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Shirya don zama likita, gina ilimin ku, jagoranci ƙungiyar kiwon lafiya, da haɓaka aikin ku tare da bayanai da sabis na ƙungiyar NEJM.
An yi hasashe cewa a cikin manyan saitunan watsawa, kula da zazzabin cizon sauro a farkon yara (<5 shekaru) na iya jinkirta samun rigakafi na aiki da kuma canza mace-macen yara daga ƙarami zuwa babba.
Mun yi amfani da bayanai daga wani bincike na tsawon shekaru 22 da aka yi a yankunan karkarar kudancin Tanzaniya don kimanta alaƙar da ke tsakanin yin amfani da gidan sauro da wuri da kuma rayuwa har zuwa girma.Duk yaran da aka haifa a wurin binciken tsakanin 1 ga Janairu 1998 da 30 ga Agusta 2000 an gayyaci su shiga binciken na tsawon lokaci daga 1998 zuwa 2003. An tabbatar da sakamakon rayuwa na manya a cikin 2019 ta hanyar wayar da kan jama'a da kiran wayar hannu. Mun yi amfani da samfurin Haɗari na Cox don ƙididdige haɗin kai tsakanin ƙananan yara da amfani da ragar da aka bi da su da kuma rayuwa a lokacin balagagge, an daidaita shi don yiwuwar rikice-rikice.
An shigar da jimillar yara 6706. A cikin 2019, mun tabbatar da mahimman bayanan matsayi ga mahalarta 5983 (89%). A cewar rahotanni daga farkon ziyarar wayar da kan jama'a, kusan kashi ɗaya cikin huɗu na yara ba su taɓa yin barci a ƙarƙashin gidan da aka yi musu magani ba, rabin suna barci a ƙarƙashin kulawar da aka yi musu magani. net a wani lokaci, kuma saura kwata ko da yaushe yana barci a ƙarƙashin gidan da aka yi masa magani.Barci a karkashin maganigidajen sauro.Cibiyar haɗari da aka ruwaito don mutuwa shine 0.57 (95% tazarar amincewa [CI], 0.45 zuwa 0.72) kasa da rabin ziyarar. Matsakaicin hadarin da ke tsakanin shekaru 5 da girma shine 0.93 (95% CI, 0.58 zuwa 1.49).
A cikin wannan dogon nazari na maganin zazzabin cizon sauro na farko a cikin manyan hanyoyin watsawa, fa'idodin rayuwa na farkon amfani da gidajen sauro sun ci gaba har zuwa girma.
Zazzabin cizon sauro ya kasance kan gaba wajen haddasa cututtuka da mutuwa a duniya.1 Daga cikin mutane 409,000 da suka mutu a shekarar 2019, sama da kashi 90 cikin 100 sun faru a yankin kudu da hamadar Sahara, kuma kashi biyu bisa uku na mace-macen sun faru ne a cikin yara ‘yan kasa da shekara biyar.1 maganin kwari- gidajen sauro da aka yi musu magani sune kashin bayan maganin zazzabin cizon sauro tun bayan sanarwar Abuja ta 2000.Gwamnatin da aka yi a tsakanin kungiyoyi a shekarun 1990 sun nuna cewa gidajen sauro na da matukar amfani ga yara ‘yan kasa da shekara 5.3. Rarraba ma'auni, 2019.1 Kashi 46% na masu fama da cutar zazzabin cizon sauro a yankin kudu da hamadar Sahara suna barci a gidajen sauro.
