Ubushobozi bwo kugera kuriimiti yica udukoko-inzitiramibu zavuwe neza no gushyira mu bikorwa gahunda ya IRS ku rwego rw'urugo byagize uruhare mu kugabanya cyane ubwandu bwa malariya bwagaragaye ku bagore bari mu kigero cyo kubyara muri Gana. Ibi bishimangira ko hakenewe ingamba zihamye zo kurwanya malariya kugira ngo habeho uruhare mu kurandura malariya muri Gana.
Amakuru y’ubu bushakashatsi yakuwe mu bushakashatsi bwakozwe ku bipimo bya malariya muri Ghana (GMIS). GMIS ni ubushakashatsi buhagarariye igihugu cyose bwakozwe n’ikigo gishinzwe ibarurishamibare muri Ghana kuva mu Ukwakira kugeza mu Ukuboza 2016. Muri ubu bushakashatsi, abagore bari hagati y’imyaka 15-49 ni bo bonyine bitabiriye ubu bushakashatsi. Abagore bari bafite amakuru ku bintu byose ni bo bashyizwe mu isesengura.
Ku bushakashatsi bwo mu 2016, MIS yo muri Ghana yakoresheje uburyo bwo gupima amatsinda menshi mu turere 10 tw’igihugu. Igihugu kigabanyijemo ibyiciro 20 (uturere 10 n’ubwoko bw’aho batuye - mu mijyi/mu cyaro). Itsinda risobanurwa nk'agace k’ibarura ry’abaturage (CE) kagizwe n’ingo zigera kuri 300-500. Mu cyiciro cya mbere cyo gupima, amatsinda atoranywa kuri buri cyiciro gifite amahirwe ajyanye n’ingano. Amatsinda 200 yose yatoranijwe. Mu cyiciro cya kabiri cyo gupima, umubare uhamye w’ingo 30 zatoranijwe mu buryo butunguranye muri buri tsinda ryatoranijwe nta wundi usimbuwe. Igihe cyose bishoboka, twaganiriye n’abagore bari hagati y’imyaka 15-49 muri buri rugo [8]. Ubushakashatsi bwa mbere bwaganiriye n’abagore 5.150. Ariko, kubera kutita ku bintu bimwe na bimwe, abagore 4861 bose hamwe bashyizwe muri ubu bushakashatsi, bangana na 94.4% by’abagore bari mu cyiciro. Amakuru arimo amakuru ku miturire, ingo, imiterere y’abagore, kwirinda malariya, n’ubumenyi bwa malariya. Amakuru yakusanyijwe hakoreshejwe uburyo bwa mudasobwa bukoresha ikiganiro cyihariye (CAPI) ku bikoresho bya tableti n'impapuro. Abashinzwe amakuru bakoresha uburyo bwa CESPro mu gutunganya no gucunga amakuru.
Umusaruro w'ibanze w'ubu bushakashatsi ni uko abagore bafite imyaka 15-49 bagaragaje ko banduye malariya, basobanurwa nk'abagore bavuze ko barwaye malariya nibura rimwe mu mezi 12 yabanjirije ubwo bushakashatsi. Ni ukuvuga ko abagore bafite imyaka 15-49 bagaragaje ko barwaye malariya, byakoreshejwe nk'ikimenyetso cyo kugaragaza ko banduye malariya koko cyangwa ko banduye mikorosikope kuko ibi bizamini bitari biboneka ku bagore igihe cy'ubushakashatsi.
Ingamba zafashwe zari zirimo kubona inzitiramibu ziterwa umuti wica udukoko mu ngo (ITN) no gukoresha IRS mu ngo mu mezi 12 yabanjirije ubushakashatsi. Imiryango yahawe izo ngamba zombi yafashwe nk'iyinjiyemo. Ingo zifite inzitiramibu ziterwa umuti wica udukoko zasobanuwe ko ari abagore batuye mu ngo zifite nibura inzitiramibu imwe yatewe umuti wica udukoko, mu gihe ingo zifite IRS zasobanuwe ko ari abagore batuye mu ngo zahawe imiti yica udukoko mu mezi 12 mbere y'uko ubushakashatsi bukorwa ku bagore.
