Kufikira kumankhwala ophera tizilombo-maukonde ogona omwe amachiritsidwa komanso kugwiritsa ntchito IRS m'nyumba kunathandiza kuchepetsa kwambiri kufalikira kwa malungo pakati pa akazi a msinkhu wobereka ku Ghana. Kupeza kumeneku kukulimbitsa kufunika kochitapo kanthu mokwanira polimbana ndi malungo kuti athandize kuthetsa malungo ku Ghana.
Deta ya kafukufukuyu yachokera ku Ghana Malaria Indicator Survey (GMIS). GMIS ndi kafukufuku woimira dziko lonse wochitidwa ndi Ghana Statistical Service kuyambira Okutobala mpaka Disembala 2016. Mu kafukufukuyu, akazi okha azaka zobereka azaka zapakati pa 15-49 ndi omwe adachita nawo kafukufukuyu. Azimayi omwe anali ndi deta pazinthu zonse adaphatikizidwa mu kusanthulaku.
Pa kafukufuku wa 2016, MIS ya ku Ghana idagwiritsa ntchito njira yowerengera magulu m'magawo ambiri m'magawo onse 10 a dzikolo. Dzikoli limagawidwa m'magulu 20 (magawo 10 ndi mtundu wa malo okhala - mumzinda/kumidzi). Gulu limatanthauzidwa ngati dera lowerengera anthu (CE) lomwe lili ndi mabanja pafupifupi 300-500. Mu gawo loyamba la zitsanzo, magulu amasankhidwa pa gulu lililonse ndi mwayi wofanana ndi kukula kwake. Magulu onse 200 adasankhidwa. Mu gawo lachiwiri la zitsanzo, chiwerengero chokhazikika cha mabanja 30 chidasankhidwa mwachisawawa kuchokera ku gulu lililonse losankhidwa popanda kusinthidwa. Nthawi iliyonse ikatheka, tidafunsa akazi azaka zapakati pa 15-49 m'banja lililonse [8]. Kafukufuku woyamba adafunsa akazi 5,150. Komabe, chifukwa chosayankha pazinthu zina, akazi okwana 4861 adaphatikizidwa mu kafukufukuyu, omwe akuyimira 94.4% ya akazi omwe ali mu chitsanzocho. Deta ikuphatikizapo zambiri zokhudza nyumba, mabanja, makhalidwe a akazi, kupewa malungo, ndi chidziwitso cha malungo. Deta inasonkhanitsidwa pogwiritsa ntchito njira yolumikizirana ndi anthu pa intaneti (CAPI) pamapiritsi ndi pamapepala. Oyang'anira deta amagwiritsa ntchito njira yowerengera anthu ndi kufufuza (CSPro) kuti asinthe ndikusamalira deta.
Zotsatira zazikulu za kafukufukuyu zinali kufalikira kwa malungo pakati pa akazi azaka zobereka 15-49, omwe amadziwika kuti ndi akazi omwe adanena kuti anali ndi vuto la malungo kamodzi m'miyezi 12 isanafike kafukufukuyu. Izi zikutanthauza kuti, kufalikira kwa malungo pakati pa akazi azaka zapakati pa 15-49 kunagwiritsidwa ntchito ngati njira yodziwira matenda enieni a malungo a RDT kapena microscopy pakati pa akazi chifukwa mayesowa sanalipo pakati pa akazi panthawi ya kafukufukuyu.
Njira zopewera zimenezi zinaphatikizapo kugwiritsa ntchito maukonde ophera tizilombo (ITN) m'nyumba ndi kugwiritsa ntchito IRS m'nyumba m'miyezi 12 kafukufukuyu asanachitike. Mabanja omwe adalandira njira zonse ziwirizi adaganiziridwa kuti adalowa nawo. Mabanja omwe anali ndi maukonde ophera tizilombo adatchulidwa kuti ndi akazi omwe amakhala m'nyumba zomwe zinali ndi ukonde umodzi wophera tizilombo, pomwe mabanja omwe ali ndi IRS adatchulidwa kuti ndi akazi omwe amakhala m'nyumba zomwe zidapatsidwa mankhwala ophera tizilombo mkati mwa miyezi 12 kafukufuku wa akazi asanachitike.