Kamar yadda shaida ta fito a cikin shekarun 1990 na fa'idar rayuwa ta gidajen sauron da aka yi wa yara ƙanana, ana hasashen cewa tasirin gidan sauro na dogon lokaci kan rayuwa a cikin saitunan watsawa mai girma zai kasance ƙasa da tasirin ɗan gajeren lokaci, kuma yana iya zama ma. korau, saboda ribar net na samun rigakafi na aiki.4-9 Duk da haka, shaidun da aka buga game da wannan batu sun iyakance ne kawai ga bincike guda uku daga Burkina Faso, Ghana, 11 tare da bin diddigin shekaru 7.5 da Kenya.12 Babu ɗaya daga cikin waɗannan wallafe-wallafen da ya nuna alamar canjin yara. mace-mace tun daga kanana har zuwa tsufa sakamakon kamuwa da cutar zazzabin cizon sauro na yara kanana.A nan, mun bayar da rahoton bayanai daga wani bincike da aka yi na tsawon shekaru 22 a yankunan karkarar kudancin Tanzaniya don kimanta alakar da ke tsakanin yara kanana amfani da gidajen sauro da aka yi wa magani da kuma rayuwa a lokacin balaga.
A cikin wannan binciken da ake shirin yi na ƙungiyar, mun bi yara tun suna ƙanana har zuwa girma. An amince da binciken da hukumomin nazarin ɗabi'a da suka dace a Tanzaniya, Switzerland da Ingila. Iyaye ko masu kula da yara ƙanana sun ba da izini ta baki ga bayanan da aka tattara tsakanin 1998 da 2003 .A cikin 2019, mun sami izini a rubuce daga mahalarta da aka yi hira da su a cikin mutum da kuma yarda da baki daga mahalarta da aka yi hira da su ta wayar tarho. Marubuta na farko da na ƙarshe sun tabbatar da cikar bayanai da daidaito.
An gudanar da wannan binciken ne a Cibiyar Kula da Lafiya ta Karkara na Ifakara (HDSS) a yankunan Kilombero da Ulanga na Tanzaniya.13 Yankin binciken da farko ya ƙunshi ƙauyuka 18, waɗanda daga baya aka raba zuwa 25 (Fig. S1 a cikin Karin Bayani, Akwai tare da cikakken rubutun wannan labarin a NEJM.org) Duk yaran da aka haifa ga mazauna HDSS tsakanin Janairu 1, 1998, da Agusta 30, 2000 sun shiga cikin binciken ƙungiyar na dogon lokaci yayin ziyarar gida kowane watanni 4 tsakanin Mayu 1998 da Afrilu 2003. Daga 1998 zuwa 2003, mahalarta sun karbi HDSS ziyara kowane watanni 4 (Fig. S2) .Daga 2004 zuwa 2015, an rubuta matsayin rayuwa na mahalarta da aka sani da zama a yankin a cikin ziyarar HDSS na yau da kullum. A cikin 2019, mun gudanar da bincike na gaba. ta hanyar wayar da kan jama'a da wayoyin hannu, tabbatar da matsayin rayuwa na duk mahalarta, masu zaman kansu ba tare da wurin zama ba da kuma bayanan HDSS. Binciken ya dogara da bayanan iyali da aka bayar a lokacin yin rajista. Mun ƙirƙiri jerin bincike ga kowane ƙauyen HDSS, yana nuna sunayen farko da na ƙarshe. na duk tsoffin 'yan uwa na kowane ɗan takara, tare da ranar haihuwa da kuma shugaban al'umma da ke da alhakin iyali a lokacin rajista. A cikin tarurrukan da shugabannin al'umma na yankin, an sake duba jerin sunayen kuma an gano sauran membobin al'umma don taimakawa wajen ganowa.
