Imiti yica udukoko igira uruhare runini mu buhinzi bwo mu cyaro, ariko kuyikoresha nabi cyane cyangwa kuyikoresha nabi bishobora kugira ingaruka mbi kuri politiki yo kurwanya malariya; Ubu bushakashatsi bwakorewe mu baturage b'abahinzi bo mu majyepfo ya Côte d'Ivoire kugira ngo hamenyekane imiti yica udukoko ikoreshwa n'abahinzi bo mu gace n'uko ibi bifitanye isano n'uko abahinzi babona malariya. Gusobanukirwa ikoreshwa ry'imiti yica udukoko bishobora gufasha mu guteza imbere gahunda zo gukangurira abantu kurwanya imibu no gukoresha imiti yica udukoko.
Ubushakashatsi bwakorewe mu ngo 1.399 mu midugudu 10. Abahinzi babajijwe ku burezi bwabo, uburyo bwo guhinga (urugero: guhinga imyaka, gukoresha imiti yica udukoko), uburyo babona malariya, n'ingamba zitandukanye zo kurwanya imibu yo mu ngo bakoresha. Imiterere y'imibereho myiza y'abaturage (SES) ya buri rugo ipimwa hashingiwe ku mitungo imwe n'imwe yo mu rugo yagenwe. Imibanire y'imibare hagati y'ibintu bitandukanye iragaragazwa, igaragaza ibintu bikomeye bishobora gutera ingaruka.
Urwego rw'uburezi rw'abahinzi rufitanye isano rikomeye n'imibereho yabo mu bukungu (p < 0.0001). Ingo nyinshi (88.82%) zemeraga ko imibu ari yo mpamvu nyamukuru itera malariya kandi ubumenyi kuri malariya bwari bufite isano ryiza n'urwego rw'uburezi bwo hejuru (OR = 2.04; 95% CI: 1.35, 3.10). Gukoresha imiti mu mazu byafitanye isano rikomeye n'imibereho myiza mu ngo, urwego rw'uburezi, ikoreshwa ry'inzitiramibu ziterwa umuti n'imiti yica udukoko mu buhinzi (p < 0.0001). Byagaragaye ko abahinzi bakoresha imiti yica udukoko mu mazu kandi bakoresha iyi miti mu kurinda imyaka.
Ubushakashatsi bwacu bwerekana ko urwego rw'uburezi rukomeje kuba ikintu cy'ingenzi gikora ku bumenyi bw'abahinzi ku ikoreshwa ry'imiti yica udukoko no kurwanya malariya. Turasaba ko itumanaho rigamije iterambere rigamije kugera ku burezi, harimo n'imibereho myiza y'abaturage, kuboneka no kubona imiti ikoreshwa mu buvuzi, rigomba kwitabwaho mu gihe cyo gutegura uburyo bwo gucunga imiti yica udukoko no kurwanya indwara ziterwa n'udukoko mu baturage.
Ubuhinzi ni bwo butera imbere mu bukungu bw'ibihugu byinshi byo muri Afurika y'Iburengerazuba. Mu 2018 na 2019, Côte d'Ivoire ni yo yari iya mbere ku isi mu guhingwa kakao na cashew, ikaba ari yo ya gatatu mu guhingwa kawa muri Afurika [1], aho serivisi z'ubuhinzi n'ibicuruzwa byayo bingana na 22% by'umusaruro mbumbe w'igihugu (GDP) [2]. Nk'abafite ubutaka bwinshi bw'ubuhinzi, abahinzi bato mu cyaro ni bo bagira uruhare runini mu iterambere ry'ubukungu bw'uru rwego [3]. Igihugu gifite ubushobozi bunini mu buhinzi, gifite hegitari miliyoni 17 z'imirima n'ibihe bitandukanye by'umwaka, bigatuma habaho ubwoko butandukanye bw'ibihingwa no guhinga ikawa, kawa, cashew, cauble, ipamba, ibirayi, ikimasa, imyumbati, umuceri n'imboga [2]. Ubuhinzi bwimbitse bugira uruhare mu gukwirakwiza udukoko, ahanini binyuze mu kongera ikoreshwa ry'imiti yica udukoko mu kurwanya udukoko [4], cyane cyane mu bahinzi bo mu cyaro, mu kurinda imyaka no kongera umusaruro w'ibihingwa [5], no kurwanya imibu [6]. Ariko, gukoresha imiti yica udukoko mu buryo butari bwo ni imwe mu mpamvu zikomeye zituma imiti yica udukoko idashobora kwangirika mu miyoboro y’indwara, cyane cyane mu turere tw’ubuhinzi aho imibu n’udukoko tw’ibihingwa bishobora kuba bihura n’umuvuduko uturutse ku miti imwe [7,8,9,10]. Gukoresha imiti yica udukoko bishobora guteza umwanda ukagira ingaruka ku ngamba zo kurwanya udukoko n’ibidukikije bityo bigasaba kwitabwaho [11, 12, 13, 14, 15].
