Ishyirwa mu bikorwa rya gahunda yo kurwanya indwara ya Strongyloides stercoralis ni imwe mu ntego z'umuryango mpuzamahanga wita ku buzima ku isi 2030. Intego y'iki gikorwa ni ugusuzuma ingaruka zishobora guterwa n'ingamba ebyiri zitandukanye zo gukumira imiti (PC) mu bijyanye n'ubukungu ndetse n'imiterere y'ubuzima ku bihe biriho (Strategy A, nta PC): Ivermectin ku bana biga mu ishuri (SAC) na Gukura abantu bakuru (ingamba B) na ivermectin bikoreshwa gusa kuri SAC (ingamba C).
Ubushakashatsi bwakorewe mu bitaro bya IRCCS Sacro Cuore Don Calabria i Negrar di Valpolicella, Verona, mu Butaliyani, kaminuza ya Florence, mu Butaliyani, na OMS i Geneve mu Busuwisi kuva muri Gicurasi 2020 kugeza muri Mata 2021. Amakuru y’uru rugero yakuwe mu bitabo. Icyitegererezo cy'imibare cyakozwe muri Microsoft Excel kugirango harebwe ingaruka z'ingamba B na C ku baturage basanzwe babarirwa muri miliyoni 1 batuye mu turere twa strongyloidiasis yanduye. Mu bihe bishingiye ku manza, hasuzumwe ubwandu bwa 15% ya strongyloidiasis; noneho ingamba eshatu zasuzumwe munsi y’ibyorezo bitandukanye, kuva kuri 5% kugeza kuri 20%. Ibisubizo byatangajwe nkumubare wanduye, umubare wimpfu, ikiguzi, nigipimo cyiyongera (ICER). Ibihe byumwaka 1 nimyaka 10 byasuzumwe.
Mu bihe bishingiye ku manza, mu mwaka wa mbere w'ishyirwa mu bikorwa ry'ingamba B na C za PC, umubare w'abanduye uzagabanuka ku buryo bugaragara: kuva ku bantu 172 500 ukurikije ingamba B kugeza kuri 77 040, kandi ukurikije ingamba C kugeza ku manza 146 700. Amafaranga yinyongera kumuntu yagaruwe ugereranije no kutavurwa mumwaka wambere. Amadolari y'Abanyamerika (USD) mu ngamba B na C ni 2.83 na 1.13. Kuri izi ngamba zombi, uko ubwiyongere bwiyongera, ikiguzi cya buri muntu wagaruwe kiri kumanuka. Ingamba B ifite umubare munini wabantu bapfuye bapfuye kurusha C, ariko ingamba C zifite igiciro gito cyo gutangaza urupfu kurusha B.
Iri sesengura ryemerera kugereranya ingaruka zuburyo bubiri bwa PC bwo kurwanya strongyloidiasis mubijyanye nigiciro no kwirinda kwandura / gupfa. Ibi birashobora kwerekana ishingiro rya buri gihugu cy’icyorezo cyo gusuzuma ingamba zishobora gushyirwa mu bikorwa hashingiwe ku nkunga ihari ndetse n’ubuzima bw’ibanze mu gihugu.
Inyo ziterwa n'ubutaka (STH) Strongyloides stercoralis itera indwara zifitanye isano n’abaturage banduye, kandi zishobora guteza impfu z’abanduye mu gihe cyo gukingira indwara [1]. Dukurikije ibigereranyo biheruka gukorwa, abantu bagera kuri miliyoni 600 ku isi barahohotewe, aho usanga abantu benshi muri Aziya y'Amajyepfo y'Uburasirazuba, Afurika ndetse na Pasifika y'Iburengerazuba [2]. Dukurikije ibimenyetso biheruka kwerekana ku mutwaro w’isi yose wa strongyloidiasis, Ishami ry’Umuryango w’abibumbye ryita ku buzima (OMS) ryashyize mu bikorwa kurwanya indwara ziterwa na faecalis mu ntego y’ikarita y’imihanda yo mu 2030 Yirengagijwe (Tropical Tropical Disease) (3). Ni ubwambere OMS isabye gahunda yo kugenzura strongyloidiasis, kandi uburyo bwihariye bwo kugenzura burasobanurwa.
