Ukuphunyezwa kwesicwangciso solawulo losulelo lwe-Strongyloides stercoralis yenye yeenjongo ze-World Health Organization's 2030 roadmap. Injongo yalo msebenzi kukuvavanya impembelelo enokwenzeka yeendlela ezimbini ezahlukeneyo zokuthintela ichemotherapy (PC) ngokubhekiselele kwizibonelelo zoqoqosho kunye nesimo sempilo kwimeko yangoku (Isicwangciso A, akukho PC): Ivermectin kubantwana besikolo (SAC) kunye I-dosing yabantu abadala (iqhinga B) kunye ne-ivermectin zisetyenziselwa kuphela i-SAC (iqhinga C).
Uphononongo lwenziwe kwi-IRCS Sacro Cuore Don Calabria Hospital e-Negrar di Valpolicella, Verona, Italy, University of Florence, Italy, kunye ne-WHO eGeneva, eSwitzerland ukususela ngoMeyi 2020 ukuya ku-Aprili 2021. Idatha yale modeli ikhutshwe kwiincwadi. Imodeli yemathematika yaphuhliswa kwi-Microsoft Excel ukuvavanya impembelelo yezicwangciso ze-B kunye ne-C kuluntu oluqhelekileyo lwezifundo ze-1 ezihlala kwiindawo apho i-strongyloidiasis ixhaphake. Kwimeko esekelwe kwimeko, i-15% yokuxhaphaka kwe-strongyloidiasis yaqwalaselwa; emva koko amaqhinga amathathu avavanywa phantsi kwemigangatho eyahlukeneyo yobhubhane, ukusuka kwi-5% ukuya kwi-20%. Iziphumo zixelwe njengenani labantu abosulelekileyo, inani labantu ababhubhileyo, iindleko, kunye nomlinganiselo wokusebenza kakuhle (ICER). Amaxesha onyaka we-1 kunye neminyaka eyi-10 aqwalaselwe.
Kwimeko esekelwe kwimeko, kunyaka wokuqala wokuphunyezwa kwezicwangciso ze-B kunye ne-C ze-PC, inani losulelo liya kuncitshiswa kakhulu: ukusuka kwi-172 500 kwiimeko ngokweqhinga B ukuya kwii-77 040 iimeko, kwaye ngokweqhinga C. ukuba 146 700 iimeko. Iindleko ezongezelelweyo ngomntu ngamnye ofunyenweyo zithelekiswa nokungabikho unyango kunyaka wokuqala. Iidola zase-US (i-USD) kwizicwangciso ze-B kunye ne-C ziyi-2.83 kunye ne-1.13, ngokulandelanayo. Kwezi zicwangciso-qhinga zimbini, njengoko ukuxhaphaka kusanda, iindleko zomntu ngamnye obuyiselweyo zikwindlela ehlayo. IQhinga B linenani elikhulu lokufa okubhengeziweyo kuno-C, kodwa iqhinga C linexabiso eliphantsi lokubhengeza ukufa kuno-B.
Olu hlalutyo luvumela ukuqikelela impembelelo yezicwangciso zePC ezimbini zokulawula i-strongyloidiasis ngokweendleko kunye nokuthintela usulelo / ukufa. Oku kunokumela isiseko selizwe ngalinye eligqugqisayo ukuvavanya amacebo anokuthi aphunyezwe ngokusekelwe kwinkxaso-mali ekhoyo kunye nezinto eziphambili zempilo zesizwe.
Iintshulube ze-Soil-borne worms (STH) I-Strongyloides stercoralis ibangela ukugula okunxulumeneyo kubantu abachaphazelekayo, kwaye inokubangela ukusweleka kwabantu abosulelekileyo kwimeko yoxinzelelo lomzimba [1]. Ngokoqikelelo lwakutsha nje, malunga 600 million abantu ehlabathini lonke abachatshazelwayo, kwaye iimeko ezininzi kuMzantsi-mpuma Asia, Afrika kunye Western Pacific [2]. Ngokobungqina bakutshanje kumthwalo wehlabathi jikelele we-strongyloidiasis, uMbutho wezeMpilo weHlabathi (i-WHO) uquke ulawulo losulelo lwe-faecalis kwi-2030 Neglected Tropical Diseases (NTD) injongo yemephu yendlela [3]. Eli lixesha lokuqala i-WHO icebisa isicwangciso solawulo se-strongyloidiasis, kunye neendlela zokulawula ezicacileyo zichazwe.
