amakuru

Witegure kuba umuganga, kubaka ubumenyi bwawe, kuyobora umuryango wita kubuzima, no guteza imbere umwuga wawe hamwe namakuru na serivisi bya NEJM.
Byaravuzwe ko mugihe cyo kwanduza cyane, kurwanya malariya mu bwana bwambere (<5 ans) bishobora gutinza kubona ubudahangarwa bwimikorere no guhindura imfu zabana kuva bakiri bato kugeza bakuru.
Twifashishije amakuru yavuye mu bushakashatsi bw’imyaka 22 y’ubushakashatsi bwakozwe mu cyaro cyo mu majyepfo ya Tanzaniya kugira ngo tugereranye isano iri hagati yo gukoresha inshundura hakiri kare ndetse no kubaho kugeza bakuze. Abana bose bavukiye mu gace k’ubushakashatsi hagati ya 1 Mutarama 1998 na 30 Kanama 2000 baratumiwe kugira uruhare ubushakashatsi bumaze igihe kirekire kuva 1998 kugeza 2003. Ibisubizo byubuzima bwabakuze byemejwe mumwaka wa 2019 no kwegera abaturage no guhamagara kuri terefone igendanwa. Twifashishije urugero rw’ingaruka ziterwa na Cox kugirango tugereranye isano iri hagati yo gukoresha abana bato bakoresheje inshundura zivurwa no kubaho mubukure, byahinduwe kubashobora kwitiranya ibintu.
Abana 6706 ni bo biyandikishije.Mu mwaka wa 2019, twagenzuye amakuru y’ingenzi ku bitabiriye 5983 (89% ).Nk'uko byatangajwe na raporo z’abasuye abaturage hakiri kare, hafi kimwe cya kane cy’abana ntibigeze baryama munsi y’urushundura, kimwe cya kabiri barara munsi y’ubuvuzi net mugihe runaka, kandi igihembwe gisigaye buri gihe cyararaga munsi yurushundura ruvuwe.Sinzira uvuweinzitiramubu.Ikigereranyo cy’impanuka zavuzwe ku rupfu cyari 0.57 (95% intera y'icyizere [CI], 0,45 kugeza 0,72) .tarenze kimwe cya kabiri cyo gusurwa. Ikigereranyo cy’ingaruka zijyanye n’imyaka 5 n’abakuze cyari 0.93 (95% CI, 0.58 kugeza 1.49).
Muri ubu bushakashatsi bwigihe kirekire bwo kurwanya malariya hakiri kare ahantu hakwirakwizwa cyane, inyungu zo kubaho zo gukoresha inshundura zavuwe hakiri kare. (Yatewe inkunga na Porofeseri wa Eckenstein-Geigy n'abandi.)
Malariya ikomeje kuba intandaro y’indwara n’urupfu ku isi hose.1 Mu bantu 409.000 bapfuye malariya mu 2019, abarenga 90% babaye muri Afurika yo munsi y’ubutayu bwa Sahara, naho bibiri bya gatatu by’impfu zabaye ku bana bari munsi y’imyaka itanu.1. inshundura zavuwe nizo nkingi yo kurwanya malariya kuva Itangazo rya Abuja ryo mu 2000 .Uruhererekane rw’ibigeragezo byateguwe byakozwe mu myaka ya za 90 byerekanaga ko inshundura zavuwe zagize akamaro kanini ku buzima ku bana bari munsi y’imyaka 5.3 Ahanini bitewe n’inini- gukwirakwiza ibipimo, 2019.1 46% by'abaturage bafite ibyago byo kurwara malariya muri Afurika yo munsi y'Ubutayu bwa Sahara baryama mu nzitiramubu zivuwe;
Nkuko ibimenyetso byagaragaye mu myaka ya za 90 inyungu zo kurokoka inshundura zavuwe kubana bato, haravugwa ko ingaruka ndende zurushundura zavuwe kurokoka ahantu hashobora kwanduzwa cyane zizaba munsi yingaruka zigihe gito, ndetse zishobora no kuba bibi, kubera inyungu zunguka zo kubona ubudahangarwa bukora.gutinda bifitanye isano.4-9 Ariko, ibimenyetso byatangajwe kuri iki kibazo bigarukira gusa ku bushakashatsi butatu bwakorewe i Burkina Faso, muri Gana, 11 bukurikiranwa n’imyaka itarenze 7.5 na Kenya.12 Nta na kimwe muri ibyo bitabo cyerekanye ibimenyetso byerekana ihinduka ry’umwana impfu kuva akiri muto kugeza zishaje biturutse ku kurwanya malariya hakiri kare. Hano, turatanga amakuru yavuye mu bushakashatsi bw’imyaka 22 y’ubushakashatsi bwakozwe mu cyaro cyo mu majyepfo ya Tanzaniya kugira ngo tugereranye isano iri hagati yo gukoresha imibu y’imiti ivurwa no kubaho mu gihe cyo gukura.
