Kukhazikitsidwa kwa dongosolo lothana ndi matenda a Strongyloides stercoralis ndi chimodzi mwa zolinga za World Health Organisation ya 2030. Cholinga cha ntchitoyi ndikuwunika momwe zingakhudzire njira ziwiri zosiyana zodzitetezera ku chemotherapy (PC) ponena za chuma ndi thanzi pazochitika zamakono (Strategy A, palibe PC): Ivermectin kwa ana a sukulu (SAC) ndi Dosing wamkulu (njira B) ndi ivermectin amangogwiritsidwa ntchito pa SAC (njira C).
Kafukufukuyu adachitika ku IRCCS Sacro Cuore Don Calabria Hospital ku Negrar di Valpolicella, Verona, Italy, University of Florence, Italy, ndi WHO ku Geneva, Switzerland kuyambira May 2020 mpaka April 2021. Deta ya chitsanzo ichi imachotsedwa m'mabuku. Chitsanzo cha masamu chinapangidwa mu Microsoft Excel kuti awunike zotsatira za njira B ndi C pa chiwerengero cha anthu okwana 1 miliyoni omwe amakhala m'madera omwe strongyloidiasis amapezeka. Pazochitikazo, chiwerengero cha 15% cha strongyloidiasis chinaganiziridwa; ndiye njira zitatuzi zidawunikidwa pansi pa miliri yosiyana, kuyambira 5% mpaka 20%. Zotsatira zimanenedwa ngati kuchuluka kwa anthu omwe ali ndi kachilomboka, kuchuluka kwa omwe amwalira, mtengo wake, komanso kuchuluka kwa magwiridwe antchito (ICER). Nthawi za 1 chaka ndi zaka 10 zaganiziridwa.
M'nkhani yochokera ku zochitika, m'chaka choyamba cha kukhazikitsidwa kwa njira za B ndi C za ma PC, chiwerengero cha matenda chidzachepetsedwa kwambiri: kuchokera ku 172 500 milandu malinga ndi ndondomeko ya B mpaka 77 040, ndipo malinga ndi ndondomeko ya C. mpaka 146 700 milandu. Mtengo wowonjezera wa munthu aliyense wochira umayerekezedwa popanda chithandizo m'chaka choyamba. Madola aku US (USD) munjira B ndi C ndi 2.83 ndi 1.13, motsatana. Kwa njira ziwirizi, pamene kufalikira kukukulirakulira, mtengo wa munthu aliyense wochira ukutsika. Strategy B ili ndi chiwerengero chochuluka cha imfa zomwe zalengezedwa kuposa C, koma njira C ili ndi mtengo wotsika wolengeza imfa kuposa B.
Kusanthula uku kumalola kuyerekezera zotsatira za njira ziwiri za PC zowongolera strongyloidiasis potengera mtengo ndi kupewa matenda / imfa. Izi zitha kuyimira maziko a dziko lililonse lomwe lili ndi kachilomboka kuti liwunike njira zomwe zingatsatidwe potengera ndalama zomwe zilipo komanso zofunikira pazaumoyo wadziko.
Nyongolotsi zoberekera m'nthaka (STH) Strongyloides stercoralis zimayambitsa matenda okhudzana ndi anthu omwe akhudzidwa, ndipo zimatha kupha anthu omwe ali ndi kachilombo ngati ali ndi vuto la immunosuppression [1]. Malinga ndi kuyerekezera kwaposachedwa, anthu pafupifupi 600 miliyoni padziko lonse lapansi akhudzidwa, ndipo ambiri amakhala ku Southeast Asia, Africa ndi Western Pacific [2]. Malinga ndi umboni waposachedwa wapadziko lonse lapansi wa strongyloidiasis, World Health Organisation (WHO) yaphatikiza kuwongolera matenda a faecalis mu 2030 Neglected Tropical Diseases (NTD) [3]. Aka ndi nthawi yoyamba WHO yalimbikitsa dongosolo lowongolera la strongyloidiasis, ndipo njira zowongolera zenizeni zikufotokozedwa.