I-S. stercoralis yabelana ngendlela yokudluliselwa kunye ne-hookworms kwaye inokusabalalisa okufanayo kwendawo kunye nezinye ii-STH, kodwa idinga iindlela zokuxilonga ezahlukeneyo kunye nonyango [4]. Enyanisweni, i-Kato-Katz, esetyenziselwa ukuvavanya ukuxhaphaka kwe-STH kwinkqubo yokulawula, inobuzwe obuphantsi kakhulu kwi-S. stercoralis. Kule parasite, ezinye iindlela zokuxilonga ngokuchaneka okuphezulu zingacetyiswa: i-Baermann kunye nenkcubeko ye-agar plate kwiindlela ze-parasitological, i-polymerase chain reaction kunye novavanyo lwe-serological [5]. Indlela yokugqibela isetyenziselwa ezinye ii-NTD, zithatha ithuba lokuqokelela igazi kwiphepha lokucoca, elivumela ukuqokelela ngokukhawuleza kunye nokugcinwa lula kweesampuli zebhayoloji [6, 7].
Ngelishwa, akukho mgangatho wegolide wokuxilongwa kwesi sifunxi-gazi [5], ngoko ke ukhetho lweyona ndlela yokuxilonga ibekwe kwinkqubo yolawulo kufuneka iqwalasele izinto ezininzi, njengokuchaneka kovavanyo, iindleko kunye nokuba nokwenzeka kokusetyenziswa. kwintsimi Kwintlanganiso yakutshanje eququzelelwe yi-WHO [8], iingcali ezikhethiweyo zamisela uvavanyo lwe-serological njengolona khetho lungcono, kwaye i-NIE ELISA yayiyeyona nto ikhethekileyo phakathi kweekhithi ze-ELISA ezithengiswayo. Ngokuphathelele unyango, i-chemotherapy yothintelo (PC) ye-STH ifuna ukusetyenziswa kwamachiza e-benzimidazole, i-albendazole okanye i-mebendazole [3]. Ezi nkqubo zihlala zijolise kubantwana abakubudala besikolo (SAC), abangowona mthwalo uphezulu wekliniki obangelwa yi-STH [3]. Nangona kunjalo, amachiza e-benzimidazole phantse awanampembelelo kwi-Streptococcus faecalis, ngoko ke ivermectin lichiza elikhethwayo [9]. Ivermectin isetyenziswe kunyango olukhulu lwe-onchocerciasis kunye ne-lymphatic filariasis (NTD) iinkqubo zokuphelisa amashumi eminyaka [10, 11]. Inokhuseleko olubalaseleyo kunye nokunyamezela, kodwa ayikhuthazwa kubantwana abangaphantsi kweminyaka emi-5 [12].
I-S. stercoralis nayo ihluke kwezinye ii-STH malunga nobude bexesha lokusuleleka, kuba ukuba ayiphathwanga ngokwaneleyo, umjikelezo okhethekileyo we-auto-infection unokubangela ukuba i-parasite iqhubeke ngokungapheliyo kwi-host host yabantu. Ngenxa yokuvela kosulelo olutsha kunye nokuzingisa kwezifo ezihlala ixesha elide ekuhambeni kwexesha, oku kukhokelela ekuxhaphakeni okuphezulu kosulelo kubuntu obudala [1, 2].
Ngaphandle kokucaciswa, ukudibanisa imisebenzi ethile kunye neenkqubo ezikhoyo zezinye izifo ezingahoywayo zetropiki kunokuzuza ekuphunyezweni kweenkqubo zokulawula izifo ezinjenge-strongyloidosis. Ukwabelana ngeziseko ezingundoqo kunye nabasebenzi kunokunciphisa iindleko kunye nokukhawulezisa imisebenzi ejoliswe ekulawuleni i-Streptococcus faecalis.
Injongo yalo msebenzi kukuqikelela iindleko kunye neziphumo zezicwangciso ezahlukeneyo ezinxulumene nokulawulwa kwe-strongyloidiasis, oko kukuthi: (A) akukho kungenelela; (B) ulawulo olukhulu lwe-SAC kunye nabantu abadala; (C) ye-SAC PC.