Ikoreshwa ry’imiti yica udukoko n’abahinzi ryakozweho ubushakashatsi mu bihe byashize [5, 16]. Urwego rw’uburezi rwagaragaye ko ari ingenzi mu ikoreshwa ry’imiti yica udukoko [17, 18], nubwo ikoreshwa ry’imiti yica udukoko n’abahinzi rikunze guterwa n’uburambe cyangwa inama z’abacuruzi [5, 19, 20]. Imbogamizi z’amafaranga ni imwe mu mbogamizi zikunze kubangamira uburyo bwo kubona imiti yica udukoko cyangwa imiti yica udukoko, bigatuma abahinzi bagura ibicuruzwa bitemewe cyangwa bishaje, akenshi bihendutse ugereranyije n’ibicuruzwa byemewe n’amategeko [21, 22]. Ingendo nk’izo zigaragara mu bindi bihugu bya Afurika y’Iburengerazuba, aho amikoro make ari yo mpamvu yo kugura no gukoresha imiti yica udukoko idakwiye [23, 24].
Muri Côte d'Ivoire, imiti yica udukoko ikoreshwa cyane ku bihingwa [25, 26], ibyo bikaba bigira ingaruka ku buhinzi n'ubwiyongere bw'abatera malariya [27, 28, 29, 30]. Ubushakashatsi bwakorewe mu turere twibasiwe na malariya bwagaragaje isano iri hagati y'imibereho myiza n'uburyo malariya iteye n'ibyago byo kwandura, hamwe n'ikoreshwa ry'inzitiramibu ziterwa umuti (ITN) [31,32,33,34,35,36,37]. Nubwo hari ubwo bushakashatsi, imbaraga zo gushyiraho politiki yihariye yo kurwanya imibu zirahungabanywa no kubura amakuru ajyanye n'ikoreshwa ry'imiti yica udukoko mu byaro n'ibintu bigira uruhare mu ikoreshwa ry'imiti ikoreshwa neza. Ubu bushakashatsi bwasuzumye imyizerere ya malariya n'ingamba zo kurwanya imibu mu ngo z'abahinzi bo muri Abeauville, mu majyepfo ya Côte d'Ivoire.
Ubu bushakashatsi bwakorewe mu midugudu 10 mu ishami rya Abeauville mu majyepfo ya Côte d'Ivoire (Ishusho ya 1). Intara ya Agbowell ifite abaturage 292.109 mu buso bwa kilometero kare 3.850 kandi ni yo ntara ituwe cyane mu karere ka Anyebi-Tiasa [38]. Ifite ikirere gishyuha gifite ibihe bibiri by'imvura (Mata kugeza Nyakanga na Ukwakira kugeza Ugushyingo) [39, 40]. Ubuhinzi ni cyo gikorwa cy'ingenzi muri ako karere kandi gikorwa n'abahinzi bato n'ibigo binini by'inganda zikora ubuhinzi. Ibi bibanza 10 birimo Aboude Boa Vincent (323.729.62 E, 651.821.62 N), Aboude Kuassikro (326.413.09 E, 651.573.06 N), Aboude Mandek (326.413.09 E, 651573.06N) Abude) (330633.05E, 652372.90) 664971.70N), Damojiang (374.039.75 E, 661.579.59 N), Casigue 1 (363.140.15 E, 634.256.47 N), Lovezzi 1 (351.545.32 E., 642.06 2.37 N), Ofa (350 924.31 E, 654 607.17 N), Ofonbo (338 578.5) 1 E, 657 302.17 latitude y'amajyaruguru) na Uji (363,990.74 longitude y'iburasirazuba, 648,587.44 latitude y'amajyaruguru).
Ubu bushakashatsi bwakozwe hagati ya Kanama 2018 na Werurwe 2019, imiryango y’abahinzi ikaba yari ifatanyije. Abaturage bose muri buri mudugudu baturutse mu ishami rishinzwe serivisi mu gace, maze abantu 1.500 batoranywa ku buryo butunguranye kuri uru rutonde. Abitabiriye ubushakashatsi batoranyijwe bari hagati ya 6% na 16% by’abaturage bo mu mudugudu. Ingo zari muri ubu bushakashatsi zari ingo z’abahinzi zemeye kwitabira. Ubushakashatsi bw’ibanze bwakozwe mu bahinzi 20 kugira ngo harebwe niba hari ibibazo bimwe na bimwe bigomba kwandikwa bundi bushya. Ibibazo byuzuzwaga n’abakusanya amakuru bahuguwe kandi bahembwa muri buri mudugudu, nibura umwe muri bo akaba yaratoranijwe mu mudugudu ubwawo. Iri hitamo ryatumye buri mudugudu ugira nibura umwe mu bakusanya amakuru uzi ibidukikije kandi uvuga ururimi rw’aho hantu. Muri buri rugo, ikiganiro imbonankubone cyakozwe n’umuyobozi w’urugo (se cyangwa nyina) cyangwa, niba umuyobozi w’urugo atari ahari, undi muntu mukuru urengeje imyaka 18. Urutonde rw'ibibazo rwari rukubiyemo ibibazo 36 bigabanyijemo ibice bitatu: (1) Imiterere y'abaturage n'imibereho myiza y'abaturage mu ngo (2) Imikorere y'ubuhinzi n'imikoreshereze y'imiti yica udukoko (3) Ubumenyi kuri malariya n'imikoreshereze y'imiti yica udukoko mu kurwanya imibu [reba Umugereka wa 1].
