Samun dama gamaganin kashe kwari- gidajen sauron da aka yi wa magani da kuma aiwatar da matakin gida na IRS sun ba da gudummawa sosai ga raguwar cutar zazzabin cizon sauro da aka ba da rahoton kai a tsakanin matan da suka kai shekarun haihuwa a Ghana. Wannan binciken ya karfafa bukatar samar da cikakken martanin yaki da zazzabin cizon sauro don taimakawa wajen kawar da zazzabin cizon sauro a Ghana.
An zana bayanai don wannan binciken daga Binciken Alamar Malaria ta Ghana (GMIS). GMIS bincike ne na wakilai na ƙasa wanda Hukumar Kididdiga ta Ghana ta gudanar daga Oktoba zuwa Disamba 2016. A cikin wannan binciken, mata masu shekaru 15-49 ne kawai suka shiga cikin binciken. Matan da ke da bayanai akan duk masu canji an haɗa su a cikin bincike.
Don binciken na 2016, MIS ta Ghana ta yi amfani da tsarin samfurin gungu mai matakai da yawa a duk yankuna 10 na ƙasar. An raba ƙasar zuwa azuzuwan 20 (yankuna 10 da nau'in mazaunin - birane / karkara). An bayyana gungu a matsayin yanki na ƙidayar jama'a (CE) wanda ya ƙunshi kusan gidaje 300-500. A mataki na farko na samfur, an zaɓi gungu ga kowane stratum tare da yuwuwar daidai da girman. An zaɓi gungu guda 200. A mataki na biyu na samfur, an zaɓi ƙayyadadden adadin gidaje 30 ba da gangan ba daga kowace gungu da aka zaɓa ba tare da maye gurbinsu ba. A duk lokacin da zai yiwu, mun yi hira da mata masu shekaru 15-49 a kowane gida [8]. Binciken farko ya yi hira da mata 5,150. Duk da haka, saboda rashin amsawa kan wasu masu canji, an haɗa jimillar mata 4861 a cikin wannan binciken, wanda ke wakiltar 94.4% na mata a cikin samfurin. Bayanai sun haɗa da bayanai kan gidaje, gidaje, halayen mata, rigakafin zazzabin cizon sauro, da ilimin zazzabin cizon sauro. An tattara bayanai ta amfani da tsarin hira na sirri na taimakon kwamfuta (CAPI) akan allunan da tambayoyin takarda. Manajojin bayanai suna amfani da tsarin ƙidayar jama'a da Binciken Bincike (CSPro) don shiryawa da sarrafa bayanai.
Sakamakon farko na wannan binciken shine cutar zazzabin cizon sauro da aka ba da rahoton kai a tsakanin mata masu shekaru 15-49, wanda aka ayyana a matsayin mata waɗanda suka bayar da rahoton cewa suna da aƙalla cutar cizon sauro guda ɗaya a cikin watanni 12 kafin binciken. Wato, cutar zazzabin cizon sauro da aka ba da rahoton kai a tsakanin mata masu shekaru 15-49 an yi amfani da su azaman wakili na ainihin zazzabin cizon sauro RDT ko microscopy positivity tsakanin mata saboda ba a samun waɗannan gwaje-gwaje a tsakanin mata a lokacin binciken.
Matsalolin sun haɗa da shiga gida zuwa gidajen yanar gizo na maganin kwari (ITN) da kuma amfani da gida na IRS a cikin watanni 12 da suka gabata binciken. An yi la'akari da cewa an haɗa dangin da suka karɓi duk abubuwan shiga tsakani. An ayyana iyalan da ke da damar yin amfani da gidajen sauron da aka yi wa maganin kwari a matsayin matan da ke zaune a gidajen da ke da aƙalla gidan gado guda ɗaya da aka yi wa maganin kwari, yayin da aka ayyana gidaje da IRS a matsayin matan da ke zaune a gidajen da aka yi wa maganin kwari cikin watanni 12 kafin binciken. na mata.