S. stercoralis isangira inzira yo kwanduza inzoka kandi ifite isaranganya risa nizindi ndwara zandurira mu mibonano mpuzabitsina, ariko bisaba uburyo butandukanye bwo gusuzuma no kuvura [4]. Mubyukuri, Kato-Katz, ikoreshwa mugusuzuma ubwiyongere bwa STH muri gahunda yo kugenzura, ifite sensibilité nkeya kuri S. stercoralis. Kuri iyi parasite, ubundi buryo bwo kwisuzumisha bufite ubunyangamugayo burashobora gusabwa: Umuco wa Baermann na agar plaque muburyo bwa parasitologiya, reaction ya polymerase no gupima serologiya [5]. Uburyo bwa nyuma bukoreshwa ku zindi NTDs, hifashishijwe uburyo bwo gukusanya amaraso ku mpapuro zungurura, zituma ikusanywa ryihuse kandi rikabikwa mu buryo bworoshye ingero z’ibinyabuzima [6, 7].
Kubwamahirwe make, ntamahame ya zahabu yo gusuzuma iyi parasite [5], bityo rero guhitamo uburyo bwiza bwo kwisuzumisha bukoreshwa muri gahunda yo kugenzura bugomba gutekereza ku bintu byinshi, nk'ukuri kw'ikizamini, ikiguzi ndetse n'uburyo bwo gukoresha mu murima Mu nama iheruka gutegurwa na OMS [8], impuguke zatoranijwe zemeje ko isuzuma rya serologiya ariryo hitamo ryiza, kandi NIE ELISA niyo yahisemo neza mubikoresho bya ELISA biboneka mubucuruzi. Ku bijyanye no kuvura, imiti igabanya ubukana (PC) kuri STH isaba gukoresha imiti ya benzimidazole, albendazole cyangwa mebendazole [3]. Izi porogaramu ubusanzwe zireba abana bageze mumashuri (SAC), aribwo mutwaro uremereye wamavuriro uterwa na STH [3]. Nyamara, imiti ya benzimidazole nta ngaruka igira kuri Streptococcus faecalis, bityo ivermectin niwo muti wahisemo [9]. Ivermectin yakoreshejwe mu kuvura nini ya onchocerciasis na lymphatic filariasis (NTD) gahunda yo kurandura imyaka mirongo [10, 11]. Ifite umutekano mwiza no kwihanganira, ariko ntibisabwa kubana bari munsi yimyaka 5 [12].
S. stercoralis nayo itandukanye nizindi ndwara zandurira mugihe cyigihe cyo kwandura, kuko iyo itavuwe bihagije, umwihariko wubwandu bwimodoka irashobora gutuma parasite ikomeza ubuziraherezo mubakira abantu. Bitewe no kuvuka kwanduye gushya no gukomeza kwandura indwara zigihe kirekire, ibi nabyo bituma ubwandu bwiyongera cyane mubukure [1, 2].
Nubwo ari umwihariko, guhuza ibikorwa byihariye na gahunda zisanzwe ku zindi ndwara zo mu turere dushyuha zititaweho zishobora kungukirwa no gushyira mu bikorwa gahunda zo kurwanya indwara zisa na strongyloidose. Kugabana ibikorwa remezo n'abakozi birashobora kugabanya ibiciro no kwihutisha ibikorwa bigamije kurwanya faecalis ya Streptococcus.
Intego y'iki gikorwa ni ukugereranya ibiciro n'ibisubizo by'ingamba zinyuranye zijyanye no kugenzura strongyloidiasis, aribyo: (A) nta gutabara; (B) ubuyobozi bunini kuri SAC n'abantu bakuru; (C) kuri PC ya SAC.