Imiti yica udukoko yavuzwe n'abahinzi yashyizwe mu byiciro hakurikijwe izina ry'ubucuruzi kandi ishyirwa mu byiciro hakurikijwe ibintu bikora n'amatsinda y'imiti hakoreshejwe Ikigereranyo cy'Ubuziranenge bw'Inyamaswa cya Ivory Coast [41]. Imiterere y'imibereho y'abaturage ya buri rugo yapimwe hakorwa isuzuma ry'umutungo [42]. Imitungo y'urugo yahinduwemo ibipimo bitandukanye [43]. Isuzuma ry'ibintu bibi rifitanye isano n'imiterere y'ubukungu iri hasi (SES), mu gihe isuzuma ry'ibintu byiza rifitanye isano n'imiterere y'ubukungu iri hejuru. Amanota y'imitungo ashyirwa hamwe kugira ngo haboneke amanota yose kuri buri rugo [35]. Hashingiwe ku manota yose, ingo zagabanyijwemo ibice bitanu by'imiterere y'ubukungu, kuva ku bakennye kugeza ku bakire [reba dosiye y'inyongera ya 4].
Kugira ngo hamenyekane niba itandukaniro ritandukanye cyane bitewe n’imiterere y’ubukungu, umudugudu, cyangwa urwego rw’uburezi rw’abayobozi b’ingo, ikizamini cya chi-square cyangwa ikizamini nyacyo cya Fisher gishobora gukoreshwa, uko bikwiye. Imiterere yo gusubiramo logistique yashyizweho ibi bikurikira: urwego rw’uburezi, imiterere y’ubukungu (byose byahinduwemo ibipimo bitandukanya), umudugudu (urimo nk’ibipimo by’icyiciro), ubumenyi bwo hejuru ku ikoreshwa rya malariya n’imiti yica udukoko mu buhinzi, n’ikoreshwa ry’imiti yica udukoko mu nzu (umusaruro uva mu mwuka unyuze mu kirere). cyangwa coil); urwego rw’uburezi, imiterere y’ubukungu n’imibereho myiza n’umudugudu, byatumye habaho ubumenyi bwinshi kuri malariya. Imiterere yo gusubiramo logistique yakozwe hakoreshejwe paki ya R lme4 (imikorere ya Glmer). Isesengura ry’ibarurishamibare ryakozwe muri R 4.1.3 (https://www.r-project.org) na Stata 16.0 (StataCorp, College Station, TX).
Mu biganiro 1.500 byakozwe, 101 ntibyemewe mu isesengura kuko ikibazo kitararangira. Igice kinini cy'ingo zabajijwe cyari i Grande Maury (18.87%) naho igice gito cyane kikaba i Ouanghi (2.29%). Ingo 1.399 zabajijwe zigizwe n'abaturage 9.023. Nk'uko bigaragara mu mbonerahamwe ya 1, 91.71% by'abayobozi b'ingo ni abagabo naho 8.29% ni abagore.
Abafite ubwinshi bw'imiryango bagera kuri 8.86% baturutse mu bihugu by'abaturanyi nka Benin, Mali, Burkina Faso na Gana. Ubwoko bw'abaturage bugaragara cyane ni Abi (60.26%), Malinke (10.01%), Krobu (5.29%) na Baulai (4.72%). Nk'uko byari byitezwe mu icyitegererezo cy'abahinzi, ubuhinzi ni bwo buryo bwonyine bwo kubona amafaranga ku bahinzi benshi (89.35%), aho kakao ihingwa cyane mu ngo z'icyitegererezo; Imboga, ibihingwa by'ibiribwa, umuceri, kawurute na plantain nabyo bihingwa ku buso buto bw'ubutaka. Abasigaye bayoboye ingo ni abacuruzi, abahanzi n'abarobyi (Imbonerahamwe ya 1). Incamake y'imiterere y'urugo hakurikijwe umudugudu igaragazwa muri dosiye y'inyongera [reba dosiye y'inyongera ya 3].
