Te urunga atu kingārara patu pepekeNā te whakamahi i ngā kupenga moenga kua rongoatia, me te whakatinanatanga o te IRS i roto i ngā whare, i tino whakaitihia te horapa o te mate malaria i roto i ngā wāhine o te tau whānau i Ghana. E whakaū ana tēnei kitenga i te hiahia mō tētahi urupare whānui mō te whakahaere i te mate malaria hei āwhina i te whakakorenga o te mate malaria i Ghana.
I tangohia ngā raraunga mō tēnei rangahau mai i te Rangahau Tohu Malaria o Ghana (GMIS). He rangahau ā-motu te GMIS i whakahaerehia e te Ratonga Tatauranga o Ghana mai i Oketopa ki Tīhema 2016. I roto i tēnei rangahau, ko ngā wāhine anake o te tau whānau tamariki i waenga i te 15-49 tau te pakeke i uru ki te rangahau. Ko ngā wāhine he raraunga mō ngā taurangi katoa i whakaurua ki te tātari.
Mō te rangahau o te tau 2016, i whakamahia e te MIS o Ghana tētahi tikanga tauira rōpū maha-wāhanga puta noa i ngā rohe 10 katoa o te whenua. E 20 ngā akomanga o te whenua (10 ngā rohe me te momo noho – tāone/tuawhenua). Ko te rōpū he rohe tatau tatauranga (CE) kei roto ko te 300–500 ngā whare. I te wāhanga tauira tuatahi, ka tīpakohia ngā rōpū mō ia paparanga me te tūponotanga e rite ana ki te rahi. E 200 ngā rōpū katoa i tīpakohia. I te wāhanga tauira tuarua, i tīpakohia matapōkeretia he maha pumau o te 30 ngā whare mai i ia rōpū kua tīpakohia me te kore he whakakapinga. I ngā wā katoa e taea ai, i uiuitia e mātou ngā wāhine 15–49 tau te pakeke i roto i ia whare [8]. I uiuitia e te rangahau tuatahi ngā wāhine 5,150. Heoi, nā te kore whakautu ki ētahi taurangi, e 4861 ngā wāhine katoa i whakaurua ki tēnei rangahau, e tohu ana i te 94.4% o ngā wāhine i roto i te tauira. Kei roto i ngā raraunga ngā mōhiohio mō te whare noho, ngā whare noho, ngā āhuatanga o ngā wāhine, te ārai i te malaria, me te mōhiotanga ki te malaria. I kohia ngā raraunga mā te whakamahi i tētahi pūnaha uiui whaiaro āwhina-rorohiko (CAPI) i runga i ngā papaaho me ngā pātai pepa. Ka whakamahia e ngā kaiwhakahaere raraunga te pūnaha Tatauranga me te Tukatuka Rangahau (CSPro) hei whakatika me te whakahaere i ngā raraunga.
Ko te putanga matua o tēnei rangahau ko te horapa o te malaria i roto i ngā wāhine whānau tamariki i waenga i te 15–49 tau te pakeke, arā, ko ngā wāhine i pūrongo kua pāngia rātou e te malaria i roto i ngā marama 12 i mua i te rangahau. Arā, ko te horapa o te malaria i roto i ngā wāhine i waenga i te 15–49 tau te pakeke i whakamahia hei tohu mō te RDT malaria tuturu, te hua rānei o te tirotiro karuārai i waenga i ngā wāhine nā te mea kāore i te wātea ēnei whakamātautau i waenga i ngā wāhine i te wā o te rangahau.
I roto i ngā wawaotanga i uru atu ai te urunga o te whānau ki ngā kupenga i rongoatia ki ngā patu pepeke (ITN) me te whakamahinga o te IRS i roto i ngā marama 12 i mua i te rangahau. Ko ngā whānau i whiwhi i ngā wawaotanga e rua i kiia he hunga kua uru atu. Ko ngā whānau whai urunga ki ngā kupenga moenga i rongoatia ki ngā patu pepeke i tautuhia ko ngā wāhine e noho ana i roto i ngā kāinga he kotahi te iti rawa o ngā kupenga moenga i rongoatia ki ngā patu pepeke, ko ngā kāinga whai IRS i tautuhia ko ngā wāhine e noho ana i roto i ngā kāinga kua rongoatia ki ngā patu pepeke i roto i ngā marama 12 i mua i te rangahau o ngā wāhine.
