nkhani

Konzekerani kukhala dokotala, pangani chidziwitso chanu, kutsogolera bungwe lazaumoyo, ndikupititsa patsogolo ntchito yanu ndi chidziwitso ndi ntchito za NEJM Group.
Zakhala zikuganiziridwa kuti m'malo opatsirana kwambiri, kuwongolera malungo muubwana (zaka zosachepera 5) kumatha kuchedwetsa kupeza chitetezo chogwira ntchito ndikusuntha kufa kwa ana kuyambira wamng'ono kupita wamkulu.
Tinagwiritsa ntchito deta kuchokera ku kafukufuku wazaka 22 wa anthu omwe akuyembekezeka kumidzi yakumwera kwa Tanzania kuti tiyerekeze mgwirizano pakati pa kugwiritsa ntchito maukonde ochiritsidwa mwamsanga ndi kupulumuka mpaka kukula. The longitudinal study from 1998 to 2003.Zotsatira za kupulumuka kwa akuluakulu zidatsimikiziridwa mu 2019 ndi anthu ammudzi ndi mafoni a m'manja.Tinagwiritsa ntchito zitsanzo za Cox proportional hazards kuti tiyerekeze mgwirizano pakati pa ubwana wogwiritsa ntchito maukonde ochiritsidwa ndi kupulumuka pauchikulire, zosinthidwa kuti zikhale zosokoneza.
Ana okwana 6706 analembetsa. ukonde nthawi ina, ndipo kotala yotsalayo nthawi zonse imagona pansi pa ukonde wothiridwa.Kugona pansi mankhwalamaukonde a udzudzu.Chiwerengero choopsa cha imfa chinali 0.57 (95% nthawi yodalirika [CI], 0.45 mpaka 0.72) zosakwana theka la maulendo.Chiyerekezo choopsa chofanana pakati pa zaka 5 ndi uchikulire chinali 0.93 (95% CI, 0.58 mpaka 1.49).
Pakafukufuku wanthawi yayitali wa matenda a malungo oyambilira m'malo opatsirana kwambiri, mapindu opulumuka akugwiritsa ntchito maukonde ochiritsidwa msanga adapitilirabe mpaka munthu wamkulu. (Mothandizidwa ndi Eckenstein-Geigy Professorship ndi ena.)
Malungo akadali omwe amayambitsa matenda ndi imfa padziko lonse lapansi.1 Mwa anthu 409,000 omwe amafa malungo mu 2019, oposa 90% amwalira ku sub-Saharan Africa, ndipo magawo awiri pa atatu aliwonse amafa ndi ana osakwanitsa zaka zisanu.1 Mankhwala ophera tizilombo- maukonde ochiritsidwa akhala msana wa kuletsa malungo kuyambira mu 2000 Abuja Declaration 2 . Mndandanda wa mayesero osankhidwa mwachisawawa omwe adachitika m'zaka za m'ma 1990 adawonetsa kuti maukonde ochiritsidwa anali ndi phindu lalikulu la kupulumuka kwa ana osakwana zaka zisanu.3 Makamaka chifukwa chachikulu- kugawa, 2019.1 46% ya anthu omwe ali pachiwopsezo cha malungo ku sub-Saharan Africa amagona mu maukonde othandizidwa ndi udzudzu
Monga umboni unawonekera mu 1990s wa phindu lopulumuka la maukonde ochiritsidwa kwa ana ang'onoang'ono, akuganiziridwa kuti zotsatira za nthawi yaitali za maukonde ochiritsidwa pakukhala ndi moyo m'malo opatsirana kwambiri zidzakhala zochepa kusiyana ndi zotsatira za nthawi yochepa, ndipo zikhoza kukhala zoipa, chifukwa cha phindu la kupeza chitetezo chokwanira.kuchedwa kogwirizana.4-9 Komabe, umboni wofalitsidwa pa nkhaniyi ndi maphunziro atatu ochokera ku Burkina Faso, Ghana, 11 ndi zotsatira zosaposa zaka 7.5 ndi Kenya. imfa kuyambira ang'ono mpaka ukalamba chifukwa cha kuletsa malungo aang'ono.Pano, timapereka lipoti la kafukufuku wazaka 22 wa anthu omwe akuyembekezeka kumidzi yakumwera kwa dziko la Tanzania kuti ayerekeze kugwirizana pakati pa ubwana wogwiritsa ntchito maudzu ochiritsidwa ndi kupulumuka pauchikulire.
