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Gadzirira kuve chiremba, kuvaka ruzivo rwako, tungamira sangano rehutano, uye kusimudzira basa rako neruzivo rweNEJM Group nemasevhisi.
Izvo zvave zvichifungidzirwa kuti munzvimbo dzepamusoro dzekutapurirana, kudzora marariya muhuduku hwekutanga (<5 makore) inogona kunonoka kuwanikwa kwemaitiro ekudzivirira uye kushandura kufa kwevana kubva kumudiki kuenda kune mukuru.
Takashandisa ruzivo kubva ku22-year-vanotarisirwa cohort kudzidza kumaruwa kumaodzanyemba kweTanzania kuti tifungidzire kushamwaridzana pakati pekutanga kushandiswa kwemambure akabatwa uye kurarama kusvika pakukura.Vana vose vakazvarwa munzvimbo yekudzidza pakati pe1 January 1998 ne30 August 2000 vakakokwa kuti vatore chikamu the longitudinal study kubva 1998 kusvika 2003. Zvigumisiro zvekupona kwevanhu vakuru zvakasimbiswa muna 2019 nenharaunda yenharaunda uye nhare mbozha.Takashandisa Cox proportional hazard models kuti tifungidzire kushamwaridzana pakati pekushandiswa kwehuduku hwemambure akarapwa uye kurarama muhukuru, zvakagadziridzwa kune vanogona kukanganisa.
Vana 6706 vakanyoresa. Muna 2019, takaongorora ruzivo rwakakosha rwevakapinda 5983 (89%). Maererano nemishumo yekushanyira nharaunda kwekutanga, chikamu chimwe muzvina chevana havana kumborara pasi pemambure akarapwa, hafu yakarara yakarapwa. mambure pane imwe nguva, uye chikamu chakasara chaigara chichirara pasi pemambure akabatwa.Kurara wakarapwamosquito net.Njodzi yakashumwa yengozi yerufu yaiva 0.57 (95% nguva yekuvimba [CI], 0.45 kusvika 0.72) . isingasviki hafu yekushanyira.Njodzi inoenderana nezera pakati pemakore 5 nekukura kwaiva 0.93 (95% CI, 0.58 kusvika 1.49).
Muchidzidzo chenguva refu ichi chekudzivirira kwemarariya kwekutanga munzvimbo dzinotapuriranwa zvakanyanya, mabhenefiti ekurarama kwekutanga kushandiswa kwemambure akarapwa akaenderera mberi kusvika pakukura. (Yakatsigirwa neEckenstein-Geigy Professorship nevamwe.
Malaria ndiyo inoramba ichinyanya kukonzera zvirwere nerufu pasi rose.1 Pavanhu 409 000 vakafa nemarariya muna 2019, chikamu chinodarika makumi mapfumbamwe kubva muzana chakaitika muSub-Saharan Africa, uye zvikamu zviviri muzvitatu zvenzufu dzevana vari pasi pemakore mashanu.1 Mushonga wezvipembenene- mambure akarapwa ndiwo ndiwo akave musimboti wekudzivirira marariya kubva muna 2000 Abuja Declaration 2 .Nhevedzano yezviedzo zvakabatanidzwa-randomized zvakaitwa muma1990 zvakaratidza kuti mambure akarapwa ane pundutso huru yekurarama kwevana vari pasi pemakore mashanu ekuberekwa. kugoverwa kwezvikero, 2019.1 46% yevanhu vari panjodzi yemarariya muSouth Africa yeSahara vanorara mumambure eumhutu akarapwa.
