Aiwatar da tsarin kula da cututtuka na Strongyloides stercoralis na ɗaya daga cikin manufofin Hukumar Lafiya ta Duniya ta 2030. Manufar wannan aikin shine don kimanta yiwuwar tasiri na biyu daban-daban na rigakafi chemotherapy (PC) dabarun dangane da albarkatun tattalin arziki da kuma kiwon lafiya halin da ake ciki a halin yanzu (Strategy A, babu PC): Ivermectin ga yara masu shekaru makaranta (SAC) da kuma Adult dosing (dabarun B) da ivermectin ana amfani dasu kawai don SAC (dabarun C).
An gudanar da binciken a asibitin IRCCS Sacro Cuore Don Calabria a Negrar di Valpolicella, Verona, Italiya, Jami'ar Florence, Italiya, da WHO a Geneva, Switzerland daga Mayu 2020 zuwa Afrilu 2021. An fitar da bayanan wannan samfurin daga wallafe-wallafe. An ƙirƙiri ƙirar lissafi a cikin Microsoft Excel don kimanta tasirin dabarun B da C akan daidaitaccen adadin mutane miliyan 1 da ke zaune a wuraren da strongyloidiasis ke da yawa. A cikin yanayin tushen yanayin, an yi la'akari da yawan 15% na strongyloidiasis; sannan aka kimanta dabarun guda uku a karkashin mabambantan matakan kamuwa da cuta, daga kashi 5% zuwa 20%. An ba da rahoton sakamakon a matsayin adadin abubuwan da suka kamu da cutar, adadin wadanda suka mutu, farashi, da ƙimar haɓaka haɓaka (ICER). An yi la'akari da lokutan shekara 1 da shekaru 10.
A cikin yanayin da ya dace, a cikin shekarar farko na aiwatar da dabarun B da C na PC, za a rage yawan kamuwa da cuta: daga 172 500 lokuta bisa ga dabarun B zuwa lokuta 77 040, kuma bisa ga dabarun C. zuwa 146 700 lokuta. Ana kwatanta ƙarin farashin kowane mutum da aka dawo da shi ba tare da magani ba a cikin shekara ta farko. Dalar Amurka (USD) a dabarun B da C sune 2.83 da 1.13, bi da bi. Ga waɗannan dabaru guda biyu, yayin da yawan yaɗuwar ya karu, farashin kowane mutum da aka kwato yana kan koma baya. Dabarun B yana da adadin adadin mutuwar da aka sanar fiye da C, amma dabarun C yana da ƙaramin farashi na sanar da mutuwa fiye da B.
Wannan bincike yana ba da damar kimanta tasirin dabarun PC guda biyu don sarrafa strongyloidiasis dangane da farashi da rigakafin kamuwa da cuta / mutuwa. Wannan na iya wakiltar ginshiƙi ga kowace ƙasa mai fama da tashe-tashen hankula don tantance dabarun da za a iya aiwatar da su bisa la'akari da kuɗin da ake samu da kuma fifikon kiwon lafiyar ƙasa.
Tsutsotsin ƙasa (STH) Strongyloides stercoralis yana haifar da cututtukan da ke da alaƙa a cikin al'ummomin da abin ya shafa, kuma yana iya haifar da mutuwar masu kamuwa da cutar a yanayin hana rigakafi [1]. Dangane da alkaluma na baya-bayan nan, kusan mutane miliyan 600 a duniya ke fama da cutar, tare da mafi yawan lokuta a kudu maso gabashin Asiya, Afirka da Yammacin Pacific [2]. Dangane da bayanan baya-bayan nan game da nauyin duniya na strongyloidiasis, Hukumar Lafiya ta Duniya (WHO) ta haɗa da sarrafa cututtukan faecalis a cikin 2030 Neglected Tropical Diseases (NTD) manufa taswirar hanya [3]. Wannan shi ne karo na farko da WHO ta ba da shawarar tsarin kulawa don strongyloidiasis, kuma ana ayyana takamaiman hanyoyin sarrafawa.
