Maukonde okhala ndi pyrethroid clofenpyr (CFP) ndi pyrethroid piperonyl butoxide (PBO) akulimbikitsidwa m'maiko omwe ali ndi matendawa kuti athandize kulamulira malungo omwe amafalitsidwa ndi udzudzu wosagonjetsedwa ndi pyrethroid. CFP ndi mankhwala ophera tizilombo omwe amafunika kuyatsidwa ndi udzudzu wa cytochrome P450 monooxygenase (P450), ndipo PBO imawonjezera mphamvu ya pyrethroid mwa kuletsa ntchito ya ma enzyme awa mu udzudzu wosagonjetsedwa ndi pyrethroid. Chifukwa chake, kuletsa P450 ndi PBO kungachepetse mphamvu ya maukonde a pyrethroid-CFP akagwiritsidwa ntchito m'nyumba imodzi ndi maukonde a pyrethroid-PBO.
Mayeso awiri oyesera a cockpit adachitika kuti awone mitundu iwiri yosiyana ya pyrethroid-CFP ITN (Interceptor® G2, PermaNet® Dual) yokha komanso kuphatikiza ndi pyrethroid-PBO ITN (DuraNet® Plus, PermaNet® 3.0). Zotsatira za tizilombo toyambitsa matenda pogwiritsa ntchito Pyrethroid resistance Vector populations kum'mwera kwa Benin. Mu maphunziro onse awiriwa, mitundu yonse ya maukonde idayesedwa mu chithandizo cha maukonde amodzi ndi awiri. Kuwunikanso kwa bioassays kudachitikanso kuti awone kukana mankhwala kwa maukonde m'nyumba ndikuphunzira momwe CFP ndi PBO zimagwirizanirana.
Chiwerengero cha ma vector chinali chokhudzidwa ndi CFP koma chinawonetsa kukana kwakukulu kwa ma pyrethroid, koma kukana kumeneku kunathetsedwa chifukwa cha kukhudzana ndi PBO asanayambe. Imfa za ma vector zinachepa kwambiri m'nyumba zomwe zimagwiritsa ntchito kuphatikiza maukonde a pyrethroid-CFP ndi maukonde a pyrethroid-PBO poyerekeza ndi nyumba zomwe zimagwiritsa ntchito maukonde awiri a pyrethroid-CFP (74% ya Interceptor® G2 vs. 85%, PermaNet® Dual 57% vs. 83 %), p < 0.001). Kukumana ndi PBO asanayambe kunachepetsa poizoni wa CFP mu mayeso a botolo, zomwe zikusonyeza kuti izi zitha kuchitika chifukwa cha kutsutsana pakati pa CFP ndi PBO. Imfa za ma vector zinali zambiri m'nyumba zomwe zimagwiritsa ntchito kuphatikiza maukonde okhala ndi ma pyrethroid-CFP poyerekeza ndi nyumba zopanda maukonde a pyrethroid-CFP, ndipo pamene maukonde a pyrethroid-CFP ankagwiritsidwa ntchito okha ngati maukonde awiri. Akagwiritsidwa ntchito pamodzi, imfa zimakhala zapamwamba kwambiri (83-85%).
Kafukufukuyu adawonetsa kuti kugwira ntchito bwino kwa ma meshes a pyrethroid-CFP kunachepa pamene agwiritsidwa ntchito limodzi ndi pyrethroid-PBO ITN poyerekeza ndi kugwiritsidwa ntchito kokha, pomwe kugwira ntchito bwino kwa ma mesh kuphatikiza ma meshes a pyrethroid-CFP kunali kwakukulu. Zotsatirazi zikusonyeza kuti kuika patsogolo kufalitsa ma network a pyrethroid-CFP kuposa mitundu ina ya ma network kudzawonjezera zotsatira zowongolera ma vector m'mikhalidwe yofanana.
Maukonde oteteza ku tizilombo toyambitsa matenda (ITNs) okhala ndi mankhwala ophera tizilombo otchedwa pyrethroid akhala njira yothandiza kwambiri polimbana ndi malungo m'zaka makumi awiri zapitazi. Kuyambira mu 2004, makonde oteteza ku tizilombo pafupifupi 2.5 biliyoni aperekedwa ku sub-Saharan Africa [1], zomwe zapangitsa kuti chiwerengero cha anthu omwe akugona pansi pa makonde oteteza ku tizilombo chiwonjezeke kuchokera pa 4% mpaka 47% [2]. Zotsatira za kukhazikitsa kumeneku zinali zazikulu. Akuti milandu pafupifupi 2 biliyoni ya malungo ndi imfa 6.2 miliyoni zinapewedwa padziko lonse lapansi pakati pa 2000 ndi 2021, ndipo kusanthula kwa zitsanzo kukusonyeza kuti makonde oteteza ku tizilombo anali omwe adayambitsa phinduli [2, 3]. Komabe, kupita patsogolo kumeneku kumabwera ndi mtengo: kupititsa patsogolo kukana kwa pyrethroid m'magulu a anthu omwe amateteza ku malungo. Ngakhale makonde oteteza ku tizilombo otchedwa pyrethroid angaperekebe chitetezo cha munthu aliyense ku malungo m'madera omwe ma vectors amawonetsa kukana kwa pyrethroid [4], maphunziro a zitsanzo amaneneratu kuti pamlingo wapamwamba kwambiri, makonde oteteza ku tizilombo adzachepetsa kufalikira kwa matenda [5]. Motero, kukana kwa pyrethroid ndi chimodzi mwa zinthu zomwe zimawopseza kwambiri kupita patsogolo kokhazikika pakulamulira malungo.