Ubushakashatsi bwakorewe mu bitaro bya IRCCS Sacro Cuore Don Calabria i Negrar di Valpolicella, Verona, mu Butaliyani, kaminuza ya Florence, mu Butaliyani, na OMS i Geneve mu Busuwisi kuva muri Gicurasi 2020 kugeza Mata 2021. Inkomoko y'amakuru kuri ubu buryo ni ibitabo biboneka. Icyitegererezo cy'imibare cyatunganijwe muri Microsoft® Excel® kuri Microsoft 365 MSO (Microsoft Corporation, Santa Rosa, Californiya, Amerika) kugirango harebwe ingamba ebyiri zishobora guterwa na strongyloidose mu turere tw’icyorezo kinini ugereranije na (A) nta gutabara Ingaruka z’ubuvuzi n’ubukungu y'ingamba (imyitozo iriho); (B) PC kuri SAC n'abantu bakuru; (C) PC kuri SAC gusa. Isuzuma ryumwaka 1 nimyaka 10 isuzumwa mubisesengura. Ubushakashatsi bwakozwe bushingiye ku cyerekezo cya gahunda y’ubuzima y’igihugu y’ibanze, ishinzwe imishinga yangiza, harimo n’amafaranga ataziguye ajyanye no gutera inkunga inzego za Leta. Icyemezo cyibiti hamwe namakuru yatanzwe mubishushanyo 1 na Imbonerahamwe 1. By'umwihariko, igiti cyemezo cyerekana ubuzima bwubuzima butandukanye buteganijwe nicyitegererezo hamwe nintambwe yo kubara intambwe ya buri ngamba zitandukanye. Iyinjiza ryamakuru igice gikurikira raporo irambuye igipimo cyo guhindura kuva muri leta imwe kurindi hamwe nibitekerezo bifitanye isano. Ibisubizo byatangajwe nkumubare wanduye, amasomo atanduye, amasomo yakize (gukira), impfu, ibiciro, nigipimo cyiyongera-inyungu (ICER). ICER ni itandukaniro ryibiciro hagati yingamba zombi zigabanijwe Itandukaniro ryingaruka zabyo nukugarura ingingo no kwirinda kwandura. Gitoya ICER yerekana ko ingamba imwe ihendutse kuruta iyindi.
Igiti cyemezo kumiterere yubuzima. PC ikumira chimiotherapie, IVM ivermectin, ubuyobozi bwa ADM, abana bo mu ishuri rya SAC
Dutekereza ko abaturage basanzwe ari abantu 1.000.000 baba mu bihugu bifite ubwiyongere bukabije bwa strongyloidiasis, muri bo 50% ni abantu bakuru (≥15) naho 25% ni abana biga mu ishuri (bafite imyaka 6-14). Iri ni ikwirakwizwa rikunze kugaragara mu bihugu byo mu majyepfo y'uburasirazuba bwa Aziya, Afurika na Pasifika y'Iburengerazuba [13]. Mu bihe bishingiye ku manza, ubwiyongere bwa strongyloidiasis ku bantu bakuru na SAC bugera kuri 27% na 15%, [2].
Mu ngamba A (imyitozo iriho), amasomo ntabwo arimo kuvurwa, turakeka rero ko ubwandu bwanduye buzakomeza kumera nyuma yumwaka 1 nimyaka 10.
Muri stratégie B, SAC n'abantu bakuru bazabona PC. Hashingiwe ku kigereranyo cyo kubahiriza 60% ku bantu bakuru na 80% kuri SAC [14], abanduye cyangwa batanduye bazahabwa ivermectine rimwe mu mwaka mu myaka 10. Dufata ko igipimo cyo gukiza indwara zanduye kigera kuri 86% [15]. Nkuko abaturage bazakomeza guhura ninkomoko yanduye (nubwo kwanduza ubutaka bishobora kugabanuka mugihe PC yatangira), kongera kwandura nindwara nshya bizakomeza kugaragara. Ikigereranyo gishya cy’ubwandu bwa buri mwaka giteganijwe kuba kimwe cya kabiri cy’igipimo cy’ubwandu bw’ibanze [16]. Kubwibyo, guhera mu mwaka wa kabiri ishyirwa mu bikorwa rya PC, umubare w’abanduye buri mwaka uzaba uhwanye n’umubare w’abanduye vuba wongeyeho umubare w’abantu bakomeza kuba beza (ni ukuvuga abataravurwa PC n’abafite ntabwo yashubijwe kwivuza). Ingamba C (PC kuri SAC gusa) isa na B, itandukaniro gusa nuko SAC yonyine izakira ivermectin, kandi abantu bakuru ntibazakira.
Mu ngamba zose, umubare w’abantu bapfa bazize indwara ya strongyloidiasis ukurwa mu baturage buri mwaka. Dufashe ko 0,4% by'abanduye bazandura indwara ya strongyloidiasis [17], naho 64,25% muri bo bazapfa [18], bagereranya izo mpfu. Gupfa kubera izindi mpamvu ntabwo biri murugero.