Tare da goyon bayan Hukumar Ci Gaba da Haɗin kai ta Switzerland da Gwamnatin Ƙasar Jamhuriyar Tanzaniya, an kafa wani shiri don gudanar da bincike kan gidajen sauro da aka yi wa magani a yankin binciken a cikin 1995.14 A cikin 1997, shirin tallan zamantakewa da nufin rarrabawa, ingantawa. da kuma dawo da wani ɓangare na farashin gidan yanar gizon, gabatar da jiyya na yanar gizo.15 Wani binciken da aka yi a cikin gida ya nuna cewa gidajen da aka kula da su suna da alaƙa da karuwar 27% na rayuwa a cikin yara masu shekaru 1 zuwa 4 shekaru (95% tazarar amincewa [CI], 3 zu45).15
Sakamakon farko shine tabbatar da rayuwa yayin ziyarar gida. Ga mahalarta wadanda suka mutu, an samo shekaru da shekarar mutuwar daga iyaye ko wasu 'yan uwa. Babban abin da ke faruwa shine amfani da gidan sauro tsakanin haihuwa da shekaru 5 ("net amfani da farkon shekaru”) Mun yi nazari akan samuwar hanyar sadarwa a matakin amfani da mutum ɗaya da al’umma. Domin amfanin kanku na gidajen sauro, a duk lokacin ziyarar gida tsakanin 1998 da 2003, an tambayi mahaifiyar yaron ko mai kula da yaron ko mahaifiyar yaron ko mai kula da yaron sun yi barci. Karkashin gidan yanar gizo a daren da ya gabata, kuma idan haka ne, idan kuma lokacin da gidan yanar gizon ya kasance maganin kwari- Sarrafa ko wanke-wanke.Mun taƙaita bayyanar kowane yaro a farkon shekara zuwa gidajen da aka yi masa magani a matsayin kashi na ziyarar da aka ruwaito yara suna barci a ƙarƙashin gidajen da aka yi musu magani. .Domin mallakar cibiyar sadarwar magani ta matakin ƙauye, mun haɗu da duk bayanan gida da aka tattara daga 1998 zuwa 2003 don ƙididdige adadin gidaje a kowane ƙauyen da ke da aƙalla hanyar sadarwa guda ɗaya a shekara.
An tattara bayanai game da cutar zazzabin cizon sauro a shekara ta 2000 a matsayin wani ɓangare na cikakken shirin sa ido don maganin haɗuwa da zazzabin cizon sauro. A ranar 16 ga Mayu, a cikin samfurin wakilci na iyalai HDSS, an auna parasitemia ta hanyar microscopy na fim mai kauri a cikin duk dangin dangi watanni 6 ko sama da haka har zuwa Yuli 2000 , 2001, 2002, 2004, 2005 Shekara da 2006.16
Don haɓaka ingancin bayanai da cikar bin diddigin a cikin 2019, mun ɗauki aiki da horar da ƙungiyar ƙwararrun masu yin tambayoyi waɗanda suka riga sun sami ilimin gida mai yawa. Ga wasu iyalai, ba a samu bayanin ilimin kulawa, samun kuɗin iyali, da lokacin zuwa wurin likita ba. An yi amfani da ƙididdiga da yawa ta hanyar yin amfani da ma'auni na sarkar don yin la'akari da rasa bayanan haɗin gwiwa a cikin sakamakonmu na farko. Dukkan masu canji da aka jera a cikin Table 1 an yi amfani da su azaman tsinkaya don waɗannan abubuwan da aka zayyana. An yi ƙarin cikakken nazarin binciken don tabbatar da cewa sakamakon bai kula da ƙima ba. hanyar da aka zaɓa.
Ƙididdiga na farko da aka kwatanta sun haɗa da ma'anar ziyarar biyo baya da mace-mace ta hanyar jima'i, shekarar haihuwa, ilimin kulawa, da nau'in samun kudin shiga na gida. An kiyasta mace-mace a matsayin mace-mace a cikin shekaru 1000 na mutum.
Mun samar da bayanai kan yadda tsarin sadarwa ya canza a tsawon lokaci.Don kwatanta alakar da ke tsakanin mallakar gidaje a matakin kauye da gidajen sauro da zazzabin cizon sauro na gida, mun samar da wani tsari na yada gadon gado na matakin kauye da yaduwar cutar parasitic matakin kauye. a shekara ta 2000.
