maganin kwari na cikin gidaFeshi (IRS) wata hanya ce mai mahimmanci don rage yaɗuwar cutar Trypanosoma cruzi ta hanyar vector, wadda ke haifar da cutar Chagas a yawancin Kudancin Amurka. Duk da haka, nasarar da IRS ta samu a yankin Grand Chaco, wanda ya ƙunshi Bolivia, Argentina da Paraguay, ba za ta iya yin gogayya da sauran ƙasashen Kudancin Cone ba.
Wannan binciken ya tantance ayyukan IRS na yau da kullun da kuma kula da ingancin magungunan kashe kwari a cikin al'umma da ta zama ruwan dare a Chaco, Bolivia.
Sinadarin aikialpha-cypermethrinAn kama (ai) a kan takardar tacewa da aka ɗora a kan bangon mai feshi kuma an auna ta a cikin maganin tankin feshi da aka shirya ta amfani da Kayan Aikin Kimantawa na Insecticide Quantitative Kit (IQK™) wanda aka tabbatar don hanyoyin HPLC masu yawa. An yi nazarin bayanai ta amfani da samfurin komawa ga tasirin mizanin mizanin mizanin mizanin mizanin don bincika alaƙar da ke tsakanin yawan maganin kwari da aka yi amfani da shi ga takardar tacewa da tsayin bangon feshi, rufewar feshi (yankin saman feshi/lokacin feshi [m2/min]), da kuma rabon feshi da aka lura/ana tsammanin. An kuma tantance bambance-bambance tsakanin bin ka'idojin masu samar da lafiya da masu gidaje ga buƙatun gidajen da babu kowa na IRS. An kuma tantance adadin daidaitawar alpha-cypermethrin bayan haɗawa a cikin tankunan feshi da aka shirya a dakin gwaje-gwaje.
An lura da bambance-bambance masu yawa a cikin yawan sinadarin alpha-cypermethrin AI, inda kashi 10.4% (50/480) na matattara da kashi 8.8% (5/57) na gidaje suka cimma yawan sinadarin da aka yi niyya na 50 mg ± 20% AI/m2. Yawan sinadarin da aka nuna ba ya dogara da yawan sinadarin da aka samu a cikin ruwan da aka yi amfani da shi. Bayan an haɗa sinadarin alpha-cypermethrin ai a cikin ruwan da aka shirya a saman tankin feshi, sai ya fara narkewa da sauri, wanda ya haifar da asarar sinadarin alpha-cypermethrin ai a minti daya da kuma asarar kashi 49% bayan mintuna 15. Kashi 7.5% (6/80) na gidaje ne kawai aka yi wa magani a cikin adadin feshi da WHO ta ba da shawarar na 19 m2/min (±10%), yayin da kashi 77.5% (62/80) na gidaje aka yi wa magani a kan adadin da aka yi tsammani. Matsakaicin yawan sinadarin da aka kai wa gidan bai shafi yawan feshi da aka lura ba. Biyan buƙatun gida bai shafi yawan feshi ko matsakaicin yawan sinadarin cypermethrin da aka kai wa gidaje ba.
Isar da IRS ba ta da kyau ba na iya zama saboda halayen zahiri na magungunan kashe kwari da kuma buƙatar sake duba hanyoyin isar da magungunan kashe kwari, gami da horar da ƙungiyoyin IRS da ilimin jama'a don ƙarfafa bin ƙa'idodi. IQK™ muhimmin kayan aiki ne mai kyau wanda ke inganta ingancin IRS kuma yana sauƙaƙa horar da masu samar da kiwon lafiya da yanke shawara ga manajoji a fannin sarrafa ƙwayoyin cuta na Chagas.
Cutar Chagas tana faruwa ne sakamakon kamuwa da kwayar cutar Trypanosoma cruzi (kinetoplastid: Trypanosomatidae), wacce ke haifar da cututtuka iri-iri a cikin mutane da sauran dabbobi. A cikin mutane, kamuwa da cuta mai tsanani yana faruwa makonni zuwa watanni bayan kamuwa da cuta kuma ana siffanta shi da zazzabi, rashin lafiya, da kuma hepatosplenomegaly. An kiyasta kashi 20-30% na kamuwa da cuta suna ci gaba zuwa nau'in da ke ci gaba da zama na yau da kullun, wanda galibi ana siffanta shi da lahani a cikin tsarin isar da sako, bugun zuciya, rashin aikin zuciya na hagu, da kuma gazawar zuciya mai cunkoso, da kuma, ba kasafai ake samunsa ba, cututtukan ciki. Waɗannan yanayi na iya dawwama tsawon shekaru da yawa kuma suna da wahalar magani [1]. Babu allurar rigakafi.
