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Lungiselela ukuba udokotela, wakhe ulwazi lwakho, uhole inhlangano yezokunakekelwa kwempilo, futhi uthuthukise umsebenzi wakho ngolwazi nezinsizakalo ze-NEJM Group.
Kuye kwacatshangwa ukuthi ezindaweni eziphakeme zokutheleleka, ukulawulwa kukamalaleveva ebuntwaneni basencane (ngaphansi kweminyaka emi-5) kungase kubambezele ukutholwa kokugonywa komzimba okusebenzayo futhi kususe ukufa kwezingane kusuka kwencane kuye kwabadala.
Sisebenzise idatha yocwaningo lweminyaka engama-22 oluzoba yiqembu ezindaweni zasemaphandleni eziseningizimu yeTanzania ukuze silinganisele ukuhlobana phakathi kokusetshenziswa kwamanethi eselashwa kusenesikhathi nokuphila kuze kube abantu abadala.Zonke izingane ezizalwe endaweni yocwaningo phakathi komhlaka-1 Januwari 1998 no-30 Agasti 2000 zamenywa ukuba zibambe iqhaza. ucwaningo lwelongitudinal kusukela ngo-1998 kuya ku-2003. Imiphumela yokusinda kwabantu abadala yaqinisekiswa ngo-2019 ngokufinyelela komphakathi kanye nezingcingo zamaselula.Sisebenzise amamodeli wezingozi ezilinganiselwe ze-Cox ukuze silinganisele ukuhlobana phakathi kokusetshenziswa kwamanethi aphathwayo kwasebuntwaneni nokuphila lapho esemdala, alungiselwe iziphazamisi ezingase zibe khona.
Isamba sezingane ezingu-6706 sabhaliswa. Ngo-2019, siqinisekise ulwazi lwesimo olubalulekile kubahlanganyeli abangu-5983 (89%). Ngokuvumelana nemibiko evela ekuvakasheni kwangaphambi kwesikhathi kokuxhumana nomphakathi, cishe ingxenye yesine yezingane ayizange ilale ngaphansi kwenethi eselakiwe, ingxenye ilale ingadliwe. inetha ngesikhathi esithile, futhi ikota esele yayihlala ilala ngaphansi kwenethi eselashiwe.Lala ungelashiweamanethi omiyane.Isilinganiso sengozi yokufa esibikiwe sasingu-0.57 (95% isikhawu sokuzithemba [CI], 0.45 kuya ku-0.72). singaphansi kwengxenye yokuvakasha.Isilinganiso sengozi esihambisanayo phakathi kweminyaka engu-5 nobudala sasingu-0.93 (95% CI, 0.58 kuya ku-1.49).
Kulolu cwaningo lwesikhathi eside lokulawulwa kukamalaleveva kwangaphambi kwesikhathi ezindaweni zokutheleleka okuphezulu, izinzuzo zokusinda zokusetshenziswa kwamanetha alashwayo zaqhubeka kwaze kwaba abantu abadala.(Ixhaswe yi-Eckenstein-Geigy Professorship kanye nabanye.)
