nūhou

E hoʻomākaukau e lilo i kauka, kūkulu i kou ʻike, alakaʻi i kahi hui mālama ola, a holomua i kāu ʻoihana me ka ʻike a me nā lawelawe a NEJM Group.
Ua manaʻo ʻia ma nā wahi hoʻoili kiʻekiʻe, hiki ke hoʻopaneʻe ka mālama ʻana i ka maʻi malaria i ka wā kamaliʻi (<5 mau makahiki) i ka loaʻa ʻana o ka palekana hana a hoʻololi i ka make o ke keiki mai ka ʻōpio a i ka nui.
Ua hoʻohana mākou i ka ʻikepili mai kahi noiʻi cohort prospective 22-makahiki ma ke kua'āina hema o Tanzania e hoʻohālikelike i ka hui ma waena o ka hoʻohana mua ʻana i nā ʻupena i mālama ʻia a me ke ola ʻana a hiki i ke kanaka makua. ka haʻawina lōʻihi mai 1998 a 2003. Ua hōʻoia ʻia nā hopena ola o ka poʻe makua ma 2019 e ke kaiāulu a me nā kelepona kelepona paʻa.
He 6706 mau keiki i kākau inoa ʻia. I ka makahiki 2019, ua hōʻoia mākou i ka ʻike kūlana koʻikoʻi no 5983 mau mea komo (89%). Wahi a nā hōʻike mai nā kipa mua ʻana o ke kaiāulu, ma kahi o kahi hapaha o nā keiki ʻaʻole i hiamoe ma lalo o kahi ʻupena i mālama ʻia, ʻo ka hapalua i hiamoe ma lalo o kahi mālama ʻia. upena i kekahi manawa, a moe mau ka hapaha i koe malalo o ka upena lapaau.Moe ma lalo o ka mālama ʻiaʻupena makika.ʻO ka ratio hazard i hōʻike ʻia no ka make he 0.57 (95% confidence interval [CI], 0.45 to 0.72). emi iho ma mua o ka hapalua o nā kipa ʻana. ʻO ka ratio hazard pili ma waena o nā makahiki 5 a me ke kanaka makua he 0.93 (95% CI, 0.58 a 1.49).
Ma kēia haʻawina lōʻihi o ka hoʻomalu ʻana i ka maʻi maʻi mua ma nā wahi hoʻouna kiʻekiʻe, ua mau nā pōmaikaʻi ola o ka hoʻohana mua ʻana i nā ʻupena i mālama ʻia a hiki i ka wā makua.
ʻO ka maʻi malaria ke kumu nui o ka maʻi a me ka make ma ka honua. ʻO nā ʻupena i mālama ʻia ka iwi kuamoʻo o ka maʻi malaria mai ka 2000 Abuja Declaration 2. ʻO kahi moʻolelo o nā hoʻokolohua cluster-randomized i hana ʻia i nā makahiki 1990 i hōʻike ʻia he pōmaikaʻi ola nui nā ʻupena i mālama ʻia no nā keiki ma lalo o 5 mau makahiki.3 Ma muli o ka nui- ka māhele ʻana, 2019.1 46% o ka poʻe maʻi maʻi ma lalo o Saharan ʻApelika e moe ana i nā ʻupena makika i mālama ʻia.
I ka puka ʻana mai o nā hōʻike i nā makahiki 1990 o ka pōmaikaʻi ola o nā ʻupena i mālama ʻia no nā keiki liʻiliʻi, ua manaʻo ʻia ʻo nā hopena lōʻihi o nā ʻupena i mālama ʻia ma ke ola ʻana ma nā wahi hoʻouna kiʻekiʻe e emi iho ma mua o nā hopena pōkole, a hiki paha ke lilo. maikaʻi ʻole, ma muli o ka loaʻa ʻana o ka palekana hana.lohi pili.4-9 Eia naʻe, ua kaupalena ʻia nā hōʻike i paʻi ʻia e pili ana i kēia pukana i ʻekolu mau haʻawina mai Burkina Faso, Ghana,11 me ka hahai ʻana ʻaʻole i oi aku ma mua o 7.5 makahiki a me Kenya.12 ʻAʻohe o kēia mau puke i hōʻike i ka hōʻike ʻana o ka hoʻololi ʻana o ke keiki. ka make mai ka ʻōpio a hiki i ka ʻelemakule ma muli o ka hoʻomalu ʻana i ka maʻi maʻi maʻi. Maʻaneʻi, hōʻike mākou i ka ʻikepili mai kahi noiʻi cohort prospective 22-makahiki ma ka ʻaoʻao hema o Tanzania e hoʻohālikelike i ka pilina ma waena o ka hoʻohana ʻana i nā ʻupena makika i mālama ʻia a me ke ola ʻana i ka wā makua.
