Kufikira kumankhwala ophera tizilombo-maukonde ochiritsidwa ndi kukhazikitsidwa kwa IRS m'banja kunathandizira kuchepetsa kufala kwa malungo pakati pa amayi a msinkhu wobereka ku Ghana. Kupeza uku kukulimbitsa kufunikira kwa mayankho athunthu oletsa malungo kuti athandizire kuthetsa malungo ku Ghana.
Deta ya kafukufukuyu yatengedwa ku Ghana Malaria Indicator Survey (GMIS). GMIS ndi kafukufuku woimira dziko lonse wopangidwa ndi Ghana Statistical Service kuyambira October mpaka December 2016. Mu kafukufukuyu, amayi okha a msinkhu wobereka a zaka 15-49 ndi omwe adatenga nawo mbali pa kafukufukuyu. Azimayi omwe anali ndi deta pazosintha zonse adaphatikizidwa pakuwunika.
Pakafukufuku wa 2016, MIS ya ku Ghana idagwiritsa ntchito njira zotsatsira magulu osiyanasiyana m'magawo 10 a dzikolo. Dzikoli lagawidwa m'magulu 20 (zigawo 10 ndi mtundu wa malo okhala - m'tawuni / kumidzi). Cluster imatanthauzidwa ngati census enumeration area (CE) yokhala ndi mabanja pafupifupi 300–500. Mugawo loyamba lachitsanzo, magulu amasankhidwa pamtundu uliwonse wokhala ndi kuthekera kolingana ndi kukula kwake. Magulu okwana 200 anasankhidwa. Mugawo lachitsanzo lachiwiri, chiwerengero chokhazikika cha mabanja 30 adasankhidwa mwachisawawa kuchokera kumagulu osankhidwa popanda kusinthidwa. Zikatheka, tidafunsa amayi azaka zapakati pa 15-49 panyumba iliyonse [8]. Kafukufuku woyamba adafunsa amayi 5,150. Komabe, chifukwa chosayankhidwa pazinthu zina, akazi onse a 4861 adaphatikizidwa mu phunziroli, akuyimira 94.4% ya amayi omwe ali pachitsanzo. Deta ili ndi zambiri zokhudzana ndi nyumba, nyumba, mawonekedwe a amayi, kupewa malungo, komanso chidziwitso cha malungo. Deta inasonkhanitsidwa pogwiritsa ntchito makina ochezera a pakompyuta (CAPI) pamapiritsi ndi mafunso a mapepala. Oyang'anira deta amagwiritsa ntchito dongosolo la Census and Survey Processing (CSPro) kuti asinthe ndi kuyang'anira deta .
Chotsatira chachikulu cha kafukufukuyu chinali kufalikira kwa malungo pakati pa amayi azaka zapakati pa 15-49, omwe amafotokozedwa kuti ndi amayi omwe adanena kuti ali ndi kachilombo ka malungo m'miyezi 12 yapitayi. Izi zikutanthauza kuti, kufalikira kwa malungo pakati pa amayi azaka zapakati pa 15-49 kunagwiritsidwa ntchito ngati njira yothetsera malungo enieni a RDT kapena microscopy positivity pakati pa amayi chifukwa mayeserowa analibe pakati pa amayi panthawi ya kafukufuku.
Zochitapo zinaphatikizapo mwayi wapakhomo wopeza maukonde ophera tizilombo (ITN) komanso kugwiritsa ntchito IRS m'nyumba m'miyezi 12 kafukufukuyu asanachitike. Mabanja omwe adalandira njira ziwirizi adaganiziridwa kuti ndi ogwirizana. Mabanja omwe ali ndi mwayi wopeza maukonde okhala ndi mankhwala ophera tizilombo amafotokozedwa kuti ndi amayi omwe amakhala m'mabanja omwe anali ndi ukonde wokhala ndi mankhwala ophera tizilombo, pomwe mabanja omwe ali ndi IRS amatanthauzidwa kuti ndi amayi omwe amakhala m'mabanja omwe adathandizidwa ndi mankhwala mkati mwa miyezi 12 kafukufukuyu asanachitike. za akazi.
