iindaba

Lungiselela ukuba ngugqirha, wakhe ulwazi lwakho, ukhokele umbutho wezempilo, kwaye uqhubele phambili umsebenzi wakho ngolwazi kunye neenkonzo zeQela le-NEJM.
Kuye kwacatshangelwa ukuba kwiindawo eziphezulu zosulelo, ukulawulwa kwe-malaria ebuntwaneni bokuqala (<iminyaka eyi-5) inokulibazisa ukufumana i-immunity esebenzayo kunye nokutshintsha ukufa kwabantwana ukusuka kumncinci ukuya kumdala.
Sisebenzise idatha evela kwi-22-year-prospective cohort study kumaphandle asezantsi eTanzania ukuqikelela umbutho phakathi kokusetyenziswa kwangoko kwemanetha aphathwayo kunye nokuphila ukuya ebudaleni.Bonke abantwana abazalelwe kwindawo yokufunda phakathi kwe-1 kaJanuwari 1998 kunye ne-30 Agasti 2000 bamenywa ukuba bathathe inxaxheba Uphononongo lwexesha elide ukusuka ku-1998 ukuya ku-2003. Iziphumo zokusinda kwabantu abadala zaqinisekiswa ngo-2019 ngokufikelela koluntu kunye neefowuni eziphathwayo.Sisebenzise imodeli yeengozi ezilinganayo ze-Cox ukuqikelela unxibelelwano phakathi kokusetyenziswa kwabantwana kwasebuntwaneni kweinetha ezinyangwayo kunye nokusinda ebudaleni, zilungelelaniselwe abanokudideka.
Bebonke bangama-6706 abantwana ababhalisiweyo. Ngo-2019, siye saqinisekisa iinkcukacha zemeko ebalulekileyo kubathathi-nxaxheba abayi-5983 (89%). net ngaxa lithile, kwaye ikota eseleyo yayihlala ilala phantsi komnatha ophathwayo.Lala phantsi konyangoinethi zeengcongconi.Ingxelo yengozi yokufa yayiyi-0.57 (i-95% yexesha lokuzithemba [CI], 0.45 ukuya kwi-0.72) .ngaphantsi kwesiqingatha sokutyelela.Umlinganiselo wengozi ehambelanayo phakathi kweminyaka eyi-5 kunye nomntu omdala ngu-0.93 (95% CI, 0.58 ukuya kwi-1.49).
Kolu phononongo lwexesha elide lokulawula isifo seengcongconi kwizicwangciso zosulelo oluphezulu, izibonelelo zokusinda zokusetyenziswa kwangethuba kweinetha ezinyangweyo ziqhubekile nokuba ngumntu omdala.(Ixhaswe yi-Eckenstein-Geigy Professorship kunye nabanye.)
Isifo seengcongconi sisengoyena nobangela uphambili wezifo nokufa kwihlabathi jikelele.1 Kubantu abangama-409,000 ababhubhe isifo seengcongconi ngo-2019, ngaphezulu kwe-90% yenzeke kwi-Afrika ekwi-sub-Sahara, kwaye isibini kwisithathu sokusweleka senzeke kubantwana abangaphantsi kweminyaka emihlanu.1 Isibulali-zinambuzane- Iinethi ezinyangweyo zingumqolo wolawulo lwemalariya ukusukela ngo-2000 i-Abuja Declaration 2 .Uthotho lwezilingo ezidibeneyo ezenziwa ngoo-1990 zibonise ukuba inethi ezinyangweyo zinenzuzo enkulu yokuphila kubantwana abangaphantsi kweminyaka emi-5 ubudala. Ukuhanjiswa kwesikali, ngo-2019.1 I-46% yabantu abasemngciphekweni wesifo seengcongconi kwi-Afrika ekwi-sub-Saharan balala kwiinethi zeengcongconi ezinyangweyo
Njengoko ubungqina buvele kwiminyaka yee-1990 yenzuzo yokusinda yenethi ephathwayo kubantwana abancinci, kucingelwa ukuba iimpembelelo zexesha elide zenethi eziphathwayo ekusindeni kwimimiselo yosulelo oluphezulu ziya kuba ngaphantsi kuneempembelelo zexesha elifutshane, kwaye zinokuba i-negative, ngenxa yenzuzo yenetha yokufumana ukhuseleko olusebenzayo.ukulibaziseka okunxulumeneyo.4-9 Nangona kunjalo, ubungqina obupapashiweyo ngalo mbandela bukhawulelwe kwizifundo ezintathu ezivela eBurkina Faso, eGhana, 11 kunye nokulandelela okungaphezu kweminyaka eyi-7.5 kunye neKenya.12 Akukho nanye kwezi mpapasho ebonise ubungqina bokutshintsha komntwana. Ukusweleka ukusuka kwabancinci ukuya ebudaleni ngenxa yolawulo lwemalariya ebuntwaneni. Apha, sinika ingxelo yedatha evela kuphononongo lweqela leminyaka engama-22 kwilali esemazantsi eTanzania ukuqikelela umanyano phakathi kokusetyenziswa kwasebuntwaneni kweinethi zengcongconi ezinyangwayo kunye nokuphila xa umntu emdala.