Icyiciro cy'uburezi nticyatandukaniye ku gitsina (p = 0.4672). Abenshi mu babajijwe bari bafite amashuri abanza (40.80%), hagakurikiraho amashuri yisumbuye (33.41%) n'abatazi gusoma no kwandika (17.97%). 4.64% gusa ni bo binjiye muri kaminuza (Imbonerahamwe ya 1). Mu bagore 116 babajijwe, abarenga 75% ni bo bari bafite nibura amashuri abanza, abandi ntibari barigeze biga. Urwego rw'uburezi rw'abahinzi ruratandukanye cyane mu midugudu (ikizamini nyacyo cya Fisher, p < 0.0001), kandi urwego rw'uburezi rw'abayobozi b'ingo rufitanye isano rikomeye n'imibereho myiza y'abaturage (ikizamini nyacyo cya Fisher, p < 0.0001). Mu by'ukuri, imiterere y'ubukungu iri hejuru igizwe ahanini n'abahinzi bize cyane, kandi imiterere y'ubukungu iri hasi igizwe n'abahinzi batazi gusoma no kwandika; Hashingiwe ku mutungo wose, ingo z'icyitegererezo zigabanyijemo imiterere itanu y'ubukire: kuva ku bakennye cyane (Q1) kugeza ku bakize cyane (Q5) [reba dosiye y'inyongera ya 4].
Hari itandukaniro rinini mu ishyingiranwa ry’abayobozi b’ingo z’abantu bafite ibyiciro bitandukanye by’ubutunzi (p < 0.0001): 83.62% bafite umugore umwe, 16.38% bafite abagore benshi (kugeza ku bashakanye 3). Nta tandukaniro rinini ryabonetse hagati y’icyiciro cy’ubutunzi n’umubare w’abashakanye.
Abenshi mu babajijwe (88.82%) bemeraga ko imibu ari imwe mu mpamvu zitera malariya. 1.65% gusa ni bo basubije ko batazi icyatera malariya. Izindi mpamvu zagaragajwe zirimo kunywa amazi mabi, kwibasirwa n'izuba, indyo mbi n'umunaniro (Imbonerahamwe ya 2). Ku rwego rw'umudugudu muri Grande Maury, ingo nyinshi zabonaga kunywa amazi mabi nk'intandaro nyamukuru ya malariya (itandukaniro ry'imibare hagati y'imidugudu, p < 0.0001). Ibimenyetso bibiri by'ingenzi bya malariya ni ubushyuhe bwinshi bw'umubiri (78.38%) no guhinduka umuhondo mu maso (72.07%). Abahinzi kandi bavuze ku kuruka, kubura amaraso no kugaragara ibara ry'umuhondo (reba Imbonerahamwe ya 2 hepfo).
Mu ngamba zo kwirinda malariya, ababajijwe bavuze ko bakoresha imiti gakondo; icyakora, iyo barwaye, haba mu buvuzi bwa miti n’ubwa gakondo bwafatwaga nk'uburyo bufatika (80.01%), aho abantu bakunda gufata imiti ijyanye n’imibereho myiza. Isano rikomeye (p < 0.0001). ): Abahinzi bafite imibereho myiza mu bukungu bakunda kandi bashobora kwishyura imiti ivura indwara, abahinzi bafite imibereho myiza mu bukungu bakunda imiti gakondo; hafi kimwe cya kabiri cy’ingo zikoresha amafaranga arenga 30.000 XOF ku mwaka mu kuvura malariya (bifitanye isano na SES; p < 0.0001). Hashingiwe ku bipimo by’ibiciro byatanzwe n’ababajijwe ubwabo, ingo zifite imibereho myiza mu bukungu zari zifite amahirwe menshi yo gukoresha XOF 30.000 (hafi US $ 50) menshi mu kuvura malariya kurusha ingo zifite imibereho myiza mu bukungu. Byongeye kandi, abenshi mu babajijwe bemeraga ko abana (49.11%) barwara malariya cyane kurusha abantu bakuru (6.55%) (Imbonerahamwe ya 2), aho iki gitekerezo gikunze kugaragara mu ngo ziri mu cyiciro cy’abakene cyane (p < 0.01).
Ku bijyanye n’urumogi rw’imibu, abenshi mu bitabiriye iyi gahunda (85.20%) bavuze ko bakoresheje inzitiramibu ziteye umuti, abenshi muri bo bakaba barazihawe mu gihe cyo gukwirakwiza mu gihugu hose mu 2017. Abantu bakuru n’abana bavuzwe ko baryama mu nzitiramibu ziteye umuti mu ngo 90.99% by’ingo. Inshuro inzitiramibu ziteye umuti mu ngo zari zirengeje 70% mu midugudu yose uretse umudugudu wa Gessigye, aho ingo 40% gusa ari zo zavuze ko zikoresha inzitiramibu ziteye umuti. Impuzandengo y’umubare w’inzitiramibu ziteye umuti zitunze urugo yari ifitanye isano rikomeye kandi ryiza n’ingano y’urugo (Pearson's correlation coefficient r = 0.41, p < 0.0001). Ibisubizo byacu byagaragaje kandi ko ingo zifite abana bari munsi y’umwaka umwe zari zifite amahirwe menshi yo gukoresha inzitiramibu ziteye umuti mu ngo ugereranije n’ingo zidafite abana cyangwa zifite abana bakuru (igipimo cy’amahirwe (OR) = 2.08, 95% CI : 1.25–3.47).