Muri ubu bushakashatsi buteganijwe bwa cohort, twakurikiranye abana kuva bakiri bato kugeza bakuze. Ubushakashatsi bwemejwe ninama zishinzwe gusuzuma imyitwarire iboneye muri Tanzaniya, Ubusuwisi n’Ubwongereza. Ababyeyi cyangwa abarezi b’abana bato bemeye mu magambo amakuru yakusanyijwe hagati ya 1998 na 2003 .Mu mwaka wa 2019, twabonye uruhushya rwanditse kubitabiriye ibiganiro babajijwe imbonankubone kandi mu magambo abitabiriye ibiganiro babajijwe kuri terefone. Abanditsi ba mbere n'abanyuma baremeza ko amakuru yuzuye kandi yuzuye.
Ubu bushakashatsi bwakorewe ahitwa Ifakara Icyaro cy’ubuzima n’ikurikiranwa ry’abaturage (HDSS) mu turere twa Kilombero na Ulanga muri Tanzaniya.13 Agace k’ubushakashatsi kari kagizwe n’imidugudu 18, nyuma kagabanyijemo 25 (Ishusho S1 ku mugereka w’inyongera, kuboneka hamwe ninyandiko yuzuye yiyi ngingo kuri NEJM.org) .Abana bose bavutse kubatuye HDSS hagati yitariki ya 1 Mutarama 1998, na 30 Kanama 2000 bitabiriye ubushakashatsi bwa cohort igihe kirekire basuye urugo buri mezi 4 hagati ya Gicurasi 1998 na Mata 2003. Kuva mu 1998 kugeza 2003, abitabiriye amahugurwa basuye HDSS buri mezi 4 (Igicapo S2). Kuva 2004 kugeza 2015, ubuzima bw'abitabiriye bazwiho kuba muri kariya gace bwanditswe mu ruzinduko rusanzwe rwa HDSS. Muri 2019, twakoze ubushakashatsi bwo gukurikirana. binyuze mu kwegera abaturage na terefone ngendanwa, kugenzura uko abitabiriye ubuzima babaho, batitaye aho batuye ndetse na HDSS.Ubushakashatsi bushingiye ku makuru y’umuryango yatanzwe mu kwiyandikisha. Twakoze urutonde rw’ishakisha kuri buri mudugudu wa HDSS, twerekana amazina n'amazina. mu bantu bose bahoze mu muryango wa buri wese mu bitabiriye amahugurwa, hamwe n’itariki yavukiyeho n’umuyobozi w’umuryango ushinzwe umuryango mu gihe cyo kwiyandikisha. Mu nama n’abayobozi b’abaturage, urutonde rwarasuzumwe ndetse n’abandi baturage bamenyekana kugira ngo bafashe gukurikirana.