S. stercoralis amagawana njira yopatsirana ndi nyongolotsi ndipo imakhala ndi malo ofanana ndi ma STHs ena, koma imafuna njira zosiyanasiyana zodziwira matenda ndi mankhwala [4]. Ndipotu, Kato-Katz, yemwe amagwiritsidwa ntchito poyesa kufalikira kwa STH mu pulogalamu yolamulira, ali ndi mphamvu zochepa kwambiri za S. stercoralis. Kwa tiziromboti, njira zina zowunikira zolondola kwambiri zitha kulimbikitsidwa: Baermann ndi chikhalidwe cha mbale ya agar mu njira za parasitological, polymerase chain reaction ndi kuyesa serological [5]. Njira yotsirizirayi imagwiritsidwa ntchito kwa ma NTD ena, kugwiritsa ntchito mwayi wopeza magazi pa pepala losefera, zomwe zimalola kusonkhanitsa mwachangu komanso kusungirako kosavuta kwa zitsanzo zachilengedwe [6, 7].
Tsoka ilo, palibe muyezo wa golide wodziwira tiziromboti [5], kotero kusankha njira yabwino kwambiri yodziwira matenda yomwe imayikidwa mu pulogalamu yowongolera iyenera kuganizira zinthu zingapo, monga kulondola kwa mayeso, mtengo wake komanso kuthekera kogwiritsa ntchito. m'munda Pamsonkhano waposachedwa wokonzedwa ndi WHO [8], akatswiri osankhidwa adatsimikiza kuwunika kwa serological ngati chisankho chabwino kwambiri, ndipo NIE ELISA ndiye chisankho chabwino kwambiri pakati pa zida za ELISA zomwe zimapezeka pamalonda. Ponena za chithandizo, chithandizo chamankhwala chodzitetezera (PC) cha matenda opatsirana pogonana chimafunika kugwiritsa ntchito mankhwala a benzimidazole, albendazole kapena mebendazole [3]. Mapulogalamuwa nthawi zambiri amayang'ana ana azaka zakusukulu (SAC), omwe ndizovuta kwambiri zachipatala chifukwa cha STH [3]. Komabe, mankhwala a benzimidazole alibe mphamvu pa Streptococcus faecalis, kotero ivermectin ndiye mankhwala osankhidwa bwino [9]. Ivermectin yakhala ikugwiritsidwa ntchito pochiza matenda akuluakulu a onchocerciasis ndi ma lymphatic filariasis (NTD) kwa zaka zambiri [10, 11]. Ili ndi chitetezo chabwino kwambiri komanso cholekerera, koma sichivomerezeka kwa ana osakwana zaka 5 [12].
S. stercoralis imakhalanso yosiyana ndi matenda ena opatsirana pogonana pokhudzana ndi nthawi ya matenda, chifukwa ngati sichikuchiritsidwa mokwanira, kuzungulira kwapadera kwa auto-infection kungapangitse kuti tizilombo toyambitsa matenda tipitirizebe kwamuyaya mwa munthu. Chifukwa cha kutuluka kwa matenda atsopano komanso kulimbikira kwa matenda a nthawi yayitali, izi zimabweretsanso kufalikira kwa matenda akakula [1, 2].
Ngakhale ndizopadera, kuphatikiza zochitika zenizeni ndi mapulogalamu omwe alipo a matenda ena onyalanyazidwa a m'madera otentha angapindule ndi kukhazikitsidwa kwa mapulogalamu oletsa matenda a strongyloidosis. Kugawana zomangamanga ndi ogwira ntchito kungachepetse ndalama ndikufulumizitsa ntchito zomwe cholinga chake ndikuwongolera Streptococcus faecalis.