Sezvo humbowo hwakabuda muma1990 hwekupona kwerubatsiro rwemambure akabatwa evana vadiki, zvinofungidzirwa kuti mhedzisiro yenguva refu yemambure akarapwa pakurarama munzvimbo dzekutapurirana kwepamusoro ichave yakaderera pane mhedzisiro yenguva pfupi, uye inogona kunge iri. yakaipa, nekuda kwekuwana mambure ekuwana functional immune.kunonoka kunoenderana.4-9 Zvisineyi, humbowo hwakaburitswa panyaya iyi hunongogumira kuzvidzidzo zvitatu kubva kuBurkina Faso, Ghana,11 nekutevera kusingapfuuri makore 7.5 neKenya.12 Hapana kana chimwe chezvinyorwa izvi chakaratidza humbowo hwekuchinja kwemwana. Kufa kwevanhu kubva kuvadiki kusvika vachembera zvichikonzerwa nekudzivirira marariya kwevacheche.Pano, tinoshuma data kubva kuongororo yemakore makumi maviri nemaviri inotarisirwa kuboka mumaruwa ekumaruwa ekumaodzanyemba kweTanzania kuti afungidzire kuwirirana pakati pekushandiswa kweudiki hwemambure akarapwa uye kurarama muhukuru.
Muchidzidzo cheboka ichi, takatevera vana kubva paucheche kusvika vakura. Ongororo iyi yakabvumwa nebhodhi rekuongorora tsika dzakanaka muTanzania, Switzerland neUnited Kingdom. .Muna 2019, takawana mvumo yakanyorwa kubva kuvatori vechikamu vakabvunzurudzwa ivo pachavo uye nemuromo kubva kune vatori vechikamu vakabvunzurudzwa parunhare.
Ongororo iyi yakaitwa paIfakara Rural Health and Demographic Surveillance Site (HDSS) kumatunhu eKilombero neUlanga kuTanzania.13 Nzvimbo yeongororo iyi pakutanga yaisanganisira misha gumi nemisere, iyo yakazopatsanurwa kuita 25 (Fig. S1 in the Supplementary Appendix, inowanika nemashoko akazara echinyorwa chino paNEJM.org).Vana vose vakazvarwa nevagari veHDSS pakati paNdira 1, 1998, naNyamavhuvhu 30, 2000 vakapinda muchidzidzo cheboka renguva refu panguva yekushanya kumba mwedzi mina yega yega pakati paChivabvu 1998 naKubvumbi 2003. Kubva ku1998 kusvika ku2003, vatori vechikamu vakagamuchira kushanya kweHDSS mwedzi yese ye4 (Fig. S2) .Kubva 2004 kusvika 2015, mararamiro ekupona kwevatori vechikamu vanozivikanwa kuti vanogara munharaunda yakanyorwa muhutano hweHDSS kushanyira.Muna 2019, takaita ongororo dzekutevera kuburikidza nenharaunda uye nharembozha, kuongorora mamiriro ekurarama kwevose vatori vechikamu, pasina nzvimbo yekugara uye zvinyorwa zveHDSS.Ongororo iyi inoenderana neruzivo rwemhuri rwunopihwa pakunyoresa.Takagadzira rondedzero yekutsvaga yemusha wega wega weHDSS, inoratidza mazita ekutanga neekupedzisira yevose vaimbove nhengo dzemhuri dzemudzidzi wega-wega, pamwe chete nemusi wekuzvarwa uye mutungamiri wenharaunda anotarisira mhuri panguva yekunyoreswa. Mumisangano nevatungamiriri venharaunda, rondedzero yakaongororwa uye dzimwe nhengo dzenharaunda dzakaonekwa kuti dzibatsire kuronda.