Ma kēia haʻawina koho koho, hahai mākou i nā keiki mai ka wā kamaliʻi a hiki i ka wā makua. Ua ʻae ʻia ke aʻo ʻana e nā papa loiloi etika kūpono ma Tanzania, Switzerland a me United Kingdom. Ua hāʻawi nā mākua a kahu paha o nā keiki liʻiliʻi i ka ʻae waha i ka ʻikepili i hōʻiliʻili ʻia ma waena o 1998 a me 2003 .Ma 2019, ua loaʻa iā mākou ka ʻae kākau ʻana mai nā poʻe i nīnau ʻia i ke kino a me ka ʻae waha mai nā poʻe i nīnau ʻia ma ke kelepona.
Ua mālama ʻia kēia noiʻi ʻana ma ka Ifakara Rural Health and Demographic Surveillance Site (HDSS) ma nā ʻāpana Kilombero a me Ulanga o Tanzania. loaʻa me ka kikokikona piha o kēia ʻatikala ma NEJM.org). Ua komo nā keiki a pau i hānau ʻia e ka poʻe noho HDSS ma waena o Ianuali 1, 1998, a me ʻAukake 30, 2000 i ke aʻo ʻana o ka cohort longitudinal i nā kipa home i kēlā me kēia 4 mahina ma waena o Mei 1998 a me ʻApelila 2003. Mai ka makahiki 1998 a hiki i 2003, ua loaʻa i nā poʻe komo nā kipa HDSS i kēlā me kēia 4 mahina (Fig. S2). ma o ke kaiaulu kaiaulu a me nā kelepona, e hōʻoia ana i ke kūlana ola o nā mea a pau i komo, kūʻokoʻa i kahi o ka noho a me nā moʻolelo HDSS. Ke hilinaʻi nei ka noiʻi i kaʻikeʻohana i hāʻawiʻia ma ke kākau inoa. ʻO nā lālā o ka ʻohana mua o kēlā me kēia hui, me ka lā hānau a me ke alakaʻi kaiāulu ke kuleana o ka ʻohana i ka manawa o ke kākau inoa ʻana.
Me ke kākoʻo o ka Swiss Agency for Development and Cooperation a me ke Aupuni o United Republic of Tanzania, ua hoʻokumu ʻia kahi papahana e alakaʻi i ka noiʻi e pili ana i nā ʻupena makika i mālama ʻia ma ka wahi aʻo ma 1995.14 Ma 1997, kahi papahana kūʻai kaiaulu e pili ana i ka hāʻawi ʻana, hoʻolaha. a me ka hoʻihoʻi ʻana i kekahi hapa o ke kumu kūʻai o nā ʻupena, ua hoʻokomo ʻia ka lāʻau lapaʻau ʻupena.15 Ua hōʻike ʻia kahi haʻawina hoʻopaʻa ʻana i nā ʻupena i hoʻopili ʻia me ka piʻi ʻana o 27% o ke ola o nā keiki mai 1 mahina a 4 mau makahiki (95% confidence interval [CI], 3 a 45).15
ʻO ka hopena mua, ʻo ke ola ʻana i hōʻoia ʻia i ka wā o nā kipa home. hoʻohana i nā makahiki mua”). Ua kālailai mākou i ka loaʻa ʻana o ka pūnaewele ma ka hoʻohana pākahi a me nā pae kaiāulu. ma lalo o ka ʻupena i ka pō ma mua, a inā pēlā, inā a i ka wā i hoʻohana ʻia ai ka ʻupena- Ka lawelawe ʻana a holoi ʻana paha. Ua hōʻuluʻulu mākou i ka ʻike mua ʻana o kēlā me kēia keiki i nā ʻupena i mālama ʻia e like me ka pakeneka o nā kipa i hōʻike ʻia e hiamoe ana nā keiki ma lalo o nā ʻupena mālama ʻia. .No ka mea nona ka oihana lapaau pae kauhale, ua hui makou i na mooolelo hale a pau i ohi ia mai ka makahiki 1998 a hiki i ka makahiki 2003 e helu ai i ka nui o na hale o kela a me keia kauhale nona ka oihana lapaau hookahi ma ka makahiki.