Cholinga cha ntchitoyi ndikuyesa mtengo ndi zotsatira za njira zosiyanasiyana zokhudzana ndi kulamulira kwa strongyloidiasis, zomwe ndi: (A) palibe kulowererapo; (B) kulamulira kwakukulu kwa SAC ndi akuluakulu; (C) kwa SAC PC.
Kafukufukuyu adachitika pachipatala cha IRCCS Sacro Cuore Don Calabria ku Negrar di Valpolicella, Verona, Italy, University of Florence, Italy, ndi WHO ku Geneva, Switzerland kuyambira Meyi 2020 mpaka Epulo 2021. Magwero amtunduwu ndi mabuku. Chitsanzo cha masamu chinapangidwa mu Microsoft® Excel® cha Microsoft 365 MSO (Microsoft Corporation, Santa Rosa, California, USA) kuti awunike njira ziwiri zomwe zingatheke ngati strongyloidosis m'madera omwe ali ndi vuto lalikulu poyerekeza ndi (A) palibe kulowererapo. za miyeso (mchitidwe wamakono); (B) ma PC a SAC ndi akuluakulu; (C) Ma PC a SAC okha. Nthawi ya 1-chaka ndi 10-year horizons ikuwunikidwa pakuwunika. Kafukufukuyu adachitidwa potengera momwe dongosolo laumoyo wadziko lonse likuyendera, lomwe limayang'anira ntchito zowononga mphutsi, kuphatikizapo ndalama zomwe zimayenderana ndi ndalama zamagulu a anthu. Mtengo wa chisankho ndi kuyika kwa deta zikufotokozedwa mu Chithunzi 1 ndi Table 1, motsatira. Makamaka, mtengo wachisankho ukuwonetsa madera azaumoyo omwe amawonetseredwa ndi chitsanzo komanso masitepe owerengera a njira iliyonse yosiyana. Gawo lazolowera m'munsimu limafotokoza mwatsatanetsatane kuchuluka kwa kutembenuka kuchokera kudera lina kupita ku lina komanso malingaliro ogwirizana nawo. Zotsatira zimanenedwa ngati kuchuluka kwa anthu omwe ali ndi kachilomboka, anthu omwe alibe kachilomboka, omwe adachiritsidwa (kuchira), kufa, mtengo, komanso kuchuluka kwa phindu lamtengo wapatali (ICER). ICER ndi kusiyana kwa mtengo pakati pa njira ziwiri zomwe zimagawidwa ndi Kusiyana kwa zotsatira zake ndikubwezeretsa mutuwo ndikupewa matenda. ICER yaying'ono ikuwonetsa kuti njira imodzi ndiyotsika mtengo kuposa ina.
Mtengo wosankha pazaumoyo. PC preventive chemotherapy, IVM ivermectin, ADM management, SAC azaka zakusukulu
Timaganiza kuti chiwerengero cha anthu ndi 1,000,000 maphunziro omwe akukhala m'mayiko omwe ali ndi vuto lalikulu la strongyloidiasis, omwe 50% ndi akuluakulu (≥15 zaka) ndi 25% ndi ana a sukulu (zaka 6-14). Uku ndikugawidwa komwe kumachitika kawirikawiri m'maiko aku Southeast Asia, Africa ndi Western Pacific [13]. Pazochitikazo, kufalikira kwa strongyloidiasis mwa akuluakulu ndi SAC akuti ndi 27% ndi 15%, motero [2].
Mu njira A (kachitidwe kamakono), maphunziro sakulandira chithandizo, kotero timaganiza kuti kufalikira kwa matenda kudzakhalabe chimodzimodzi kumapeto kwa chaka chimodzi ndi zaka 10.
