Ukufinyelela ku-isibulala-zinambuzane-inethi zokulala eziphathwe kahle kanye nokusetshenziswa kwe-IRS ezingeni lasekhaya kube negalelo ekunciphiseni okukhulu kokusabalala kwe-malaria okubikwe ngabodwa phakathi kwabesifazane abasebangeni lokuzala eGhana. Lokhu okutholakele kuqinisa isidingo sempendulo ephelele yokulawula i-malaria ukuze kufakwe isandla ekuqedeni i-malaria eGhana.
Idatha yalolu cwaningo ithathwe ku-Ghana Malaria Indicator Survey (GMIS). I-GMIS iyinhlolovo emele izwe lonke eyenziwe yi-Ghana Statistical Service kusukela ngo-Okthoba kuya kuDisemba 2016. Kulolu cwaningo, abesifazane abaneminyaka engu-15-49 kuphela ababambe iqhaza kulolu cwaningo. Abesifazane ababenedatha yazo zonke iziguquguquko bafakiwe ekuhlaziyweni.
Ocwaningweni lwango-2016, i-MIS yaseGhana isebenzise inqubo yokuqoqa amasampula ezigaba eziningi kuzo zonke izifunda eziyi-10 zezwe. Izwe lihlukaniswe ngezigaba ezingama-20 (izifunda eziyi-10 kanye nohlobo lwendawo yokuhlala - yasemadolobheni/yasemakhaya). Iqoqo lichazwa njengendawo yokubalwa kwabantu (CE) equkethe imizi engaba ngu-300-500. Esigabeni sokuqala sokuqoqa amasampula, amaqoqo akhethwa esigabeni ngasinye ngamathuba ahambisana nosayizi. Kwakhethwa amaqoqo angama-200. Esigabeni sesibili sokuqoqa amasampula, inani elinqunyiwe lemindeni engama-30 lakhethwa ngokungahleliwe eqenjini ngalinye elikhethiwe ngaphandle kokufakwa esikhundleni salo. Noma nini lapho kungenzeka, saxoxa nabesifazane abaneminyaka engu-15-49 emndenini ngamunye [8]. Ucwaningo lokuqala lwaxoxa nabesifazane abangu-5,150. Kodwa-ke, ngenxa yokungaphenduli kwezinye izinto eziguquguqukayo, inani labesifazane abangu-4861 lafakwa kulolu cwaningo, elimelela ama-94.4% abesifazane kulesi sampula. Idatha ifaka ulwazi ngezindlu, imizi, izici zabesifazane, ukuvimbela umalaleveva, kanye nolwazi lwemalariya. Idatha yaqoqwa kusetshenziswa uhlelo lwengxoxo yomuntu siqu olusizwa yikhompyutha (i-CAPI) kumathebhulethi kanye nemibuzo yamaphepha. Abaphathi bedatha basebenzisa uhlelo lwe-Census and Survey Processing (CSPro) ukuhlela nokuphatha idatha.
Umphumela oyinhloko walolu cwaningo kwaba ukusabalala komalariya okubikiwe ngokwabo phakathi kwabesifazane abaneminyaka engu-15-49 ubudala, okuchazwe njengabesifazane ababike ukuthi bane-malaria okungenani eyodwa okungenani ezinyangeni ezingu-12 ezandulele ucwaningo. Okusho ukuthi, ukusabalala komalariya okubikiwe ngokwabo phakathi kwabesifazane abaneminyaka engu-15-49 ubudala kwasetshenziswa njengendlela yokubonisa ukuthi i-RDT yangempela noma i-microscopy iyatholakala yini phakathi kwabesifazane ngoba lokhu kuhlolwa kwakungatholakali phakathi kwabesifazane ngesikhathi socwaningo.
Ukungenelela kwakuhlanganisa ukufinyelela emindenini kumanethi aphathwe ngezibulala-zinambuzane (i-ITN) kanye nokusetshenziswa kwemindeni kwe-IRS ezinyangeni eziyi-12 ezandulele inhlolovo. Imindeni eyathola zombili lezi zindlela zokungenelela yabhekwa njengehlangene. Imindeni eyayinokufinyelela kumanethi aphathwa ngezibulala-zinambuzane yachazwa njengabesifazane abahlala emindenini eyayinenethi elilodwa okungenani eliphathwa ngezibulala-zinambuzane, kanti imindeni ene-IRS yachazwa njengabesifazane abahlala emindenini eyayiphathwe ngezibulala-zinambuzane zingakapheli izinyanga eziyi-12 ngaphambi kocwaningo lwabesifazane.