Uphononongo lwenziwe kwi-IRCS Sacro Cuore Don Calabria Hospital e-Negrar di Valpolicella, Verona, Italy, University of Florence, Italy, kunye ne-WHO eGeneva, eSwitzerland ukususela ngoMeyi 2020 ukuya ku-Aprili 2021. Umthombo wedatha wale modeli luncwadi olukhoyo. Imodeli yemathematika yaphuhliswa kwi-Microsoft® Excel® ye-Microsoft 365 MSO (Microsoft Corporation, Santa Rosa, California, USA) ukuvavanya ukungenelela okunokubakho kwe-strongyloidosis-njengemimandla ephezulu xa kuthelekiswa (A) nongenelelo. yemilinganiselo (inkqubo yangoku); (B) IiPC ze-SAC kunye nabantu abadala; (C) IiPC ze-SAC kuphela. I-1-year kunye ne-10-year time horizons ivavanywa kuhlalutyo. Uphononongo luqhutywe ngokusekelwe kwimbono yenkqubo yezempilo yesizwe yendawo, ejongene neeprojekthi zokubulala iintshulube, kubandakanywa iindleko ezithe ngqo ezinxulumene nenkxaso-mali yecandelo likarhulumente. Umthi wesigqibo kunye negalelo ledatha lichazwe kuMfanekiso 1 kunye neThebhile 1, ngokulandelanayo. Ngokukodwa, umthi wesigqibo ubonisa iimeko zempilo ezihlangeneyo ezibonwe kwangaphambili yimodeli kunye namanyathelo engqiqo yokubala kwisicwangciso ngasinye esahlukileyo. Icandelo ledatha yegalelo elingezantsi linika ingxelo ngokweenkcukacha izinga lokuguqulwa ukusuka kwelinye ilizwe ukuya kwelinye kunye neengqikelelo ezinxulumeneyo. Iziphumo zichazwe njengenani lezifundo ezosulelekileyo, izifundo ezingosulelwanga, izifundo eziphilisiweyo (ukubuyisela), ukufa, iindleko, kunye nomlinganiselo weendleko-inzuzo eyongezelelweyo (ICER). I-ICER ngumahluko weendleko phakathi kwezicwangciso ezimbini ezahlulwe nguMahluko kwiimpembelelo zabo kukubuyisela isifundo kunye nokuphepha usulelo. I-ICER encinci ibonisa ukuba isicwangciso esinye sineendleko eziphezulu kunesinye.
Umthi wesigqibo malunga nobume bempilo. I-PC yokuthintela i-chemotherapy, i-IVM ivermectin, ulawulo lwe-ADM, abantwana besikolo se-SAC
Sicinga ukuba inani labantu abaqhelekileyo lizifundo ze-1,000,000 ezihlala kumazwe anezinga eliphezulu le-strongyloidiasis, apho i-50% ingabantu abadala (≥15 iminyaka ubudala) kunye ne-25% ngabantwana besikolo (iminyaka eyi-6-14 ubudala). Olu lunikezelo olujongwa rhoqo kumazwe akuMzantsi-mpuma weAsia, eAfrika nakwintshona yePasifiki [13]. Kwimeko esekelwe kwimeko, ukuxhaphaka kwe-strongyloidiasis kubantu abadala kunye ne-SAC kuqikelelwa ukuba yi-27% kunye ne-15%, ngokulandelanayo [2].
Kwisicwangciso A (umsebenzi wangoku), izifundo azifumani unyango, ngoko sicinga ukuba ukuxhaphaka kokusuleleka kuya kuhlala kufana ekupheleni konyaka-1 kunye ne-10 iminyaka.
