Ukuqaliswa kokusetshenziswa kohlelo lokulawula ukutheleleka kwe-Strongyloides stercoralis kungenye yezinjongo zomhlahlandlela we-World Health Organization wezi-2030. Inhloso yalo msebenzi ukuhlola umthelela ongaba khona wamasu amabili ahlukene okuvimbela ngamakhemikhali (PC) ngokwemithombo yezomnotho nesimo sezempilo esimweni samanje (Isu A, akukho PC): Ivermectin yezingane ezifunda esikoleni (SAC) kanye Ukulinganisa kwabadala (isu B) kanye ne-ivermectin kusetshenziselwa kuphela i-SAC (isu C).
Ucwaningo lwenziwe esibhedlela i-IRCS Sacro Cuore Don Calabria e-Negrar di Valpolicella, Verona, Italy, University of Florence, Italy, kanye ne-WHO eGeneva, eSwitzerland kusukela ngoMeyi 2020 kuya ku-April 2021. Idatha yale modeli ikhishwe ezincwadini. Imodeli yezibalo yathuthukiswa ku-Microsoft Excel ukuze kuhlolwe umthelela wamasu B no-C esibalweni esijwayelekile sezifundo eziyisigidi esi-1 ezihlala ezindaweni lapho i-strongyloidiasis idlange khona. Esimeni esisekelwe ecaleni, ukusabalala kwe-strongyloidiasis kwe-15% kucatshangelwe; kwase kuthi amasu amathathu ahlolwa ngaphansi kwemikhawulo ehlukene yobhubhane, kusukela ku-5% kuya ku-20%. Imiphumela ibikwa njengenani labantu abangenwe yileli gciwane, inani labashonile, izindleko, kanye nesilinganiso sokusebenza kahle esikhuphukayo (ICER). Izikhathi zonyaka o-1 kanye neminyaka eyi-10 zicatshangelwe.
Esimeni esisekelwe ecaleni, ngonyaka wokuqala wokuqaliswa kwamasu B no-C wama-PC, inani lezifo lizoncishiswa kakhulu: kusuka ku-172 500 amacala ngokusho kwesu B kuya ku-77 040 amacala, futhi ngokusho kwesu C. kumacala ayi-146 700. Izindleko ezengeziwe ngomuntu ngamunye otholiwe ziqhathaniswa nokungatholakali kokwelashwa onyakeni wokuqala. Amadola aseMelika (i-USD) kumasu B no-C angu-2.83 no-1.13, ngokulandelana. Kulawa maqhinga amabili, njengoba ukwanda kunyuka, izindleko zomuntu ngamunye otholiwe zisezingeni eliphansi. Isu B linenani elikhulu lokufa okumenyezelwe kuno-C, kodwa isu C linezindleko eziphansi zokumemezela ukufa kuno-B.
Lokhu kuhlaziya kuvumela ukulinganisa umthelela wamasu amabili e-PC ukulawula i-strongyloidiasis ngokwezindleko nokuvimbela ukutheleleka/ukufa. Lokhu kungamela isisekelo sezwe ngalinye eliwumqedazwe ukuze lihlole amasu angasetshenziswa ngokusekelwe kuxhaso lwezimali olutholakalayo kanye nezinto ezibalulekile zempilo zikazwelonke.
Izikelemu ze-Soil-borne (STH) I-Strongyloides stercoralis ibangela ukugula okuhlobene emiphakathini ethintekile, futhi ingabangela ukufa kwabantu abangenwe yileli gciwane esimweni sokucindezeleka komzimba [1]. Ngokwezilinganiso zakamuva, cishe abantu abayizigidi ezingama-600 emhlabeni wonke bayathinteka, kanti iningi labantu liseNingizimu-mpumalanga ye-Asia, i-Afrika kanye ne-Western Pacific [2]. Ngokobufakazi bakamuva mayelana nomthwalo womhlaba wonke we-strongyloidiasis, i-World Health Organization (WHO) ifake ukulawulwa kwezifo ze-faecalis kumgomo wemephu yomgwaqo we-2030 Neglected Tropical Diseases (NTD) [3]. Kungokokuqala i-WHO incoma uhlelo lokulawula i-strongyloidiasis, futhi kuchazwa izindlela ezithile zokulawula.
