Komo ilāʻau lāʻau lāʻauʻO nā ʻupena moe i mālama ʻia a me ka hoʻokō ʻana i ka home-level IRS i hāʻawi i ka hōʻemi nui o ka maʻi malaria i hōʻike ʻia ma waena o nā wahine o ka makahiki hānau ma Ghana. Hoʻoikaika kēia ʻike i ka pono o ka pane ʻana i ka maʻi malaria e kōkua i ka hoʻopau ʻana i ka maʻi maʻi ma Ghana.
Kuhi ʻia nā ʻikepili no kēia noiʻi mai ka Ghana Malaria Indicator Survey (GMIS). ʻO ka GMIS kahi noiʻi ʻelele aupuni i mālama ʻia e ka Ghana Statistical Service mai ʻOkakopa a Dekemaba 2016. Ma kēia noiʻi ʻana, ʻo nā wahine hānau keiki wale nō nā makahiki 15-49 i komo i ka anamanaʻo. ʻO nā wāhine i loaʻa kaʻikepili i nā mea hoʻololi a pau i hoʻokomoʻia i ka hōʻuluʻulu.
No ke aʻo ʻana o 2016, ua hoʻohana ʻo MIS o Ghana i kahi kaʻina hana hoʻohālike puʻupuʻu lehulehu ma nā wahi āpau o 10 o ka ʻāina. Hoʻokaʻawale ʻia ka ʻāina i 20 mau papa (10 mau ʻāina a me ke ʻano o ka noho ʻana - kūlanakauhale / kuaʻāina). Ua wehewehe ʻia kahi pūʻulu ma ke ʻano he census enumeration area (CE) ma kahi o 300-500 mau ʻohana. Ma ka pae hoʻohālike mua, koho ʻia nā pūʻulu no kēlā me kēia stratum me ka like like me ka nui. Ua koho ʻia he 200 hui. Ma ka lua o ka la'ana, ua koho wale 'ia ka heluna o 30 mau hale mai kela a me keia puulu i waeia me ka pani ole. I nā manawa e hiki ai, ua nīnauele mākou i nā wāhine he 15-49 makahiki i kēlā me kēia hale. Ua ninaninau ka noiʻi mua i 5,150 wahine. Eia naʻe, ma muli o ka pane ʻole ʻana i kekahi mau mea hoʻololi, he 4861 mau wahine i hoʻokomo ʻia i loko o kēia haʻawina, e hōʻike ana i ka 94.4% o nā wahine i ka hāpana. Aia ka ʻikepili i ka ʻike e pili ana i ka hale, nā hale, nā ʻano wahine, ka pale ʻana i ka maʻi malaria, a me ka ʻike malaria. Ua hōʻiliʻili ʻia ka ʻikepili me ka hoʻohana ʻana i kahi ʻōnaehana nīnauele pilikino kōkua kamepiula (CAPI) ma nā papa a me nā nīnau pepa. Hoʻohana nā luna ʻikepili i ka ʻōnaehana Census and Survey Processing (CSPro) e hoʻoponopono a mālama i ka ʻikepili.
ʻO ka hopena mua o kēia noiʻi ʻana ʻo ia ka maʻi malaria i hōʻike ʻia ma waena o nā wahine hānau keiki 15-49 mau makahiki, i wehewehe ʻia ʻo nā wahine i hōʻike i ka loaʻa ʻana o hoʻokahi manawa o ka maʻi malaria i nā mahina 12 ma mua o ke aʻo ʻana. ʻO ia hoʻi, ua hoʻohana ʻia ka maʻi malaria i hōʻike ʻia ma waena o nā wahine he 15-49 makahiki ma ke ʻano he koho no ka RDT malaria maoli a i ʻole microscopy positivity i waena o nā wahine no ka mea ʻaʻole i loaʻa kēia mau hoʻokolohua ma waena o nā wahine i ka manawa o ke aʻo ʻana.
Hoʻokomo ʻia nā hana i ka loaʻa ʻana o ka home i nā ʻupena lapaʻau insecticide-treated (ITN) a me ka hoʻohana ʻana i ka IRS i ka home i nā mahina 12 ma mua o ka hoʻokolokolo. Ua manaʻo ʻia nā ʻohana i loaʻa nā hana ʻelua. ʻO nā hale me ka loaʻa ʻana o nā ʻupena moe i mālama ʻia i nā pepeke, ua wehewehe ʻia ʻo ia nā wahine e noho ana i nā hale i loaʻa i hoʻokahi ʻupena moe i mālama ʻia i nā pepeke, aʻo nā home me IRS i wehewehe ʻia ʻo ia nā wahine e noho ana i nā hale i mālama ʻia me nā insecticides i loko o 12 mau mahina ma mua o ka noiʻi. o na wahine.