An kiyasta nauyin cutar Chagas a duniya a shekarar 2017 a kan mutane miliyan 6.2, wanda ya haifar da mutuwar mutane 7900 da kuma shekarun rayuwa 232,000 da aka daidaita ta hanyar nakasa (DALYs) ga dukkan shekaru [2,3,4]. Triatominus cruzi ana yada ta a ko'ina cikin Tsakiya da Kudancin Amurka, da kuma a wasu sassan Kudancin Amurka, ta hanyar Triatominus cruzi (Hemiptera: Reduviidae), wanda ya kai 30,000 (77%) na jimillar sabbin kamuwa da cutar a Latin Amurka a shekarar 2010 [5]. Sauran hanyoyin kamuwa da cutar a yankunan da ba su da cututtuka kamar Turai da Amurka sun haɗa da yaduwar cutar da aka haifa da kuma zubar da jinin da ya kamu da cutar. Misali, a Spain, akwai kimanin mutane 67,500 da suka kamu da cutar a tsakanin bakin haure na Latin Amurka [6], wanda ya haifar da farashin tsarin kiwon lafiya na shekara-shekara na dala miliyan 9.3 [7]. Tsakanin 2004 da 2007, kashi 3.4% na mata masu juna biyu 'yan asalin Latin Amurka da aka duba a wani asibiti a Barcelona sun nuna alamun cutar Trypanosoma cruzi [8]. Saboda haka, ƙoƙarin da ake yi na shawo kan yaduwar ƙwayoyin cuta a ƙasashen da ke fama da cutar yana da matuƙar muhimmanci don rage nauyin cutar a ƙasashen da ba su da ƙwayoyin cuta na triatomine [9]. Hanyoyin da ake amfani da su a yanzu sun haɗa da feshin ƙwayoyin cuta a cikin gida (IRS) don rage yawan ƙwayoyin cuta a cikin gidaje da kewaye, gwajin uwa don gano da kuma kawar da yaduwar ƙwayoyin cuta a cikin haihuwa, tantance wuraren dashen jini da gabobin jiki, da shirye-shiryen ilimi [5,10,11,12].
A Kudancin Cone na Kudancin Amurka, babban mai cutar shine kwaroron triatomine mai cutarwa. Wannan nau'in galibi yana da endivoreous da endivoreous kuma yana da nau'ikan da yawa a cikin gidaje da rumfunan dabbobi. A cikin gine-gine marasa kyau, tsagewa a bango da rufi suna ɗauke da kwaroron triatomine, kuma kamuwa da cuta a cikin gidaje yana da matuƙar tsanani [13, 14]. Shirin Southern Cone (INCOSUR) yana haɓaka ƙoƙarin ƙasa da ƙasa don yaƙi da cututtukan cikin gida a Tri. Yi amfani da IRS don gano ƙwayoyin cuta masu cutarwa da sauran magunguna na musamman a wurin [15, 16]. Wannan ya haifar da raguwa sosai a yawan kamuwa da cutar Chagas kuma daga baya Hukumar Lafiya ta Duniya ta tabbatar da cewa an kawar da yaduwar cutar ta hanyar vector a wasu ƙasashe (Uruguay, Chile, sassan Argentina da Brazil) [10, 15].
Duk da nasarar da INCOSUR ta samu, kwayar halittar Trypanosoma cruzi ta ci gaba da wanzuwa a yankin Gran Chaco na Amurka, wani yanayi na dazuzzuka da ke bushewa a lokacin damina wanda ya kai murabba'in kilomita miliyan 1.3 a kan iyakokin Bolivia, Argentina da Paraguay [10]. Mazauna yankin suna cikin ƙungiyoyin da aka fi mayar da hankali a kansu kuma suna rayuwa cikin matsanancin talauci tare da ƙarancin damar samun kulawar lafiya [17]. Yawan kamuwa da cutar T. cruzi da kuma yaɗuwar ƙwayoyin cuta a cikin waɗannan al'ummomi yana cikin mafi girma a duniya [5,18,19,20] tare da kashi 26-72% na gidaje da ke cike da ƙwayoyin cuta na trypanosomatids. infestans [13, 21] da kashi 40-56% na ƙwayoyin cuta na Tri. Masu cutarwa suna kamuwa da Trypanosoma cruzi [22, 23]. Mafi yawan (>93%) na duk shari'o'in cutar Chagas da ke ɗauke da ƙwayoyin cuta a yankin Southern Cone suna faruwa ne a Bolivia [5].
A halin yanzu IRS ita ce hanya ɗaya tilo da aka yarda da ita wajen rage triacine a cikin mutane. infestans dabara ce da aka tabbatar a tarihi don rage nauyin cututtuka da dama da ke ɗauke da ƙwayoyin cuta a cikin mutane [24, 25]. Kason gidaje a ƙauyen Tri. infestans (ƙididdigar kamuwa da cuta) babbar alama ce da hukumomin lafiya ke amfani da ita don yanke shawara game da tura IRS, kuma, mafi mahimmanci, don ba da hujjar maganin yara masu kamuwa da cuta na tsawon lokaci ba tare da haɗarin sake kamuwa da cuta ba [16, 26, 27, 28, 29]. Ingancin IRS da dorewar watsa ƙwayoyin cuta a yankin Chaco suna da tasiri ga abubuwa da yawa: rashin ingancin ginin gini [19, 21], hanyoyin aiwatar da IRS marasa kyau da sa ido kan cututtuka [30], rashin tabbas na jama'a game da buƙatun IRS Ƙarancin bin ƙa'idodi [31], ɗan gajeren aikin magungunan kashe kwari [32, 33] da Tri. infestans sun rage juriya da/ko rashin jin daɗin maganin kwari [22, 34].
Ana amfani da magungunan kashe kwari na roba na pyrethroid a IRS saboda yawansu na kashe ƙwayoyin triatomine masu saurin kamuwa da su. A ƙarancin yawansu, an kuma yi amfani da magungunan kashe kwari na pyrethroid a matsayin abubuwan da ke haifar da haushi don fitar da ƙwayoyin cuta daga cikin tsagewar bango don dalilai na sa ido [35]. Bincike kan kula da inganci na ayyukan IRS yana da iyaka, amma a wasu wurare an nuna cewa akwai bambance-bambance masu mahimmanci a cikin yawan sinadaran kashe kwari (AIs) da aka kai gidaje, tare da matakan da yawa suna faɗuwa ƙasa da iyakar yawan da aka yi niyya [33,36,37,38]. Ɗaya daga cikin dalilan rashin binciken kula da inganci shine cewa babban aikin chromatography na ruwa (HPLC), ma'aunin zinare don auna yawan sinadaran da ke aiki a cikin magungunan kashe kwari, yana da rikitarwa a zahiri, yana da tsada, kuma galibi bai dace da yanayi mai yaɗuwa a cikin al'umma ba. Ci gaban da aka samu kwanan nan a gwajin dakin gwaje-gwaje yanzu yana ba da hanyoyi daban-daban kuma masu araha don tantance isar da magungunan kashe kwari da ayyukan IRS [39, 40].