Kafukufukuyu adawunika magulu awiri ophatikizika amitundu yosokoneza, yomwe ndi mikhalidwe yabanja ndi mikhalidwe yamunthu. Zimaphatikizapo makhalidwe apakhomo; dera, mtundu wa nyumba (kumidzi ndi kumidzi), jenda kwa mutu wa banja, kukula kwa nyumba, magetsi apakhomo, mtundu wa mafuta ophikira (olimba kapena osalimba), zipangizo zapansi, khoma lalikulu, denga, gwero la madzi akumwa. (zotukuka kapena zosakonzedwa), mtundu wa chimbudzi (chotukuka kapena chosasinthika) ndi gulu lachuma chapakhomo (osauka, apakati ndi olemera). Magulu a machitidwe apakhomo adasinthidwanso malinga ndi miyezo ya malipoti ya DHS mu 2016 GMIS ndi 2014 Ghana Demographic Health Survey (GDHS) malipoti [8, 9]. Makhalidwe aumwini omwe amaganiziridwa ndi monga msinkhu wa mayiyo, mlingo wapamwamba wa maphunziro, msinkhu wa mimba panthawi yofunsa mafunso, inshuwalansi ya umoyo, chipembedzo, chidziwitso chokhudzana ndi matenda a malungo m'miyezi 6 isanayambe kuyankhulana, ndi chidziwitso cha mayiyo chokhudza malungo. nkhani. . Mafunso asanu odziwa zambiri anagwiritsidwa ntchito poyesa chidziwitso cha amayi, kuphatikizapo chidziwitso cha amayi cha zomwe zimayambitsa malungo, zizindikiro za malungo, njira zopewera malungo, chithandizo cha malungo, komanso kuzindikira kuti malungo akuphimbidwa ndi bungwe la Ghana National Health Insurance Scheme (NHIS). Azimayi omwe adagoletsa 0-2 ankaonedwa kuti anali ndi chidziwitso chochepa, amayi omwe adapeza 3 kapena 4 ankaonedwa kuti ali ndi chidziwitso chochepa, ndipo amayi omwe adapeza 5 amaonedwa kuti amadziwa zonse zokhudza malungo. Zosintha zapayekha zakhala zikugwirizana ndi mwayi wopeza maukonde ophera tizilombo, IRS, kapena kuchuluka kwa malungo m'mabuku.
Mawonekedwe akumbuyo kwa amayi adafotokozedwa mwachidule pogwiritsa ntchito ma frequency ndi maperesenti amitundu yosiyanasiyana, pomwe zosinthika mosalekeza zidafotokozedwa mwachidule pogwiritsa ntchito njira ndi zopatuka. Makhalidwewa adaphatikizidwa ndi momwe amachitirapo kanthu kuti awone kusalinganika komwe kungakhalepo komanso kuchuluka kwa anthu omwe akuwonetsa kukondera komwe kungasokoneze. Mapu a contour anagwiritsidwa ntchito pofotokoza za kufalikira kwa malungo pakati pa amayi komanso kufalikira kwa njira ziwirizi potengera malo. Chiwerengero cha Scott Rao chi-square test statistics, chomwe chimapanga mawonekedwe a kafukufuku (ie, stratification, clustering, ndi sampling weights), chinagwiritsidwa ntchito kuwunika kugwirizana pakati pa kufalikira kwa malungo omwe amadzinenera okha komanso mwayi wochitapo kanthu komanso mawonekedwe ake. Kuchuluka kwa malungo odziwonetsera okha kunawerengedwa ngati chiwerengero cha amayi omwe adakumana ndi vuto limodzi la malungo m'miyezi 12 isanafike kafukufuku wogawidwa ndi chiwerengero cha amayi oyenerera omwe adayesedwa.