Nerutsigiro rweSwiss Agency for Development and Cooperation uye Hurumende yeUnited Republic of Tanzania, chirongwa chekuita tsvakiridzo pamambure eumhutu akarapwa chakatangwa munzvimbo yekudzidza muna 1995.14 Muna 1997, chirongwa chekushambadzira munharaunda chine chinangwa chekuparadzira, kusimudzira. uye kudzoreredza chikamu chemutengo wemambure, yakaunza kurapa mambure.15 Imwe nested case-control yekuongorora yakaratidza kuti mambure akabatwa akabatanidzwa ne 27% kuwedzera kwekupona kwevana vane mwedzi 1 kusvika kumakore mana (95% nguva yekuvimba [CI], 3 kusvika ku45).15
Mhedzisiro yekutanga yaive yechokwadi yekupona panguva yekushanya kumba.Kune vatori vechikamu vakafa, zera negore rekufa zvakawanikwa kubva kuvabereki kana dzimwe nhengo dzemhuri.Musiyano mukuru wekufumurwa kwaive kushandiswa kwemambure ekudzivirira Umhutu kubva pakuzvarwa kusvika pamakore mashanu ("mambure". shandisai makore ekutanga”).Takaongorora kuwanikwa kwenetiweki pamashandisirwo emunhu uye munharaunda. Pakushandisa mambure eumhutu, panguva yekushanya kwega kwega pamba pakati pa1998 na2003, amai vemwana kana muchengeti vakabvunzwa kana amai vemwana kana muchengeti vakarara. pasi pemambure husiku hwapfuura, uye kana zvakadaro, kana uye apo mambure anga ari mushonga wezvipembenene- Kubata kana kuwacha.Takapfupisa kusangana kwemwana wega-wega pazera remakore ekutanga kumambure akacheneswa sechikamu chekushanya uko vana vainzi vairara pasi pemambure ane mishonga. .Kuvaridzi venetiweki yekurapa mumusha, takabatanidza zvinyorwa zvese zvemumba zvakaunganidzwa kubva muna 1998 kusvika 2003 kuti tiverenge huwandu hwemhuri mumusha wega wega idzo dzinenge iine network imwechete yekurapa pagore.
Mashoko pamusoro pemalaria parasitemia akaunganidzwa muna 2000 sechikamu chechirongwa chakazara chekutarisa kurapwa kwemusanganiswa wemarariya.Musi wa16 Chivabvu, mumuenzaniso wemumiriri wemhuri dzeHDSS, parasitemia yakayerwa nemakrosikopu akakora munhengo dzemhuri dzese dzine mwedzi mitanhatu kana kupfuura kusvika Chikunguru 2000. , 2001, 2002, 2004, 2005 Gore uye 2006.16
Kuti tiwedzere kunaka kwedata uye kuzara kwekutevera muna 2019, takatsvaga nekudzidzisa chikwata chevabvunzurudza vane ruzivo vagara vaine ruzivo rwakadzama munharaunda.Kune dzimwe mhuri, ruzivo nezvedzidzo yevachengeti, mari yemhuri, uye nguva yekuenda kunzvimbo yekurapa yakanga isingawanikwe. Multiple imputation using chain equations yakashandiswa kuverengera kushayikwa kwe data covariate mumhedzisiro yedu yekutanga.Zvose zvakasiyana-siyana zvakanyorwa muTebhenekeri 1 zvakashandiswa sezvifananidzi zvezvipikiso izvi.Chimwezve chidzidzo chakakwana chakaitwa kuti chione kuti migumisiro yakanga isinganzwisisi kune kuregererwa. nzira yakasarudzwa.
Nhamba dzekutanga dzinotsanangura dzaisanganisira kushanya kwekutevera uye kufa nebonde, gore rekuzvarwa, dzidzo yevachengeti, uye chikamu chemari yemumba.Kufa kunofungidzirwa sekufa pa1000 munhu-makore.
Isu tinopa ruzivo rwekuti mambure achinja sei nekufamba kwenguva.Kutaridza hukama huripo pakati pevaridzi vemibhedha yakarapwa mumusha uye kutapurirwa kwemalaria, takagadzira nharaunda yekuvharirwa mambure akarapwa mumusha uye kuwanda kwechirwere cheparasitic. muna 2000.
Kuti tifungidzire kudyidzana pakati pekushandisa mambure uye kurarama kwenguva refu, takatanga kufungidzira kusagadziriswa mwero weKaplan-Meier wekupona tichienzanisa vana vaiti vakarara pasi pemambure akarapwa panguva inosvika 50% yekushanya kwekutanga nemhedzisiro yekurarama. Vana vanonzi vakarara vasina kurapwa. mosquito nets isingasviki 50% yekushanya kwekutanga. Iyo 50% cutoff yakasarudzwa kuti ienderane netsanangudzo iri nyore "kazhinji yenguva".Kuona kuti mhedzisiro haina kukanganiswa nekuderedzwa kwechipo ichi, isu takafungidzirawo zvisina kurongeka muyero Kaplan-Meier. survival curves achienzanisa vana vaigara vachirondedzera kurara pasi pemambure akarapwa neavo vasina kumbotaura vakarara pasi pemambure akarapwa Kupona kwevana vari pasi pemambure.Isu tinofungidzira kusagadziriswa kweKaplan-Meier curves yekusiyana uku mushure menguva yose (0 kusvika 20 makore) uye uduku hwepakutanga (5 kusvika kumakore 20) .Kuongorora kwehupenyu hwose hwakanga hushoma kune nguva pakati pebvunzurudzo yekutanga yekuongorora uye bvunzurudzo yekupedzisira yekuongorora, iyo zvakakonzera kucheka kwekuruboshwe uye kuregeredzwa kwekurudyi.