Ua nānā ka haʻawina i ʻelua ʻāpana ākea o nā mea hoʻololi hoʻohālikelike, ʻo ia hoʻi nā ʻano ʻohana a me nā ʻano pilikino. Loaʻa nā hiʻohiʻona hale; ʻāpana, ʻano noho (kūʻai-kūlanakauhale), ke kāne o ke poʻo ʻohana, ka nui o ka hale, ka hoʻohana ʻana i ka uila o ka hale, ke ʻano o ka wahie kuke (paʻa a paʻa ʻole paha), mea papahele nui, mea pā nui, mea hale, kumu wai inu. (hoʻomaikaʻi a hoʻomaikaʻi ʻole paha), ʻano halepaku (hoʻomaikaʻi a hoʻomaikaʻi ʻole paha) a me ka ʻāpana waiwai o ka hale (ʻilihune, waena a waiwai). Ua hoʻololi houʻia nāʻano o nāʻano o ka home e like me nā kūlana hōʻike DHS ma nā hōʻike 2016 GMIS a me 2014 Ghana Demographic Health Survey (GDHS) [8, 9]. ʻO nā hiʻohiʻona pilikino i manaʻo ʻia ʻo ia ka makahiki o ka wahine i kēia manawa, ka pae kiʻekiʻe o ka hoʻonaʻauao, ke kūlana hāpai i ka manawa o ka nīnauele, ke kūlana ʻinikua olakino, ka hoʻomana, ka ʻike e pili ana i ka maʻi malaria i nā mahina 6 ma mua o ka ninaninau, a me ka pae o ka ʻike o ka wahine e pili ana i ka malaria. pilikia. . Ua hoʻohana ʻia ʻelima mau nīnau ʻike no ka loiloi ʻana i ka ʻike wahine, me ka ʻike o nā wahine i nā kumu o ka maʻi maʻi, nā hōʻailona o ka maʻi maʻi, nā ʻano o ka pale ʻana i ka maʻi maʻi, ka mālama ʻana i ka maʻi maʻi, a me ka ʻike ua uhi ʻia ka maʻi maʻi e ka Ghana National Health Insurance Scheme (NHIS). Ua manaʻo ʻia he haʻahaʻa ka ʻike o nā wahine i loaʻa i ka 0-2, ʻo nā wahine i loaʻa i ka 3 a i ʻole 4 i manaʻo ʻia he haʻahaʻa ko lākou ʻike, a ʻo nā wahine i loaʻa i ka 5 ua manaʻo ʻia he ʻike piha e pili ana i ka maʻi malaria. Hoʻopili ʻia nā ʻano like ʻole me ka loaʻa ʻana o nā ʻupena lapaʻau insecticide, IRS, a i ʻole ka maʻi malaria ma ka palapala.
Ua hōʻuluʻulu ʻia nā hiʻohiʻona hope o nā wahine me ka hoʻohana ʻana i nā alapine a me nā pākēneka no nā ʻano like ʻole, ʻoiai ua hōʻuluʻulu ʻia nā ʻano hoʻololi mau me ka hoʻohana ʻana i nā ala a me nā ʻokoʻa maʻamau. Ua hōʻuluʻulu ʻia kēia mau hiʻohiʻona e ke kūlana intervention no ka nānā ʻana i nā imbalances kūpono a me ka hoʻolālā demographic e hōʻike ana i ka manaʻo hoʻohālikelike. Ua ho'ohana 'ia nā palapala 'āina no ka wehewehe 'ana i ka ma'i malaria i hō'ike 'ia ma waena o nā wāhine a me ka uhi 'ana i nā hana 'elua e ka wahi 'āina. Ua ho'ohana 'ia ka helu helu ho'ā'o chi-square Scott Rao, e pili ana i nā hi'ohi'ona ho'olālā noi'i ('o ia ho'i, stratification, clustering, a me sampling weights), no ka loiloi 'ana i ka pilina ma waena o ka ma'i malaria i hō'ike 'ia iho a me ke komo 'ana i nā hana a me nā hi'ohi'ona pili. Ua helu ʻia ka nui o ka maʻi malaria i hōʻike ʻia e like me ka nui o nā wahine i loaʻa ma kahi o hoʻokahi manawa o ka maʻi maʻi ma nā mahina 12 ma mua o ka hoʻopaʻa ʻana i puʻunaue ʻia e ka huina o nā wahine kūpono i nānā ʻia.