Kwiqhinga B, bobabini i-SAC kunye nabantu abadala baya kufumana iiPC. Ngokusekelwe kumlinganiselo oqikelelweyo wokuthotyelwa kwe-60% kubantu abadala kunye ne-80% ye-SAC [14], izifundo zombini ezosulelekileyo kunye nezingenantsholongwane ziya kufumana ivermectin kanye ngonyaka kwiminyaka eyi-10. Sicinga ukuba izinga lokunyanga abantu abosulelekileyo limalunga nama-86% [15]. Njengoko uluntu luya kuqhubeka lubonakaliswe kumthombo wokusuleleka (nangona ukungcoliseka komhlaba kunokunciphisa ixesha elide ukususela ekubeni i-PC iqalile), ukusuleleka kwakhona kunye nosulelo olutsha luya kuqhubeka. Izinga losulelo olutsha lonyaka luqikelelwa ukuba sisiqingatha senqanaba losulelo olusisiseko [16]. Ke ngoko, ukusukela kunyaka wesibini wokuphunyezwa kwePC, inani lamatyala abosulelekileyo ngonyaka ngamnye liyakulingana nenani lamatyala asandula ukusuleleka kunye nenani lamatyala ahlala enethemba (okt, abo bangakhange balufumane unyango lwePC kunye nabo baye bafumana unyango lwe-PC kunye nabo baye bachaphazeleka. ayiphendulwanga kunyango). I-Strategy C (i-PC kuphela ye-SAC) ifana ne-B, umahluko kuphela kukuba i-SAC kuphela iya kufumana ivermectin, kwaye abantu abadala abayi kufumana.
Kuwo onke amaqhinga, inani eliqikelelwayo lokufa ngenxa ye-strongyloidiasis enzima liyasuswa kubemi ngonyaka ngamnye. Ukucinga ukuba i-0.4% yezifundo ezisulelekileyo ziya kuhlakulela i-strongyloidiasis enzima [17], kwaye i-64.25% yazo iya kufa [18], qikelela oku kufa. Ukufa ngenxa yezinye izizathu akubandakanywa kwimodeli.
Impembelelo yezi zicwangciso zibini zaye zavavanywa phantsi kwamanqanaba ahlukeneyo okuxhaphaka kwe-strongyloidosis kwi-SAC: 5% (ehambelana ne-9% yokuxhaphaka kwabantu abadala), i-10% (18%) kunye ne-20% (36%).
Sicinga ukuba i-Strategy A ayinanto yakwenza naziphi na iindleko ezithe ngqo kwinkqubo yezempilo yesizwe, nangona iziganeko zesifo esifana ne-strongyloidia sinokuthi sibe nempembelelo yezoqoqosho kwinkqubo yezempilo ngenxa yokulaliswa esibhedlele kunye nokubonisana nezigulana ngaphandle, nangona kungenakubaluleka. Iinzuzo kwimbono yentlalo (ezifana nokunyuka kwemveliso kunye namazinga okubhalisa, kunye nokunciphisa ilahleko yexesha lokubonisana), nangona zinokuba zifanelekileyo, azithathelwa ngqalelo ngenxa yobunzima bokuqikelela ngokuchanekileyo.
Ukuphunyezwa kwezicwangciso ze-B kunye ne-C, siqwalasele iindleko ezininzi. Inyathelo lokuqala kukuqhuba uphando olubandakanya i-0.1% yabemi be-SAC ukufumanisa ukuxhaphaka kosulelo kwindawo ekhethiweyo. Iindleko zophando ngama-27 eedola zase-US (USD) ngesifundo ngasinye, kubandakanywa neendleko ze-parasitology (i-Baermann) kunye novavanyo lwe-serological (ELISA); iindleko ezongezelelweyo zolungiselelo ngokuyinxenye zisekwe kwiprojekthi yokulinga ecetywayo e-Ethiopia. Lilonke, uphando lwabantwana abangama-250 (i-0.1% yabantwana kuluntu lwethu olusemgangathweni) luya kuxabisa i-US$6,750. Iindleko zonyango lwe-ivermectin lwe-SAC kunye nabantu abadala (i-US $ 0.1 kunye ne-US $ 0.3, ngokulandelanayo) isekelwe kwindleko elindelekileyo ye-prequalified generic ivermectin nguMbutho wezeMpilo weHlabathi [8]. Ekugqibeleni, iindleko zokuthatha ivermectin ye-SAC kunye nabantu abadala yi-0.015 USD kunye ne-0.5 USD ngokulandelanayo) [19, 20].