Binciken ya bincika manyan nau'ikan nau'ikan sauye-sauye masu rudani, wato halaye na iyali da halayen mutum ɗaya. Ya haɗa da halayen gida; yanki, nau'in wurin zama (ƙarau-ƙarar birni), jinsi na shugaban gida, girman iyali, amfani da wutar lantarki na gida, nau'in mai dafa abinci (mai ƙarfi ko mara ƙarfi), babban kayan ƙasa, babban kayan bango, kayan rufin, tushen ruwan sha (inganta ko ba a inganta ba), nau'in bayan gida (inganta ko rashin ingantawa) da nau'in dukiyar gida (malakawa, tsakiya da masu arziki). An sake canza nau'ikan halayen gida bisa ga ka'idodin rahoton DHS a cikin 2016 GMIS da 2014 Ghana Demographic Health Survey (GDHS) rahotanni [8, 9]. Abubuwan da aka yi la'akari da su sun haɗa da shekarun mace a halin yanzu, matakin ilimi mafi girma, yanayin ciki a lokacin hira, yanayin inshorar lafiya, addini, bayanin kamuwa da cutar zazzabin cizon sauro a cikin watanni 6 kafin hirar, da kuma matakin ilimin mace game da zazzabin cizon sauro. batutuwa. . An yi amfani da tambayoyin ilimi guda biyar wajen tantance ilimin mata, da suka hada da sanin mata kan abubuwan da ke haifar da zazzabin cizon sauro, alamun zazzabin cizon sauro, hanyoyin rigakafin zazzabin cizon sauro, maganin zazzabin cizon sauro, da sanin cewa zazzabin cizon sauro yana cikin tsarin inshorar lafiya na Ghana (NHIS). Matan da suka ci 0 – 2 an dauke su da karancin ilimi, matan da suka ci 3 ko 4 ana ganin suna da matsakaicin ilimi, sannan matan da suka ci 5 ana ganin suna da cikakkiyar masaniya kan cutar zazzabin cizon sauro. An danganta bambance-bambancen daidaikun mutane da samun damar yin amfani da gidajen sauron da aka yi wa maganin kwari, IRS, ko zazzabin cizon sauro a cikin adabi.
An taƙaita halayen mata na asali ta amfani da mitoci da kaso don bambance-bambancen mabambanta, yayin da aka taƙaita ci gaba da masu canji ta amfani da ma'ana da madaidaitan sabani. Waɗannan halayen an haɗa su ta hanyar shiga tsakani don bincika yuwuwar rashin daidaituwa da tsarin alƙaluma waɗanda ke nuna yiwuwar ruɗani. An yi amfani da taswirorin kwane-kwane don bayyana yadda cutar zazzabin cizon sauro ke yaduwa a tsakanin mata da kuma ɗaukar matakai guda biyu ta wurin wuri. Ƙididdiga na gwaji na Scott Rao chi-square, wanda ke lissafin halayen ƙirƙira binciken (watau rarrabuwa, tari, da ma'aunin ƙima), an yi amfani da shi don tantance alaƙa tsakanin yaduwar cutar cizon sauro da aka ba da rahoton kai da kuma samun damar shiga tsakani da halayen mahallin. An kididdige yawan cutar zazzabin cizon sauro da aka ba da rahoton kai a matsayin adadin matan da suka samu akalla kashi daya na zazzabin cizon sauro a cikin watanni 12 kafin binciken ya raba da adadin matan da suka cancanta da aka tantance.
An yi amfani da wani gyare-gyaren samfurin regression Poisson don ƙididdige tasirin samun damar shawo kan cutar zazzabin cizon sauro a kan yaduwar cutar cizon sauro da mata suka yi da kansu16, bayan daidaitawa ga yiwuwar ma'aunin jiyya (IPTW) da ma'aunin bincike ta amfani da samfurin "svy-linearization" a cikin Stata. IC . (Kamfanin Stata, Kwalejin Kwalejin, Texas, Amurka). An kiyasta yiwuwar juzu'in nauyin jiyya (IPTW) don shiga "i" da mace "j" kamar:
Ana daidaita ma'aunin ma'aunin ƙarshe na ƙarshe da aka yi amfani da shi a cikin tsarin koma bayan Poisson kamar haka:
Daga cikinsu, \(fw_{ij}\) shine madaidaicin nauyi na ƙarshe na mutum j da sa baki i, \(sw_{ij}\) shine samfurin nauyin j da sa baki i a cikin 2016 GMIS.