Njira yosinthidwa yolemetsa ya Poisson idagwiritsidwa ntchito kuyerekeza zotsatira za mwayi wothana ndi malungo pakukula kwa malungo kwa amayi omwe amadziwonetsa okha16, atasinthiratu kuthekera kwamankhwala olemetsa (IPTW) ndi masikelo a kafukufuku pogwiritsa ntchito chitsanzo cha "svy-linearization" ku Stata. KODI . (Stata Corporation, College Station, Texas, USA). Kuthekera kosiyana kwa kulemera kwamankhwala (IPTW) kuti alowererepo "i" ndi mkazi "j" akuyerekezedwa ngati:
Zosiyanasiyana zolemetsa zomaliza zomwe zimagwiritsidwa ntchito mumtundu wa Poisson regression zimasinthidwa motere:
Pakati pawo, \(fw_{ij}\) ndi kulemera komaliza kwa j payekha ndi intervention i, \(sw_{ij}\) ndi kulemera kwa chitsanzo cha munthu j ndi kulowererapo mu 2016 GMIS.
Lamulo laposachedwa la "margins, dydx (intervention_i)" mu Stata lidagwiritsidwa ntchito kuyerekeza kusiyana kwapakati (zotsatira) za kulowererapo "i" pakudzinenera kuti ali ndi malungo pakati pa azimayi atakwaniritsa njira yosinthidwa yolemetsa ya Poisson kuti aziwongolera. mitundu yonse yamitundu yosiyanasiyana.
Mitundu itatu yosiyanasiyana yobwereranso idagwiritsidwanso ntchito ngati kusanthula kwachidziwitso: kusinthika kwazinthu zamabinala, kusinthika kwapang'onopang'ono, ndi njira zowongolera zofananira kuti athe kuyerekeza momwe njira iliyonse yothanirana ndi malungo imakhudzira kufalikira kwa malungo pakati pa azimayi aku Ghana. Nthawi zodalirika za 95% zidayerekezedwa pazolinga zonse za kufalikira kwa mfundo, kuchuluka kwa kuchuluka, komanso kuyerekezera zotsatira. Kusanthula konse kwa ziwerengero mu kafukufukuyu kunkawoneka kuti ndikofunikira pamlingo wa alpha wa 0.050. Mtundu 16 wa Stata IC (StataCorp, Texas, USA) unagwiritsidwa ntchito posanthula ziwerengero.
M'mitundu inayi yobwereranso, kuchuluka kwa malungo omwe adadzinenera okha sikunatsike kwambiri pakati pa amayi omwe amalandila ITN ndi IRS poyerekeza ndi amayi omwe amalandila ITN okha. Kuphatikiza apo, m'chitsanzo chomaliza, anthu omwe amagwiritsa ntchito ITN ndi IRS sanawonetse kuchepa kwakukulu kwa kufalikira kwa malungo poyerekeza ndi anthu omwe amagwiritsa ntchito IRS okha.
Zotsatira za mwayi wopeza njira zothana ndi malungo pakukula kwa malungo omwe amanenedwa ndi amayi malinga ndi mawonekedwe apakhomo
Zotsatira zakupeza njira zothana ndi malungo pazodzinenera zokha zakufalikira kwa malungo pakati pa amayi, malinga ndi mawonekedwe a amayi.
Phukusi la njira zopewera matenda a malungo linathandiza kwambiri kuchepetsa kufala kwa malungo pakati pa amayi azaka zakubadwa ku Ghana. Kuchuluka kwa malungo omwe adadziwonetsa okha kunatsika ndi 27% mwa amayi omwe amagwiritsa ntchito maukonde ophera tizilombo komanso IRS. Kupeza kumeneku kumagwirizana ndi zotsatira za mayesero oyendetsedwa mwachisawawa omwe adawonetsa kuchepa kwakukulu kwa malungo a DT positivity pakati pa ogwiritsa ntchito IRS poyerekeza ndi osagwiritsa ntchito IRS m'dera lomwe lili ndi malungo ambiri koma miyezo yapamwamba ya ITN yofikira ku Mozambique [19]. Kumpoto kwa Tanzania, maukonde okhala ndi mankhwala ophera tizilombo ndi IRS adaphatikizidwa kuti achepetse kuchuluka kwa Anopheles komanso katemera wa katemera [20]. Njira zophatikizira zolimbana ndi tizilombo toyambitsa matenda zimathandizidwanso ndi kafukufuku wa anthu m'chigawo cha Nyanza kumadzulo kwa Kenya, omwe adapeza kuti kupopera mbewu m'nyumba ndi maukonde ophera tizilombo kunali kothandiza kwambiri kuposa mankhwala ophera tizilombo. Kuphatikizako kungapereke chitetezo china ku malungo. maukonde amaganiziridwa mosiyana [21].