Ku nkunga y'Ikigo cy'Ubusuwisi gishinzwe Iterambere n'Ubutwererane na Guverinoma ya Repubulika yunze ubumwe ya Tanzaniya, hashyizweho gahunda yo gukora ubushakashatsi ku nzitiramubu zavuwe mu gace k’ubushakashatsi mu 1995.14 Mu 1997, gahunda yo kwamamaza imibereho igamije gukwirakwiza, guteza imbere no kugarura igice cyigiciro cyurushundura, hashyizweho uburyo bwo kuvura net.15 Ubushakashatsi bwakorewe mu bushakashatsi bwakozwe bwerekanye ko inshundura zavuwe zajyanye no kwiyongera kwa 27% mu mibereho y’abana bafite ukwezi kumwe kugeza ku myaka 4 (95% intera y'icyizere [CI], 3 kugeza 45).15
Igisubizo cyibanze ni ukurokoka byagenzuwe mugihe cyo gusura ingo.Ku bitabiriye amahugurwa bapfuye, imyaka n'umwaka by'urupfu babonetse ku babyeyi cyangwa ku bandi bagize umuryango. Impinduka nyamukuru yagaragaye ni ugukoresha inzitiramubu hagati y’amavuko n’imyaka 5 (“net gukoresha mu myaka ya mbere ”). Twasesenguye kuboneka kw'urusobe ku mikoreshereze ya buri muntu no ku rwego rw'abaturage. Kugira ngo umuntu akoreshe inzitiramubu, muri buri ruzinduko mu rugo hagati ya 1998 na 2003, nyina w'umwana cyangwa umurezi yabajijwe niba nyina w'umwana cyangwa umurezi yararyamye. munsi y'urushundura ijoro ryakeye, kandi niba aribyo, niba nigihe inshundura yari yica udukoko- Gufata cyangwa gukaraba.Twagaragaje muri make buri mwana wumwaka wa mbere guhura ninshundura zavuwe nkijanisha ryabasuye abana bavugaga ko baryamye munsi yinshundura zavuwe; .Ku mutungo wo murwego rwo kuvura urwego rwumudugudu, twahujije inyandiko zose zo murugo zegeranijwe kuva 1998 kugeza 2003 kugirango tubare umubare wimiryango muri buri mudugudu wari ufite byibuze umuyoboro umwe wo kuvura kumwaka.
Amakuru yerekeye parasitemiya ya malariya yakusanyijwe mu 2000 muri gahunda yo kugenzura byimazeyo uburyo bwo kuvura imiti igabanya ubukana.Ku ya 16 Gicurasi, mu cyitegererezo cy’imiryango ya HDSS, parasitemiya yapimwe na microscopi ya firime yuzuye mu bagize umuryango wose amezi 6 cyangwa arenga kugeza muri Nyakanga 2000 , 2001, 2002, 2004, 2005 Umwaka na 2006.16
Kugira ngo amakuru arusheho kuba meza kandi yuzuye yo gukurikiranwa muri 2019, twashakishije kandi duhugura itsinda ry’ababajijwe bafite uburambe bari basanzwe bafite ubumenyi bwagutse bwaho.Ku miryango imwe n'imwe, amakuru yerekeye uburezi bw'abarezi, amafaranga yinjira mu muryango, ndetse n'igihe cyo kwivuza ntabwo yaboneka. Kwiyongera kwinshi ukoresheje urunigi rwakoreshejwe mukubara amakuru yabuze covariate mubisubizo byibanze byacu.Impinduka zose ziri kurutonde rwimbonerahamwe ya 1 zakoreshejwe nkabahanuzi kuri izo mpinduka. uburyo bwatoranijwe.
Imibare yambere isobanura harimo gusobanura gukurikiranwa nimpfu zishingiye ku mibonano mpuzabitsina, umwaka wavutse, amashuri yita ku barezi, hamwe n’icyiciro cy’amafaranga yinjira mu rugo. Urupfu rugereranywa n’impfu ku bantu 1000-ku myaka.
Dutanga amakuru yukuntu ubwishingizi bwurusobe bwahindutse mugihe.Kugaragaza isano iri hagati yumudugudu wo murwego rwumudugudu ufite inshundura zanduye hamwe na malariya yanduye, twashizeho ikwirakwizwa ryumudugudu uringaniza uburiri hamwe numudugudu wanduye indwara ya parasitike. mu 2000.