Kolu phando lulindelekileyo lweqela, siye salandela abantwana ukususela ebuntwaneni ukuya ekubeni ngabantu abadala.Uphononongo luvunywe ziibhodi zophononongo lokuziphatha ezifanelekileyo eTanzania, eSwitzerland naseUnited Kingdom.Abazali okanye abagcini babantwana abancinci banike imvume yomlomo kwidatha eqokelelwe phakathi ko-1998 no-2003 .Ngo-2019, safumana imvume ebhaliweyo evela kubathathi-nxaxheba ekwenziwe udliwano-ndlebe nabo ngokwabo kunye nemvume yomlomo evela kubathathi-nxaxheba ekwenziwe udliwano-ndlebe nabo ngomnxeba.
Olu phononongo luqhutywe kwi-Ifakara Rural Health and Demographic Surveillance Site (HDSS) kwimimandla yaseKilombero nase-Ulanga yaseTanzania.13 Ummandla wophononongo ekuqaleni wawuquka iilali eziyi-18, ezathi kamva zahlulwa zaba ngama-25 (umzobo S1 kwisiHlomelo esongezelelweyo, ifumaneka ngombhalo opheleleyo weli nqaku kwi-NEJM.org).Bonke abantwana abazalwa ngabahlali be-HDSS phakathi koJanuwari 1, 1998, no-Agasti 30, 2000 bathathe inxaxheba kwisifundo seqela elide ngexesha lokutyelela amakhaya rhoqo kwiinyanga ezi-4 phakathi kukaMeyi 1998 no-Aprili 2003. Ukususela kwi-1998 ukuya kwi-2003, abathathi-nxaxheba bafumana ukutyelelwa kwe-HDSS rhoqo kwiinyanga ze-4 (Umfanekiso we-S2) .Ukususela kwi-2004 ukuya kwi-2015, isimo sokusinda sabathathi-nxaxheba abaziwayo ukuba bahlala kwindawo yabhalwa kwiindwendwe ze-HDSS zesiqhelo.Ngo-2019, senze uphando lokulandelelana. ngokusebenzisa uluntu kunye neeselfowuni, ukuqinisekiswa kwemeko yokuphila kwabo bonke abathathi-nxaxheba, ngokuzimeleyo kwendawo yokuhlala kunye neerekhodi ze-HDSS.Uphando luxhomekeke kulwazi lwentsapho olunikezelwe ekubhaliseni.Sidale uluhlu lokukhangela kwi-HD nganye.Ilali ye-SS, ebonisa igama lokuqala nelokugqibela lawo onke amalungu osapho angaphambili omthathi-nxaxheba ngamnye, kunye nomhla wokuzalwa kunye nenkokeli yoluntu enoxanduva losapho ngexesha lobhaliso. Kwiintlanganiso kunye neenkokheli zasekuhlaleni, uluhlu lwajongwa kwaye amanye amalungu oluntu achongiwe ukunceda umkhondo.