An tsara wannan binciken ne don auna canje-canje a yawan magungunan kashe kwari a lokacin kamfen na IRS na yau da kullun da ke kai hari ga ƙwayoyin cuta na Tri. Phytophthora a yankin Chaco, Bolivia. An auna yawan sinadaran maganin kashe kwari a cikin shirye-shiryen da aka shirya a cikin tankunan feshi da kuma samfuran takarda masu tacewa da aka tattara a cikin ɗakunan feshi. An kuma tantance abubuwan da za su iya tasiri ga isar da magungunan kashe kwari zuwa gidaje. Don wannan dalili, mun yi amfani da gwajin launi na sinadarai don auna yawan ƙwayoyin pyrethroids a cikin waɗannan samfuran.
An gudanar da binciken ne a garin Itanambicua, gundumar Camili, sashen Santa Cruz, Bolivia (20°1′5.94″ S; 63°30′41″ W) (Hoto na 1). Wannan yanki wani ɓangare ne na yankin Gran Chaco na Amurka kuma yana da alaƙa da dazuzzukan da ke bushewa a lokacin yanayi tare da yanayin zafi na 0–49°C da ruwan sama na 500–1000 mm/shekara [41]. Itanambicua yana ɗaya daga cikin al'ummomin Guaraní 19 a cikin birnin, inda kimanin mazauna 1,200 ke zaune a gidaje 220 da aka gina musamman daga tubalin hasken rana (adobe), shinge na gargajiya da tabiques (wanda aka sani da tabique), itace, ko gaurayen waɗannan kayan. Sauran gine-gine da gine-gine kusa da gidan sun haɗa da rumfunan dabbobi, ɗakunan ajiya, kicin da bayan gida, waɗanda aka gina daga kayan iri ɗaya. Tattalin arzikin yankin ya dogara ne akan noma na rayuwa, galibi masara da gyada, da kuma ƙananan kaji, aladu, awaki, agwagwa da kifi, tare da yawan amfanin gona na gida da ake sayarwa a garin Kamili na yankin (kimanin kilomita 12). Garin Kamili kuma yana ba da damammaki da dama na aikin yi ga jama'a, galibi a fannin gine-gine da ayyukan gida.
A cikin wannan binciken, adadin kamuwa da cutar T. cruzi tsakanin yara 'yan Itanambiqua (shekaru 2-15) ya kai kashi 20% [20]. Wannan yayi kama da yawan kamuwa da cutar a tsakanin yara da aka ruwaito a cikin al'ummar Guarani da ke makwabtaka, wanda kuma ya ga karuwar yaduwar cutar yayin da shekaru suka yi yawa, inda mafi yawan mazauna sama da shekaru 30 ke kamuwa da cutar [19]. Ana ɗaukar yaduwar cutar a matsayin babbar hanyar kamuwa da cutar a cikin waɗannan al'ummomi, inda Tri ita ce babbar hanyar kamuwa da cutar. Infestans suna mamaye gidaje da gine-gine [21, 22].
Sabuwar hukumar lafiya ta birni da aka zaɓa ba ta iya bayar da rahotanni kan ayyukan IRS a Itanambicua ba kafin wannan binciken, duk da haka rahotanni daga al'ummomin da ke kusa sun nuna a sarari cewa ayyukan IRS a cikin gundumar ba sa tafiya akai-akai tun daga 2000 kuma an yi feshin kashi 20% na beta cypermethrin a cikin 2003, sannan aka yi feshin gidaje da suka mamaye daga 2005 zuwa 2009 [22] da kuma feshin magani na yau da kullun daga 2009 zuwa 2011 [19].
A cikin wannan al'umma, ƙwararrun likitoci uku da aka horar da su a cikin al'umma sun yi aikin IRS ta amfani da kashi 20% na maganin alpha-cypermethrin suspension concentrate [SC] (Alphamost®, Hockley International Ltd., Manchester, UK). An tsara maganin kwari tare da yawan isar da shi na 50 mg ai/m2 bisa ga buƙatun Shirin Kula da Cututtuka na Chagas na Sashen Gudanarwa na Santa Cruz (Servicio Departamental de Salud-SEDES). An yi amfani da maganin kwari ta amfani da na'urar fesawa ta baya ta Guarany® (Guarany Indústria e Comércio Ltda, Itu, São Paulo, Brazil) mai ƙarfin aiki mai inganci na 8.5 l (lambar tanki: 0441.20), sanye take da bututun fesa mai faɗi da kuma yawan kwararar da ba a saba gani ba na 757 ml/min, wanda ke samar da kwararar kusurwa ta 80° a matsin lamba na silinda na 280 kPa. Ma'aikatan tsafta kuma sun haɗa gwangwanin aerosol da gidajen da aka fesa. Ma'aikatan sun riga sun sami horo daga ma'aikatar lafiya ta birnin yankin don shiryawa da isar da magungunan kashe kwari, da kuma fesa magungunan kashe kwari a bangon ciki da na waje na gidaje. Haka kuma ana shawartar su da su bukaci mazauna su share dukkan abubuwan da ke cikin gidan, gami da kayan daki (ban da firam ɗin gado), akalla awanni 24 kafin IRS ta ɗauki mataki don ba da damar shiga cikin gidan gaba ɗaya don fesawa. Ana auna bin wannan buƙatu kamar yadda aka bayyana a ƙasa. Ana kuma shawartar mazauna su jira har sai bangon da aka fenti ya bushe kafin su sake shiga gidan, kamar yadda aka ba da shawara [42].
