Inzitiramibu zirimo pyrethroid clofenpyr (CFP) na pyrethroid piperonyl butoxide (PBO) ziri guterwa inkunga mu bihugu bikunze kugaragaramo indwara kugira ngo hakorwe neza uburyo bwo kurwanya malariya yanduzwa n'imibu irwanya pyrethroid. CFP ni umuti wica udukoko usaba ko umuti wica udukoko ukoreshwa n'umubu witwa cytochrome P450 monooxygenase (P450), kandi PBO yongera ubushobozi bwa pyrethroid mu kubuza iyi enzymes gukora mu mibu irwanya pyrethroid. Bityo, PBO ishobora kugabanya ubushobozi bwa P450 mu kugabanya ubushobozi bwa pyrethroid-CFP iyo ikoreshejwe mu rugo rumwe n'imibu yitwa pyrethroid-PBO.
Ibizamini bibiri by’igerageza byakozwe mu cyumba cy’indembe kugira ngo hasuzumwe ubwoko bubiri butandukanye bwa pyrethroid-CFP ITN (Interceptor® G2, PermaNet® Dual) byonyine kandi bihujwe na pyrethroid-PBO ITN (DuraNet® Plus, PermaNet® 3.0). Ingaruka z’ikoreshwa ry’udukoko mu kurwanya pyrethroid mu majyepfo ya Benin. Muri ubwo bushakashatsi bwombi, ubwoko bwose bw’udukoko bwageragejwe mu kuvura udukoko duto n’udukoko duto. Isuzuma rya bioassay ryakozwe kandi kugira ngo hasuzumwe uburyo udukoko duto duhangana n’imiti mu kazu no kwiga imikoranire iri hagati ya CFP na PBO.
Umubare w’abatera ibiyobyabwenge wari wibasiwe na CFP ariko wagaragaje urwego rwo hejuru rwo kurwanya pyrethroid, ariko uku kurwanya kwatsinzwe no kwangirika mbere yo guhura na PBO. Impfu z’abatera ibiyobyabwenge zagabanutse cyane mu mazu hakoreshejwe inzitiramibu za pyrethroid-CFP n’iz’abatera ibiyobyabwenge za pyrethroid-PBO ugereranije n’amazu akoresha inzitiramibu ebyiri za pyrethroid-CFP (74% kuri Interceptor® G2 ugereranyije na 85%, PermaNet® Dual 57% ugereranyije na 83%), p < 0.001). Kuhura na PBO mbere yo guhura na byo byagabanyije uburozi bwa CFP mu isuzuma ry’ibinyabuzima mu macupa, bigaragaza ko iyi ngaruka ishobora guterwa n’amakimbirane hagati ya CFP na PBO. Impfu z’abatera ibiyobyabwenge zari nyinshi mu mazu hakoreshejwe inzitiramibu zirimo inzitiramibu za pyrethroid-CFP ugereranije n’amazu adafite inzitiramibu za pyrethroid-CFP, kandi iyo inzitiramibu za pyrethroid-CFP zakoreshejwe zonyine nk’inzitiramibu ebyiri. Iyo zikoreshejwe hamwe, impfu ziba nyinshi cyane (83-85%).
Ubu bushakashatsi bwagaragaje ko ubushobozi bwa meshes za pyrethroid-CFP bwagabanutse iyo zikoreshejwe hamwe na pyrethroid-PBO ITN ugereranije n'uburyo bwonyine bwo gukoresha, mu gihe ubushobozi bwa mesh ivanze irimo meshes za pyrethroid-CFP bwari hejuru. Ibi byavuye mu bushakashatsi bigaragaza ko gushyira imbere ikwirakwizwa rya pyrethroid-CFP kurusha ubundi bwoko bw'imiyoboro bizatuma ingaruka zo kugenzura vector zigira ingaruka nziza mu bihe nk'ibyo.
Inzitiramibu ziterwa umuti wica udukoko (ITNs) zirimo imiti yica udukoko ya pyrethroid zabaye inkingi ikomeye yo kurwanya malariya mu myaka makumyabiri ishize. Kuva mu 2004, inzitiramibu zigera kuri miliyari 2.5 zahawe Afurika yo munsi y'ubutayu bwa Sahara [1], bituma umubare w'abaturage baryama mu nzitiramibu ziterwa umuti wica udukoko wiyongera kuva kuri 4% kugeza kuri 47% [2]. Ingaruka z'iri shyirwa mu bikorwa zari zikomeye. Bivugwa ko abantu bagera kuri miliyari 2 barwaye malariya n'impfu miliyoni 6.2 birinzwe ku isi hagati ya 2000 na 2021, aho isesengura ry'icyitegererezo ryerekana ko inzitiramibu zatewe umuti ari zo zagize uruhare runini muri iyi nyungu [2, 3]. Ariko, izi ntambwe ziza ku giciro: kwiyongera kwihutisha kwa pyrethroid mu mibare y'abantu batera malariya. Nubwo inzitiramibu ziterwa umuti wa pyrethroid zishobora gukomeza gutanga uburinzi bwa buri muntu kuri malariya mu turere aho inyamaswa zigaragaza ubudahangarwa bwa pyrethroid [4], ubushakashatsi bw'icyitegererezo bugaragaza ko ku rwego rwo hejuru rw'ubudahangarwa, inzitiramibu ziterwa umuti zizagabanya ingaruka z'ibyorezo [5]. Bityo, kurwanya indwara ya pyrethroid ni kimwe mu bintu bikomeye bibangamira iterambere rirambye mu kurwanya malariya.