Ua hoʻohana ʻia kahi kumu hoʻohālike Poisson regression i hoʻololi ʻia e koho i ka hopena o ke komo ʻana i nā hana hoʻomalu malaria i ka maʻi malaria i hōʻike ʻia e nā wahine16, ma hope o ka hoʻololi ʻana no ka likelika inverse o nā kaupaona lapaʻau (IPTW) a me nā anana ana i ka hoʻohana ʻana i ke kumu hoʻohālike "svy-linearization" ma Stata IC . (Stata Corporation, College Station, Texas, USA). Ua manaʻo ʻia ka likelika o ka paona lapaʻau (IPTW) no ka hana "i" a me ka wahine "j":
Hoʻololi ʻia nā mea hoʻololi paona hope loa i hoʻohana ʻia i ke kumu hoʻohālike Poisson regression penei:
Ma waena o lākou, \(fw_{ij}\) ka hoʻololi paona hope o kēlā me kēia j a me ke komo ʻana i, \(sw_{ij}\) ʻo ia ka hāpana paona o kēlā me kēia j a me ke komo ʻana i ka GMIS 2016.
Ua hoʻohana ʻia ke kauoha post-estimation "margins, dydx (intervention_i)" ma Stata no ka hoʻohālikelike ʻana i ka ʻokoʻa marginal (hopena) o ka hana "i" ma luna o ka maʻi malaria i hōʻike ʻia ma waena o nā wahine ma hope o ka hoʻopili ʻana i kahi kumu hoʻohālikelike Poisson regression i hoʻololi ʻia e kāohi. ʻike ʻia nā mea hoʻololi huikau a pau.
Ua hoʻohana pū ʻia ʻekolu mau hiʻohiʻona regression e like me ka nānā ʻana i ka sensitivity: binary logistic regression, probabilistic regression, a me linear regression models e manaʻo ai i ka hopena o kēlā me kēia hana hoʻomalu malaria ma luna o ka hōʻike ponoʻī ʻana i ka maʻi maʻi ma waena o nā wahine Ghana. Ua manaʻo ʻia he 95% mau manawa hilinaʻi no nā helu helu prevalence a pau, ratio prevalence, a me nā koho hopena. Ua manaʻo nui ʻia nā loiloi helu helu āpau ma kēia haʻawina ma kahi pae alpha o 0.050. Ua hoʻohana ʻia ʻo Stata IC version 16 (StataCorp, Texas, USA) no ka ʻikepili helu.
I loko o ʻehā mau hiʻohiʻona regression, ʻaʻole i emi iki ka nui o ka maʻi malaria i hōʻike ʻia ma waena o nā wahine e loaʻa ana i ka ITN a me IRS i hoʻohālikelike ʻia me nā wahine e loaʻa ana i ka ITN wale nō. Eia kekahi, i ka hoʻohālike hope loa, ʻaʻole i hōʻike ka poʻe e hoʻohana ana i ka ITN a me IRS i kahi hōʻemi nui o ka maʻi maʻi malaria i hoʻohālikelike ʻia me ka poʻe e hoʻohana ana iā IRS wale nō.
Ka hopena o ke komo ʻana i nā hana anti-malaria ma luna o nā wahine i hōʻike ʻia i ka maʻi malaria e nā ʻano ʻohana
Ka hopena o ka loaʻa ʻana o ka maʻi maʻi maʻi ma luna o ka maʻi malaria i hōʻike ʻia ma waena o nā wahine, e nā ʻano wahine.
ʻO kahi pūʻolo o nā hoʻolālā pale ʻana i ka maʻi malaria i kōkua nui i ka hōʻemi ʻana i ka hōʻike pilikino o ka maʻi maʻi ma waena o nā wahine o ka makahiki hānau ma Ghana. Ua hōʻemi ʻia ka maʻi malaria i hōʻike ʻia e 27% ma waena o nā wahine e hoʻohana ana i nā ʻupena moe i mālama ʻia i ka insecticide a me IRS. Ua kūlike kēia ʻike me nā hopena o kahi hoʻokolohua hoʻokele randomized i hōʻike i ka haʻahaʻa haʻahaʻa o ka maʻi DT positivity i waena o nā mea hoʻohana IRS i hoʻohālikelike ʻia me nā mea hoʻohana ʻole IRS ma kahi wahi me ka maʻi malaria kiʻekiʻe akā nā kūlana kiʻekiʻe o ka loaʻa ʻana o ITN ma Mozambique [19]. Ma ka ʻĀkau ʻo Tanzania, ua hui pū ʻia nā ʻupena moe i mālama ʻia i ka insecticide a me IRS e hōʻemi nui i ka density Anopheles a me nā helu o ka lāʻau lapaʻau [20]. Kākoʻo pū ʻia nā hoʻolālā hoʻokele vector hoʻohui ʻia e kahi noiʻi heluna kanaka ma ka ʻāina ʻo Nyanza ma ke komohana o Kenya, kahi i ʻike ʻia ʻoi aku ka maikaʻi o ka hoʻoulu ʻana i loko a me nā ʻupena moe i mālama ʻia i nā pepeke ma mua o nā insecticides. Hiki i ka hui ʻana ke hāʻawi i ka pale hou aku i ka maʻi malaria. manaʻo kaʻawale nā pūnaewele [21].