Umalaleveva usalokhu uyimbangela ehamba phambili yezifo nokufa emhlabeni wonke.1 Kubantu abangu-409,000 abafe umalaleveva ngo-2019, bangaphezu kwama-90% abashone e-sub-Saharan Africa, kanti izingxenye ezimbili kwezintathu zokufa zenzeka ezinganeni ezineminyaka engaphansi kwemihlanu.1 Izibulala-zinambuzane- amanethi alashwayo abe umgogodla wokulawula umalaleveva kusukela ngo-2000 i-Abuja Declaration 2 .Uchungechunge lwezivivinyo ezingahleliwe olwenziwa ngama-1990s lwabonisa ukuthi amanetha alashwayo abe nenzuzo enkulu yokuphila kwezingane ezingaphansi kweminyaka engu-5 ubudala.3 Ikakhulukazi ngenxa yokukhulu- ukusatshalaliswa ngesilinganiso, 2019.1 Ama-46% abantu abasengozini kamalaleveva e-sub-Saharan Africa alala emanethini omiyane alashiwe
Njengoba ubufakazi bavela ngeminyaka yawo-1990 ngenzuzo yokusinda yamanethi alashwayo ezingane ezincane, kucatshangelwa ukuthi imiphumela yesikhathi eside yamanethi alashwayo ekusindeni ezindaweni ezidluliselwa kakhulu izoba ngaphansi kunemiphumela yesikhashana, futhi ingase okungalungile, ngenxa yenzuzo yonke yokuthola ukungatheleleki okusebenzayo.ukubambezeleka okuhlobene.4-9 Nokho, ubufakazi obushicilelwe ngalolu daba bukhawulelwe ezifundweni ezintathu ezivela eBurkina Faso, eGhana,11 ngokulandelelwa okungeqile eminyakeni engu-7.5 naseKenya.12 Akukho nokukodwa kwalezi zincwadi okubonisa ubufakazi bokushintsha kwengane. Ukushona kwabantu kusukela kwabancane kuye kubantu abadala ngenxa yokulawulwa kukamalaleveva ezinganeni.Lapha, sibika idatha evela ocwaningweni lweqembu oluzoba neminyaka engu-22 ezindaweni zasemaphandleni eziseningizimu yeTanzania ukuze kulinganiswe ukuhlobana phakathi kokusetshenziswa kwasebuntwaneni amanethi alashwayo kanye nokuphila lapho esemdala.
Kulolu cwaningo lweqembu, silandele izingane kusukela zisencane kuze kube abantu abadala.Ucwaningo lugunyazwe amabhodi afanele okubuyekeza ukuziphatha eTanzania, Switzerland nase-United Kingdom.Abazali noma ababheki bezingane ezincane banikeze imvume yomlomo kudatha eqoqwe phakathi kuka-1998 no-2003. .Ngo-2019, sathola imvume ebhaliwe evela kubahlanganyeli okukhulunywe nabo mathupha nemvume yomlomo evela kubahlanganyeli okukhulunywe nabo ngocingo. Ababhali bokuqala nabokugcina bafakazela ukuphelela nokunemba kwedatha.
Lolu cwaningo lwenziwe e-Ifakara Rural Health and Demographic Surveillance Site (HDSS) esifundeni sase-Kilombero nase-Ulanga eTanzania.13 Indawo yocwaningo ekuqaleni yayihlanganisa izigodi eziyi-18, kamuva ezahlukaniswa zaba ngama-25 (Fig. S1 in the Supplementary Appendix, itholakala ngombhalo ogcwele walesi sihloko ku-NEJM.org).Zonke izingane ezizalwa izakhamuzi ze-HDSS phakathi kukaJanuwari 1, 1998, no-Agasti 30, 2000 zabamba iqhaza ocwaningweni lweqembu lobude ngesikhathi sokuvakasha emakhaya njalo ezinyangeni ezi-4 phakathi kukaMeyi 1998 no-April 2003. Kusukela ngo-1998 kuya ku-2003, ababambiqhaza bathola ukuvakashelwa kwe-HDSS njalo ezinyangeni ezi-4 (Fig. S2).Kusuka ku-2004 kuya ku-2015, isimo sokusinda sabahlanganyeli abaziwa ukuthi behlala endaweni sabhalwa ekuvakasheni kwe-HDSS okujwayelekile.Ngo-2019, senze izinhlolovo zokulandelela ngokusebenzisa ukuxhumana nomphakathi nomakhalekhukhwini, ukuqinisekisa isimo sokusinda sabo bonke ababambiqhaza, ngaphandle kwendawo yokuhlala kanye namarekhodi e-HDSS.Inhlolovo incike olwazini lomndeni olunikezwa lapho kubhaliswa.Sidale uhlu lokucinga lwe-HD ngayinye.SS village, ekhombisa izibongo nezibongo zawo wonke amalungu omndeni wangaphambili womhlanganyeli ngamunye, kanye nosuku lokuzalwa kanye nomholi womphakathi obhekele umndeni ngesikhathi sokubhalisa.Emihlanganweni nabaholi bomphakathi wendawo, uhlu lubuyekeziwe futhi amanye amalungu omphakathi akhonjwe ukusiza ukulandelela.