Ubushakashatsi bwasuzumye ibyiciro bibiri binini by’ibintu bidasanzwe, ari byo imiterere y’umuryango n’imiterere y’umuntu ku giti cye. Harimo imiterere y’urugo; akarere, ubwoko bw’aho batuye (icyaro-umujyi), igitsina cy’umutware w’urugo, ingano y’urugo, amashanyarazi akoreshwa mu rugo, ubwoko bw’ibicanwa byo gutekesha (bikomeye cyangwa bidafite imbaraga), ibikoresho byo hasi, ibikoresho byo ku nkuta, ibikoresho byo hejuru, isoko y’amazi yo kunywa (yarushijeho kuba meza cyangwa atari meza), ubwoko bw’ubwiherero (bwarushijeho kuba bwiza cyangwa budafite imbaraga) n’icyiciro cy’umutungo w’urugo (ubukene, ubw’igihagararo n’ubukire). Ibyiciro by’imiterere y’urugo byasubiwemo hakurikijwe amahame ngenderwaho ya DHS muri raporo ya GMIS ya 2016 na raporo y’ubushakashatsi ku buzima bw’abaturage muri Ghana (GDHS) yo mu 2014 [8, 9]. Imiterere y’umuntu yasuzumwe harimo imyaka y’umugore ubu, urwego rwo hejuru rw’amashuri, uko atwite mu gihe cy’ikiganiro, ubwishingizi bw’ubuzima, idini, amakuru yerekeye guhura na malariya mu mezi 6 mbere y’ikiganiro, n’ubumenyi bw’umugore ku bibazo bya malariya. Ibibazo bitanu by'ubumenyi byakoreshejwe mu gusuzuma ubumenyi bw'abagore, harimo ubumenyi bw'abagore ku mpamvu zitera malariya, ibimenyetso bya malariya, uburyo bwo kwirinda malariya, kuvura malariya, no kumenya ko malariya ishyirwa mu bikorwa n'Ishami ry'Ubwishingizi bw'Ubuzima rya Ghana (NHIS). Abagore bagize amanota 0-2 bafatwaga nk'abafite ubumenyi buke, abagore bagize amanota 3 cyangwa 4 bafatwaga nk'abafite ubumenyi buri ku rugero, naho abagore bagize amanota 5 bafatwaga nk'abafite ubumenyi bwuzuye kuri malariya. Ibisobanuro bya buri wese byagiye bifitanye isano no kubona inzitiramibu ziterwa n'imiti, IRS, cyangwa ikwirakwira rya malariya mu nyandiko.
Imiterere y’abagore yasobanuwe hakoreshejwe inshuro n’ijanisha ku bipimo by’ibyiciro, mu gihe ibipimo bihoraho byasobanuwe hakoreshejwe uburyo n’itandukaniro risanzwe. Ibi biranga byakusanyijwe hamwe hakurikijwe uko ibikorwa bihagaze kugira ngo harebwe ubusumbane bushoboka n’imiterere y’abaturage bigaragaza ko hari urwikekwe rushobora gutera urujijo. Amakarita y’imbonerahamwe yakoreshejwe mu gusobanura ikwirakwizwa rya malariya mu bagore no gupimwa kwabyo hakurikijwe aho biherereye. Imibare y’ikizamini cya Scott Rao chi-square, igaragaza imiterere y’ubushakashatsi (ni ukuvuga ibyiciro, gushyira hamwe, no gupima uburemere), yakoreshejwe mu gusuzuma isano iri hagati y’ubwandu bwa malariya bwavuzwe n’uburyo bwo kubona imiti n’imiterere y’aho biherereye. Ubwandu bwa malariya bwavuzwe n’abagore bahuye n’icyorezo kimwe cya malariya mu mezi 12 mbere y’uko ubushakashatsi bukorwa, igabanyijwemo umubare w’abagore bose bujuje ibisabwa basuzumwe.