Mu kafukufuku wamagulu amene akuyembekezeka, tidatsata ana kuyambira ali makanda mpaka akakula. Kafukufukuyu adavomerezedwa ndi mabungwe owunikiranso zamakhalidwe abwino ku Tanzania, Switzerland ndi United Kingdom.Makolo kapena olera a ana aang'ono adapereka chilolezo chapakamwa ku zomwe zidasonkhanitsidwa pakati pa 1998 ndi 2003 .Mu 2019, tidalandira chilolezo cholembedwa kuchokera kwa omwe adafunsidwa mwachindunji ndi chilolezo chapakamwa kuchokera kwa omwe adafunsidwa patelefoni.
Kafukufukuyu adachitika ku Ifakara Rural Health and Demographic Surveillance Site (HDSS) m'zigawo za Kilombero ndi Ulanga ku Tanzania.13 Malo ophunzirira poyamba anali ndi midzi ya 18, yomwe pambuyo pake idagawidwa kukhala 25 (Fig. S1 in Supplementary Appendix, likupezeka ndi mawu onse a nkhaniyi pa NEJM.org).Ana onse obadwa ku HDSS okhala pakati pa Januware 1, 1998, ndi Ogasiti 30, 2000 adachita nawo phunziro la gulu lotalikirapo pamaulendo akunyumba miyezi inayi iliyonse pakati pa Meyi 1998 ndi Epulo 2003. Kuchokera ku 1998 mpaka 2003, otenga nawo mbali adalandira maulendo a HDSS miyezi yonse ya 4 (mkuyu. S2) .Kuchokera ku 2004 mpaka 2015, kupulumuka kwa omwe akudziwika kuti akukhala m'derali adalembedwa muzoyendera za HDSS.Mu 2019, tinachita kafukufuku wotsatira. kudzera m'magulu a anthu ndi mafoni a m'manja, kutsimikizira kuti onse omwe atenga nawo mbali ali ndi moyo, osadalira malo okhala ndi zolemba za HDSS. Kafukufukuyu amadalira zambiri za banja zomwe zimaperekedwa polembetsa.Mudzi wa SS, kusonyeza mayina oyamba ndi omaliza a onse omwe kale anali m'banja la aliyense wotenga nawo mbali, pamodzi ndi tsiku lobadwa ndi mtsogoleri wamudzi yemwe ali ndi udindo wa banja panthawi yolembetsa. anthu ena ammudzi adadziwika kuti awathandize.
