Isibulala-zinambuzane sangaphakathiUkufutha (i-IRS) kuyindlela ebalulekile yokunciphisa ukudluliswa kwe-Trypanosoma cruzi ethwalwa yi-vector, okubangela isifo saseChagas engxenyeni enkulu yeNingizimu Melika. Kodwa-ke, impumelelo ye-IRS esifundeni saseGrand Chaco, esihlanganisa iBolivia, i-Argentina neParaguay, ayikwazi ukuncintisana neyamanye amazwe aseNingizimu yeCone.
Lolu cwaningo luhlole imikhuba ejwayelekile ye-IRS kanye nokulawulwa kwekhwalithi yezibulala-zinambuzane emphakathini ovamile otholakala eChaco, eBolivia.
Isithako esisebenzayoi-alpha-cypermethrin(ai) yathathwa ephepheni lokuhlunga elifakwe odongeni lwesifutho futhi yalinganiswa ngezixazululo zethangi lokufutha elilungisiwe kusetshenziswa i-Insecticide Quantitative Kit (IQK™) elungisiwe eqinisekisiwe ngezindlela ze-HPLC ezinobuningi. Idatha yahlaziywa kusetshenziswa imodeli yokulinganisa imiphumela exubile ye-binomial engemihle ukuze kuhlolwe ubudlelwano phakathi kokuhlushwa kwezinambuzane okusetshenziswe ephepheni lokuhlunga kanye nokuphakama kodonga lwesifutho, ukumbozwa kwesifutho (indawo yobuso besifutho/isikhathi sesifutho [m2/min]), kanye nesilinganiso sesilinganiso sesifutho esibonwe/esilindelwe. Umehluko phakathi kokuthobela kwabahlinzeki bezempilo kanye nabanikazi bezindlu izidingo ze-IRS zezindlu ezingenamuntu nakho kwahlolwa. Izinga lokuxazulula le-alpha-cypermethrin ngemva kokuxubana namathangi esifutho alungisiwe lalinganiswa elabhorethri.
Ukwehluka okuphawulekayo kwabonwa ekugxilweni kwe-alpha-cypermethrin AI, kanye no-10.4% kuphela (50/480) wezihlungi kanye no-8.8% (5/57) wemizi efinyelela ekugxilweni okuqondiwe okungu-50 mg ± 20% AI/m2. Ukugxila okubonisiwe akuxhomekile ekugxilweni okutholakala ezixazululweni zokufutha ezifanele. Ngemva kokuxuba i-alpha-cypermethrin ai esixazululweni esilungisiwe sethangi lokufutha kwahlala ngokushesha, okwaholela ekulahlekelweni okuqondile kwe-alpha-cypermethrin ai ngomzuzu kanye nokulahlekelwa okungu-49% ngemva kwemizuzu eyi-15. Kuphela u-7.5% (6/80) wemizi elashwe ngesilinganiso sokufutha esinconywe yi-WHO esingu-19 m2/min (±10%), kuyilapho u-77.5% (62/80) wemizi elashwe ngesilinganiso esiphansi kunalokho obekulindelwe. Ukugxila okujwayelekile kwesithako esisebenzayo esilethwe ekhaya kwakungahlobene kakhulu nokumbozwa kokufutha okubonwe. Ukuthobela imithetho yomndeni akuzange kuthinte kakhulu ukumbozwa kokufutha noma ukugxilwa okujwayelekile kwe-cypermethrin elethwe emizini.
Ukulethwa kwe-IRS okungafanele kungabangelwa ngokwengxenye yizakhiwo zomzimba zezibulala-zinambuzane kanye nesidingo sokubuyekeza izindlela zokulethwa kwezibulala-zinambuzane, okuhlanganisa ukuqeqeshwa kwamaqembu e-IRS kanye nemfundo yomphakathi ukukhuthaza ukuthobela imithetho. I-IQK™ iyithuluzi elibalulekile elinobungani nensimu elithuthukisa ikhwalithi ye-IRS futhi lenze kube lula ukuqeqeshwa kwabahlinzeki bezempilo kanye nokwenza izinqumo kubaphathi ekulawulweni kwe-vector ye-Chagas.
Isifo se-Chagas sibangelwa ukutheleleka nge-parasite i-Trypanosoma cruzi (kinetoplastid: Trypanosomatidae), ebangela izifo eziningi kubantu nakwezinye izilwane. Kubantu, ukutheleleka okuphawulekayo okunezimpawu kwenzeka emavikini kuya ezinyangeni ngemva kokutheleleka futhi kubonakala ngomkhuhlane, ukucasuka, kanye ne-hepatosplenomegaly. Kulinganiselwa ukuthi ama-20-30% okutheleleka aqhubekela esimweni esingamahlalakhona, okuvame kakhulu ukuba yi-cardiomyopathy, ebonakala ngokukhubazeka kwesistimu yokuhambisa umoya, ukungasebenzi kahle kwenhliziyo, ukungasebenzi kahle kwe-ventricular kwesobunxele, kanye nokwehluleka kwenhliziyo okungapheli kanye, okungavamile, isifo samathumbu. Lezi zimo zingaqhubeka amashumi eminyaka futhi kunzima ukuzelapha [1]. Akukho muthi wokugomela.
Umthwalo womhlaba wonke wesifo iChagas ngo-2017 walinganiselwa kubantu abayizigidi ezingu-6.2, okwaholela ekufeni kwabantu abangu-7900 kanye neminyaka yokuphila elungisiwe yokukhubazeka (ama-DALY) angu-232,000 kubo bonke ubudala [2,3,4]. I-Triatominus cruzi idluliselwa kulo lonke elaseCentral naseNingizimu Melika, kanye nasezingxenyeni eziseningizimu yeNyakatho Melika, yi-Triatominus cruzi (Hemiptera: Reduviidae), ebiza abantu abangu-30,000 (77%) yenani eliphelele lamacala amasha eLatin America ngo-2010 [5]. Ezinye izindlela zokutheleleka ezindaweni ezingezona ezivamile njengeYurophu ne-United States zifaka phakathi ukudluliselwa kokuzalwa kanye nokumpontshelwa igazi elinegciwane. Isibonelo, eSpain, kunezimo ezingaba ngu-67,500 zokutheleleka phakathi kwabokufika baseLatin America [6], okuholela ezindlekweni zonyaka zesistimu yokunakekelwa kwempilo ezingama-US$9.3 million [7]. Phakathi kuka-2004 no-2007, u-3.4% wabesifazane abakhulelwe abavela kwamanye amazwe baseLatin America abahlolwe esibhedlela saseBarcelona babene-seropositive ye-Trypanosoma cruzi [8]. Ngakho-ke, imizamo yokulawula ukudluliswa kwe-vector emazweni agcwele ibalulekile ekunciphiseni umthwalo wesifo emazweni angenayo i-triatomine vector [9]. Izindlela zokulawula zamanje zifaka phakathi ukufutha endlini (IRS) ukunciphisa inani le-vector emakhaya nasezindaweni ezizungezile, ukuhlolwa komama ukuze kutholakale futhi kuqedwe ukudluliswa kokuzalwa, ukuhlolwa kwegazi nezitho zomzimba, kanye nezinhlelo zemfundo [5,10,11,12].