Kugira ngo tugereranye isano iri hagati yo gukoresha neti no kubaho igihe kirekire, twabanje kugereranya umurongo uteganijwe udakosorwa wa Kaplan-Meier ugereranije no kugereranya abana bavugaga ko baryamye munsi y'urushundura ruvurwa mugihe byibuze 50% byabasuye hakiri kare hamwe nibisubizo byo kurokoka. Bivugwa ko abana baryamye bavuwe inzitiramubu mu gihe kitageze kuri 50% yo gusurwa hakiri kare. Guhagarika 50% byatoranijwe kugirango bihuze n’ibisobanuro byoroshye "igihe kinini". Kugirango tumenye neza ko ibisubizo bitagize ingaruka kuri uku kugabanuka uko bishakiye, twagereranije kandi Kaplan-Meier usanzwe udakosowe umurongo wo kurokoka ugereranya abana bahora bavuga ko basinziriye munsi y'urushundura ruvuwe nabatigeze bavuga ko basinziriye munsi y'urushundura rwavuwe Ingaruka zo kurokoka kw'abana bari kuri net.Twagereranije imirongo ya Kaplan-Meier idakosowe kuri iri tandukaniro nyuma yigihe cyose (0 kugeza 20) hamwe nubwana bwambere (5 kugeza 20) .Isesengura ryose ryabayeho ryagarukiye kumwanya uri hagati yikiganiro cya mbere cyubushakashatsi n’ikiganiro giheruka gukorwa, byaviriyemo kugabanya ibumoso no kugenzura iburyo.
Twifashishije ingero ziterwa na Cox kugirango tugereranye ibintu bitatu byingenzi bitandukanya inyungu, biterwa no kwitiranya ibintu - icya mbere, isano iri hagati yo kubaho hamwe nijanisha ryabasuye abana bivugwa ko baryamye munsi yinshundura;icya kabiri, Itandukaniro mubuzima hagati yabana bakoresheje inshundura zirenze kimwe cya kabiri cyabasuye nabakoresha inshundura zivuwe mugihe kitarenze kimwe cya kabiri cyabasuye;icya gatatu, itandukaniro ryo kubaho hagati yabana bahora bavuga ko basinziriye mugihe cyo gusurwa hakiri kare Mugihe cyinzitiramubu zivuwe, abana ntibigeze bavuga ko basinziriye munsi yinshundura zavuwe mururu ruzinduko.Ku ishyirahamwe ryambere, ijanisha ryabasuye risesengurwa nkijambo risobanutse.Isesengura risigaye rya martingale byakozwe kugirango hemezwe ko iki gitekerezo gihagije. Isesengura ryibisigisigi byachoenfeld17 byakoreshejwe mugupima ingaruka ziterwa n’impanuka. Kugira ngo habeho urujijo, ibigereranyo byinshi bitandukanye byagereranijwe bitatu byambere byagereranijwe byahinduwe mubyiciro byinjira murugo, igihe cyo kwivuza cyegereye, abarezi icyiciro cy'uburezi, igitsina cy'umwana, n'imyaka y'umwana.vuka. Ubwoko bwose butandukanye kandi bwarimo ibitekerezo 25 byihariye by’imidugudu, byadushoboje gukuraho itandukaniro rishingiye kuri gahunda mu rwego rw’imidugudu idakurikiranwa nk’abashobora kwitiranya ibintu. Kugira ngo ibisubizo by’ibisubizo byatanzwe byubahwe. Kuri icyitegererezo cyatoranijwe, twagereranije kandi binini ebyiri zinyuranye dukoresheje intanga, kaliperi hamwe na algorithm ihuye neza.
