Ukutheleleka kwe-helminth (STH) okudluliselwe emhlabathini (STH) sekuyisikhathi eside kuyinkinga ebalulekile yezempilo yomphakathi ePhilippines.Kulokhu kubuyekezwa, sichaza isimo samanje sokutheleleka kwe-STH lapho futhi sigqamisa izinyathelo zokulawula zokunciphisa umthwalo we-STH.
Uhlelo lukazwelonke lwe-STH mass drug administration (MDA) lwaqalwa ngo-2006, kodwa ukusabalala okuphelele kwe-STH e-Philippines kusalokhu kuphezulu, kusukela ku-24.9% kuya ku-97.4%. okuhlanganisa nokungazi ngokubaluleka kokwelashwa okuvamile, ukungaqondi kahle mayelana namasu e-MDA, ukungazethembi emithini esetshenziswayo, ukwesaba izehlakalo ezimbi, nokungathenjwa okuvamile kwezinhlelo zikahulumeni.Izinhlelo ezikhona zamanzi, ukukhucululwa kwendle kanye nenhlanzeko (WASH) sezingenile. indawo emiphakathini [isib., izinhlelo eziholwa ngumphakathi zokukhucululwa kwendle (CLTS) ezihlinzeka ngezindlu zangasese futhi zixhase ukwakhiwa kwezindlu zangasese] nasezikoleni [isb, uhlelo lwe-WASH yesikole (WINS)], kodwa ukuqaliswa okuqhubekayo kuyadingeka ukuze kuzuzwe imiphumela efiselekayo.Naphezu kokusabalala kokwanda kwezindlu zangasese. ukufundiswa kwe-WASH ezikoleni, ukudidiyelwa kwe-STH njengesifo kanye nodaba lomphakathi ohlelweni lwemfundo yamabanga aphansi lukahulumeni lwamanje luhlala lunganele.Ukuhlola okuqhubekayokuyodingeka oHlelweni Oludidiyelwe Lokulawula I-Helminth (IHCP) olukhona njengamanje ezweni, olugxile ekuthuthukiseni ukuthuthwa kwendle nenhlanzeko, imfundo yezempilo kanye nokwelashwa ngamakhemikhali. Ukusimama kwalolu hlelo kuseyinselelo.
Naphezu kwemizamo emikhulu yokulawula ukutheleleka nge-STH ePhilippines eminyakeni engamashumi amabili edlule, ukwanda okuqhubekayo kwe-STH kuye kwabikwa ezweni lonke, mhlawumbe ngenxa yokufakwa kwe-MDA okulinganiselwe kanye nemikhawulo ye-WASH nezinhlelo zemfundo yezempilo..Ukulethwa okusimeme kwendlela yokulawula edidiyelwe kuzoqhubeka nokubamba iqhaza elibalulekile ekulawuleni nasekuqedeni i-STH e-Philippines.
Ukutheleleka kwe-helminth (STH) okudluliswa umhlabathi kuseyinkinga enkulu yezempilo yomphakathi emhlabeni jikelele, okulinganiselwa ukuthi ukutheleleka kwabantu abangaphezu kwezigidigidi eziyi-1.5 [1]. , 3];futhi livame kakhulu emazweni anemali ephansi, kanti izifo eziningi zenzeka ezingxenyeni zase-Asia, e-Afrika, naseLatin America [4].Izingane zasenkulisa ezineminyaka engu-2 kuya kwengu-4 (PSAC) kanye nezingane zesikole ezineminyaka engu-5 kuya kweyi-12 (SAC) abathinteka kakhulu, abanokwanda okukhulu nokuqina kokutheleleka.Idatha etholakalayo iphakamisa ukuthi ama-PSAC angaphezu kwezigidi ezingu-267.5 kanye nama-SAC angaphezu kwezigidi ezingu-568.7 ahlala ezindaweni ezinokutheleleka okukhulu kwe-STH futhi adinga ukwelashwa ngamakhemikhali wokuvimbela [5].Umthwalo womhlaba wonke we-STH ulinganiselwa ibe yiminyaka eyi-19.7-3.3 million yokuphila kokukhubazeka (DALYs) [6, 7].
Ukutheleleka kwe-STH kungase kuholele ekusweleni kokudla okunomsoco kanye nokukhubazeka ngokomzimba kanye nokuthuthukiswa kwengqondo, ikakhulukazi ezinganeni [8].Ukutheleleka kwe-STH okunamandla kakhulu kwandisa ukugula [9,10,11].I-Polyparasitism (ukutheleleka ngama-parasites amaningi) nayo iboniswe ukuthi ihlotshaniswa ngokufa okuphezulu nokwanda kokungenwa kwezinye izifo [10, 11] .Imiphumela emibi yalezi zifo ingathinta hhayi impilo kuphela kodwa futhi nokukhiqiza kwezomnotho [8, 12].
I-Philippines iyizwe elinemali engenayo ephansi nephakathi.Ngo-2015, cishe i-21.6% yabantu basePhilippine abayizigidi ezingu-100.98 babehlala ngaphansi komugqa wezwe wobumpofu [13].Ibuye ibe nokusabalala okuphezulu kakhulu kwe-STH eNingizimu-mpumalanga ye-Asia [14] . Idatha ka-2019 evela ku-WHO Preventive Chemotherapy Database ibonisa ukuthi cishe izingane eziyizigidi ezingu-45 zisengozini yokutheleleka ezidinga ukwelashwa [15].