ESouthern Cone yaseNingizimu Melika, i-vector eyinhloko yi-pathogenic triatomine bug. Lolu hlobo luvame kakhulu ukuhlala ezindaweni ezivalekile futhi luhlala ezindaweni ezivalekile futhi luzala kakhulu emakhaya nasezindlini zezilwane. Ezakhiweni ezakhiwe kabi, imifantu ezindongeni nasemaphahleni igcina izimbungulu ze-triatomine, futhi ukutheleleka emakhaya kubi kakhulu [13, 14]. I-Southern Cone Initiative (INCOSUR) ikhuthaza imizamo yamazwe ngamazwe yokulwa nokutheleleka kwasekhaya eTri. Sebenzisa i-IRS ukuthola amabhaktheriya abangela izifo kanye nezinye izinto ezithinta indawo ethile [15, 16]. Lokhu kwaholela ekunciphiseni okukhulu kwezehlakalo zesifo seChagas kanye nokuqinisekiswa okulandelayo yi-World Health Organisation ukuthi ukudluliselwa okuthwalwa yi-vector sekuqediwe kwamanye amazwe (e-Uruguay, eChile, ezingxenyeni zase-Argentina naseBrazil) [10, 15].
Naphezu kwempumelelo ye-INCOSUR, i-vector Trypanosoma cruzi iyaqhubeka esifundeni saseGran Chaco e-USA, indawo yokuhlala yehlathi elomile ngezikhathi ezithile ehlanganisa amakhilomitha-skwele ayizigidi ezingu-1.3 ngaphesheya kwemingcele yeBolivia, i-Argentina neParaguay [10]. Izakhamuzi zalesi sifunda ziphakathi kwamaqembu ahlukunyezwe kakhulu futhi zihlala ebumpofwini obukhulu futhi zinokufinyelela okulinganiselwe ekunakekelweni kwezempilo [17]. Ukwanda kokutheleleka kwe-T. cruzi kanye nokudluliswa kwe-vector kule miphakathi kuphakathi kweziphezulu kakhulu emhlabeni [5,18,19,20] lapho amakhaya angama-26-72% agcwele ama-trypanosomatids. infestans [13, 21] kanye nama-40-56% Tri. Amabhaktheriya abangela izifo athelela i-Trypanosoma cruzi [22, 23]. Iningi (>93%) lazo zonke izimo zesifo se-Chagas esithwalwa yi-vector esifundeni saseSouthern Cone lenzeka eBolivia [5].
I-IRS okwamanje iyindlela kuphela eyamukelwa kabanzi yokunciphisa i-triacine kubantu. I-infestans isu elifakazelwe ngokomlando lokunciphisa umthwalo wezifo eziningana ezithwalwa yi-vector kubantu [24, 25]. Ingxenye yezindlu edolobhaneni lase-Tri. infestans (inkomba yokutheleleka) iyisibonakaliso esibalulekile esisetshenziswa yiziphathimandla zezempilo ukwenza izinqumo mayelana nokusetshenziswa kwe-IRS futhi, okubalulekile, ukuthethelela ukwelashwa kwezingane ezinegciwane elingamahlalakhona ngaphandle kwengozi yokutheleleka kabusha [16,26,27,28,29]. Ukusebenza kahle kwe-IRS kanye nokuqhubeka kokudluliselwa kwe-vector esifundeni sase-Chaco kuthonywa yizici eziningana: ikhwalithi ephansi yokwakhiwa kwesakhiwo [19, 21], ukusetshenziswa kwe-IRS okungaphansi kokufanele kanye nezindlela zokuqapha ukutheleleka [30], ukungaqiniseki komphakathi mayelana nezidingo ze-IRS Ukuthobela okuphansi [31], umsebenzi omfushane osele wezinhlobo zezibulala-zinambuzane [32, 33] kanye ne-Tri. infestans zinokumelana okunciphile kanye/noma ukuzwela ezibulala-zinambuzane [22, 34].
Ama-insecticide e-pyrethroid asetshenziswa kakhulu ku-IRS ngenxa yokuthi abulala kakhulu izinambuzane ze-triatomine. Uma esezingeni eliphansi, ama-insecticide e-pyrethroid nawo asetshenziswe njengezinto ezicasulayo ukususa ama-vector emifantwini yodonga ngezinjongo zokuqapha [35]. Ucwaningo ngokulawulwa kwekhwalithi yemikhuba ye-IRS lulinganiselwe, kodwa kwenye indawo kuboniswe ukuthi kunezinguquko ezibalulekile ekugxilweni kwezithako ezisebenzayo zezibulala-zinambuzane (ii-AI) ezilethwa emakhaya, amazinga avame ukuwela ngaphansi kobubanzi bokugxila okuhlosiwe okusebenzayo [33,36,37,38]. Esinye isizathu sokuntuleka kocwaningo lokulawula ikhwalithi ukuthi i-chromatography yoketshezi esebenza kahle kakhulu (i-HPLC), indinganiso yegolide yokulinganisa ukugxilwa kwezithako ezisebenzayo kuma-pesticides, iyinkimbinkimbi ngobuchwepheshe, iyabiza, futhi ngokuvamile ayifaneleki ezimweni ezisakazekile emphakathini. Intuthuko yakamuva ekuhlolweni kwelabhorethri manje inikeza izindlela ezihlukile nezingabizi kakhulu zokuhlola ukulethwa kwezibulala-zinambuzane kanye nemikhuba ye-IRS [39, 40].