Urebye ko gukoresha inshundura hakiri kare bishobora gusobanurwa nimiryango idakurikiranwa cyangwa abarezi nkubumenyi bwubuzima cyangwa ubushobozi bwumuntu ku giti cye kubona serivisi zubuvuzi, twagereranije kandi urugero rwumudugudu nkikinyuranyo cya kane.Kugereranya, twakoresheje umudugudu- urwego rwohejuru rwurugo rufite inshundura zavuwe (kwinjiza nkigihe cyumurongo) mumyaka 3 yambere aho abana bagaragaye nkimpinduka zacu zambere zerekana. Imidugudu yo murwego rwo hejuru ifite ibyiza byo kutishingikiriza cyane kubana cyangwa kurwego rwurugo kandi bigomba bityo rero ntukagire ingaruka nke ziterwa no kwitiranya ibintu.Ubusanzwe, kongera ubwiyongere bwurwego rwumudugudu bigomba kugira ingaruka zikomeye zo kurinda ubwiyongere bw’abantu ku giti cyabo bitewe n’ingaruka nyinshi ku baturage b’imibu no kwandura malariya.18
Kugirango habeho ubuvuzi bwo murwego rwumudugudu kimwe nubusabane bwumudugudu muri rusange, amakosa asanzwe yabazwe hifashishijwe igereranya rya Huber cluster-robust variance igereranya.Ibisubizo byatangajwe nkikigereranyo cyerekana amanota 95% intera.Ubugari bwintera yicyizere ntabwo yahinduwe kubwinshi, intera rero ntigomba gukoreshwa muguhitamo amashyirahamwe yashinzwe. Isesengura ryibanze ryacu ntabwo ryateganijwe;kubwibyo, nta P-gaciro byatangajwe. Isesengura ry’imibare ryakozwe hifashishijwe porogaramu ya Stata SE (StataCorp) verisiyo 16.0.19
Kuva muri Gicurasi 1998 kugeza Mata 2003, abitabiriye 6706 bavutse hagati ya 1 Mutarama 1998 na 30 Kanama 2000 bashyizwe mu itsinda (Ishusho 1) .Imyaka yo kwiyandikisha yari hagati y'amezi 3 na 47, bivuze ko ari amezi 12. Hagati aho Gicurasi 1998 na Mata 2003, 424 bitabiriye amahugurwa barapfuye. Muri 2019, twasuzumye ubuzima bw'abitabiriye 5.983 (89% by'abiyandikishije) .Abitabiriye 180 bose bapfuye hagati ya Gicurasi 2003 na Ukuboza 2019, bituma abantu bapfa muri rusange. 6.3 bapfa kumuntu 1000-mumyaka.
Nkuko bigaragara mu mbonerahamwe ya 1, icyitegererezo cyari gishingiye ku gitsina;ugereranije, abana bariyandikishije mbere yujuje umwaka umwe hanyuma bagakurikiranwa imyaka 16. Abarezi benshi barangije amashuri abanza, kandi ingo nyinshi zifite amazi ya robine cyangwa iriba.Imbonerahamwe S1 itanga ibisobanuro byinshi kubyerekeranye no guhagararirwa nicyitegererezo cyubushakashatsi. umubare w'abantu bapfa ku myaka 1000-wabaye muto cyane mu bana bafite abarezi bize cyane (4.4 ku myaka 1000-umuntu) kandi ukaba mwinshi mu bana bari barengeje amasaha 3 uvuye ku kigo nderabuzima (9.2 ku bantu 1000-imyaka) na Muri ingo zidafite amakuru kubyerekeye uburezi (8.4 kumuntu 1.000-yumuntu) cyangwa amafaranga yinjiza (19.5 kumuntu 1.000).
Imbonerahamwe 2 yerekana muri make impinduka nyamukuru zerekana. Hafi ya kimwe cya kane cyabitabiriye ubushakashatsi bivugwa ko batigeze baryama munsi y'urushundura ruvuwe, ikindi gihembwe bavuga ko basinziriye munsi y'urushundura rwavuwe buri gihe cyo gusurwa hakiri kare, naho igice gisigaye bakaryama munsi ya bamwe ariko siko bose bavuga ko basinziriye bavuwe inzitiramubu mugihe cyo gusurwa.Umubare wabana bahoraga baryama munsi yinzitiramubu zavuwe wiyongereye uva kuri 21% byabana bavutse mumwaka wa 1998 ugera kuri 31% byabana bavutse 2000.
Imbonerahamwe S2 itanga ibisobanuro birambuye kubyerekeranye nigikorwa rusange cyo gukoresha imiyoboro kuva 1998 kugeza 2003. Nubwo byavuzwe ko 34% byabana baryamye munsi yinzitiramubu zavuwe nijoro muri 1998, kugeza 2003 iyo mibare yariyongereye igera kuri 77% .Figure S3 yerekana inshuro nyinshi zikoreshwa zavuwe hakiri kare mubuzima.Figure S4 yerekana itandukaniro ryinshi rya nyirubwite, aho ingo zitageze kuri 25% zivuye inshundura mumudugudu wa Iragua mumwaka wa 1998, mugihe mumidugudu ya Igota, Kivukoni na Lupiro, ingo zirenga 50% zari zifite bavuwe inshundura muri uwo mwaka.