Nakuba kuye kwaqalwa izinyathelo ezinkulu eziningana zokulawula noma zokuphazamisa ukudluliselwa, i-STH isalokhu ivame kakhulu ePhilippines [16].Kulesi sihloko, sinikeza umbono jikelele wesimo samanje sokutheleleka kwe-STH ePhilippines;gqamisa imizamo yokulawula eqhubekayo edlule neyamanje, ibhale phansi izinselele nobunzima bokusetshenziswa kohlelo, ihlole umthelela wayo ekwehliseni umthwalo we-STH, futhi inikeze imibono engase ibe khona yokulawula izikelemu zamathumbu .Ukutholakala kwalolu lwazi kunganikeza isisekelo sokuhlela nokusebenzisa i-STH Uhlelo oluqhubekayo lokulawula i-STH ezweni.
Lokhu kubuyekezwa kugxile ezifweni ezine ezivame kakhulu ze-STH - i-roundworm, i-Trichuris trichiura, i-Necator americanus ne-Ancylostoma duodenale.Nakuba i-Ancylostoma ceylanicum ivela njengohlobo olubalulekile lwe-zoonotic hookworm eNingizimu-mpumalanga ye-Asia, ulwazi olulinganiselwe luyatholakala okwamanje e-Philippines futhi ngeke kuxoxwe ngalo. lapha.
Nakuba lokhu kungekona ukubuyekezwa okuhlelekile, indlela esetshenziswa ekubuyekezweni kwezincwadi imi kanje.Sifune izifundo ezifanele ezibika ukusabalala kwe-STH e-Philippines sisebenzisa imininingwane egciniwe ye-inthanethi ye-PubMed, Scopus, ProQuest, ne-Google Scholar. asetshenziswe njengamagama angukhiye ekusesheni: (“Ama-Helminthiases” noma izikelemu ezithwalwa umhlabathi” noma “STH” noma “Ascaris lumbricoides” noma “Trichuris trichiura” noma “Ancylostoma spp.” noma “Necator americanus” noma “Roundworm” noma “Whichworm” noma i-“Hookworm”) kanye (“Epidemiology”) kanye (“Philippines”).Awukho umkhawulo ngonyaka wokushicilelwa.Ama-athikili ahlonzwe ngemibandela yosesho aqale ahlolwa ngesihloko nokuqukethwe okungacacile, lawo angaphenywanga okungenani ama-Athikili amathathu anokuvama noma ukushuba kweyodwa yama-STH awazange afakwe.Ukuhlolwa kombhalo ogcwele kwakuhlanganisa izifundo zokubheka (izigaba ezihlukene, ukulawula icala, ubude/iqoqo) noma izivivinyo ezilawulwayo ezibika ukuvama kwesisekelo.Ukukhishwa kwedatha kuhlanganisa indawo yokufunda, unyaka wokufunda, unyaka wokushicilelwa kocwaningo, uhlobo locwaningo (isigaba esihlukene, isilawuli-kesi, noma ubude/iqembu), usayizi wesampula, inani locwaningo, ukusabalala kanye nokuqina kwe-STH ngayinye, kanye nendlela esetshenziselwa ukuxilongwa.
Ngokusekelwe ekusesheni kwezincwadi, isamba samarekhodi we-1421 akhonjwe ngokusesha kusizindalwazi [PubMed (n = 322);Ububanzi (n = 13);I-ProQuest (n = 151) kanye ne-Google Scholar (n = 935)].Isamba samaphepha angu-48 ahlungwa ngokusekelwe ekubuyekezweni kwesihloko, amaphepha ayi-6 awazange afakwe, futhi isamba samaphepha angu-42 agcina efakwe ku-qualitative synthesis (Umdwebo 1). ).
Kusukela ngawo-1970, ucwaningo oluningi luye lwenziwa ePhilippines ukuze kunqunywe ukusabalala kanye nokuqina kokutheleleka nge-STH.Ithebula 1 libonisa isifinyezo sezifundo ezihlonziwe.Umehluko wezindlela zokuxilonga ze-STH phakathi kwalezi zifundo zabonakala ngokuhamba kwesikhathi, ne-formalin Indlela ye-ether concentration (FEC) evame ukusetshenziswa ezinsukwini zakuqala (1970-1998). Nokho, indlela ye-Kato-Katz (KK) iye yasetshenziswa kakhulu eminyakeni eyalandela futhi isetshenziswa njengendlela eyinhloko yokuxilonga yokuqapha izinqubo zokulawula i-STH kuzwelonke. izinhlolovo.
Ukutheleleka nge-STH kube futhi kuseyinkinga enkulu yezempilo yomphakathi ePhilippines, njengoba kuboniswa ucwaningo olwenziwe kusukela ngeminyaka yawo-1970 kuya ku-2018. Iphethini ye-epidemiological yokutheleleka nge-STH kanye nokusabalala kwayo kuqhathaniswa nalokhu okubikwe kwamanye amazwe emhlabeni jikelele, ukwanda okuphezulu kokutheleleka okurekhodwe ku-PSAC kanye ne-SAC [17].La maqembu obudala asengozini enkulu ngoba lezi zingane zivame ukuchayeka ku-STH ezindaweni zangaphandle.
Ngokomlando, ngaphambi kokuqaliswa koHlelo Oludidiyelwe Lokulawula I-Helminth Lomnyango Wezempilo (IHCP), ukusabalala kwanoma yikuphi ukutheleleka nge-STH kanye nokutheleleka okunzima ezinganeni ezineminyaka engu-1-12 kusukela ku-48.6-66.8% kuya ku-9.9-67.4%, ngokulandelana.
Idatha ye-STH evela ku-National Schistosomiasis Survey yabo bonke ubudala kusukela ku-2005 kuya ku-2008 ibonise ukuthi ukutheleleka kwe-STH kwakusakazeke ezindaweni ezintathu eziyinhloko zezwe, ne-A. lumbricoides kanye ne-T. trichiura ikakhulukazi ku-Visayas [16].
