Kuitwa kwechirongwa cheStrongyloides stercoralis chekudzivirira chirwere ndechimwe chezvinangwa zveWorld Health Organisation's 2030 roadmap. Chinangwa chebasa iri ndechekuongorora zvingangoitika zvemaitiro maviri akasiyana ekudzivirira chemotherapy (PC) maererano nehupfumi hwehupfumi uye mamiriro ehutano pamamiriro ezvinhu aripo (Strategy A, hapana PC): Ivermectin yevana vezera rechikoro (SAC) uye Adult dosing (strategy B) uye ivermectin inongoshandiswa kuSAC (strategy C).
Chidzidzo ichi chakaitwa paICCS Sacro Cuore Don Calabria Hospital muNegrar di Valpolicella, Verona, Italy, University of Florence, Italy, uye WHO muGeneva, Switzerland kubva munaMay 2020 kusvika muna Kubvumbi 2021. Iyo data yemuenzaniso uyu inotorwa kubva mumabhuku. Muenzaniso wemasvomhu wakagadzirwa muMicrosoft Excel kuti uongorore kushanda kwemaitiro B neC pahuwandu hwevanhu vanosvika miriyoni imwe chete yezvidzidzo vanogara munzvimbo dzine strongyloidiasis. Mumamiriro ezvinhu-based-scenario, 15% kupararira kwe strongyloidiasis kwakaonekwa; zvino mazano matatu akaongororwa pasi pematanho akasiyana edenda, kubva pa5% kusvika pa20%. Mhedzisiro iyi inonzi huwandu hwevanhu vane hutachiona, huwandu hwevanhu vafa, mutengo, uye kuwedzera kwekuita basa (ICER). Nguva dze 1 gore nemakore gumi dzakatariswa.
Muchiitiko chechiitiko, mugore rokutanga rekushandiswa kwemaitiro B uye C ePC, nhamba yehutachiona huchaderedzwa zvikuru: kubva ku172 500 kesi maererano nechirongwa B kusvika ku77 040, uye maererano nehurongwa C. kusvika ku146 700 kesi. Mari yekuwedzera pamunhu anenge aporeswa inofananidzwa nekusarapwa mugore rekutanga. Madhora eUS (USD) mumazano B neC ari 2.83 uye 1.13, zvichiteerana. Kune aya maviri mazano, sezvo kuwanda kunowedzera, mutengo weumwe neumwe akadzoreredzwa uri mukudzika. Strategy B ine nhamba huru yekufa kwakaziviswa kupfuura C, asi zano C rine mutengo wakaderera wekuzivisa rufu kupfuura B.
Ongororo iyi inobvumira kufungidzira kukanganisa kwemaitiro maviri ePC kudzora strongyloidiasis maererano nemutengo uye kudzivirira kwehutachiona / rufu. Izvi zvinogona kumiririra hwaro hwenyika imwe neimwe ine nharaunda kuti iongorore nzira dzinogona kuitwa zvichibva pamari iripo uye zvakakosha pahutano hwenyika.
Honye dzinotakura ivhu (STH) Strongyloides stercoralis inokonzera kurwara kwakabatana muhuwandu hwakakanganiswa, uye inogona kukonzera kufa kwevanhu vane utachiona munyaya yekudzivirira muviri [1]. Maererano nefungidziro dzichangobva kuitika, vanhu vangangosvika mamirioni mazana matanhatu pasi rose vanobatwa, uye zviitiko zvakawanda muSoutheast Asia, Africa uye Western Pacific [2]. Zvinoenderana nehumbowo huchangobva kuitika pamusoro pemutoro wepasi rose westrongyloidiasis, World Health Organisation (WHO) yakasanganisira kutonga kwehutachiona hwefecalis mu2030 Neglected Tropical Diseases (NTD) chinangwa chemepu yemugwagwa [3]. Aka ndekekutanga WHO ichikurudzira chirongwa chekutonga che strongyloidiasis, uye nzira dzekudzora dzakananga dziri kutsanangurwa.