Domin tantance yawan lambda-cypermethrin AI da aka kawo a gidaje, masu binciken sun sanya takardar tacewa (Whatman No. 1; diamita 55 mm) a saman bangon gidaje 57 da ke gaban IRS. Duk gidajen da suka karɓi IRS a wancan lokacin sun shiga (gidaje 25/25 a watan Nuwamba 2016 da gidaje 32/32 a watan Janairu-Fabrairu 2017). Waɗannan sun haɗa da gidajen adobe 52 da gidaje tabik 5. An sanya takarda tace guda takwas zuwa tara a kowane gida, an raba su zuwa tsayin bango uku (0.2, 1.2 da 2 m daga ƙasa), tare da zaɓar kowanne daga cikin bangon uku a akasin agogo, farawa daga babban ƙofar. Wannan ya samar da kwafi uku a kowane tsayin bango, kamar yadda aka ba da shawarar don sa ido kan isar da magungunan kashe kwari masu inganci [43]. Nan da nan bayan amfani da maganin kwari, masu binciken sun tattara takardar tacewa suka busar da ita daga hasken rana kai tsaye. Da zarar ta bushe, an naɗe takardar tacewa da tef mai haske don karewa da riƙe maganin kwari a saman da aka rufe, sannan a naɗe ta da foil ɗin aluminum a adana a zafin 7°C har sai an gwada. Daga cikin jimillar takardun tacewa 513 da aka tattara, gidaje 480 daga cikin 57 sun kasance don gwaji, wato takardun tacewa 8-9 a kowane gida. Samfuran gwajin sun haɗa da takardun tacewa 437 daga gidajen adobe 52 da takardun tacewa 43 daga gidaje 5. Samfurin ya yi daidai da yawan nau'ikan gidaje a cikin al'umma (76.2% [138/181] adobe da 11.6% [21/181] tabika) da aka rubuta a cikin binciken ƙofa zuwa ƙofa na wannan binciken. An bayyana nazarin takardar tacewa ta amfani da Kayan Ƙididdige Ƙwayoyin Cuta (IQK™) da ingancinsa ta amfani da HPLC a cikin Ƙarin Fayil na 1. Yawan magungunan kashe kwari da aka yi niyya shine 50 mg ai/m2, wanda ke ba da damar jurewa ± 20% (watau 40-60 mg ai/m2).
An tantance yawan adadin AI a cikin gwangwani 29 da ma'aikatan lafiya suka shirya. Mun yi samfurin tankuna 1-4 da aka shirya a kowace rana, tare da matsakaicin tankuna 1.5 (daga: 1-4) da aka shirya a kowace rana tsawon kwanaki 18. Jerin samfuran ya biyo bayan jerin samfuran da ma'aikatan kiwon lafiya suka yi amfani da su a watan Nuwamba 2016 da Janairu 2017. Ci gaban yau da kullun daga; Janairu Fabrairu. Nan da nan bayan haɗa abubuwan da ke ciki sosai, an tattara 2 ml na maganin daga saman abubuwan da ke ciki. Sannan an haɗa samfurin 2 mL a cikin dakin gwaje-gwaje ta hanyar yin vortex na minti 5 kafin a tattara samfuran 5.2 μL guda biyu kuma a gwada su ta amfani da IQK™ kamar yadda aka bayyana (duba Ƙarin fayil 1).
An auna yawan zubar da sinadarin maganin kwari a cikin tankuna huɗu na feshi da aka zaɓa musamman don wakiltar yawan sinadaran farko (sifili) a cikin kewayon sama, ƙasa, da manufa. Bayan haɗawa na tsawon mintuna 15 a jere, cire samfuran 5.2 µL guda uku daga saman kowane samfurin vortex na mL 2 a tazara na mintuna 1. Yawan maganin da aka yi niyya a cikin tankin shine 1.2 mg ai/ml ± 20% (watau 0.96–1.44 mg ai/ml), wanda yayi daidai da cimma yawan abin da aka yi niyya da aka kai wa takardar tacewa, kamar yadda aka bayyana a sama.
Domin fahimtar alaƙar da ke tsakanin ayyukan feshin maganin kwari da isar da magungunan kashe kwari, wani mai bincike (RG) ya raka ma'aikatan lafiya na IRS guda biyu na gida yayin da ake tura IRS zuwa gidaje 87 (gidaje 57 da aka yi samfurinsu a sama da gidaje 30 daga cikin gidaje 43 da aka fesa da magungunan kashe kwari). Maris 2016). An cire gidaje goma sha uku daga cikin waɗannan gidaje 43 daga cikin binciken: masu gidaje shida sun ƙi, kuma gidaje bakwai an yi musu magani kaɗan. An auna jimlar yankin saman da za a fesa (mita murabba'i) a ciki da wajen gidan dalla-dalla, kuma an rubuta jimlar lokacin da ma'aikatan lafiya suka kashe wajen fesawa (minti) a ɓoye. Ana amfani da waɗannan bayanan shigarwa don ƙididdige ƙimar fesawa, wanda aka ayyana a matsayin yankin saman da aka fesa a minti ɗaya (m2/minti). Daga waɗannan bayanan, ana iya ƙididdige rabon fesawa da aka lura/ana tsammanin ana tsammani a matsayin ma'auni na dangi, tare da shawarar da aka ba da shawarar ƙimar fesawa ita ce 19 m2/minti ± 10% don takamaiman kayan aikin fesawa [44]. Don rabon da aka lura/ana tsammani, kewayon haƙuri shine 1 ± 10% (0.8–1.2).