Ngo-2009, ukuhlolwa kokulandelela kwe-SAC ka-2004 [20] kanye no-2006 [21] National STH Prevalence Surveys kwenziwa ukuze kuhlolwe umthelela we-IHCP [26]. inhlolovo) kanye nama-44.7% ku-SAC (54% kuhlolovo lwango-2006) [26].Lezi zibalo ziphansi kakhulu kunalezo ezibikwe ocwaningweni olubili lwangaphambilini.Izinga eliphezulu lokutheleleka nge-STH lalingu-22.4% ku-PSAC ngo-2009 (aliqhathanisi inhlolovo yango-2004 ngoba ukusabalala kwezifo ezimbi kakhulu akuzange kubikwe) kanye ne-19.7% ku-SAC (uma kuqhathaniswa no-23.1% ocwaningweni luka-2006), ukwehla ngo-14% [26]. I-STH kubantu be-PSAC kanye ne-SAC ayizange ihlangabezane nenhloso ye-WHO echazwe ngo-2020 yokuvama okukhulayo okungaphansi kwama-20% kanye nezinga elibi lokutheleleka nge-STH elingaphansi kwe-1% ukukhombisa ukulawula ukugula [27, 48].
Olunye ucwaningo olusebenzisa ukuhlola kwe-parasitological olwenziwa ngezikhathi eziningi (2006-2011) ukuqapha umthelela we-MDA yesikole ku-SAC yabonisa izitayela ezifanayo [22, 28, 29]. ;Nokho, noma iyiphi i-STH (ububanzi, 44.3% kuya ku-47.7%) kanye nokutheleleka okunzima (uhla, 14.5% kuya ku-24.6%) kubikwe ocwaningweni olulandelayo ukusabalala akukakafiki ezingeni eliqondiwe lokulawulwa kwezigameko ezichazwe yi-WHO (Ithebula 1).
Idatha evela kwezinye izifundo ezilandela ukwethulwa kwe-IHCP ePhilippines ngo-2007-2018 ibonise ukusabalala okuphezulu okuqhubekayo kwe-STH ku-PSAC kanye ne-SAC (Ithebula 1) [30,31,32,33,34,35,36,37,38, 39 ].Ukuvama kwanoma iyiphi i-STH okubikwe kulolu cwaningo kusuka ku-24.9% kuya ku-97.4% (nge-KK), futhi ukusabalala kwezifo ezimaphakathi kuya kwezinzima kusuka ku-5.9% kuya ku-82.6%.A.i-lumbricoides kanye ne-T. trichiura kuhlala kuyi-STH evame kakhulu, nokutholakala okusuka ku-15.8-84.1% kuya ku-7.4-94.4%, ngokulandelana, kuyilapho ama-hookworms evame ukuba nokwanda okuphansi, kusukela ku-1.2% kuya ku-25.3% [30,31, 32,33 ,34,35,36,37,38,39] (Ithebula 1).Nokho, ngo-2011, ucwaningo olusebenzisa i-molecular diagnostic quantitative real-time polymerase chain reaction (qPCR) lubonise ukusabalala kwe-hookworm (Ancylostoma spp.) ye-48.1 % [45].I-Co-infection yabantu abane-A. lumbricoides kanye ne-T. trichiura nayo ibonakale kaningi ezifundweni eziningana [26, 31, 33, 36, 45].
Indlela ye-KK ituswa yi-WHO ngokusebenziseka kwayo kalula ensimini kanye nezindleko eziphansi [46], ikakhulukazi zokuhlola izinhlelo zokwelashwa zikahulumeni zokulawula i-STH.Nokho, umehluko wokusabalala kwe-STH ubikwe phakathi kwe-KK nokunye ukuhlola. ucwaningo lwango-2014 esifundazweni saseLaguna, noma yikuphi ukutheleleka kwe-STH (33.8% ku-KK vs 78.3% kwe-qPCR), A. lumbricoides (20.5% KK vs 60.8% ye-qPCR) kanye ne-T. trichiura (KK 23.6% vs 38.8% ye-qPCR). Kukhona futhi ukutheleleka kwe-hookworm [6.8% ukusabalala;ihlanganisa i-Ancylostoma spp.(4.6%) kanye ne-N. americana (2.2%)] zitholwe kusetshenziswa i-qPCR futhi zahlulelwa njenge-KK [36].Ukusabalala kwangempela kokutheleleka nge-hookworm kungase kubonakale kuncane kakhulu ngoba ukuxilongwa okusheshayo kwamaqanda ohudo kudinga ukushintshwa ngokushesha ngokulungiselela ama-slide e-KK nokufunda [36,45,47], inqubo evame ukuba nzima ukuyifinyelela ngaphansi kwezimo zensimu.Ngaphezu kwalokho, amaqanda ezinhlobo ze-hookworm awakwazi ukuhlukaniswa ngokwe-morphologically, okubeka inselele eyengeziwe yokuhlonza okulungile [45].