I-S. stercoralis yabelana ngomzila wokudlulisela nama-hookworms futhi inokusabalalisa okufanayo kwendawo namanye ama-STH, kodwa idinga izindlela zokuxilonga ezihlukene kanye nokwelashwa [4]. Eqinisweni, i-Kato-Katz, esetshenziselwa ukuhlola ukusabalala kwe-STH ohlelweni lokulawula, inokuzwela okuphansi kakhulu ku-S. stercoralis. Kulesi sitshalo, ezinye izindlela zokuxilonga ezinokunemba okuphezulu zinganconywa: i-Baermann ne-agar plate culture ngezindlela ze-parasitological, i-polymerase chain reaction kanye nokuhlolwa kwe-serological [5]. Indlela yokugcina isetshenziselwa amanye ama-NTD, isebenzisa ithuba lokuqoqa igazi ephepheni lokuhlunga, elivumela ukuqoqwa okusheshayo nokugcinwa kalula kwamasampula ezinto eziphilayo [6, 7].
Ngeshwa, alikho izinga legolide lokuxilongwa kwalesi silwane [5], ngakho-ke ukukhethwa kwendlela yokuxilonga engcono kakhulu esetshenziswe ohlelweni lokulawula kufanele kucabangele izici eziningana, njengokunemba kokuhlolwa, izindleko kanye nokuba nokwenzeka kokusetshenziswa. kulo mkhakha Emhlanganweni wakamuva ohlelwe yi-WHO [8], ochwepheshe abakhethiwe banqume ukuhlolwa kwe-serological njengokukhetha okungcono kakhulu, futhi i-NIE ELISA yayiyisinqumo esingcono kakhulu phakathi kwamakhithi e-ELISA atholakalayo kwezohwebo. Mayelana nokwelashwa, i-protection chemotherapy (PC) ye-STH idinga ukusetshenziswa kwezidakamizwa ze-benzimidazole, i-albendazole noma i-mebendazole [3]. Lezi zinhlelo ngokuvamile ziqondise izingane ezifunda isikole (SAC), okungumthwalo omkhulu womtholampilo obangelwa i-STH [3]. Kodwa-ke, izidakamizwa ze-benzimidazole cishe azinawo umthelela ku-Streptococcus faecalis, ngakho-ke i-ivermectin iwumuthi okhethwayo [9]. I-Ivermectin isetshenziselwe ukwelashwa okukhulu kwe-onchocerciasis kanye ne-lymphatic filariasis (NTD) izinhlelo zokuqeda amashumi eminyaka [10, 11]. Inokuphepha okuhle kakhulu nokubekezeleleka, kodwa ayinconyelwe izingane ezingaphansi kweminyaka engu-5 ubudala [12].
I-S. stercoralis iphinde ihluke kwamanye ama-STH ngokwesikhathi sokutheleleka, ngoba uma ingelashwa ngokwanele, umjikelezo okhethekile wokutheleleka okuzenzakalelayo ungabangela i-parasite ukuthi iqhubeke ngokungapheli kumuntu ophethe. Ngenxa yokuvela kwezifo ezintsha kanye nokuphikelela kwezifo ezihlala isikhathi eside ngokuhamba kwesikhathi, lokhu kubuye kuholele ekusakazekeni okuphezulu kwezifo lapho umuntu esekhulile [1, 2].
Naphezu kokukhethekile, ukuhlanganisa imisebenzi ethile nezinhlelo ezikhona zezinye izifo ezinganakiwe zasezindaweni ezishisayo kungase kuzuze ekusetshenzisweni kwezinhlelo zokulawula izifo ezifana ne-strongyloidosis. Ukwabelana ngengqalasizinda kanye nabasebenzi kungase kunciphise izindleko futhi kusheshise imisebenzi ehloselwe ukulawula i-Streptococcus faecalis.
