Njira Yatsopano Yolimbana ndi Chifuwa cha TB

CHIFUWA CHA TB ndi matenda opatsirana akale kwambiri ogwira anthu ndipo TB adakali matenda oopsa kwambiri kotero kuti bungwe la World Health Organization (WHO) lawayerekezera ndi bomba loyendera nthaŵi. “Tikuthamangitsana ndi nthaŵi,” lipoti la WHO lonena za TB likuchenjeza motero. Munthu akalephera kuchotsa matenda onga bomba amenewa, nthaŵi ina adzasanduka matenda osamva mankhwala amene “angafalitsidwe ndi mphepo, koma ali osachiritsika ngati AIDS.” Bungwe la WHO likuti, nthaŵi yakwana yoti tizindikire kuopsa kwa TB. “Munthu aliyense amene amapuma mpweya pa dziko lapansi ayenera kuda nkhaŵa kuti mwina ingadzam’gwire.”

Kodi kunenaku n’kuchulukitsa gaga m’diŵa? Ayi ndithu. Taganizirani mmene dziko lonse lingagwedezekere ngati matenda ena ake atangosanduka osachiritsika ndipo kenaka tingoyerekeza kuti akupulula anthu onse a m’dziko la Canada m’zaka khumi zokha! Ngakhale kuti mwina zikumveka ngati nthano tsoka limeneli lilipodi. Padziko lonse, TB ikupha anthu ambiri kuposa AIDS, malungo, ndi matenda ambiri a kumayiko otentha: anthu 8000 patsiku. Tsopano pali anthu 20 miliyoni amene akudwala TB, ndipo enanso okwanira 30 miliyoni mwina adzafa nayo m’zaka khumi zotsatirazi—chiŵerengero choposa anthu onse a m’dziko la Canada—onani bokosi loti “TB yapanikiza mayiko onse,” patsamba 18.

Tsopano Nkhani Yabwino

Komabe, tsopano pali chiyembekezo. Patatha zaka khumi za kafukufuku, ofufuza atulukira njira yochititsa kuti matenda a TB asakhalenso ovuta kuwachiza koma m’malo mwake azitha kuchiritsika. Dr. Hiroshi Nakajima, amene kale anali wamkulu wa bungwe la WHO, anatcha njira imeneyi “imodzi mwa njira zofunika kwambiri zimene zatulukiridwa pa zaumoyo wa anthu kuchokera pa zaka khumi zapitazo mpaka lero.” Ndipo Dr. Arata Kochi, woyang’anira wa ntchito yogonjetsa TB padziko lonse m’bungwe la WHO, akuti njira imeneyi ikupereka mwayi kwa nthaŵi yoyamba wakuti mliri wa TB ungagonjetsedwe.” Kodi chapangitsa anthu ameneŵa kunena zonsezi ndi chiyani? Njira yotchedwa DOTS.

DOTS ndi chidule cha mawu akuti Directly Observed Treatment, Short-course. (Chithandizo Choyang’aniridwa Mwachindunji, Mankhwala Achidule.) Imeneyi ndi njira yochiritsira imene ingachize anthu ambiri odwala TB m’miyezi isanu ndi umodzi kapena isanu ndi itatu koma osagona m’chipatala ngakhale tsiku limodzi. Njira ya DOTS imadalira zinthu zisanu kuti igwire bwino ntchito. Ngati chimodzi mwa zinthu zimenezi palibe, basi mwayi woti odwala TB tingawachizenso “tauphonya”, anatero a WHO. Kodi zinthu zimenezi ndi chiyani?

● 1. Directly (Mwachindunji): TB yoopsa kwambiri ndi imene siinatulukiridwe. Bungwe la WHO likugogomezera kuti choyamba, anthu azaumoyo ayenera kuyesetsa mwachindunji kupeza anthu kudera limenelo amene akudwala matenda a TB amene angathe kupatsira ena.