Ngenkxaso ye-Arhente yaseSwitzerland yoPhuhliso kunye neNtsebenziswano kunye noRhulumente weRiphabhlikhi yaseTanzania, inkqubo yokwenza uphando kwiinethi zengcongconi ezinyangweyo zasekwa kwindawo yokufunda kwi-1995.14 Ngo-1997, inkqubo yokuthengisa intlalo ejoliswe ekusasazeni, ekukhuthazeni. kunye nokubuyisela inxalenye yeendleko zenetha, yazisa unyango olunetha.15 Uphononongo lwe-nested-control control lubonise ukuba inetha eziphathwayo zidibene nokunyuka kwe-27% yokuphila kwabantwana abaneminyaka eyi-1 ukuya kwi-4 iminyaka (i-95% yexesha lokuzithemba [CI], 3 ukuya kuma-45).15
Esona siphumo siphambili yaba bubungqina bokusinda ngexesha lotyelelo lwamakhaya. Kubathathi-nxaxheba abaswelekileyo, ubudala kunye nonyaka wokusweleka kwafunyanwa kubazali okanye kwamanye amalungu osapho. Eyona nto iphambili yokuvezwa kukusetyenziswa kweinethi zokuthintela iingcongconi phakathi kokuzalwa kunye neminyaka emi-5 ubudala (“inethi kusetyenziswa kwiminyaka yokuqala”).Sihlalutye ukufumaneka kothungelwano kusetyenziso lomntu ngamnye kunye nenqanaba loluntu. Kusetyenziso lomntu siqu lwenethi zokuthintela iingcongconi, kutyelelo ngalunye lwekhaya phakathi ko-1998 no-2003, umama okanye umkhathaleli womntwana wabuzwa ukuba umama womntwana okanye umkhathaleli uye walala. phantsi kwenethi kubusuku obudlulileyo, kwaye ukuba kunjalo, ukuba kwaye nini inetha yayisisibulali zinambuzane- Ukuphatha okanye ukuhlanjwa.Sishwankathele ukuchanabeka komntwana ngamnye kunyaka wokuqala kwiinethi ezinyangweyo njengepesenti yotyelelo apho abantwana kuxelwe ukuba balele phantsi kweinethi ezinyangweyo. .Kubunini bothungelwano lonyango olukwinqanaba lelali, sidibanise zonke iirekhodi zamakhaya eziqokelelwe ukusuka ku-1998 ukuya ku-2003 ukubala ubungakanani bemizi kwilali nganye enobuncinci inethiwekhi yonyango yindlebe.
Idatha ngemalariya parasitemia yaqokelelwa ngo-2000 njengenxalenye yenkqubo yokucupha ebanzi yonyango oludityanisiweyo lwemalariya.Ngomhla we-16 kuMeyi, kwisampulu emele iintsapho ze-HDSS, i-parasitemia yalinganiswa ngefilimu eshinyeneyo ye-microscopy kuwo onke amalungu osapho aneenyanga ezi-6 nangaphezulu ukuya kuJulayi ka-2000. , 2001, 2002, 2004, 2005 Unyaka kunye no-2006.16
Ukwandisa umgangatho wedatha kunye nokugqibelela kokulandelelwa ngo-2019, siye saqesha kwaye saqeqesha iqela labadliwano-ndlebe abanamava abasele benolwazi olubanzi lwendawo.Kwezinye iintsapho, ulwazi malunga nemfundo yomnakekeli, ingeniso yosapho, kunye nexesha lokuya kwiziko lonyango lalingekho. I-Imputation Multiple usebenzisa i-equations chain equations yayisetyenziselwa ukulinganisa idatha ye-covariate elahlekileyo kwisiphumo sethu esiphambili.Zonke izinto eziguquguqukayo ezidweliswe kwiThebhile 1 zisetyenziswe njengeziqikelelo zolu tshintsho.Uphononongo olongezelelweyo olupheleleyo lwenziwa ukuze kuqinisekiswe ukuba iziphumo azizange zibe novelwano kwi-imputation. indlela ekhethiweyo.