S. stercoralis yana raba hanyar watsawa tare da hookworms kuma yana da irin wannan rarrabawar yanki tare da sauran STHs, amma yana buƙatar hanyoyin bincike daban-daban da jiyya [4]. A gaskiya ma, Kato-Katz, wanda aka yi amfani dashi don tantance yawan STH a cikin shirin sarrafawa, yana da ƙananan hankali ga S. stercoralis. Don wannan ƙwayar cuta, ana iya ba da shawarar wasu hanyoyin bincike tare da daidaito mafi girma: Baermann da al'adun farantin agar a cikin hanyoyin parasitological, amsawar sarkar polymerase da gwajin serological [5]. Ana amfani da hanyar ta ƙarshe don wasu NTDs, yin amfani da damar yiwuwar tattara jini akan takarda mai tacewa, wanda ke ba da damar tattarawa da sauri da sauƙin adana samfuran halitta [6, 7].
Abin baƙin ciki shine, babu wani ma'auni na zinariya don ganewar asali na wannan parasite [5], don haka zaɓin mafi kyawun hanyar bincike da aka tura a cikin shirin kulawa ya kamata yayi la'akari da abubuwa da yawa, kamar daidaiton gwajin, farashi da yuwuwar amfani. A cikin filin a cikin wani taron kwanan nan da wane ne [8], masana da aka zaɓa sun yanke kimantawa a matsayin mafi kyawun zaɓi, kuma Nii Elisa shine mafi kyawun zaɓi tsakanin kayan Elisa. Dangane da jiyya, rigakafin chemotherapy (PC) don STH yana buƙatar amfani da magungunan benzimidazole, albendazole ko mebendazole [3]. Waɗannan shirye-shiryen yawanci suna yin hari ga yara masu zuwa makaranta (SAC), waɗanda sune mafi girman nauyin asibiti da STH [3] ke haifarwa. Duk da haka, magungunan benzimidazole ba su da wani tasiri a kan Streptococcus faecalis, don haka ivermectin shine maganin zabi [9]. An yi amfani da Ivermectin don babban sikelin jiyya na onchocerciasis da shirye-shiryen kawar da filariasis na lymphatic (NTD) shekaru da yawa [10, 11]. Yana da kyakkyawan aminci da juriya, amma ba a ba da shawarar ga yara a ƙasa da shekaru 5 [12].
S. stercoralis kuma ya bambanta da sauran STH dangane da tsawon lokacin kamuwa da cuta, saboda idan ba a yi masa magani sosai ba, sake zagayowar kamuwa da cuta ta musamman na iya haifar da parasites ta ci gaba har abada a cikin gidan ɗan adam. Saboda bullowar sabbin cututtuka da dauwamar cututtuka na tsawon lokaci, wannan kuma yana haifar da yawaitar cututtuka a lokacin balagaggu [1, 2].
Duk da keɓancewar, haɗa takamaiman ayyuka tare da shirye-shiryen da ake dasu don sauran cututtukan wurare masu zafi da aka yi watsi da su na iya amfana daga aiwatar da shirye-shiryen sarrafa cututtuka irin na strongyloidosis. Rarraba ababen more rayuwa da ma'aikata na iya rage farashi da kuma hanzarta ayyukan da ke da nufin sarrafa streptococcus faecalis.
Manufar wannan aikin shine kimanta farashi da sakamakon dabaru daban-daban masu alaƙa da sarrafa strongyloidiasis, wato: (A) babu shiga tsakani; (B) gudanarwa mai girma ga SAC da manya; (C) don SAC PC.