Lolu cwaningo lwenzelwe ukukala izinguquko ekugxilweni kwezibulala-zinambuzane ngesikhathi semikhankaso ejwayelekile ye-IRS ehlose i-Tri. Phytophthora infestans yamazambane esifundeni saseChaco, eBolivia. Ukugxilwa kwezithako ezisebenzayo zezibulala-zinambuzane kwalinganiswa ekwakhiweni okulungiselelwe ematangini okufafaza kanye nasemasampuleni ephepha lokuhlunga aqoqwe emakamelweni okufafaza. Izici ezingase zithonye ukulethwa kwezibulala-zinambuzane emakhaya nazo zahlolwa. Ngenxa yalokhu, sisebenzise i-chemical colorimetric assay ukuze silinganise ukugxilwa kwama-pyrethroids kulawa masampula.
Ucwaningo lwenziwe e-Itanambicua, umasipala waseCamili, umnyango waseSanta Cruz, eBolivia (20°1′5.94″ S; 63°30′41″ W) (Isithombe 1). Lesi sifunda siyingxenye yesifunda saseGran Chaco e-USA futhi sibonakala ngamahlathi omile ngezikhathi ezithile anamazinga okushisa angu-0–49 °C kanye nemvula engu-500–1000 mm/ngonyaka [41]. I-Itanambicua ingenye yemiphakathi engu-19 yamaGuaraní edolobheni, lapho izakhamuzi ezingaba ngu-1,200 zihlala khona ezindlini ezingu-220 ezakhiwe ngokuyinhloko ngezitini zelanga (i-adobe), uthango lwendabuko kanye nama-tabique (aziwa endaweni ngokuthi ama-tabique), ukhuni, noma ingxube yalezi zinto. Ezinye izakhiwo nezakhiwo eziseduze nendlu zifaka phakathi amashede ezilwane, amagumbi okugcina impahla, amakhishi nezindlu zangasese, ezakhiwe ngezinto ezifanayo. Umnotho wendawo usekelwe kwezolimo eziziphilisayo, ikakhulukazi ummbila namakinati, kanye nezinkukhu ezincane, izingulube, izimbuzi, amadada nezinhlanzi, kanti umkhiqizo wasekhaya omningi uthengiswa edolobheni lemakethe lendawo laseKamili (cishe amakhilomitha ayi-12 ukusuka lapha). Idolobha laseKamili liphinde linikeze amathuba emisebenzi kubantu, ikakhulukazi emkhakheni wezokwakha kanye nezinsizakalo zasekhaya.
Esifundweni samanje, izinga lokutheleleka kwe-T. cruzi phakathi kwezingane zase-Itanambiqua (ezineminyaka engu-2-15) lalingu-20% [20]. Lokhu kufana nokusabalala kwegciwane ezinganeni ezibikwe emphakathini oseduze waseGuarani, okwabona nokwanda kokusabalala ngokuguga, kanti iningi labantu abahlala khona abaneminyaka engaphezu kwengu-30 ubudala batheleleka [19]. Ukudluliselwa kwegciwane kubhekwa njengendlela eyinhloko yokutheleleka kule miphakathi, kanti i-Tri iyi-vector eyinhloko. Ama-Infestan angena ezindlini nasezindlini zangaphandle [21, 22].
Isiphathimandla sezempilo sikamasipala esisanda kukhethwa asikwazanga ukunikeza imibiko ngemisebenzi ye-IRS e-Itanambicua ngaphambi kwalolu cwaningo, nokho imibiko evela emiphakathini eseduze ikhombisa ngokusobala ukuthi imisebenzi ye-IRS kumasipala ibilokhu iqhubeka ngezikhathi ezithile kusukela ngo-2000 kanye nokufuthwa okuvamile kwe-20% beta cypermethrin; kwenziwa ngo-2003, kwalandelwa ukufuthwa okugxilile kwezindlu ezigcwele kusukela ngo-2005 kuya ku-2009 [22] kanye nokufuthwa okuhleliwe kusukela ngo-2009 kuya ku-2011 [19].
Kulo mphakathi, i-IRS yenziwa ochwepheshe bezempilo abathathu abaqeqeshwe umphakathi besebenzisa ifomula engu-20% ye-alpha-cypermethrin suspension concentrate [SC] (Alphamost®, Hockley International Ltd., Manchester, UK). Isibulala-zinambuzane sakhiwe ngenani eliqondiwe lokulethwa elingu-50 mg ai/m2 ngokwezidingo zoHlelo Lokulawula Izifo lweChagas loMnyango Wokuphatha waseSanta Cruz (Servicio Departmentamental de Salud-SEDES). Izibulala-zinambuzane zasetshenziswa kusetshenziswa i-Guarany® backpack sprayer (Guarany Indústria e Comércio Ltda, Itu, São Paulo, Brazil) enekhono elisebenzayo elingu-8.5 l (ikhodi yethangi: 0441.20), ifakwe i-flat-spray nozzle kanye nesilinganiso sokugeleza esingu-757 ml/min, okukhiqiza umfudlana we-engeli engu-80° ngokucindezela okujwayelekile kwesilinda okungu-280 kPa. Izisebenzi zokuhlanzeka zahlanganisa namathini e-aerosol kanye nezindlu ezifuthwe. Izisebenzi zaziqeqeshwe ngaphambilini ngumnyango wezempilo wedolobha lendawo ukulungiselela nokuletha izibulala-zinambuzane, kanye nokufutha izibulala-zinambuzane ezindongeni zangaphakathi nezangaphandle zezindlu. Ziyalulekwa futhi ukuthi zicele abantu abahlala endlini ukuthi basuse zonke izinto endlini, okuhlanganisa ifenisha (ngaphandle kohlaka lwemibhede), okungenani amahora angama-24 ngaphambi kokuba i-IRS ithathe isinyathelo sokuvumela ukufinyelela okugcwele ngaphakathi kwendlu ukuze kufuthwe. Ukuthobela le mfuneko kulinganiswa njengoba kuchaziwe ngezansi. Izakhamuzi nazo ziyalulekwa ukuba zilinde kuze kube yilapho izindonga ezipendiwe zomile ngaphambi kokungena kabusha endlini, njengoba kunconywa [42].