Takashandisa mienzaniso yeCox proportional hazards kuti tifungidzire misiyano mitatu mikuru yekufarira, ine chirevo pane zvinoonekwa zvinovhiringidza-kutanga, kushamwaridzana pakati pekupona uye muzana yekushanya uko vana vanonzi vairara pasi pemambure akabatwa;chechipiri, Misiyano mukupona pakati pevana vakashandisa mambure akarapwa painopfuura hafu yeshanyo dzavo uye avo vakashandisa mambure akarapwa nguva isingasviki hafu yeshanyo dzavo;chechitatu, kusiyana kwekurarama pakati pevana nguva dzose vanoshumwa vakarara pakushanya kwavo kwekutanga Pasi pemambure eumhutu akarapwa, vana havana kumbotaura vakarara pasi pemambure akarapwa panguva idzi.Kusangano rekutanga, chikamu cheshanyo chinoongororwa semutsara.A martingale residual analysis. yakaitwa kuti isimbise kukwana kwefungidziro iyi yemutsara.Schoenfeld residual analysis17 yakashandiswa kuedza kufungidzira kwengozi dzekuenzanisa.Kuzvidavirira kuvhiringidza, zviyero zvose zvakasiyana-siyana zvekuenzanisa zvitatu zvekutanga zvakagadziridzwa kune chikamu chemari yemhuri, nguva yekuenda kunzvimbo yezvokurapa iri pedyo, mutarisiri. chikamu chedzidzo, bonde remwana, nezera remwana.akaberekwa.Mienzaniso yose yakasiyana-siyana yaisanganisirawo mitsetse makumi maviri neshanu yakanangana nemusha, izvo zvakatibvumira kusabvisa misiyano yakarongeka muzvinhu zvisingatarisirwi zvemumusha sezvingangovhiringidza.Kuona kusimba kwezviwanikwa zvine ruremekedzo. kune yakasarudzwa empirical modhi, isu takafungidzirawo maviri mabhinari akasiyana tichishandisa kernels, calipers uye chaiwo anoenderana algorithms.
Tichifunga kuti kukurumidza kushandiswa kwemambure akarapwa kunogona kutsanangurwa nevasingacherechedzi vemba kana vachengeti seruzivo rwezveutano kana kukwanisa kwemunhu kuwana rubatsiro rwekurapa, takafungidzirawo muenzaniso wepamusha semusiyano wechina. Pakuenzanisa uku, takashandisa musha- mwero weavhareji wevaridzi vedzimba vanobatwa mambure (yekupinza semutsara wetemu) mumakore matatu ekutanga umo vana vaionekwa sevaridzi vedu vekutanga.Kuratidzwa kwemumusha kune mukana wekusanyanya kutsamira kune mumwe munhu kana weimba-pamwero wevakori uye unofanirwa saka usakanganiswa nekuvhiringika.Nepfungwa, kuwedzera kwenharaunda yemusha kunofanirwa kuve nekudzivirira kwakakura pane kuwedzera kuvharika kwemunhu nekuda kwekukanganisa kukuru kwehuwandu hweumhutu uye kutapurirana kwemalaria.18
Kuzvidavirira kune musha-level mambure kurapwa pamwe mumusha-level correlations kazhinji, zvikanganiso zvakajairwa zvakaverengerwa pachishandiswa Huber's cluster-robust variance estimator.Migumisiro inoshumwa sefungidziro yepfungwa ine 95% nguva yekuvimba.Kupamhama kwenguva dzekuvimba hakusi yakagadziridzwa kuti iwande, saka nguva dzepakati hadzifanirwe kushandiswa kufungidzira masangano akasimbiswa.Ongororo yedu yekutanga haina kutsanangurwa;saka, hapana P-values ​​yakataurwa.Kuongorora kweStatistical kwakaitwa pachishandiswa Stata SE software (StataCorp) vhezheni 16.0.19
Kubva munaMay 1998 kusvika munaApril 2003, nhamba yevatori vechikamu 6706 vakazvarwa pakati paJanuary 1, 1998 naAugust 30, 2000 vakabatanidzwa muboka (Mufananidzo 1) . Chivabvu 1998 naKubvumbi 2003, vatori vechikamu 424 vakafa. Muna 2019, takaona mamiriro akakosha evatori vechikamu 5,983 (89% yevakanyoresa). Vanhu zana nemakumi masere vakafa pakati paMay 2003 naZvita 2019, zvichikonzera kufa zvisina tsarukano. 6.3 kufa pa1000 munhu-makore.