An gudanar da binciken a Asibitin IRCCS Sacro Cuore Don Calabria a Negrar di Valpolicella, Verona, Italiya, Jami'ar Florence, Italiya, da WHO a Geneva, Switzerland daga Mayu 2020 zuwa Afrilu 2021. Tushen bayanan wannan samfurin yana samuwa wallafe-wallafe. An ƙirƙira ƙirar lissafi a cikin Microsoft® Excel® don Microsoft 365 MSO (Microsoft Corporation, Santa Rosa, California, Amurka) don kimanta yiwuwar shiga tsakani masu ƙarfi guda biyu masu kama da ƙarfi a cikin wuraren da ba su da ƙarfi idan aka kwatanta da (A) babu sa baki Tasirin asibiti da tattalin arziki. na matakan (aiki na yanzu); (B) Kwamfutoci na SAC da manya; (C) Kwamfutoci don SAC kawai. Ana kimanta yanayin lokaci na shekara 1 da 10 a cikin bincike. An gudanar da binciken ne bisa mahangar tsarin kiwon lafiya na gida, wanda ke da alhakin lalata tsutsotsi, ciki har da farashin kai tsaye da ke hade da kudaden jama'a. An ba da rahoton bishiyar yanke shawara da shigar da bayanai a cikin Hoto 1 da Tebu 1, bi da bi. Musamman, bishiyar yanke shawara tana nuna jihohin kiwon lafiya masu ma'amala da juna da aka zayyana ta hanyar ƙira da ƙididdige matakan dabaru na kowane dabaru daban-daban. Sashen bayanan shigar da ke ƙasa yana ba da rahoto daki-daki game da canjin canjin daga wata jiha zuwa na gaba da kuma zato masu alaƙa. An ba da rahoton sakamakon a matsayin adadin abubuwan da suka kamu da cutar, abubuwan da ba su kamu da cutar ba, abubuwan da aka warkar da su (farfadowa), mace-mace, farashi, da haɓaka ƙimar fa'ida (ICER). ICER shine bambancin farashi tsakanin dabarun biyu da aka raba ta Bambanci a cikin tasirin su shine mayar da batun da kuma guje wa kamuwa da cuta. Karamin ICER yana nuna cewa dabara ɗaya ta fi wani tsada.
Bishiyar yanke shawara don matsayin lafiya. PC rigakafin chemotherapy, IVM ivermectin, Gudanar da ADM, SAC yara masu shekaru makaranta
Muna ɗauka cewa ma'auni na yawan jama'a shine batutuwa 1,000,000 da ke zaune a cikin ƙasashe masu yawan gaske na strongyloidiasis, wanda 50% daga cikinsu manya ne (≥15 shekaru) da 25% yara ne masu zuwa makaranta (shekaru 6-14). Wannan rabo ne akai-akai ana gani a cikin ƙasashe a kudu maso gabashin Asiya, Afirka da Yammacin Pacific [13]. A cikin yanayin tushen yanayin, an kiyasta yawan ƙarfin ƙarfi da ƙarfi a cikin manya da SAC zuwa 27% da 15%, bi da bi [2].
A cikin dabarun A (aiki na yanzu), batutuwa ba su karɓar magani, don haka muna ɗauka cewa yawan kamuwa da cuta zai kasance iri ɗaya a ƙarshen shekaru 1 da shekaru 10.
A cikin dabarun B, duka SAC da manya za su sami PC. Dangane da kimanta ƙimar yarda na 60% na manya da 80% na SAC [14], duka masu kamuwa da cuta da marasa kamuwa da cuta za su karɓi ivermectin sau ɗaya a shekara har tsawon shekaru 10. Muna ɗauka cewa adadin maganin abubuwan da suka kamu da cutar ya kai kusan 86% [15]. Yayin da al'umma za su ci gaba da nunawa ga tushen kamuwa da cuta (ko da yake gurɓataccen ƙasa na iya raguwa a tsawon lokaci tun lokacin da PC ya fara), sake kamuwa da cututtuka da sababbin cututtuka za su ci gaba da faruwa. An kiyasta adadin sabon kamuwa da cuta na shekara-shekara zuwa rabin adadin kamuwa da cuta na asali [16]. Don haka, farawa daga shekara ta biyu na aiwatar da PC, adadin masu kamuwa da cutar a kowace shekara zai zama daidai da jimillar sabbin cututtukan da kuma adadin waɗanda suka kasance masu inganci (watau waɗanda ba su karɓi maganin PC ba da waɗanda ke da cutar. ba a amsa magani). Strategy C (PC kawai don SAC) yayi kama da B, kawai bambanci shine SAC kawai zai karɓi ivermectin, kuma manya ba za su iya ba.
A cikin dukkan dabarun, an rage kiyasin adadin mace-mace saboda tsananin karfi da karfi daga cikin jama'a kowace shekara. Tsammanin cewa kashi 0.4% na abubuwan da suka kamu da cutar za su haifar da mai tsanani strongyloidiasis [17], kuma 64.25% daga cikinsu za su mutu [18], kiyasta wadannan mutuwar. Ba a haɗa mace-mace ta wasu dalilai a cikin ƙirar ba.