S. stercoralis inogovera nzira yekufambisa nehokowo uye ine nzvimbo yakafanana yekugovera nedzimwe STH, asi inoda nzira dzakasiyana dzekuongorora uye marapirwo [4]. Kutaura zvazviri, Kato-Katz, yakashandiswa kuongorora kupararira kweSTH muchirongwa chekutonga, ine kuderera kwakanyanya kuS. stercoralis. Kune iyi parasite, dzimwe nzira dzekuongorora dzine hunyoro hwepamusoro dzinogona kukurudzirwa: Baermann uye agar plate tsika muparasitological nzira, polymerase chain reaction uye serological test [5]. Iyo yekupedzisira nzira inoshandiswa kune mamwe maNTD, kutora mukana wemukana wekuunganidza ropa papepa resefa, iyo inobvumira kukurumidza kuunganidza uye nyore kuchengetedza yebiological samples [6, 7].
Nehurombo, hapana chiyero chegoridhe chekuongororwa kweparasite iyi [5], saka kusarudzwa kweiyo nzira yekuongorora yakanakisa yakaiswa muchirongwa chekutonga kunofanirwa kufunga zvinhu zvakati wandei, senge kurongeka kwebvunzo, mutengo uye kugona kwekushandisa. mumunda Mumusangano uchangoburwa wakarongwa neWHO [8], nyanzvi dzakasarudza dzakasarudza kuongorora serological seyakanakisa sarudzo, uye NIE ELISA yaive sarudzo yakanakisa pakati peiyo inotengeswa ELISA kits. Kana iri kurapwa, kudzivirira chemotherapy (PC) yeSTH inoda kushandiswa kwemishonga benzimidazole, albendazole kana mebendazole [3]. Zvirongwa izvi zvinowanzo kunanga vana vezera rechikoro (SAC), vanova mutoro wepamusoro wekiriniki unokonzerwa neSTH [3]. Zvisinei, benzimidazole mishonga inenge isina simba paStreptococcus faecalis, saka ivermectin ndiwo mushonga wekusarudza [9]. Ivermectin yakashandiswa pakurapa kwakakura kwe onchocerciasis uye lymphatic filariasis (NTD) ekubvisa zvirongwa kwemakumi emakore [10, 11]. Iine kuchengetedzwa kwakanyanya uye kushivirira, asi haikurudzirwe kuvana vari pasi pemakore mashanu [12].
S. stercoralis yakasiyanawo nemamwe maSTH maererano nenguva yehutachiwana, nokuti kana isina kurapwa zvakakwana, iyo yakakosha yehutachiona hwehutachiona hunogona kuita kuti hutachiona hurambe husingagumi mumunhu. Nekuda kwekubuda kwehutachiona hutsva uye kuramba kwezvirwere zvenguva refu nekufamba kwenguva, izvi zvinotungamirawo kuhuwandu hwehutachiona muhukuru [1, 2].
Pasinei nekunyanya, kubatanidza zviitiko zvakanangana nezvirongwa zviripo zvezvimwe zvakaregeredzwa zvirwere zvemunzvimbo dzinopisa zvinogona kubatsirwa kubva mukuitwa kwestrongyloidosis-senge zvirongwa zvekudzivirira zvirwere. Kugovera zvivakwa uye vashandi kunogona kuderedza mitengo uye kukurumidzira zviitiko zvine chinangwa chekudzora Streptococcus faecalis.
Chinangwa chebasa iri ndechekufungidzira mari nemigumisiro yezvirongwa zvakasiyana-siyana zvine chokuita nekutonga kwe strongyloidiasis, iyo: (A) hapana kupindira; (B) hukuru hwehutungamiri hweSAC nevakuru; (C) yeSAC PC.