M'zaka zingapo zapitazi, mbadwo watsopano wa maukonde ophera tizilombo, omwe amaphatikiza ma pyrethroids ndi mankhwala ena, wapangidwa kuti akonze bwino kulamulira malungo omwe amafalitsidwa ndi udzudzu wosagonjetsedwa ndi ma pyrethroids. Gulu latsopano loyamba la ITN lili ndi synergist piperonyl butoxide (PBO), yomwe imalimbitsa ma pyrethroids mwa kuletsa ma enzymes ochotsa poizoni omwe amagwirizana ndi kukana kwa ma pyrethroids, makamaka kugwira ntchito kwa cytochrome P450 monooxygenases (P450s) [6]. Maukonde ophera tizilombo omwe amachiritsidwa ndi fluprone (CFP), mankhwala ophera tizilombo omwe ali ndi njira yatsopano yogwirira ntchito yolunjika ku kupuma kwa maselo, nawonso apezeka posachedwapa. Pambuyo pa kuwonetsedwa kwa kusintha kwa mphamvu ya tizilombo m'mayesero oyeserera nyumba [7, 8], mndandanda wa mayeso olamulidwa mwachisawawa (cRCT) adachitika kuti awone ubwino wa maukonde awa paumoyo wa anthu poyerekeza ndi maukonde ophera tizilombo omwe amagwiritsa ntchito ma pyrethroids okha ndikupereka umboni wofunikira kuti upereke malingaliro ochokera ku World Health Organization (WHO) [9]. Kutengera umboni wa kusintha kwa mphamvu ya matenda kuchokera ku CRCTs ku Uganda [11] ndi Tanzania [12], WHO idavomereza maukonde otetezedwa ndi tizilombo a pyrethroid-PBO [10]. Pyrethroid-CFP ITN idasindikizidwanso posachedwa pambuyo poti ma RCT ofanana ku Benin [13] ndi Tanzania [14] awonetsa kuti prototype ITN (Interceptor® G2) idachepetsa kuchuluka kwa malungo a ana ndi 46% ndi 44%, motsatana. 10].
Pambuyo pa zoyesayesa zatsopano za Global Fund ndi ena opereka malungo kuti athetse kukana mankhwala ophera tizilombo pofulumizitsa kuyambitsa maukonde atsopano [15], maukonde a pyrethroid-PBO ndi pyrethroid-CFP akugwiritsidwa kale ntchito m'madera omwe ali ndi kachilomboka. Amalowa m'malo mwa maukonde achikhalidwe ophera tizilombo omwe amagwiritsa ntchito maukonde a pyrethroid okha. Pakati pa 2019 ndi 2022, chiwerengero cha maukonde a udzudzu a PBO pyrethroid omwe amaperekedwa ku sub-Saharan Africa chinawonjezeka kuchoka pa 8% kufika pa 51% [1], pomwe maukonde a udzudzu a PBO pyrethroid, kuphatikiza maukonde a udzudzu a CFP pyrethroid, maukonde a udzudzu a "dual action" akuyembekezeka kukhala 56% ya zotumizidwa. Lowani pamsika waku Africa pofika chaka cha 2025[16]. Monga umboni wa kugwira ntchito bwino kwa maukonde a udzudzu a pyrethroid-PBO ndi pyrethroid-CFP akupitiliza kukula, maukonde awa akuyembekezeka kupezeka kwambiri m'zaka zikubwerazi. Motero, pakufunika kudzaza mipata yokhudzana ndi kugwiritsa ntchito bwino maukonde atsopano ophera tizilombo kuti akwaniritse zotsatira zabwino kwambiri akagwiritsidwa ntchito mokwanira.
Popeza kuchulukana kwa maukonde a udzudzu a pyrethroid CFP ndi maukonde a PBO a pyrethroid, National Malaria Control Program (NMCP) ili ndi funso limodzi lofufuza: Kodi mphamvu yake idzachepa - PBO ITN? Chifukwa cha nkhawa iyi ndikuti PBO imagwira ntchito poletsa ma enzymes a udzudzu a P450 [6], pomwe CFP ndi mankhwala ophera tizilombo omwe amafunika kuyatsidwa kudzera mu P450s [17]. Chifukwa chake, akuganiziridwa kuti pamene pyrethroid-CFP ITN ndi pyrethroid-CFP ITN zimagwiritsidwa ntchito m'nyumba imodzi, mphamvu yoletsa ya PBO pa P450 ingachepetse mphamvu ya pyrethroid-CFP ITN. Kafukufuku wambiri wa labotale wasonyeza kuti kukhudzana ndi PBO kusanayambe kumachepetsa poizoni wa CFP ku ma vectors a udzudzu poyesa mwachindunji [18,19,20,21,22]. Komabe, pochita kafukufuku pakati pa maukonde osiyanasiyana m'munda, kuyanjana pakati pa mankhwala awa kudzakhala kovuta kwambiri. Kafukufuku wosasindikizidwa wafufuza zotsatira za kugwiritsa ntchito mitundu yosiyanasiyana ya maukonde ophera tizilombo pamodzi. Motero, maphunziro akumunda ofufuza momwe kugwiritsa ntchito maukonde ophera tizilombo a pyrethroid-CFP ndi pyrethroid-PBO m'nyumba imodzi kudzathandiza kudziwa ngati kutsutsana komwe kungachitike pakati pa maukonde amenewa kungayambitse vuto pakugwira ntchito ndikuthandizira kudziwa njira yabwino kwambiri yogwiritsira ntchito madera ake omwe amagawidwa mofanana.
Nthawi yotumizira: Sep-21-2023