I tirotirohia e te rangahau ngā wāhanga whānui e rua o ngā taurangi whakapoauau, arā, ngā āhuatanga o te whānau me ngā āhuatanga takitahi. Kei roto ko ngā āhuatanga o te whare; te rohe, te momo noho (tuawhenua-tāone), te ira tangata o te upoko o te whare, te rahi o te whare, te whakamahinga hiko o te whare, te momo wahie tunu kai (totoka, kore totoka rānei), te rauemi papa matua, te rauemi pakitara matua, te rauemi tuanui, te puna wai inu (kua pai ake, kāore rānei i pai ake), te momo wharepaku (kua pai ake, kāore rānei i pai ake) me te wāhanga taonga o te whare (rawakore, waenga me te whai rawa). I tāruatia ngā wāhanga o ngā āhuatanga o te whare i runga anō i ngā paerewa pūrongo a te DHS i roto i ngā pūrongo a te GMIS 2016 me te Rangahau Hauora Taupori o Ghana (GDHS) 2014 [8, 9]. Ko ngā āhuatanga whaiaro i whakaarohia ko te tau o nāianei o te wahine, te taumata mātauranga teitei rawa atu, te tūnga haputanga i te wā o te uiui, te tūnga inihua hauora, te whakapono, ngā mōhiohio e pā ana ki te pānga ki te malaria i roto i ngā marama e 6 i mua i te uiui, me te taumata mōhiotanga o te wahine mō ngā take malaria. E rima ngā pātai mātauranga i whakamahia hei aromatawai i te mātauranga o ngā wāhine, tae atu ki te mātauranga o ngā wāhine ki ngā take o te malaria, ngā tohu o te malaria, ngā tikanga ārai malaria, te rongoā i te malaria, me te mōhiotanga kei raro i te kaupapa inihua hauora ā-motu o Ghana (NHIS) te malaria. Ko ngā wāhine i whiwhi i te 0–2 i kiia he iti te mātauranga, ko ngā wāhine i whiwhi i te 3, i te 4 rānei i kiia he taurite te mātauranga, ā, ko ngā wāhine i whiwhi i te 5 i kiia he tino mātauranga mō te malaria. Kua honoa ngā taurangi takitahi ki te urunga atu ki ngā kupenga i rongoatia ki ngā patu pepeke, ki te IRS, ki te horapa rānei o te malaria i roto i ngā tuhinga.
I whakarapopototia ngā āhuatanga papamuri o ngā wāhine mā te whakamahi i ngā auau me ngā ōrau mō ngā taurangi kāwai, engari i whakarapopototia ngā taurangi tonu mā te whakamahi i ngā toharite me ngā paerewa rerekētanga. I whakakotahihia ēnei āhuatanga e te mana wawaotanga hei tirotiro i ngā taurite kore pea me te hanganga taupori e tohu ana i te whakaaro whakapoauau pea. I whakamahia ngā mahere āwhata hei whakaahua i te horapa o te malaria i roto i ngā wāhine me te kapinga o ngā wawaotanga e rua mā te tauwāhi whenua. I whakamahia te tatauranga whakamātautau chi-square a Scott Rao, e whakamārama ana i ngā āhuatanga hoahoa rangahau (arā, te wehewehenga, te whakarōpūtanga, me ngā taumaha tauira), hei aromatawai i te hononga i waenga i te horapa o te malaria i pūrongohia e rātou anō me te urunga atu ki ngā wawaotanga me ngā āhuatanga horopaki. I tatauhia te horapa o te malaria i pūrongohia e rātou anō hei te maha o ngā wāhine i pāngia e te malaria i te iti rawa i te kotahi wāhanga i roto i ngā marama 12 i mua i te rangahau, wehea ki te tapeke o ngā wāhine whai mana i tirotirohia.