Chidzidzo ichi chakaitwa paICCS Sacro Cuore Don Calabria Hospital muNegrar di Valpolicella, Verona, Italy, University of Florence, Italy, uye WHO muGeneva, Switzerland kubva muna Chivabvu 2020 kusvika Kubvumbi 2021. Nzvimbo yedata yemuenzaniso uyu inowanikwa mabhuku. Muenzaniso wemasvomhu wakagadzirwa muMicrosoft® Excel® yeMicrosoft 365 MSO (Microsoft Corporation, Santa Rosa, California, USA) kuti iongorore maitiro maviri angangoita strongyloidosis-senge munzvimbo dzine dambudziko repamusoro zvichienzaniswa ne (A) hapana kupindira. yezviyero (zvino maitiro); (B) maPC eSAC nevakuru; (C) MaPC eSAC chete. Iyo 1-gore uye 10-gore nguva horizons inoongororwa mukuongorora. Chidzidzo ichi chakaitwa zvichibva pamaonero ehurongwa hwezvehutano hwenharaunda, hune basa rekuita mapurojekiti ekubvisa makonye, ​​kusanganisira mari dzakananga dzine chekuita nemari yehurumende. Muti wesarudzo uye kupinza data kunotaurwa muMufananidzo 1 uye Tafura 1, zvichiteerana. Kunyanya, muti wesarudzo unoratidza hutano hwakasarudzika hunoonekwa nemuenzaniso uye nhanho dzekuverengera dzemaitiro ega ega akasiyana. Chikamu chedata rekuisa pazasi chinoshuma zvakadzama mwero wekutendeuka kubva kune imwe nyika kuenda kune inotevera uye fungidziro dzine chekuita. Mhedzisiro iyi inonzi nhamba yevane hutachiona, vasina hutachiona, vakarapwa zvidzidzo (kupora), kufa, mutengo, uye kuwedzera mutengo-benefit ratio (ICER). ICER ndiyo mutsauko wemutengo pakati pemaitiro maviri akakamurwa neMusiyano mumhedzisiro yavo ndeyekudzoreredza chidzidzo uye kudzivirira kutapukirwa. ICER diki inoratidza kuti imwe nzira inodhura-inoshanda pane imwe.
Muti wesarudzo wehutano hwehutano. PC kudzivirira chemotherapy, IVM ivermectin, ADM manejimendi, SAC vezera rechikoro vana
Isu tinofungidzira kuti huwandu hwehuwandu hwevanhu ndeye 1,000,000 zvidzidzo zvinogara munyika dzine kupararira kwakanyanya kwe strongyloidiasis, avo 50% vanhu vakuru (≥15 yemakore) uye 25% vana vezera rechikoro (makore 6-14). Uku kugoverwa kunowanzoonekwa munyika dziri kuSoutheast Asia, Africa neWestern Pacific [13]. Muchiitiko-chakavakirwa mamiriro ezvinhu, kuwanda kweiyo strongyloidiasis muvakuru uye SAC inofungidzirwa kuva 27% uye 15%, maererano [2].
Muchirongwa A (ikozvino maitiro), zvidzidzo hazvisi kugamuchira kurapwa, saka tinofungidzira kuti kuwanda kwehutachiona hucharamba hwakafanana pakupera kwe1-gore uye 10-gore nguva.
Muchirongwa B, vese SAC nevakuru vachawana maPC. Kubva pachiyero chinofungidzirwa chekuteerera che60% chevakuru uye 80% yeSAC [14], vose vane utachiona uye vasina hutachiona vanowana ivermectin kamwe chete pagore kwemakore gumi. Isu tinofungidzira kuti huwandu hwekurapa kwevanotapukirwa hunosvika 86% [15]. Sezvo mharaunda icharamba ichiratidzwa kune chitubu chetachiona (kunyangwe kusvibiswa kwevhu kunogona kuderera nekufamba kwenguva kubva pakatanga PC), hutachiona zvakare uye hutachiona hutsva hucharamba huchiitika. Mutengo wepagore wehutachiona hutsva unofungidzirwa kuva hafu yehuwandu hwehutachiona hwehutachiona [16]. Naizvozvo, kutanga kubva pagore rechipiri rekushandiswa kwePC, huwandu hwenyaya dzehutachiona gore rega rega huchaenzana nehuwandu hwenyaya dzichangotapukirwa pamwe nehuwandu hwenyaya dzinoramba dziripo (kureva, avo vasina kugamuchira PC kurapwa uye avo haana kupindura kurapwa). Strategy C (PC chete yeSAC) yakafanana neB, musiyano chete ndewekuti SAC chete ichagamuchira ivermectin, uye vanhu vakuru havazoiti.
Mune mazano ese, nhamba inofungidzirwa yevakafa nekuda kwesimba rakasimba inobviswa kubva muhuwandu gore negore. Tichifunga kuti 0.4% yevanhu vane utachiona vachakura zvakasimba strongyloidiasis [17], uye 64.25% yavo vachafa [18], fungidzira kufa uku. Rufu nekuda kwezvimwe zvikonzero hazvibatanidzwe mumuenzaniso.