Kafukufukuyu adafufuza magulu awiri akuluakulu a zinthu zosiyanasiyana zomwe zimasokoneza, zomwe ndi makhalidwe a banja ndi makhalidwe a munthu aliyense payekha. Kuphatikizapo makhalidwe a banja; chigawo, mtundu wa nyumba (kumidzi-kumidzi), jenda la mutu wa banja, kukula kwa banja, kugwiritsa ntchito magetsi a pabanja, mtundu wa mafuta ophikira (olimba kapena osalimba), zipangizo zapansi, zipangizo zapakhoma, zipangizo za padenga, komwe madzi akumwa amapezeka (okwera kapena osakwera), mtundu wa chimbudzi (okwera kapena osakwera) ndi gulu la chuma cha pabanja (osauka, apakati ndi olemera). Magulu a makhalidwe a pabanja adasinthidwanso malinga ndi miyezo ya malipoti a DHS mu malipoti a 2016 GMIS ndi 2014 Ghana Demographic Health Survey (GDHS) [8, 9]. Makhalidwe a munthu payekha omwe adaganiziridwa anali ndi zaka za mayiyo, maphunziro apamwamba, momwe alili ndi pakati panthawi yofunsidwa mafunso, momwe alili ndi inshuwalansi yazaumoyo, chipembedzo, zambiri zokhudza kukhudzidwa ndi malungo m'miyezi 6 isanafike kuyankhulana, komanso momwe mayiyo alili ndi chidziwitso chokhudza nkhani za malungo. Mafunso asanu odziwa zambiri adagwiritsidwa ntchito poyesa chidziwitso cha akazi, kuphatikizapo chidziwitso cha akazi pa zomwe zimayambitsa malungo, zizindikiro za malungo, njira zopewera malungo, chithandizo cha malungo, ndi kuzindikira kuti malungo amathandizidwa ndi Ghana National Health Insurance Scheme (NHIS). Akazi omwe adapeza 0-2 adawonedwa kuti alibe chidziwitso chokwanira, akazi omwe adapeza 3 kapena 4 adawonedwa kuti ali ndi chidziwitso chochepa, ndipo akazi omwe adapeza 5 adawonedwa kuti ali ndi chidziwitso chokwanira chokhudza malungo. Zinthu zosiyanasiyana zakhala zikugwirizana ndi kupeza maukonde ophera tizilombo, IRS, kapena kuchuluka kwa malungo m'mabuku.
Makhalidwe a akazi oyambira adafupikitsidwa pogwiritsa ntchito ma frequency ndi ma percentage a ma classical variables, pomwe ma continuous variables adafupikitsidwa pogwiritsa ntchito njira ndi standard deviation. Makhalidwe amenewa adaphatikizidwa ndi momwe anthu akugwirira ntchito kuti aone kusalingana komwe kungachitike komanso kapangidwe ka anthu komwe kumasonyeza tsankho losokoneza. Mapu a contour adagwiritsidwa ntchito pofotokoza kufalikira kwa malungo pakati pa akazi komanso kufalikira kwa ma medication awiriwa potengera malo. Ziwerengero za mayeso a Scott Rao chi-square, zomwe zimafotokoza makhalidwe a kafukufuku (monga, stratification, clustering, and sampling weights), zidagwiritsidwa ntchito poyesa mgwirizano pakati pa kufalikira kwa malungo komwe kunachitika komanso mwayi wopeza ma medication ndi makhalidwe a m'deralo. Kufalikira kwa malungo komwe kunachitika kunawerengedwa ngati chiwerengero cha akazi omwe adakumana ndi vuto limodzi la malungo m'miyezi 12 kafukufukuyu asanachitike kugawidwa ndi chiwerengero chonse cha akazi oyenerera omwe adayesedwa.