Imirongo yo kubaho idakosowe ya Kaplan-Meier irerekanwa.Panels A na C bagereranya inzira yo kubaho (idakosowe) yo kubaho yabana bavuze ko bakoresheje inshundura zavuwe byibuze kimwe cya kabiri cyumubare wabasuye abakoresha gake.Paneli B na D igereranya abana batigeze bigera byavuzwe ko uryamye munsi yinshundura zavuwe (23% byicyitegererezo) hamwe nabahora bavuga ko basinziriye munsi yinshundura zavuwe (25% byicyitegererezo).byahinduwe) inzira. Inet yerekana amakuru amwe kuri y-axis yagutse.
Igicapo ca 2 Kugereranya inzira yo kubaho kwabitabiriye kurokoka hashingiwe ku gukoresha hakiri kare inshundura zavuwe, harimo kugereranya ubuzima bwo kubaho mugihe cyose (Ishusho 2A na 2B) hamwe nu murongo wo kurokoka uteganijwe kubaho kugeza kumyaka 5 (Ishusho 2C na 2D) .A abantu 604 bapfuye banditswe mu gihe cyo kwiga;485. kimwe ku ijana by'abitabiriye gukoresha inshundura zavuwe barokotse bakuze;ibi kandi byabaye no ku bana 80% gusa badakoresheje inshundura zavuwe hakiri kare (Imbonerahamwe 2 nishusho ya 2B) .Icyorezo cya parasite mu 2000 cyari gifitanye isano ribi cyane ninshundura zaryamye zifitwe nimiryango yabana bari munsi yimyaka 5 (coefficient de la coiffe) , ~ 0,63) hamwe nabana bafite imyaka 5 cyangwa irenga (coefficient de la coiffe, ~ 0.51) (Ishusho S5).).
Kwiyongera kw'amanota 10 ku ijana mu gukoresha hakiri kare inshundura zavuwe byajyanaga no kuba 10% byo guhitanwa n’urupfu (igipimo cy’ibyago, 0,90; 95% CI, 0.86 kugeza 0.93), hashyizweho urutonde rwuzuye rw’abarezi hamwe n’abo babana mu rugo nabo. nk'ingaruka zifatika z'umudugudu (Imbonerahamwe 3) .Abana bakoresheje inshundura zavuwe mugihe cyo gusurwa mbere bari bafite ibyago byo gupfa 43% ugereranije nabana bakoreshaga inshundura zivuwe mugihe kitarenze kimwe cya kabiri cyabasuye (igipimo cya hazard, 0.57; 95% CI, . Kwiyongera kw'amanota 10 ku nyungu zo kuryama zafashwe zifitanye isano na 9% yo guhitanwa n'urupfu (igipimo cya hazard, 0,91; 95% CI, 0.82 kugeza 1.01).
Gukoresha inshundura zavuwe mugihe byibuze kimwe cya kabiri cyabasuye ubuzima bwambere byavuzwe ko bifitanye isano nikigereranyo cya 0,93 (95% CI, 0.58 kugeza 1.49) bapfa kuva kumyaka 5 kugeza bakuze (Imbonerahamwe 3) .Mu ntangiriro gihe cyo kuva 1998 kugeza 2003, mugihe twahinduye imyaka, amashuri yita kubarezi, amafaranga yinjiza murugo nubutunzi, umwaka wavukiyeho numudugudu wavukiyemo (Imbonerahamwe S3).
Imbonerahamwe S4 yerekana amanota ya surrogate hamwe nigereranya nyaryo ryagereranijwe kubintu bibiri byombi bihindagurika, kandi ibisubizo birasa nkibiri mu mbonerahamwe ya 3. Imbonerahamwe ya S5 yerekana itandukaniro mubuzima bwo gutondekanya ukurikije umubare wabasuye hakiri kare. gusurwa hakiri kare, ingaruka zigereranijwe zo gukingira zisa nkaho ari nyinshi mu bana bafite gusurwa cyane kuruta mu bana basuye bike. Imbonerahamwe S6 yerekana ibisubizo by'isesengura ryuzuye;ibisubizo birasa nkibya analyse yacu nyamukuru, hamwe nibisobanuro bihanitse gato kubigereranyo kurwego rwumudugudu.