Uburyo bwahinduwe bwo gusuzuma uburemere bwa Poisson bwakoreshejwe mu gupima ingaruka zo kubona uburyo bwo kurwanya malariya ku bagore bagaragaje ubwandu bwa malariya16, nyuma yo guhindura uburyo bwo gusuzuma uburemere bw’ubuvuzi (IPTW) no gusuzuma uburemere hakoreshejwe uburyo bwa "svy-linearization" muri Stata IC. (Stata Corporation, College Station, Texas, USA). Uburemere bw’uburemere bw’ubuvuzi (IPTW) ku bufasha "i" na "j" bw’umugore bugereranywa nka:
Hanyuma, ibipimo bya nyuma byo gupima uburemere byakoreshejwe muri moderi ya Poisson yo gusubira inyuma birahindurwa ku buryo bukurikira:
Muri byo, \(fw_{ij}\) ni ihinduka rya nyuma ry'uburemere bwa j y'umuntu ku giti cye na intervention i, \(sw_{ij}\) ni urugero rw'uburemere bwa j y'umuntu ku giti cye na intervention i muri GMIS ya 2016.
Itegeko rya nyuma yo gupima "margins, dydx (intervention_i)" muri Stata ryakoreshejwe mu gupima itandukaniro ry'inyongera (ingaruka) z'ubutabazi "i" ku ikwirakwizwa rya malariya mu bagore ryavuzwe ubwabo nyuma yo gushyira mu bikorwa icyitegererezo cya Poisson regression cyahinduwe kugira ngo gigenzurwe. Byose byabonye ibintu bitera urujijo.
Uburyo butatu butandukanye bwo gusubira inyuma bwakoreshejwe kandi nk'isesengura ry'uburyo bwo kumva: gusubira inyuma kw'ibintu bibiri, gusubira inyuma kw'ibintu bishoboka, na moderi zo gusubira inyuma ku murongo kugira ngo hamenyekane ingaruka za buri gikorwa cyo kurwanya malariya ku ikwirakwizwa rya malariya mu bagore bo muri Ghana. Ibipimo bya 95% by'icyizere byagereranyijwe ku bipimo byose by'ubwandu, ibipimo by'ubwandu, n'ibipimo by'ingaruka. Isesengura ryose ry'ibarurishamibare muri ubu bushakashatsi ryafashwe nk'ingenzi ku rwego rwa alpha rwa 0.050. Verisiyo ya 16 ya Stata IC (StataCorp, Texas, USA) yakoreshejwe mu isesengura ry'ibarurishamibare.
Mu buryo bune bwo gusubira inyuma, ubwandu bwa malariya bwavuzweho ubwabwo ntibwari buri hasi cyane mu bagore bahabwaga ITN na IRS ugereranije n'abagore bahabwaga ITN gusa. Byongeye kandi, mu buryo bwa nyuma, abantu bakoreshaga ITN na IRS ntibagaragaje igabanuka rikomeye ry'ubwandu bwa malariya ugereranije n'abantu bakoresha IRS gusa.
Ingaruka zo kubona uburyo bwo kurwanya malariya ku bagore bavugwaho ko banduye malariya bitewe n'imiterere y'urugo
Ingaruka zo kubona uburyo bwo kurwanya malariya ku bagore ubwabo, bitewe n’imiterere y’abagore.
Gahunda yo gukumira malariya yafashije cyane kugabanya ikwirakwira rya malariya mu bagore bari mu kigero cyo kubyara muri Ghana. Ikwirakwira rya malariya ryagabanutseho 27% mu bagore bakoreshaga inzitiramubu ziterwa umuti na IRS. Ibi bihuye n'ibyavuye mu igerageza ryagenzuwe ryagaragaje ko umubare muto cyane w'abarwaye malariya DT mu bakoresha IRS ugereranije n'abatari abakoresha IRS mu gace gakunze kugaragara malariya ariko kakaba gafite imiterere yo hejuru y'ikoreshwa rya ITN muri Mozambike [19]. Mu majyaruguru ya Tanzaniya, inzitiramubu ziterwa umuti na IRS byahujwe kugira ngo bigabanye cyane ubucucike bwa Anopheles n'umubare w'inkingo z'udukoko [20]. Ingamba zo kurwanya malariya zihujwe nazo zishyigikiwe n'ubushakashatsi bwakozwe mu ntara ya Nyanza mu burengerazuba bwa Kenya, bwagaragaje ko gutera imiti mu nzu no gutera imiti yica udukoko byari ingirakamaro kurusha imiti yica udukoko. Uruvange rushobora gutanga uburinzi bw'inyongera kuri malariya. Imiyoboro ifatwa ukwayo [21].