Ua manaʻo kēia haʻawina he 34% o nā wahine i loaʻa i ka maʻi malaria i nā mahina he 12 ma mua o ka noiʻi ʻana, me ka 95% o ka manaʻo o ka manawa hilinaʻi o 32-36%. ʻO nā wāhine e noho ana i loko o nā hale me ka loaʻa ʻana o nā upena moe i mālama ʻia i ka lāʻau insecticide (33%) he haʻahaʻa haʻahaʻa loa ka nui o ka maʻi malaria i hōʻike ʻia iā lākou iho ma mua o nā wahine e noho ana i nā hale me ka loaʻa ʻole o nā upena moe i mālama ʻia i ka insecticide (39%). Pēlā nō, he 32% ka nui o ka maʻi malaria i hōʻike ʻia e nā wahine e noho ana i loko o nā hale i hoʻoheheʻe ʻia, i hoʻohālikelike ʻia me 35% i nā hale ʻaʻole i hoʻopā ʻia. ʻAʻole i hoʻomaikaʻi maikaʻi ʻia nā halepaku a maikaʻi ʻole nā kūlana maʻemaʻe. ʻO ka hapa nui o lākou aia ma waho a hōʻuluʻulu ka wai lepo i loko o lākou. Hāʻawi kēia mau kino wai ʻeleʻele i kahi ʻāina hoʻohua kūpono no nā makika Anopheles, ke kumu nui o ka maʻi maʻi ma Ghana. ʻO ka hopena, ʻaʻole i hoʻomaikaʻi maikaʻi nā halepaku a me nā kūlana hoʻomaʻemaʻe, i alakaʻi pololei i ka hoʻonui ʻia ʻana o ka maʻi malaria i loko o ka heluna kanaka. Pono e hoʻoikaika ʻia nā hana e hoʻomaikaʻi i nā halepaku a me nā kūlana hoʻomaʻemaʻe ma nā hale a me nā kaiāulu.
He mau palena koʻikoʻi kēia haʻawina. ʻO ka mea mua, ua hoʻohana ka haʻawina i ka ʻikepili noiʻi cross-sectional, i mea paʻakikī ke ana i ka kumu. No ka lanakila ʻana i kēia palena, ua hoʻohana ʻia nā ʻano helu kumu no ka hoʻohālikelike ʻana i ka hopena lapaʻau maʻamau o ka hana. Hoʻoponopono ka loiloi no ka hana lapaʻau a hoʻohana i nā ʻano nui e koho i nā hopena kūpono no nā wahine i loaʻa i ko lākou ʻohana ka wawao (inā ʻaʻohe hana) a no nā wahine i loaʻa ʻole i ko lākou ʻohana.
ʻO ka lua, ʻo ka loaʻa ʻana o nā ʻupena moe i mālama ʻia i nā pepeke ʻaʻole ia e pili ana i ka hoʻohana ʻana i nā ʻupena moe i mālama ʻia i nā pepeke, no laila pono e hoʻohana ʻia ke akahele i ka unuhi ʻana i nā hopena a me nā hopena o kēia haʻawina. ʻO ke kolu, ʻo nā hopena o kēia noiʻi e pili ana i ka maʻi malaria i hōʻike ʻia ma waena o nā wahine he mea koho no ka laha ʻana o ka maʻi maʻi ma waena o nā wahine i nā mahina he 12 i hala a no laila hiki ke hoʻohālikelike ʻia e ka pae o ka ʻike wahine e pili ana i ka maʻi malaria, ʻoi aku ka maikaʻi o nā hihia maikaʻi ʻole.
ʻO ka mea hope loa, ʻaʻole i helu ʻia ka haʻawina no nā maʻi maʻi malaria he nui i kēlā me kēia mea i loko o ka manawa kuhikuhi hoʻokahi makahiki, ʻaʻole hoʻi i ka manawa kūpono o nā maʻi malaria a me nā hana. Hāʻawi ʻia i nā palena o nā haʻawina nānā, ʻoi aku ka ikaika o nā hoʻokolohua hoʻokele randomized e lilo i mea noʻonoʻo nui no ka noiʻi e hiki mai ana.
ʻO nā hale i loaʻa iā ITN a me IRS he haʻahaʻa haʻahaʻa i hōʻike ʻia e ka maʻi malaria i hoʻohālikelike ʻia me nā hale i loaʻa ʻole i ka hana. Ke kākoʻo nei kēia ʻike i nā kāhea no ka hoʻohui ʻana i nā hana hoʻomalu malaria e kōkua i ka hoʻopau ʻana i ka maʻi maʻi ma Ghana.
Ka manawa hoʻouna: Oct-15-2024