Chitsanzo chosinthidwa cha Poisson regression chinagwiritsidwa ntchito poyesa momwe kupeza njira zochepetsera malungo kumakhudzira kuchuluka kwa malungo komwe kunanenedwa ndi akazi, pambuyo posintha mwayi wopeza kulemera kwa chithandizo (IPTW) ndikufufuza kulemera pogwiritsa ntchito chitsanzo cha "svy-linearization" mu Stata IC. (Stata Corporation, College Station, Texas, USA). Kuthekera kotheratu kwa kulemera kwa chithandizo (IPTW) pa chithandizo cha "i" ndi "j" cha mkazi kumayesedwa motere:
Zosintha zomaliza zolemera zomwe zimagwiritsidwa ntchito mu chitsanzo cha Poisson regression zimasinthidwa motere:
Pakati pawo, \(fw_{ij}\) ndi chosinthika chomaliza cha kulemera kwa munthu payekha ndipo kulowererapo i, \(sw_{ij}\) ndi kulemera kwa chitsanzo cha munthu payekha ndi kulowererapo i mu 2016 GMIS.
Lamulo loti "margins, dydx (intervention_i)" mu Stata linagwiritsidwa ntchito kuyerekeza kusiyana kwapakati (zotsatira) za kulowererapo kwa "i" pa kufalikira kwa malungo komwe kunanenedwa mwa akazi pambuyo poyika chitsanzo chosinthidwa cha Poisson regression kuti chiwongolere. Zonsezi zinawona zinthu zosokoneza.
Mitundu itatu yosiyana ya regression inagwiritsidwanso ntchito ngati kusanthula kwa sensitivity: binary logistic regression, probabilistic regression, ndi linear regression models kuti ayese momwe njira iliyonse yowongolera malungo imakhudzira kufalikira kwa malungo pakati pa akazi aku Ghana. 95% ya chidaliro pakati pa ziwerengero zonse za kufalikira kwa malungo, kuchuluka kwa kufalikira, ndi kuyerekezera zotsatira. Kusanthula konse kwa ziwerengero mu kafukufukuyu kunaonedwa kuti n'kofunika kwambiri pamlingo wa alpha wa 0.050. Stata IC version 16 (StataCorp, Texas, USA) idagwiritsidwa ntchito posanthula ziwerengero.
Mu zitsanzo zinayi zoyerekeza, kuchuluka kwa malungo komwe kunanenedwa kuti kunali kotsika kwambiri pakati pa akazi omwe amalandira ITN ndi IRS poyerekeza ndi akazi omwe amalandira ITN yokha. Komanso, mu chitsanzo chomaliza, anthu omwe amagwiritsa ntchito ITN ndi IRS sanawonetse kuchepa kwakukulu kwa kuchuluka kwa malungo poyerekeza ndi anthu omwe amagwiritsa ntchito IRS yokha.
Zotsatira za kupezeka kwa njira zothana ndi malungo pa kuchuluka kwa malungo komwe kunanenedwa ndi akazi malinga ndi momwe mabanja alili
Zotsatira za kupeza njira zothanirana ndi malungo pa kufalikira kwa malungo pakati pa akazi, malinga ndi makhalidwe a akazi.
Phukusi la njira zopewera matenda a malungo linathandiza kwambiri kuchepetsa kufalikira kwa malungo pakati pa akazi a msinkhu wobereka ku Ghana. Kufalikira kwa malungo komwe kunadziwika kokha kunachepa ndi 27% pakati pa akazi omwe amagwiritsa ntchito maukonde ophera tizilombo ndi IRS. Kupeza kumeneku kukugwirizana ndi zotsatira za kafukufuku wolamulidwa mwachisawawa womwe unawonetsa kuchuluka kochepa kwa matenda a malungo a DT pakati pa ogwiritsa ntchito IRS poyerekeza ndi omwe si ogwiritsa ntchito IRS m'dera lomwe lili ndi matenda ambiri a malungo koma miyezo yapamwamba ya ITN ku Mozambique [19]. Kumpoto kwa Tanzania, maukonde ophera tizilombo ndi IRS adaphatikizidwa kuti achepetse kwambiri kuchuluka kwa Anopheles ndi kuchuluka kwa katemera wa tizilombo [20]. Njira zophatikizira zopewera matenda a malungo zimathandizidwanso ndi kafukufuku wa anthu m'chigawo cha Nyanza kumadzulo kwa Kenya, komwe kunapeza kuti kupopera mankhwala m'nyumba ndi maukonde ophera tizilombo kunali kothandiza kwambiri kuposa mankhwala ophera tizilombo. Kuphatikiza kumeneku kungapereke chitetezo chowonjezera ku malungo. maukonde amaganiziridwa padera [21].