Ua hōʻiliʻili ʻia ka ʻikepili e pili ana i ka malaria parasitemia i ka makahiki 2000 ma ke ʻano he papahana kiaʻi piha no ka lāʻau hui antimalarial. , 2001, 2002, 2004, 2005 makahiki a me 2006.16
No ka hoʻonui ʻana i ka maikaʻi o ka ʻikepili a me ka hoʻopiha piha ʻana o ka hahai ʻana i ka makahiki 2019, ua kiʻi a hoʻomaʻamaʻa mākou i kahi hui o nā nīnauele akamai i loaʻa mua i ka ʻike kūloko. Ua hoʻohana ʻia ka helu helu ʻana me ka hoʻohana ʻana i nā kaulahao no ka nalo ʻana o ka ʻikepili covariate i kā mākou hopena mua. ʻano i koho ʻia.
Ua hoʻokomo ʻia nā ʻikepili wehewehe mua i nā kipa ukali a me ka make ma muli o ke kāne, ka makahiki hānau, ka hoʻonaʻauao kahu, a me ka ʻāpana kālā o ka home. Ua manaʻo ʻia ka make ma ke ʻano he make no 1000 kanaka-makahiki.
Hāʻawi mākou i ka ʻikepili e pili ana i ka loli ʻana o ka ʻupena pūnaewele i ka wā. i ka makahiki 2000.
No ka hoʻohālikelike ʻana i ka pilina ma waena o ka hoʻohana ʻana i ka ʻupena a me ke ola lōʻihi, ua manaʻo mua mākou i ka hoʻoponopono ʻole ʻia ʻana o ka maʻamau ola Kaplan-Meier e hoʻohālikelike ana i nā keiki i hōʻike ʻia e hiamoe ana ma lalo o ka ʻupena i mālama ʻia ma ka liʻiliʻi o 50% o nā kipa mua me kēlā hopena ola. ʻupena makika ma lalo o 50% o nā kipa mua ʻana. Ua koho ʻia ka 50% cutoff e kūlike i ka wehewehe maʻalahi "ka hapa nui o ka manawa". survival curves hoʻohālikelike i nā keiki i hōʻike mau i ka hiamoe ma lalo o ka ʻupena mālama ʻia me ka poʻe i hōʻike ʻole i ka hiamoe ma lalo o ka ʻupena mālama ʻia Nā hopena ola o nā keiki ma lalo o ka ʻupena.Ua manaʻo mākou i hoʻoponopono ʻole ʻia ʻo Kaplan-Meier i kēia mau ʻokoʻa ma hope o ka manawa holoʻokoʻa (0 a 20 mau makahiki) a me ka wā kamaliʻi (5 a 20 mau makahiki). ua hopena i ka ʻoki ʻana hema a me ka censoring ʻākau.