Inhloso yalo msebenzi ukulinganisa izindleko nemiphumela yamasu ahlukene ahlobene nokulawulwa kwe-strongyloidiasis, okungukuthi: (A) akukho ukungenelela; (B) ukuphathwa ngezinga elikhulu kwe-SAC kanye nabantu abadala; (C) ye-SAC PC.
Ucwaningo lwenziwe esibhedlela i-IRCS Sacro Cuore Don Calabria e-Negrar di Valpolicella, Verona, Italy, University of Florence, Italy, kanye ne-WHO e-Geneva, Switzerland kusukela ngoMeyi 2020 kuya ku-April 2021. Umthombo wedatha wale modeli uyizincwadi ezitholakalayo. Imodeli yezibalo yathuthukiswa ku-Microsoft® Excel® ye-Microsoft 365 MSO (Microsoft Corporation, Santa Rosa, California, USA) ukuze kuhlolwe ukungenelela okubili okungaba okufana ne-strongyloidosis ezindaweni eziyingozi kakhulu uma kuqhathaniswa (A) nokungenelela komtholampilo kanye nezomnotho. wezinyathelo (umkhuba wamanje); (B) Ama-PC we-SAC kanye nabantu abadala; (C) Ama-PC we-SAC kuphela. Ama-horizons wesikhathi sonyaka ongu-1 kanye nonyaka we-10 ayahlolwa ekuhlaziyeni. Ucwaningo lwenziwe ngokusekelwe kumbono wohlelo lwezempilo lukazwelonke lwendawo, olubhekele amaphrojekthi okubulala izikelemu, okuhlanganisa nezindleko eziqondile ezihlobene nokuxhaswa ngezimali komkhakha womphakathi. Isihlahla sesinqumo nokokufaka kwedatha kubikwa kuMfanekiso 1 kanye neThebula 1, ngokulandelana. Ikakhulukazi, isihlahla sesinqumo sibonisa izimo zempilo ezikhethekile ezibonwa kusengaphambili yimodeli kanye nezinyathelo ezinengqondo zokubala zesu ngalinye elihlukile. Isigaba sedatha yokufaka esingezansi sibika ngokuningiliziwe izinga lokuguqulwa ukusuka kwesinye isimo ukuya kwesinye kanye nokuqagela okuhlobene. Imiphumela ibikwa njengenani lezifundo ezithelelekile, izifundo ezingatheleleki, izifundo ezelashiwe (ukululama), ukufa, izindleko, kanye nenani elikhulayo lezindleko zenzuzo (ICER). I-ICER umehluko wezindleko phakathi kwamasu amabili ahlukaniswe ngokuthi Umehluko emiphumeleni yawo ukubuyisela isihloko nokugwema ukutheleleka. I-ICER encane ikhombisa ukuthi isu elilodwa libiza kakhulu kunelinye.
Isihlahla sesinqumo ngesimo sempilo. I-PC yokuvimbela i-chemotherapy, i-IVM ivermectin, ukuphathwa kwe-ADM, izingane ze-SAC zesikole
Sicabanga ukuthi inani labantu elijwayelekile liyizifundo ezingu-1,000,000 ezihlala emazweni anokusabalala okuphezulu kwe-strongyloidiasis, lapho u-50% wabo kungabantu abadala (≥iminyaka engu-15 ubudala) kanye no-25% izingane ezifunda isikole (iminyaka engu-6-14 ubudala). Lokhu ukusatshalaliswa okuvame ukubonwa emazweni aseNingizimu-mpumalanga ye-Asia, e-Afrika nase-Western Pacific [13]. Esimeni esisekelwe esimweni, ukusabalala kwe-strongyloidiasis kubantu abadala kanye ne-SAC kulinganiselwa ku-27% kanye ne-15%, ngokulandelana [2].
Kusu A (umkhuba wamanje), izifundo azikutholi ukwelashwa, ngakho-ke sicabanga ukuthi ukusabalala kokutheleleka kuzohlala kunjalo ekupheleni konyaka ongu-1 kanye nenkathi engu-10.