Ucwaningo luhlole izigaba ezimbili ezibanzi zezinto eziguquguqukayo ezididayo, okungukuthi izici zomndeni kanye nezici zomuntu ngamunye. Kufaka phakathi izici zomndeni; isifunda, uhlobo lwendawo yokuhlala (yasemakhaya-yasemadolobheni), ubulili benhloko yomndeni, usayizi womndeni, ukusetshenziswa kukagesi komndeni, uhlobo lwephethiloli lokupheka (eliqinile noma elingaqinile), izinto eziphansi, izinto eziyinhloko zodonga, izinto zophahla, umthombo wamanzi okuphuza (othuthukisiwe noma ongathuthukisiwe), uhlobo lwendlu yangasese (ethuthukisiwe noma engathuthukisiwe) kanye nesigaba somcebo womndeni (ompofu, ophakathi nocebile). Izigaba zezici zomndeni zahlelwa kabusha ngokwezindinganiso zokubika ze-DHS emibikweni ye-GMIS ka-2016 kanye ne-2014 Ghana Demographic Health Survey (GDHS) [8, 9]. Izici zomuntu siqu ezicatshangelwe zihlanganisa iminyaka yowesifazane yamanje, izinga eliphezulu lemfundo, isimo sokukhulelwa ngesikhathi sengxoxo, isimo somshuwalense wezempilo, inkolo, ulwazi mayelana nokuchayeka kumalariya ezinyangeni ezi-6 ngaphambi kwengxoxo, kanye nezinga lolwazi lowesifazane ngezinkinga zemalariya. Imibuzo emihlanu yolwazi yasetshenziswa ukuhlola ulwazi lwabesifazane, okuhlanganisa ulwazi lwabesifazane ngezimbangela ze-malaria, izimpawu ze-malaria, izindlela zokuvimbela i-malaria, ukwelashwa kwe-malaria, kanye nokuqwashisa ukuthi i-malaria imbozwe yi-Ghana National Health Insurance Scheme (NHIS). Abesifazane abathole amaphuzu angu-0-2 babhekwa njengabanolwazi oluphansi, abesifazane abathole amaphuzu angu-3 noma angu-4 babhekwa njengabanolwazi oluphakathi, kanti abesifazane abathole amaphuzu angu-5 babhekwa njengabanolwazi oluphelele nge-malaria. Izinguquko ngazinye ziye zahlotshaniswa nokufinyelela amanethi aphathwe ngezibulala-zinambuzane, i-IRS, noma ukusabalala kwe-malaria ezincwadini.
Izici zangemuva zabesifazane zifingqiwe kusetshenziswa amaza namaphesenti eziguquguquko zezigaba, kanti iziguquguquko eziqhubekayo zifingqiwe kusetshenziswa izindlela kanye nokuphambuka okujwayelekile. Lezi zici zahlanganiswa ngesimo sokungenelela ukuze kuhlolwe ukungalingani okungenzeka kanye nesakhiwo sabantu esibonisa ubandlululo olungaba khona oludidayo. Amamephu e-contour asetshenziswa ukuchaza ukusabalala kwe-malaria okubikiwe phakathi kwabesifazane kanye nokumbozwa kokungenelela okubili ngendawo. Izibalo zokuhlolwa kwe-Scott Rao chi-square, ezichaza izici zokuklama inhlolovo (okungukuthi, ukuhlukaniswa, ukuqoqana, kanye nesisindo sesampula), zasetshenziswa ukuhlola ubudlelwano phakathi kokusabalala kwe-malaria okubikiwe kanye nokufinyelela kokubili ukungenelela kanye nezici zomongo. Ukusabalala kwe-malaria okubikiwe kubalwe njengenani labesifazane abake baba nengxenye okungenani eyodwa ye-malaria ezinyangeni ezingu-12 ngaphambi kocwaningo oluhlukaniswe ngenani eliphelele labesifazane abafanelekile abahlolwe.