Mothandizidwa ndi Swiss Agency for Development and Cooperation ndi Boma la United Republic of Tanzania, pulogalamu yochita kafukufuku pa maukonde otetezedwa adakhazikitsidwa mdera lophunzirira mu 1995.14 Mu 1997, pulogalamu yotsatsa malonda yomwe cholinga chake chinali kugawa, kulimbikitsa ndikubwezeretsanso gawo la mtengo wa maukonde, adayambitsa chithandizo chamankhwala.15 Kafukufuku wopangidwa ndi zisa adawonetsa kuti maukonde ochiritsidwa amagwirizanitsidwa ndi kuwonjezeka kwa 27% kwa moyo wa ana a zaka za mwezi umodzi mpaka zaka 4 (95% nthawi yodalirika [CI], 3 mpaka 45).15
Chotsatira chachikulu chinali kutsimikizika kwa kupulumuka paulendo woyendera kunyumba. Kwa omwe adamwalira, zaka ndi chaka chomwalira zidatengedwa kuchokera kwa makolo kapena achibale ena. Kusintha kwakukulu kunali kugwiritsa ntchito ma neti oteteza udzudzu pakati pa kubadwa ndi zaka zisanu ("net kugwiritsa ntchito zaka zoyambilira”).Tidasanthula kapezekedwe ka maukonde pa kagwiritsidwe ntchito kayekha komanso anthu ammudzi. Pogwiritsa ntchito ma neti oteteza udzudzu, paulendo uliwonse wa kunyumba pakati pa 1998 ndi 2003, mayi wa mwanayo kapena womulera anafunsidwa ngati mayi kapena womulera mwanayo anagona. Pansi pa ukonde usiku watha, ndipo ngati zinali choncho, ngati ndi pamene ukonde unali mankhwala ophera tizilombo- Kugwira kapena kuchapa. .Pokhala eni ake ammudzi wa chithandizo chamankhwala, tinaphatikiza zolemba zonse zapakhomo kuyambira 1998 mpaka 2003 kuti tiwerengere kuchuluka kwa mabanja m'mudzi uliwonse omwe anali ndi netiweki imodzi yamankhwala ndi y.khutu.
Zokhudza malungo parasitemia zinasonkhanitsidwa mchaka cha 2000 monga gawo la ndondomeko yowunika bwino za chithandizo chamankhwala cholimbana ndi malungo. , 2001, 2002, 2004, 2005 Chaka ndi 2006.16
Kuti tiwonjezere kuchuluka kwa deta komanso kukwanira kotsatira mu 2019, tidalemba ndi kuphunzitsa gulu la ofunsa mafunso omwe anali kale ndi chidziwitso chambiri mdera lanu. Kwa mabanja ena, zambiri zokhudzana ndi maphunziro osamalira, ndalama zabanja, komanso nthawi yopita kuchipatala sizinalipo. Kuwerengera kangapo pogwiritsa ntchito ma equation a unyolo kunagwiritsidwa ntchito kuwerengera kusowa kwa data ya covariate muzotsatira zathu zoyambirira.Zosintha zonse zomwe zalembedwa mu Table 1 zinagwiritsidwa ntchito monga zolosera za izi.Kufufuza kowonjezereka kunachitidwa kuti zitsimikizire kuti zotsatirazo sizinali zokhudzidwa ndi kutengeka. njira yosankhidwa.
Ziwerengero zoyambirira zofotokozera zinaphatikizapo maulendo otsatila ndi imfa mwa kugonana, chaka chobadwa, maphunziro a olera, ndi gulu la ndalama zapakhomo.Kufa kumawerengedwa ngati imfa pazaka 1000 za munthu.
Timapereka chidziwitso cha momwe kufalikira kwa netiweki kwasinthira pakapita nthawi. Kuti tiwonetse ubale womwe ulipo pakati pa umwini wapakhomo wa mabedi ochiritsidwa ndi kufalitsa malungo, tidapanga gawo lalikulu la ukonde wothandizidwa ndi midzi komanso kufalikira kwa matenda am'midzi. mu 2000.
Kuti tiyerekeze kugwirizana pakati pa kugwiritsa ntchito ukonde ndi kukhala ndi moyo kwa nthawi yayitali, tidayerekeza poyamba makhoti osasinthika a Kaplan-Meier opulumuka kuyerekeza ana omwe akuti amagona pansi pa ukonde wothandizidwa ndi 50% ya maulendo oyambilira ndi zotsatira za kupulumuka. maukonde a udzudzu osakwana 50% ya maulendo oyambirira. The 50% cutoff anasankhidwa kuti agwirizane ndi tanthauzo losavuta "nthawi zambiri". kupulumuka kokhotakhota kuyerekeza ana omwe nthawi zonse amanena kuti amagona muukonde wochiritsidwa ndi omwe sananenepo kuti akugona pansi pa ukonde wothandizidwa Zotsatira za kupulumuka kwa ana pansi pa ukonde.Tinkayerekeza mapindikidwe osasinthika a Kaplan-Meier pazosiyanazi patatha nthawi yonseyo (zaka 0 mpaka 20) komanso ubwana (zaka 5 mpaka 20). Zowunikira zonse za kupulumuka zinali zochepa pa nthawi yapakati pa kuyankhulana koyamba ndi kafukufuku womaliza, womwe. zidapangitsa kutsika kumanzere ndikuwunika kumanja.