Ingaruka z'izi ngamba zombi zaje gusuzumwa mu nzego zitandukanye z’ubwiyongere bwa strongyloidose muri SAC: 5% (bihuye na 9% by’abantu bakuru), 10% (18%), na 20% (36%).
Dutekereza ko Ingamba A ntaho ihuriye n’ibiciro byose bitaziguye muri gahunda y’ubuzima y’igihugu, nubwo kwandura indwara zisa na strongyloidia bishobora kugira ingaruka ku bukungu kuri gahunda y’ubuzima bitewe n’ibitaro ndetse n’inama z’ubuvuzi, nubwo bishobora kuba bidafite akamaro. Ibyiza bivuye muburyo bw'imibereho (nko kongera umusaruro nigipimo cyo kwiyandikisha, no kugabanya gutakaza igihe cyo kugisha inama), nubwo bishobora kuba ngombwa, ntibitabwaho kubera ingorane zo kubipima neza.
Kugirango dushyire mubikorwa ingamba B na C, twasuzumye ibiciro byinshi. Intambwe yambere nugukora ubushakashatsi burimo 0.1% byabaturage ba SAC kugirango hamenyekane ubwandu bwanduye mukarere katoranijwe. Igiciro cyubushakashatsi ni 27 US $ (USD) kuri buri somo, harimo ikiguzi cya parasitologiya (Baermann) no gupima serologiya (ELISA); ikiguzi cyinyongera cyibikoresho gishingiye kubice byumushinga uteganijwe muri Etiyopiya. Muri rusange, ubushakashatsi bwakozwe ku bana 250 (0.1% by'abana mu baturage bacu basanzwe) buzatwara amadolari ya Amerika 6.750. Igiciro cyo kuvura ivermectin kuri SAC hamwe n’abantu bakuru (US $ 0.1 na US $ 0.3, ukurikije) igiciro giteganijwe cya ivermectine rusange yemewe n’umuryango w’ubuzima ku isi [8]. Hanyuma, ikiguzi cyo gufata ivermectin kuri SAC nabakuze ni 0.015 USD na 0.5 USD) [19, 20].
Imbonerahamwe 2 na Imbonerahamwe 3 byerekana umubare rusange w’abana banduye kandi batanduye hamwe n’abantu bakuru mu baturage basanzwe b’abantu barengeje imyaka 6 mu ngamba eshatu, hamwe n’ibiciro bifitanye isano n’isesengura ry’umwaka 1 n’imyaka 10. Imibare yo kubara nicyitegererezo cyimibare. By'umwihariko, Imbonerahamwe ya 2 ivuga itandukaniro ry’umubare wanduye bitewe ningamba ebyiri za PC ugereranije nuwagereranya (nta ngamba zo kuvura). Iyo ubwiyongere bw'abana bungana na 15% na 27% mu bantu bakuru, abantu 172.500 baranduye. Umubare wanduye wanduye werekanye ko kwinjiza PC bigenewe SAC nabakuze byagabanutseho 55.3%, kandi niba PC yibasiye SAC gusa, yagabanutseho 15%.
Mu isesengura rirambye (imyaka 10), ugereranije n’ingamba A, kugabanya kwandura ingamba B na C byiyongereye kugera kuri 61,6% na 18,6%. Byongeye kandi, gushyira mu bikorwa ingamba B na C bishobora gutuma igabanuka rya 61% n’impfu z’imyaka 10 zingana na 48%, ugereranije no kutakira imiti.
Igishushanyo cya 2 cyerekana umubare w’ubwandu mu ngamba eshatu mu gihe cy’imyaka 10 y’isesengura: Nubwo uyu mubare utigeze uhinduka nta gutabara, mu myaka mike ya mbere yo gushyira mu bikorwa ingamba zombi za PC, umubare w’abanduye wagabanutse vuba. Buhoro buhoro nyuma.