An kimanta tasirin waɗannan dabarun guda biyu a ƙarƙashin matakan daban-daban na ƙarfin ƙarfin ƙarfi a cikin SAC: 5% (daidai da 9% yaduwa a cikin manya), 10% (18%), da 20% (36%).
Muna ɗauka cewa Dabarun A ba shi da alaƙa da kowane farashi kai tsaye ga tsarin kiwon lafiya na ƙasa, kodayake abubuwan da suka faru na cututtukan ƙarfi kamar su ƙarfi na iya samun tasirin tattalin arziƙi akan tsarin kiwon lafiya saboda asibiti da tuntuɓar marasa lafiya, kodayake yana iya zama maras muhimmanci. Fa'idodin daga hangen zaman jama'a (kamar haɓaka yawan aiki da ƙimar rajista, da rage asarar lokacin shawarwari), kodayake suna iya dacewa, ba a la'akari da su ba saboda wahalar ƙididdige su daidai.
Don aiwatar da dabarun B da C, mun yi la'akari da farashi da yawa. Mataki na farko shine gudanar da binciken da ya ƙunshi 0.1% na yawan jama'ar SAC don sanin yawan kamuwa da cuta a yankin da aka zaɓa. Farashin binciken shine dalar Amurka 27 (USD) akan kowane batu, gami da farashin parasitology (Baermann) da gwajin serological (ELISA); ƙarin farashin kayan aiki ya dogara ne akan aikin gwajin da aka tsara a Habasha. Gabaɗaya, binciken yara 250 (0.1% na yara a daidaitattun yawan jama'a) zai ci dalar Amurka 6,750. Kudin jiyya na ivermectin na SAC da manya (US$0.1 da US$0.3, bi da bi) ya dogara ne akan farashin da ake sa ran na prequalified generic ivermectin ta Hukumar Lafiya ta Duniya [8]. A ƙarshe, farashin shan ivermectin na SAC da manya shine 0.015 USD da 0.5 USD bi da bi) [19, 20].
Table 2 da Table 3 bi da bi suna nuna jimlar adadin yara da marasa lafiya da marasa lafiya a cikin daidaitattun mutane fiye da shekaru 6 a cikin dabarun uku, da kuma farashin da ke da alaƙa a cikin bincike na shekara 1 da 10. Ƙididdigar lissafi samfurin lissafi ne. Musamman, Table 2 yana ba da rahoton bambanci a cikin adadin masu kamuwa da cuta saboda dabarun PC guda biyu idan aka kwatanta da mai kwatanta (babu dabarun magani). Lokacin da yawan yara ya kai kashi 15% da 27% na manya, mutane 172,500 a cikin jama'a sun kamu da cutar. Adadin abubuwan da suka kamu da cutar ya nuna cewa gabatarwar PCs da aka yi niyya a SAC da manya sun ragu da 55.3%, kuma idan PC ɗin ya yi niyya kawai SAC, an rage shi da 15%.
A cikin bincike na dogon lokaci (shekaru 10), idan aka kwatanta da dabarun A, rage kamuwa da cuta na dabarun B da C ya karu zuwa 61.6% da 18.6%, bi da bi. Bugu da kari, yin amfani da dabarun B da C na iya haifar da raguwar 61% da yawan mace-mace na shekaru 10 na 48%, bi da bi, idan aka kwatanta da rashin samun magani.
Hoto na 2 yana nuna adadin cututtuka a cikin dabarun uku a lokacin nazarin shekaru 10: Kodayake wannan adadin ya kasance ba canzawa ba tare da tsoma baki ba, a cikin 'yan shekarun farko na aiwatar da dabarun PC guda biyu, adadin mu ya ragu da sauri. Da sannu a hankali daga baya.
Dangane da dabaru guda uku, kiyasin raguwar adadin cututtuka a cikin shekaru. PC rigakafin chemotherapy, SAC yara masu shekaru makaranta
Game da ICER, daga shekaru 1 zuwa 10 na bincike, ƙarin farashin kowane mutum da aka dawo da shi ya ƙaru kaɗan (Hoto 3). Yin la'akari da raguwar masu kamuwa da cutar a cikin jama'a, farashin guje wa kamuwa da cuta a dabarun B da C ya kasance dalar Amurka 2.49 da dalar Amurka 0.74, bi da bi, ba tare da magani ba tsawon shekaru 10.