Tinagwiritsa ntchito zitsanzo za Cox proportional hazards kuti tiyese kusiyana kwakukulu katatu kochititsa chidwi, kokhazikika pa zosokoneza zowoneka-choyamba, mgwirizano pakati pa kupulumuka ndi kuchuluka kwa maulendo omwe ana akuti amagona pansi pa maukonde ochiritsidwa;chachiwiri, Kusiyana kwa kukhala ndi moyo pakati pa ana omwe amagwiritsa ntchito maukonde ochiritsidwa pa nthawi yoposa theka la maulendo awo ndi omwe amagwiritsa ntchito maukonde ochiritsidwa pa nthawi yosakwana theka la maulendo awo;chachitatu, kusiyana kwa kupulumuka pakati pa ana nthawi zonse kumasonyeza kuti akugona pa maulendo awo oyambirira Pansi pa maukonde otetezedwa ndi udzudzu, ana sananenepo kuti akugona pansi pa maukonde ochiritsidwa panthawiyi.Kwa mgwirizano woyamba, chiwerengero cha maulendo amawunikidwa ngati mzere wotsatira.A martingale residual analysis adachitidwa kuti atsimikizire kukwanira kwa lingaliro la mzerewu.Schoenfeld residual analysis17 anagwiritsidwa ntchito poyesa kulingalira koopsa kofanana. gulu la maphunziro, kugonana kwa mwana, ndi msinkhu wa mwana wobadwa.Zitsanzo zonse za multivariate zinaphatikizansopo njira 25 zokhudzana ndi midzi, zomwe zinatilola kuti tisakhale ndi kusiyana kwadongosolo muzinthu zapamudzi zomwe sizingawoneke ngati zosokoneza.Kuonetsetsa kulimba kwa zotsatira zoperekedwa ndi ulemu. ku mtundu wosankhidwa wa epirical, tidayerekezanso ma cont awiri a binaryma rasts pogwiritsa ntchito maso, ma calipers ndi ma aligorivimu ofananira ndendende.
Poganizira kuti kugwiritsa ntchito maukonde ochiritsidwa msanga kungafotokozedwe ndi makhalidwe omwe anthu a m'banja mwawo kapena olera sakuwaona monga chidziwitso cha zaumoyo kapena kuthekera kwa munthu kupeza chithandizo chamankhwala, tinayerekezanso chitsanzo chapamudzi ngati chosiyana chachinayi. Mulingo wapakatikati wa eni ake am'nyumba a maukonde otetezedwa (zolowera ngati mzere) m'zaka zitatu zoyambirira zomwe ana adawonedwa ngati kusintha kwathu. Chifukwa chake musakhudzidwe kwambiri ndi zosokoneza. Mwachidziwitso, kuwonjezeka kwa kufalikira kwa midzi kuyenera kukhala ndi chitetezo chachikulu kuposa kuonjezera chitetezo cha munthu payekha chifukwa cha zotsatira zazikulu pa udzudzu ndi kufalitsa malungo.18
Kuwerengera za chithandizo chamankhwala ammudzi komanso kulumikizana kwapamudzi mochulukira, zolakwika zokhazikika zidawerengedwa pogwiritsa ntchito estimator ya Huber ya cluster-robust variance. zosinthidwa kuti zichuluke, kotero kuti nthawizo zisagwiritsidwe ntchito poyesa mayanjano okhazikitsidwa.Kusanthula kwathu koyamba sikunatchulidwe;chifukwa chake, palibe ma P-values ​​omwe adanenedwa.Kusanthula kwachiwerengero kudachitika pogwiritsa ntchito pulogalamu ya Stata SE (StataCorp) mtundu 16.0.19
Kuyambira May 1998 mpaka April 2003, chiwerengero cha anthu 6706 omwe anabadwa pakati pa January 1, 1998 ndi August 30, 2000 anaphatikizidwa mu gulu (Chithunzi 1) . Mu Meyi 1998 ndi Epulo 2003, otenga nawo mbali 424 adamwalira. 6.3 amafa pazaka 1000 zamunthu.