I whakamahia he tauira whakatautau Poisson taumaha kua whakarerekētia hei whakatau tata i te pānga o te urunga atu ki ngā wawaotanga whakahaere malaria ki te horapa o te malaria i pūrongohia e ngā wāhine16, whai muri i te whakatikatika mō te tūponotanga whakamuri o ngā taumaha maimoatanga (IPTW) me ngā taumaha rangahau mā te whakamahi i te tauira "svy-linearization" i roto i te Stata IC. (Stata Corporation, College Station, Texas, USA). Ko te tūponotanga whakamuri o te taumaha maimoatanga (IPTW) mō te wawaotanga "i" me te wahine "j" ka whakatau tatahia penei:
Kātahi ka whakatikatikaina ngā taurangi taumaha whakamutunga i whakamahia i roto i te tauira whakatauranga Poisson penei:
I roto i ēnei, ko \(fw_{ij}\) te taurangi taumaha whakamutunga o te takitahi j me te wawaotanga i, \(sw_{ij}\) te taumaha tauira o te takitahi j me te wawaotanga i i te GMIS 2016.
I muri i te whakaurunga o tētahi tauira whakatau tata "tawhē, dydx (wawaotanga_i)" i roto i a Stata, i whakamahia hei whakatau tata i te rerekētanga taha (pānga) o te wawaotanga "i" ki te horapa o te malaria i roto i ngā wāhine i muri i te whakaurunga o tētahi tauira whakatau tata Poisson taumaha kua whakarerekētia ki te mana whakahaere. i kitea katoatia ngā taurangi whakapoauau.
E toru ngā tauira whakatauira rerekē i whakamahia hei tātaritanga aro: te whakatauira whakarōpū rua, te whakatauira tūponotanga, me ngā tauira whakatauira rārangi hei whakatau tata i te pānga o ia wawaotanga whakahaere malaria ki te horapa o te malaria i roto i ngā wāhine Ghana. I whakatau tatahia ngā wā whakawhirinaki 95% mō ngā whakatauira horapa katoa, ngā ōwehenga horapa, me ngā whakatauira pānga. I kiia ngā tātaritanga tatauranga katoa i roto i tēnei rangahau he mea nui i te taumata alpha o te 0.050. I whakamahia te Stata IC putanga 16 (StataCorp, Texas, USA) mō te tātari tatauranga.
I roto i ngā tauira whakatauira e whā, kāore i tino iti iho te horapa o te malaria i roto i ngā wāhine e whiwhi ana i te ITN me te IRS ki te whakataurite ki ngā wāhine e whiwhi ana i te ITN anake. Heoi anō, i roto i te tauira whakamutunga, kāore i whakaatuhia e te hunga e whakamahi ana i te ITN me te IRS he whakahekenga nui o te horapa o te malaria ki te whakataurite ki te hunga e whakamahi ana i te IRS anake.
Te pānga o te urunga atu ki ngā wawaotanga ārai-malaria ki te horapa o te malaria i pūrongohia e ngā wāhine mā roto i ngā āhuatanga o te whare.
Te pānga o te urunga atu ki ngā wawaotanga whakahaere malaria ki te horapa o te malaria i roto i ngā wāhine, nā ngā āhuatanga o ngā wāhine.
I āwhina tētahi kete rautaki ārai mate pāwera ki te whakaiti i te horapa o te mate pāwera i roto i ngā wāhine o te tau whānautanga i Ghana. I heke te horapa o te mate pāwera i roto i ngā wāhine e whakamahi ana i ngā kupenga moenga i rongoatia ki ngā pepeke me te IRS mā te 27%. He rite tēnei kitenga ki ngā hua o tētahi whakamātautau whakahaere matapōkere i whakaatu i te iti iho o te mate pāwera ki te DT i roto i ngā kaiwhakamahi IRS ki te whakataurite ki ngā kaiwhakamahi ehara i te IRS i roto i tētahi rohe he nui te horapa o te mate pāwera engari he teitei ngā paerewa urunga ITN i Mozambique [19]. I te raki o Tanzania, i whakakotahihia ngā kupenga moenga i rongoatia ki ngā pepeke me te IRS hei whakaiti i te nui o te Anopheles me ngā reiti werohanga pepeke [20]. E tautokona ana hoki ngā rautaki whakahaere mate pāwera whakauru e tētahi rangahau taupori i te kawanatanga o Nyanza i te taha hauauru o Kenya, i kitea ai he pai ake te rehu o roto me ngā kupenga moenga i rongoatia ki ngā pepeke i ngā pepeke. Tērā pea ka whakaratohia e te whakakotahitanga he parenga atu ki te mate pāwera. Ka whakaarohia motuhaketia ngā whatunga [21].
