Kei te whakatairangahia ngā kupenga moenga kei roto te pyrethroid clofenpyr (CFP) me te pyrethroid piperonyl butoxide (PBO) i roto i ngā whenua e horapa ana te malaria hei whakapai ake i te whakahaere i te malaria e tukuna ana e ngā waeroa ātete ki te pyrethroid. Ko te CFP he proinsecticide e hiahia ana kia whakahohehia e te waeroa cytochrome P450 monooxygenase (P450), ā, ka whakarei ake te PBO i te whai huatanga o ngā pyrethroid mā te aukati i te mahi a ēnei whākōkī i roto i ngā waeroa ātete ki te pyrethroid. Nō reira, ko te aukati i te P450 e te PBO ka whakaiti i te whai huatanga o ngā kupenga pyrethroid-CFP ina whakamahia i roto i te kāinga kotahi me ngā kupenga pyrethroid-PBO.
E rua ngā whakamātautau i whakahaerehia hei aromatawai i ngā momo pyrethroid-CFP ITN rerekē e rua (Interceptor® G2, PermaNet® Dual) anake, me te whakakotahitanga me te pyrethroid-PBO ITN (DuraNet® Plus, PermaNet® 3.0). Ngā pānga pepeke o te whakamahinga Ātete Pyrethroid ki ngā taupori kawe i te tonga o Benin. I roto i ngā rangahau e rua, i whakamatautauria ngā momo mata katoa i roto i ngā maimoatanga mata kotahi me te mata takirua. I whakahaerehia hoki ngā whakamātautau koiora hei aromatawai i te ātete rongoā o ngā taupori kawe i roto i te whare, me te ako i te taunekeneke i waenga i te CFP me te PBO.
I pāngia te taupori kawe i te CFP engari he nui te ātete ki ngā pyrethroid, engari i hinga tēnei ātete i te wā i mua i te pānga ki te PBO. I tino heke te mate o ngā kawe i roto i ngā whare iti mā te whakamahi i te huinga o ngā kupenga pyrethroid-CFP me ngā kupenga pyrethroid-PBO ki te whakataurite ki ngā whare iti e whakamahi ana i ngā kupenga pyrethroid-CFP e rua (74% mō te Interceptor® G2 vs. 85%, PermaNet® Dual 57% vs. 83%), p < 0.001). I whakaitihia e te wā i mua i te pānga ki te PBO te paitini o te CFP i roto i ngā whakamātautau koiora pounamu, e kī ana ko tēnei pānga pea nā te pakanga i waenga i te CFP me te PBO. He teitei ake te mate o ngā kawe i roto i ngā whare iti e whakamahi ana i ngā huinga kupenga kei roto ngā kupenga pyrethroid-CFP ki te whakataurite ki ngā whare kāore he kupenga pyrethroid-CFP, ā, i te wā i whakamahia takitahi ai ngā kupenga pyrethroid-CFP hei kupenga e rua. Ina whakamahia ngātahi, ko te mate teitei rawa atu (83-85%).
I whakaatuhia e tēnei rangahau kua heke te whai huatanga o ngā mata pyrethroid-CFP i te wā i whakamahia ngātahitia ai me te pyrethroid-PBO ITN ki te whakataurite ki te whakamahinga anake, engari he teitei ake te whai huatanga o ngā huinga mata kei roto ngā mata pyrethroid-CFP. E whakaatu ana ēnei hua mā te whakarite i te tohatoha o ngā whatunga pyrethroid-CFP ki runga ake i ētahi atu momo whatunga ka whakanui ake i ngā pānga whakahaere whākōkī i roto i ngā āhuatanga ōrite.
Ko ngā kupenga moenga i rongoatia ki ngā patu pepeke (ITN) kei roto ngā patu pepeke pyrethroid kua noho hei pou matua mō te whakahaere i te malaria i roto i ngā tekau tau e rua kua pahure ake nei. Mai i te tau 2004, tata ki te 2.5 piriona ngā kupenga moenga i rongoatia ki ngā patu pepeke kua tukuna ki Awherika ki te tonga o te Sahara [1], ā, kua piki ake te ōwehenga o te taupori e moe ana i raro i ngā kupenga moenga i rongoatia ki ngā patu pepeke mai i te 4% ki te 47% [2]. He nui te pānga o tēnei whakatinanatanga. E kiia ana tata ki te 2 piriona ngā keehi malaria me te 6.2 miriona mate i karohia puta noa i te ao i waenga i te tau 2000 me te 2021, me ngā tātaritanga tauira e kī ana ko ngā kupenga i rongoatia ki ngā patu pepeke tetahi o ngā take nui o tēnei painga [2, 3]. Heoi, he utu kei roto i ēnei whanaketanga: te tere o te whanaketanga o te ātete pyrethroid i roto i ngā taupori kawe malaria. Ahakoa ka taea tonu e ngā kupenga moenga i rongoatia ki ngā patu pepeke pyrethroid te whakarato i te tiaki takitahi ki te malaria i ngā wāhi e whakaatu ana ngā kawe i te ātete pyrethroid [4], e matapaetia ana e ngā rangahau tauira i ngā taumata ātete teitei ake, ka whakaitihia e ngā kupenga moenga i rongoatia ki ngā patu pepeke te pānga mate urutā [5]. Nō reira, ko te ātete ki te piretiroid tētahi o ngā tūmomo riri nui ki te ahunga whakamua pumau o te whakahaere i te malaria.