Don ƙididdige haɗin kai tsakanin amfani da yanar gizo da kuma rayuwa na dogon lokaci, mun fara ƙididdige ƙayyadaddun ƙayyadaddun ƙa'idodin rayuwa na Kaplan-Meier idan aka kwatanta yaran da suka ba da rahoton barci a ƙarƙashin gidan yanar gizon da aka bi da su yayin aƙalla 50% na farkon ziyarar tare da sakamakon rayuwa. gidajen sauro a cikin ƙasa da 50% na farkon ziyarar. An zaɓi yanke 50% don dacewa da ma'anar "mafi yawan lokaci" mai sauƙi. Don tabbatar da cewa sakamakon da aka samu bai shafi wannan tsattsauran ra'ayi ba, mun kuma kiyasta daidaitattun daidaitattun Kaplan-Meier. tsinkayar rayuwa ta kwatanta yaran da ko da yaushe suka ba da rahoton barci a ƙarƙashin gidan yanar gizon da aka yi musu magani da waɗanda ba su taɓa bayar da rahoton barci a ƙarƙashin saƙon ceton yara a ƙarƙashin gidan yanar gizo ba.Mun ƙididdige matakan Kaplan-Meier marasa daidaituwa don waɗannan bambance-bambancen bayan duk lokacin (0 zuwa 20 shekaru) da farkon yara (shekaru 5 zuwa 20). Duk nazarin rayuwa ya iyakance ga lokacin da ke tsakanin tambayoyin binciken farko da na ƙarshe na binciken, wanda ya haifar da guntuwar hagu da tantacewar dama.
Mun yi amfani da ƙididdiga masu haɗari na Cox don ƙididdige bambance-bambance masu mahimmanci guda uku na sha'awa, sharuɗɗa a kan abubuwan da za a iya gani - na farko, ƙungiyar tsakanin rayuwa da yawan adadin ziyarar da aka ruwaito yara sun yi barci a karkashin raga;na biyu, Bambance-bambancen rayuwa tsakanin yaran da suka yi amfani da gidan sauro fiye da rabin ziyararsu da wadanda suka yi amfani da tarun da bai wuce rabin ziyararsu ba;na uku, bambance-bambance na rayuwa tsakanin yara ko da yaushe suna ba da rahoton barci a farkon ziyararsu Karkashin gidajen sauro, yaran ba su taɓa bayar da rahoton barci a ƙarƙashin gidajen sauro ba yayin waɗannan ziyarar. Ga ƙungiyar farko, ana nazarin kaso na ziyarar a matsayin madaidaiciyar lokaci.A martingale residual analysis. An yi amfani da shi don tabbatar da dacewa da wannan zato na layi.Schoenfeld residual analysis17 an yi amfani dashi don gwada ra'ayin haɗari na haɗari. Don yin la'akari da rikice-rikice, duk ƙididdiga masu yawa don kwatancen uku na farko an daidaita su don nau'in samun kudin shiga na gida, lokaci zuwa wurin likita mafi kusa, mai kulawa. nau'in ilimi, jima'i na yara, da shekarun yara.born.Duk nau'ikan nau'ikan nau'ikan nau'ikan sun haɗa da ƙayyadaddun ƙayyadaddun ƙauye 25, wanda ya ba mu damar ware bambance-bambancen tsari a cikin abubuwan matakin ƙauyen da ba a lura da su ba a matsayin masu iya ruɗawa.Don tabbatar da ƙarfin sakamakon da aka gabatar tare da girmamawa. zuwa ga zaɓaɓɓen ƙirar ƙira, mun kuma ƙididdige bambance-bambancen binary guda biyu ta amfani da kernels, calipers da daidaitattun algorithms masu daidaitawa.
Ganin cewa fara amfani da gidajen sauro da aka yi wa magani ana iya bayyana su ta hanyar gidan da ba a lura da su ba ko halayen masu kulawa kamar ilimin kiwon lafiya ko ikon mutum na samun sabis na kiwon lafiya, mun kuma ƙiyasta samfurin matakin ƙauye a matsayin bambanci na huɗu. Don wannan kwatancen, mun yi amfani da ƙauye- matsakaicin matsakaicin ikon mallakar gida na gidajen sauro (shigarwa azaman layin layi) a cikin shekaru 3 na farko da aka lura da yara a matsayin canjin mu na farko. Bayyanar matakin ƙauye yana da fa'idar kasancewa ƙasa da dogaro ga ƙungiyoyin daidaikun mutane ko na gida kuma ya kamata. Don haka a rage yawan ruɗani.