Kamar yadda aka ambata a sama, an sanya takardar tacewa a bango gidaje 57. Domin gwada ko kasancewar takardar tacewa a gani ya shafi yawan feshi na ma'aikatan tsafta, an kwatanta yawan feshi a cikin waɗannan gidaje 57 da yawan feshi a gidaje 30 da aka yi wa magani a watan Maris na 2016 ba tare da an sanya takardar tacewa ba. An auna yawan feshi ne kawai a cikin gidaje masu takardar tacewa.
An tabbatar da cewa mazauna gidaje 55 sun cika ka'idojin tsaftace gidaje na IRS a baya, ciki har da gidaje 30 da aka fesa a watan Maris na 2016 da gidaje 25 da aka fesa a watan Nuwamba na 2016. 0–2 (0 = duk ko yawancin abubuwa suna nan a gidan; 1 = yawancin abubuwan da aka cire; 2 = an bar gidan gaba ɗaya). An yi nazarin tasirin bin ƙa'idodin mai shi kan yawan fesawa da yawan ƙwayoyin cuta na moxa.
An ƙididdige ƙarfin ƙididdiga don gano manyan karkacewa daga yawan alpha-cypermethrin da ake tsammani da aka yi amfani da shi a takardar tacewa, da kuma gano manyan bambance-bambance a cikin yawan kwari da kuma yawan feshi tsakanin ƙungiyoyin gidaje da aka haɗa su. An ƙididdige mafi ƙarancin ƙarfin ƙididdiga (α = 0.05) don mafi ƙarancin adadin gidaje da aka samo don kowace ƙungiya ta rukuni (watau, girman samfurin da aka ƙayyade) wanda aka ƙayyade a farkon tushe. A taƙaice, kwatanta matsakaicin yawan magungunan kashe kwari a cikin samfuri ɗaya a cikin kaddarorin 17 da aka zaɓa (wanda aka rarraba a matsayin masu mallakar da ba su bi ka'ida ba) yana da ƙarfin 98.5% don gano karkacewa 20% daga matsakaicin yawan da ake tsammani na 50 mg ai/m2, inda aka ƙididdige bambancin (SD = 10) bisa ga abubuwan da aka lura da aka buga a wani wuri [37, 38]. Kwatanta yawan maganin kwari a cikin gwangwani na aerosol da aka zaɓa a gida don daidai tasiri (n = 21) > 90%.
Kwatanta samfuran matsakaiciyar yawan magungunan kashe kwari guda biyu a cikin n = 10 da n = gidaje 12 ko matsakaicin yawan feshi a cikin n = 12 da n = gidaje 23 sun samar da ƙarfin ƙididdiga na 66.2% da 86.2% don ganowa. Ƙimar da ake tsammani don bambancin 20% shine 50 mg ai/m2 da 19 m2/min, bi da bi. A ra'ayin mazan jiya, an ɗauka cewa za a sami manyan bambance-bambance a cikin kowace ƙungiya don yawan feshi (SD = 3.5) da yawan kwari (SD = 10). Ƙarfin ƙididdiga ya kasance >90% don kwatancen daidai na ƙimar feshi tsakanin gidaje masu takardar tacewa (n = 57) da gidaje marasa takardar tacewa (n = 30). An yi duk lissafin wutar lantarki ta amfani da shirin SAMPSI a cikin software na STATA v15.0 [45]).
An duba takardun tacewa da aka tattara daga gidan ta hanyar haɗa bayanan zuwa samfurin tasirin binomial mai canzawa mai yawa (shirin MENBREG a cikin STATA v.15.0) tare da wurin ganuwar a cikin gidan (matakai uku) azaman sakamako bazuwar. Yawan hasken Beta. An yi amfani da samfuran -cypermethrin io don gwada canje-canje da ke da alaƙa da tsayin bangon nebulizer (matakai uku), ƙimar nebulization (m2/min), ranar shigar da IRS, da matsayin mai ba da sabis na kiwon lafiya (matakai biyu). An yi amfani da samfurin layi na gabaɗaya (GLM) don gwada alaƙar da ke tsakanin matsakaicin yawan alpha-cypermethrin akan takardar tacewa da aka kai wa kowane gida da yawan yawan maganin da ya dace a cikin tankin feshi. An binciki yawan magungunan kashe kwari a cikin maganin feshi akan lokaci ta hanyar haɗa ƙimar farko (lokaci sifili) azaman daidaitawar samfurin, gwada lokacin hulɗa na ID na tanki × lokaci (kwanaki). Ana gano wuraren bayanai na waje x ta hanyar amfani da ƙa'idar iyaka ta Tukey, inda x < Q1 – 1.5 × IQR ko x > Q3 + 1.5 × IQR. Kamar yadda aka nuna, an cire adadin feshi na gidaje bakwai da kuma matsakaicin yawan maganin kwari na gida ɗaya daga cikin nazarin kididdiga.
An tabbatar da daidaiton ƙididdigar sinadarai na ai IQK™ na yawan alpha-cypermethrin ta hanyar kwatanta ƙimar samfuran takarda mai tacewa guda 27 daga gidajen kaji uku da IQK™ da HPLC suka gwada (ma'aunin zinare), kuma sakamakon ya nuna alaƙa mai ƙarfi (r = 0.93; p < 0.001) (Hoto na 2).