Mu njira B, onse a SAC ndi akulu adzalandira ma PC. Kutengera kuchuluka kwa kutsata kwa 60% kwa akulu ndi 80% kwa SAC [14], onse omwe ali ndi kachilomboka komanso omwe alibe kachilomboka adzalandira ivermectin kamodzi pachaka kwa zaka 10. Tikuganiza kuti chiwopsezo cha anthu omwe ali ndi kachilomboka ndi pafupifupi 86% [15]. Pamene anthu ammudzi adzapitirizabe kukumana ndi gwero la matenda (ngakhale kuipitsidwa kwa nthaka kungachepe pakapita nthawi kuyambira pamene PC inayamba), kuyambiranso ndi matenda atsopano adzapitirizabe kuchitika. Chiwopsezo chatsopano chapachaka chikuyembekezeka kukhala theka lachiwopsezo choyambira matenda [16]. Chifukwa chake, kuyambira chaka chachiwiri cha kukhazikitsidwa kwa PC, kuchuluka kwa anthu omwe ali ndi kachilombo chaka chilichonse kudzakhala kofanana ndi kuchuluka kwa omwe angodwala kumene kuphatikiza kuchuluka kwa milandu yomwe ikukhalabe yabwino (ie, omwe sanalandire chithandizo cha PC ndi omwe adadwala. osayankhidwa chithandizo). Strategy C (PC yokha ya SAC) ndi yofanana ndi B, kusiyana kokha ndiko kuti SAC yokha idzalandira ivermectin, ndipo akuluakulu sadzalandira.
M'njira zonse, chiwerengero cha anthu omwe amafa chifukwa cha strongyloidiasis chimachotsedwa pakati pa anthu chaka chilichonse. Poganiza kuti 0.4% ya anthu omwe ali ndi kachilomboka adzakhala ndi strongyloidiasis [17], ndipo 64.25% ya iwo adzafa [18], yerekezerani imfa izi. Imfa chifukwa cha zifukwa zina sizinaphatikizidwe mu chitsanzo.
Zotsatira za njira ziwirizi zinayesedwa pansi pa magulu osiyanasiyana a strongyloidosis kufalikira mu SAC: 5% (mogwirizana ndi 9% kufalikira kwa akuluakulu), 10% (18%), ndi 20% (36%).
Tikuganiza kuti Strategy A ilibe kanthu kochita ndi ndalama zachindunji ku dongosolo la thanzi la dziko, ngakhale kuti matenda a strongyloidia-ngati matenda angakhale ndi zotsatira zachuma pa kayendetsedwe ka zaumoyo chifukwa cha chipatala ndi kukaonana ndi odwala, ngakhale kuti zingakhale zosafunika. Ubwino wokhudzana ndi chikhalidwe cha anthu (monga kuchuluka kwa zokolola ndi chiwerengero cha anthu olembetsa, ndi kuchepetsa kutaya nthawi yofunsira), ngakhale kuti zingakhale zofunikira, sizikuganiziridwa chifukwa cha zovuta kuziwerengera molondola.
Pokhazikitsa njira B ndi C, tidaganizira ndalama zingapo. Chinthu choyamba ndikuchita kafukufuku wokhudza 0.1% ya anthu a SAC kuti adziwe kuchuluka kwa matenda m'dera losankhidwa. Mtengo wa kafukufukuyu ndi madola 27 aku US (USD) pa phunziro lililonse, kuphatikiza mtengo wa parasitology (Baermann) ndi kuyesa serological (ELISA); ndalama zowonjezera zogulira zimatengera ntchito yoyeserera yomwe idakonzedwa ku Ethiopia. Ponseponse, kafukufuku wa ana 250 (0.1% ya ana mu chiwerengero chathu chokhazikika) adzawononga US$6,750. Mtengo wa chithandizo cha ivermectin kwa SAC ndi akuluakulu (US $ 0.1 ndi US $ 0.3, motsatira) zimachokera ku mtengo woyembekezeredwa wa ivermectin yovomerezeka ndi World Health Organization [8]. Pomaliza, mtengo wotengera ivermectin kwa SAC ndi akulu ndi 0.015 USD ndi 0.5 USD motsatana) [19, 20].