I roto i ngā tau kua pahure ake nei, kua whakawhanakehia he whakatupuranga hou o ngā kupenga moenga kua rongoatia ki ngā pepeke patupatu, e whakakotahi ana i ngā pyrethroid me tētahi matū tuarua, hei whakapai ake i te whakahaere i te malaria e tukuna ana e ngā waeroa ātete ki ngā pyrethroid. Kei roto i te akomanga hou tuatahi o te ITN te piperonyl butoxide (PBO) synergist, e whakapakari ana i ngā pyrethroid mā te whakakore i ngā whākōkī whakamate e pā ana ki te ātete ki ngā pyrethroid, inā koa te whai huatanga o ngā cytochrome P450 monooxygenases (P450s) [6]. Kua wātea mai hoki ngā kupenga moenga kua rongoatia ki te fluprone (CFP), he pepeke patupatu azole me tētahi tikanga mahi hou e aro ana ki te manawa pūtau. Whai muri i te whakaaturanga o te pānga pepeke kua whakapaitia i roto i ngā whakamātautau whakamātautau whare [7, 8], i whakahaerehia he raupapa o ngā whakamātautau whakahaere matapōkere rōpū (cRCT) hei aromatawai i ngā painga hauora tūmatanui o ēnei kupenga ki te whakataurite ki ngā kupenga kua rongoatia ki ngā pepeke patupatu e whakamahi ana i ngā pyrethroid anake, me te whakarato i ngā taunakitanga e tika ana hei whakamōhio i ngā taunakitanga kaupapa here mai i te World Health Organization (WHO) [9]. I runga i ngā taunakitanga o te pānga mate urutā kua pai ake mai i ngā CRCT i Uganda [11] me Tanzania [12], i tautoko te WHO i ngā kupenga moenga i rongoatia ki te patu pepeke pyrethroid-PBO [10]. I whakaputaina anō hoki te pyrethroid-CFP ITN i muri i ngā RCT ōrite i Benin [13] me Tanzania [14] i whakaatu ko te tauira ITN (Interceptor® G2) i whakaiti i te maha o ngā mate malaria o ngā tamariki mā te 46% me te 44%, ia. 10]. ].
Whai muri i ngā mahi hou a te Global Fund me ētahi atu kaituku nui o te malaria ki te aro atu ki te ātete ki ngā pepeke whakamate mā te whakateretere i te whakaurunga o ngā kupenga moenga hou [15], kua whakamahia kētia ngā kupenga moenga pyrethroid-PBO me te pyrethroid-CFP i ngā wāhi mate urutā. Ka whakakapi i ngā pepeke whakamate tuku iho. kupenga moenga kua rongoatia e whakamahi ana i ngā pyrethroid anake. I waenga i te tau 2019 me te tau 2022, kua piki ake te ōwehenga o ngā kupenga waeroa pyrethroid PBO i tukuna ki Awherika ki te tonga o te Sahara mai i te 8% ki te 51% [1], i te mea ko ngā kupenga waeroa pyrethroid PBO, tae atu ki ngā kupenga waeroa pyrethroid CFP, e matapaetia ana ko ngā kupenga waeroa "mahi rua" ka eke ki te 56% o ngā tuku. Whakauru atu ki te mākete o Awherika i te tau 2025 [16]. I te mea kei te tipu haere tonu ngā taunakitanga o te whai huatanga o ngā kupenga waeroa pyrethroid-PBO me te pyrethroid-CFP, e matapaetia ana ka nui ake te wātea o ēnei kupenga i ngā tau e haere ake nei. Nō reira, kei te piki haere te hiahia ki te whakakī i ngā āputa mōhiohio e pā ana ki te whakamahinga pai rawa atu o ngā kupenga moenga i rongoatia ki ngā patu pepeke o te whakatupuranga hou kia eke ai ki te hua tino pai ina whakanuia ake mō te whakamahinga katoa.
I te mea kei te horapa haere tonu ngā kupenga waeroa pyrethroid CFP me te pyrethroid PBO, kotahi te pātai rangahau mahi a te National Malaria Control Program (NMCP): Ka whakaitihia tōna whai huatanga – PBO ITN? Ko te take o tēnei āwangawanga ko te mahi a te PBO mā te aukati i ngā whākōkī waeroa P450 [6], engari ko te CFP he proinsecticide e hiahia ana kia whakahohehia mā roto i ngā P450 [17]. Nō reira, e whakapaetia ana ina whakamahia te pyrethroid-CFP ITN me te pyrethroid-CFP ITN i te kāinga kotahi, ka whakaitihia pea e te pānga aukati o te PBO ki te P450 te whai huatanga o te pyrethroid-CFP ITN. He maha ngā rangahau taiwhanga kua whakaatu ko te whakaaturanga i mua i te PBO ka whakaiti i te paitini nui o te CFP ki ngā kawe waeroa i roto i ngā whakamātautau koiora whakaaturanga tika [18,19,20,21,22]. Heoi, i te wā e whakahaerehia ana ngā rangahau i waenga i ngā whatunga rerekē i te mara, ka uaua ake ngā taunekeneke i waenga i ēnei matū. Kua tirotirohia e ngā rangahau kāore anō kia whakaputaina ngā pānga o te whakamahi i ngā momo kupenga rerekē kua rongoatia ki ngā patu ngārara. Nō reira, mā ngā rangahau mara e aromatawai ana i te pānga o te whakamahi i te huinga o ngā kupenga moenga pyrethroid-CFP kua rongoatia ki ngā patu pepeke me ngā kupenga pyrethroid-PBO i roto i te whare kotahi ka āwhina ki te whakatau mēnā he raruraru whakahaere te pakanga pea i waenga i ēnei momo kupenga, ā, ka āwhina hoki ki te whakatau i te rautaki pai rawa atu mō ōna rohe kua tohatohahia.
Wā tuku: Hepetema-21-2023