I whakatauhia e tēnei rangahau he 34% o ngā wāhine kua pāngia e te malaria i roto i ngā marama 12 i mua i te rangahau, me te whakatau tata 95% o te 32–36%. Ko ngā wāhine e noho ana i ngā whare e whai urunga ana ki ngā kupenga moenga kua rongoatia ki ngā patu pepeke (33%) he iti ake te maha o ngā mate malaria i pūrongohia e rātou anō i ngā wāhine e noho ana i ngā whare kāore e whai urunga ki ngā kupenga moenga kua rongoatia ki ngā patu pepeke (39%). Waihoki, ko ngā wāhine e noho ana i ngā whare rehuhia he 32% te maha o ngā mate malaria i pūrongohia e rātou anō, ki te whakaritea ki te 35% i roto i ngā whare kāore i rehuhia. Kāore anō kia whakapaitia ngā wharepaku, ā, he kino ngā āhuatanga akuaku. Ko te nuinga o rātou kei waho, ā, ka kohia te wai paru ki roto. Ko ēnei wai paru, he wāhi pai mō te whakatipuranga o ngā waeroa Anopheles, te kaikawe matua o te malaria i Ghana. Nō reira, kāore i pai ake ngā āhuatanga o ngā wharepaku me te akuaku, ā, i arahi tika tēnei ki te pikinga o te horapa o te malaria i roto i te taupori. Me kaha ake ngā mahi ki te whakapai ake i ngā āhuatanga o ngā wharepaku me te akuaku i roto i ngā whare me ngā hapori.
He maha ngā herenga nui o tēnei rangahau. Tuatahi, i whakamahia e te rangahau ngā raraunga rangahau whakawhiti-wāhanga, ā, he uaua ki te ine i te hononga take. Hei whakakore i tēnei herenga, i whakamahia ngā tikanga tatauranga mō te hononga take hei whakatau tata i te pānga maimoatanga toharite o te wawaotanga. Ka whakarerekē te tātari mō te tautapa maimoatanga, ā, ka whakamahia ngā taurangi nui hei whakatau tata i ngā putanga pea mō ngā wāhine nō rātou ngā whare i whiwhi i te wawaotanga (mēnā kāore he wawaotanga) me ngā wāhine nō rātou ngā whare kāore i whiwhi i te wawaotanga.
Tuarua, ko te urunga atu ki ngā kupenga moenga kua rongoatia ki ngā patu pepeke kāore e tohu ana i te whakamahinga o ngā kupenga moenga kua rongoatia ki ngā patu pepeke, nō reira me tūpato i te whakamaoritanga i ngā hua me ngā whakatau o tēnei rangahau. Tuatoru, ko ngā hua o tēnei rangahau mō te malaria i pūrongohia e te wahine he tohu mō te horapa o te malaria i roto i ngā wāhine i ngā marama 12 kua pahure ake nei, nō reira, tera pea ka pāngia e te taumata mōhiotanga o ngā wāhine mō te malaria, inā koa ko ngā kēhi pai kāore anō kia kitea.
Hei whakamutunga, kāore te rangahau i whai whakaaro ki ngā take malaria maha mō ia kaiuru i te wā tohutoro kotahi tau, kāore hoki i whai whakaaro ki te wā tika o ngā wā me ngā wawaotanga malaria. I runga i ngā herenga o ngā rangahau tirotiro, he mea nui te whakaaro ki ngā whakamātautau matapōkere pakari ake mō ngā rangahau ā muri ake nei.
Ko ngā whare i whiwhi i te ITN me te IRS he iti ake te horapa o te malaria i roto i ā rātou ake pūrongo, ki te whakaritea ki ngā whare kāore i whiwhi i tētahi o ngā wawaotanga. E tautoko ana tēnei kitenga i ngā karanga mō te whakaurunga o ngā mahi whakahaere malaria hei whai wāhi ki te whakakore i te malaria i Ghana.
Wā tuku: Oketopa-15-2024