Kudin kowane mutum da aka kwato a cikin bincike na shekara 1 da 10. PC rigakafin chemotherapy, SAC yara masu shekaru makaranta
Figures 4 da 5 suna ba da rahoton adadin cututtukan da PC ke gujewa da kuma haɗin haɗin kowane mai tsira idan aka kwatanta da babu magani. Matsakaicin ƙimar yaduwa a cikin shekara ya bambanta daga 5% zuwa 20%. Musamman ma, idan aka kwatanta da ainihin halin da ake ciki, lokacin da yawan karuwar ya ragu (alal misali, 10% ga yara da 18% na manya), farashin kowane mutum da aka dawo da shi zai kasance mafi girma; akasin haka, a cikin yanayin da ya fi girma Ana buƙatar ƙananan farashi a cikin yanayi.
Adadin yaɗuwar shekara ta farko ya bambanta daga 5% zuwa 20% na adadin cututtukan talla. PC rigakafin chemotherapy, SAC yara masu shekaru makaranta
Farashin kowane mutum da aka samu tare da yawan kashi 5% zuwa 20% a cikin shekarar farko. PC rigakafin chemotherapy, SAC yara masu shekaru makaranta
Tebur na 4 yana mayar da adadin mutuwar da farashin dangi a cikin shekaru 1 da shekaru 10 na dabarun PC daban-daban. Don duk ƙimar da aka yi la'akari da shi, farashin guje wa mutuwa don dabarun C yana da ƙasa da dabarun B. Ga duka dabarun, farashin zai ragu a tsawon lokaci, kuma zai nuna yanayin ƙasa yayin da yawancin ya karu.
A cikin wannan aikin, idan aka kwatanta da rashin tsare-tsaren kulawa na yanzu, mun kimanta yiwuwar dabarun PC guda biyu don farashin sarrafa strongyloidiasis, tasiri mai tasiri akan yaduwar strongyloidiasis, da tasiri akan sarkar fecal a cikin daidaitattun mutane. Tasirin mutuwar da ke da alaƙa da cocci. A matsayin mataki na farko, ana ba da shawarar ƙima ta asali, wanda zai kai kusan dalar Amurka 27 ga kowane mutum na gwaji (watau jimlar dalar Amurka 6750 don gwada yara 250). Ƙarin farashi zai dogara ne akan dabarun da aka zaɓa, wanda zai iya zama (A) ba aiwatar da shirin PC ba (yanayin halin yanzu, babu ƙarin farashi); (B) Gudanar da PC ga dukan jama'a (0.36 USD ta kowane mai magani); (C) ) Ko PC mai adireshin SAC ($ 0.04 ga kowane mutum). Dukansu dabarun B da C za su haifar da raguwa mai yawa a cikin adadin cututtuka a cikin shekarar farko ta aiwatar da PC: tare da yawan 15% a cikin shekarun makaranta da 27% a cikin manya, jimlar yawan mutanen da suka kamu da cutar za su kasance. a cikin aiwatar da dabarun B da C Daga baya, an rage adadin shari'o'in daga 172 500 a tushe zuwa 77 040 da 146 700 bi da bi. Bayan haka, adadin lokuta har yanzu zai ragu, amma a hankali. Farashin kowane mutum da aka dawo da shi ba kawai yana da alaƙa da dabarun biyu ba (idan aka kwatanta da dabarun C, farashin aiwatar da dabarun B yana da girma sosai, a $3.43 da $1.97 a cikin shekaru 10, bi da bi), amma kuma tare da haɓakar asali. Binciken ya nuna cewa tare da karuwa a cikin yaduwa, farashin kowane mutum da aka dawo da shi yana kan koma baya. Tare da yawan adadin SAC na 5%, zai ragu daga dalar Amurka 8.48 ga kowane mutum don Dabarun B da US $ 3.39 ga kowane mutum don Dabarun C. Zuwa USD 2.12 ga mutum da 0.85 ga kowane mutum tare da yawan adadin 20%, dabarun B da C. ana karbe su bi da bi. A ƙarshe, ana nazarin tasirin waɗannan dabarun biyu akan mutuwar talla. Idan aka kwatanta da Dabarun C (mutane 66 da 822 a cikin shekaru 1 da shekaru 10, bi da bi), Dabarun B a fili ya haifar da ƙarin mutuwar da ake tsammanin (245 da 2717 a cikin shekaru 1 da shekaru 10, bi da bi). Amma wani abin da ke da alaƙa shine kuɗin ayyana mutuwa. Farashin duka dabarun yana raguwa akan lokaci, kuma dabarun C (shekaru 10 $ 288) yayi ƙasa da B (shekaru 10 $ 969).