Imodeli yokuguqulwa kwesisindo se-Poisson eguquliwe isetshenziswe ukulinganisa umphumela wokufinyelela ekungeneleleni kokulawula umalaleveva ekusabalaleni komalaleveva kwabesifazane abazibika ngokwabo16, ngemuva kokulungisa amathuba okwelashwa aphambene (i-IPTW) kanye nokuhlola isisindo kusetshenziswa imodeli ethi "svy-linearization" ku-Stata IC. (Stata Corporation, College Station, Texas, USA). Amathuba okwelashwa aphambene (i-IPTW) okungenelela "i" kanye no-"j" wesifazane kulinganiselwa kanje:
Iziguquguquko zokugcina zokulinganisa ezisetshenziswe kumodeli yokuguqulwa kwe-Poisson zibe sezilungiswa kanje:
Phakathi kwazo, i-\(fw_{ij}\) iyisiguquguquli sokugcina sesisindo se-j yomuntu ngamunye kanye nokungenelela i, i-\(sw_{ij}\) iyisisindo sesampula se-j yomuntu ngamunye kanye nokungenelela i ku-GMIS ka-2016.
Umyalo we-post-estimation othi “margins, dydx (intervention_i)” ku-Stata wabe ususetshenziswa ukulinganisa umehluko ongaphansi (umphumela) wokungenelela “i” ekusakazekeni komalaleveva okubikiwe phakathi kwabesifazane ngemuva kokufaka imodeli yokuguqulwa kwe-Poisson regression ukulawula. Bonke babonile iziguquguquko ezididayo.
Kusetshenziswe amamodeli amathathu ahlukene okubuyela emuva njengokuhlaziywa kokuzwela: ukuhlehla kwe-binary logistic, ukuhlehla okungenzeka, kanye namamodeli okubuyela emuva okuqondile ukulinganisa umthelela wokungenelela ngakunye kokulawula umalaleveva ekusakazekeni komalaleveva okubikiwe phakathi kwabesifazane baseGhana. Izikhawu zokuzethemba ezingama-95% zalinganiselwa kuzo zonke izilinganiso zokusabalala kwamaphuzu, izilinganiso zokusabalala, kanye nezilinganiso zomphumela. Konke ukuhlaziywa kwezibalo kulolu cwaningo kubhekwe njengokubalulekile ezingeni le-alpha elingu-0.050. Inguqulo ye-Stata IC 16 (StataCorp, Texas, USA) yasetshenziselwa ukuhlaziywa kwezibalo.
Kumamodeli amane okubuyela emuva, ukusabalala komalariya okubikiwe ngokwakho bekungephansi kakhulu phakathi kwabesifazane abathola i-ITN kanye ne-IRS uma kuqhathaniswa nabesifazane abathola i-ITN kuphela. Ngaphezu kwalokho, kumodeli wokugcina, abantu abasebenzisa i-ITN kanye ne-IRS abazange babonise ukwehla okukhulu kokusabalala komalariya uma kuqhathaniswa nabantu abasebenzisa i-IRS kuphela.
Umthelela wokufinyelela ekungeneleleni kokulwa nomalaleveva ekusabalaleni komalaleveva okubikwe ngabesifazane ngokwezimpawu zasekhaya
Umthelela wokufinyelela ekungeneleleni kokulawula umalaleveva ekusabalaleni komalaleveva okubikiwe ngabo kwabesifazane, ngokwezimpawu zabesifazane.
Iphakheji yamasu okuvimbela i-malaria vector control yasiza kakhulu ekunciphiseni ukwanda kwe-malaria okubikiwe ngokwabo phakathi kwabesifazane abaseminyakeni yokuzala eGhana. Ukusabalala kwe-malaria okubikiwe ngokwabo kwehle ngo-27% phakathi kwabesifazane abasebenzisa amanethi ombhede aphathwe ngezinambuzane kanye ne-IRS. Lokhu okutholakele kuhambisana nemiphumela yocwaningo olulawulwa ngokungahleliwe olubonise amazinga aphansi kakhulu okutholakala kwe-malaria DT phakathi kwabasebenzisi be-IRS uma kuqhathaniswa nabasebenzisi abangebona i-IRS endaweni enesifo se-malaria esiphezulu kodwa amazinga aphezulu okufinyelela kwe-ITN eMozambique [19]. Enyakatho yeTanzania, amanethi ombhede aphathwe ngezinambuzane kanye ne-IRS ahlanganiswe ukuze kuncishiswe kakhulu ubuningi be-Anopheles kanye namazinga okugoma izinambuzane [20]. Amasu okulawula izinambuzane ahlanganisiwe nawo asekelwa ucwaningo lwabantu esifundazweni saseNyanza entshonalanga yeKenya, oluthole ukuthi ukufutha ngaphakathi kanye namanethi ombhede aphathwe ngezinambuzane asebenza kangcono kunezibulala-zinambuzane. Inhlanganisela inganikeza isivikelo esengeziwe ngokumelene ne-malaria. Amanethiwekhi acatshangelwa ngokwehlukana [21].