An yi amfani da umarnin bayan-ƙididdigar “margins, dydx (intervention_i)” a cikin Stata don ƙididdige bambance-bambancen gefe (tasirin) shiga tsakani “i” kan cutar zazzabin cizon sauro da aka ba da rahoton kai a tsakanin mata bayan dacewa da wani gyare-gyaren samfurin regression Poisson don sarrafawa. duk abubuwan da aka lura masu rikicewa.
An kuma yi amfani da nau'o'in koma baya daban-daban guda uku a matsayin nazari na hankali: koma bayan dabaru na binary, da yiwuwar koma baya, da kuma tsarin koma baya na layi don kimanta tasirin kowane maganin zazzabin cizon sauro kan cutar zazzabin cizon sauro da aka ba da rahoton kai a tsakanin matan Ghana. An kiyasta tazarar amincewa 95% don duk ƙididdige ƙididdige yawan ma'auni, ƙimar yaɗuwa, da ƙididdigar sakamako. Dukkan ƙididdigar ƙididdiga a cikin wannan binciken an yi la'akari da mahimmanci a matakin alpha na 0.050. An yi amfani da sigar Stata IC 16 (StataCorp, Texas, Amurka) don nazarin ƙididdiga.
A cikin nau'ikan koma-baya guda hudu, cutar zazzabin cizon sauro da aka ba da rahoton kai ba ta yi ƙasa sosai a tsakanin matan da ke karɓar ITN da IRS ba idan aka kwatanta da matan da ke karɓar ITN kaɗai. Bugu da ƙari, a cikin samfurin ƙarshe, mutanen da ke amfani da duka ITN da IRS ba su nuna raguwa mai yawa a cikin zazzabin cizon sauro ba idan aka kwatanta da mutanen da ke amfani da IRS kadai.
Tasirin damar yin maganin zazzabin cizon sauro ga mata da aka ba da rahoton kamuwa da cutar ta hanyar halayen gida
Tasirin samun damar shawo kan cutar zazzabin cizon sauro a kan cutar zazzabin cizon sauro da aka ba da rahoton kai tsaye a tsakanin mata, ta halayen mata.
Kunshin dabarun rigakafin cutar zazzabin cizon sauro ya taimaka matuka wajen rage yawan kamuwa da cutar zazzabin cizon sauro da ake yi a tsakanin matan da suka kai shekarun haihuwa a Ghana. Cutar zazzabin cizon sauro da aka ba da rahoton kai ta ragu da kashi 27 cikin ɗari a tsakanin mata masu amfani da gidan sauron da aka yi wa maganin kwari da kuma IRS. Wannan binciken ya yi daidai da sakamakon gwajin gwajin da aka bazu wanda ya nuna mahimmancin ƙananan ƙimar cutar zazzabin cizon sauro DT tsakanin masu amfani da IRS idan aka kwatanta da masu amfani da IRS ba a cikin wani yanki da ke fama da cutar zazzabin cizon sauro amma babban ma'auni na samun damar ITN a Mozambique [19]. A arewacin Tanzaniya, gidajen gado da aka yi wa maganin kwari da IRS an haɗa su don rage yawan adadin Anopheles da ƙimar rigakafin kwari [20]. Har ila yau, ana samun goyon bayan hadakar dabarun shawo kan cutar ta hanyar binciken jama'a a lardin Nyanza da ke yammacin kasar Kenya, wanda ya nuna cewa feshin cikin gida da gidan sauron da aka yi wa maganin kwari ya fi maganin kwari. Haɗin zai iya ba da ƙarin kariya daga zazzabin cizon sauro. ana la'akari da cibiyoyin sadarwa daban [21].