Ua hoʻohana mākou i nā hiʻohiʻona o Cox proportional hazards no ka hoʻohālikelike ʻana i ʻekolu mau ʻokoʻa nui o ka hoihoi, e pili ana i nā mea huikau i ʻike ʻia - ʻo ka mua, ʻo ka hui ma waena o ke ola a me ka pākēneka o nā kipa i ʻōlelo ʻia e moe ai nā keiki ma lalo o nā ʻupena i mālama ʻia;ʻO ka lua, ʻO nā ʻokoʻa o ke ola ʻana ma waena o nā keiki i hoʻohana i nā ʻupena i mālama ʻia ma mua o ka hapalua o kā lākou kipa ʻana a me ka poʻe i hoʻohana i nā ʻupena i mālama ʻia ma lalo o ka hapalua o kā lākou kipa ʻana;ʻO ke kolu, ʻo nā ʻokoʻa o ke ola ma waena o nā keiki i hōʻike mau ʻia e hiamoe ana i kā lākou kipa mua ʻana Ma lalo o nā ʻupena makika i mālama ʻia, ʻaʻole i hōʻike nā keiki i ka hiamoe ʻana ma lalo o nā ʻupena mālama ʻia i kēia mau kipa ʻana. Ua hana ʻia e hōʻoia i ka lawa o kēia manaʻo linearity. Ua hoʻohana ʻia ʻo Schoenfeld koena analysis17 e hoʻāʻo i ka manaʻo pōʻino like ʻole. ʻano hoʻonaʻauao, ke kāne o ke keiki, a me ka makahiki o ke keiki. hānau ʻia. Ua komo pū nā ʻano multivariate āpau i 25 mau ʻāpana kūʻokoʻa kauhale, i ʻae iā mākou e kāpae i nā ʻokoʻa ʻōnaehana i nā kumu kūlana kauhale i ʻike ʻole ʻia e like me nā confounders. i ke kumu hoʻohālike i koho ʻia, ua koho pū mākou i ʻelua mau ʻokoʻa binary me ka hoʻohana ʻana i nā kernels, calipers a me nā algorithm pili pono.
Ma muli o ka hoʻohana mua ʻana i nā ʻupena i mālama ʻia e hiki ke wehewehe ʻia e nā ʻano ʻohana i mālama ʻole ʻia e like me ka ʻike olakino a i ʻole ka hiki i ke kanaka ke komo i nā lawelawe lapaʻau, ua manaʻo pū mākou i kahi kumu hoʻohālike o ke kauhale ma ke ʻano he ʻehā. ka pae awelika o ka home nona nā ʻupena i mālama ʻia (hoʻokomo ʻia ma ke ʻano he huaʻōlelo laina) i nā makahiki 3 mua i ʻike ʻia ai nā keiki ma ke ʻano o kā mākou hoʻololi mua. no laila, e emi iho ka hopena o ka huikau. Ma ke ano manao, pono e loaa i ka hoonui ana i ka uhi pae kauhale ka hopena pale nui ma mua o ka hoonui ana i ka uhi kanaka ma muli o ka nui o ka hopena o ka namu a me ka ma'i malaria.18
No ka helu ʻana i ka mālama ʻana i ka ʻupena pae kauhale a me ka hoʻoponopono ʻana i ka pae kauhale ma ke ʻano maʻamau, ua helu ʻia nā hewa maʻamau me ka hoʻohana ʻana i ka cluster-robust variance estimator a Huber. hoʻoponopono ʻia no ka lehulehu, no laila ʻaʻole pono e hoʻohana ʻia nā wā āpau e ʻike i nā hui i hoʻokumu ʻia.no laila, ʻaʻohe P-waiwai i hōʻike ʻia. Ua hana ʻia ka ʻikepili helu me ka hoʻohana ʻana i ka polokalamu Stata SE (StataCorp) version 16.0.19
Mai Mei 1998 a hiki i ʻApelila 2003, ua hoʻokomo ʻia ka huina o 6706 mau mea i hānau ma waena o Ianuali 1, 1998 a me ʻAukake 30, 2000 i loko o ka hui (Figure 1). Mei 1998 a me ʻApelila 2003, 424 poʻe i make. 6.3 make no 1000 kanaka-makahiki.