Izibalo zokuqala ezichazayo zibandakanya ukutyelelwa okulandelelanayo kunye nokufa ngokwesondo, unyaka wokuzalwa, imfundo yomnakekeli, kunye nenqanaba lengeniso yekhaya.Ukufa kuqikelelwa njengokusweleka kwi-1000 leminyaka yomntu.
Sinikezela ngedatha malunga nendlela uthungelwano olutshintshile ngayo ngokuhamba kwexesha.Ukubonisa ubudlelwane phakathi kobunini bendlu kwilali ezinyangwayo kunye nosulelo lwesifo seengcongconi, sidale indawo esasazekileyo yokhuselo lwebhedi olunyangwayo kwinqanaba lelali kunye nokuxhaphaka kwesifo separasitic kwinqanaba lelali. ngo-2000.
Ukuqikelela unxulumano phakathi kokusetyenziswa komnatha kunye nokusinda kwexesha elide, siqale saqikelela umgangatho ongalungiswanga amagophe okusinda eKaplan-Meier xa sithelekisa abantwana abaxele ukuba balele phantsi kwenethi enyangweyo ngexesha lobuncinci be-50% yotyelelo lokuqala kunye nezo ziphumo zokusinda. inethi zeengcongconi ngaphantsi kwe-50% yotyelelo lokuqala. I-50% cutoff yakhethwa ukuze ihambelane nenkcazo elula "ixesha elininzi". amagophe okusinda ethelekisa abantwana abasoloko bexela ukuba balele phantsi kwenethi enyangwayo kunye nabo bangazange baxele ukuba balele phantsi kwenethi enyangweyo Iziphumo zokusinda kwabantwana abaphantsi komnatha.Siqikelele amagophe eKaplan-Meier angalungiswanga kwezi zantlukwano emva kwexesha lonke (iminyaka eyi-0 ukuya kwengama-20) kunye nobuntwana (iminyaka emi-5 ukuya kwengama-20) .Lonke uhlahlelo lokusinda lwakhawulelwa kwixesha eliphakathi kodliwano-ndlebe lwesaveyi yokuqala kunye nodliwano-ndlebe lokugqibela. kubangele ukunqunyulwa kwekhohlo kunye nokuhluzwa kwasekunene.
Sasebenzisa i-Cox imodeli yeengozi ezilinganayo ukuqikelela ukuchasana okuphambili okuthathu komdla, okuxhomekeke kwi-confounders ebonakalayo-okokuqala, ukudibanisa phakathi kokusinda kunye nepesenti yokutyelela apho abantwana kuthiwa balala phantsi kwemanetha ephathwayo;okwesibini, Umahluko wokuphila phakathi kwabantwana abasebenzisa inethi ezinyangweyo ngaphezu kwesiqingatha sotyelelo lwabo kunye nabo basebenzise inethi ezinyangweyo ngaphantsi kwesiqingatha sotyelelo lwabo;okwesithathu, iyantlukwano yokuphila phakathi kwabantwana isoloko ibika ukuba belele kutyelelo lwabo lwangaphambili Ngaphantsi kwenethi zeengcongconi ezinyangwayo, abantwana abazange baxele ukuba balele phantsi kweenethi ezinyangweyo ngexesha lolu tyelelo.Kumbutho wokuqala, ipesenti yokutyelela ihlalutywa njengekota yomgca.Uhlalutyo lwentsalela ye-martingale kwenziwa ukuze kuqinisekiswe ukufaneleka kolu qikelelo lomgca.Uhlalutyo lwentsalela ye-Schoenfeld17 lusetyenziselwe ukuvavanya ukucingelwa kweengozi ezilinganayo.Ukwenzela ukudidanisa, zonke iingqikelelo ze-multivariate zokuthelekisa ezintathu zokuqala zilungelelaniswe kwinqanaba lengeniso yekhaya, ixesha lokuya kwiziko lezonyango elikufutshane, umnakekeli. udidi lwemfundo, isini somntwana, kunye nobudala bomntwana.Yonke imifuziselo ehlukahlukeneyo iquke ne-25 yokuthintela okuthe ngqo kwilali, nto leyo eyasivumela ukuba singabandakanyi iiyantlukwano ezicwangcisiweyo kwimiba yenqanaba lelali engajongwa njengento enokubakho.Ukuqinisekisa ukomelela kweziphumo ezibonisiweyo ngentlonipho. kwimodeli ekhethiweyo ye-empirical, sikwaqikelele ukuqhubeka kokubiniiirasts zisebenzisa iinkozo, iicalipers kunye ne-algorithms yokudibanisa ngqo.