Sezvinoratidzwa muTebhurari 1, sampuli yakanga yakaenzana nevakadzi;paavhareji, vana vakanyoreswa vasati vasvitsa gore uye vozotevera kwemakore 16. Vachengeti vakawanda vakawanda vakapedza dzidzo yepuraimari, uye mhuri zhinji dzine mvura yepombi kana yetsime. nhamba yenzufu pa1000 yemakore-yaive yakaderera pakati pevana vane vachengeti vakadzidza zvakanyanya (4.4 pamakore 1000 emunhu-makore) uye yepamusoro pakati pevana vaive neanopfuura maawa matatu kubva kunzvimbo yekurapa (9.2 pamakore 1000 emunhu) uye Pakati pevana Mhuri dzisina ruzivo rwedzidzo (8.4 pamakore 1,000 evanhu-makore) kana mari (19.5 pamakore 1,000 evanhu).
Tafura 2 inopfupikisa misiyano mikuru yekufumurwa.Chinenge chikamu chimwe muzvina chevatori vechidzidzo vanonzi havana kumborara pasi pemambure akarapwa, imwe kota yakanzi yakarara pasi pemambure akarapwa pakushanya kwega kwega, uye hafu yakasara yairara pasi pevamwe asi vasiri vese Vanonzi vakarara pasi pekurapwa. Huwandu hwevana vanogara vakarara vasina mambure anodzivirira umhutu hwakawedzera kubva pachikamu che21% chevana vakazvarwa muna 1998 kusvika pa31% yevana vakazvarwa mugore ra2000.
Tafura S2 inopa mamwe mashoko pamusoro pemafambiro ose mukushandiswa kwenetiweki kubva muna 1998 kusvika 2003.Kunyangwe zvakashumwa kuti chikamu che34% chevana vakarara pasi pekurapwa mambure eumhutu husiku hwapfuura muna 1998, pakazosvika 2003 nhamba iyi yakawedzera kusvika pa77%. Mufananidzo S4 unoratidza kusiyana kukuru kwevaridzi, mhuri isingasviki 25% yedzimba dzakarapa mambure mumusha weIragua muna 1998, ukuwo mumisha yeIgota, Kivukoni neLupiro, dzimba dzinodarika makumi mashanu kubva muzana dzakabatwa. kurapa mambure mugore rimwe chete.
Unadjusted Kaplan-Meier survival curves anoratidzwa.Panera A neC anoenzanisa (zvisina kugadziriswa) nzira dzekupona dzevana vakashuma vachishandisa mambure akarapwa kweinenge hafu yenhamba yekushanya kune avo vasingawanzo shandisa.Panera B naD inoenzanisa vana vasina kumbobvira vakanzi vakarara pasi pemambure akabatwa (23% yemuenzaniso) neavo vaigara vachitaura vakarara pasi pemambure akabatwa (25% yemuenzaniso).yakagadziridzwa) track.Chinyorwa chinoratidza data rimwechete pane yakakurisa y-axis.