Table 2 ndi Table 3 motsatana akuwonetsa chiwerengero chonse cha ana omwe ali ndi kachilombo komanso omwe alibe kachilomboka komanso akuluakulu omwe ali ndi anthu opitilira zaka 6 mu njira zitatuzi, komanso ndalama zofananira pakuwunika kwa chaka chimodzi ndi 10. Fomula yowerengera ndi masamu masamu. Makamaka, Table 2 ikufotokoza kusiyana kwa chiwerengero cha anthu omwe ali ndi kachilomboka chifukwa cha njira ziwiri za PC poyerekeza ndi woyerekeza (palibe njira ya chithandizo). Pamene kufalikira kwa ana kuli kofanana ndi 15% ndi 27% mwa akuluakulu, anthu 172,500 mwa anthu ali ndi kachilomboka. Chiwerengero cha anthu omwe ali ndi kachilomboka chinasonyeza kuti kuyambitsidwa kwa ma PC omwe akukhudzidwa ndi SAC ndi akuluakulu adachepetsedwa ndi 55.3%, ndipo ngati ma PC akuyang'ana SAC yokha, adachepetsedwa ndi 15%.
Pakuwunika kwa nthawi yayitali (zaka 10), poyerekeza ndi njira A, kuchepetsa matenda a njira B ndi C kunawonjezeka kufika 61,6% ndi 18,6%, motero. Kuonjezera apo, kugwiritsa ntchito njira za B ndi C kungapangitse kuchepa kwa 61% ndi imfa ya zaka 10 za 48%, motero, poyerekeza ndi kusalandira chithandizo.
Chithunzi cha 2 chikuwonetsa kuchuluka kwa matenda mu njira zitatu pa nthawi ya kusanthula kwa zaka 10: Ngakhale kuti chiwerengerochi sichinasinthe popanda kuchitapo kanthu, m'zaka zoyamba za kukhazikitsidwa kwa njira ziwiri za PC, chiwerengero chathu cha milandu chinachepa mofulumira. Pang'onopang'ono pambuyo pake.
Malingana ndi njira zitatu, kuyerekezera kwa kuchepetsa chiwerengero cha matenda pazaka zambiri. PC preventive chemotherapy, SAC ana azaka zakusukulu
Ponena za ICER, kuchokera ku 1 mpaka zaka 10 za kusanthula, mtengo wowonjezera wa munthu aliyense wochira unakula pang'ono (Chithunzi 3). Poganizira za kuchepa kwa anthu omwe ali ndi kachilombo mu chiwerengero cha anthu, mtengo wopewa matenda mu njira B ndi C unali US $ 2.49 ndi US $ 0.74 motsatira, popanda chithandizo kwa zaka khumi.
Mtengo wa munthu wobwezedwa pakuwunika kwa chaka chimodzi ndi zaka 10. PC preventive chemotherapy, SAC ana azaka zakusukulu
Zithunzi 4 ndi 5 zimafotokoza kuchuluka kwa matenda omwe amapewa ndi PC komanso mtengo wogwirizana ndi wopulumuka poyerekeza ndi chithandizo chilichonse. Chiwerengero cha kufalikira mkati mwa chaka chimachokera ku 5% mpaka 20%. Makamaka, poyerekeza ndi momwe zinthu zilili, pamene chiwerengero cha kufalikira ndi chochepa (mwachitsanzo, 10% kwa ana ndi 18% kwa akuluakulu), mtengo wa munthu wochira udzakhala wapamwamba; m'malo mwake, pankhani ya kufala kwapamwamba Kutsika mtengo kumafunika m'chilengedwe.