Ukurikije ingamba eshatu, ikigereranyo cyo kugabanya umubare wanduye mu myaka yashize. PC ikumira chimiotherapie, SAC abana bageze mumashuri
Kubijyanye na ICER, kuva kumyaka 1 kugeza 10 yisesengura, igiciro cyinyongera cya buri muntu wakize cyiyongereyeho gato (Ishusho 3). Urebye igabanuka ry’abantu banduye mu baturage, ikiguzi cyo kwirinda kwandura mu ngamba B na C cyari US $ 2.49 na US $ 0.74, nta kwivuza mu gihe cy’imyaka 10.
Igiciro kumuntu wagaruwe mumwaka 1 nimyaka 10. PC ikumira chimiotherapie, SAC abana bageze mumashuri
Igishushanyo cya 4 nicya 5 byerekana umubare wanduye wirinda PC hamwe nigiciro kijyanye na buri muntu warokotse ugereranije no kutavurwa. Agaciro ko kwamamara mugihe cyumwaka kiva kuri 5% kugeza 20%. By'umwihariko, ugereranije n'ibihe by'ibanze, iyo igipimo cy’ubwiyongere kiri hasi (urugero, 10% ku bana na 18% ku bantu bakuru), ikiguzi ku muntu wakize kizaba kinini; muburyo bunyuranye, mugihe cyiganje cyane Ibiciro byo hasi birasabwa mubidukikije.
Umwaka wambere wamamaye uri hagati ya 5% na 20% byumubare wanduye. PC ikumira chimiotherapie, SAC abana bageze mumashuri
Igiciro kumuntu wagaruwe ufite ubwiganze bwa 5% kugeza 20% mumwaka wambere. PC ikumira chimiotherapie, SAC abana bageze mumashuri
Imbonerahamwe 4 iragarura umubare wimpfu nigiciro cyagereranijwe mumyaka 1 nimyaka 10 yingamba zitandukanye za PC. Ku bipimo by’ubwiyongere byose byasuzumwe, ikiguzi cyo kwirinda urupfu rwingamba C kiri munsi yingamba B. Kuri izo ngamba zombi, igiciro kizagabanuka uko igihe kigenda gihita, kandi kizerekana inzira igabanuka uko ubwiyongere bwiyongera.
Muri iki gikorwa, ugereranije no kubura gahunda yo kugenzura muri iki gihe, twasuzumye ingamba ebyiri zishoboka za PC ku giciro cyo kugenzura indwara ya strongyloidiasis, ingaruka zishobora kuba ku bwiyongere bwa strongyloidiasis, ndetse n'ingaruka ku ruhererekane rw'imyanda mu baturage basanzwe. Ingaruka zimpfu ziterwa na cocci. Nintambwe yambere, hasabwa isuzuma ryibanze ry’ubwiyongere, rizatwara amadolari ya Amerika 27 kuri buri muntu ku giti cye (ni ukuvuga amadolari ya Amerika 6750 yo gupima abana 250). Igiciro cyinyongera kizaterwa ningamba zatoranijwe, zishobora kuba (A) kudashyira mubikorwa gahunda ya PC (uko ibintu bimeze ubu, nta giciro cyinyongera); (B) Ubuyobozi bwa PC kubaturage bose (0.36 USD kumuntu uvura); (C)) Cyangwa PC ibariza SAC ($ 0.04 kumuntu). Izi ngamba zombi B na C zizatuma igabanuka rikabije ry’ubwandu mu mwaka wa mbere w’ishyirwa mu bikorwa rya PC: aho ubwiganze bwa 15% mu baturage biga mu ishuri na 27% ku bantu bakuru, umubare w’abantu banduye uzaba mu ishyirwa mu bikorwa ry'ingamba B na C Nyuma, umubare w'imanza wagabanutse uva kuri 172 500 ku murongo fatizo ugera kuri 77 040 na 146 700. Nyuma yibyo, umubare wimanza uzakomeza kugabanuka, ariko ku gipimo gito. Igiciro cya buri muntu wagaruwe ntabwo kijyanye gusa nuburyo bubiri (ugereranije ningamba C, ikiguzi cyo gushyira mubikorwa ingamba B kiri hejuru cyane, ku $ 3.43 na $ 1.97 mumyaka 10,), ariko kandi nubwinshi bwibanze. Isesengura ryerekana ko hamwe no kwiyongera kwinshi, ikiguzi cya buri muntu wagaruwe kiri kumanuka. Hamwe n’igipimo cya SAC kingana na 5%, kizagabanuka kiva kuri US $ 8.48 kuri buri muntu kuri Strategy B na US $ 3.39 kuri buri muntu kuri Strategy C. Kugera kuri USD 2.12 kumuntu na 0,85 kumuntu ufite ubwandu bwa 20%, ingamba B na C Byemewe. Hanyuma, ingaruka zizi ngamba zombi ku rupfu rwo kwamamaza zirasesengurwa. Ugereranije na Strategy C (abantu 66 na 822 bari hagati yumwaka 1 nimyaka 10), Strategy B yatumye abantu benshi bapfa (245 na 2717 mumyaka 1 nimyaka 10). Ariko ikindi kintu gifitanye isano nigiciro cyo gutangaza urupfu. Igiciro cyingamba zombi kigabanuka mugihe, kandi ingamba C (imyaka 10 $ 288) iri munsi ya B (imyaka 10 $ 969).