Ukuze kulinganiswe ukugcwala kwe-lambda-cypermethrin AI engeniswa emakhaya, abacwaningi bafake iphepha lokuhlunga (i-Whatman No. 1; ububanzi obungu-55 mm) ezindaweni zodonga zezindlu ezingu-57 phambi kwe-IRS. Zonke izindlu ezazithola i-IRS ngaleso sikhathi zazihilelekile (izindlu ezingu-25/25 ngoNovemba 2016 kanye nezindlu ezingu-32/32 ngoJanuwari-Febhuwari 2017). Lokhu kufaka phakathi izindlu ze-adobe ezingu-52 kanye nezindlu ezingu-5 ze-tabik. Izingcezu eziyisishiyagalombili kuya kweziyisishiyagalolunye zephepha lokuhlunga zafakwa endlini ngayinye, zahlukaniswa zaba ukuphakama kodonga okuthathu (0.2, 1.2 kanye no-2 m ukusuka phansi), kanti udonga ngalunye lwezintathu lukhethwe ngokuphambene newashi, kusukela emnyango omkhulu. Lokhu kwanikeza ukukopisha okuthathu ekuphakameni kodonga ngalunye, njengoba kunconyiwe ukuqapha ukulethwa kwezibulala-zinambuzane okuphumelelayo [43]. Ngokushesha ngemva kokusebenzisa isibulala-zinambuzane, abacwaningi baqoqa iphepha lokuhlunga balimisa kude nokukhanya kwelanga okuqondile. Uma selomile, iphepha lokuhlunga laligoqwa ngeteyipu ecacile ukuze livikele futhi libambe isibulala-zinambuzane endaweni emboziwe, bese ligoqwa nge-aluminium foil bese ligcinwa ku-7°C kuze kube yilapho lihlolwa. Kuwo wonke amaphepha okuhlunga angu-513 aqoqwe, izindlu ezingu-480 kwezingu-57 zazitholakala ukuze zihlolwe, okungukuthi amaphepha okuhlunga angu-8-9 ngekhaya ngalinye. Amasampula okuhlola afaka amaphepha okuhlunga angu-437 avela ezindlini ze-adobe ezingu-52 kanye namaphepha okuhlunga angu-43 avela ezindlini ze-tabik ezingu-5. Isampula ilingana nokwanda kwezinhlobo zezindlu emphakathini (76.2% [138/181] adobe kanye no-11.6% [21/181] tabika) okuqoshwe ezinhlolovo zomnyango nomnyango zalolu cwaningo. Ukuhlaziywa kwephepha lokuhlunga kusetshenziswa i-Insecticide Quantification Kit (IQK™) kanye nokuqinisekiswa kwayo kusetshenziswa i-HPLC kuchazwe kuFayela Elingeziwe 1. Ukuhlushwa kwezibulala-zinambuzane okuqondiwe kungu-50 mg ai/m2, okuvumela ukubekezelela okungu-± 20% (okungukuthi 40–60 mg ai/m2).
Ukuhlushwa kwe-AI okulinganiselwe kunqunywe emabhokisini angu-29 alungiselelwe izisebenzi zezokwelapha. Sathatha amasampula amathangi alungisiwe angu-1-4 ngosuku, ngesilinganiso samatangi angu-1.5 (ububanzi: 1-4) alungiselelwe ngosuku esikhathini sezinsuku ezingu-18. Uchungechunge lwesampula lulandele uchungechunge lwesampula olusetshenziswa izisebenzi zezempilo ngoNovemba 2016 nangoJanuwari 2017. Intuthuko yansuku zonke kusukela; ngoJanuwari uFebhuwari. Ngokushesha ngemva kokuxuba ngokuphelele ukwakheka, kwaqoqwa ama-2 ml esisombululo ebusweni bokuqukethwe. Isampula engu-2 mL yabe isixutshwa elabhorethri ngokuvortex imizuzu emi-5 ngaphambi kokuba kuqoqwe amasampula amabili angama-5.2 μL futhi ahlolwe kusetshenziswa i-IQK™ njengoba kuchaziwe (bheka ifayela elingeziwe 1).
Amazinga okufakwa kwesithako esisebenzayo sezinambuzane alinganiswe emathangini amane okufafaza akhethwe ngokukhethekile ukumela amazinga okuqala (zero) esithako esisebenzayo ngaphakathi kwezinga eliphezulu, eliphansi, kanye neliqondiwe. Ngemva kokuxuba imizuzu eyi-15 elandelanayo, susa amasampula amathathu angu-5.2 µL kusuka kungqimba olungaphezulu lwesampula ngayinye ye-vortex engu-2 mL ngezikhathi zomzuzu ongu-1. Ukugxila kwesisombululo esiqondiwe ethangini kungu-1.2 mg ai/ml ± 20% (okungukuthi 0.96–1.44 mg ai/ml), okulingana nokufinyelela amazinga okuqondiwe alethwe ephepheni lokuhlunga, njengoba kuchaziwe ngenhla.
Ukuze kuqondwe ubudlelwano phakathi kwemisebenzi yokufutha izibulala-zinambuzane kanye nokulethwa kwezibulala-zinambuzane, umcwaningi (RG) uhambe nezisebenzi zezempilo ezimbili ze-IRS zasendaweni ngesikhathi sokuthunyelwa kwe-IRS njalo emakhaya angu-87 (izindlu ezingu-57 ezithathwe amasampula ngenhla kanye nezindlu ezingu-30 kwezingu-43 ezifuthwe ngezibulala-zinambuzane). Mashi 2016). Izindlu eziyishumi nantathu kulezi ezingu-43 azifakwanga ekuhlaziyweni: abanikazi abayisithupha benqaba, kanti izindlu eziyisikhombisa zaphathwa kancane kuphela. Indawo yonke yobuso okufanele ifuthwe (amamitha-skwele) ngaphakathi nangaphandle kwekhaya yalinganiswa ngokuningiliziwe, kanti isikhathi esiphelele esichithwa ngabasebenzi bezempilo befutha (imizuzu) saqoshwa ngasese. Le datha yokufaka isetshenziselwa ukubala izinga lokufutha, elichazwa njengendawo yobuso efuthwa ngomzuzu (m2/min). Kusukela kule datha, isilinganiso sokufutha esibonwe/esilindelwe singabalwa njengesilinganiso esilinganiselwe, kanti izinga lokufutha elinconywayo elilindelwe lingu-19 m2/min ± 10% wemininingwane yemishini yokufutha [44]. Ngesilinganiso esibonwe/esilindelwe, ububanzi bokubekezelelana bungu-1 ± 10% (0.8–1.2).