Don yin lissafin jiyya na matakin ƙauye da kuma alaƙar matakin ƙauye gabaɗaya, an ƙididdige daidaitattun kurakurai ta amfani da ƙididdigar bambance-bambance masu ƙarfi na Huber. Ana ba da rahoton sakamako a matsayin ƙiyasin ƙiyasin tare da tazarar amincewa 95%. an daidaita shi don yawa, don haka bai kamata a yi amfani da tazara don nuna ƙungiyoyin da aka kafa ba.Ba a ƙayyadadden ƙididdigar mu na farko ba;don haka, ba a ba da rahoton ƙimar P ba. An yi nazarin ƙididdiga ta amfani da software na Stata SE (StataCorp) 16.0.19
Daga Mayu 1998 zuwa Afrilu 2003, jimlar mahalarta 6706 da aka haifa tsakanin Janairu 1, 1998 da Agusta 30, 2000 an haɗa su a cikin ƙungiyar (Hoto 1) Shekarun rajista sun kasance daga 3 zuwa watanni 47, tare da ma'anar watanni 12. Tsakanin Mayu 1998 da Afrilu 2003, mahalarta 424 sun mutu. A cikin 2019, mun tabbatar da mahimmancin matsayin mahalarta 5,983 (89% na rajista) jimlar mahalarta 180 sun mutu tsakanin Mayu 2003 da Disamba 2019, wanda ya haifar da adadin mutuwar gabaɗaya na 6.3 mutuwa a cikin 1000 mutum-shekara.
Kamar yadda aka nuna a cikin Table 1, samfurin ya kasance daidai da jinsi;a matsakaita, yara sun yi rajista kafin su cika shekara ɗaya kuma ana bin su har tsawon shekaru 16. Yawancin masu kulawa sun kammala karatun firamare, kuma yawancin gidaje suna da damar yin amfani da famfo ko rijiyar ruwa. Tebur S1 yana ba da ƙarin bayani game da wakilcin samfurin binciken. Yawan adadin mace-mace a cikin shekaru 1000 ya kasance mafi ƙanƙanta a tsakanin yara masu ilimi mai zurfi (4.4 a cikin 1000 mutum-shekaru) kuma mafi girma a cikin yara waɗanda ke da fiye da sa'o'i 3 nesa da wurin kiwon lafiya (9.2 a kowace shekara mutum 1000) da kuma Daga cikin Magidanta da ba su da bayanai kan ilimi (8.4 a kowace shekara mutum 1,000) ko samun kudin shiga (19.5 a cikin shekara 1,000 na mutum).
Tebu na 2 ya taƙaita manyan sauye-sauyen bayyanar cututtuka. Kimanin kashi ɗaya bisa huɗu na mahalarta binciken ba a ba da rahoton cewa ba su taɓa yin barci a ƙarƙashin gidan da aka yi musu magani ba, wani kwata ya ruwaito barci a ƙarƙashin gidan da aka yi masa magani a kowace ziyara ta farko, sauran rabin kuma suna barci a ƙarƙashin wasu amma ba duka ba ne aka ruwaito barci a karkashin kulawa. gidajen sauro a lokacin ziyara.Yawan yaran da kodayaushe suke kwana a karkashin gidan sauro ya karu daga kashi 21% na yaran da aka haifa a shekarar 1998 zuwa kashi 31% na yaran da aka haifa a shekarar 2000.
Tebura S2 yana ba da ƙarin cikakkun bayanai kan yadda ake amfani da cibiyar sadarwa gabaɗaya daga 1998 zuwa 2003. Ko da yake an ba da rahoton cewa kashi 34% na yara suna barci a ƙarƙashin gidan sauro a daren da ya gabata a 1998, ta 2003 adadin ya karu zuwa 77%. Hoto S3 ya nuna. Hoton S4 ya nuna babban bambancin mallakar mallakar, tare da kasa da kashi 25% na gidaje sun yi maganin tarun a ƙauyen Iragua a cikin 1998, yayin da a ƙauyukan Igota, Kivukoni da Lupiro, fiye da kashi 50% na gidaje sun sami magani. bi da raga a cikin wannan shekara.