Itheyibhile yesi-2 kunye neThebhile yesi-3 ngokulandelelana ibonisa inani elipheleleyo labantwana abosulelekileyo nabangosulelwanga kunye nabantu abadala kuluntu oluqhelekileyo lwabantu abangaphezu kweminyaka emi-6 ubudala kwizicwangciso ezithathu, kunye neendleko ezinxulumene nohlalutyo lwe-1 unyaka kunye ne-10 leminyaka. Ifomula yokubala yimodeli yemathematika. Ngokukodwa, iThebhile 2 ibika umahluko kwinani labantu abosulelekileyo ngenxa yezicwangciso zePC ezimbini xa kuthelekiswa nomqhathanisi (akukho sicwangciso sonyango). Xa ukuxhaphaka kwabantwana kulingana ne-15% kunye ne-27% kubantu abadala, abantu abangama-172,500 kubemi babosulelekileyo. Inani lezifundo ezisulelekileyo zibonise ukuba ukuqaliswa kweePC ezijoliswe kwi-SAC kunye nabantu abadala bancitshiswa nge-55.3%, kwaye ukuba iiPC zijolise kuphela kwi-SAC, yancitshiswa nge-15%.
Kuhlalutyo lwexesha elide (iminyaka eyi-10), xa kuthelekiswa nesicwangciso A, ukuncitshiswa kokusuleleka kwezicwangciso ze-B kunye ne-C kwanda ukuya kwi-61.6% kunye ne-18.6%, ngokulandelanayo. Ukongezelela, ukusetyenziswa kwezicwangciso ze-B kunye ne-C kunokubangela ukunciphisa i-61% kunye ne-10 yeminyaka yokufa kwe-48%, ngokulandelanayo, xa kuthelekiswa nokungafumani unyango.
Umzobo we-2 ubonisa inani lokusuleleka kwizicwangciso ezintathu ngexesha lokuhlalutya kweminyaka eyi-10: Nangona eli nani lahlala lingatshintshi ngaphandle kokungenelela, kwiminyaka embalwa yokuqala yokuphunyezwa kwezicwangciso zePC ezimbini, inani lethu lamatyala liyancipha ngokukhawuleza. Ngokucotha ngakumbi emva koko.
Ngokusekelwe kubuchule obuthathu, uqikelelo lokuncitshiswa kwenani losulelo ekuhambeni kweminyaka. I-PC yokuthintela ichemotherapy, abantwana abakwiminyaka yesikolo ye-SAC
Ngokumalunga ne-ICER, ukusuka kwi-1 ukuya kwi-10 iminyaka yokuhlalutya, iindleko ezongezelelweyo zomntu ngamnye ofunyenweyo zanda kancinci (Umfanekiso 3). Kuthathelwa ingqalelo ukuhla kwabantu abosulelekileyo kubemi, iindleko zokuthintela usulelo kwizicwangciso ze-B kunye no-C zaziyi-US$2.49 kunye ne-US$0.74, ngokulandelelanayo, ngaphandle konyango kwisithuba seminyaka eli-10.
Iindleko zomntu ngamnye ofunyenweyo kuhlalutyo lwe-1 kunye ne-10 yeminyaka. I-PC yokuthintela ichemotherapy, abantwana abakwiminyaka yesikolo ye-SAC
Amanani 4 kunye ne-5 anika ingxelo ngenani losulelo oluthintelwe yi-PC kunye neendleko ezinxulumene nexhoba ngalinye xa kuthelekiswa nonyango. Ixabiso lokuxhaphaka phakathi konyaka livela kwi-5% ukuya kwi-20%. Ngokukodwa, xa kuthelekiswa nemeko esisiseko, xa izinga lokuxhaphaka liphantsi (umzekelo, i-10% yabantwana kunye ne-18% yabantu abadala), iindleko zomntu ngamnye obuyiselweyo ziya kuba phezulu; ngokuchaseneyo, kwimeko yokuxhaphaka okuphezulu Iindleko eziphantsi ziyafuneka kwindawo esingqongileyo.