Daidaita yawan alpha-cypermethrin a cikin samfuran takardar tacewa da aka tattara daga gidajen kaji bayan IRS, wanda aka auna ta hanyar HPLC da IQK™ (n = Takardun tacewa 27 daga gidajen kaji uku)
An gwada IQK™ akan takaddun tacewa guda 480 da aka tattara daga gidajen kaji guda 57. A kan takardar tacewa, abun cikin alpha-cypermethrin ya kasance daga 0.19 zuwa 105.0 mg ai/m2 (matsakaicin 17.6, IQR: 11.06-29.78). Daga cikin waɗannan, kashi 10.4% (50/480) ne kawai ke cikin kewayon yawan da ake so na 40-60 mg ai/m2 (Hoto na 3). Yawancin samfuran (84.0% (403/480)) suna da 60 mg ai/m2. Bambancin da aka kiyasta matsakaicin yawan da ake samu a kowace gida don matatun gwaji 8-9 da aka tattara a kowace gida shine girman girma, tare da matsakaicin 19.6 mg ai/m2 (IQR: 11.76-28.32, kewayon: 0. 60-67.45). Kashi 8.8% (5/57) ne kawai na wuraren da aka samu yawan magungunan kashe kwari da ake tsammani; Kashi 89.5% (51/57) sun kasance ƙasa da iyakokin kewayon da aka yi niyya, kuma kashi 1.8% (1/57) sun wuce iyakokin kewayon da aka yi niyya (Hoto na 4).
Rarraba yawan yawan alpha-cypermethrin akan matatun da aka tattara daga gidajen da aka yi wa magani da IRS (n = gidaje 57). Layin tsaye yana wakiltar kewayon yawan cypermethrin ai da aka yi niyya (50 mg ± 20% ai/m2).
Matsakaicin yawan beta-cypermethrin av akan takaddun tacewa 8-9 a kowace gida, wanda aka tattara daga gidaje da IRS ta sarrafa (n = gidaje 57). Layin kwance yana wakiltar kewayon yawan alpha-cypermethrin ai da aka yi niyya (50 mg ± 20% ai/m2). Sandunan kuskure suna wakiltar ƙananan da manyan iyakoki na ƙimar matsakaici da ke maƙwabtaka.
Matsakaicin yawan da aka kai wa matatun da tsayin bango na 0.2, 1.2 da 2.0 m sun kasance 17.7 mg ai/m2 (IQR: 10.70–34.26), 17.3 mg a .i./m2 (IQR: 11.43–26.91) da 17.6 mg ai/m2. bi da bi (IQR: 10.85–31.37) (an nuna a cikin Ƙarin fayil na 2). Dangane da ranar IRS, samfurin tasirin gauraye bai nuna wani bambanci mai mahimmanci a cikin yawan da aka samu tsakanin tsayin bango ba (z < 1.83, p > 0.067) ko manyan canje-canje ta hanyar fesawa (z = 1.84 p = 0.070). Matsakaicin yawan da aka samu ga gidajen adobe 5 bai bambanta da matsakaicin yawan da aka samu ga gidajen adobe 52 ba (z = 0.13; p = 0.89).
Yawan AI a cikin gwangwanin aerosol na Guarany® guda 29 da aka shirya daban-daban kafin amfani da IRS ya bambanta da 12.1, daga 0.16 mg na AI/mL zuwa 1.9 mg na AI/mL a kowace gwangwani (Hoto na 5). Kashi 6.9% (2/29) kawai na gwangwanin aerosol sun ƙunshi yawan AI a cikin adadin da aka yi niyya na 0.96–1.44 mg na AI/mL, da kuma 3.5% (1/29) na gwangwanin aerosol sun ƙunshi yawan AI fiye da 1.44 mg na AI/mL..
An auna matsakaicin yawan alpha-cypermethrin ai a cikin nau'ikan feshi guda 29. Layin kwance yana wakiltar yawan AI da aka ba da shawarar don gwangwanin aerosol (0.96–1.44 mg/ml) don cimma matsakaicin yawan AI da aka yi niyya na 40–60 mg/m2 a gidan kaji.
Daga cikin gwangwani 29 na aerosol da aka duba, guda 21 sun yi daidai da gidaje 21. Matsakaicin yawan ai da aka kai wa gidan bai shafi yawan da ke cikin tankunan feshi da aka yi amfani da su wajen kula da gidan ba (z = -0.94, p = 0.345), wanda aka nuna a cikin ƙarancin haɗin gwiwa (rSp2 = -0.02) (Hoto na .6).
Alaƙa tsakanin yawan sinadarin beta-cypermethrin AI akan takardun tacewa 8-9 da aka tattara daga gidajen da aka yi wa magani da IRS da kuma yawan sinadarin AI a cikin maganin feshi da aka shirya a gida da ake amfani da shi don magance kowace gida (n = 21)
Yawan AI a cikin mafita na saman feshi guda huɗu da aka tattara nan da nan bayan girgiza (lokacin 0) ya bambanta da 3.3 (0.68–2.22 mg AI/ml) (Hoto na 7). Ga tanki ɗaya ƙimar tana cikin kewayon manufa, ga tanki ɗaya ƙimar tana sama da abin da aka nufa, ga sauran tanki biyu ƙimar tana ƙasa da abin da aka nufa; Sannan yawan magungunan kashe kwari ya ragu sosai a cikin dukkan tafkuna huɗu a lokacin ɗaukar samfurin bin diddigin mintuna 15 (b = −0.018 zuwa −0.084; z > 5.58; p < 0.001). Idan aka yi la'akari da ƙimar farko ta tanki ɗaya, ID na Tanki x Lokacin hulɗar lokaci (minti) ba shi da mahimmanci (z = -1.52; p = 0.127). A cikin tafkuna huɗu, matsakaicin asarar maganin kwari na mg ai/ml shine kashi 3.3% a minti ɗaya (95% CL 5.25, 1.71), wanda ya kai kashi 49.0% (95% CL 25.69, 78.68) bayan mintuna 15 (Hoto na 7).