Ngenxa yokuba ukusetyenziswa kwangethuba kweinetha ezinyangweyo kunokuchazwa ziimpawu zekhaya ezingajongwanga okanye zomnonopheli ezifana nolwazi lwezempilo okanye ukukwazi komntu ukufikelela kwiinkonzo zonyango, sikwaqikelele imodeli yomgangatho welali njengomlinganiso wesine. Kolu thelekiso, sisebenzise ilali- Inqanaba lomndilili wobunini bemizi yenethi eziphathwayo (igalelo njengexesha lomgca) kwiminyaka emi-3 yokuqala apho abantwana bajongwa njengotshintsho lwethu oluphambili.Utyhileko kwinqanaba lelali linenzuzo yokungaxhomekeki kancinci kumntu ngamnye okanye kusapho losapho kwaye kufuneka. Ngoko ke, ukungachatshazelwa kangako kukubhidanisa. Ngokombono, ukonyuka kommandla welali kufuneka kube nefuthe elikhuselayo kunokwandisa ukhuseleko lomntu ngamnye ngenxa yempembelelo enkulu kubuninzi beengcongconi kunye nosulelo lwemalariya.18
Ukunika ingxelo yonyango lwelali kunye nolungelelwaniso lwelali ngokubanzi, iimpazamo ezisemgangathweni zibalwe kusetyenziswa i-Huber's cluster-robust variance estitimator.Iziphumo zixelwa njengoqikelelo lwamanqaku kunye ne-95% yexesha lokuzithemba.Ububanzi bezithuba zokuzithemba azikho ilungelelaniselwe ukuphindaphinda, ngoko ke ikhefu akufanele lisetyenziswe ukuthobela imibutho emiselweyo.Uhlalutyo lwethu oluphambili aluzange luchazwe;ke ngoko, akukho maxabiso e-P axeliweyo.Uhlalutyo lweStatistical lwenziwa kusetyenziswa isoftwe yeStata SE (StataCorp) uguqulelo 16.0.19
Ukususela ngoMeyi 1998 ukuya ku-Aprili 2003, inani labathathi-nxaxheba be-6706 abazalwa phakathi koJanuwari 1, 1998 kunye no-Agasti 30, 2000 baqukwa kwiqela (umzobo 1) .Iminyaka yokubhalisa yayisuka kwi-3 ukuya kwiinyanga ze-47, kunye nenani leenyanga ze-12. Phakathi NgoMeyi ka-1998 nango-Epreli ka-2003, kwasweleka abathathi-nxaxheba abangama-424. Ngo-2019, siye saqinisekisa imeko ebalulekileyo yabathathi-nxaxheba abayi-5,983 (89% yobhaliso). Itotali yabathathi-nxaxheba abayi-180 basweleka phakathi kukaMeyi ka-2003 noDisemba ka-2019, okubangele izinga lokufa ngokungekho mthethweni lilonke. 6.3 abantu abasweleka nge-1000 leminyaka yomntu.