Ngokusekelwa yi-Swiss Agency for Development and Cooperation kanye noHulumeni wase-United Republic of Tanzania, uhlelo lokuqhuba ucwaningo ngamanethi omiyane alashiwe lwasungulwa endaweni yocwaningo ngo-1995.14 Ngo-1997, uhlelo lokumaketha komphakathi okuhloswe ngalo ukusabalalisa, ukukhuthaza. kanye nokubuyisela ingxenye yezindleko zamanetha, kwethulwa ukwelashwa kwenetha.15 Ucwaningo olufakwe esidlekeni lwe-case-control lubonise ukuthi amanetha aphathwayo ahlotshaniswa nokwanda okungama-27% kokuphila kwezingane ezineminyaka eyi-1 ukuya eminyakeni emi-4 (95% isikhawu sokuzethemba [CI], 3 kuya ku-45).15
Umphumela oyinhloko kwaba ukusinda kwaqinisekiswa ngesikhathi sokuvakasha ekhaya. Kubabambiqhaza abashonile, iminyaka neminyaka yokushona itholwe kubazali noma kwamanye amalungu omndeni. Okuguquguqukayo okukhulu kokuchayeka kwakuwukusetshenziswa kwamanethi omiyane phakathi kokuzalwa neminyaka emihlanu (“net sebenzisa eminyakeni yokuqala”).Sihlaziye ukutholakala kwenethiwekhi emazingeni okusetshenziswa komuntu ngamunye kanye namazinga omphakathi.Ukusebenzisa amanethi omiyane, ngesikhathi sokuvakasha ngakunye ekhaya phakathi kuka-1998 no-2003, umama noma umnakekeli wengane wabuzwa ukuthi unina noma umnakekeli wengane uke walala yini. ngaphansi kwenethi ngobusuku obudlule, futhi uma kunjalo, uma futhi ngesikhathi inetha bekuyisibulala-zinambuzane- Ukuphatha noma ukuwasha.Sifingqa ukuchayeka kwengane ngayinye esemncane emanethi ahlanzekile njengamaphesenti okuvakasha okubikwa ukuthi izingane zilele ngaphansi kwamanethi ahlanziwe. .Ngobunikazi benethiwekhi yokwelashwa ezingeni lendawo, sihlanganise wonke amarekhodi omndeni aqoqwe kusukela ngo-1998 kuya ku-2003 ukuze sibale ingxenye yemizi endaweni ngayinye ephethe okungenani inethiwekhi eyodwa yokwelapha y.indlebe.
Idatha nge-malaria yaqoqwa ngo-2000 njengengxenye yohlelo lokuqapha olubanzi lwe-antimalarial combination therapy.Ngomhla ziyi-16 kuNhlaba, kwisampula emele imindeni ye-HDSS, i-parasitemia yalinganiswa nge-microscopy yefilimu ewugqinsi kuwo wonke amalungu omndeni anezinyanga ezingu-6 noma ngaphezulu kuze kube nguJulayi 2000. , 2001, 2002, 2004, 2005 Year kanye 2006.16
Ukuze kwandiswe ikhwalithi yedatha nokuphelela kokulandelela ngo-2019, siqashe futhi saqeqesha ithimba labanolwazi olunzulu ngemibuzo abase benolwazi olubanzi lwasendaweni.Kweminye imindeni, ulwazi ngemfundo yomnakekeli, imali yomndeni, nesikhathi sokuya esikhungweni sezokwelapha besingatholakali. I-Imputation Multiple kusetshenziswa i-chain equations yasetshenziselwa ukulandisa ngedatha ye-covariate engekho emphumeleni wethu oyinhloko.Zonke iziguquko ezibalwe kuThebula 1 zisetshenziswe njengezibikezelo zalokhu kuthonywa.Ucwaningo lwecala olugcwele olwengeziwe lwenziwa ukuze kuqinisekiswe ukuthi imiphumela yayingazweli ekutholweni. indlela ekhethiwe.