Wannan binciken ya kiyasta cewa kashi 34 cikin 100 na mata sun kamu da zazzabin cizon sauro a cikin watanni 12 da suka gabata, inda aka kiyasta kashi 95 cikin 100 na amincewa da kashi 32-36%. Matan da ke zaune a gidajen da ke da damar yin amfani da gidajen sauron da aka yi wa maganin kwari (33%) sun sami raguwar adadin kamuwa da cutar zazzabin cizon sauro da kansu fiye da matan da ke zaune a gidaje ba tare da samun gidajen gadon da aka yi wa maganin kwari ba (39%). Hakazalika, matan da ke zaune a gidajen da aka fesa sun sami rahoton kamuwa da cutar zazzabin cizon sauro da kansu ya kai kashi 32%, idan aka kwatanta da kashi 35% na mutanen da ba sa fesa. Ba a inganta bandakunan ba kuma yanayin tsafta ba shi da kyau. Yawancinsu a waje suke kuma dattin ruwa ya taru a cikinsu. Wadannan jikunan ruwa masu datti da datti suna samar da kyakkyawan wurin haifuwa ga sauro Anopheles, babban maganin zazzabin cizon sauro a Ghana. A sakamakon haka, bandakuna da tsaftar muhalli ba su inganta ba, wanda kai tsaye ya haifar da yaduwar cutar zazzabin cizon sauro a cikin al'umma. Yakamata a kara kaimi wajen inganta bandakuna da tsaftar muhalli a gidaje da al'umma.
Wannan binciken yana da iyakoki masu mahimmanci da yawa. Na farko, binciken ya yi amfani da bayanan bincike na yanki, wanda ya sa ya yi wuya a auna dalilin. Don shawo kan wannan ƙayyadaddun, an yi amfani da hanyoyin ƙididdiga na ƙididdiga don ƙididdige yawan tasirin maganin sa baki. Binciken ya daidaita don aikin jiyya kuma yana amfani da maɓalli masu mahimmanci don ƙididdige sakamako mai yuwuwa ga matan da gidajensu suka sami shiga tsakani (idan ba a sami shiga ba) da kuma matan da danginsu ba su sami taimakon ba.
Na biyu, samun damar yin amfani da gidajen gadon da aka yi wa maganin kwari ba lallai ba ne yana nufin yin amfani da gidajen gadon da aka yi wa maganin kwari ba, don haka dole ne a yi taka tsantsan wajen fassara sakamakon da kammala wannan binciken. Na uku, sakamakon binciken da aka yi kan cutar zazzabin cizon sauro da mata ke yi wa kansu, shi ne sanadin yawaitar cutar zazzabin cizon sauro a tsakanin mata a cikin watanni 12 da suka gabata, don haka yana iya kasancewa da son zuciya da sanin matakin da mata suka dauka game da cutar zazzabin cizon sauro, musamman wadanda ba a gano su ba.
A ƙarshe, binciken bai yi la'akari da cutar zazzabin cizon sauro da yawa ga kowane ɗan takara ba a cikin tsawon shekara guda, ko madaidaicin lokacin kamuwa da cutar zazzabin cizon sauro da matakan ba. Idan aka ba da iyakokin nazarin binciken, ƙarin ƙarfin gwajin sarrafa bazuwar zai zama muhimmiyar la'akari don bincike na gaba.
Iyalan da suka karɓi ITN da IRS duka sun sami raguwar yaduwar cutar zazzabin cizon sauro idan aka kwatanta da gidajen da ba su sami shiga tsakani ba. Wannan binciken ya goyi bayan kiraye-kirayen a hada kai da kokarin shawo kan cutar zazzabin cizon sauro don taimakawa wajen kawar da zazzabin cizon sauro a Ghana.
Lokacin aikawa: Oktoba-15-2024