Isu eliyinhloko lokulawula i-STH elikhuthazwa yi-WHO ligxile ekwelapheni nge-mass prophylactic chemotherapy ngealbendazolenoma i-mebendazole emaqenjini asengozini enkulu, ngenhloso yokwelapha okungenani u-75% we-PSAC ne-SAC ngo-2020 [48].Ngaphambi kokwethulwa kwakamuva kwe-Neglected Tropical Diseases (NTDs) Roadmap eya ku-2030, i-WHO yancoma ukuthi i-PSAC, i-SAC kanye abesifazane abaneminyaka yobudala yokuzala (iminyaka engu-15-49, kuhlanganise nalabo abasesigabeni sesibili nesesithathu) bathola ukunakekelwa okuvamile [49].Ngaphezu kwalokho, lesi siqondiso sihlanganisa izingane ezincane (izinyanga ezingu-12-23) kanye namantombazane asakhula (iminyaka engu-10-19) [ 49], kodwa ayifaki izincomo zangaphambilini zokwelashwa kwabantu abadala abasengozini enkulu emsebenzini [50].I-WHO incoma i-MDA yonyaka yezingane ezincane, i-PSAC, i-SAC, amantombazane asakhula, nabesifazane abaneminyaka yobudala yokuzala ezindaweni ezine-STH ezivame kakhulu phakathi kwe-20% ne-50 %, noma kabili ngonyaka uma ukusabalala kungaphezu kwama-50%.Kwabesifazane abakhulelwe, izikhathi zokwelashwa azikasungulwa [49].Ngaphezu kwe-chemotherapy yokuvimbela, i-WHO igcizelele amanzi, ukukhucululwa kwendle kanye nenhlanzeko (WASH) njengengxenye ebalulekile yokulawula i-STH [ 48, 49].
I-IHCP yethulwa ngo-2006 ukuze inikeze isiqondiso senqubomgomo yokulawula i-STH nezinye izifo ze-helminth [20, 51].Le phrojekthi ilandela isu lokulawula i-STH eligunyazwe yi-WHO,albendazolenoma i-mebendazole chemotherapy njengendlela eyinhloko yokulawula i-STH, eqondiswe ezinganeni ezineminyaka engu-1-12 kanye namanye amaqembu asengozini enkulu njengabesifazane abakhulelwe, abesifazane abasebasha, abalimi, abaphethe ukudla kanye nabantu bomdabu.Izinhlelo zokulawula zibuye zihambisane nokufakwa kwamanzi. kanye nezindawo zokukhucululwa kwendle kanye nezindlela zokuthuthukisa ezempilo nezindlela zemfundo [20, 46].
I-MDA yengxenye yonyaka ye-PSAC yenziwa ikakhulukazi amayunithi ezempilo e-barangay (esigodini), abasebenzi bezempilo abaqeqeshiwe nabanakekela izingane ezindaweni zomphakathi njengeGarantisadong Pambata noma “Izingane Ezinempilo” (iphakheji ehlinzeka ngephrojekthi) Yezinsizakalo Zezempilo ze-PSAC) , kuyilapho i-MDA ye-SAC yenganyelwe futhi isetshenziswa uMnyango wezeMfundo (DepEd) [20]. 2016, uMnyango Wezempilo ukhiphe imihlahlandlela emisha yokufaka izikelemu ezikoleni zamabanga aphezulu (izingane ezingaphansi kweminyaka engu-18) [52].
I-MDA yokuqala kazwelonke yonyaka wesibili yenziwa ezinganeni ezineminyaka engu-1-12 ngo-2006 [20] futhi yabika ukutholakala kwezikelemu ezingama-82.8% ezigidini ezingu-6.9 zama-PSAC kanye nama-31.5% wama-SAC ayizigidi ezingu-6.3 [53]. kuya ku-2014 (ububanzi obungu-59.5% kuya ku-73.9%), isibalo esingaphansi ngokuqhubekayo kwesilinganiso esinconyiwe se-WHO sama-75% [54].Ukwembozwa kwezikelemu okuphansi kungase kube ngenxa yokuntula ulwazi ngokubaluleka kokwelashwa okujwayelekile [55], ukungaqondi kahle kwe-MDA amasu [56, 57], ukuntula ukuzethemba emithini esetshenziswayo [58], nokwesaba izenzakalo ezimbi [55, 56, 58, 59, 60].Ukwesaba ukukhubazeka kokuzalwa kuye kwabikwa njengesizathu esisodwa sokuthi abesifazane abakhulelwe benqabe ukwelashwa kwe-STH [61].Ngaphezu kwalokho, izinkinga zokuhlinzeka kanye nokusetshenziswa kwezidakamizwa ze-MDA zihlonzwe njengokushiyeka okukhulu okuhlangatshezwane nakho ekusetshenzisweni kwe-MDA ezweni lonke [54].
Ngo-2015, i-DOH ibambisene ne-DepEd ukuze isingathe uSuku Lokuqala Lwezikole Lokulwa Nezikelemu (NSDD), okuhloswe ngalo ukuxosha ama-SAC acishe abe izigidi eziyi-16 (amabanga 1 kuya ku-6) abhalise kuzo zonke izikole zamabanga aphansi zikahulumeni ngosuku olulodwa [62]. -isinyathelo esisekelwe kumphumela wesilinganiso kuzwelonke sokutholakala kwezikelemu esingu-81%, esiphezulu kunaseminyakeni edlule [54].Kodwa-ke, ulwazi olungamanga oluzungeza emphakathini mayelana nokufa kwezingane ezibulala izikelemu kanye nokusetshenziswa kwezidakamizwa eziphelelwe yisikhathi kuye kwabangela ukuxakeka okukhulu nokwethuka, okuholele ekutheni ukwanda kwemibiko yezenzakalo ezimbi ngemva kwe-MDA (AEFMDA) eNhlonhlweni yaseZamboanga, eMindanao [63] .Nokho, ucwaningo lokulawulwa kwecala lubonise ukuthi ukuba yicala le-AEFMDA kwakuhlotshaniswa nomlando wangaphambili wokuqeda izikelemu [63].