Izibalo zokuqala ezichazayo zazihlanganisa ukuvakasha kokulandelela nokufa kwabantu ngocansi, unyaka wokuzalwa, imfundo yomnakekeli, kanye nesigaba semali engenayo yasekhaya.Ukufa kulinganiselwa njengokufa ngonyaka ngamunye we-1000.
Sihlinzeka ngedatha yokuthi ukutholakala kwenethiwekhi kuye kwashintsha kanjani ngokuhamba kwesikhathi.Ukukhombisa ubudlelwano phakathi kobunikazi bomndeni wezinga lesigodi lemanethi alashiwe kanye nokudluliswa kukamalaleveva, sidale isiqephu sokutholakala kwenethi eselashwayo endaweni kanye nokusabalala kwezifo eziwumshayabhuqe. ngo-2000.
Ukuze silinganisele ukuhlobana phakathi kokusetshenziswa kwenetha nokuphila kwesikhathi eside, siqale salinganisela amajika okusinda e-Kaplan-Meier ajwayelekile aqhathanisa izingane ezibike zilala ngaphansi kwenethi elashiwe okungenani phakathi no-50% wokuvakasha kwangaphambi kwesikhathi naleyo miphumela yokusinda. Izingane kubikwa ukuthi zilale zingelashiwe. amanethi omiyane esikhathini esingaphansi kuka-50% sokuvakashelwa kusenesikhathi. Ukunqamuka okungu-50% kwakhethwa ukuze kufane nencazelo elula “yesikhathi esiningi”. Ukuqinisekisa ukuthi imiphumela ayizange ithintwe ngalokhu kuncishiswa okungenangqondo, silinganisele ne-Kaplan-Meier evamile engalungiswanga. amajika okusinda eqhathanisa izingane ezihlale zibika ukuthi zilala ngaphansi kwenethi eselashwayo nalabo abangakaze babike ukuthi balele ngaphansi kwenethi elilashiwe Imiphumela yokusinda kwezingane ngaphansi kwenethi.Silinganisele amajika e-Kaplan-Meier angalungisiwe kulokhu kugqama ngemva kwaso sonke isikhathi (iminyaka engu-0 kuye kwengu-20) kanye nengane encane (iminyaka emi-5 kuye kwengama-20). Konke ukuhlaziya okusinda bekukhawulelwe esikhathini esiphakathi kwenhlolokhono yokuqala nenhlolokhono yokugcina kuphumele ekunqanyulweni kwesokunxele kanye nokuvinjelwa kwesokudla.
Sisebenzise amamodeli we-Cox proportional hazards ukuze silinganisele ukuhluka okuthathu okuyinhloko kwentshisekelo, okunemibandela ekudidekeni okubonwayo—okokuqala, ukuhlobana phakathi kokusinda kanye nephesenti lokuvakasha okubikwa ukuthi izingane zazilala ngaphansi kwamanethi alashiwe;okwesibili, Umehluko wokusinda phakathi kwezingane ezisebenzisa amanetha ahlanzekile esikhathini esingaphezu kwesigamu sokuvakashela kwazo kanye nalezo ezisebenzisa amanetha ahlanzekile esikhathini esingaphansi kwengxenye yokuvakasha kwazo;okwesithathu, umehluko wokuphila phakathi kwezingane njalo zibikwa zilele ekuvakasheleni kwazo kusenesikhathi Ngaphansi kwamanethi omiyane alashiwe, izingane azikaze zibike ukuthi zilele ngaphansi kwamanethi alashiwe phakathi nalokhu kuvakasha.Ngososeshini bokuqala, iphesenti lokuvakasha lihlaziywa njengethemu eliwumugqa.A martingale residual analysis kwenziwa ukuze kuqinisekiswe ukufaneleka kwalokhu kucatshangelwa komugqa.Ukuhlaziywa kwensalela ye-Schoenfeld17 kwasetshenziselwa ukuhlola ukuqagela kwezingozi ezilinganayo.Ukulandisa ngokudidayo, zonke izilinganiso ezixubile zokuqhathanisa ezintathu zokuqala zalungiselelwa isigaba semali engenayo yasekhaya, isikhathi sokuya esikhungweni sezokwelapha esiseduze, umnakekeli. isigaba semfundo, ubulili bengane, kanye neminyaka yengane.ezelwe.Wonke amamodeli ahlukahlukene aphinde afaka phakathi izindlela zokunqanda eziqondene nedolobhana ezingama-25, okusivumele ukuba singafaki umehluko ohleliwe ezicini ezingabhekwa ezingeni lendawo njengeziphambanisi ezingase zibe khona.Ukuqinisekisa ukuqina kwemiphumela ethulwayo ngenhlonipho. kumodeli ye-empirical ekhethiwe, siphinde salinganisela ukuqhubeka okubili kanambambiliama-rasts asebenzisa ama-kernel, ama-caliper nama-algorithms afanayo nse.