Zaɓin dabarun PC don sarrafa strongyloidiasis zai dogara ne akan abubuwa daban-daban, gami da samun kuɗi, manufofin kiwon lafiyar ƙasa, da abubuwan more rayuwa. Sa'an nan, kowace ƙasa za ta yi wani shiri na takamaiman manufofinta da albarkatunta. Tare da shirin PC don sarrafa STH a cikin SAC, ana iya la'akari da cewa haɗin kai tare da ivermectin ya fi sauƙi don aiwatarwa a farashi mai mahimmanci; yana da kyau a lura cewa ana buƙatar rage farashin don guje wa mutuwa ɗaya. A gefe guda, in babu manyan ƙuntatawa na kuɗi, aikace-aikacen PC ga dukan jama'a tabbas zai haifar da ƙarin raguwa a cikin cututtuka, don haka adadin mutuwar jimlar strongyloides zai ragu sosai cikin lokaci. A zahiri, dabarar ta ƙarshe za ta sami goyan baya ta hanyar rarrabawar cututtukan Streptococcus faecalis a cikin yawan jama'a, wanda ke haɓaka haɓakawa da shekaru, sabanin abubuwan lura na trichomes da roundworms [22]. Duk da haka, ci gaba da haɗin kai na shirin STH PC tare da ivermectin yana da ƙarin fa'idodi, wanda za'a iya la'akari da muhimmancin gaske ban da tasirin karfi da karfi. A haƙiƙa, haɗin ivermectin da albendazole/mebendazole sun tabbatar sun fi tasiri a kan trichinella fiye da benzimidazole kadai [23]. Wannan na iya zama dalili don tallafawa haɗin PC a cikin SAC don kawar da damuwa game da ƙananan yaduwar wannan rukunin shekaru idan aka kwatanta da manya. Bugu da ƙari, wata hanyar da za a yi la'akari da ita na iya zama shirin farko na SAC sannan kuma fadada shi don haɗa da matasa da manya idan zai yiwu. Duk kungiyoyin shekaru, ko an haɗa su a cikin wasu shirye-shiryen PC ko a'a, za su kuma amfana daga yuwuwar tasirin ivermectin akan cututtukan ectoparasites ciki har da scabies [24].
Wani abu da zai yi tasiri sosai akan farashi / fa'idar amfani da ivermectin don maganin PC shine yawan kamuwa da cuta a cikin yawan jama'a. Yayin da ƙimar yaɗuwar ta karu, raguwar cututtuka ya zama mafi bayyane, kuma farashin kowane mai tsira yana raguwa. Saita kofa don aiwatar da PC akan Streptococcus faecalis yakamata yayi la'akari da ma'auni tsakanin waɗannan bangarorin biyu. Dole ne a yi la'akari da cewa ga sauran STHs, ana ba da shawarar sosai don aiwatar da PC tare da ƙimar yaduwa na 20% ko mafi girma, dangane da rage yawan abin da aka yi niyya [3]. Koyaya, wannan bazai zama madaidaicin manufa don S. stercoralis ba, saboda haɗarin mutuwar abubuwan da suka kamu da cutar za su ci gaba da kasancewa a kowane girman kamuwa da cuta. Duk da haka, yawancin ƙasashen da ke fama da cutar na iya tunanin cewa ko da farashin kula da PC na Streptococcus faecalis ya yi yawa a cikin ƙananan ƙwayar cuta, saita iyakar jiyya a kusan 15-20% na yawan yaduwar cutar na iya zama mafi dacewa. Bugu da ƙari, lokacin da yawan yaɗuwar ya kasance ≥ 15%, gwajin jini yana ba da ƙima mafi inganci fiye da lokacin da yawan yaɗuwar ya ragu, wanda ke ƙoƙarin samun ƙarin tabbataccen ƙarya [21]. Wani abin da ya kamata a yi la'akari da shi shi ne cewa babban tsarin gudanar da ivermectin a cikin yankunan Loa loa endemic zai zama ƙalubale saboda an san marasa lafiya da ƙananan ƙananan jini na microfilaria suna cikin hadarin rashin lafiya na encephalopathy [25].