Njengoko kuboniswe kwiThebhile 1, isampuli yayinokulinganisela ngokwesini;ngokomndilili, abantwana babhaliswa kanye phambi kokuba bafike kunyaka omnye ubudala baze balandele iminyaka eli-16. Uninzi lwabanonopheli luyigqibile imfundo yamabanga aphantsi, kwaye uninzi lwamakhaya lufikelela kwitephu okanye kumanzi amaqula. Inani labantu ababhubhileyo kwi-1000 leminyaka yayilelona lisezantsi kubantwana abanabanonopheli abafundiswa kakhulu (4.4 nge-1000 leminyaka yomntu) kwaye liphezulu kubantwana ababengaphezu kweeyure ezi-3 kude neziko lezonyango (9.2 nge-1000 leminyaka yomntu) kunye amakhaya angenalwazi ngemfundo (esi-8.4 kwi-1,000 lomntu-minyaka) okanye umvuzo (19.5 kwi-1,000 leminyaka yomntu).
Itheyibhile yesi-2 ishwankathela izinto eziguquguqukayo eziphambili. Malunga nekota yabathathi-nxaxheba kuphononongo baxelwe ukuba abazange balale phantsi kwenethi enyangwayo, enye ikota ichaze ukuba ilele phantsi kwenethi enyangwayo kutyelelo ngalunye lokuqala, kwaye isiqingatha esiseleyo silele phantsi kwezinye kodwa asiyiyo yonke ingxelo elele phantsi konyango. Iinethi zokuthintela iingcongconi ngexesha lotyelelo.Umlinganiselo wabantwana abasoloko belele phantsi kweenethi zengcongconi ezinyangweyo unyuke ukusuka kwi-21% yabantwana abazalwa ngo-1998 ukuya kwi-31% yabantwana abazalwa ngo-2000.
Itheyibhile S2 inika iinkcukacha ezithe vetshe malunga neendlela ezisetyenziswayo zothungelwano ukusuka ku-1998 ukuya ku-2003. Nangona kwakuxelwe ukuba i-34% yabantwana balala phantsi kweenethi zengcongconi ezinyangweyo kubusuku obungaphambi kowe-1998, ngo-2003 elo nani liye landa laya kutsho kuma-77%. Umzobo S4 ubonisa umahluko omkhulu wobunini, ngaphantsi kwe-25% yemizi ethe yanyanga inethi kwilali yase-Iragua ngo-1998, ngelixa kwilali zase-Igota, eKivukoni naseLupiro, ngaphezulu kwe-50% yamakhaya ayenayo. iinethi eziphathwayo kwangaloo nyaka.
I-Unadjusted Kaplan-Meier curves curves are displayed.Iipaneli A kunye no-C zithelekisa iindlela zokuphila (ezingalungiswanga) zabantwana abathe babika besebenzisa iminatha ephathwayo kangangesiqingatha senani lokutyelela kwabo basebenzise kancinane.Iipaneli B kunye no-D zithelekisa abantwana abangazange ingxelo yokulala phantsi kweemanetha eziphathwayo (i-23% yesampuli) kunye nabo bahlala bexela ukulala phantsi kweemanetha eziphathwayo (25% yesampuli).adjusted) umzila.I-inset ibonisa idatha efanayo kwi-axis ka-y eyandisiweyo.
Umzobo 2 Ukuthelekiswa kwendlela yokuphila yabathathi-nxaxheba ukuya kubuntu obudala obusekwe ekusetyenzisweni kwangoko kwemanetha enyangweyo, kubandakanywa uqikelelo lokusinda kulo lonke ixesha (Amanani 2A kunye ne-2B) kunye namagophe okusinda alungiselelwe ukusinda kwiminyaka eyi-5 ubudala (Amanani 2C kunye ne-2D). bebonke abantu ababhubhileyo abangama-604 barekhodwa ngexesha lophononongo;I-485 (80%) yenzeke kwiminyaka yokuqala ye-5 yobomi. Ingozi yokufa yanyuka kunyaka wokuqala wobomi, yehla ngokukhawuleza kwaze kwaba yiminyaka eyi-5, yahlala iphantsi, kodwa yanda kancinci malunga neminyaka eyi-15 (umzobo S6) .Amashumi asithoba- ipesenti enye yabathathi-nxaxheba abasoloko besebenzisa iinethi ezinyangwayo yasinda yada yaba badala;oku kwaba njalo kuphela kwi-80% yabantwana abangazange basebenzise inethi ezinyangweyo kwangethuba (Itheyibhile 2 kunye neFigure 2B). Ukuxhaphaka kweParasite ngo-2000 kwakunxulunyaniswa kakhulu neinethi zokulala ezinyangwayo zemizi yabantwana abangaphantsi kweminyaka emi-5 (i-correlation coefficient). , ~ 0.63) kunye nabantwana abaneminyaka eyi-5 ubudala okanye ngaphezulu (i-coefficient coefficient, ~ 0.51) (Fig. S5).).