Uma kubhekwa ukuthi ukusetshenziswa kwamanethi aselashwa kusenesikhathi kungachazwa izici zomndeni ezinganakiwe noma zomnakekeli ezinjengolwazi lwezempilo noma ikhono lomuntu lokuthola usizo lwezokwelapha, siphinde salinganisela imodeli yezinga lesigodi njengokuqhathanisa kwesine.Kulesi siqhathaniso, sisebenzise isigodi- Isilinganiso sezinga lobunikazi bomndeni bamanethi aphathwayo (okufakwayo njengetemu eliqondile) eminyakeni yokuqala emi-3 lapho izingane zazibhekwa njengokuhluka kwethu okuyinhloko. ngakho-ke ungathinteki kakhulu ekudidekeni.Ngokwengqondo, ukwanda kokutholakala kwezinga lesigodi kufanele kube nomthelela omkhulu wokuvikela kunokwandisa ukuvikeleka komuntu ngamunye ngenxa yemiphumela emikhulu ebuningini bomiyane kanye nokudluliswa kukamalaleveva.18
Ukuze kulandiswe ukwelashwa kwenetha yeleveli yesigodi kanye nokuhlotshaniswa kweleveli yesigodi ngokujwayelekile, amaphutha ajwayelekile abalwe kusetshenziswa isilinganiso se-Huber's cluster-robust variance.Imiphumela ibikwa njengezilinganiso zamaphuzu ezinezikhawu zokuzethemba ezingu-95%. Ububanzi bezikhawu zokuzethemba akubona ilungiselwe ukuphindaphindeka, ngakho izikhawu akufanele zisetshenziselwe ukucabangela izinhlangano ezisunguliwe.Ukuhlaziya kwethu okuyinhloko akuzange kucaciswe;ngakho-ke, awekho amanani e-P abikiwe.Ukuhlaziywa kwezibalo kwenziwa kusetshenziswa isofthiwe ye-Stata SE (StataCorp) inguqulo 16.0.19
Kusukela ngoMeyi 1998 kuya ku-April 2003, inani labahlanganyeli abangu-6706 abazalwa phakathi kukaJanuwari 1, 1998 kanye no-Agasti 30, 2000 bafakwe eqenjini (Umfanekiso 1). Iminyaka yokubhalisa yayisukela ezinyangeni ezi-3 kuya kwezingu-47, nesilinganiso sezinyanga ezingu-12. Phakathi Ngo-May 1998 no-April 2003, kwashona ababambiqhaza abangu-424. Ngo-2019, siqinisekise isimo esibalulekile sabahlanganyeli abangu-5,983 (89% yababhalisile). Isamba sabahlanganyeli abangu-180 bashona phakathi kukaMeyi 2003 noDisemba 2019, okuholele ekutheni kube nenani lokufa okungafanele lilonke. 6.3 abantu abafa ngeminyaka eyi-1000.
