwe ukungalingani okungaba khona kanye nokwakheka kwezibalo zabantu okubonisa ukuchema okungaba khona okudidayo. Amamephu ekhonsathi asetshenziswa ukuchaza ukusabalala kukamalaleveva okuzibikayo phakathi kwabesifazane kanye nokutholakala kokungenelela okubili ngendawo yendawo. Izibalo zokuhlolwa kwesikwele se-Scott Rao chi-square, esilandisa ngezici zedizayini yenhlolovo (okungukuthi, ukuhlukanisa, ukuhlanganisa, nezisindo zesampula), sasetshenziswa ukuze kuhlolwe ukuhlotshaniswa phakathi kokusabalala kukamalaleveva okuzibikayo kanye nokufinyelela kukho kokubili ukungenelela nezici zomongo. Ukusabalala kamalaleveva okuzibikayo kubalwa njengenani labesifazane abaye bahlangabezana okungenani nesiqephu esisodwa sikamalaleveva ezinyangeni eziyi-12 ngaphambi kocwaningo oluhlukaniswe ngenani eliphelele labesifazane abafanelekile abahloliwe.
Imodeli ye-Poisson regression regression model eguquliwe yasetshenziselwa ukulinganisa umphumela wokufinyelela ekulawuleni umalaleveva ekusakazekeni kukamalaleveva okuzibikayo16, ngemva kokulungiswa kwamathuba aphambene nezisindo zokwelashwa (IPTW) nezisindo zenhlolovo kusetshenziswa imodeli ye-“svy-linearization” ku-Stata. IC . (Stata Corporation, College Station, Texas, USA). Amathuba aphambene wesisindo sokwelashwa (IPTW) okungenelela okuthi “i” nowesifazane “j” alinganiselwa ngokuthi:
Okuguquguqukayo kokugcina kwesisindo okusetshenziswe kumodeli ye-Poisson regression bese kulungiswa kanjena:
Phakathi kwazo, \(fw_{ij}\) inguquko yokugcina yesisindo sika-j ngamunye kanye nokungenelela i, \(sw_{ij}\) yisampula yesisindo somuntu ngamunye j kanye nokungenelela i ku-GMIS ka-2016.
Umyalo we-post-estimation othi “margins, dydx (intervention_i)” ku-Stata wabe ususetshenziswa ukulinganisa umehluko ongaseceleni (umphumela) wokungenelela “i” ekuzibikeleni kwesifo sikamalaleveva phakathi kwabesifazane ngemva kokufaka imodeli yokuhlehla ye-Poisson enesisindo esilungisiwe ukuze ilawulwe. konke okuguquguqukayo okubonwayo okudidayo.
Amamodeli amathathu ahlukene okuhlehla aphinde asetshenziswa njengokuhlaziya ukuzwela: ukuhlehla kokuhamba kanambambili, ukuhlehla okungenzeka, kanye namamodeli okuhlehla ngomugqa ukuze kulinganiswe umthelela wokungenelela ngakunye kokulawula umalaleveva ekusakazekeni kukamalaleveva okuzibikayo phakathi kwabesifazane baseGhana. Izikhawu zokuzethemba ezingu-95% zilinganiselwe kuzo zonke izilinganiso zokuvama kwamaphoyinti, izilinganiso zokuvama, kanye nezilinganiso zomphumela. Konke ukuhlaziya kwezibalo kulolu cwaningo kuthathwe njengokubalulekile ezingeni le-alpha lika-0.050. Inguqulo 16 ye-Stata IC (StataCorp, Texas, USA) isetshenziselwe ukuhlaziywa kwezibalo.
Kumamodeli amane okuhlehla, ukusabalala kamalaleveva okuzibikayo bekungephansi kakhulu kwabesifazane abathola kokubili i-ITN ne-IRS uma kuqhathaniswa nabesifazane abathola i-ITN bodwa. Ngaphezu kwalokho, kumodeli yokugcina, abantu abasebenzisa kokubili i-ITN ne-IRS abazange babonise ukwehla okukhulu kokuvama kukamalaleveva uma kuqhathaniswa nabantu abasebenzisa i-IRS kuphela.
Umthelela wokufinyelela ekungeneleleni kokulwa nomalaleveva ekusakazekeni kukamalaleveva okubikwe ngabesifazane ngezici zasekhaya
Umthelela wokufinyelela ekulawuleni umalaleveva ekulawuleni umalaleveva okuzibikayo phakathi kwabesifazane, ngezici zabesifazane.