Ubu bushakashatsi bwagaragaje ko 34% by'abagore bari barwaye malariya mu mezi 12 yabanjirije ubwo bushakashatsi, aho icyizere cyari hagati ya 95% cy'igihe cy'ubwizere cyari hagati ya 32-36%. Abagore batuye mu ngo zifite inzitiramibu ziterwa umuti (33%) bari bafite igipimo gito cyane cy'ubwandu bwa malariya ku bagore batuye mu ngo zidafite inzitiramibu ziterwa umuti (39%). Mu buryo nk'ubwo, abagore batuye mu ngo ziterwa umuti bari bafite igipimo cya 32% cy'ubwandu bwa malariya, ugereranije na 35% mu ngo zitaterwa umuti. Ubwiherero ntiburatunganywa kandi isuku ni mbi. Inyinshi muri zo ziba hanze kandi amazi mabi arazirundanya. Izi mvubura zanduye kandi zihagaze neza zitanga ahantu heza ho kororokera imibu ya Anopheles, itera malariya muri Ghana. Kubera iyo mpamvu, ubwiherero n'isuku ntibyateye imbere, byatumye malariya yiyongera mu baturage. Hakwiye kongerwa imbaraga mu kunoza ubwiherero n'isuku mu ngo no mu baturage.
Ubu bushakashatsi bufite imbogamizi nyinshi z'ingenzi. Ubwa mbere, ubushakashatsi bwakoresheje amakuru y’ubushakashatsi ashingiye ku bice bitandukanye, bituma bigorana gupima impamvu. Kugira ngo harebwe iyi mbogamizi, hakoreshejwe uburyo bw’imibare bwo gupima impamvu kugira ngo hamenyekane ingaruka z’ubuvuzi bw’ingaruka mbi. Isesengura rihindura uburyo bwo kuvura kandi rigakoresha ibintu bikomeye kugira ngo hamenyekane ingaruka zishobora kubaho ku bagore bo mu ngo zabo bahawe ubufasha (niba nta bufasha bwabayeho) no ku bagore bo mu ngo zabo batahawe ubufasha.
Icya kabiri, kubona inzitiramibu zirimo imiti yica udukoko ntabwo bivuze ko ari ngombwa gukoresha inzitiramibu zirimo imiti yica udukoko, bityo rero hagomba kwitonda mu gusobanura ibyavuye muri ubu bushakashatsi n'imyanzuro. Icya gatatu, ibyavuye muri ubu bushakashatsi ku ndwara ya malariya yibasiwe n'abagore ni ikimenyetso cy'ubwiyongere bwa malariya mu bagore mu mezi 12 ashize, bityo bikaba bishobora kubogamirwa n'ubumenyi bw'abagore kuri malariya, cyane cyane abanduye bataramenyekana.
Amaherezo, ubushakashatsi ntibwagaragaje abarwayi benshi ba malariya kuri buri muntu mu gihe cy'umwaka umwe, cyangwa igihe nyacyo cyo gupima malariya n'uburyo bwo kuyivura. Bitewe n'imbogamizi z'ubushakashatsi bwo kwitegereza, igeragezwa rikomeye ryagenzuwe rizaba ikintu cy'ingenzi mu bushakashatsi bw'ejo hazaza.
Ingo zahawe imiti igabanya ubukana bwa malariya ndetse n’iy’ubwisungane mu kwivuza (IRS) zari zifite ubwandu bwa malariya buke ugereranije n’ingo zitahawe ubufasha. Ibi bishyigikira icyifuzo cyo gushyira hamwe ingamba zo kurwanya malariya kugira ngo habeho uruhare mu kurandura malariya muri Ghana.
Igihe cyo kohereza: 15 Ukwakira 2024