Njengoba kukhonjisiwe kuThebula loku-1, isampula yayilinganiselwe ngokobulili;ngokwesilinganiso, izingane zazibhaliswa ngaphambi nje kokuba zihlanganise unyaka owodwa ubudala futhi zilandelwe iminyaka eyi-16. Iningi labanakekeli seliqedile imfundo yamabanga aphansi, futhi amakhaya amaningi ayakwazi ukuthola amanzi ompompi noma amanzi omthombo. isibalo sokufa kwabantu abayi-1000 eminyakeni eyi-1000 yayiphansi kakhulu phakathi kwezingane ezinabanakekeli abafundile (4.4 per 1000 person-year) futhi laliphezulu kakhulu phakathi kwezingane ebeziqhele ngamahora angaphezu kwama-3 esikhungweni sezokwelapha (9.2 per 1000 person-year) and Phakathi amakhaya antula ulwazi ngemfundo (engu-8.4 ngeminyaka eyi-1,000 yabantu) noma iholo (19.5 ngeminyaka eyi-1,000 yabantu).
Ithebula lesi-2 lifingqa okuguquguqukayo kokuchayeka okuyinhloko. Cishe ingxenye yesine yabahlanganyeli bocwaningo kubikwa ukuthi ayizange ilale ngaphansi kwenethi elilashiwe, enye ikota ibike ukuthi yayilala ngaphansi kwenethi eselashiwe ngesikhathi sokuvakasha ngakunye, kanti ingxenye esele yayilala ngaphansi kokunye kodwa kungebona bonke Kubikwe ukuthi balala bengelashiwe. amanethi omiyane ngesikhathi sokuvakasha.Inani lezingane ezihlale zilala ngaphansi kwamanethi omiyane aselashiwe lenyuke lisuka ku-21% wezingane ezizalwe ngo-1998 laya ku-31% wezingane ezizalwe ngo-2000.
Ithebula S2 linikeza imininingwane eyengeziwe mayelana nemikhuba ekusetshenzisweni kwenethiwekhi kusukela ngo-1998 kuya ku-2003. Nakuba kwabikwa ukuthi u-34% wezingane zazilala ngaphansi kwamanethi omiyane aselashiwe ngobusuku bangaphambi kuka-1998, ngo-2003 lelo nani lase likhuphuke lafinyelela ku-77%. Umdwebo S4 ukhombisa ukwehlukahlukana okuphezulu kobunikazi, njengoba ingaphansi kuka-25% yemindeni eyake yaphatha amanetha esigodini sase-Iragua ngo-1998, kanti esigodini sase-Igota, eKivukoni naseLupiro, imindeni engaphezu kuka-50%. amanetha elaphayo ngawo lowo nyaka.
Amajika okusinda e-Kaplan-Meier angalungisiwe abonisiwe.Amaphaneli A no-C aqhathanisa izindlela zokusinda (ezingalungisiwe) zezingane ezibike zisebenzisa amanethi aphethwe okungenani isigamu senani lokuvakashela kulabo abasebenzisa kancane.Amaphaneli B kanye no-D aqhathanisa izingane ezingakaze zenzeke. kubika ukulala ngaphansi kwamanethi aselashiwe (amaphesenti angu-23 esampula) nalabo abahlale bebika ukuthi balele ngaphansi kwamanethi aselashiwe (ama-25% esampula).adjusted) ithrekhi.Isethi ibonisa idatha efanayo ku-axis ka-y ekhulisiwe.
Umfanekiso 2 Ukuqhathaniswa kwendlela yokusinda yabahlanganyeli ukuya ekubeni abantu abadala ngokusekelwe ekusetshenzisweni kusenesikhathi kwamanethi alashiwe, okuhlanganisa izilinganiso zokusinda zaso sonke isikhathi (Izibalo 2A kanye no-2B) kanye namajika okusinda asekelwe ekusindeni kweminyaka engu-5 ubudala (Izibalo 2C kanye no-2D). isamba sokufa kwabantu abangama-604 sarekhodwa ngesikhathi socwaningo;I-485 (80%) yenzeke eminyakeni yokuqala ye-5 yokuphila.Ingozi yokufa yanda onyakeni wokuqala wokuphila, yehla ngokushesha kwaze kwaba yilapho ineminyaka engu-5 ubudala, yahlala iphansi kakhulu, kodwa yanda kancane cishe eminyakeni engu-15 (Fig. S6).Amashumi ayisishiyagalolunye- iphesenti elilodwa labahlanganyeli ababesebenzisa amanetha asetshenziswa njalo lasinda laze lakhula;lokhu kwaba njalo ezinganeni ezingamaphesenti angama-80 kuphela ezingazange zisebenzise amanethi alashwe kusenesikhathi (Ithebula lesi-2 kanye noMdwebo 2B). Ukuvama kwama-parasite ngo-2000 kwakuhlobene kakhulu namanethi aphathwayo aphethwe yimizi yezingane ezineminyaka engaphansi kwemihlanu (correlation coefficient). , ~0.63) kanye nezingane ezineminyaka engu-5 ubudala noma ngaphezulu (i-correlation coefficient, ~0.51) (Fig. S5).).