E like me ka mea i hōʻike ʻia ma ka Papa 1, ua kaulike ke kāne;ma ka awelika, ua kākau inoa ʻia nā keiki ma mua o ka piha ʻana i hoʻokahi makahiki a hahai ʻia no nā makahiki 16. Ua pau ka hapa nui o nā kahu mālama i ka hoʻonaʻauao mua, a ua hiki i ka hapa nui o nā hale ke komo i ka paipa a i ʻole ka wai puna. ʻO ka helu o nā make no 1000 kanaka-makahiki ka mea haʻahaʻa loa i waena o nā keiki me nā kahu hoʻonaʻauao kiʻekiʻe (4.4 no 1000 kanaka-makahiki) a ʻoi aku ka kiʻekiʻe ma waena o nā keiki i ʻoi aku ma mua o 3 mau hola mai kahi hale lapaʻau (9.2 no 1000 kanaka-makahiki) a me waena. nā ʻohana nele i ka ʻike e pili ana i ka hoʻonaʻauao (8.4 no 1,000 kanaka-makahiki) a i ʻole loaʻa kālā (19.5 no 1,000 kanaka-makahiki).
ʻO ka papa 2 ka hōʻuluʻulu ʻana i nā ʻano hoʻololi nui. Ma kahi o ka hapaha o ka poʻe i komo i ke aʻo ʻana i hōʻike ʻia ʻaʻole i hiamoe ma lalo o kahi ʻupena i mālama ʻia, hōʻike ʻia kekahi hapaha e hiamoe ana ma lalo o kahi ʻupena i mālama ʻia i kēlā me kēia mākaʻikaʻi mua, a ʻo ke koena hapa i hiamoe ma lalo o kekahi akā ʻaʻole i hōʻike ʻia e hiamoe ana ma lalo o ka mālama ʻia. ʻO ka hapa o nā keiki e moe mau ana ma lalo o nā ʻupena makika i mālama ʻia, ua hoʻonui ʻia mai ka 21% o nā keiki i hānau ʻia i ka makahiki 1998 a i ka 31% o nā keiki i hānau ʻia i ka makahiki 2000.
Hāʻawi ka Papa S2 i nā kikoʻī hou aku e pili ana i nā ʻano holoʻokoʻa o ka hoʻohana ʻana i ka pūnaewele mai 1998 a 2003. ʻOiai ua hōʻike ʻia he 34% o nā keiki i hiamoe ma lalo o nā ʻupena makika i mālama ʻia i ka pō ma mua o ka makahiki 1998, ma ka makahiki 2003 ua hoʻonui ʻia kēlā helu i 77%. Hōʻike ka Figure S3 i ka. ʻO ke alapine o ka hoʻohana ʻana i mālama ʻia i ka wā mua. Hōʻike ka S4 i ka loli kiʻekiʻe o ka ʻona, me ka liʻiliʻi o 25% o nā ʻohana i mālama i nā ʻupena ma ke kauhale ʻo Iragua i ka makahiki 1998, ʻoiai ma nā kauhale ʻo Igota, Kivukoni a me Lupiro, ʻoi aku ma mua o 50% o nā ʻohana. ʻupena mālama ʻia i ka makahiki hoʻokahi.
Hōʻike ʻia nā pihi ola ʻo Kaplan-Meier i hoʻoponopono ʻole ʻia. Hoʻohālikelike nā panela A a me C i nā ala ola (ʻaʻole i hoʻoponopono ʻia) o nā keiki i hōʻike i ka hoʻohana ʻana i nā ʻupena i mālama ʻia no ka hapalua o ka helu o nā kipa i ka poʻe i hoʻohana pinepine ʻole. hōʻike ʻia e hiamoe ana ma lalo o nā ʻupena i mālama ʻia (23% o ka hāpana) me ka poʻe i hōʻike mau i ka hiamoe ma lalo o nā ʻupena i mālama ʻia (25% o ka hāpana).hoʻoponopono) track. Hōʻike ka inset i ka ʻikepili like ma kahi axis i hoʻonui ʻia.