Uretse gukoresha inzitiramibu ziterwa umuti, abahinzi babajijwe kandi ku bundi buryo bwo kurwanya imibu mu ngo zabo no ku bihingwa bikoreshwa mu kurwanya udukoko tw’ibihingwa. 36.24% by’abitabiriye ubushakashatsi gusa bavuze ko batera imiti yica udukoko mu ngo zabo (bifitanye isano rikomeye kandi ryiza na SES p < 0.0001). Ibikoresho byavuzwe byaturutse ku bicuruzwa icyenda by’ubucuruzi kandi byagejejwe cyane cyane ku masoko yo mu gace n’abacuruzi bamwe na bamwe mu buryo bwa fumigating coils (16.10%) n’imiti yica udukoko (83.90%). Ubushobozi bw’abahinzi bwo kuvuga amazina y’imiti yica udukoko yatewe mu ngo zabo bwiyongereye uko urwego rwabo rw’uburezi (12.43%; p < 0.05). Ibikomoka ku buhinzi byakoreshejwe byabanje kugurwa mu masanduku hanyuma bigashyirwa mu miyoboro itera imiti mbere yo kuyikoresha, aho umubare munini ukunze kuba ugenewe ibihingwa (78.84%) (Imbonerahamwe ya 2). Umudugudu wa Amangbeu ufite umubare muto w’abahinzi bakoresha imiti yica udukoko mu ngo zabo (0.93%) n’ibihingwa (16.67%).
Umubare ntarengwa w’imiti yica udukoko (isukari cyangwa imiyoboro) yasabwe kuri buri rugo wari 3, kandi SES yari ifite isano ryiza n’umubare w’imiti yakoreshejwe (ikizamini nyacyo cya Fisher p < 0.0001, ariko mu bihe bimwe na bimwe iyi miti yagaragaye ko irimo kimwe); ibintu bikora mu mazina atandukanye y’ubucuruzi. Imbonerahamwe ya 2 igaragaza inshuro abahinzi bakoresha imiti yica udukoko buri cyumweru hakurikijwe uko imibereho yabo ihagaze.
Pyrethroids ni ubwoko bw’ibinyabutabire bugaragara cyane mu ngo (48.74%) n’ubw’ubuhinzi (54.74%). Ibikoresho bikorwa muri buri muti wica udukoko cyangwa bivanze n’indi miti yica udukoko. Uruvange rw’imiti yica udukoko ikoreshwa mu ngo ni carbamate, organophosphates na pyrethroids, mu gihe neonicotinoids na pyrethroids ari ibisanzwe mu miti yica udukoko ikoreshwa mu buhinzi (Umugereka wa 5). Ishusho ya 2 igaragaza umubare w’imiryango itandukanye y’imiti yica udukoko ikoreshwa n’abahinzi, yose ishyirwa mu cyiciro cya kabiri (icyago kiringaniye) cyangwa icya gatatu (icyago gito) nk’uko Umuryango w’Abibumbye wita ku buzima ushyira mu byiciro imiti yica udukoko [44]. Hari igihe byagaragaye ko igihugu cyakoreshaga umuti wica udukoko witwa deltamethrin, ugenewe ubuhinzi.
Ku bijyanye n'ibintu bikora, propoxur na deltamethrin ni byo bicuruzwa bikunze gukoreshwa mu gihugu no mu murima, uko bikurikirana. Inyandiko y'inyongera ya 5 irimo amakuru arambuye ku bicuruzwa bya shimi bikoreshwa n'abahinzi mu ngo zabo no ku bihingwa byabo.
Abahinzi bavuze ubundi buryo bwo kurwanya imibu, harimo umuyaga w’amababi (pêpê mu rurimi rwa Abbey rwo muri ako gace), gutwika amababi, gusukura aho hantu, gukuraho amazi ahagaze, gukoresha imiti yica imibu, cyangwa gukoresha amashuka mu kwirukana imibu gusa.
Ibintu bifitanye isano n'ubumenyi bw'abahinzi kuri malariya no gutera imiti yica udukoko mu nzu (isesengura ry'uburyo bwo gusubira inyuma kw'imiti).