Ukwenyuka ngakunye ngamaphesenti angu-10 ekusetshenzisweni kusenesikhathi kwamanethi alashiwe kwakuhlotshaniswa nengozi ephansi engu-10% yokufa (isilinganiso sengozi, 0.90; 95% CI, 0.86 kuya ku-0.93), inqobo nje uma isethi egcwele yabanakekeli kanye nabasebenza ekhaya nabo njengemiphumela emisiwe yasesigodini (Ithebula 3 ).Izingane ezisebenzise amanetha alashiwe ekuhambeleni kwangaphambili zibe nengozi ephansi yokufa ngama-43% uma kuqhathaniswa nezingane ezisebenzisa amanethi alashiwe ngesikhathi esingaphansi kwesigamu sokuvakasha kwazo (isilinganiso sengozi, 0.57; 95% CI, 0.45 kuya ku-0.72).Ngokunjalo, izingane ezihlale zilala ngaphansi kwamanethi ahlanzekile zinengozi ephansi yokufa ngama-46% kunezingane ezingakaze zilale ngaphansi kwamanethi (ingozi isilinganiso, 0.54; 95% CI, 0.39 kuya ku-0.74). Ezingeni lesigodi, a Ukunyuka ngamaphesenti angu-10 kubunikazi benetha yombhede eselakiwe kuhlotshaniswa nengozi ephansi yokufa ngo-9% (isilinganiso sengozi, 0.91; 95% CI, 0.82 kuya ku-1.01).
Ukusetshenziswa kwamanethi alashiwe phakathi nokungenani ingxenye yokuvakasha kwasebusheni kubikwe ukuthi kuhlotshaniswa nenani lengozi lika-0.93 (95% CI, 0.58 kuya ku-1.49) ekufeni kusukela eminyakeni engu-5 kuya ekubeni umuntu omdala (Ithebula 3). kusukela ngo-1998 kuya ku-2003, lapho silungisela iminyaka, imfundo yomnakekeli, imali engenayo yasekhaya kanye nengcebo, unyaka wokuzalwa kanye nedolobhana lokuzalwa (Ithebula S3).
Ithebula le-S4 libonisa izikolo zokuthambekela okulinganiselwe kanye nezilinganiso eziqondile ezifanayo zokuguquguquka kokuchayeka kanambambili kwethu okubili, futhi imiphumela icishe ifane naleyo ekuThebula 3.Ithebula S5 libonisa umehluko wokusinda ohlukaniswe ngenani lokuvakasha kwangaphambi kwesikhathi.Naphezu kokubhekwa okumbalwa okungenani izikhathi ezine okungenani ezine ukuvakasha kusenesikhathi, umphumela wokuvikela olinganiselwe ubonakala umkhulu kuzingane ezinokuvakashelwa okuningi kunasezinganeni ezinokuvakasha okumbalwa.Ithebula S6 libonisa imiphumela yokuhlaziywa kwecala eligcwele;le miphumela icishe ifane naleyo yokuhlaziya kwethu okuyinhloko, ngokunemba okuphezulu kancane kwezilinganiso zezinga lesigodi.