Kiʻi 2 Ka hoʻohālikelike ʻana i nā ala e ola ai nā mea komo i ka wā makua ma muli o ka hoʻohana mua ʻana i nā ʻupena i mālama ʻia, me ka helu ʻana o ke ola no ka manawa holoʻokoʻa (Nā Kiʻi 2A a me 2B) a me nā pihi ola i hoʻonohonoho ʻia i ke ola ʻana a hiki i 5 mau makahiki (Nā Kiʻi 2C a me 2D).A ʻo ka huina o 604 mau make i hoʻopaʻa ʻia i ka wā aʻo;485 (80%) i nā makahiki 5 mua o ke ola. Ua piʻi ka nui o ka make i ka makahiki mua o ke ola, ua emi koke a hiki i ka makahiki 5, a laila noho haʻahaʻa, akā ua hoʻonui iki i ka makahiki 15 (Fig. S6). hoʻokahi pākēneka o nā mea komo i hoʻohana mau i nā ʻupena i mālama ʻia i ola a hiki i ka wā makua;ʻO kēia hoʻi ka hihia no 80% wale nō o nā keiki i hoʻohana ʻole i nā ʻupena i mālama ʻia i ka wā ma mua (Table 2 a me Figure 2B). , ~ 0.63) a me nā keiki 5 makahiki a ʻoi paha (ka helu hoʻohālikelike, ~ 0.51) (Fig. S5).).
ʻO kēlā me kēia 10-pakeneka-helu piʻi i ka hoʻohana mua ʻana i nā ʻupena i mālama ʻia ua pili pū me ka 10% haʻahaʻa o ka make (hazard ratio, 0.90; 95% CI, 0.86 a i 0.93), hāʻawi ʻia ka pūʻulu piha o nā kahu mālama a me nā covariates home. e like me nā hopena paʻa o ke kauhale (Table 3). ʻO nā keiki i hoʻohana i nā ʻupena i mālama ʻia i nā kipa mua ʻana he 43% ka haʻahaʻa o ka make ma mua o nā keiki i hoʻohana i nā ʻupena i mālama ʻia ma lalo o ka hapalua o kā lākou kipa ʻana (hazard ratio, 0.57; 95% CI, 0.45 a hiki i 0.72).Pēlā hoʻi, ʻo nā keiki e moe mau ana ma lalo o nā ʻupena mālama ʻia, he 46% ka haʻahaʻa o ka make ma mua o nā keiki i moe ʻole ma lalo o ka ʻupena (hazard ratio, 0.54; 95% CI, 0.39 a 0.74). Ma ka pae kauhale, he ʻO ka piʻi ʻana o ka ʻupena moe he 10% me ka 9% haʻahaʻa o ka make (hazard ratio, 0.91; 95% CI, 0.82 a 1.01).
ʻO ka hoʻohana ʻana i nā ʻupena i mālama ʻia i ka hapa liʻiliʻi o nā kipa mua o ke ola i hōʻike ʻia e pili ana me kahi lākiō pōʻino o 0.93 (95% CI, 0.58 a i 1.49) no ka make mai ka makahiki 5 a hiki i ke kanaka makua (Table 3). mai ka makahiki 1998 a hiki i ka makahiki 2003, ia makou i hooponopono ai no ka makahiki, ka hoonaauao kahu, ka loaa ana o ka hale a me ka waiwai, makahiki o ka hanau a me ke kauhale o ka hanau (Papa S3).
Hōʻike ka Papa S4 i nā helu propensity a me nā koho hoʻohālikelike pololei no kā mākou mau ʻokoʻa hoʻololi binary ʻelua, a ua aneane like nā hopena me nā mea ma ka Papa 3. Hōʻike ka Papa S5 i nā ʻokoʻa o ke ola i hoʻopaʻa ʻia e ka helu o nā kipa mua. nā kipa mua, ʻike ʻia ka hopena palekana i manaʻo ʻia i nā keiki me ka nui o nā kipa ʻana ma mua o nā keiki me ka liʻiliʻi o nā kipa. Hōʻike ka Papa S6 i nā hopena o ka loiloi hihia piha;ʻaneʻane like kēia mau hualoaʻa me nā mea o kā mākou loiloi nui, me ka ʻoi aʻe o ka pololei no nā kuhi pae kauhale.