Kusu B, bobabili i-SAC kanye nabantu abadala bazothola ama-PC. Ngokusekelwe esilinganisweni sokuthobela esilinganiselwe sama-60% kubantu abadala kanye nama-80% ku-SAC [14], kokubili abantu abangenwe yileli gciwane nabangenalo igciwane bazothola i-ivermectin kanye ngonyaka iminyaka eyi-10. Sicabanga ukuthi izinga lokwelapha abantu abangenwe yileli gciwane lilinganiselwa ku-86% [15]. Njengoba umphakathi uzoqhubeka nokuchayeka emthonjeni wokutheleleka (nakuba ukungcola kwenhlabathi kungase kwehle ngokuhamba kwesikhathi kusukela i-PC yaqala), ukusuleleka kabusha kanye nokutheleleka okusha kuzoqhubeka kwenzeka. Izinga lokutheleleka okusha lonyaka lilinganiselwa ukuthi liyingxenye yezinga lokutheleleka kwesisekelo [16]. Ngakho-ke, kusukela onyakeni wesibili wokuqaliswa kwe-PC, inani lamacala angenwe yileli gciwane unyaka ngamunye lizolingana nesamba samacala asanda kutheleleka kanye nenani lamacala ahlala enethemba (okungukuthi, labo abangakalutholi ukwelashwa kwe-PC kanye nalabo abaye bathola i-PC). ayiphendulwanga ekwelashweni). I-Strategy C (i-PC kuphela ye-SAC) ifana no-B, umehluko kuphela ukuthi yi-SAC kuphela ezothola ivermectin, futhi abantu abadala ngeke.
Kuwo wonke amasu, inani elilinganisiwe lokufa ngenxa ye-strongyloidiasis enzima lisuswa kubantu unyaka ngamunye. Ngokucabanga ukuthi i-0.4% yezifundo ezingenwe yilesi sifo zizoba ne-strongyloidiasis enzima [17], futhi i-64.25% yazo izofa [18], linganisela lokhu kufa. Ukufa okubangelwa ezinye izimbangela akufakiwe kumodeli.
Umthelela walawa maqhinga amabili wabe esehlolwa ngaphansi kwamazinga ahlukene okuvama kwe-strongyloidosis ku-SAC: 5% (okuhambisana no-9% ukusabalala kwabantu abadala), 10% (18%), kanye no-20% (36%).
Sicabanga ukuthi Isu A alihlangene nanoma yiziphi izindleko eziqondile ohlelweni lwezempilo lukazwelonke, nakuba izehlakalo zesifo esifana ne-strongyloidia singase sibe nomthelela wezomnotho ohlelweni lwezempilo ngenxa yokulaliswa esibhedlela kanye nokubonisana neziguli ezingaphandle, nakuba kungase kungabi nalutho. Izinzuzo ngokombono wezenhlalo (ezifana nokwanda kokukhiqiza namazinga okubhalisa, nokuncipha kokulahlekelwa isikhathi sokubonisana), nakuba zingase zifaneleke, azinakwa ngenxa yobunzima bokuzilinganisa ngokunembile.
Ukuze kusetshenziswe amasu B no-C, sicabangele izindleko ezimbalwa. Isinyathelo sokuqala ukwenza ucwaningo olubandakanya u-0.1% wabantu be-SAC ukuze kutholwe ukusabalala kokutheleleka endaweni ekhethiwe. Izindleko zocwaningo zingama-27 US dollars (USD) ngesifundo ngasinye, okuhlanganisa izindleko ze-parasitology (Baermann) kanye nokuhlolwa kwe-serological (ELISA); izindleko ezengeziwe zokuthutha ngokwengxenye zisekelwe kuphrojekthi yokuhlola ehlelelwe e-Ethiopia. Sekukonke, inhlolovo yezingane ezingama-250 (u-0.1% wezingane emphakathini wethu ojwayelekile) izobiza u-US$6,750. Izindleko zokwelashwa kwe-ivermectin ye-SAC kanye nabantu abadala (US$0.1 kanye ne-US$0.3, ngokulandelanayo) zisekelwe ezindlekweni ezilindelekile ze-ivermectin eyenziwe ngaphambilini ye-generic yiNhlangano Yezempilo Yomhlaba [8]. Okokugcina, izindleko zokuthatha i-ivermectin ye-SAC kanye nabantu abadala ngu-0.015 USD kanye no-0.5 USD ngokulandelanayo) [19, 20].