Mhedzisiro yezvirongwa zviviri izvi zvakabva zvaongororwa pasi pezvikamu zvakasiyana zvesimba rakasimba muSAC: 5% (inoenderana ne9% kuwanda kwevanhu vakuru), 10% (18%), uye 20% (36%).
Isu tinofungidzira kuti Strategy A haina chekuita nemitengo yakananga kuhurongwa hwehutano hwenyika, kunyangwe chiitiko chechirwere che strongyloidia-sechirwere chingave chine chekuita nehupfumi pahurongwa hwehutano nekuda kwekuiswa muchipatara uye kubvunzana kwevarwere, kunyangwe zvingave zvisingakoshi. Zvakanakira kubva pakuona kwevanhu (zvakadai sekuwedzera kubereka uye huwandu hwekunyoresa, uye kuderedzwa kurasikirwa kwenguva yekubvunzurudza), kunyangwe zvingave zvakakosha, hazvifungidzirwe nekuda kwekuoma kwekunyatsozvifungidzira.
Pakuitwa kwemaitiro B neC, takafunga nezvemitengo yakati wandei. Danho rokutanga nderokuita tsvakurudzo inobatanidza 0.1% yevanhu veSAC kuti vaone kupararira kwehutachiona munzvimbo yakasarudzwa. Mutengo weongororo ndeye 27 US madhora (USD) pachidzidzo, kusanganisira mutengo weparasitology (Baermann) uye serological test (ELISA); iyo yekuwedzera mutengo wezvishandiso unobva pane imwe purojekiti yekuyedza yakarongwa muEthiopia. Pakazara, ongororo yevana mazana maviri nemakumi mashanu (0.1% yevana muhuwandu hwedu) ichaita US$6,750. Mutengo wekurapa ivermectin weSAC nevakuru (US$0.1 uye US$0.3, zvichiteerana) unobva pamutengo unotarisirwa weprequalified generic ivermectin neWorld Health Organisation [8]. Pakupedzisira, mari yekutora ivermectin yeSAC nevakuru ndeye 0.015 USD uye 0.5 USD maererano) [19, 20].
Tafura 2 neTafura 3 zvichitevedzana inoratidza huwandu hwese hwevana vane hutachiona uye vasina utachiona uye vakuru muhuwandu hwevanhu vanopfuura makore matanhatu ezera mumazano matatu, uye mari inoenderana muongororo yegore rimwe uye gumi. Iyo yekuverenga formula imhando yemasvomhu. Kunyanya, Tafura 2 inoshuma musiyano wehuwandu hwevanhu vane hutachiona nekuda kwemaitiro maviri ePC akaenzaniswa nemuenzanisi (hapana nzira yekurapa). Kana hutachiwana muvana hwakaenzana nechikamu che15% ne27% muvanhu vakuru, vanhu 172,500 muhuwandu vanobatwa nechirwere ichi. Nhamba yezvidzidzo zvakatapukirwa zvakaratidza kuti kuiswa kwePC kwakanangidzirwa kuSAC uye vanhu vakuru vakaderedzwa ne55.3%, uye kana maPC akatarisa SAC chete, yakaderedzwa ne15%.
Mukuongorora kwenguva refu (makore gumi), zvichienzaniswa nehurongwa A, kuderedzwa kwehutachiona hwemaitiro B neC kwakawedzera kusvika 61.6% uye 18.6%, maererano. Mukuwedzera, kushandiswa kwemaitiro B neC kunogona kukonzera kuderedzwa kwe61% uye makore gumi ekufa kwe 48%, maererano, zvichienzaniswa nekusagamuchira kurapwa.
Mufananidzo 2 unoratidza nhamba yezvirwere mumatanho matatu munguva yekuongorora kwegore re10: Kunyange zvazvo nhamba iyi yakaramba isina kuchinjwa pasina kupindira, mumakore mashomanana ekutanga ekushandiswa kwemaitiro maviri ePC, nhamba yedu yezviitiko yakaderera nokukurumidza. Zvishoma nezvishoma pashure.
Kubva pamatanho matatu, fungidziro yekuderedzwa kwenhamba yezvirwere mumakore apfuura. PC yekudzivirira chemotherapy, SAC yezera rechikoro vana
Nezve ICER, kubva ku1 kusvika ku10 makore ekuongorora, iyo yekuwedzera mutengo weumwe neumwe akapora yakawedzera zvishoma (Mufananidzo 3). Tichitarisa kuderera kwevanhu vane utachiona muhuwandu hwevanhu, mutengo wekudzivirira kutapukira muhurongwa B neC waive US$2.49 neUS$0,74, zvichitevedzana, pasina kurapwa kwenguva yemakore gumi.