Ba a daidaita Kaplan-Meier masu lankwasa na rayuwa ba an nuna.Panels A da C sun kwatanta yanayin rayuwa (ba a daidaita su ba) na yaran da suka bayar da rahoton yin amfani da gidajen sauro na akalla rabin adadin ziyara ga waɗanda ba su yi amfani da su akai-akai ba.Panels B da D suna kwatanta yaran da ba su taɓa yin ba. ya ba da rahoton barci a ƙarƙashin gidajen da aka kula da su (23% na samfurin) tare da waɗanda ko da yaushe suka ba da rahoton barci a ƙarƙashin gidajen da aka yi musu magani (25% na samfurin).daidaitawa) waƙa. Wurin shigarwa yana nuna bayanai iri ɗaya akan ƙaramar y-axis.
Hoto 2 Kwatanta yanayin rayuwar mahalarta zuwa girma dangane da farkon amfani da gidajen sauro, gami da kididdigar rayuwa na tsawon lokaci (Hoto na 2A da 2B) da lanƙwan rayuwa da aka tsara akan rayuwa zuwa shekaru 5 (Hoto 2C da 2D).A. An rubuta adadin mutuwar 604 a lokacin binciken;485 (80%) ya faru a cikin shekaru 5 na farko na rayuwa. Haɗarin mace-mace ya kai kololuwa a cikin shekarar farko ta rayuwa, ya ragu da sauri har zuwa shekaru 5, sannan ya kasance kaɗan kaɗan, amma ya ƙaru a kusan shekaru 15 (Fig. S6).Tasa'in- kashi ɗaya cikin ɗari na mahalarta waɗanda suka ci gaba da yin amfani da tarunan magani sun tsira har zuwa girma;wannan kuma ya kasance ga kashi 80 cikin 100 na yaran da ba su yi amfani da tarun da aka yi musu magani da wuri ba (Table 2 da Figure 2B) .Yawancin ƙwayoyin cuta a cikin 2000 suna da alaƙa da mummunar alaƙa da gidajen gadon da aka kula da su mallakar gidaje na yara a ƙarƙashin shekaru 5 (daidaituwar ƙima. , ~ 0.63) da yara 5 masu shekaru ko fiye (daidaitaccen daidaituwa, ~ 0.51) (Fig. S5).).
Kowane 10-kashi-maki karuwa a farkon amfani da tarunan jiyya yana da alaƙa da 10% ƙananan haɗarin mutuwa (rabin haɗari, 0.90; 95% CI, 0.86 zuwa 0.93), idan har an ba da cikakken saitin masu kulawa da masu haɗin gwiwar gida. kamar yadda ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙayyadaddun ƙauyen (Table 3) .Yaran da suka yi amfani da ragamar da aka yi amfani da su a farkon ziyara suna da 43% ƙananan haɗarin mutuwa idan aka kwatanta da yara da suka yi amfani da ragamar da aka yi amfani da su a ƙasa da rabin ziyarar su (haɗarin haɗari, 0.57; 95% CI, 0.45 zuwa 0.72).Hakazalika, yaran da suke kwana a ƙarƙashin gidajen da aka yi musu magani suna da 46% ƙananan haɗarin mutuwa fiye da yara waɗanda ba su taɓa yin barci a ƙarƙashin raga (haɗarin haɗari, 0.54; 95% CI, 0.39 zuwa 0.74) .A matakin ƙauye, 10-kashi-kashi-maki karuwa a kula da gidan net mallaki yana da alaƙa da 9% ƙananan haɗarin mutuwa (rabin haɗari, 0.91; 95% CI, 0.82 zuwa 1.01).
An ba da rahoton yin amfani da ragar da aka yi amfani da su a lokacin aƙalla rabin ziyarar farko na rayuwa tare da haɗarin haɗari na 0.93 (95% CI, 0.58 zuwa 1.49) don mutuwa daga shekaru 5 zuwa girma (Table 3) .A cikin farko. lokacin daga 1998 zuwa 2003, lokacin da muka daidaita shekaru, ilimin kulawa, samun kudin shiga gida da dukiya, shekarar haihuwa da ƙauyen haihuwa (Table S3).