Lolu cwaningo lulinganisele ukuthi abesifazane abangu-34% babenomalaleveva ezinyangeni ezingu-12 ezandulele ucwaningo, kanye nesilinganiso sokuzethemba esingu-95% esingu-32-36%. Abesifazane abahlala emakhaya athola amanethi ombhede aphathwe ngezibulala-zinambuzane (33%) babenezinga eliphansi kakhulu lokwanda kwemalaleveva abazibike lona kunabesifazane abahlala emakhaya angenayo amanethi ombhede aphathwe ngezibulala-zinambuzane (39%). Ngokufanayo, abesifazane abahlala emakhaya afuthwe ngezibulala-zinambuzane babenezinga lokwanda kwemalaleveva elibikiwe lona elingu-32%, uma kuqhathaniswa no-35% emakhaya angafuthwanga. Izindlu zangasese azikathuthukiswa futhi izimo zokuhlanzeka azizinhle. Iningi lazo lingaphandle futhi amanzi angcolile ayaqongelela kuzo. Lezi zindawo zamanzi ezimile, ezingcolile ziyindawo ekahle yokuzalela omiyane be-Anopheles, okuyimbangela eyinhloko yemalaleveva eGhana. Ngenxa yalokho, izindlu zangasese kanye nezimo zokuhlanzeka azizange zithuthuke, okwaholela ngqo ekudlulisweni kwemalaleveva kubantu. Imizamo kufanele iqiniswe yokuthuthukisa izindlu zangasese kanye nezimo zokuhlanzeka emakhaya nasemiphakathini.
Lolu cwaningo lunemikhawulo eminingana ebalulekile. Okokuqala, ucwaningo lusebenzise idatha yocwaningo oluhlanganisa izingxenye, okwenza kube nzima ukulinganisa imbangela. Ukuze kunqotshwe lo mkhawulo, izindlela zezibalo zezimbangela zasetshenziswa ukulinganisa umphumela wokwelashwa ojwayelekile wokungenelela. Ukuhlaziywa kulungisa isabelo sokwelashwa futhi kusebenzisa iziguquguquko ezibalulekile ukulinganisa imiphumela engaba khona kwabesifazane abanemindeni ethole ukungenelela (uma kungekho ukungenelela) kanye nabesifazane abanemindeni engazange ithole ukungenelela.
Okwesibili, ukufinyelela emanethini ombhede aphathwe ngezibulala-zinambuzane akusho ukuthi kufanele kusetshenziswe amanethi ombhede aphathwe ngezibulala-zinambuzane, ngakho-ke kufanele kuqashelwe lapho kuhunyushwa imiphumela neziphetho zalolu cwaningo. Okwesithathu, imiphumela yalolu cwaningo mayelana nomalaleveva ozibike wona phakathi kwabesifazane iyimbangela yokusabalala komalaleveva phakathi kwabesifazane ezinyangeni eziyi-12 ezedlule futhi ngenxa yalokho ingase ithambekele ezingeni lolwazi lwabesifazane mayelana nomalaleveva, ikakhulukazi amacala angatholakalanga.
Okokugcina, ucwaningo aluzange lubalule amacala amaningi e-malaria ngomuntu ngamunye ngesikhathi sokubhekisela sonyaka owodwa, noma isikhathi esiqondile sezigameko ze-malaria kanye nokungenelela. Njengoba kunikezwe imikhawulo yezifundo zokubukela, izivivinyo ezilawulwa ngokungahleliwe eziqinile kakhulu zizoba yinto ebalulekile okufanele icatshangelwe ocwaningweni lwesikhathi esizayo.
Imindeni ethole i-ITN kanye ne-IRS ibike ukuthi ihlaselwe yi-malaria ephansi uma kuqhathaniswa nemindeni engazange ithole kungenelela. Lokhu okutholakele kusekela izingcingo zokuhlanganiswa kwemizamo yokulawula i-malaria ukuze kufakwe isandla ekuqedeni i-malaria eGhana.
Isikhathi sokuthunyelwe: Okthoba-15-2024