Bayan an haɗa ruwan da ke cikin tankunan sosai, an auna yawan ruwan sama na alpha-cypermethrin ai. a cikin tankunan feshi guda huɗu a tazara ta minti 1 na tsawon minti 15. An nuna layin da ke wakiltar mafi dacewa da bayanai ga kowane tafki. Abubuwan lura (maki) suna wakiltar matsakaicin samfuran samfura uku.
Matsakaicin yankin bango a kowane gida don yiwuwar maganin IRS shine 128 m2 (IQR: 99.0–210.0, kewayon: 49.1–480.0) kuma matsakaicin lokacin da ma'aikatan kiwon lafiya suka kashe shine mintuna 12 (IQR: 8. 2–17.5, kewayon: 1.5–36.6).) an fesa kowace gida (n = 87). An lura da fesawa a cikin waɗannan gidajen kaji daga 3.0 zuwa 72.7 m2/min (matsakaici: 11.1; IQR: 7.90–18.00) (Hoto na 8). An cire waɗanda ba su da shi kuma an kwatanta fesawa da kewayon fesawa da WHO ta ba da shawarar na 19 m2/min ± 10% (17.1–20.9 m2/min). 7.5% (6/80) na gidaje ne kawai ke cikin wannan kewayon; Kashi 77.5% (62/80) suna cikin ƙananan iyaka kuma kashi 15.0% (12/80) suna cikin manyan iyaka. Ba a sami wata alaƙa tsakanin matsakaicin yawan AI da aka kai wa gidaje da kuma yadda aka lura da feshi ba (z = -1.59, p = 0.111, n = gidaje 52).
An lura da yawan feshi (min/m2) a gidajen kaji da aka yi wa magani da IRS (n = 87). Layin ma'auni yana wakiltar kewayon juriyar feshi da ake tsammanin na 19 m2/min (±10%) da aka ba da shawarar ta hanyar ƙayyadaddun kayan aikin feshi na tankin feshi.
Kashi 80% na gidaje 80 suna da rabon feshi da aka lura/ana sa ran samu a waje da kewayon jurewa na 1 ± 10%, inda kashi 71.3% (57/80) na gidaje suka kasance ƙasa, kashi 11.3% (9/80) ya kasance mafi girma, kuma gidaje 16 sun faɗi cikin kewayon jurewa a cikin kewayon. An nuna rarraba mitar ƙimar rabo da aka lura/ana sa ran a cikin Ƙarin fayil na 3.
Akwai babban bambanci a matsakaicin ƙimar nebulization tsakanin ma'aikatan kiwon lafiya guda biyu waɗanda ke yin IRS akai-akai: 9.7 m2/min (IQR: 6.58–14.85, n = 68) idan aka kwatanta da 15.5 m2/min (IQR: 13.07–21.17, n = 12). (z = 2.45, p = 0.014, n = 80) (kamar yadda aka nuna a Ƙarin Fayil 4A) da kuma rabon fesawa da aka lura/ana tsammanin (z = 2.58, p = 0.010) (kamar yadda aka nuna a Ƙarin Fayil 4B Show).
Banda yanayi marasa kyau, ma'aikacin lafiya ɗaya ne kawai ya fesa gidaje 54 inda aka sanya takardar tacewa. Matsakaicin adadin fesawa a waɗannan gidaje shine 9.23 m2/min (IQR: 6.57–13.80) idan aka kwatanta da 15.4 m2/min (IQR: 10.40–18.67) a cikin gidaje 26 ba tare da takardar tacewa ba (z = -2.38, p = 0.017).
Biyan buƙatun gidaje na barin gidajensu don isar da kayayyaki daga IRS ya bambanta: kashi 30.9% (17/55) ba su bar gidajensu ba wani ɓangare kuma kashi 27.3% (15/55) ba su bar gidajensu gaba ɗaya ba; sun lalata gidajensu.
Matakan feshi da aka lura a gidajen da ba su da komai (17.5 m2/min, IQR: 11.00–22.50) sun fi na gidajen da ba su da komai (14.8 m2/min, IQR: 10.29–18 .00) da kuma gidajen da ba su da komai (11.7 m2). /min, IQR: 7.86–15.36), amma bambancin bai yi yawa ba (z > -1.58; p > 0.114, n = 48) (wanda aka nuna a cikin Ƙarin fayil 5A). An sami irin wannan sakamako lokacin da aka yi la'akari da canje-canje da ke da alaƙa da kasancewar ko rashin takardar tacewa, wanda ba a gano a matsayin babban covariate a cikin samfurin ba.
A cikin rukunonin uku, cikakken lokacin da ake buƙata don fesa gidaje bai bambanta tsakanin gidaje ba (z < -1.90, p > 0.057), yayin da matsakaicin yankin saman ya bambanta: gidaje marasa komai (104 m2 [IQR: 60.0–169, 0 m2)]) ya fi ƙanƙanta a kididdiga fiye da gidaje marasa komai (224 m2 [IQR: 174.0–284.0 m2]) da gidaje marasa komai (132 m2 [IQR: 108.0–384.0 m2]) (z > 2 .17; p < 0.031, n = 48). Gidajen da babu kowa gaba ɗaya kusan rabin girman (yankin) gidajen da ba babu kowa ko rabin sarari ba ne.