Guhitamo ingamba za PC zo kurwanya strongyloidiasis bizashingira ku bintu bitandukanye, harimo kubona amafaranga, politiki y’ubuzima bw’igihugu, n’ibikorwa remezo bihari. Noneho, buri gihugu kizagira gahunda yintego n'umutungo wacyo. Hamwe na gahunda ya PC ihari kugirango igenzure STH muri SAC, birashobora gufatwa ko kwishyira hamwe na ivermectin byoroshye kubishyira mubikorwa ku giciro cyiza; birakwiye ko tumenya ko ikiguzi kigomba kugabanywa kugirango wirinde urupfu rumwe. Ku rundi ruhande, mu gihe nta mbogamizi zikomeye z’amafaranga zihari, ikoreshwa rya PC ku baturage bose byanze bikunze bizagabanuka kurushaho kwandura indwara, bityo umubare w’impfu za strongyloide zose uzagabanuka cyane uko igihe kigenda gihita. Mubyukuri, ingamba zanyuma zizashyigikirwa no gukwirakwiza kwandura indwara ya Streptococcus faecalis mu baturage, ikunda kwiyongera uko imyaka igenda ishira, bitandukanye n’ubushakashatsi bwakozwe na trichomes n’inzoka zangiza [22]. Ariko, gukomeza guhuza gahunda ya STH PC na ivermectin bifite inyungu zinyongera, zishobora gufatwa nkigiciro cyinshi hiyongereyeho ingaruka kuri strongyloidiasis. Mubyukuri, guhuza ivermectin wongeyeho albendazole / mebendazole byagaragaye ko ari byiza kurwanya trichinella kuruta benzimidazole wenyine [23]. Iyi ishobora kuba impamvu yo gushyigikira guhuza PC muri SAC kugirango ikureho impungenge zijyanye no kugabanuka kwiri tsinda ugereranije nabakuze. Byongeye kandi, ubundi buryo bwo gusuzuma bushobora kuba gahunda yambere ya SAC hanyuma ukayagura kugirango ushiremo ingimbi n'abakuru igihe bishoboka. Amatsinda yose yimyaka, yaba yashyizwe muri zindi gahunda za PC cyangwa atayashyizeho, azungukirwa n'ingaruka zishobora guterwa na ivermectine kuri ectoparasite harimo ibisebe [24].
Ikindi kintu kizagira ingaruka zikomeye kubiciro / inyungu zo gukoresha ivermectin mu kuvura PC ni igipimo cyanduye mu baturage. Mugihe agaciro k'ubwiyongere kiyongera, kugabanuka kwanduye kugaragara cyane, kandi ikiguzi kuri buri warokotse kigabanuka. Gushiraho urwego rwo gushyira mubikorwa PC kurwanya Streecococcus faecalis bigomba kuzirikana uburinganire buri hagati yibi bintu byombi. Tugomba gutekereza ko ku zindi ndwara zandurira mu mibonano mpuzabitsina, birasabwa cyane gushyira mu bikorwa PC ifite ubwiyongere bwa 20% cyangwa irenga, hashingiwe ku kugabanya cyane umubare w’abaturage bateganijwe [3]. Ariko, ibi ntibishobora kuba intego nziza kuri S. stercoralis, kuko ibyago byo gupfa byanduye byanduye bizakomeza gukomera kwanduye. Nyamara, ibihugu byinshi byanduye birashobora gutekereza ko niyo ikiguzi cyo kubungabunga PC kuri Streptococcus faecalis kiri hejuru cyane ku kigero cyo hasi cy’abantu benshi, hashyizweho urwego rwo kwivuza rugera kuri 15-20% by’igipimo cy’ubwandu gishobora kuba gikwiye cyane. Byongeye kandi, iyo igipimo cyanduye ari ≥ 15%, ibizamini bya serologiya bitanga ikigereranyo cyizewe kuruta igihe igipimo cyanduye kiri hasi, gikunda kugira ibyiza byinshi [21]. Ikindi kintu kigomba kwitabwaho ni uko imiyoborere nini ya ivermectine mu gace ka Loa loa yanduye izaba igoye kuko abarwayi bafite ubwinshi bw’amaraso ya microfilariya bizwi ko bashobora guhura na encephalopathie yica [25].