Amaxabiso onyaka wokuqala aqala ukusuka kwi-5 ukuya kwi-20% yenani losulelo lwentengiso. I-PC yokuthintela ichemotherapy, abantwana abakwiminyaka yesikolo ye-SAC
Iindleko zomntu ngamnye ofunyenweyo kunye nokuxhaphaka kwe-5% ukuya kuma-20% kunyaka wokuqala. I-PC yokuthintela ichemotherapy, abantwana abakwiminyaka yesikolo ye-SAC
Itheyibhile 4 ibuyisela inani lokufa kunye neendleko ezihambelanayo kwi-1-year kunye ne-10-year ranges zezicwangciso ezahlukeneyo zePC. Kuzo zonke iireyithi zokuxhaphakeka eziqwalaselwayo, iindleko zokuphepha ukufa kweqhinga C liphantsi kuneqhinga B. Kuzo zombini izicwangciso, iindleko ziya kuncipha ngokuhamba kwexesha, kwaye ziya kubonisa ukuhla kwenyuka njengoko ukwanda kunyuka.
Kulo msebenzi, xa kuthelekiswa nokungabikho kwangoku kwezicwangciso zokulawula, sivavanye izicwangciso ezimbini ze-PC ezinokuthi zenzeke ngeendleko zokulawula i-strongyloidiasis, impembelelo enokubakho ekuxhasweni kwe-strongyloidiasis, kunye nefuthe kwikhonkco le-fecal kuluntu oluqhelekileyo. Impembelelo yokufa okunxulumene ne-cocci. Njengenyathelo lokuqala, uvavanyo olusisiseko lokuxhaphaka luyacetyiswa, oluya kuxabisa malunga ne-US$27 ngovavanyo lomntu ngamnye (okt, iyonke ye-US$6750 yokuvavanya abantwana abangama-250). Iindleko ezongezelelweyo ziya kuxhomekeka kwisicwangciso esikhethiweyo, esinokuthi (A) singayisebenzisi inkqubo yePC (imeko yangoku, akukho ndleko eyongezelelweyo); (B) Ulawulo lwePC kubo bonke abantu (i-0.36 USD ngomntu wonyango); (C) ) Okanye i-PC idilesi ye-SAC (i-$ 0.04 ngomntu ngamnye). Zombini izicwangciso ze-B kunye no-C ziya kukhokelela ekunciphiseni ngokukhawuleza kwenani losulelo kunyaka wokuqala wokuphunyezwa kwe-PC: kunye nokuxhaphaka kwe-15% kubantu abaneminyaka yobudala besikolo kunye ne-27% kubantu abadala, inani elipheleleyo labantu abosulelekileyo liya kuba. ekuphunyezweni kwamaqhinga B no-C Kamva, inani lamatyala lancitshiswa ukusuka kwi-172 500 kwisiseko ukuya kuma-77 040 kunye ne-146 700 ngokulandelelanayo. Emva koko, inani lamatyala liya kuncipha, kodwa ngesantya esiphantsi. Iindleko zomntu ngamnye ofunyenweyo azihambelani kuphela nezicwangciso ezimbini (xa kuthelekiswa neqhinga C, iindleko zokuphumeza isicwangciso B siphezulu kakhulu, kwi-$ 3.43 kunye ne-$ 1.97 kwiminyaka eyi-10, ngokulandelanayo), kodwa kunye nokuxhaphaka kwesiseko. Uhlalutyo lubonisa ukuba ngokunyuka kokuxhaphaka, iindleko zomntu ngamnye ofunyenweyo ziphantsi kwendlela. Ngomlinganiselo we-SAC wokuxhaphaka kwe-5%, iya kuhla ukusuka kwi-US $ 8.48 ngomntu ngamnye kwi-Strategy B kunye ne-US $ 3.39 ngomntu ngamnye kwi-Strategy C. ukuya kwi-USD 2.12 ngomntu kunye ne-0.85 ngomntu ngamnye onomlinganiselo we-20%, izicwangciso ze-B kunye ne-C zamkelwa ngokulandelelanayo. Ekugqibeleni, impembelelo yezi zicwangciso zimbini ekufeni kweentengiso zihlalutywa. Xa kuthelekiswa ne-Strategy C (i-66 kunye ne-822 abantu kwi-1-year kunye ne-10-year range, ngokulandelanayo), i-Strategy B ngokucacileyo ibangele ukufa okulindelekileyo (245 kunye ne-2717 kwi-1-year kunye ne-10-year range, ngokulandelanayo). Kodwa enye inkalo ehambelana nayo lixabiso lokubhengeza ukufa. Iindleko zezicwangciso zombini ziyancipha ngokuhamba kwexesha, kwaye iqhinga C (i-10-year 288 $) lingaphantsi kwe-B (i-10-year 969 $).