Teburin S4 yana nuna makin madaidaicin ma'auni da madaidaicin kididdigar daidaitawa don ma'aunin fiddawa na mu guda biyu, kuma sakamakon kusan iri ɗaya ne da waɗanda ke cikin Tebura 3. Tebura S5 yana nuna bambance-bambance a cikin rayuwa wanda aka ƙaddara ta adadin ziyartan farko. farkon ziyarar, ƙimar kariya da aka kiyasta ya bayyana ya fi girma a cikin yara tare da ƙarin ziyara fiye da yara masu ƙananan ziyara.Table S6 yana nuna sakamakon cikakken binciken binciken;waɗannan sakamakon kusan sun yi kama da na babban binciken mu, tare da ɗan ƙaramin madaidaicin ƙimar matakin ƙauye.
Ko da yake akwai kwakkwarar shaida da ke nuna cewa gidajen sauron da aka yi amfani da su na iya inganta rayuwa a cikin yara 'yan ƙasa da shekaru 5, nazarin tasirin dogon lokaci yana ci gaba da yin karanci, musamman a wuraren da ake yawan watsawa.20 Sakamakonmu ya nuna cewa yara suna da fa'ida ta dogon lokaci ta amfani da su. Wadannan sakamakon suna da ƙarfi a cikin ka'idoji masu mahimmanci kuma suna ba da shawarar cewa damuwa game da karuwar mace-mace a baya yara ko samartaka, wanda zai iya kasancewa saboda jinkirin ci gaban rigakafi na aiki, ba shi da tushe.Ko da yake bincikenmu bai auna aikin rigakafi ba, zai iya a yi gardamar cewa rayuwa har zuwa girma a wuraren da cutar zazzabin cizon sauro ke haifarwa ita kanta nunin rigakafin aiki ne.
Ƙarfin bincikenmu ya haɗa da girman samfurin, wanda ya haɗa da yara fiye da 6500;lokacin da aka biyo baya, wanda shine ma'anar shekaru 16;ƙananan ƙarancin asarar da ba zato ba tsammani zuwa biyo baya (11%);da daidaiton sakamako a duk faɗin nazari. Yawan bin diddigin na iya kasancewa ne saboda haɗuwa da abubuwan da ba a saba gani ba, kamar yawan amfani da wayar hannu, haɗin kai na al'ummomin karkara a cikin yanki na binciken, da zurfi da kyakkyawar zamantakewa. dangantaka ta haɓaka tsakanin masu bincike da mutanen gida.Al'umma ta hanyar HDSS.
Akwai ƙayyadaddun ƙayyadaddun bincikenmu, gami da rashin bin diddigin mutum ɗaya daga 2003 zuwa 2019;babu wani bayani kan yaran da suka mutu kafin ziyarar binciken farko, wanda ke nufin cewa adadin tsira ba su da cikakken wakilci na duk haihuwa a lokaci guda;da kuma nazari na lura.Ko da samfurin mu ya ƙunshi adadi mai yawa na covariates, ragowar rikicewa ba za a iya kawar da su ba. Bisa ga waɗannan iyakoki, muna ba da shawarar cewa ana buƙatar ƙarin bincike game da tasirin ci gaba da amfani da gidajen gado na dogon lokaci da kuma muhimmancin lafiyar jama'a. na gidajen sauron da ba a kula da su ba, musamman ganin damuwar da ake da ita game da juriyar kwari.
Wannan binciken na dogon lokaci da ke da alaƙa da kula da zazzabin cizon sauro na yara ya nuna cewa tare da matsakaicin matsakaicin ɗaukar hoto, fa'idodin rayuwa na gidan sauron da aka yi wa maganin kwari yana da yawa kuma yana dagewa har zuwa girma.
Tarin bayanai a lokacin bin 2019 na Farfesa Eckenstein-Geigy da tallafi daga 1997 zuwa 2003 ta Hukumar Cigaban Ƙasa da Haɗin kai da Swiss National Science Foundation.