● 2. Observed (Kuyang’anira): Mbali yachiŵiri ya DOTS imaika udindo wonse wa kuchiza odwala m’manja mwa onse okhudzidwa ndi zaumoyo—osati wodwalayo. Anthu ogwira ntchito ya zaumoyo kapena odzipereka ophunzitsidwa, monga eni masitolo, aphunzitsi, ngakhalenso amene anadwalapo TB kale, amayang’anira wodwalayo nthaŵi zonse akamamwa mapilisi a TB. “Oyang’anira odwala” ameneŵa ndi ofunika kwambiri kuti zinthu ziyende bwino chifukwa chakuti odwala ambiri amasiya msanga kwambiri kumwa mankhwala ndipo n’chifukwa chake TB idakalipobe mpaka lero. (Onani bokosi lakuti “N’chifukwa Chiyani Yayambiranso?” patsamba 18.) Pakangotha masabata angapo akulandira mankhwala amayamba kupezako bwino, basi akatero amasiya kumwa mankhwala aja. Komatu kuti tizilombo toyambitsa matenda a TB titheretu m’thupi mankhwalawo ayenera kumwedwa miyezi isanu ndi umodzi kapena mpaka miyezi isanu ndi itatu.

● 3. Treatment (Chithandizo): Pa miyezi isanu ndi umodzi kapena isanu ndi itatu imeneyi, ogwira ntchito ya zaumoyo amakhala akuyang’anira zotsatira za chithandizocho ndipo amalemba mmene wodwalayo akusinthira. Njira imeneyi imawathandiza kukhala otsimikiza ngati wodwala wachiradi ndipo ngati sangapatsire ena matendawo.

● 4. Short-Course (Mankhwala Achidule): Kugwiritsa ntchito msanganizo woyenera ndi mlingo woyenera wa mankhwala a TB, kotchedwa short-course chemotherapy (mankhwala achidule), komanso utali wanthaŵi woyenera, ndiyo mbali yachinayi ya DOTS. Mankhwala ameneŵa amapheratu tizilombo tonse ta matenda a TB.a Mankhwalawa ayenera kukhalapo okwanira kuti kumwa kwake kusakhale kolekezalekeza.

● 5. !: Bungwe la WHO likusonyeza mbali yachisanu ya njira ya DOTS ndi mfuuliro monga lemba lotsirizira polemba DOTS! Lemba limeneli likuimira chithandizo cha ndalama ndi malamulo a zachuma othandiza. Bungwe la WHO likulimbikitsa magulu a zaumoyo kuti apeze chithandizo chodalirika cha ndalama kuchokera ku boma kapena mabungwe amene si a boma ndiponso kuika chithandizo cha TB pa mpambo wa ntchito ya anthu a zaumoyo m’dzikomo.

Pa zachithandizo cha ndalama, njira ya DOTS ikulimbikitsa onse amene amapanga malamulo a zachuma kuti achirikize njira imeneyi. Bungwe la World Bank lanena kuti DOTS ndi “imodzi mwa njira zotsika mtengo kwambiri zogonjetsera . . . matenda.” Ndalama zimene zingagwiritsidwe ntchito pa njira imeneyi m’mayiko osauka ndi zokwanira $100 pa munthu wodwala aliyense. “Nthaŵi zina sizipitirira masenti 10 (U.S.) pa munthu aliyense m’mayiko amene akutukuka kumene, zimene zili ndalama zochepa ngakhale ndalama zitavuta chotani.” Ngakhale mtengo wake uli wochepa chonchi phindu lake ndi lalikulu.

Kodi N’njothandiza Motani?

Anthu oimira bungwe la WHO, mu March 1997 ananena kuti kugwiritsidwa ntchito kwa apa ndi apo kwa njira ya DOTS panthaŵi imeneyo kunkachititsa kuti, “mliri wa padziko lonse wa TB uchepe kwa nthaŵi yoyamba pakutha kwa zaka zambiri. Kumene njira ya DOTS ikugwiritsidwa ntchito mwayi wochiza munthu ndi waukulu pafupifupi kaŵiri.” Ntchito yoyesa njira ya DOTS imene inachitidwa m’malo amene TB ili yofala kwambiri yasonyeza kale kuti njirayi ikugwira ntchito. Taonani nkhani zingapo izi zosonyeza kupambana zonenedwa ndi bungwe la WHO.