Ga ƙaramin adadin gidaje (n = 25) waɗanda ke da bayanan bin ƙa'idodi da kuma na magungunan kashe ƙwari, babu wani bambanci a cikin matsakaicin yawan AI da aka kai wa gidaje tsakanin waɗannan nau'ikan bin ƙa'idodi (z < 0.93, p > 0.351), kamar yadda aka ƙayyade a cikin Ƙarin Fayil na 5B. An sami irin wannan sakamako lokacin da ake sarrafa kasancewar/rashin takardar tacewa da kuma rufewar feshi da aka lura (n = 22).
Wannan binciken ya kimanta ayyuka da hanyoyin IRS a cikin al'ummar karkara ta yau da kullun a yankin Gran Chaco na Bolivia, yanki mai dogon tarihi na watsa vector [20]. Yawan alpha-cypermethrin ai da ake bayarwa a lokacin IRS na yau da kullun ya bambanta sosai tsakanin gidaje, tsakanin matatun mutum ɗaya a cikin gidan, da kuma tsakanin tankunan feshi guda ɗaya da aka shirya don cimma irin wannan yawan ai/m2 na 50 mg. Kashi 8.8% na gidaje (10.4% na matatun) ne kawai ke da yawan a cikin kewayon da aka nufa na 40-60 mg ai/m2, tare da mafi yawan (89.5% da 84% bi da bi) suna da yawan a cikin ƙasa da ƙarancin iyaka da aka yarda.
Ɗaya daga cikin abubuwan da ke iya haifar da rashin kyawun isar da alpha-cypermethrin zuwa gida shine rashin daidaiton narkewar magungunan kashe kwari da kuma matakan dakatarwa marasa daidaito da aka shirya a cikin tankunan feshi [38, 46]. A cikin wannan binciken, lura da masu binciken suka yi wa ma'aikatan kiwon lafiya ya tabbatar da cewa sun bi girke-girke na shirya magungunan kashe kwari kuma SEDES sun horar da su don su motsa maganin sosai bayan an narkar da shi a cikin tankin feshi. Duk da haka, nazarin abubuwan da ke cikin tafki ya nuna cewa yawan AI ya bambanta da kashi 12, tare da kashi 6.9% kawai (2/29) na mafita na tafki na gwaji suna cikin kewayon da aka nufa; Don ƙarin bincike, an ƙididdige mafita a saman tankin feshi a yanayin dakin gwaje-gwaje. Wannan yana nuna raguwar layi a cikin alpha-cypermethrin ai na 3.3% a minti daya bayan gauraya da kuma asarar jimillar ai na 49% bayan mintuna 15 (95% CL 25.7, 78.7). Yawan zubar da ruwa mai yawa sakamakon tarin magungunan kashe kwari da aka samar bayan narkar da maganin foda mai laushi (WP) ba sabon abu bane (misali, DDT [37, 47]), kuma wannan binciken ya ƙara nuna wannan ga magungunan kashe kwari na SA. Ana amfani da sinadaran da aka tattara sosai a cikin IRS kuma, kamar duk shirye-shiryen kashe kwari, kwanciyar hankalinsu na zahiri ya dogara da abubuwa da yawa, musamman girman barbashi na sinadarin da ke aiki da sauran sinadaran. Haka kuma, zubar da ruwa na iya shafar taurin ruwan da ake amfani da shi don shirya slurry, wani abu da ke da wahalar sarrafawa a fagen. Misali, a cikin wannan wurin binciken, samun ruwa ya takaita ne ga kogunan gida waɗanda ke nuna bambancin yanayi a cikin kwarara da barbashi na ƙasa da aka dakatar. Ana gudanar da bincike kan hanyoyin sa ido kan daidaiton yanayin abubuwan da ke cikin SA [48]. Duk da haka, an yi amfani da magungunan subcutaneous cikin nasara don rage kamuwa da cuta a cikin ƙwayoyin cuta masu cutarwa na Tri. a wasu sassan Latin Amurka [49].
An kuma bayar da rahoton rashin isassun magungunan kashe kwari a wasu shirye-shiryen sarrafa vector. Misali, a cikin shirin kula da leishmaniasis na visceral a Indiya, kashi 29% ne kawai na ƙungiyoyin feshi 51 suka sa ido kan maganin DDT da aka shirya daidai kuma aka haɗa su, kuma babu wani tankin feshi da aka cika kamar yadda aka ba da shawara [50]. Wani kimantawa na ƙauyuka a Bangladesh ya nuna irin wannan yanayin: kashi 42-43% ne kawai na ƙungiyoyin sashen IRS suka shirya maganin kwari da kuma cike gwangwani kamar yadda aka tsara, yayin da a wani ƙaramin gunduma adadi ya kasance kashi 7.7% kawai [46].
Canje-canjen da aka lura a cikin yawan AI da aka kawo cikin gida ba su da wani bambanci. A Indiya, kashi 7.3% ne kawai (41 cikin 560) na gidaje da aka yi wa magani suka sami yawan DDT da aka nufa, tare da bambance-bambance a cikin gidaje da tsakanin su sun yi daidai [37]. A Nepal, takardar tacewa ta sha matsakaicin 1.74 mg ai/m2 (iyaka: 0.0–17.5 mg/m2), wanda shine kashi 7% kawai na yawan da aka nufa (25 mg ai/m2) [38]. Binciken HPLC na takardar tacewa ya nuna manyan bambance-bambance a cikin yawan deltamethrin ai akan bangon gidaje a Chaco, Paraguay: daga 12.8–51.2 mg ai/m2 zuwa 4.6–61.0 mg ai/m2 akan rufin gidaje [33]. A Tupiza, Bolivia, Shirin Kula da Chagas ya ba da rahoton isar da deltamethrin zuwa gidaje biyar a yawan 0.0–59.6 mg/m2, wanda HPLC ta ƙididdige [36].
Lokacin Saƙo: Afrilu-16-2024