Kafukufukuyu adawonetsa kuti akazi 34% adadwala malungo m'miyezi 12 isanafike kafukufukuyu, ndipo 95% anali ndi chidaliro pakati pa 32-36%. Akazi okhala m'mabanja omwe ali ndi maukonde ophera tizilombo (33%) anali ndi chiŵerengero chochepa kwambiri cha matenda a malungo poyerekeza ndi akazi okhala m'mabanja omwe alibe maukonde ophera tizilombo (39%). Mofananamo, akazi okhala m'mabanja omwe adapopera mankhwala anali ndi chiŵerengero cha matenda a malungo cha 32%, poyerekeza ndi 35% m'mabanja omwe sanapopera mankhwala. Zimbudzi sizinakonzedwe ndipo ukhondo ndi woipa. Ambiri mwa iwo ali panja ndipo madzi odetsedwa amasonkhana m'madziwo. Madzi osasunthika, odetsedwa awa amapereka malo abwino oberekera udzudzu wa Anopheles, womwe ndi woyambitsa malungo ku Ghana. Zotsatira zake, zimbudzi ndi ukhondo sizinasinthe, zomwe zidapangitsa kuti malungo afalikire kwambiri m'mabanja ndi m'madera osiyanasiyana. Ntchito ziyenera kukulitsidwa kuti zimbudzi ndi ukhondo zipitirire m'mabanja ndi m'madera osiyanasiyana.
Kafukufukuyu ali ndi zofooka zingapo zofunika. Choyamba, kafukufukuyu adagwiritsa ntchito deta yofufuza yomwe imagwiritsa ntchito magawo osiyanasiyana, zomwe zimapangitsa kuti zikhale zovuta kuyeza chifukwa cha vutoli. Pofuna kuthana ndi vutoli, njira zowerengera za chifukwa cha vutoli zinagwiritsidwa ntchito poyesa kuchuluka kwa chithandizo chomwe chimachitika chifukwa cha vutoli. Kusanthulaku kumasintha momwe chithandizochi chimagwiritsidwira ntchito ndipo kumagwiritsa ntchito zinthu zofunika kwambiri poyesa zotsatira zomwe zingachitike kwa akazi omwe mabanja awo adalandira chithandizochi (ngati palibe chithandizo) komanso kwa akazi omwe mabanja awo sanalandire chithandizochi.
Chachiwiri, kupeza maukonde oteteza ku matenda ophera tizilombo sikutanthauza kugwiritsa ntchito maukonde oteteza ku matenda ophera tizilombo, choncho kusamala kuyenera kugwiritsidwa ntchito potanthauzira zotsatira ndi mfundo za kafukufukuyu. Chachitatu, zotsatira za kafukufukuyu pa malungo omwe akazi adadzinenera okha ndi umboni wa kufalikira kwa malungo pakati pa akazi m'miyezi 12 yapitayi ndipo chifukwa chake zitha kusokonezedwa ndi kuchuluka kwa chidziwitso cha akazi chokhudza malungo, makamaka milandu yomwe sinapezeke.
Pomaliza, kafukufukuyu sanafotokoze milandu ingapo ya malungo pa munthu aliyense panthawi ya chaka chimodzi, komanso nthawi yeniyeni ya zochitika za malungo ndi njira zothandizira. Popeza pali zofooka za maphunziro owonera, mayeso olimba kwambiri olamulidwa mwachisawawa adzakhala chinthu chofunikira kwambiri pa kafukufuku wamtsogolo.
Mabanja omwe adalandira ITN ndi IRS anali ndi chiwerengero chochepa cha malungo poyerekeza ndi mabanja omwe sanalandire chithandizo chilichonse. Izi zikugwirizana ndi pempho loti pakhale mgwirizano pakati pa ntchito zothana ndi malungo kuti athandize kuthetsa malungo ku Ghana.
Nthawi yotumizira: Okutobala-15-2024