Mutengo pamunhu akadzoserwa mune 1-gore uye gumi-gore ongororo. PC yekudzivirira chemotherapy, SAC yezera rechikoro vana
Figure 4 uye 5 inoshuma huwandu hwehutachiona hunodziviswa nePC uye mutengo unobatanidzwa pamunhu anenge apona zvichienzaniswa nekusarapwa. Kuwanda kwehuwandu mukati megore kubva pa5% kusvika ku20%. Kunyanya, kana zvichienzaniswa nemamiriro ezvinhu ekutanga, kana huwandu hwehuwandu hwakaderera (somuenzaniso, 10% yevana uye 18% yevakuru), mari yemunhu anenge adzorerwa ichave yakakwirira; pane zvinopesana, muchiitiko chepamusoro kupararira Mari yakaderera inodiwa munharaunda.
Gore rekutanga kuwanda kwehuwandu hunobva pa5% kusvika 20% yehuwandu hwehutachiona hwekushambadzira. PC yekudzivirira chemotherapy, SAC yezera rechikoro vana
Mutengo pamunhu akadzorerwa ane huwandu hwe5% kusvika 20% mugore rekutanga. PC yekudzivirira chemotherapy, SAC yezera rechikoro vana
Tafura 4 inodzoreredza huwandu hwevakafa uye mari inodiwa mu1-gore uye 10-gore renji remhando dzakasiyana dzePC. Pahuwandu hwehuwandu hwehuwandu hunotaridzirwa, mari yekudzivisa kufa kwechirongwa C yakaderera pane nzira B. Pamusoro pemaitiro ose maviri, mari yacho ichaderera nekufamba kwenguva, uye icharatidza kuderera kwepamusoro sezvo kuwanda kunowedzera.
Mubasa iri, tichienzaniswa nekushaikwa kwezvirongwa zvekutonga, takaongorora nzira mbiri dzinogona kuitika dzePC dzemutengo wekudzora strongyloidiasis, zvinogona kukanganisa kuwanda kweiyo strongyloidiasis, uye kukanganisa kweketani yefecal muhuwandu hwevanhu. Mhedzisiro yekufa kwakabatana necocci. Sedanho rekutanga, ongororo yekutanga yehuwandu inokurudzirwa, iyo ichaita mari inosvika US$27 pamunhu pabvunzo (kureva, inokwana US$6750 yekuongorora vana mazana maviri nemakumi mashanu). Mari yekuwedzera ichaenderana nesarudzo yakasarudzwa, inogona kunge iri (A) isiri kuita chirongwa chePC (yazvino mamiriro, hapana imwe mari); (B) PC kutonga kwevanhu vose (0.36 USD pamunhu wekurapa); (C) ) Kana PC inotaura SAC ($0.04 pamunhu). Mazano ese maviri B neC achaita kuti kuderera kwakanyanya kwehuwandu hwehutachiona mugore rekutanga rekushandiswa kwePC: nehuwandu hwe15% muhuwandu hwezera rechikoro uye 27% muvakuru, huwandu hwevanhu vane hutachiona huchave. mukushandiswa kwemaitiro B neC Gare gare, nhamba yemhosva yakaderedzwa kubva pa172 500 pakutanga kusvika ku77 040 uye 146 700 maererano. Mushure meizvi, nhamba yezviitiko zvicharamba zvichiderera, asi zvishoma nezvishoma. Mutengo wemunhu mumwe nemumwe akadzoserwa haungoenderane chete nemazano maviri (uchienzaniswa nehurongwa C, mutengo wekushandisa zano B wakakwira zvakanyanya, pamadhora mazana matatu nemakumi mana nematatu uye $1.97 mumakore gumi, zvichiteerana), asiwo nehuwandu hwekutanga. Kuongorora kunoratidza kuti nekuwedzera kwehuwandu, mari yemunhu mumwe nomumwe akadzorerwa iri pakuderera. Nechikamu cheSAC che5%, chichadzika kubva paUS$8.48 pamunhu paStrategy B uye US$3.39 pamunhu paStrategy C. Kusvika paUSD 2.12 pamunhu uye 0,85 pamunhu ane huwandu hwe20%, strategy B neC. zvinogamuchirwa zvichiteerana. Pakupedzisira, kukanganisa kwemaitiro maviri aya pakufa kwekushambadzira kunoongororwa. Kuenzaniswa neStrategy C (66 uye 822 vanhu mune 1-gore uye 10-gore renji, zvichiteerana), Strategy B zvakajeka zvakakonzera kufa kwakawanda kwaitarisirwa (245 uye 2717 mune 1-gore uye 10-gore renji, zvichiteerana). Asi chimwe chinhu chakabatana mutengo wekuzivisa rufu. Mutengo wemazano ese ari maviri unodzikira nekufamba kwenguva, uye zano C (10-gore $288) yakaderera pane B (10-gore $969).