Chaka choyamba kufalikira kumachokera ku 5% mpaka 20% ya chiwerengero cha matenda otsatsa. PC preventive chemotherapy, SAC ana azaka zakusukulu
Mtengo pa munthu wochira wokhala ndi kuchuluka kwa 5% mpaka 20% mchaka choyamba. PC preventive chemotherapy, SAC ana azaka zakusukulu
Table 4 imabwezeretsanso chiwerengero cha imfa ndi ndalama zachibale mu zaka za 1 ndi zaka 10 za njira zosiyanasiyana za PC. Paziwerengero zonse zomwe zimaganiziridwa, mtengo wopewa kufa kwa njira C ndi wotsika kuposa njira B. Pa njira zonsezi, mtengowo udzachepa pakapita nthawi, ndipo udzawonetsa kutsika pamene chiwerengero chikuwonjezeka.
Mu ntchito iyi, poyerekeza ndi kusowa kwa ndondomeko zowongolera panopa, tinayesa njira ziwiri zomwe zingatheke pa PC za mtengo wolamulira strongyloidiasis, zomwe zingakhudze kufalikira kwa strongyloidiasis, ndi zotsatira za unyolo wa fecal mu chiwerengero cha anthu. Zotsatira za kufa kwa cocci. Monga gawo loyamba, kuwunika koyambira kachulukidwe kumalimbikitsidwa, komwe kungawononge pafupifupi US$27 pa munthu aliyense woyezetsa (ie, ndalama zokwana US$6750 zoyesa ana 250). Ndalama zowonjezera zidzadalira njira yosankhidwa, yomwe ingakhale (A) osagwiritsa ntchito pulogalamu ya PC (zochitika zamakono, palibe ndalama zowonjezera); (B) Kuwongolera kwa PC kwa anthu onse (0.36 USD pa munthu wamankhwala); (C) ) Kapena PC yolankhula ndi SAC ($ 0.04 pa munthu). Njira zonsezi B ndi C zidzachepetsa kwambiri chiwerengero cha matenda m'chaka choyamba cha kukhazikitsidwa kwa PC: ndi chiwerengero cha 15% mwa anthu a msinkhu wa sukulu ndi 27% mwa akuluakulu, chiwerengero cha anthu omwe ali ndi kachilomboka chidzakhala. pokhazikitsa njira B ndi C Kenako, chiwerengero cha milandu chinachepetsedwa kuchoka pa 172 500 poyambira kufika pa 77 040 ndi 146 700 motsatira. Pambuyo pake, chiwerengero cha milandu chidzacheperachepera, koma pang'onopang'ono. Mtengo wa munthu aliyense wobwezeretsedwa sungokhudzana ndi njira ziwiri zokha (poyerekeza ndi njira C, mtengo wogwiritsira ntchito njira B ndi wapamwamba kwambiri, pa $ 3.43 ndi $ 1.97 m'zaka za 10, motsatira), komanso ndi kufalikira koyambirira. Kusanthula kukuwonetsa kuti pakuwonjezeka kwa kufalikira, mtengo wa munthu aliyense wochira ukukwera pansi. Ndi chiwerengero cha SAC cha 5%, chidzatsika kuchokera ku US $ 8.48 pa munthu pa Strategy B ndi US $ 3.39 pa munthu pa Strategy C. Kufika ku USD 2.12 pa munthu ndi 0.85 pa munthu aliyense wokhala ndi chiwerengero cha 20%, njira B ndi C amatengedwa motsatana. Pomaliza, zotsatira za njira ziwirizi pa imfa ya malonda zimawunikidwa. Poyerekeza ndi Strategy C (anthu 66 ndi 822 muzaka za 1 ndi zaka 10, motsatana), Strategy B idapangitsa kuti anthu ambiri afe (245 ndi 2717 mu chaka chimodzi ndi zaka 10, motsatana). Koma chinthu china chogwirizana nacho ndi mtengo wolengeza imfa. Mtengo wa njira zonsezi umachepa pakapita nthawi, ndipo njira C (10-year $288) ndi yotsika kuposa B (10-year $969).