Ana samun fom ɗin bayyanawa da marubutan suka bayar tare da cikakken rubutun wannan labarin a NEJM.org.
Bayanin raba bayanan da marubutan suka bayar yana samuwa tare da cikakken rubutun wannan labarin a NEJM.org.
Daga Cibiyar Kula da Lafiyar Jama'a ta Swiss Tropical da Jami'ar Basel, Basel, Switzerland (GF, CL);Ifakara Health Institute, Dar es Salaam, Tanzania (SM, SA, RK, HM, FO);Jami'ar Columbia, New York Mailman School of Public Health (SPK);da Makarantar Kiwon Lafiya ta London da Magungunan wurare masu zafi (JS).
Ana iya tuntubar Dr. Fink a [email protected] ko a Cibiyar Kula da Lafiyar Jama'a ta Switzerland (Kreuzstrasse 2, 4123 Allschwil, Switzerland).
1. Rahoton Malaria ta Duniya 2020: Shekaru 20 na Ci gaban Duniya da Kalubale.Geneva: Hukumar Lafiya ta Duniya, 2020.
2. Hukumar Lafiya ta Duniya.Bayanin Abuja da Tsarin Aiki: Abubuwan da aka samo daga taron koli na Afirka na Roll Back Malaria.25 Afrilu 2000 (https://apps.who.int/iris/handle/10665/67816).
3. Pryce J, Richardson M, Lengeler C. Gidan sauro na maganin kwari don rigakafin zazzabin cizon sauro.Cochrane Database System Rev 2018;11: CD000363-CD000363.
4. Snow RW, Omumbo JA, Lowe B, et al. Haɗin kai tsakanin kamuwa da cutar zazzabin cizon sauro mai tsanani a cikin yara da matakin watsa Plasmodium falciparum a Afirka.Lancet 1997; 349: 1650-1654.
5. Gwaje-gwaje na Molineaux L. Nature: Menene abubuwan da ke haifar da rigakafin zazzabin cizon sauro?Lancet 1997; 349: 1636-1637.
6. D’Alessandro U. Maleriya mai tsanani da matakin watsa Plasmodium falciparum.Lancet 1997;350:362-362.
8. Snow RW, Marsh K. Clinical Malaria Epidemiology in African Children.Bull Pasteur Institut 1998;96:15-23.
9. Smith TA, Leuenberger R, Lengeler C. Yawan mace-macen yara da zazzabin cizon sauro a Afirka.Trend Parasite 2001;17:145-149.
10. Diallo DA, Cousens SN, Cuzin-Ouattara N, Nebié I, Ilboudo-Sanogo E, Esposito F. Labulen maganin kwari na kare mace-macen yara a yammacin Afirka har zuwa shekaru 6. Bull World Health Organ 2004;82:85 -91.
11. Binka FN, Hodgson A, Adjuik M, Smith T. Mutuwa a cikin gwaji na tsawon shekaru bakwai da rabi na gidan sauro na maganin kwari a Ghana.Trans R Soc Trop Med Hyg 2002;96:597 -599.
12. Eisele TP, Lindblade KA, Wannemuehler KA, et al.Sakamakon ci gaba da amfani da gidan sauron da aka yi wa maganin kwari kan duk wani sanadin mace-macen yara a yankunan yammacin Kenya inda zazzabin cizon sauro ke da yawa.Am J Trop Med Hyg 2005;73 : 149-156.
13. Geubbels E, Amri S, Levira F, Schellenberg J, Masanja H, Nathan R. Gabatarwa ga Tsarin Kula da Lafiya da Jama'a: Ifakara Rural and Urban Health and Population Surveillance System (Ifakara HDSS) .Int J Epidemiol 2015;44: 848-861.
14. Schellenberg JR, Abdulla S, Minja H, et al.KINET: Shirye-shiryen tallace-tallace na zamantakewa don Cibiyar Kula da Malaria ta Tanzaniya da ke kimanta lafiyar yara da kuma rayuwa na dogon lokaci.Trans R Soc Trop Med Hyg 1999;93:225-231.