Ipesenti nganye ye-10-ipesenti yokunyuka kokusetyenziswa kwangoko kwamanetha aphathwayo idibaniswe ne-10% yengozi ephantsi yokufa (umlinganiselo wengozi, i-0.90; i-95% CI, i-0.86 ukuya kwi-0.93), ibonelele isethi epheleleyo yabanonophelo kunye ne-covariates yasekhaya. njengeziphumo ezilungisiweyo zelali (Itheyibhile 3) .Abantwana abasebenzisa amanetha anyangweyo kutyelelo lwangaphambili babenomngcipheko ophantsi wama-43% wokufa xa kuthelekiswa nabantwana abasebenzisa inethi eziphathwayo ngaphantsi kwesiqingatha sotyelelo lwabo (umlinganiselo wengozi, 0.57; 95% CI, 0.45 ukuya ku-0.72) Ngokunjalo, abantwana abasoloko belala phantsi kweenethi ezinyangweyo babenomngcipheko ongaphantsi wama-46% wokufa kunabantwana abangazange balale phantsi kweminatha (ingozi, 0.54; 95% CI, 0.39 ukuya ku-0.74). Kwinqanaba lelali, a Ipesenti ze-10 zokunyuka kobunini bebhedi ephathwayo yayinxulumene ne-9% yengozi ephantsi yokufa (umlinganiselo wengozi, 0.91; 95% CI, 0.82 kwi-1.01).
Ukusetyenziswa kwamanetha aphathwayo ngexesha lobuncinci besiqingatha sokutyelela ubomi bokuqala kwaxelwa ukuba kuhambelana nomlinganiselo wengozi ye-0.93 (95% CI, 0.58 ukuya kwi-1.49) yokufa ukusuka kwiminyaka eyi-5 ukuya kumdala (Itheyibhile 3) . ukusuka ku-1998 ukuya ku-2003, xa sasilungelelanisa iminyaka, imfundo yomntu okhathalelayo, umvuzo wekhaya kunye nobutyebi, unyaka wokuzalwa kunye nelali yokuzalwa (Itheyibhile S3).
Itheyibhile S4 ibonisa amanqaku okutyekela kunye noqikelelo oluchanekileyo lweendlela zethu ezimbini zokuvezwa kokubini, kwaye iziphumo ziphantse zifane nezo zikuTheyibhile 3.Itheyibhile S5 ibonisa iyantlukwano ekuphileni okucwangcisiweyo ngenani lotyelelo kwangethuba.Ngaphezu kwemigqaliselo embalwa ubuncinane kane ubuncinane. ukutyelelwa kwangaphambili, umphumo oqikelelweyo wokukhusela ubonakala ukhulu kubantwana abanokutyelela okuninzi kunabantwana abanokutyelela okumbalwa.Itheyibhile S6 ibonisa iziphumo zohlalutyo olupheleleyo;ezi ziphumo ziphantse zafana nezo zohlalutyo lwethu oluphambili, ngokuchaneka okuphezulu kancinci kuqikelelo lomgangatho welali.