Ngo-2017, uMnyango Wezempilo wethula umuthi omusha wokugomela udenga futhi wawunikeza izingane zesikole ezingaba ngu-800,000. Ukutholakala kwalo mgomo kuye kwaphakamisa ukukhathazeka okukhulu ngokuphepha futhi kubangele ukwanda kokungathembani ezinhlelweni ze-DOH, okuhlanganisa nohlelo lwe-MDA [64, 65]. Ngenxa yalokhu, ukutholakala kwezinambuzane kwehle kusuka ku-81% kanye nama-73% we-PSAC ne-SAC ngo-2017 kuya ku-63% no-52% ngo-2018, futhi kuya ku-60% kanye nama-59% ngo-2019 [15].
Ukwengeza, ngenxa yobhubhane lwamanje lomhlaba jikelele lwe-COVID-19 (isifo se-coronavirus 2019), uMnyango Wezempilo ukhiphe iMemorandamu yoMnyango No. 2020-0260 noma i-Interim Guidance for Integrated Helminth Control Plans kanye ne-Schistosomiasis Control and Elimination Plans Ngesikhathi se-COVID- 19 Pandemic 》” Juni 23, 2020, ihlinzekela ukuthi i-MDA imiswe kuze kube kunesinye isaziso.Ngenxa yokuvalwa kwezikole, umphakathi uvamise ukuqeda izikelemu izingane ezineminyaka engu-1-18, usabalalise imithi ngokuvakashela indlu ngendlu noma izindawo ezimisiwe, kuyilapho ugcina ukuqhelelana ngokomzimba futhi uqondise ku-COVID-19 -19 nezindlela ezifanele zokuvimbela nokulawula ukutheleleka [66].Kodwa-ke, imikhawulo ekuhambeni kwabantu kanye nokukhathazeka komphakathi ngenxa yobhubhane lwe-COVID-19 kungase kuholele ekwelashweni okuphansi.
I-WASH ingenye yezindlela zokungenelela ezibalulekile zokulawula i-STH ezichazwe yi-IHCP [20, 46].Lolu uhlelo olubandakanya ama-ejensi kahulumeni amaningana, okuhlanganisa uMnyango Wezempilo, Umnyango Wezasekhaya kanye Nohulumeni Wasekhaya (DILG), Amayunithi Ohulumeni Basekhaya ( LGU) kanye Nomnyango Wezemfundo.Uhlelo lomphakathi lwe-WASH luhlanganisa ukuhlinzekwa kwamanzi aphephile, oluholwa iminyango kahulumeni wendawo, ngokusekelwa yi-DILG [67], kanye nokuthuthukiswa kokukhucululwa kwendle okwenziwa yi-DOH ngosizo lweminyango kahulumeni wendawo, ukuhlinzeka ngezindlu zangasese kanye uxhaso lokwakhiwa kwezindlu zangasese [68, 69] ].Okwamanje, uhlelo lwe-WASH ezikoleni zamabanga aphansi zikahulumeni lwenganyelwe uMnyango wezeMfundo ngokubambisana noMnyango Wezempilo.
Idatha yakamuva evela kwaPhilippine Statistics Authority (PSA) 2017 National Population Health Survey ibonisa ukuthi i-95% yemindeni yase-Filipino ithola amanzi okuphuza emithonjeni yamanzi athuthukisiwe, nengxenye enkulu kakhulu (43%) emanzini asemabhodleleni kanye no-26% kuphela emithonjeni yamapayipi[ 70] ithole.Ikota yemindeni yasePhilippines isasebenzisa izindawo zokukhucululwa kwendle ezingagculisi [70];cishe i-4.5% yabantu ihlambalaza obala, umkhuba ophindwe kabili ezindaweni zasemaphandleni (6%) kunasemadolobheni (3%) [70].
Eminye imibiko iphakamisa ukuthi ukuhlinzeka ngezindawo zokukhucululwa kwendle kukodwa akuqinisekisi ukusetshenziswa kwazo, futhi akuthuthukisi izinqubo zokukhucululwa kwendle nenhlanzeko [32, 68, 69].Phakathi kwemizi engenazo izindlu zangasese, izizathu ezicashunwe kakhulu zokungathuthuki ukuthuthwa kwendle zihlanganisa izithiyo zobuchwepheshe (okungukuthi, ukuntuleka kwesikhala ekhaya sendlu yangasese noma ithange le-septic elizungeze ikhaya, nezinye izici zendawo ezifana nezimo zenhlabathi kanye nokuba seduze kwemigudu yamanzi), ubunikazi bomhlaba kanye nokuntuleka kwezimali [71, 72].
Ku-2007, uMnyango Wezempilo wasePhilippine wamukela indlela yokuthuthwa kwendle eholwa ngumphakathi (CLTS) ngohlelo lwe-East Asia Sustainable Health Development Programme [68, 73] .CLTS umqondo wokuhlanzeka okuphelele ohlanganisa uhla lokuziphatha okufana nokuyeka ukuvuleka. Ukukhipha indle, ukuqinisekisa ukuthi wonke umuntu usebenzisa izindlu zangasese ezihlanzekile, ukugeza izandla njalo nangendlela efanele, ukuthuthwa kwendle kokudla namanzi, ukulahlwa okuphephile kwezilwane nemfuywa, nokudalwa nokugcinwa kwendawo ehlanzekile nephephile [68, 69].Ukuqinisekisa ukusimama kwendawo Indlela ye-CLTS, isimo se-ODF yesigodi kufanele sigadwe ngokuqhubekayo ngisho nangemva kokuba imisebenzi ye-CLTS isinqanyuliwe.Nokho, izifundo ezimbalwa zibonise ukusabalala okuphezulu kwe-STH emiphakathini eye yazuza isimo se-ODF ngemva kokuqaliswa kwe-CLTS [32, 33].Lokhu kungase kubangelwe ukuntuleka kokusetshenziswa kwezindawo zokukhucululwa kwendle, ukuphinda kuqale kabusha ukuthulula okuvulekile, kanye nokufakwa kwe-MDA okuphansi [32].