Amakuru yagaragaje isano ikomeye hagati yo gukoresha imiti yica udukoko mu ngo n'ibintu bitanu bigena ibipimo: urwego rw'uburezi, SES, ubumenyi ku mibu nk'impamvu nyamukuru itera malariya, ikoreshwa rya ITN, n'ikoreshwa ry'imiti yica udukoko mu buhinzi. Ishusho ya 3 igaragaza OR zitandukanye kuri buri gipimo cy'ibipimo. Iyo bishyizwe mu byiciro hakurikijwe umudugudu, ibintu byose bigena ibipimo byagaragaje isano nziza n'ikoreshwa ry'imiti yica udukoko mu ngo (usibye ubumenyi ku mpamvu nyamukuru zitera malariya, byari bifitanye isano itandukanye no gukoresha imiti yica udukoko (OR = 0.07, 95% CI: 0.03, 0.13) . )) (Ishusho ya 3). Muri ibi bipimo byiza, kimwe gishimishije ni ikoreshwa ry'imiti yica udukoko mu buhinzi. Abahinzi bakoresheje imiti yica udukoko mu bihingwa bari bafite amahirwe menshi yo gukoresha imiti yica udukoko mu ngo zabo ku kigero cya 188% (95% CI: 1.12, 8.26). Ariko, ingo zifite ubumenyi bwinshi ku ikwirakwira rya malariya ntizashoboraga gukoresha imiti yica udukoko mu ngo. Abantu bafite amashuri menshi bari bafite amahirwe menshi yo kumenya ko imibu ari yo mpamvu nyamukuru itera malariya (OR = 2.04; 95% CI: 1.35, 3.10), ariko nta sano ry’imibare ryagaragaye hagati ya SES nyinshi (OR = 1.51; 95% CI: 0.93, 2.46).
Nk’uko umuyobozi w’urugo abivuga, umubare w’imibu uba mwinshi mu gihe cy’imvura, naho nijoro ukaba ari wo ukunze kurumwa n’imibu (85.79%). Ubwo abahinzi babazwaga uko babona ingaruka zo gutera imiti yica udukoko ku mibu itera malariya, 86.59% bemeje ko imibu isa n’aho irimo kugira ubudahangarwa ku miti yica udukoko. Kudashobora gukoresha imiti ihagije bitewe no kutagira iboneka ni byo bifatwa nk’impamvu nyamukuru ituma imiti idakoreshwa neza cyangwa idakoreshwa neza, ibyo bikaba ari ibindi bintu bifatwa nk’impamvu zigaragaza. By’umwihariko, iyi ngingo ya nyuma yafitanye isano no kuba nta mashuri menshi afite (p < 0.01), ndetse no mu gihe cyo kugenzura SES (p < 0.0001). 12.41% gusa by’ababajijwe basanze ubudahangarwa ku mibu ari imwe mu mpamvu zishobora gutuma imiti yica udukoko idashobora gukoreshwa.
Hari isano nziza hagati y’inshuro zikoreshwa mu mibu mu rugo n’uko imibu irwanya imiti yica udukoko (p < 0.0001): raporo z’uko imibu irwanya imiti yica udukoko zari zishingiye ahanini ku ikoreshwa ry’imiti yica udukoko mu ngo n’abahinzi inshuro 3-4 mu cyumweru (90.34%). Uretse inshuro zikoreshwa, ingano y’imiti yica udukoko yakoreshejwe nayo yari ifitanye isano ryiza n’uko abahinzi babona ko imiti yica udukoko irwanya udukoko (p < 0.0001).
Ubu bushakashatsi bwibanze ku buryo abahinzi babona malariya n'imiti yica udukoko. Ibisubizo byacu bigaragaza ko uburezi n'imibereho myiza y'abaturage bigira uruhare runini mu myitwarire n'ubumenyi kuri malariya. Nubwo abakuru b'ingo benshi bigaga mu mashuri abanza, kimwe n'ahandi hose, umubare w'abahinzi batize ni munini [35, 45]. Iki kibazo gishobora gusobanurwa n'uko nubwo abahinzi benshi batangira kwiga, abenshi muri bo bagomba kuva mu ishuri kugira ngo batunge imiryango yabo binyuze mu bikorwa by'ubuhinzi [26]. Ahubwo iki kibazo kigaragaza ko isano iri hagati y'imibereho myiza y'abaturage n'uburezi ari ingenzi mu gusobanura isano iri hagati y'imibereho myiza y'abaturage n'ubushobozi bwo gushyira mu bikorwa amakuru.
Mu turere twinshi tugaragaramo malariya, abitabiriye iyi nama bazi impamvu n'ibimenyetso bya malariya [33,46,47,48,49]. Muri rusange byemewe ko abana bashobora kwandura malariya [31, 34]. Uku kumenya bishobora kuba bifitanye isano n'uburyo abana bashobora kwandura malariya ndetse n'ubukana bw'ibimenyetso bya malariya [50, 51].
Abitabiriye iyi nama bavuze ko bakoresheje impuzandengo y'amadolari 30.000, hatabariwemo ubwikorezi n'ibindi bintu.
Igereranya ry’ubukungu n’imibereho y’abahinzi rigaragaza ko abahinzi bafite imibereho myiza y’abaturage batanga amafaranga menshi kurusha abahinzi bakize. Ibi bishobora guterwa n’uko ingo zifite imibereho myiza y’abaturage zibona ko ibiciro biri hejuru (kubera uburemere bwazo mu micungire y’imari muri rusange) cyangwa bitewe n’inyungu zituruka ku mirimo ya leta n’iy’abikorera ku giti cyabo (nk’uko bimeze ku ngo zikize cyane). ): Bitewe n’uko hari ubwishingizi bw’ubuzima, inkunga yo kuvura malariya (ugereranyije n’ibiciro byose) ishobora kuba iri hasi cyane ugereranyije n’ibiciro by’imiryango idahabwa ubwishingizi [52]. Mu by’ukuri, byatangajwe ko ingo zikize cyane zikoreshaga ubuvuzi bwa muganga ugereranije n’ingo zikennye cyane.