Kafukufukuyu akuti 34% ya amayi anali ndi malungo m'miyezi 12 yapitayi kafukufukuyu, ndipo 95% ya nthawi yodalirika ya 32-36%. Amayi omwe amakhala m'mabanja omwe ali ndi mwayi wopeza zokwawa zothiridwa mankhwala ophera tizilombo (33%) anali ndi chiwerengero chochepa cha anthu omwe amadwala malungo poyerekeza ndi amayi omwe amakhala m'mabanja opanda mankhwala ophera tizilombo (39%) . Momwemonso, amayi omwe amakhala m'nyumba zopopera adadziwonetsa okha kuti ali ndi malungo 32%, poyerekeza ndi 35% m'mabanja osapopera mankhwala. Zimbudzi sizinakonzedwe ndipo ukhondo ndi woipa. Ambiri a iwo ali panja ndipo madzi auve amaunjikana mmenemo. Madzi osasunthika ndi auve amenewa ndi malo abwino kwambiri oberekera udzudzu wa Anopheles, womwe umafalitsa malungo ku Ghana. Zotsatira zake, zimbudzi ndi ukhondo sizinayende bwino, zomwe zinapangitsa kuti kufalikira kwa malungo kuchuluke pakati pa anthu. Khama liyenera kulimbikitsidwa pakuwongolera zimbudzi ndi ukhondo m'mabanja ndi m'madera.
Kafukufukuyu ali ndi zolepheretsa zingapo zofunika. Choyamba, phunziroli linagwiritsa ntchito deta yofufuza zamagulu, zomwe zimapangitsa kuti zikhale zovuta kuyeza chifukwa. Kuti athetse vutoli, njira zowerengera za causality zinagwiritsidwa ntchito kuyerekezera kuchuluka kwa chithandizo chamankhwala. Kusanthula kumasintha ntchito ya chithandizo ndipo kumagwiritsa ntchito kusintha kwakukulu kuti athe kulingalira zotsatira zomwe zingatheke kwa amayi omwe mabanja awo adalandira chithandizo (ngati panalibe kuthandizira) komanso kwa amayi omwe mabanja awo sanalandire chithandizo.
Chachiwiri, kupeza maukonde okhala ndi mankhwala ophera tizilombo sikutanthauza kugwiritsa ntchito maukonde ophera tizirombo, choncho kusamala kuyenera kugwiritsidwa ntchito pomasulira zotsatira ndi mfundo za kafukufukuyu. Kachitatu, zotsatira za kafukufukuyu wokhudza malungo omwe amadzinenera okha pakati pa amayi ndizomwe zikuthandizira kufalikira kwa malungo pakati pa amayi m'miyezi 12 yapitayi kotero kuti akhoza kukondera chifukwa cha chidziwitso cha amayi chokhudza malungo, makamaka omwe sakudziwika.
Pomaliza, phunziroli silinawerengere milandu yambiri ya malungo kwa wophunzira aliyense pa nthawi ya chaka chimodzi, kapena nthawi yeniyeni ya malungo ndi njira zothandizira. Poganizira zoperewera za maphunziro owonetsetsa, mayesero owonjezereka olamulidwa mwachisawawa adzakhala ofunika kwambiri pa kafukufuku wamtsogolo.
Mabanja omwe adalandira ITN ndi IRS anali ndi matenda a malungo ochepa poyerekeza ndi mabanja omwe sanalandirepo chithandizo. Izi zikuthandizira kuyitanitsa kuphatikizika kwa zoyeserera zowongolera malungo kuti zithandizire kuthetsa malungo ku Ghana.
Nthawi yotumiza: Oct-15-2024