Izinhlelo ze-WASH ezisetshenziswa ezikoleni zilandela izinqubomgomo ezishicilelwe yi-DOH kanye ne-DepEd.Ngo-1998, uMnyango Wezempilo wakhipha Imithetho Nemithetho Yokulandelwa Kwekhodi Yezempilo Yesikole sase-Philippine Health and Health Services (IRR) (PD No. 856) [74].Le IRR ibeka imithetho neziqondiso zokuhlanzeka kwesikole kanye nokukhucululwa kwendle okwanelisayo, okuhlanganisa nezindlu zangasese, izinsiza zamanzi, nokugcinwa nokugcinwa kwalezi zikhungo [74] . akuphoqelelwa ngokuqinile futhi ukusekelwa kwesabelomali akwanele [57, 75, 76, 77].Ngakho-ke, ukuqapha nokuhlola kusabalulekile ukuze kuqinisekiswe ukusimama kokuqaliswa kokuqaliswa koHlelo lwe-WASH koMnyango Wezemfundo.
Ukwengeza, ukuze kumiswe imikhuba emihle yezempilo kubafundi, uMnyango Wezemfundo ukhiphe i-Departmental Order (DO) No. 56, Article 56.2009 enesihloko esithi “Masinyane kwakhiwe izindawo zokugezela izandla kuzo zonke izikole ukuze kunqandwe uMkhuhlane A (H1N1)” kanye ne-DO No. .65, ikhasi.I-2009 enesihloko esithi "Uhlelo Lokunakekelwa Kwezempilo Olubalulekile (EHCP) Lwezingane Zesikole" [78, 79] .Nakuba uhlelo lokuqala lwaklanyelwe ukuvimbela ukusabalala kwe-H1N1, lokhu kuhlobene nokulawulwa kwe-STH.Lokhu kokugcina kulandela indlela efanelekile yesikole futhi igxile ekungeneleleni okuthathu kwezempilo yesikole okusekelwe ebufakazini: ukugeza izandla ngensipho, ukuxubha nge-fluoridated toothpaste njengomsebenzi weqembu wansuku zonke, kanye ne-STH's biannual MDA [78, 80].Ngo-2016, i-EHCP manje isihlanganiswe ohlelweni lwe-WASH In Schools (WINS) .Yanwetshwa ukuze ihlanganise ukuhlinzekwa kwamanzi, ukukhucululwa kwendle, ukuphathwa nokulungisa ukudla, ukuthuthukiswa kwenhlanzeko (isb, ukuphathwa kwenhlanzeko yokuya esikhathini), ukulwa nezikelemu, kanye nemfundo yezempilo [79].
Nakuba ngokuvamile i-WASH ifakiwe ku-curricula yesikole samabanga aphansi [79], ukufakwa kokutheleleka nge-STH njengesifo nenkinga yezempilo yomphakathi kusantuleka.Ucwaningo lwakamuva ezikoleni zamabanga aphansi ezikhethiwe esifundazweni saseCagayan lubike ukuthi imfundo yezempilo ehlobene ne-WASH isebenza kubo bonke abafundi kungakhathaliseki ukuthi iliphi ibanga kanye nohlobo lwesikole, futhi ibuye ihlanganiswe ezifundweni eziningi futhi isetshenziswe kabanzi.Ukufinyelela ngaphandle (okungukuthi, izinto ezikhuthaza imfundo yezempilo zethulwa ngokubonakalayo emakilasini, ezindaweni ze-WASH, nakuso sonke isikole) [57].Kodwa-ke, ucwaningo olufanayo luphakamise ukuthi othisha badinga ukuqeqeshwa nge-STH kanye nokubulala izikelemu ukuze bajulise ukuqonda kwabo izimuncagazi futhi kangcono. qonda i-STH njengendaba yezempilo yomphakathi, okuhlanganisa: izihloko ezihlobene nokudluliswa kwe-STH, ingozi yokutheleleka, ingozi yokutheleleka izoqhuba ukukhishwa kwe-Post-worm evulekile kanye namaphethini okuphinda atheleleke angeniswe ohlelweni lwezifundo zesikole [57].
Ezinye izifundo nazo zibonise ubuhlobo phakathi kwemfundo yezempilo nokwamukelwa kokwelashwa [56, 60] okuphakamisa ukuthi imfundo yezempilo ethuthukisiwe nokukhuthazwa (ukuthuthukisa ulwazi lwe-STH nokulungisa imibono eyiphutha ye-MDA mayelana nokwelashwa nezinzuzo) kungakhuphula ukubamba iqhaza kokwelashwa kwe-MDA nokwamukelwa [56], 60].
Ngaphezu kwalokho, ukubaluleka kwemfundo yezempilo ekuthonyeni ukuziphatha okuhle okuhlobene nokuhlanzeka kuye kwabonakala njengenye yezingxenye ezibalulekile zokuqaliswa kwe-WASH [33, 60].Njengoba izifundo zangaphambilini zibonisile, ukukhishwa okuvulekile akubangelwa ukuntuleka kokungena endlini yangasese [33, 60]. 32, 33].Izici ezifana nemikhuba yokuthulula evulekile kanye nokuntuleka kokusetshenziswa kwezindawo zokuthuthwa kwendle kungase kube nomthelela emiphumeleni evulekile yokukhishwa kwendle [68, 69].Kolunye ucwaningo, ukuthuthwa kwendle okubi kwakuhlotshaniswa nengozi enkulu yokungakwazi ukufunda nokubhala phakathi kwama-SAC e-Visayas [ 81].Ngakho-ke, ukufakwa kwemfundo yezempilo kanye namasu okukhuthaza okuhloswe ngawo ukuthuthukisa imikhuba yamathumbu nenhlanzeko, kanye nokwamukelwa nokusetshenziswa okufanele kwalezi zakhiwo zezempilo, kudinga ukuhlanganiswa ukuze kugcinwe ukutholwa kokungenelela kwe-WASH.