Kusankhidwa kwa njira ya PC yoyendetsera strongyloidiasis kudzakhazikitsidwa pazifukwa zosiyanasiyana, kuphatikizapo kupezeka kwa ndalama, ndondomeko zaumoyo za dziko, ndi zomangamanga zomwe zilipo. Ndiye, dziko lirilonse lidzakhala ndi ndondomeko ya zolinga zake zenizeni ndi zothandizira. Ndi pulogalamu ya PC yomwe imayang'anira STH mu SAC, zikhoza kuganiziridwa kuti kuphatikizana ndi ivermectin ndikosavuta kugwiritsa ntchito pamtengo wokwanira; Ndikoyenera kudziwa kuti mtengo uyenera kuchepetsedwa kuti upewe imfa imodzi. Kumbali ina, pakalibe zoletsa zazikulu zachuma, kugwiritsa ntchito PC kwa anthu onse kudzachititsa kuti matenda achuluke, kotero kuti chiwerengero cha imfa za strongyloides chidzatsika kwambiri pakapita nthawi. M'malo mwake, njira yotsirizirayi idzathandizidwa ndi kufalikira kwa matenda a Streptococcus faecalis mwa anthu, omwe amachulukirachulukira ndi zaka, mosiyana ndi zomwe ma trichomes ndi mphutsi zozungulira [22] zimawonekera. Komabe, kuphatikizika kosalekeza kwa pulogalamu ya STH PC ndi ivermectin kuli ndi maubwino owonjezera, omwe angaganizidwe kuti ndi amtengo wapatali kwambiri kuwonjezera pa zotsatira za strongyloidiasis. Ndipotu, kuphatikiza kwa ivermectin kuphatikiza albendazole/mebendazole kunakhala kothandiza kwambiri polimbana ndi trichinella kuposa benzimidazole yokha [23]. Izi zikhoza kukhala chifukwa chothandizira kuphatikiza kwa PC mu SAC kuti athetse nkhawa za kuchepa kwa msinkhu wa msinkhu uwu poyerekeza ndi akuluakulu. Kuphatikiza apo, njira ina yoti muganizire ingakhale dongosolo loyambirira la SAC ndikulikulitsa kuti liphatikizepo achinyamata ndi akulu ngati kuli kotheka. Magulu onse azaka, kaya akuphatikizidwa mu mapulogalamu ena a PC kapena ayi, adzapindulanso ndi zotsatira za ivermectin pa ectoparasites kuphatikizapo mphere [24].
Chinthu china chomwe chidzakhudza kwambiri mtengo / phindu la kugwiritsa ntchito ivermectin pa PC mankhwala ndi chiwerengero cha matenda mwa anthu. Pamene chiwerengero chikuwonjezeka, kuchepa kwa matenda kumawonekera kwambiri, ndipo mtengo wa munthu aliyense wopulumuka umachepa. Kuyika malire a PC kukhazikitsidwa motsutsana ndi Streptococcus faecalis kuyenera kuganizira za kusanja pakati pa mbali ziwirizi. Ziyenera kuganiziridwa kuti kwa ma STHs ena, akulimbikitsidwa kuti agwiritse ntchito PC ndi chiwerengero cha 20% kapena apamwamba, kutengera kuchepetsa kwambiri chiwerengero cha anthu omwe akuwafuna [3]. Komabe, ichi sichingakhale chandamale choyenera cha S. stercoralis, chifukwa chiopsezo cha imfa ya anthu omwe ali ndi kachilombo chidzapitirirabe pamtundu uliwonse wa matenda. Komabe, mayiko ambiri omwe ali ndi kachilomboka angaganize kuti ngakhale mtengo wosungira ma PC a Streptococcus faecalis ndi wokwera kwambiri pa chiwerengero chochepa cha kufalikira, kuika pakhomo lachipatala pafupi ndi 15-20% ya chiwerengero cha kufalikira kungakhale koyenera kwambiri. Kuonjezera apo, pamene chiwerengero cha kufalikira ndi ≥ 15%, kuyesa kwa serological kumapereka chiwerengero chodalirika kuposa pamene chiwerengero cha kufalikira chili chochepa, chomwe chimakhala ndi zolakwika zambiri [21]. Chinthu chinanso chomwe chiyenera kuganiziridwa ndi chakuti kulamulira kwakukulu kwa ivermectin m'madera a Loa loa endemic kudzakhala kovuta chifukwa odwala omwe ali ndi magazi ochuluka a microfilaria amadziwika kuti ali pachiopsezo cha imfa ya encephalopathy [25].