Monga momwe tawonetsera mu Table 1, chitsanzocho chinali choyenera pakati pa amuna ndi akazi;pa avareji, ana analembedwa atangokwanitsa chaka chimodzi ndipo amatsatira kwa zaka 16. Olera ambiri amaliza maphunziro a pulaimale, ndipo mabanja ambiri ali ndi mwayi wopeza madzi apampopi kapena a m’chitsime.Table S1 imapereka zambiri zokhudza kuimira chitsanzo cha phunzirolo. chiwerengero cha imfa pa zaka 1000 munthu chinali chotsika kwambiri pakati pa ana omwe ali ndi olera ophunzira kwambiri (4.4 pa zaka 1000 za munthu) komanso okwera kwambiri mwa ana omwe anali kutali ndi maola atatu kuchokera kuchipatala (9.2 pa zaka 1000 za anthu) ndi Pakati mabanja opanda chidziwitso cha maphunziro (8.4 pa 1,000 munthu zaka) kapena ndalama (19.5 pa 1,000 munthu zaka).
Table 2 ikufotokoza mwachidule zosintha zazikuluzikulu zowonekera. Pafupifupi kotala la ochita nawo kafukufuku akuti sanagone pansi pa ukonde wothandizidwa, gawo lina linanena kuti amagona pansi pa ukonde wothandizidwa nthawi iliyonse yoyambira, ndipo theka lotsalalo limagona pansi pa ena koma osati onse Amati akugona mopanda chithandizo. Ma neti oteteza udzudzu pa nthawi yoyendera.Chiwerengero cha ana omwe nthawi zonse amagona pansi pa maukonde otetezedwa adakwera kuchoka pa 21% ya ana omwe anabadwa mu 1998 kufika pa 31% ya ana omwe anabadwa mu 2000.
Table S2 ikupereka tsatanetsatane wa kagwiritsidwe ntchito ka maukonde kuyambira 1998 mpaka 2003. Chithunzi cha S4 chikuwonetsa kusiyana kwakukulu kwa umwini, pomwe mabanja ochepera 25% adathira makoka m'mudzi wa Iragua mchaka cha 1998, pomwe m'midzi ya Igota, Kivukoni ndi Lupiro, mabanja opitilira 50% anali ndi makoka ochiritsa mchaka chomwecho.
Zokhotakhota zosasinthika za Kaplan-Meier zikuwonetsedwa.Panelo A ndi C amafananiza njira (zosasinthika) za kupulumuka kwa ana omwe adanena kuti akugwiritsa ntchito maukonde ochiritsidwa kwa osachepera theka la chiwerengero cha maulendo kwa omwe sagwiritsa ntchito kawirikawiri. adanenanso kuti amagona muukonde wothiridwa mankhwala (23% ya zitsanzo) ndi omwe nthawi zonse amanena kuti akugona pansi pa maukonde ochiritsidwa (25% ya zitsanzo).sintha) njanji.Cholembacho chikuwonetsa deta yomweyi pa y-axis yokulirapo.