Njengoba kushiwo ngenhla, izindlu ezingu-57 zazifake iphepha lokuhlunga ezindongeni zazo. Ukuze kuhlolwe ukuthi ukuba khona okubonakalayo kwephepha lokuhlunga kuthinte yini amazinga okufafaza abasebenzi bezokuhlanzeka, amazinga okufafaza kulezi zindlu ezingu-57 aqhathaniswa namazinga okufafaza emizini engu-30 elashwe ngoMashi 2016 ngaphandle kokufakwa kwephepha lokuhlunga. Amazinga okubulala izinambuzane alinganiswa kuphela emizini efakwe iphepha lokuhlunga.
Izakhamuzi zasemakhaya angu-55 zabhalwa phansi ukuthi ziyahambisana nezimfuneko zokuhlanza izindlu zangaphambilini ze-IRS, okuhlanganisa izindlu ezingu-30 ezafuthwa ngoMashi 2016 kanye nezindlu ezingu-25 ezafuthwa ngoNovemba 2016. 0–2 (0 = zonke noma iningi lezinto lihlala endlini; 1 = iningi lezinto lisusiwe; 2 = indlu ingenalutho ngokuphelele). Umphumela wokuthobela umnikazi amazinga okufuthwa kanye nokugcwala kwezinambuzane ze-moxa wafundwa.
Amandla ezibalo abalwa ukuze kutholakale ukuphambuka okuphawulekayo ekugxilweni okulindelekile kwe-alpha-cypermethrin esetshenziswa ephepheni lokuhlunga, kanye nokuthola umehluko obalulekile ekugxilweni kwezibulala-zinambuzane kanye namazinga okufafaza phakathi kwamaqembu ezindlu ahlanganiswe ngokwezigaba. Amandla amancane ezibalo (α = 0.05) abalwa ngenani elincane lezindlu ezithathwe amasampula kunoma yiliphi iqembu elihlukaniswe ngokwezigaba (okungukuthi, usayizi wesampula ohleliwe) onqunywe ekuqaleni. Ngamafuphi, ukuqhathaniswa kokugcwala kwezibulala-zinambuzane okumaphakathi kusampula eyodwa kuzo zonke izakhiwo ezingu-17 ezikhethiwe (ezihlukaniswe njengabanikazi abangalandeli imithetho) kwakunamandla angu-98.5% okuthola ukuphambuka okungu-20% ekugxilweni okulindelwe okumaphakathi okungu-50 mg ai/m2, lapho ukuhluka (SD = 10) kulinganiselwa ngokweqile ngokusekelwe ekubonweni okushicilelwe kwenye indawo [37, 38]. Ukuqhathaniswa kokugcwala kwezibulala-zinambuzane kumathini e-aerosol akhethwe ekhaya ukuze kusebenze kahle ngokulinganayo (n = 21) > 90%.
Ukuqhathaniswa kwamasampula amabili okuhlushwa kwemithi yokubulala izinambuzane okumaphakathi ku-n = 10 kanye no-n = 12 izindlu noma amazinga okufafaza amaphakathi ku-n = 12 kanye no-n = 23 izindlu kuveze amandla ezibalo angu-66.2% kanye no-86.2% ukuze kutholakale. Amanani alindelekile omehluko ongu-20% angama-50 mg ai/m2 kanye no-19 m2/min, ngokulandelana. Ngokwesiko, kwakucatshangwa ukuthi kuzoba nokwehluka okukhulu eqenjini ngalinye ngesilinganiso sokufafaza (SD = 3.5) kanye nokuhlushwa kwemithi yokubulala izinambuzane (SD = 10). Amandla ezibalo ayengu->90% ekuqhathanisweni okulinganayo kwamazinga okufafaza phakathi kwezindlu ezinephepha lokuhlunga (n = 57) kanye nezindlu ezingenalo iphepha lokuhlunga (n = 30). Zonke izibalo zamandla zenziwe kusetshenziswa uhlelo lwe-SAMPSI kusofthiwe ye-STATA v15.0 [45]).
Amaphepha okuhlunga aqoqwe endlini ahlolwe ngokufaka idatha kumodeli ye-multivariate negative binomial mixed-effects (uhlelo lwe-MENBREG ku-STATA v.15.0) nendawo yezindonga ngaphakathi kwendlu (amazinga amathathu) njengomphumela ongahleliwe. Ukuhlushwa kwemisebe ye-Beta. Amamodeli e-cypermethrin io asetshenziswa ukuhlola izinguquko ezihlotshaniswa nokuphakama kodonga lwe-nebulizer (amazinga amathathu), izinga lokuhlushwa kwemisebe (m2/min), usuku lokufaka i-IRS, kanye nesimo somhlinzeki wezempilo (amazinga amabili). Imodeli eqondile ejwayelekile (i-GLM) yasetshenziswa ukuhlola ubudlelwano phakathi kokuhlushwa okumaphakathi kwe-alpha-cypermethrin ephepheni lokuhlunga elilethwe ekhaya ngalinye kanye nokuhlushwa esixazululweni esifanele ethangini lokufafaza. Ukuthuthwa kwengxenyana yezibulala-zinambuzane esixazululweni sethangi lokufafaza ngokuhamba kwesikhathi kwahlolwa ngendlela efanayo ngokufaka inani lokuqala (isikhathi esingu-zero) njenge-offset yemodeli, kuhlolwa isikhathi sokusebenzisana se-tank ID × isikhathi (izinsuku). Amaphuzu edatha angaphandle x atholakala ngokusebenzisa umthetho ojwayelekile we-Tukey boundary, lapho x < Q1 - 1.5 × IQR noma x > Q3 + 1.5 × IQR. Njengoba kubonisiwe, amazinga okufafaza ezindlini eziyisikhombisa kanye nokuhlushwa okuphakathi kwe-ai yezinambuzane endlini eyodwa akufakiwe ekuhlaziyweni kwezibalo.
Ukunemba kokulinganiswa kwamakhemikhali e-ai IQK™ kokuhlushwa kwe-alpha-cypermethrin kwaqinisekiswa ngokuqhathanisa amanani amasampula ephepha lokuhlunga angu-27 avela ezindlini ezintathu zezinkukhu ezihlolwe yi-IQK™ kanye ne-HPLC (izinga legolide), futhi imiphumela ibonise ukuhlangana okuqinile (r = 0.93; p < 0.001) (Isithombe 2).