Iphakethe lamasu okuvimbela ama-vector umalaleveva lisize kakhulu ukunciphisa ukusabalala okuzibikayo kwe-malaria phakathi kwabesifazane abaneminyaka yobudala yokuzala eGhana. Ukuvama kukamalaleveva okuzibikayo kwehle ngamaphesenti angama-27 kwabesifazane abasebenzisa amanethi afakwe izibulala-zinambuzane kanye ne-IRS. Lokhu kutholakala kuhambisana nemiphumela yokuhlolwa okulawulwa ngokungahleliwe okubonise amazinga aphansi kakhulu e-malaria DT positivity phakathi kwabasebenzisi be-IRS uma kuqhathaniswa nabasebenzisi abangewona ama-IRS endaweni ene-malaria ephezulu kodwa amazinga aphezulu okufinyelela kwe-ITN eMozambique [19]. Enyakatho yeTanzania, amanetha afakwe izibulala-zinambuzane kanye ne-IRS ahlanganiswa ukuze kwehliswe kakhulu ukuminyana kwe-Anopheles kanye namazinga okugonywa kwezinambuzane [20]. Amasu adidiyelwe okulawula ama-vector nawo asekelwa inhlolovo yabantu esifundazweni saseNyanza entshonalanga yeKenya, ethole ukuthi ukufuthwa endlini namanethi afakwe izibulala-zinambuzane asebenza kakhulu kunezibulala-zinambuzane. Inhlanganisela ingase inikeze ukuvikeleka okwengeziwe kumalaleveva. amanethiwekhi abhekwa ngokwehlukana [21].
Lolu cwaningo lulinganisela ukuthi u-34% wabesifazane babekade benomalaleveva ezinyangeni eziyi-12 ezandulele ucwaningo, kanye nesilinganiso sesikhathi sokuzethemba esingama-95% esingama-32-36%. Abesifazane abahlala emizini ekwazi ukuthola amanetha afakwe izibulala-zinambuzane (33%) babenezinga eliphansi kakhulu lezibalo ze-malaria ezibikwayo kunabesifazane abahlala emakhaya abangenawo amanethi afakwe izibulala-zinambuzane (39%). Ngokufanayo, abesifazane abahlala ezindlini ezifuthwe babenezinga lokutholakala kwesifo sikamalaleveva elingama-32%, uma kuqhathaniswa nama-35% emakhaya angafafaziwe. Izindlu zangasese azikathuthukiswa futhi nezimo zokuhlanzeka zimbi. Iningi lazo lingaphandle futhi amanzi angcolile aqoqana kuwo. Lawa manzi amile, angcolile ayindawo ekahle yokuzalela omiyane i-Anopheles, umgudu oyinhloko we-malaria eGhana. Ngenxa yalokho, izindlu zangasese kanye nezimo zokukhucululwa kwendle azizange zibe ngcono, okwaholela ngokuqondile ekwandeni kokudluliselwa komalaleveva phakathi kwabantu. Kumele kuqiniswe imizamo yokuthuthukisa izindlu zangasese kanye nezimo zokukhucululwa kwendle emakhaya nasemiphakathini.
Lolu cwaningo lunemikhawulo embalwa ebalulekile. Okokuqala, ucwaningo lwasebenzisa idatha yocwaningo oluhlukene, okwenza kube nzima ukukala imbangela. Ukuze unqobe lo mkhawulo, izindlela zezibalo ze-causality zasetshenziselwa ukulinganisa umphumela wokwelapha ojwayelekile wokungenelela. Ukuhlaziywa kulungisa isabelo sokwelashwa futhi kusebenzisa okuguquguqukayo okubalulekile ukulinganisa imiphumela engaba khona kwabesifazane abanemizi yabo ethole ukungenelela (uma kungekho ukungenelela) kanye nakwabesifazane imindeni yabo engazange ikuthole ukungenelela.
Okwesibili, ukufinyelela amanetha afakwe izibulala-zinambuzane akusho ngempela ukusetshenziswa kwamanethi afakwe izibulala-zinambuzane, ngakho-ke kufanele kuqashelwe uma kuchazwa imiphumela neziphetho zalolu cwaningo. Okwesithathu, imiphumela yalolu cwaningo mayelana nomalaleveva ozibikayo phakathi kwabesifazane iwummeleli wokwanda kukamalaleveva phakathi kwabesifazane ezinyangeni eziyi-12 ezedlule ngakho-ke ingase icheme ngezinga lolwazi lwabesifazane mayelana nomalaleveva, ikakhulukazi izimo ezinhle ezingatholakali.
Okokugcina, ucwaningo aluzange lubheke amacala amaningi kamalaleveva umhlanganyeli ngamunye phakathi nenkathi yereferensi yonyaka owodwa, noma isikhathi esinembile seziqephu zikamalaleveva kanye nokungenelela. Uma kubhekwa imikhawulo yezifundo zokuqaphela, ukuhlola okuqinile okulawulwa ngokungahleliwe kuzoba ukucatshangelwa okubalulekile ocwaningweni oluzayo.
Imindeni ethole kokubili i-ITN kanye ne-IRS ibe nenani eliphansi likamalaleveva elizibikayo uma liqhathaniswa nemindeni engatholanga ukungenelela. Lokhu okutholakele kusekela izingcingo zokuhlanganiswa kwemizamo yokulawula umalaleveva ukuze kube neqhaza ekuqedeni umalaleveva eGhana.
Isikhathi sokuthumela: Oct-15-2024