Ukukhethwa kwesicwangciso sePC sokulawula i-strongyloidiasis iya kusekelwa kwizinto ezahlukeneyo, kuquka ukufumaneka kwemali, imigaqo-nkqubo yezempilo yesizwe, kunye neziseko ezikhoyo. Emva koko, ilizwe ngalinye liya kuba nesicwangciso seenjongo zalo ezithile kunye nezibonelelo. Ngeprogram yePC endaweni yokulawula i-STH kwi-SAC, kunokuqwalaselwa ukuba ukudibanisa kunye ne-ivermectin kulula ukuphumeza ngexabiso elifanelekileyo; Kufanelekile ukuqaphela ukuba iindleko kufuneka zincitshiswe ukuphepha ukufa okunye. Ngakolunye uhlangothi, ngokungabikho kwezithintelo ezinkulu zemali, ukusetyenziswa kwePC kubo bonke abantu ngokuqinisekileyo kuya kukhokelela ekunciphiseni ngakumbi usulelo, ngoko ke inani lokufa kwe-strongyloides lilonke liya kuhla ngokukhawuleza ngokuhamba kwexesha. Enyanisweni, isicwangciso sokugqibela siya kuxhaswa ngokusasazwa okubonwayo kwe-Streptococcus faecalis usulelo kuluntu, oluvame ukukhula ngokukhula, ngokuchasene nokuqwalaselwa kwe-trichomes kunye ne-roundworms [22]. Nangona kunjalo, ukuhlanganiswa okuqhubekayo kweprogram ye-PC ye-STH kunye ne-ivermectin ineenzuzo ezongezelelweyo, ezinokuthi zithathwe njengexabiso elibaluleke kakhulu ngaphezu kwemiphumo ye-strongyloidiasis. Ngapha koko, indibaniselwano ye-ivermectin kunye ne-albendazole/mebendazole ingqineke isebenza ngakumbi ngokuchasene ne-trichinella kune-benzimidazole yodwa [23]. Oku kunokuba sisizathu sokuxhasa indibaniselwano yePC kwi-SAC ukuphelisa iinkxalabo malunga nokuxhaphaka okuphantsi kweli qela lobudala xa kuthelekiswa nabantu abadala. Ukongeza, enye indlela ekufuneka iqwalaselwe inokuba sisicwangciso sokuqala se-SAC kwaye sandise ukubandakanya abafikisayo kunye nabantu abadala xa kunokwenzeka. Onke amaqela eminyaka ubudala, nokuba afakwe kwezinye iinkqubo zePC okanye cha, aya kuzuza kwakhona kwimiphumo enokubakho ye-ivermectin kwi-ectoparasites kuquka i-scabi [24].
Enye into eya kuchaphazela kakhulu iindleko / inzuzo yokusebenzisa i-ivermectin yonyango lwe-PC yizinga losulelo kuluntu. Njengoko ixabiso lokuxhaphaka linyuka, ukuhla kosulelo kuya kubonakala ngakumbi, kwaye iindleko zexhoba ngalinye ziyehla. Ukumisela umda wokuphunyezwa kwePC ngokuchasene neStreptococcus faecalis kufuneka ithathele ingqalelo ibhalansi phakathi kwale miba mibini. Kufuneka kuthathelwe ingqalelo ukuba kwezinye ii-STH, kucetyiswa ngamandla ukuphumeza i-PC kunye nezinga lokuxhaphaka kwe-20% okanye ngaphezulu, ngokusekelwe ekunciphiseni kakhulu iziganeko zabantu ekujoliswe kuzo [3]. Nangona kunjalo, oku kusenokungabi yinjongo echanekileyo ye-S. stercoralis, njengoko umngcipheko wokufa kwabantu abosulelekileyo uya kuqhubeka kuwo nawuphi na umngcipheko wosulelo. Nangona kunjalo, amazwe amaninzi ase-endemic anokucinga ukuba nokuba iindleko zokugcina iiPC ze-Streptococcus faecalis ziphezulu kakhulu kwizinga eliphantsi lokuxhaphaka, ukubeka umda wonyango malunga ne-15-20% yezinga lokuxhaphaka linokuba lifanelekileyo kakhulu. Ukongezelela, xa izinga lokuxhaphaka liyi-≥ 15%, uvavanyo lwe-serological lunikeza uqikelelo oluthembekileyo ngakumbi xa izinga lokuxhaphaka liphantsi, elivame ukuba neempawu zobuxoki [21]. Enye into ekufuneka iqwalaselwe kukuba ulawulo olukhulu lwe-ivermectin kwindawo ye-Loa loa endemic luya kuba ngumngeni kuba izigulane ezine-microfilaria ephezulu yegazi ziyaziwa ukuba zisengozini yokubulala i-encephalopathy [25].