Nangona kukho ubungqina obuqinileyo bokuthi inetha eziphathwayo zinokuphucula ubomi kubantwana abangaphantsi kweminyaka eyi-5 ubudala, izifundo zeziphumo zexesha elide zihlala zinqabile, ngakumbi kwiindawo ezinamazinga aphezulu osulelo.20 Iziphumo zethu zibonisa ukuba abantwana banenzuzo ebalulekileyo yexesha elide ekusebenziseni. Ezi ziphumo zomelele kuzo zonke izithethe ezibanzi zobungqina kwaye zicebisa ukuba iinkxalabo malunga nokunyuka kokusweleka komntwana emva kwexesha okanye ukufikisa, okunokuthi ngokwethiyori kube ngenxa yokulibaziseka kophuhliso lwamajoni omzimba, azinasiseko. kuxoxwe ukuba ukusinda ube ngumntu omdala kwiindawo ezigquba isifo seengcongconi kukodwa kuyimbonakaliso yokugonywa okusebenzayo.
Amandla okufunda kwethu abandakanya ubungakanani besampulu, ebandakanya abantwana abangaphezu kwama-6500;ixesha lokulandelela, nto leyo yayiyiminyaka eyi-16;izinga eliphantsi ngokungalindelekanga lelahleko ekulandeleni (11%);kunye nokuhambelana kweziphumo kulo lonke uhlalutyo.Izinga eliphezulu lokulandelwa lingaba ngenxa yendibaniselwano engaqhelekanga yezinto, ezifana nokusetyenziswa ngokubanzi kweefowuni eziphathwayo, ukubambisana koluntu lwasemaphandleni kwindawo yophando, kunye nentlalo enzulu kunye nelungileyo. amakhonkco aphuhlisiwe phakathi kwabaphandi kunye nabantu basekuhlaleni.Uluntu nge-HDSS.
Kukho imida ethile kwisifundo sethu, kubandakanya ukunqongophala kokulandelwa komntu ngamnye ukusuka ku-2003 ukuya ku-2019;akukho nkcukacha kubantwana abasweleke phambi kotyelelo lokuqala, nto leyo ethetha ukuba amazinga okusinda eqela alimelanga ngokupheleleyo lonke ukuzalwa ngexesha elinye;kunye nohlalutyo lokujonga.Nangona imodeli yethu iqulethe inani elikhulu le-covariates, ukudideka okushiyekileyo akukwazi ukukhutshwa.Ngenxa yale mida, sicebisa ukuba uphando olongezelelweyo lufunekayo kwimpembelelo yokusetyenziswa kwexesha elide leebhedi kunye nokubaluleka kwempilo yoluntu. yeinethi ezinganyangwanga, ingakumbi xa kujongwa iinkxalabo zangoku malunga nokuxhathisa amayeza okubulala izinambuzane.
Olu phononongo lwexesha elide lokusinda olunxulumene nolawulo lwemalariya yabantwana baselula lubonisa ukuba ngokugqunywa okuphakathi koluntu, iingenelo zokusinda kwiinetha ezifakwe izibulali zinambuzane zininzi kwaye ziyaqhubeka nokuba ngumntu omdala.
Ukuqokelela idatha ngexesha lokulandelwa kwe-2019 nguProf Eckenstein-Geigy kunye nenkxaso esuka kwi-1997 ukuya kwi-2003 yi-Swiss Agency for Development and Cooperation kunye ne-Swiss National Science Foundation.
Ifomu yokubhengeza enikezelwe ngababhali iyafumaneka kunye nesicatshulwa esipheleleyo seli nqaku kwi-NEJM.org.
Ingxelo yokwabelana ngedatha enikezelwe ngababhali ifumaneka ngesicatshulwa esipheleleyo seli nqaku NEJM.org.
Ukusuka kwi-Swiss Tropical and Public Health Institute kunye neYunivesithi yaseBasel, eBasel, eSwitzerland (GF, CL);Ifakara Health Institute, Dar es Salaam, Tanzania (SM, SA, RK, HM, FO);IYunivesithi yaseColumbia, iSikolo saseNew York soMmeli weSikole seMpilo yoLuntu (SPK);kunye neLondon School of Hygiene and Tropical Medicine (JS).
UGqr. Fink unokuqhagamshelana naye [i-imeyile ekhuselweyo] okanye kwi-Swiss Institute for Tropical and Public Health (Kreuzstrasse 2, 4123 Allschwil, Switzerland).
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