Mu myaka mike ishize, hakozwe inzitiramubu nshya zivurwa n’imiti yica udukoko, zihuza imiti yica udukoko n’indi miti, kugira ngo zirusheho kurwanya malariya yanduzwa n’imibu irwanya udukoko. Ubwoko bushya bwa mbere bwa ITN burimo synergist piperonyl butoxide (PBO), yongerera imbaraga pyrethroids binyuze mu kugabanya enzymes zikuraho uburozi zijyanye no kurwanya udukoko, cyane cyane ubushobozi bwa cytochrome P450 monooxygenases (P450s) [6]. Inzitiramubu zavuwe na fluprone (CFP), umuti wica udukoko witwa azole ufite uburyo bushya bwo gukora bugamije guhumeka kw’uturemangingo, nazo ziherutse kuboneka. Nyuma yo kugaragaza ingaruka nziza z’udukoko mu igerageza ry’igerageza rya hut [7, 8], hakozwe urukurikirane rw’ibizamini byagenzuwe na buri wese (cRCT) kugira ngo harebwe akamaro k’izi nzitiramubu ku buzima rusange ugereranije n’inzitiramubu zivurwa n’imiti zikoresha imiti yica udukoko gusa no gutanga ibimenyetso bikenewe kugira ngo hamenyekane inama za politiki zitangwa n’Ishami ry’Umuryango w’Abibumbye ryita ku Buzima (OMS) [9]. Hashingiwe ku bimenyetso byerekana ko CRCTs zagize ingaruka nziza ku ndwara muri Uganda [11] na Tanzaniya [12], OMS yemeje inzitiramibu ziterwa umuti wica udukoko witwa pyrethroid-PBO [10]. ITN ya pyrethroid-CFP nayo iherutse gusohoka nyuma y’uko RCTs zisanzwe muri Benin [13] na Tanzaniya [14] zigaragaje ko ITN y’icyitegererezo (Interceptor® G2) yagabanyije ubwandu bwa malariya mu bana ku kigero cya 46% na 44%, uko bikurikirana. 10].
Nyuma y’ingamba zongeye gushyirwaho n’Ikigega Mpuzamahanga n’abandi baterankunga bakomeye ba malariya zo guhangana n’ubudahangarwa bw’imiti yica udukoko hifashishijwe kwihutisha ishyirwaho ry’inzitiramibu nshya [15], inzitiramibu za pyrethroid-PBO na pyrethroid-CFP zisanzwe zikoreshwa mu turere twakunze kugaragara. Zisimbura inzitiramibu gakondo zivuwe zikoresha pyrethroid gusa. Hagati ya 2019 na 2022, igipimo cy’inzitiramibu za PBO pyrethroid zitangwa muri Afurika yo munsi y’ubutayu bwa Sahara cyiyongereye kuva kuri 8% kigera kuri 51% [1], mu gihe inzitiramibu za PBO pyrethroid, harimo n’inzitiramibu za CFP pyrethroid, inzitiramibu "zifite ibikorwa bibiri" ziteganijwe kuba 56% by’ibyoherezwa. Zinjira ku isoko rya Afurika bitarenze 2025 [16]. Nk’ikimenyetso cy’uko inzitiramibu za pyrethroid-PBO na pyrethroid-CFP zikomeje kwiyongera, izi nzitiramibu ziteganijwe kuboneka cyane mu myaka iri imbere. Bityo, hari hakenewe cyane kuzuza amakuru ajyanye n'ikoreshwa ryiza ry'inzitiramibu ziterwa umuti mu buryo bushya kugira ngo zigere ku ngaruka nziza mu gihe zongerewe ubushobozi bwo kuzikoresha mu buryo bwuzuye.
Bitewe n’ubwiyongere bw’inzitiramibu za pyrethroid CFP na PBO, Gahunda y’Igihugu yo Kurwanya Malariya (NMCP) ifite ikibazo kimwe cy’ubushakashatsi ku mikorere: Ese ubushobozi bwayo buzagabanuka - PBO ITN? Impamvu y’iyi mpungenge ni uko PBO ikora ibuza enzymes za P450 z’umubu [6], mu gihe CFP ari umuti wica udukoko usaba gukoreshwa binyuze muri P450s [17]. Kubwibyo, bitekerezwa ko iyo pyrethroid-CFP ITN na pyrethroid-CFP ITN bikoreshejwe mu rugo rumwe, ingaruka zo gukumira PBO kuri P450 zishobora kugabanya ubushobozi bwa pyrethroid-CFP ITN. Ubushakashatsi bwinshi bwa laboratwari bwagaragaje ko kwishyira kuri PBO mbere yo guhura na CFP bigabanya uburozi bwa CFP ku mibu itera imibu mu gihe cy’isuzuma ry’ibinyabuzima [18,19,20,21,22]. Ariko, mu gihe hakorwa ubushakashatsi hagati y’imiyoboro itandukanye mu rwego rw’imiti, imikoranire hagati y’iyi miti izaba ingorabahizi kurushaho. Ubushakashatsi butasohotse bwasuzumye ingaruka zo gukoresha ubwoko butandukanye bw’inzitiramibu ziterwa hamwe. Bityo, inyigo zo mu murima zisuzuma ingaruka zo gukoresha inzitiramibu zivanze imiti yica udukoko ya pyrethroid-CFP na pyrethroid-PBO mu rugo rumwe bizafasha kumenya niba amakimbirane ashobora kubaho hagati y’ubwo bwoko bw’inzitiramibu ateza ikibazo mu mikorere no gufasha kumenya ingamba nziza zo gushyiraho mu turere dukwirakwijwemo.
Igihe cyo kohereza ubutumwa: 21 Nzeri 2023