Mufananidzo 2 Kuenzaniswa kwenzira dzekupona dzevatori vechikamu kusvika pakukura zvichibva pakushandiswa kwekutanga kwemambure akarapwa, kusanganisira fungidziro yekurarama kwenguva yese (Figure 2A ne2B) uye macurves ekupona anoenderana nekupona kusvika kumakore mashanu (Figures 2C uye 2D). hwerengedzo yevakafa mazana matanhatu neina yakanyorwa panguva yekudzidza;485 (80%) yakaitika mumakore ekutanga ehupenyu 5. Dambudziko rekufa rakakwira mugore rokutanga rehupenyu, rakaderera nokukurumidza kusvika pazera remakore 5, ndokuramba rakaderera, asi rakawedzera zvishoma pazera remakore 15 (Fig. S6) . Makumi mapfumbamwe- chikamu chimwe kubva muzana chevatori vechikamu vaigara vachishandisa mambure akarapwa vakararama kusvika vakura;izvi ndizvo zvakaitikawo kuchikamu che80% chevana vasina kushandisa mambure akarapwa kare (Table 2 and Figure 2B). Kupararira kweParasite muna 2000 kwaienderana zvakanyanya nemambure emubhedha akarapwa edzimba dzevana vari pasi pemakore mashanu (correlation coefficient). , ~ 0.63) uye vana vane makore mashanu kana kupfuura (correlation coefficient, ~ 0.51) (Fig. S5).)
Imwe neimwe 10-percentage-point yekuwedzera mukushandiswa kwekutanga kwemambure akarapwa yakabatana ne10% yakaderera njodzi yerufu (hazard ratio, 0.90; 95% CI, 0.86 kusvika 0.93), chero seti yakazara yevachengeti uye veimba covariates vaive zvakare. as the village fixed effects (Table 3) .Vana vakashandisa mambure akarapwa pakushanya kwokutanga vaiva ne43% yengozi yakaderera yerufu zvichienzaniswa nevana vakashandisa mambure akarapwa panguva isingasviki hafu yekushanya kwavo (hazard ratio, 0.57; 95% CI, 0.45 kusvika 0.72).Saizvozvowo, vana vanogara vakarara vasina mambure akarapwa vane mikana yakaderera yerufu ne46% pane vana vasina kumbobvira varara nemambure (hazard ratio, 0.54; 95% CI, 0.39 to 0.74).Pachikamu chemusha, a 10-muzana-peji yekuwedzera mukurapwa kwemuridzi wemubhedha wakabatanidzwa ne9% yakaderera njodzi yerufu (hazard ratio, 0.91; 95% CI, 0.82 kusvika 1.01).
Kushandiswa kwemambure akarapwa panguva inokwana hafu yekushanya kwehupenyu hwepakutanga kwakanzi kwakabatana nehuwandu hwenjodzi ye0.93 (95% CI, 0.58 kusvika 1.49) parufu kubva pazera re5 kusvika pakukura (Table 3). nguva kubva ku1998 kusvika ku2003, patakagadzirisa zera, dzidzo yevachengeti, mari yemhuri uye hupfumi, gore rekuzvarwa uye musha wekuzvarwa (Table S3).
Tafura S4 inoratidza surrogate propensity zvibodzwa uye chaiyo match estimates edu maviri mabhinari exposure variables, uye zvabuda zvinenge zvakafanana nezviri paTable 3.Table S5 inoratidza misiyano mukupona inorongwa nenhamba yekushanya kwekutanga.Pasinei nekuona zvishoma kweinenge ina mana. kushanya kwekutanga, iyo inofungidzirwa kudzivirira inoita seyakakura kune vana vane kushanya kwakawanda kupfuura kune vana vane kushanya kushoma.Tafura S6 inoratidza mhedzisiro yekuongororwa kwenyaya yakazara;mhinduro idzi dzakada kufanana nedzekuongorora kwedu kukuru, zvine humbowo hwakati tsvikiti hwefungidziro yemumusha.