Byongeye kandi, urebye ko ivermectin ishobora gutera imbaraga nyuma yimyaka myinshi yubuyobozi bunini, hagomba gukurikiranwa imikorere yibiyobyabwenge [26].
Intambamyi zubu bushakashatsi zirimo hypotheses nyinshi tutashoboye kubona ibimenyetso bifatika, nkigipimo cyo kongera kwandura nimpfu ziterwa na strongyloidiasis. Nubwo byaba bigarukira gute, dushobora guhora tubona impapuro nkishingiro ryicyitegererezo cyacu. Indi mbogamizi ni uko dushingira ibiciro bimwe na bimwe byifashishwa mu ngengo y’ubushakashatsi bw’icyitegererezo buzatangirira muri Etiyopiya, bityo ntibishobora kuba bihwanye neza n’amafaranga ateganijwe mu bindi bihugu. Biteganijwe ko ubushakashatsi bumwe buzatanga andi makuru yo gusesengura ingaruka za PC na ivermectin yibasira SAC. Izindi nyungu z'ubuyobozi bwa ivermectin (nk'ingaruka ku bisebe ndetse no kongera umusaruro w'izindi ndwara zandurira mu mibonano mpuzabitsina) ntizigeze zibarwa, ariko ibihugu by’icyorezo birashobora kubitekereza mu rwego rw’ibindi bikorwa bifitanye isano n’ubuzima. Hanyuma, hano ntabwo twapimye ingaruka ziterwa n’inyongera zishoboka, nk'amazi, isuku, hamwe n’isuku y’umuntu ku giti cye (WASH), ibyo bikaba bishobora kurushaho gufasha kugabanya ubwandu bwa STH [27] kandi rwose Umuryango w’ubuzima ku isi wasabwe [3] . Nubwo dushyigikiye guhuza PC kuri STH hamwe na WASH, gusuzuma ingaruka zabyo birenze iyi nyigo.
Ugereranije n'ibihe biriho (bitavuwe), izi ngamba zombi za PC zatumye igabanuka ryinshi ryanduye. Ingamba B yateje impfu nyinshi kuruta ingamba C, ariko ibiciro bijyanye ningamba zanyuma byari bike. Ikindi kintu kigomba kwitabwaho ni uko kuri ubu, mu bice hafi ya byose bisa na strongyloidose, gahunda yo kwangiza amashuri yashyizwe mu bikorwa kugira ngo ikwirakwize benzimidazole yo kurwanya STH [3]. Ongeraho ivermectin kuriyi sisitemu yo gukwirakwiza benzimidazole isanzwe bizagabanya ibiciro byo gukwirakwiza ivermectin ya SAC. Twizera ko iki gikorwa gishobora gutanga amakuru yingirakamaro kubihugu byifuza gushyira mubikorwa ingamba zo kugenzura Streecococcus faecalis. Nubwo PC zagaragaje uruhare runini kubaturage muri rusange kugirango bagabanye umubare w’ubwandu n’umubare wuzuye w’impfu, PC yibasira SAC irashobora guteza imbere impfu ku giciro gito. Urebye uburinganire buri hagati yikiguzi ningaruka zo gutabara, igipimo cyanduye cya 15-20% cyangwa kirenga gishobora gusabwa nkurwego rusabwa kuri PC ya ivermectin.
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