Kuphatikiza apo, poganizira kuti ivermectin imatha kukana pambuyo pa zaka zingapo zaulamuliro waukulu, mphamvu ya mankhwalawa iyenera kuyang'aniridwa [26].
Zoperewera za phunziroli zikuphatikizapo malingaliro angapo omwe sitinathe kupeza umboni wamphamvu, monga chiwerengero cha reinfection komanso imfa chifukwa cha strongyloidiasis. Ziribe kanthu kuti ndizochepa bwanji, nthawi zonse tikhoza kupeza mapepala ena monga maziko a chitsanzo chathu. Cholepheretsa china ndi chakuti timayika ndalama zina zoyendetsera ndalama pa bajeti ya kafukufuku woyendetsa ndege yomwe idzayambike ku Ethiopia, kotero kuti sizingakhale zofanana ndendende ndi zomwe zikuyembekezeredwa m'mayiko ena. Zikuyembekezeka kuti phunziro lomwelo lipereka deta yowonjezereka kuti ifufuze zotsatira za PC ndi ivermectin yolunjika ku SAC. Zopindulitsa zina za kayendetsedwe ka ivermectin (monga momwe zimakhudzira mphere ndi kuwonjezeka kwa mphamvu za ma STH ena) sizinatchulidwe, koma mayiko omwe ali ndi vuto la matenda amatha kuwaganizira potsata njira zina zokhudzana ndi thanzi. Pomaliza, apa sitinayeze zotsatira za njira zina zowonjezera, monga madzi, ukhondo, ndi ukhondo waumwini (WASH), zomwe zingathandize kuchepetsa kufalikira kwa STH [27] ndipo ndithudi World Health Organization Analimbikitsa [3] . Ngakhale timathandizira kuphatikiza kwa ma PC a STH ndi WASH, kuwunika momwe zimakhudzira maphunzirowa sikungatheke.
Poyerekeza ndi momwe zinthu zilili panopa (zopanda chithandizo), njira zonsezi za PC zinapangitsa kuti chiwerengero cha matenda chichepetse kwambiri. Njira B idapha anthu ambiri kuposa njira C, koma ndalama zomwe zimagwirizanitsidwa ndi njira yomalizayi zinali zotsika. Mbali ina yomwe iyenera kuganiziridwa ndi yakuti pakali pano, pafupifupi m'madera onse a strongyloidosis-monga, mapulogalamu othetsa nyongolotsi m'sukulu akhazikitsidwa kuti agawire benzimidazole kuti athetse matenda a STH [3]. Kuonjezera ivermectin pa pulatifomu yogawa ya benzimidazole yomwe ilipo imachepetsanso ndalama zogawa za ivermectin za SAC. Tikukhulupirira kuti ntchitoyi ikhoza kupereka deta yothandiza kwa mayiko omwe akufuna kugwiritsa ntchito njira zoyendetsera Streptococcus faecalis. Ngakhale kuti ma PC awonetsa kukhudzidwa kwakukulu kwa chiwerengero cha anthu kuti achepetse chiwerengero cha matenda ndi chiwerengero cha imfa, ma PC omwe akulunjika ku SAC akhoza kulimbikitsa imfa pamtengo wotsika. Poganizira za kulinganiza pakati pa mtengo ndi zotsatira za kulowererapo, chiwerengero cha 15-20% kapena chapamwamba chikhoza kulimbikitsidwa ngati gawo lovomerezeka la PC ya ivermectin.
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