Kunyange zvazvo kune uchapupu hwakasimba hwokuti mambure akabatwa anogona kuvandudza mararamiro evana vari pasi pemakore mashanu, zvidzidzo zvenguva refu zvinoramba zvisingasviki, kunyanya munzvimbo dzine huwandu hwehutachiwana hwehutachiwana.20 Zvigumisiro zvedu zvinoratidza kuti vana vane zvikomborero zvakakosha zvenguva refu kurapwa mambure.Izvi mhedzisiro dzakasimba pane yakafara empirical tsika uye dzinoratidza kuti kunetseka pamusoro pekuwedzera kwekufa muhudiki kana kuyaruka, izvo zvinogona kunge zvichikonzerwa nekunonoka kusimba kwesimba rekudzivirira kwemuviri, hazvina hwaro.Kunyangwe chidzidzo chedu chisina kuyera zvakananga kushanda kwe immune, kunogona kupikiswa kuti kupona kusvika munhu mukuru munzvimbo dzine marariya irwo pacharwo chiratidzo chekushanda kwekudzivirira.
Kusimba kwechidzidzo chedu kunosanganisira saizi yemuenzaniso, iyo yaisanganisira vanopfuura 6500 vana;nguva yekutevera, iyo yaireva makore gumi nematanhatu;chiyero chisingatarisirwi chekurasikirwa kwekutevera (11%);uye kuwirirana kwemigumisiro pane kuongorora.Chiyero chepamusoro chekutevera chinogona kunge chiri chikonzero chekusanganiswa kusina kujairika kwezvinhu, zvakadai sekushandiswa kwakapararira kwemafoni efoni, kubatana kwevanhu vekumaruwa munzvimbo yekudzidza, uye kudzika uye kushamwaridzana kwakanaka. hukama hwakagadziridzwa pakati pevaongorori nevanhu veko.Community via HDSS.
Pane zvimwe zvinogumira pakudzidza kwedu, kusanganisira kushomeka kwekutevera kubva muna 2003 kusvika 2019;hapana ruzivo rwevana vakafa vasati vashanya kwekutanga kudzidza, izvo zvinoreva kuti huwandu hwekupona hwemapoka haumiriri zvakakwana kune vese vanozvarwa panguva imwe chete;uye kuongorora kwekucherechedza.Kunyange kana muenzaniso wedu une nhamba yakawanda yevakoriates, kuvhiringidzika kwakasara hakugoni kubviswa kunze.Tichifunga izvi zvisingakwanisi, tinokurudzira kuti mamwe tsvakurudzo anodiwa pamusoro pemigumisiro yenguva refu inoshandiswa kushandiswa kwemambure emubhedha uye kukosha kwehutano hwevanhu. zvemambure asina kurapwa, kunyanya zvichipiwa zviri kunetsa pari zvino pamusoro pekurwisa kwezvipembenene.
Ongororo yekurarama kwenguva refu iyi ine chekuita nekudzivirira marariya kwevana vachiri vadiki inoratidza kuti nekuvharirwa kuri pakati nepakati munharaunda, mabhenefiti ekuraramiswa nemambure ane mishonga yezvipembenene akanyanya uye anoramba achikura kusvika munhu mukuru.
Kuunganidzwa kwedata panguva yekutevera kwa2019 naProf. Eckenstein-Geigy uye rutsigiro kubva 1997 kusvika 2003 neSwiss Agency for Development and Cooperation uye Swiss National Science Foundation.
Iro fomu rekuburitsa pachena rakapihwa nevanyori rinowanikwa nezvinyorwa zvizere zvechinyorwa ichi paNEJM.org.
Chirevo chekugovanisa data chakapihwa nevanyori chinowanikwa nemashoko akazara echinyorwa ichi paNEJM.org.
Kubva kuSwitzerland Tropical uye Public Health Institute uye University of Basel, Basel, Switzerland (GF, CL);Ifakara Health Institute, Dar es Salaam, Tanzania (SM, SA, RK, HM, FO);Columbia University, New York Mailman School of Public Health (SPK);uye London School of Hygiene and Tropical Medicine (JS).
Dr. Fink anogona kubatwa pa [email protected] kana kuSwiss Institute for Tropical and Public Health (Kreuzstrasse 2, 4123 Allschwil, Switzerland).
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