Bugu da ƙari, la'akari da cewa ivermectin na iya haɓaka juriya bayan shekaru da yawa na gudanarwa mai girma, ya kamata a kula da ingancin maganin [26].
Ƙayyadaddun wannan binciken sun haɗa da hasashe da yawa waɗanda ba mu iya samun shaida mai ƙarfi don su ba, kamar yawan sake kamuwa da cuta da mace-mace saboda tsananin strongyloidiasis. Komai iyakancewa, koyaushe zamu iya samun wasu takardu a matsayin tushen tsarin mu. Wani ƙayyadaddun shi ne cewa muna dogara da wasu kuɗaɗen kayan aiki akan kasafin kuɗin binciken matukin jirgi da za a fara a Habasha, don haka ƙila ba za su kasance daidai da kashe kuɗin da ake sa ran a wasu ƙasashe ba. Ana tsammanin wannan binciken zai samar da ƙarin bayanai don nazarin tasirin PC da ivermectin da ke niyya SAC. Sauran fa'idodin gudanarwar ivermectin (kamar tasiri akan scabies da ƙarin ingancin sauran STHs) ba a ƙididdige su ba, amma ƙasashen da ke fama da cutar na iya la'akari da su a cikin mahallin sauran ayyukan lafiya masu alaƙa. A ƙarshe, a nan ba mu auna tasirin yuwuwar ƙarin ayyukan ba, kamar ayyukan ruwa, tsafta, da tsaftar mutum (WASH), wanda zai iya ƙara taimakawa wajen rage yawan STH [27] kuma haƙiƙa Hukumar Lafiya ta Duniya ta ba da shawarar [3] . Kodayake muna tallafawa haɗin PC don STH tare da WASH, kimanta tasirin sa ya wuce iyakar wannan binciken.
Idan aka kwatanta da halin da ake ciki yanzu (ba a kula da su ba), duka waɗannan dabarun PC sun haifar da raguwa mai yawa a cikin adadin kamuwa da cuta. Dabarun B ya haifar da ƙarin mace-mace fiye da dabarun C, amma farashin da ke hade da dabarun ƙarshe sun yi ƙasa. Wani al'amari da ya kamata a yi la'akari da shi shi ne cewa a halin yanzu, a kusan dukkanin yankuna masu kama da karfi, an aiwatar da shirye-shiryen deworming na makaranta don rarraba benzimidazole don sarrafa STH [3]. Ƙara ivermectin zuwa wannan dandalin rarraba benzimidazole na makaranta zai ƙara rage farashin rarraba ivermectin na SAC. Mun yi imanin wannan aikin zai iya samar da bayanai masu amfani ga ƙasashen da ke son aiwatar da dabarun sarrafawa don Streptococcus faecalis. Kodayake PCs sun nuna babban tasiri akan yawan jama'a don rage yawan kamuwa da cuta da cikakken adadin mace-mace, PCs da ke niyya SAC na iya haɓaka mutuwa a ƙaramin farashi. Idan aka yi la'akari da ma'auni tsakanin farashi da tasirin sa baki, ana iya ba da shawarar yawan adadin 15-20% ko sama da haka azaman ƙofa da aka ba da shawarar don ivermectin PC.
Krolewiecki AJ, Lammie P, Jacobson J, Gabrielli AF, Levecke B, Socias E, da dai sauransu. Amsar lafiyar jama'a ga karfi da karfi: Lokaci ya yi da za a fahimci helminths na ƙasa. PLoS Negl Trop Dis. 2013; 7 (5): e2165.