Ukongeza, ngokuqwalasela ukuba i-ivermectin inokukhula ukuchasana emva kweminyaka emininzi yolawulo olukhulu, ukusebenza kwechiza kufuneka kubekwe iliso [26].
Imida yolu phononongo ibandakanya iingqikelelo ezininzi apho asikwazanga ukufumana ubungqina obuqinileyo, njengenqanaba lokuphinda usuleleke kunye nokufa ngenxa ye-strongyloidiasis enzima. Kungakhathaliseki ukuba kunqongophele kangakanani, sinokuhlala sifumana amaphepha athile njengesiseko semodeli yethu. Omnye umda kukuba siseke ezinye iindleko zolungiselelo kuhlahlo lwabiwo-mali lophononongo olulingwayo oluya kuqala e-Ethiopia, ngoko ke zisenokungafani ncam nenkcitho elindelekileyo kwamanye amazwe. Kulindeleke ukuba uphando olufanayo luya kubonelela ngedatha eyongezelelweyo ukuhlalutya imiphumo ye-PC kunye ne-ivermectin ekujoliswe kuyo kwi-SAC. Ezinye izibonelelo zolawulo lwe-ivermectin (ezifana nefuthe kwi-scabi kunye nokunyuka kokuphumelela kwezinye ii-STH) azizange zilinganiswe, kodwa amazwe e-endmic angawaqwalasela kumxholo wezinye iindlela zempilo ezinxulumene nazo. Ekugqibeleni, apha asizange silinganise impembelelo yongenelelo olongezelelweyo olunokwenzeka, njengamanzi, ucoceko, kunye nococeko lomntu (WASH) izenzo, ezinokuthi zincede ngakumbi ukunciphisa ukuxhaphaka kwe-STH [27] kwaye ngokwenene i-World Health Organization icetyiswa [3] . Nangona sixhasa ukudityaniswa kweePC ze-STH nge-WASH, ukuvavanywa kwempembelelo yayo kungaphaya kobubanzi bolu phononongo.
Xa kuthelekiswa nemeko yangoku (engaphathwanga), zombini ezi zicwangciso zePC zibangele ukuncitshiswa okukhulu kwamazinga osulelo. IQhinga B libangele ukufa kwabantu abaninzi kuneqhinga C, kodwa iindleko ezinxulumene nesi sicwangciso sokugqibela bezisezantsi. Omnye umba omele uqwalaselwe kukuba okwangoku, phantse kuzo zonke iindawo ezifana ne-strongyloidosis, iinkqubo zesikolo zokubulala iintshulube ziye zaphunyezwa ukusasaza i-benzimidazole ukulawula i-STH [3]. Ukongeza ivermectin kweli qonga likhoyo lokuhambisa ibenzimidazole lesikolo kuya kunciphisa ngakumbi iindleko zokuhanjiswa kwe-ivermectin ye-SAC. Sikholelwa ukuba lo msebenzi unokubonelela ngedatha eluncedo kumazwe anqwenela ukuphumeza izicwangciso zokulawula i-Streptococcus faecalis. Nangona ii-PC zibonise impembelelo enkulu kuluntu ngokubanzi ukunciphisa inani losulelo kunye nenani elipheleleyo lokufa, ii-PC ezijolise kwi-SAC zinokukhuthaza ukufa ngexabiso eliphantsi. Ukuqwalasela ibhalansi phakathi kweendleko kunye nomphumo wongenelelo, izinga lokuxhaphaka kwe-15-20% okanye ngaphezulu kunokucetyiswa njengomlinganiselo ocetyiswayo we-PC ye-ivermectin.
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