Chithunzi 2 Kuyerekeza njira zopulumutsira otenga nawo gawo ku ukalamba kutengera kugwiritsa ntchito maukonde ochiritsidwa msanga, kuphatikiza kuyerekeza kupulumuka kwa nthawi yonseyo (Zithunzi 2A ndi 2B) ndi mapindikidwe opulumuka omwe amakhala ndi moyo mpaka zaka 5 (Zithunzi 2C ndi 2D). chiwerengero cha imfa za 604 zinalembedwa panthawi yophunzira;485 (80%) inachitika m'zaka zoyambirira za moyo wa 5. Chiwopsezo cha imfa chinafika m'chaka choyamba cha moyo, chinatsika mofulumira mpaka zaka 5, kenako chinakhalabe chochepa, koma chinawonjezeka pang'ono pa zaka pafupifupi 15 (mkuyu S6) . mmodzi mwa anthu 100 alionse amene ankagwiritsa ntchito maukonde ochiritsidwa anapulumuka mpaka atakula;Izi zinali chonchonso kwa ana 80 pa 100 alionse amene sanagwiritse ntchito maukonde ochiritsidwa msanga (Table 2 ndi Chithunzi 2B). Kuchuluka kwa majeremusi mchaka cha 2000 kunali kogwirizana kwambiri ndi maukonde omangika a m'mabanja a ana osakwana zaka zisanu (correlation coefficient). , ~ 0.63) ndi ana a zaka 5 kapena kuposerapo (kugwirizanitsa coefficient, ~ 0.51) (mkuyu S5).).
Kuwonjezeka kulikonse kwa 10 peresenti pakugwiritsa ntchito maukonde ochiritsidwa koyambirira kunagwirizanitsidwa ndi 10% chiopsezo chochepa cha imfa (chiwerengero choopsa, 0.90; 95% CI, 0.86 mpaka 0.93), malinga ndi chiwerengero chonse cha osamalira ndi ogwira nawo ntchito apakhomo. monga momwe mudzi unakhazikitsira zotsatira (Table 3) .Ana omwe ankagwiritsa ntchito maukonde ochiritsidwa pa maulendo oyambirira anali ndi chiopsezo chochepa cha imfa ndi 43% poyerekeza ndi ana omwe amagwiritsa ntchito maukonde ochiritsidwa pasanathe theka la maulendo awo (chiwerengero cha ngozi, 0.57; 95% CI, 0.45 mpaka 0.72) Momwemonso, ana omwe nthawi zonse amagona pansi pa maukonde otetezedwa anali ndi chiopsezo chochepa cha imfa ndi 46% kusiyana ndi ana omwe sanagonepo ndi maukonde (hazard ratio, 0.54; 95% CI, 0.39 mpaka 0.74). Kuwonjezeka kwa 10-peresenti pa umwini wa ukonde wothandizidwa kumalumikizidwa ndi 9% kutsika kwachiwopsezo cha kufa (chiwerengero chowopsa, 0.91; 95% CI, 0.82 mpaka 1.01).
Kugwiritsiridwa ntchito kwa maukonde ochiritsidwa pazaka zosachepera theka la maulendo oyambirira a moyo kunanenedwa kuti kumagwirizanitsidwa ndi chiwopsezo cha 0.93 (95% CI, 0.58 mpaka 1.49) pa imfa kuyambira zaka 5 mpaka kukula (Table 3). kuyambira 1998 mpaka 2003, pamene tidasinthira zaka, maphunziro a olera, ndalama zapakhomo ndi chuma, chaka chobadwa ndi mudzi wobadwira (Table S3).
Table S4 ikuwonetsa ziwopsezo zongoyerekeza komanso zofananira zenizeni zamitundu iwiri yapawiri, ndipo zotsatira zake zimakhala zofanana ndi zomwe zili mu Table 3.Table S5 ikuwonetsa kusiyana kwa kupulumuka komwe kumayenderana ndi maulendo oyambilira. maulendo oyambilira, zotsatira zodzitetezera zimawoneka ngati zazikulu kwa ana omwe amayendera maulendo ambiri kusiyana ndi ana omwe ali ndi maulendo ochepa.Table S6 imasonyeza zotsatira za kusanthula kwathunthu;zotsatira izi zikufanana ndi zomwe tafufuza, ndikulondola pang'ono pakuyerekeza kwapamudzi.