Nakuba kunobufakazi obuqinile bokuthi amanetha aphathwayo angathuthukisa ukuphila kwezingane ezingaphansi kweminyaka engu-5 ubudala, izifundo zemiphumela yesikhathi eside zihlala ziyindlala, ikakhulukazi ezindaweni ezinamazinga aphezulu okudlulisela.20 Imiphumela yethu iphakamisa ukuthi izingane zinezinzuzo ezibalulekile zesikhathi eside ngokusebenzisa Le miphumela inamandla kuzo zonke izinkambiso ezibanzi zobufakazi futhi iphakamisa ukuthi ukukhathazeka mayelana nokufa kwabantu kamuva ebuntwaneni noma ebusheni, okungenzeka kube ngenxa yokubambezeleka kokukhula kokuzivikela komzimba, akunasisekelo. kungaphikiswana ngokuthi ukusinda uze ube umuntu omdala ezindaweni ezigcwele umalaleveva kukodwa kuwukubonakaliswa kokungavikeleki okusebenzayo.
Amandla ocwaningo lwethu ahlanganisa usayizi wesampula, ohlanganisa izingane ezingaphezu kuka-6500;isikhathi sokulandelela, okwakuyiminyaka eyi-16;izinga eliphansi ngokungalindelekile lokulahlekelwa ukuze kulandelelwe (11%);kanye nokuvumelana kwemiphumela kukho konke ukuhlaziya.Izinga eliphezulu lokulandelela lingase libe ngenxa yenhlanganisela engajwayelekile yezinto, njengokusetshenziswa kabanzi komakhalekhukhwini, ukuhlangana komphakathi wasemaphandleni endaweni yocwaningo, kanye nenhlalo ejulile nenhle. ubudlelwano obakhiwe phakathi kwabacwaningi nabantu bendawo.Umphakathi nge-HDSS.
Kunemikhawulo ethile yocwaningo lwethu, okuhlanganisa nokuntuleka kokulandelelwa komuntu ngamunye kusukela ngo-2003 kuya ku-2019;alukho ulwazi lwezingane ezashona ngaphambi kokuvakasha kokuqala kocwaningo, okusho ukuthi amanani okusinda eqembu awameleli ngokugcwele konke ukuzalwa ngesikhathi esifanayo;kanye nokuhlaziywa kokuqaphela.Ngisho noma imodeli yethu iqukethe inani elikhulu lama-covariate, ukudideka okusalayo akunakugwenywa.Ngenxa yale mikhawulo, siphakamisa ukuthi ucwaningo olwengeziwe luyadingeka ngomthelela wokusetshenziswa okuqhubekayo kwesikhathi eside kwamanethi ombhede kanye nokubaluleka kwezempilo yomphakathi. lamanethi embhede angalashiwe, ikakhulukazi uma kubhekwa ukukhathazeka kwamanje mayelana nokumelana nezibulala-zinambuzane.
Lolu cwaningo lokusinda lwesikhathi eside oluhlobene nokulawulwa kukamalaleveva ezinganeni lubonisa ukuthi ngokutholakala komphakathi okusesilinganisweni, izinzuzo zokusinda kwamanethi afakwe izibulala-zinambuzane zinkulu futhi ziyaqhubeka nokuba abantu abadala.
Ukuqoqwa kwedatha phakathi nokulandelela kuka-2019 kukaProf. Eckenstein-Geigy nokusekelwa kusukela ngo-1997 kuya ku-2003 yi-Swiss Agency for Development and Cooperation kanye ne-Swiss National Science Foundation.
Ifomu lokudalula elinikezwe ababhali liyatholakala nombhalo ogcwele wale ndatshana ku-NEJM.org.
Isitatimende sokwabelana ngedatha esinikezwe ababhali siyatholakala ngombhalo ogcwele walesi sihloko ku-NEJM.org.
Kusukela ku-Swiss Tropical and Public Health Institute kanye naseNyuvesi yaseBasel, e-Basel, eSwitzerland (GF, CL);Ifakara Health Institute, Dar es Salaam, Tanzania (SM, SA, RK, HM, FO);Columbia University, New York Mailman School of Public Health (SPK);kanye neLondon School of Hygiene and Tropical Medicine (JS).
UDkt. Fink angathintwa kokuthi [i-imeyili ivikelwe] noma e-Swiss Institute for Tropical and Public Health (Kreuzstrasse 2, 4123 Allschwil, Switzerland).
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