Nubwo abahinzi benshi babona ko imibu ari yo mpamvu nyamukuru itera malariya, bake gusa ni bo bakoresha imiti yica udukoko (bakoresheje gutera imiti no kuyitera) mu ngo zabo, kimwe n'ibyavumbuwe muri Kameruni na Guinée Equatoriale [48, 53]. Kutagira impungenge ku mibu ugereranije n'udukoko tw'ibihingwa biterwa n'agaciro k'ubukungu bw'ibihingwa. Kugira ngo bigabanye ibiciro, uburyo buhendutse nko gutwika amababi mu ngo cyangwa kwirukana imibu n'intoki ni bwo bwiza. Uburozi bugaragara nabwo bushobora kuba impamvu: impumuro y'ibicuruzwa bimwe na bimwe bya shimi n'ububabare nyuma yo kubikoresha bituma bamwe mu bakoresha batitabira kubikoresha [54]. Gukoresha imiti yica udukoko cyane mu ngo (85.20% by'ingo bivugwa ko bayikoresha) nabyo bigira uruhare mu ikoreshwa rito ry'imiti yica udukoko ku mibu. Kuba hari inzitiramibu ziterwa umuti mu ngo bifitanye isano rikomeye no kuba hari abana bari munsi y'umwaka umwe, bishoboka ko biterwa n'inkunga y'abaganga batwite bahabwa inzitiramibu ziterwa umuti mu gihe cyo kubyara [6].
Imiti ya Pyrethroids ni yo miti y’ingenzi yica udukoko ikoreshwa mu nzitiramibu ivurwa [55] kandi ikoreshwa n’abahinzi mu kurwanya udukoko n’imibu, ibi bikaba byatera impungenge ku kwiyongera k’ubudahangarwa bw’imiti [55, 56, 57,58,59]. Iyi ngingo ishobora gusobanura kugabanuka k’ubudahangarwa bw’imibu ku miti yica udukoko igaragara ku bahinzi.
Kuba urwego rw'ubukungu ruhanitse mu mibereho myiza y'abaturage ntabwo byari bifitanye isano no kumenya neza malariya n'imibu nk'impamvu yayo. Bitandukanye n'ibyavumbuwe mbere na Ouattara na bagenzi be mu 2011, abantu bakize bakunze kumenya neza impamvu za malariya kuko babona amakuru yoroshye binyuze kuri televiziyo na radiyo [35]. Isesengura ryacu ryerekana ko urwego rw'uburezi bwo hejuru rugaragaza ko malariya irushaho kumenyekana neza. Iki gitekerezo kiremeza ko uburezi bukomeje kuba ingenzi mu bumenyi bw'abahinzi kuri malariya. Impamvu imiterere y'ubukungu mu mibereho myiza y'abaturage itagira ingaruka nyinshi ni uko imidugudu ikunze gusangira televiziyo na radiyo. Ariko, imiterere y'ubukungu mu mibereho myiza y'abaturage igomba kwitabwaho mu gihe hashyirwa mu bikorwa ubumenyi ku ngamba zo kwirinda malariya mu ngo.
Ubukungu n'ubukungu byo hejuru hamwe n'urwego rw'amashuri makuru byafitanye isano ryiza n'ikoreshwa ry'imiti yica udukoko mu ngo (isuka cyangwa isuka). Igitangaje ni uko ubushobozi bw'abahinzi bwo kumenya imibu nk'impamvu nyamukuru itera malariya bwagize ingaruka mbi kuri urwo rugero. Iki gipimo cyagaragaje ko cyafitanye isano ryiza n'ikoreshwa ry'imiti yica udukoko iyo ishyizwe mu byiciro mu baturage bose, ariko kikaba gifitanye isano mbi n'ikoreshwa ry'imiti yica udukoko iyo ishyizwe mu byiciro hakurikijwe umudugudu. Ibi bisubizo bigaragaza akamaro k'ingaruka zo kurya abantu ku myitwarire yabo ndetse no kuba hakenewe ingaruka zidasanzwe mu isesengura. Ubushakashatsi bwacu bwerekanye ku nshuro ya mbere ko abahinzi bafite uburambe mu gukoresha imiti yica udukoko mu buhinzi bashobora gukoresha imiti yica udukoko n'imigozi nk'ingamba zo kurwanya malariya kurusha abandi.