Sarudzo yePC zano rekudzora strongyloidiasis ichabva pane zvakasiyana siyana, kusanganisira kuwanikwa kwemari, mitemo yezvehutano yenyika, uye zvivakwa zviripo. Zvadaro, nyika imwe neimwe ichava nehurongwa hwezvinangwa zvayo uye zviwanikwa. Nechirongwa chePC chiripo chekudzora STH muSAC, zvinogona kutariswa kuti kubatanidzwa ne ivermectin kuri nyore kuita nemutengo unonzwisisika; zvakakosha kucherechedza kuti mutengo unofanirwa kuderedzwa kudzivirira kufa kumwe chete. Kune rumwe rutivi, mukusavapo kwezvirambidzo zvakakura zvemari, kushandiswa kwePC kune vanhu vose kuchaita kuti kuwedzere kuderedzwa kwezvirwere, saka nhamba yekufa kweiyo yese strongyloides ichadonha zvakanyanya nekufamba kwenguva. Muchokwadi, iyo yekupedzisira zano ichatsigirwa nekucherechedzwa kugoverwa kweStreptococcus faecalis hutachiona muhuwandu, hunowanzo wedzera nezera, zvinopesana nekuona kwe trichomes uye roundworms [22]. Zvisinei, kubatanidzwa kunoenderera mberi kwechirongwa cheSTH PC ne ivermectin kune mamwe mabhenefiti, ayo anogona kunzi akakosha zvakanyanya mukuwedzera kune mhedzisiro pane strongyloidiasis. Kutaura zvazviri, kusanganiswa kwe ivermectin pamwe nealbendazole/mebendazole kwakaratidza kuva kunoshanda zvikuru pakurwisa trichinella pane benzimidazole yoga [23]. Ichi chinogona kuva chikonzero chekutsigira kusanganiswa kwePC muSAC kubvisa kushushikana pamusoro pekupararira kwezera rezera rino zvichienzaniswa nevanhu vakuru. Pamusoro pezvo, imwe nzira yekufunga nezvayo inogona kunge iri hurongwa hwekutanga hweSAC wobva wawedzera kuti ubatanidze vechidiki nevakuru pazvinogoneka. Mapoka ese ezera, angave akabatanidzwa mune mamwe mapurogiramu ePC kana kwete, achabatsirwawo kubva kune zvinogona kuitika zveivermectin pane ectoparasites kusanganisira scabies [24].
Chimwe chinhu chinozokanganisa zvakanyanya mutengo / bhenefiti yekushandisa ivermectin yePC therapy ndeye huwandu hwehutachiona muhuwandu. Sezvo kukosha kwekupararira kunowedzera, kuderedzwa kwezvirwere kunowedzera kuoneka, uye mutengo wemupukunyuki wega wega unodzikira. Kuisa chikumbaridzo chePC kuita kurwisa Streptococcus faecalis kunofanirwa kufunga nezve chiyero pakati pezvinhu zviviri izvi. Inofanira kuonekwa kuti kune mamwe maSTHs, inokurudzirwa zvakasimba kushandisa PC nehuwandu hwehuwandu hwe20% kana kupfuura, zvichienderana nekuderedza zvakanyanya kuitika kwevanhu vanotarirwa [3]. Zvisinei, iyi inogona kunge isiri iyo chinangwa chakakodzera cheS. Zvisinei, nyika dzakawanda dzine dambudziko dzingafunga kuti kunyange kana mari yekuchengetedza maPC eStreptococcus faecalis yakanyanyisa pahuwandu hwehuwandu hwehuwandu, kuisa chikumbaridzo chekurapa panenge 15-20% yehuwandu hwehuwandu hungave hwakakodzera. Mukuwedzera, kana kuwanda kwehuwandu huri ≥ 15%, kuongorora serological kunopa fungidziro inovimbika kupfuura apo chiyero chekupararira chiri pasi, icho chinowanzova nehuwandu hwenhema [21]. Chimwe chinhu chinofanira kutariswa ndechekuti hukuru hwekutonga kwe ivermectin muLoa loa endemic nzvimbo dzichava dzakaoma nekuti varwere vane huwandu hwepamusoro hwehutachiona hwehutachiona hwehutachiona hunozivikanwa kuti vari panjodzi yekuuraya encephalopathy [25].