Ukuhlangana kwamazinga e-alpha-cypermethrin kumasampula ephepha lokuhlunga aqoqwe ezindlini zezinkukhu zangemva kwe-IRS, okulinganiswe yi-HPLC kanye ne-IQK™ (n = amaphepha okuhlunga angu-27 avela ezindlini zezinkukhu ezintathu)
I-IQK™ ihlolwe emaphepheni okuhlunga angu-480 aqoqwe ezindlini zezinkukhu ezingu-57. Ephepheni lokuhlunga, okuqukethwe kwe-alpha-cypermethrin kwakusukela ku-0.19 kuya ku-105.0 mg ai/m2 (okuphakathi kuka-17.6, IQR: 11.06-29.78). Kulawa, yi-10.4% kuphela (50/480) eyayingaphakathi kobubanzi bokuhlushwa obuqondiwe obungu-40–60 mg ai/m2 (Isithombe 3). Iningi lamasampula (84.0% (403/480)) lalino-60 mg ai/m2. Umehluko ekuhlushweni okulinganiselwe okulinganiselwe ngekhaya ngalinye kwezihlungi zokuhlola ezingu-8-9 eziqoqwe ngekhaya ngalinye wawungu-oda lobukhulu, ngesilinganiso esingu-19.6 mg ai/m2 (IQR: 11.76-28.32, ububanzi: 0. 60-67.45). Yi-8.8% kuphela (5/57) yezindawo ezithole amazinga okudla okubulala izinambuzane alindelekile; Ama-89.5% (51/57) ayengaphansi kwemingcele yobubanzi obuqondiwe, kanti ama-1.8% (1/57) ayengaphezulu kwemingcele yobubanzi obuqondiwe (Isithombe 4).
Ukusatshalaliswa kwemvamisa kokuhluzwa kwe-alpha-cypermethrin ezihlungini eziqoqwe emakhaya aphathwe yi-IRS (n = izindlu ezingu-57). Umugqa oqondile umelela ububanzi bokuhluzwa okuqondiwe kwe-cypermethrin ai (50 mg ± 20% ai/m2).
Ukuhlushwa okumaphakathi kwe-beta-cypermethrin av kumaphepha okuhlunga angu-8-9 ngekhaya ngalinye, aqoqwe emakhaya acutshungulwe yi-IRS (n = amakhaya angu-57). Umugqa ovundlile umele ububanzi bokuhlushwa okuqondiwe kwe-alpha-cypermethrin ai (50 mg ± 20% ai/m2). Amabha amaphutha amelela imikhawulo ephansi nephezulu yamanani aphakathi aseduze.
Ukugxila okumaphakathi okulethwe ezihlungini ezinokuphakama kodonga okungu-0.2, 1.2 kanye no-2.0 m kwakungu-17.7 mg ai/m2 (IQR: 10.70–34.26), 17.3 mg a .i./m2 (IQR: 11.43–26.91) kanye no-17.6 mg ai/m2. ngokulandelana (IQR: 10.85–31.37) (kuboniswe kufayela elingeziwe 2). Ukulawula usuku lwe-IRS, imodeli yemiphumela exubile ayizange iveze umehluko omkhulu ekugxileni phakathi kokuphakama kodonga (z < 1.83, p > 0.067) noma izinguquko ezibalulekile ngosuku lokufafaza (z = 1.84 p = 0.070). Ukugxila okumaphakathi okulethwe ezindlini ze-adobe ezi-5 kwakungafani nokugxilisa okumaphakathi okulethwe ezindlini ze-adobe ezingu-52 (z = 0.13; p = 0.89).
Ukuhlushwa kwe-AI kumathini angu-29 e-aerosol e-Guarany® alungiselelwe ngokuzimela athathwe isampula ngaphambi kokusetshenziswa kwe-IRS kwahluka ngo-12.1, kusukela ku-0.16 mg AI/mL kuya ku-1.9 mg AI/mL ngethini ngalinye (Isithombe 5). Amathini angu-6.9% (2/29) kuphela e-aerosol aqukethe ukuhlushwa kwe-AI ngaphakathi kobubanzi besilinganiso somthamo esiqondiwe esingu-0.96–1.44 mg AI/ml, kanye no-3.5% (1/29) wamathini e-aerosol aqukethe ukuhlushwa kwe-AI >1.44 mg AI/ml.
Amazinga aphakathi e-alpha-cypermethrin ai alinganiswe ngezindlela zokufutha ezingu-29. Umugqa ovundlile umelela amazinga e-AI anconywayo amathini e-aerosol (0.96–1.44 mg/ml) ukuze kufezwe ububanzi bokuhlushwa kwe-AI obuqondiwe obungu-40–60 mg/m2 endlini yezinkukhu.
Kumathini angu-29 e-aerosol ahlolwe, angu-21 ahambelana nezindlu ezingu-21. Ukuhlushwa okumaphakathi kwe-ai okulethwe endlini akuhlotshaniswa nokuhlushwa kwamatangi okufutha asetshenziswa ukwelapha indlu (z = -0.94, p = 0.345), okuboniswe ekuxhumaneni okuphansi (rSp2 = -0.02) (Isithombe .6). ).
Ubudlelwano phakathi kokuhlushwa kwe-beta-cypermethrin AI kumaphepha okuhlunga angu-8-9 aqoqwe ezindlini eziphathwe nge-IRS kanye nokuhlushwa kwe-AI kuzixazululo zokufutha ezilungiselelwe ekhaya ezisetshenziselwa ukwelapha indlu ngayinye (n = 21)
Ukuhlushwa kwe-AI ezixazululweni zangaphezulu zezifutho ezine eziqoqwe ngokushesha ngemva kokushukuma (isikhathi 0) kwahluka ngo-3.3 (0.68–2.22 mg AI/ml) (Isithombe 7). Kwithangi elilodwa amanani angaphakathi kobubanzi bokuhlosiwe, kwithangi elilodwa amanani angaphezulu komgomo, kwamanye amathangi amabili amanani angaphansi komgomo; Ukuhlushwa kwezibulala-zinambuzane kwabe sekwehla kakhulu kuwo wonke amachibi amane ngesikhathi sokulandela isampula yemizuzu eyi-15 (b = −0.018 kuya ku-−0.084; z > 5.58; p < 0.001). Uma kucatshangelwa amanani okuqala ethangi ngalinye, isikhathi sokusebenzisana kwe-Tank ID x Isikhathi (imizuzu) sasingabonakali (z = -1.52; p = 0.127). Emachibini amane, ukulahleka okujwayelekile kwesibulala-zinambuzane i-mg ai/ml kwakungu-3.3% ngomzuzu (95% CL 5.25, 1.71), kufinyelela ku-49.0% (95% CL 25.69, 78.68) ngemva kwemizuzu eyi-15 (Isithombe 7).