Mu gushimangira ubushakashatsi bwakozwe mbere ku ngaruka z’ubukungu n’imibereho y’abahinzi ku myumvire yabo ku miti yica udukoko [16, 60, 61, 62, 63], ingo zikize zagaragaje ko hari itandukaniro rikomeye n’inshuro nyinshi ikoreshwa ry’imiti yica udukoko. Ababajijwe bemezaga ko gutera imiti myinshi yica udukoko ari bwo buryo bwiza bwo kwirinda ko imibu idashobora kuyirwanya, ibyo bikaba bihuye n’impungenge zagaragajwe ahandi [64]. Bityo, ibicuruzwa byo mu rugo bikoreshwa n’abahinzi bifite imiterere imwe y’imiti mu mazina atandukanye y’ubucuruzi, bivuze ko abahinzi bagomba gushyira imbere ubumenyi bwa tekiniki ku musaruro n’ibintu biwugize. Hakwiye kandi kwitabwaho ku bagurisha, kuko ari bimwe mu bintu by’ingenzi abaguzi b’imiti yica udukoko [17, 24, 65, 66, 67].
Kugira ngo hagire ingaruka nziza ku ikoreshwa ry’imiti yica udukoko mu byaro, politiki n’ibikorwa bigomba kwibanda ku kunoza ingamba zo gutumanaho, hazirikanwa urwego rw’uburezi n’imyitwarire mu rwego rwo guhangana n’umuco n’ibidukikije, ndetse no gutanga imiti yica udukoko mu buryo butekanye. Abantu bazagura hashingiwe ku giciro (amafaranga bashobora kugura) n’ubwiza bw’umusaruro. Iyo ubuziranenge bubonetse ku giciro gito, icyifuzo cyo guhindura imyitwarire mu kugura ibicuruzwa byiza cyitezweho kwiyongera cyane. Kwigisha abahinzi ibijyanye no gusimbuza imiti yica udukoko kugira ngo basenye urusobe rw’imiti irwanya udukoko, byemeza neza ko gusimbuza bidasobanura impinduka mu kumenyekanisha ibicuruzwa; (kubera ko ibirango bitandukanye birimo ikintu kimwe gikora), ahubwo ko ari itandukaniro mu bigize imikorere. Ubu burezi bushobora kandi gushyigikirwa no gushyira ibirango byiza ku bicuruzwa binyuze mu buryo bworoshye kandi busobanutse.
Kubera ko imiti yica udukoko ikoreshwa cyane n'abahinzi bo mu cyaro mu Ntara ya Abbotville, gusobanukirwa ubumenyi buke bw'abahinzi n'imyumvire yabo ku ikoreshwa ry'imiti yica udukoko mu bidukikije bisa nkaho ari ngombwa kugira ngo habeho gahunda nziza zo kumenyekanisha. Ubushakashatsi bwacu bwemeza ko uburezi bukomeje kuba ikintu cy'ingenzi mu ikoreshwa neza ry'imiti yica udukoko no kumenya malariya. Imiterere y'imibereho myiza mu muryango na yo yafatwaga nk'igikoresho cy'ingenzi cyo gusuzuma. Uretse imiterere y'imibereho myiza n'urwego rw'uburezi rw'umukuru w'urugo, hari ibindi bintu nko kumenya malariya, gukoresha imiti yica udukoko mu kurwanya udukoko, no kubona ko imibu irwanya imiti yica udukoko bigira ingaruka ku myumvire y'abahinzi ku ikoreshwa ry'imiti yica udukoko.
Uburyo bwo gusubiza ibibazo bushingiye ku bibazo nk'ibibazo bushobora kwibukwa ndetse n'ubusumbane mu mibanire y'abantu. Biroroshye gukoresha imiterere y'urugo kugira ngo upime imiterere y'imibereho y'abaturage, nubwo ibi bipimo bishobora kuba byihariye ku gihe n'imiterere y'akarere byakorewemo kandi ntibishobora kugaragaza kimwe ukuri kw'ibintu byihariye bifite agaciro k'umuco, bigatuma kugereranya ubushakashatsi bigorana. Mu by'ukuri, hashobora kubaho impinduka zikomeye mu gutunga urugo ibice by'ingenzi bitazatuma ubukene bugabanuka.
Hari abahinzi batibuka amazina y'imiti yica udukoko, bityo ingano y'imiti yica udukoko abahinzi bakoresha ishobora gusuzugurwa cyangwa kurenza urugero. Ubushakashatsi bwacu ntibwatekereje ku myumvire y'abahinzi ku bijyanye no gutera imiti yica udukoko ndetse n'uko babona ingaruka z'ibikorwa byabo ku buzima bwabo n'ibidukikije. Abacuruzi nabo ntibashyizwe muri ubu bushakashatsi. Ingingo zombi zishobora gusuzumwa mu bushakashatsi bw'ejo hazaza.
Amakuru yakoreshejwe cyangwa yasesenguwe mu gihe cy'ubushakashatsi buriho araboneka ku mwanditsi ubisabye mu buryo bwumvikana.
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Igihe cyo kohereza: 28 Mata 2024