ʻOiai aia nā hōʻike ikaika e hiki i nā ʻupena i mālama ʻia ke hoʻomaikaʻi i ke ola o nā keiki ma lalo o 5 mau makahiki, ʻaʻole liʻiliʻi nā haʻawina o nā hopena lōʻihi, ʻoi aku hoʻi ma nā wahi me ka nui o ka hoʻouna ʻana. Ua paʻa kēia mau hopena ma waena o nā loina empirical ākea a manaʻo ʻia he kumu ʻole nā ​​hopohopo e pili ana i ka piʻi ʻana o ka make ma hope o ka wā kamaliʻi a i ʻole ka wā ʻōpio, ʻo ia paha ke kumu o ka hoʻopaneʻe ʻana i ka hoʻomohala ʻana i ka immune. e hoʻopaʻapaʻa ʻia ʻo ke ola ʻana a hiki i ke kanaka makua ma nā wahi maʻi maʻi maʻi maʻi he hōʻike ia o ka pale ʻana i ka hana.
ʻO nā ikaika o kā mākou noiʻi ʻana e pili ana i ka nui o ka laʻana, ʻoi aku ka nui o nā keiki 6500;ka manawa hahai, he 16 makahiki ia;ka haʻahaʻa haʻahaʻa haʻahaʻa haʻahaʻa o ka pohō i ka hahai ʻana (11%);a me ke kūlike o nā hualoaʻa ma waena o nā kālailai. ʻO ka helu kiʻekiʻe o ka hahai ʻana ma muli paha o ka hui like ʻole o nā kumu, e like me ka hoʻohana nui ʻana o nā kelepona paʻa, ka hui ʻana o ke kaiāulu kuaʻāina i ka wahi aʻo, a me ka pilikanaka hohonu a maikaʻi. Ua ulu ka pilina ma waena o ka poʻe noiʻi a me ka poʻe kūloko. Kaiaulu ma o HDSS.
Aia kekahi mau palena o kā mākou noiʻi ʻana, me ka nele o ka hahai ʻana o kēlā me kēia kanaka mai 2003 a 2019;ʻaʻohe ʻike e pili ana i nā keiki i make ma mua o ka huakaʻi aʻo mua, ʻo ia hoʻi, ʻaʻole i hōʻike piha ʻia nā helu ola o ka cohort no nā hānau hānau a pau i ka manawa like;a me ka nānā ʻana. ʻOiai inā he nui nā covariates i kā mākou kumu hoʻohālike, ʻaʻole hiki ke kāpae ʻia ke koena huikau. o nā ʻupena moe i mālama ʻole ʻia, ʻoi aku ka nui o nā hopohopo e pili ana i kēia manawa e pili ana i ka pale ʻana i nā pepeke.
Ke hōʻike nei kēia haʻawina ola lōʻihi e pili ana i ka hoʻomalu ʻana i ka maʻi malaria i ka wā kamaliʻi me ka uhi ʻana o ke kaiāulu haʻahaʻa, ʻoi aku ka nui o nā pōmaikaʻi ola o nā ʻupena moe i mālama ʻia i nā pepeke a hoʻomau i ka wā makua.
ʻOhi ʻikepili i ka 2019 ka hahai ʻana e Prof. Eckenstein-Geigy a me ke kākoʻo mai 1997 a i 2003 e ka Swiss Agency for Development and Cooperation a me ka Swiss National Science Foundation.
Loaʻa ka palapala hōʻike i hāʻawi ʻia e nā mea kākau me ka kikokikona piha o kēia ʻatikala ma NEJM.org.
Loaʻa ka ʻōlelo hoʻoili ʻikepili i hāʻawi ʻia e nā mea kākau me ka kikokikona piha o kēia ʻatikala ma NEJM.org.
Mai Swiss Tropical and Public Health Institute a me ke Kulanui o Basel, Basel, Switzerland (GF, CL);Ifakara Health Institute, Dar es Salaam, Tanzania (SM, SA, RK, HM, FO);Ke Kulanui ʻo Columbia, New York Mailman School of Public Health (SPK);a me London School of Hygiene and Tropical Medicine (JS).
Hiki ke hoʻopili ʻia ʻo Dr. Fink ma [email protected] a i ʻole ma Swiss Institute for Tropical and Public Health (Kreuzstrasse 2, 4123 Allschwil, Switzerland).
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