Idatha eqoqwe phakathi namashumi amabili eminyaka adlule ibonisa ukuthi ukusabalala kanye nokuqina kokutheleleka nge-STH phakathi kwezingane ezineminyaka engaphansi kwe-12 e-Philippines kusalokhu kuphezulu, naphezu kwemizamo ehlukahlukene kahulumeni wase-Philippine. kuhlonzwe ukuze kuqinisekiswe ukufakwa kwe-MDA okuphezulu.Kufanelekile futhi ukucabangela ukusebenza kwezidakamizwa ezimbili okwamanje ezisetshenziswa ohlelweni lokulawula i-STH (i-albendazole ne-mebendazole), njengoba ukutheleleka okuphezulu kwe-T. trichiura kuye kwabikwa kwezinye izifundo zakamuva ePhilippines [33, 34, 42].Le mithi yomibili kubikwe ukuthi ingasebenzi kahle ku-T. trichiura, kanye namazinga okwelapha ahlanganisiwe angu-30.7% kanye nama-42.1%albendazolekanye ne-mebendazole, ngokulandelana, kanye nokunciphisa ngo-49.9% kanye no-66.0% ekuzaleni [82].Ngenxa yokuthi le mithi yomibili inemiphumela encane yokwelapha, lokhu kungase kube nomthelela obalulekile ezindaweni lapho i-Trichomonas itholakala khona. Umthwalo we-helminth kubantu abangenwe yilesi sifo ngaphansi komkhawulo wesigameko, kodwa ukusebenza kahle kwahluka phakathi kwezinhlobo ze-STH. Ngokuphawulekayo, izidakamizwa ezikhona azikuvimbi ukutheleleka kabusha, okungenzeka ngokushesha ngemva kokwelashwa.Ngakho-ke, izidakamizwa ezintsha kanye namasu okuhlanganiswa kwezidakamizwa kungase kudingeke esikhathini esizayo [83] .
Njengamanje, akukho ukwelashwa kwe-MDA okuyimpoqo kubantu abadala ePhilippines.I-IHCP igxile kuphela ezinganeni ezineminyaka engu-1-18 ubudala, kanye nokukhishwa kwezikelemu okukhethekile kwamanye amaqembu asengozini enkulu njengabesifazane abakhulelwe, abesifazane abasebasha, abalimi, abaphathi bokudla, kanye nezibalo zabantu bomdabu [46].Nokho, amamodeli akamuva ezibalo [84,85,86] nokubuyekezwa okuhlelekile nokuhlaziywa kwemeta [87] kuphakamisa ukuthi ukwanda komphakathi jikelele kwezinhlelo zokubulala izikelemu ukuze kuhlanganiswe wonke amaqembu eminyaka kunganciphisa ukusabalala kwe-STH abantu abasengozini enkulu.- Amaqembu ezingane zesikole ezisengozini.Nokho, ukukhuphula i-MDA kusukela ekuphathweni kwezidakamizwa okuhlosiwe kuya emphakathini wonke kungase kube nemithelela ebalulekile yezomnotho ezinhlelweni zokulawula i-STH ngenxa yesidingo sezinsiza ezengeziwe.Noma kunjalo, ukwelashwa kwenqwaba okuphumelelayo umkhankaso we-lymphatic filariasis ePhilippines ugcizelela ukuthi kungenzeka ukuhlinzeka ngokwelashwa komphakathi wonke [52].
Ukuqubuka kabusha kwezifo ze-STH kulindeleke njengoba imikhankaso ye-MDA esekelwe esikoleni emelene ne-STH kulo lonke elase-Philippines isiyekile ngenxa yobhadane oluqhubekayo lwe-COVID-19. Amamodeli akamuva ezibalo asikisela ukuthi ukubambezeleka kwe-MDA ezindaweni eziphezulu ze-STH kungase kusho umgomo wokuqeda i-STH. njengenkinga yezempilo yomphakathi (EPHP) ngo-2030 (okuchazwa njengokufeza < 2% ukusabalala kwezifo ezimaphakathi kuya kweziphezulu ku-SAC [88] ]) zingase zingafezeki, nakuba amasu okunciphisa ukwenza imizuliswano ye-MDA ephuthelwe ( okungukuthi ukufakwa okuphezulu kwe-MDA, >75%) kungaba yinzuzo [89].Ngakho-ke, amasu okulawula okuzinzile okwandisa i-MDA adingeka ngokushesha ukuze kuliwe nokutheleleka nge-STH e-Philippines.