Ngemva kokuxuba kahle izixazululo ematangini, izinga lemvula le-alpha-cypermethrin ai lalinganiswa. ematangini amane okufafaza ngezikhawu zomzuzu owodwa imizuzu eyi-15. Umugqa omelela ukulingana okungcono kakhulu kwedatha uboniswa kudoti ngalinye. Ukuqaphelwa (amaphuzu) kumelela isilinganiso samasampula amathathu angaphansi.
Indawo evamile yodonga ngekhaya ngalinye yokwelashwa kwe-IRS kwakungu-128 m2 (IQR: 99.0–210.0, ububanzi: 49.1–480.0) kanti isikhathi esimaphakathi esichithwa ngabasebenzi bezempilo kwakungu-12 imizuzu (IQR: 8. 2–17.5, ububanzi: 1.5–36.6). ) indlu ngayinye yafuthwa (n = 87). Ukumbozwa kwesifutho okubonwe kulezi zindlu zezinkukhu kwakusukela ku-3.0 kuya ku-72.7 m2/min (okumaphakathi: 11.1; IQR: 7.90–18.00) (Isithombe 8). Ama-outliers awafakwanga futhi amazinga okufutha aqhathaniswa nobubanzi besilinganiso sokufutha esinconywe yi-WHO obungu-19 m2/min ± 10% (17.1–20.9 m2/min). Amakhaya angu-7.5% kuphela (6/80) ayekulolu hlu; Ama-77.5% (62/80) ayesezingeni eliphansi kanti ama-15.0% (12/80) ayesezingeni eliphezulu. Akukho buhlobo obutholakale phakathi kokuhlushwa okujwayelekile kwe-AI okulethwe emakhaya kanye nokumbozwa kwesifutho okubonwe (z = -1.59, p = 0.111, n = amakhaya angu-52).
Izinga lokufafaza elibonwe (min/m2) ezindlini zezinkukhu eziphathwe nge-IRS (n = 87). Umugqa wokubhekisela umele ububanzi bokubekezelela izinga lokufafaza elilindelekile elingu-19 m2/min (±10%) elinconywe yizincazelo zemishini yethangi lokufafaza.
Izindlu ezingu-80% kwezingu-80 zazinesilinganiso sokumbozwa kokufuthwa okubonwe/okulindelekile ngaphandle kwebanga lokubekezelelana elingu-1 ± 10%, kanti izindlu ezingu-71.3% (57/80) zaziphansi, ezingu-11.3% (9/80) zaziphezulu, kanti izindlu ezingu-16 zazingaphansi kwebanga lokubekezelelana ngaphakathi kwebanga. Ukusatshalaliswa kwemvamisa yamanani esilinganiso abonwe/okulindelekile kuboniswe kufayela elingeziwe 3.
Kube nomehluko omkhulu esilinganisweni sokufiphaza esimaphakathi phakathi kwabasebenzi bezempilo ababili ababevame ukwenza i-IRS: 9.7 m2/min (IQR: 6.58–14.85, n = 68) uma kuqhathaniswa no-15.5 m2/min (IQR: 13.07–21.17, n = 12). (z = 2.45, p = 0.014, n = 80) (njengoba kuboniswe kuFayela Elingeziwe 4A) kanye nesilinganiso sesilinganiso sokufafaza esibonwe/esilindelwe (z = 2.58, p = 0.010) (njengoba kuboniswe kuFayela Elingeziwe 4B Show).
Ngaphandle kwezimo ezingavamile, isisebenzi sezempilo esisodwa kuphela esifuthe izindlu ezingu-54 lapho kwafakwa khona iphepha lokuhlunga. Izinga eliphakathi lokufutha kulezi zindlu lalingu-9.23 m2/min (IQR: 6.57–13.80) uma kuqhathaniswa no-15.4 m2/min (IQR: 10.40–18.67) ezindlini ezingu-26 ezingenalo iphepha lokuhlunga (z = -2.38, p = 0.017). ).
Ukuthobela imindeni imfuneko yokushiya amakhaya ayo ukuze idilive i-IRS kwahlukahluka: 30.9% (17/55) abazange bashiye amakhaya abo ngokwengxenye kanti 27.3% (15/55) abazange bashiye amakhaya abo ngokuphelele; bachitha amakhaya abo.
Amazinga okufafaza abonwe ezindlini ezingenalutho (17.5 m2/min, IQR: 11.00–22.50) ngokuvamile ayephezulu kunasezindlini ezingenalutho (14.8 m2/min, IQR: 10.29–18 .00) kanye nasezindlini ezingenalutho ngokuphelele (11.7 m2). /min, IQR: 7.86–15.36), kodwa umehluko wawungabalulekile (z > -1.58; p > 0.114, n = 48) (kuboniswe kufayela elingeziwe 5A). Imiphumela efanayo itholakale lapho kucatshangelwa izinguquko ezihlobene nokuba khona noma ukungabikho kwephepha lokuhlunga, okungatholakalanga ukuthi kuyi-covariate ebalulekile kumodeli.
Kuwo wonke amaqembu amathathu, isikhathi esiphelele esidingekayo sokufafaza izindlu asizange sihluke phakathi kwezindlu (z < -1.90, p > 0.057), kuyilapho indawo ephakathi nendawo yahlukile: izindlu ezingenalutho ngokuphelele (104 m2 [IQR: 60.0–169, 0 m2) ]) zincane ngokwezibalo kunezindlu ezingenalutho (224 m2 [IQR: 174.0–284.0 m2]) kanye nezindlu ezingenalutho kancane (132 m2 [IQR: 108.0–384.0 m2]) (z > 2 .17; p < 0.031, n = 48). Izindlu ezingenalutho ngokuphelele cishe ziyingxenye yobukhulu (indawo) bezindlu ezingenalutho noma ezingenalutho kancane.