Ithebula lesi-2 kanye neThebula lesi-3 ngokulandelana libonisa isamba senani lezingane nabantu abadala abangenwe yileli gciwane nabangenalo igciwane esibalweni esijwayelekile sabantu abaneminyaka engaphezu kweyisi-6 kumasu amathathu, kanye nezindleko ezihlobene nokuhlaziywa konyaka ongu-1 kanye neminyaka eyi-10. Ifomula yokubala iyimodeli yezibalo. Ikakhulukazi, Ithebula lesi-2 libika umehluko enanini labantu abangenwe yileli gciwane ngenxa yamasu amabili e-PC uma kuqhathaniswa nesiqhathanisi (alikho isu lokwelapha). Lapho izinga lokutheleleka kwezingane lilingana no-15% kanye no-27% kubantu abadala, abantu abangu-172,500 emphakathini batheleleka. Inani lezifundo ezithelelekile libonise ukuthi ukwethulwa kwama-PC aqondiswe ku-SAC kanye nabantu abadala kwehliswe ngo-55.3%, futhi uma ama-PC eqondiswe ku-SAC kuphela, ancishiswa ngo-15%.
Ekuhlaziyweni kwesikhathi eside (iminyaka eyi-10), uma kuqhathaniswa nesu A, ukuncishiswa kokutheleleka kwamasu B no-C kukhuphuke kwafinyelela ku-61.6% no-18.6%, ngokulandelana. Ukwengeza, ukusetshenziswa kwamasu B no-C kungaholela ekwehleni okungama-61% kanye nezinga lokufa leminyaka engu-10 lika-48%, ngokulandelana, uma kuqhathaniswa nokungatholi ukwelashwa.
Umfanekiso we-2 ubonisa inani lezifo kumasu amathathu phakathi nenkathi yokuhlaziya ye-10: Nakuba le nombolo yahlala ingashintshile ngaphandle kokungenelela, eminyakeni embalwa yokuqala yokuqaliswa kwamasu amabili e-PC, inani lethu lamacala lehla ngokushesha. Kancane kancane ngemva kwalokho.
Ngokusekelwe kumasu amathathu, isilinganiso sokuncipha kwenani lokutheleleka phakathi neminyaka. I-PC yokuvimbela i-chemotherapy, izingane zesikole ze-SAC
Mayelana ne-ICER, kusukela onyakeni ongu-1 kuye kweyi-10 wokuhlaziya, izindleko ezengeziwe zomuntu ngamunye otholakele zikhuphuke kancane (Umfanekiso 3). Uma kucatshangelwa ukwehla kwabantu abangenwe yileli gciwane emphakathini, izindleko zokugwema ukutheleleka ngamasu B no-C zazingama-US$2.49 kanye nama-US$0.74, ngokulandelana, ngaphandle kokwelashwa esikhathini esiyiminyaka eyi-10.
Izindleko zomuntu ngamunye otholiwe ekuhlaziyeni konyaka ongu-1 neminyaka eyi-10. I-PC yokuvimbela i-chemotherapy, izingane zesikole ze-SAC
Amanani 4 kanye no-5 abika inani lezifo ezigwenywe yi-PC kanye nezindleko ezihambisanayo ngosindile ngamunye uma kuqhathaniswa nokungalashwa. Inani lokuvama phakathi nonyaka lisukela ku-5% ukuya ku-20%. Ikakhulukazi, uma kuqhathaniswa nesimo esiyisisekelo, lapho izinga lokusabalala liphansi (isibonelo, u-10% wezingane kanye no-18% wabantu abadala), izindleko zomuntu ngamunye otholiwe zizoba phezulu; ngokuphambene nalokho, esimweni sokudlanga okuphezulu Izindleko eziphansi ziyadingeka endaweni ezungezile.