Mukuwedzera, tichifunga kuti ivermectin inogona kukura kushorwa mushure memakore akawanda ehukuru hwehutungamiri, kushanda kwechirwere kunofanira kuongororwa [26].
Izvo zvinogumira zvechidzidzo ichi zvinosanganisira fungidziro dzinoverengeka dzatakatadza kuwana humbowo hwakasimba, hwakadai sehuwandu hwekudzokazve uye kufa nekuda kweiyo yakasimbayloidiasis. Hazvina mhosva kuti zvishoma sei, tinogona kuwana mamwe mapepa sehwaro hwemuenzaniso wedu. Chimwe chidziviso ndechekuti isu tinoisa mamwe mitengo yezvinhu pabhajeti reongororo yekuongorora ichatanga muEthiopia, saka inogona kunge isina kunyatsofanana nemashandisirwo anotarisirwa mune dzimwe nyika. Zvinotarisirwa kuti chidzidzo chimwe chete chichapa imwe data yekuongorora mhedzisiro yePC uye ivermectin yakananga SAC. Zvimwe zvikomborero zvekutonga kwe ivermectin (zvakadai semigumisiro yescabies uye kuwedzera kwehutano hwemamwe maSTH) hazvina kuverengerwa, asi nyika dzine dambudziko dzingazvifunga mumamiriro ezvinhu ehutano hwehutano hunoenderana. Pakupedzisira, pano isu hatina kuyera kukanganiswa kwezvingabvira zvimwe zvinopindira, zvakadai semvura, hutsanana, uye hutsanana hwemunhu (WASH) maitiro, izvo zvinogona kuwedzera kubatsira kuderedza kupararira kweSTH [27] uye zvechokwadi World Health Organization Recommended [3] . Kunyangwe isu tichitsigira kubatanidzwa kwemaPC eSTH neWASH, kuongororwa kwemabatiro ayo kuri kupfuura chiyero chechidzidzo ichi.
Kuenzaniswa nemamiriro ezvinhu emazuva ano (asina kurapwa), zvose izvi zvePC zvakakonzera kuderera kukuru kwehuwandu hwehutachiona. Strategy B yakakonzera kufa kwakawanda kupfuura zano C, asi mitengo yakabatana neyekupedzisira zano yaive yakaderera. Chimwe chinhu chinofanirwa kutariswa ndechekuti parizvino, munzvimbo dzinenge dzakasimba-senge dzakasimba, zvirongwa zvekubvisa makonye muzvikoro zvakaitwa kugovera benzimidazole kudzora STH [3]. Kuwedzera ivermectin kune iyi iripo chikoro benzimidazole yekugovera chikuva kuchawedzera kuderedza mutengo wekugovera ivermectin weSAC. Isu tinotenda kuti basa iri rinogona kupa ruzivo rwakakosha kune nyika dzinoda kushandisa nzira dzekudzora Streptococcus faecalis. Kunyangwe maPC aratidza kukanganisa kukuru pahuwandu hwese kudzikisa huwandu hwehutachiona uye huwandu hwakakwana hwevakafa, maPC akananga kuSAC anogona kukurudzira kufa nemutengo wakaderera. Tichifunga nezvechiyero pakati pemutengo uye mhedzisiro yekupindira, kuwanda kwehuwandu hwe15-20% kana yakakwirira inogona kukurudzirwa seyakakurudzirwa chikumbaridzo cheivermectin PC.
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