Nubwo hari ibimenyetso bifatika byerekana ko inshundura zivuwe zishobora guteza imbere ubuzima bwabana bari munsi yimyaka 5, ubushakashatsi bwingaruka zigihe kirekire buracyari ingume, cyane cyane mubice bifite umuvuduko mwinshi.20 Ibisubizo byacu byerekana ko abana bafite inyungu zigihe kirekire mugukoresha inshundura zavuwe.Ibisubizo birakomeye mumahame yagutse kandi byerekana ko impungenge zijyanye no kongera imfu zabana bato cyangwa ubwangavu, zishobora kuba zatewe no gutinda gukura kwimikorere yumubiri, nta shingiro bifite.Nubwo ubushakashatsi bwacu butigeze bupima imikorere yubudahangarwa, burashobora mpaka ko kubaho mubukure mu bice bya malariya-ubwabyo ubwabyo bigaragaza ubudahangarwa bw'imikorere.
Imbaraga zinyigisho zacu zirimo ingano yicyitegererezo, yarimo abana barenga 6500;igihe cyo gukurikirana, cyari uburyo bwimyaka 16;igipimo gito gitunguranye cyigihombo cyo gukurikirana (11%);hamwe no guhuza ibisubizo murwego rwo gusesengura.Igipimo kinini cyo gukurikirana gishobora guterwa no guhuza ibintu bidasanzwe, nko gukoresha terefone zigendanwa cyane, guhuza abaturage bo mu cyaro aho biga, hamwe n’imibereho yimbitse kandi nziza umubano wateye imbere hagati yabashakashatsi nabantu baho.Umuryango ukoresheje HDSS.
Hariho imbogamizi zimwe mubyigisho byacu, harimo no kubura gukurikirana umuntu kuva 2003 kugeza 2019;nta makuru ku bana bapfuye mbere yo gusura bwa mbere ubushakashatsi, bivuze ko ibipimo byo kubaho kwa cohort bidahagarariwe byimazeyo kuvuka kwose mugihe kimwe;nisesengura ryokwitegereza.Nubwo icyitegererezo cyacu kirimo umubare munini wa covariates, urujijo rusigaye ntirushobora kuvaho. Dutanze izo mbogamizi, turasaba ko hakenewe ubundi bushakashatsi ku ngaruka ziterwa no gukomeza gukoresha inshundura zigihe kirekire kandi akamaro k'ubuzima rusange y'urushundura rutavuwe, cyane cyane urebye impungenge zubu zirwanya udukoko.
Ubu bushakashatsi bumaze igihe kirekire bujyanye no kurwanya malariya yo mu bwana bwerekana ko hamwe no gukwirakwiza abaturage mu buryo butagereranywa, inyungu zo kubaho ziva mu buriri zivura udukoko twica udukoko twinshi kandi zikomeza kuba mukuru.
Ikusanyamakuru mu gihe cya 2019 gikurikiranwa na Prof. Eckenstein-Geigy n'inkunga kuva 1997 kugeza 2003 n'ikigo cy'Ubusuwisi gishinzwe iterambere n'ubutwererane hamwe na Fondasiyo y’ubumenyi y’Ubusuwisi.
Ifishi yo gutangaza yatanzwe nabanditsi irahari hamwe ninyandiko yuzuye yiyi ngingo kuri NEJM.org.
Ibisobanuro byo gusangira amakuru byatanzwe nabanditsi birahari hamwe ninyandiko yuzuye yiyi ngingo kuri NEJM.org.
Kuva mu Busuwisi bushyuha n’ubuzima rusange na kaminuza ya Basel, Basel, Ubusuwisi (GF, CL);Ikigo nderabuzima cya Ifakara, Dar es Salaam, Tanzaniya (SM, SA, RK, HM, FO);Kaminuza ya Columbia, New York Mailman Ishuri ryubuzima rusange (SPK);n'ishuri rya Londere ryisuku nubuvuzi bwubushyuhe (JS).
Dr. Fink ashobora kuvugana na [imeri irinzwe] cyangwa mu kigo cy’Ubusuwisi gishinzwe Ubushyuhe n’Ubuzima rusange (Kreuzstrasse 2, 4123 Allschwil, Ubusuwisi).
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