Amanani okuvama konyaka wokuqala asukela ku-5% kuya ku-20% yenani lezifo zokukhangisa. I-PC yokuvimbela i-chemotherapy, izingane zesikole ze-SAC
Izindleko zomuntu ngamunye otholakele ezitholakala ku-5% kuya ku-20% ngonyaka wokuqala. I-PC yokuvimbela i-chemotherapy, izingane zesikole ze-SAC
Ithebula lesi-4 libuyisela inani lokufa kanye nezindleko ezihambisanayo ezibangeni zonyaka ongu-1 kanye neminyaka eyi-10 zamasu ahlukene e-PC. Kuwo wonke amanani okuvama okucatshangelwayo, izindleko zokugwema ukufa kwesu C ziphansi kunesu B. Kuwo womabili amasu, izindleko zizokwehla ngokuhamba kwesikhathi, futhi zizobonisa ukwehla njengoba ukwanda kunyuka.
Kulo msebenzi, uma kuqhathaniswa nokuntuleka kwamanje kwezinhlelo zokulawula, sihlole amasu amabili e-PC angenzeka ngezindleko zokulawula i-strongyloidiasis, umthelela ongaba khona ekwandeni kwe-strongyloidiasis, kanye nomthelela kuchungechunge lwe-fecal kubantu abajwayelekile. Umthelela wokufa okuhlobene ne-cocci. Njengesinyathelo sokuqala, ukuhlolwa okuyisisekelo kokuvama kuyanconywa, okuzobiza cishe ama-US$27 ngokuhlolwa komuntu ngamunye (okungukuthi, isamba sama-US$6750 sokuhlola izingane ezingama-250). Izindleko ezengeziwe zizoncika esu elikhethiwe, okungenzeka (A) lingasebenzisi uhlelo lwe-PC (isimo samanje, azikho izindleko ezengeziwe); (B) Ukuphathwa kwe-PC kuso sonke isibalo sabantu (0.36 USD ngomuntu ngamunye wokwelashwa); (C) ) Noma i-PC ekhuluma ne-SAC ($0.04 umuntu ngamunye). Womabili amasu B no-C azoholela ekwehleni okukhulu kwenani lezifo ngonyaka wokuqala wokuqaliswa kwe-PC: ngokusabalala kwe-15% kubantu abafunda isikole kanye nama-27% kubantu abadala, inani eliphelele labantu abathelelekile lizoba ekusetshenzisweni kwamasu B no-C Kamuva, inani lamacala lehliswa lisuka ku-172 500 ekuqaleni laya ku-77 040 kanye ne-146 700 ngokulandelana. Ngemva kwalokho, inani lamacala lisazokwehla, kodwa ngesilinganiso esincane. Izindleko zomuntu ngamunye otholiwe azihlobene kuphela namasu amabili (uma kuqhathaniswa nesu C, izindleko zokusebenzisa isu B ziphezulu kakhulu, ku-$3.43 kanye no-$1.97 eminyakeni eyi-10, ngokulandelana), kodwa futhi nokusabalala kwesisekelo. Ukuhlaziywa kukhombisa ukuthi ngokwanda kwesibalo, izindleko zomuntu ngamunye otholiwe zisezingeni eliphansi. Ngezinga lokuvama kwe-SAC elingu-5%, lizokwehla lisuka ku-US$8.48 kumuntu ngamunye ku-Strategy B kanye no-US$3.39 ngomuntu ngamunye ku-Strategy C. liye ku-USD 2.12 umuntu ngamunye kanye no-0.85 ngomuntu ngamunye onezinga lokuvama elingu-20%, amasu B no-C zamukelwe ngokulandelana. Ekugcineni, umthelela walawa masu amabili ekufeni kokukhangisa uyahlaziywa. Uma kuqhathaniswa ne-Strategy C (abantu abangu-66 kanye nabangu-822 ebangeni lonyaka owodwa kanye ne-10, ngokulandelana), Isu B ngokusobala liholele ekufeni okulindelekile okwengeziwe (abangu-245 nabangu-2717 ebangeni lonyaka ongu-1 kanye ne-10, ngokulandelana). Kodwa esinye isici esihlobene nezindleko zokumemezela ukufa. Izindleko zawo womabili amasu ziyehla ngokuhamba kwesikhathi, futhi isu C (iminyaka eyi-10 $288) liphansi kuno-B (iminyaka eyi-10 $969).