Ngaphezu kwe-MDA, ukuphazamiseka kokudlulisela kudinga izinguquko ekuziphatheni kwenhlanzeko, ukufinyelela emanzini aphephile, nokuthuthwa kwendle okuthuthukisiwe ngokusebenzisa izinhlelo ezisebenzayo ze-WASH kanye ne-CLTS. Nokho, ngokudabukisayo, kukhona imibiko yezindawo zokukhucululwa kwendle ezingasetshenziswa kancane ezinikezwa ohulumeni basekhaya kweminye imiphakathi, okubonisa i izinselele ekusetshenzisweni kwe-WASH [68, 69, 71, 72].Ngaphezu kwalokho, ukusabalala kwe-STH okuphezulu kubikwe emiphakathini eyazuza isimo se-ODF ngemva kokuqaliswa kwe-CLTS ngenxa yokuqaliswa kabusha kokuziphatha okuvulekile kokukhishwa kwe-defecation kanye nokufakwa kwe-MDA okuphansi [32]. ukuqwashisa nge-STH nokuthuthukisa izinqubo zokuhlanzeka kuyizindlela ezibalulekile zokunciphisa ingcuphe yomuntu yokutheleleka futhi empeleni kuyizithasiselo ezinezindleko eziphansi ezinhlelweni ze-MDA ne-WASH.
Imfundo yezempilo ehlinzekwa ezikoleni ingase isize ekuqiniseni nasekuthuthukiseni ulwazi olujwayelekile kanye nokuqwashisa nge-STH phakathi kwabafundi nabazali, okuhlanganisa nezinzuzo ezicatshangwayo zokubulala izikelemu.Uhlelo lwe-“Magic Glasses” luyisibonelo sokungenelela kwezemfundo yezempilo okusanda kuphumelela kakhulu ezikoleni.Lokhu ukungenelela okufushane kwekhathuni okuklanyelwe ukufundisa abafundi mayelana nokutheleleka nge-STH nokuvimbela, okuhlinzeka ngobufakazi besimiso sokuthi imfundo yezempilo ingathuthukisa ulwazi futhi ibe nomthelela ekuziphatheni okuhlobene nokutheleleka nge-STH [90].Inqubo yaqala ukusetshenziswa kubafundi besikole samabanga aphansi saseShayina e-Hunan Isifundazwe, kanye nezigameko zokutheleleka nge-STH zehliswe ngo-50% ezikoleni zokungenelela uma kuqhathaniswa nezikole ezilawulayo (isilinganiso sezilinganiso = 0.5, 95% isikhawu sokuzithemba: 0.35-0.7, P <0.0001).90].Lokhu kushintshiwe futhi kwavivinywa kanzima ePhilippines [91] naseVietnam;futhi okwamanje ithuthukiswa esifundeni saseMekong esiphansi, okuhlanganisa ukujwayela kwayo ukutheleleka kwesibindi se-carcinogenic Opisthorchis.Okuhlangenwe nakho emazweni amaningana ase-Asia, ikakhulukazi iJapane, iKorea kanye neSifundazwe saseTaiwan saseChina, kubonise ukuthi nge-MDA, ukukhucululwa kwendle nemfundo yenhlanzeko njenge ingxenye yezinhlelo zokulawula zikazwelonke, ngokusebenzisa izindlela ezisekelwe esikoleni kanye nokusebenzisana kukanxantathu ukuze kuqedwe ukutheleleka kwe-STH kungenzeka ngezikhungo, ama-NGO kanye nochwepheshe besayensi [92,93,94].
Kunamaphrojekthi amaningana e-Philippines ahlanganisa izilawuli ze-STH, njenge-WASH/EHCP noma i-WINS esetshenziswa ezikoleni, kanye ne-CLTS esetshenziswa emiphakathini. Nokho, ukuze kube namathuba amaningi okusimama, ukusebenzelana okukhulu phakathi kwezinhlangano ezisebenzisa lolu hlelo kuyadingeka.Ngakho-ke, ukwahlukanisa izinhlelo nemizamo yamaqembu amaningi njenge-Philippines' yokulawula i-STH ingaphumelela kuphela ngokubambisana kwesikhathi eside, ukubambisana nokusekelwa kukahulumeni wendawo.Ukwesekwa kukahulumeni ekuthengeni nasekusatshalalisweni kwemithi kanye nokubekwa phambili kwezinye izingxenye zezinhlelo zokulawula, ezifana njengemisebenzi yokuthuthukisa ukuthuthwa kwendle kanye nemfundo yezempilo, iyadingeka ukuze kusheshiswe ukuzuza okuhlosiwe kwe-EPHP ka-2030 [88]. Lapho kubhekene nezinselelo zobhubhane lwe-COVID-19, le misebenzi idinga ukuqhubeka futhi ihlanganiswe ne-COVID-19 eqhubekayo. Uma kungenjalo, ukufaka engcupheni uhlelo lokulawula i-STH oseluyinselele kungase kube nezinkinga ezinkulu zesikhathi eside emphakathini.lth imiphumela.
Cishe iminyaka engamashumi amabili, i-Philippines yenze imizamo emikhulu yokulawula ukutheleleka nge-STH.Noma kunjalo, ukusabalala okubikiwe kwe-STH kuye kwahlala kuphakeme ezweni lonke, mhlawumbe ngenxa yokumbozwa kwe-MDA ephansi kanye nemikhawulo ye-WASH kanye nezinhlelo zemfundo yezempilo.Ohulumeni kazwelonke kufanele manje bacabangele ukuqinisa isikole. -ama-MDA asekelwe kanye nokwandisa ama-MDA omphakathi wonke;ukuqapha ngokucophelela ukusebenza kwezidakamizwa phakathi nemicimbi ye-MDA kanye nokuphenya ukuthuthukiswa nokusetshenziswa kwezidakamizwa ezintsha ze-antihelminthic noma izinhlanganisela zezidakamizwa;kanye nokuhlinzekwa okusimeme kwe-WASH kanye nemfundo yezempilo njengendlela yokuhlasela ebanzi yokulawula i-STH esikhathini esizayo e-Philippines.
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Isikhathi sokuthumela: Mar-15-2022