Buonfrate D, Bisanzio D, Giorli G, Odermatt P, Fürst T, Greenaway C, da dai sauransu. Yaɗuwar cutar ƙarfi ta stercoralis a duniya. Pathogen (Basel, Switzerland). 2020; 9 (6): 468.
Montresor A, Mupfasoni D, Mikhailov A, Mwinzi P, Lucianez A, Jamsheed M, da dai sauransu. Ci gaban duniya game da magance cututtukan tsutsotsi na ƙasa a cikin 2020 da burin Hukumar Lafiya ta Duniya na 2030. PLoS Negl Trop Dis. 2020; 14 (8): e0008505.
Fleitas PE, Travacio M, Martí-Soler H, Socías ME, Lopez WR, Krolewiecki AJ. Strongyloides stercoralis-Hookworm Association a matsayin wata hanya don kimanta nauyin duniya na strongyloidiasis: nazari na yau da kullum. PLoS Negl Trop Dis. 2020; 14 (4): e0008184.
Buonfrate D, Formenti F, Perandin F, Bisoffi Z. Sabuwar hanya don ganewar asali na strongyloides faecalis kamuwa da cuta. Kamuwa da cuta na ƙwayoyin cuta. 2015; 21 (6): 543-52.
Forenti F, Buonfrate D, Prandi R, Marquez M, Caicedo C, Rizzi E, da dai sauransu Tsoffin ƙwayoyin cuta. 2016; 7:1778.
Mounsey K, Kearns T, Rampton M, Llewellyn S, King M, Holt D, da dai sauransu. An yi amfani da busassun tabo na jini don ayyana martanin antigen ga recombinant antigen NIE na Strongyloides faecalis. Jarida. 2014; 138: 78-82.
Hukumar Lafiya ta Duniya, Hanyoyin Bincike don Kula da Strongyloidiasis a cikin 2020; Taro Mai Kyau. Hukumar Lafiya ta Duniya, Geneva, Switzerland.
Henriquez-Camacho C, Gotuzzo E, Echevarria J, White AC Jr, Terrashima A, Samalvides F, da dai sauransu. Ivermectin da albendazole ko thiabendazole a cikin maganin karfi na faecalis kamuwa da cuta. Tsarin tsarin bayanai na Cochrane 2016; 2016 (1): CD007745.
Bradley M, Taylor R, Jacobson J, Guex M, Hopkins A, Jensen J, da dai sauransu Taimakawa shirin ba da gudummawar magunguna na duniya don kawar da nauyin cututtuka na wurare masu zafi da aka yi watsi da su. Trans R Soc Trop Med Hyg. 2021. PubMed PMID: 33452881. Epub 2021/01/17. Turanci
Chosidow A, Gendrel D. [Tsarin ivermectin na baka a cikin yara]. Arch pediatr: Organe officiel de la Societe francaise de pediatrie. 2016;23 (2):204-9. PubMed PMID: 26697814. EPUB 2015/12/25. Tolerance de l'ivermectine orale chez l'enfant. kyauta.
Dala na yawan jama'ar duniya daga 1950 zuwa 2100. https://www.populationpyramid.net/africa/2019/. An ziyarci Fabrairu 23, 2021.
Knopp S, B mutum, Ame SM, Ali SM, Muhsin J, Juma S, da dai sauransu Praziquantel ɗaukar hoto a makarantu da kuma al'ummomi da nufin kawar da schistosomiasis a cikin genitourinary tsarin na Zanzibar: giciye-sashe binciken. Parasitic vector. 2016; 9:5 ku.
Buonfrate D, Salas-Coronas J, Muñoz J, Maruri BT, Rodari P, Castelli F, da dai sauransu. Multi-dose da single-dose ivermectin a cikin maganin Strongyloides faecalis kamuwa da cuta (Karfin Jiyya 1 zuwa 4): cibiyar da yawa, buɗaɗɗen lakabin, lokaci 3, gwajin fa'ida mai sarrafawa bazuwar. Lancet yana kamuwa da dis. 2019;19 (11):1181–90.
Khieu V, Hattendorf J, Schär F, Marti H, Char MC, Muth S, da dai sauransu Strongyloides faecalis kamuwa da cuta da reinfection a cikin rukuni na yara a Cambodia. Parasite International 2014; 63 (5): 708-12.