Ngakhale pali umboni wamphamvu wosonyeza kuti maukonde ochiritsidwa amatha kukhala ndi moyo kwa ana osakwana zaka 5, maphunziro okhudza zotsatira za nthawi yayitali amakhalabe ochepa, makamaka m'madera omwe ali ndi kachilombo koyambitsa matenda.20 Zotsatira zathu zimasonyeza kuti ana ali ndi phindu lalikulu lokhalitsa "Zotsatirazi ndizolimba m'mikhalidwe yozama yamphamvu ndipo zikuwonetsa kuti nkhawa zokhudzana ndi kufa kwaubwana kapena unyamata, zomwe mwina zitha kukhala chifukwa cha kuchedwa kwa magwiridwe antchito a chitetezo chamthupi, ndizopanda maziko. tinene kuti kupulumuka kufikira uchikulire m'madera omwe muli malungo ndikokomwe kumawonetsera chitetezo chogwira ntchito.
Mphamvu za phunziro lathu zikuphatikizapo kukula kwachitsanzo, chomwe chinaphatikizapo ana oposa 6500;nthawi yotsatila, yomwe inali zaka 16;chiwopsezo chochepa chosayembekezereka cha kutayika kotsatira (11%);ndi kusasinthasintha kwa zotsatira ponseponse kusanthula.Kutsatira kwakukulu kotsatira kungakhale chifukwa cha kusakanizika kwachilendo kwa zinthu, monga kufalikira kwa mafoni a m'manja, kugwirizana kwa anthu akumidzi m'dera la phunziroli, ndi chikhalidwe chakuya ndi chabwino. maubwenzi opangidwa pakati pa ochita kafukufuku ndi anthu akumaloko.Community kudzera HDSS.
Pali zoletsa zina za phunziro lathu, kuphatikiza kusowa kwa kutsata kwamunthu kuyambira 2003 mpaka 2019;palibe chidziwitso chokhudza ana omwe anamwalira ulendo woyamba wamaphunziro usanachitike, zomwe zikutanthauza kuti kuchuluka kwa anthu omwe apulumuka sikuyimilira mokwanira za onse obadwa munthawi imodzi;ndi kusanthula koyang'anitsitsa.Ngakhale chitsanzo chathu chili ndi chiwerengero chachikulu cha covariates, kusokonezeka kotsalira sikungatheke.Kutengera malirewa, timapereka kuti kufufuza kwina kukufunika pa zotsatira za nthawi yayitali yogwiritsira ntchito maukonde ogona komanso kufunika kwa thanzi la anthu. za maukonde osathandizidwa, makamaka chifukwa cha nkhawa zaposachedwa zokhudzana ndi kukana mankhwala ophera tizilombo.
Kafukufuku wanthawi yayitali wokhudzana ndi kuwongolera malungo adakali aang'ono akuwonetsa kuti ndi kufalikira kwapang'onopang'ono kwa anthu, mapindu akukhalabe ndi maukonde okhala ndi mankhwala ophera tizirombo ndi ochulukirapo ndipo amapitilirabe mpaka akakula.
Kusonkhanitsa deta panthawi ya 2019 yotsatiridwa ndi Prof. Eckenstein-Geigy ndi thandizo kuchokera ku 1997 mpaka 2003 ndi Swiss Agency for Development and Cooperation ndi Swiss National Science Foundation.
Fomu yowulula yoperekedwa ndi olemba ikupezeka ndi zolemba zonse za nkhaniyi ku NEJM.org.
Mawu ogawana deta operekedwa ndi olemba akupezeka ndi zolemba zonse za nkhaniyi NEJM.org.
Kuchokera ku Swiss Tropical and Public Health Institute ndi 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);ndi London School of Hygiene and Tropical Medicine (JS).
Dr. Fink angapezeke pa [imelo yotetezedwa] kapena ku Swiss Institute for Tropical and Public Health (Kreuzstrasse 2, 4123 Allschwil, Switzerland).
1. Lipoti la Malungo Padziko Lonse la 2020: Zaka 20 za Patsogolo Padziko Lonse ndi Zovuta.Geneva: World Health Organization, 2020.
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