Ngenani elincane kakhulu lezindlu (n = 25) ezinemininingwane yokuthobela imithetho kanye ne-AI yezibulala-zinambuzane, bekungekho mehluko ekugxilweni kwe-AI okumaphakathi okulethwe emakhaya phakathi kwalezi zigaba zokuthobela imithetho (z < 0.93, p > 0.351), njengoba kuchaziwe kuFayela Elingeziwe 5B. Imiphumela efanayo itholakale lapho kulawulwa ukuba khona/ukungabikho kwephepha lokuhlunga kanye nokumbozwa kwesifutho okubonwe (n = 22).
Lolu cwaningo luhlola imikhuba nezinqubo ze-IRS emphakathini ojwayelekile wasemakhaya esifundeni saseGran Chaco eBolivia, indawo enomlando omude wokudluliselwa kwe-vector [20]. Ukuhlushwa kwe-alpha-cypermethrin ai enikezwa ngesikhathi se-IRS ejwayelekile kwahlukahluka kakhulu phakathi kwezindlu, phakathi kwezihlungi ngazinye ngaphakathi kwendlu, naphakathi kwamathangi okufafaza ngazinye alungiselelwe ukufeza ukuhlushwa okufanayo okulethwayo okungu-50 mg ai/m2. Amakhaya angu-8.8% kuphela (10.4% wezihlungi) ayenokuhlushwa ngaphakathi kobubanzi obuqondiwe obungu-40–60 mg ai/m2, kanti iningi (89.5% kanye no-84% ngokulandelana) linamazinga angaphansi komkhawulo ophansi ovunyelwe.
Esinye isici esingaba khona sokulethwa kwe-alpha-cypermethrin ekhaya ukungaxutshwa kahle kwezibulala-zinambuzane kanye namazinga angaguquki okumiswa okulungiselelwe ematangini okufafaza [38, 46]. Ocwaningweni lwamanje, okubonwe ngabacwaningi ngabasebenzi bezempilo kuqinisekisile ukuthi balandela izindlela zokupheka izibulala-zinambuzane futhi baqeqeshwa yi-SEDES ukuvuselela ngamandla isixazululo ngemva kokuxutshwa etangini lokufafaza. Kodwa-ke, ukuhlaziywa kokuqukethwe kwetangi kubonise ukuthi ukuhlushwa kwe-AI kwahlukahluka ngesilinganiso esingu-12, kanti kuphela u-6.9% (2/29) wezixazululo zetangi lokuhlola ezingaphakathi kobubanzi obuqondiwe; Ukuze kuqhutshekwe nophenyo, izixazululo ebusweni betangi lokufafaza zalinganiswa ezimweni zelebhu. Lokhu kukhombisa ukwehla okuqondile kwe-alpha-cypermethrin ai okungu-3.3% ngomzuzu ngemva kokuxuba kanye nokulahlekelwa okuhlangene kwe-ai okungu-49% ngemva kwemizuzu eyi-15 (95% CL 25.7, 78.7). Amazinga aphezulu okusatshalaliswa ngenxa yokuhlanganiswa kwezithasiselo zezibulala-zinambuzane ezakhiwe lapho kuxutshwa amafomula e-wettable powder (WP) akuvamile (isib. i-DDT [37, 47]), futhi lolu cwaningo luqhubeka lubonisa lokhu ngezinhlobo ze-SA pyrethroid. Ama-suspension concentrates asetshenziswa kabanzi ku-IRS futhi, njengawo wonke amalungiselelo okubulala izinambuzane, ukuzinza kwawo ngokomzimba kuncike ezintweni eziningi, ikakhulukazi usayizi wezinhlayiya zesithako esisebenzayo nezinye izithako. Ukusatshalaliswa kungathinteka futhi bulukhuni bamanzi asetshenziselwa ukulungiselela i-slurry, into okunzima ukuyilawula ensimini. Isibonelo, kulesi siza socwaningo, ukufinyelela kwamanzi kukhawulelwe emifuleni yasendaweni ekhombisa ukushintshashintsha kwesizini ekugelezeni kanye nezinhlayiya zomhlabathi ezilengisiwe. Izindlela zokuqapha ukuzinza ngokomzimba kwezakhi ze-SA zingaphansi kocwaningo [48]. Kodwa-ke, izidakamizwa ezingaphansi kwesikhumba zisetshenziswe ngempumelelo ukunciphisa ukutheleleka kwasekhaya kumabhaktheriya e-Tri. pathogenic kwezinye izingxenye zeLatin America [49].
Ukwakheka okungenanele kokubulala izinambuzane kuye kwabikwa nakwezinye izinhlelo zokulawula i-vector. Isibonelo, ohlelweni lokulawula i-visceral leishmaniasis eNdiya, ama-29% kuphela amaqembu okufafaza angu-51 aqaphe izixazululo ze-DDT ezilungiselelwe kahle futhi ezixutshwe kahle, futhi awekho amathangi okufafaza agcwalisiwe njengoba kunconyiwe [50]. Ukuhlolwa kwamadolobhana aseBangladesh kubonise ukuthambekela okufanayo: ama-42-43% kuphela amaqembu e-IRS alungiselela ama-insecticide nama-canister agcwalisiwe ngokwenqubo, kuyilapho kwesinye isifunda esincane isibalo sasingu-7.7% kuphela [46].
Izinguquko ezibonwe ekugxilweni kwe-AI ezilethwa ekhaya nazo azihlukile. ENdiya, amakhaya aphathwe kahle angu-7.3% kuphela (41 kwangu-560) athola ukugxilwa kwe-DDT okuqondiwe, kanti umehluko ngaphakathi naphakathi kwemakhaya wawumkhulu ngokulinganayo [37]. ENepal, iphepha lokuhlunga lamunca isilinganiso esingu-1.74 mg ai/m2 (ububanzi: 0.0–17.5 mg/m2), okuyi-7% kuphela yokugxilwa okuqondiwe (25 mg ai/m2) [38]. Ukuhlaziywa kwe-HPLC kwephepha lokuhlunga kubonise umehluko omkhulu ekugxilweni kwe-deltamethrin ai ezindongeni zezindlu eChaco, eParaguay: kusukela ku-12.8–51.2 mg ai/m2 kuya ku-4.6–61.0 mg ai/m2 ophahleni [33]. ETupiza, eBolivia, i-Chagas Control Program ibike ukulethwa kwe-deltamethrin emakhaya amahlanu ekugxilweni okungu-0.0–59.6 mg/m2, okulinganiswe yi-HPLC [36].
Isikhathi sokuthunyelwe: Ephreli-16-2024