Ukukhethwa kwesu le-PC lokulawula i-strongyloidiasis kuzosekelwe ezintweni ezihlukahlukene, okuhlanganisa ukutholakala kwezimali, izinqubomgomo zezempilo zikazwelonke, nengqalasizinda ekhona. Ngemuva kwalokho, izwe ngalinye lizoba nohlelo lwezinhloso zalo ezithile kanye nezinsiza. Ngohlelo lwe-PC endaweni yokulawula i-STH ku-SAC, kungacatshangwa ukuthi ukuhlanganiswa ne-ivermectin kulula ukukusebenzisa ngezindleko ezifanele; kufanele kuqashelwe ukuthi izindleko zidinga ukwehliswa ukuze kugwenywe ukufa okukodwa. Ngakolunye uhlangothi, ngokungabikho kwemikhawulo emikhulu yezezimali, ukusetshenziswa kwe-PC kubo bonke abantu kuzoholela ekunciphiseni okwengeziwe kwezifo, ngakho-ke inani lokufa kwe-strongyloides eliphelele lizokwehla kakhulu ngokuhamba kwesikhathi. Eqinisweni, isu lokugcina lizosekelwa ukusatshalaliswa okubonwayo kwezifo ze-Streptococcus faecalis kubantu, okuvame ukwanda ngokuya ngeminyaka, ngokuphambene nokubonwa kwama-trichomes nezikelemu eziyindilinga [22]. Kodwa-ke, ukuhlanganiswa okuqhubekayo kohlelo lwe-PC ye-STH ne-ivermectin kunezinzuzo ezengeziwe, ezingabhekwa njengezibaluleke kakhulu ngaphezu kwemiphumela ye-strongyloidiasis. Eqinisweni, inhlanganisela ye-ivermectin kanye ne-albendazole/mebendazole ibonakale iphumelela kakhulu ngokumelene ne-trichinella kune-benzimidazole iyodwa [23]. Lokhu kungase kube isizathu sokusekela inhlanganisela ye-PC ku-SAC ukuze kuqedwe ukukhathazeka mayelana nokusabalala okuphansi kwaleli qembu lobudala uma kuqhathaniswa nabantu abadala. Ukwengeza, enye indlela okufanele icatshangelwe ingase ibe wuhlelo lokuqala lwe-SAC bese ilunweba ukuze lubandakanye intsha kanye nabantu abadala uma kungenzeka. Wonke amaqembu eminyaka yobudala, kungakhathaliseki ukuthi afakwe kwezinye izinhlelo ze-PC noma cha, azozuza emiphumeleni engaba khona ye-ivermectin kuma-ectoparasites kuhlanganise notwayi [24].
Esinye isici esizothinta kakhulu izindleko/inzuzo yokusebenzisa i-ivermectin yokwelashwa kwe-PC izinga lokutheleleka kubantu. Njengoba inani lokusabalala likhuphuka, ukwehla kwezifo kuba sobala kakhulu, futhi izindleko zomuntu ngamunye osindile ziyehla. Ukusetha umkhawulo wokusetshenziswa kwe-PC ngokumelene ne-Streptococcus faecalis kufanele kucabangele ibhalansi phakathi kwalezi zici ezimbili. Kumelwe kucatshangelwe ukuthi kwamanye ama-STH, kunconywa kakhulu ukusebenzisa i-PC enezinga lokusabalala kwe-20% noma ngaphezulu, ngokusekelwe ekunciphiseni kakhulu izehlakalo zabantu okuhlosiwe [3]. Kodwa-ke, lokhu kungase kungabi umgomo olungile we-S. stercoralis, njengoba ingozi yokufa kwezifundo ezithelelekile izoqhubeka nganoma yibuphi umfutho wokutheleleka. Kodwa-ke, amazwe amaningi asengozini angase acabange ukuthi ngisho noma izindleko zokugcina ama-PC e-Streptococcus faecalis ziphezulu kakhulu ngezinga eliphansi lokusabalala, ukubeka umkhawulo wokwelashwa cishe ku-15-20% wezinga lokuvama kungase kube okufanele kakhulu. Ukwengeza, lapho izinga lokusabalala lingu-≥ 15%, ukuhlolwa kwe-serological kunikeza isilinganiso esithembeke kakhulu kunalapho izinga lokusabalala liphansi, okuvame ukuba nezinto eziningi ezingamanga [21]. Esinye isici okufanele sicatshangelwe ukuthi ukuphathwa okukhulu kwe-ivermectin ezindaweni ze-Loa loa endemic kuzoba yinselele ngoba iziguli ezinegazi eliphezulu le-microfilaria zaziwa ukuthi zisengozini ye-encephalopathy ebulalayo [25].
Ukwengeza, uma kucatshangelwa ukuthi i-ivermectin ingase ihlakulele ukumelana ngemva kweminyaka eminingana yokuphatha ngezinga elikhulu, ukusebenza kahle komuthi kufanele kuqashelwe [26].
Imikhawulo yalolu cwaningo ihlanganisa imibono eminingana esingakwazanga ukuthola ubufakazi obuqinile ngayo, njengezinga lokutheleleka kabusha kanye nokufa ngenxa ye-strongyloidiasis enzima. Kungakhathaliseki ukuthi kulinganiselwe kangakanani, singakwazi ukuthola amaphepha athile njengesisekelo semodeli yethu. Omunye umkhawulo ukuthi sisekela izindleko ezithile zezokuthutha kusabelomali socwaningo lokuhlola oluzoqala e-Ethiopia, ngakho zingase zingafani ncamashi nezindleko ezilindelwe kwamanye amazwe. Kulindeleke ukuthi ucwaningo olufanayo luzohlinzeka ngedatha eyengeziwe ukuze kuhlaziywe imiphumela ye-PC kanye ne-ivermectin eqondise ku-SAC. Ezinye izinzuzo zokuphathwa kwe-ivermectin (njengomphumela ku-scabi kanye nokwenyuka kokusebenza kahle kwamanye ama-STH) azikabalwa, kodwa amazwe asengozini angase azibheke kumongo wokungenelela kwezempilo okuhlobene. Okokugcina, lapha asizange silinganise umthelela wokungenelela okungenzeka okwengeziwe, njengamanzi, ukukhucululwa kwendle, kanye nemikhuba yenhlanzeko yomuntu siqu (WASH), engasiza ngokuqhubekayo ukunciphisa ukusabalala kwe-STH [27] futhi ngempela I-World Health Organization Inconyiwe [3] . Nakuba sisekela ukuhlanganiswa kwama-PC e-STH ne-WASH, ukuhlolwa komthelela wawo kungaphezu kobubanzi balolu cwaningo.
Uma kuqhathaniswa nesimo samanje (esingalashwa), womabili lawa masu e-PC abangele ukwehla okuphawulekayo kwamazinga okutheleleka. Isu B lidale ukufa kwabantu abaningi kunesu C, kodwa izindleko ezihambisana naleli su lakamuva zaziphansi. Esinye isici okufanele sicatshangelwe ukuthi njengamanje, cishe kuzo zonke izindawo ezifana ne-strongyloidosis, izinhlelo zesikole zokuqeda izikelemu seziqalisiwe ukuze kusatshalaliswe i-benzimidazole ukulawula i-STH [3]. Ukwengeza i-ivermectin kule nkundla yokusabalalisa ye-benzimidazole yesikole kuzophinde kwehlise izindleko zokusabalalisa i-ivermectin ye-SAC. Sikholelwa ukuthi lo msebenzi unganikeza idatha ewusizo emazweni afisa ukusebenzisa amasu okulawula i-Streptococcus faecalis. Nakuba ama-PC abonise umthelela omkhulu kumphakathi wonkana ukuze kwehliswe inani lokutheleleka kanye nenani eliphelele lokufa, ama-PC aqondise ku-SAC angakhuthaza ukufa ngezindleko eziphansi. Uma kucatshangelwa ibhalansi phakathi kwezindleko nomthelela wokungenelela, izinga lokuvama kwe-15-20% noma ngaphezulu linganconywa njengomkhawulo onconywayo we-PC ye-ivermectin.
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