Ku India “njira ya DOTS yagwiritsidwa ntchito kwa anthu oposa 12 miliyoni m’madera oyesera. . . . Tsopano anthu 4 mwa anthu 5 alionse a TB akuchiritsidwa.” Pa ntchito ina yoyesa yokhudza anthu 1 miliyoni ku Bangladesh, “87 peresenti [ya odwala TB] anachiritsidwa.” Pa chilumba china ku Indonesia, ntchito ya DOTS “ikuchiritsa anthu odwala 9 mwa 10 alionse amene angafalitse matenda. Ku China ntchito yoyesa, “inayenda bwino koposa,” 94 peresenti ya odwala anachira. Mu mzinda wina wa ku South Africa, “[odwala TB] oposa 80 peresenti akuchiritsidwa.” Posachedwapa njira ya DOTS inayambanso kugwiritsidwa ntchito mu mzinda wa New York, ndipo zinthu zinayenda bwino kwambiri.

Dr. Kochi, akutsiriza ponena kuti zimene kuyesera njirayi pa odwala enieni kwasonyeza m’mayiko ambiri, “zingagwiritsidwe ntchito kulikonse ndipo zingathe kuchiritsa 85 peresenti ya odwala kapenanso kuposerapo.”

Si Zachangu—Koma ndi Kupita Patsogolo

Chifukwa choti njira ya DOTS ingathe kuchotseratu matenda opatsirana a mtundu wa anthu oopsa kwambiriwa, mosavuta komanso motsika mtengo, mwina mungaganize kuti njira ya DOTS iyenera kuchita mwachangu kwambiri. “N’zodabwitsa kwambiri kuti ndi mayiko ochepa chabe amene akugwiritsa ntchito njira imeneyi yochepetsera TB imene ili yovomerezeka ndi bungwe la WHO komanso ya mtengo wochepa”, akutero mayi wina woyimira bungwe la WHO. N’zoona, kumayambiriro kwa 1996, mayiko 34 okha ndi amene ankagwiritsa ntchito njirayi m’zigawo zawo zonse.

Komabe, zinthu zikuyenda bwino. Chaka cha 1993 chisanakwane, pamene bungwe la WHO linalengeza za kubukanso kwa TB padziko lonse, ndi wodwala mmodzi yekha mwa odwala 50 amene ankamuchiritsa mwa njira ya DOTS. Tsopano ndi mmodzi mwa odwala 10. Akuti mu 1998 mayiko 96 amagwiritsira ntchito njira ya DOTS. Ngati mayiko ambiri atayamba kugwiritsa ntchito njira ya DOTS, chiŵerengero cha pachaka cha anthu a TB ‘chingachepe ndi theka m’zaka khumi basi.’ Akutero Dr. Kochi: “Tili ndi njira yochiritsira yotsimikizika imene kwangotsala n’kuti iyambe kugwiritsidwa ntchito kwambiri basi.”

Chifukwa chakuti munthu ali ndi chidziŵitso komanso zida zotha kulimbana ndi TB ndipo n’kupambana, chimene changotsalapo ndi ‘anthu oonetsetsa kuti mankhwala ameneŵa akugwiritsidwa ntchito padziko lonse lapansi. N’chifukwa chake m’magazini imene imalembedwa kaamba ka madokotala ndi ogwira ntchito za chipatala ena padziko lapansi, bungwe la WHO likufunsa kuti “Kodi tikudikira chiyani?”

[Mawu a M’munsi]

[Mawu Otsindika patsamba 17]

Pa sekondi iliyonse, munthu mmodzi padziko lapansi amagwidwa ndi Chifuwa cha TB

[Mawu Otsindika patsamba 17]

‘Mankhwala opulumutsira miyoyo ali khale m’kabati pamene anthu mamiliyoni akufa.’—Dr. Arata Kochi

[Mawu Otsindika patsamba 19]

“DOTS ndi njira yofunika kwambiri ya za umoyo wa anthu imene yatulukiridwa m’zaka khumi zapitazi.”—Nkhani yolengezedwa ndi WHO

[Bokosi patsamba 18]

N’chifukwa Chiyani YAYAMBIRANSO?

Mankhwala a chifuwa cha TB anatulukiridwa zaka zoposa makumi anayi zapitazo. Kuyambira nthaŵi imeneyo, anthu opitirira 120 miliyoni afa ndi TB, ndipo pafupifupi anthu 3 miliyoni angafe chaka chino. Koma nanga n’chifukwa chiyani anthu ambiri chonchi akufabe ndi TB koma mankhwala alipo? Chifukwa cha zinthu zitatu: kulekelera, HIV/AIDS, ndi TB yosamva mankhwala.

Kulekelera. Dziko lonse latanganidwa ndi matenda ena otha kufalitsidwa monga AIDS ndi Ebola. Komabe ndi anthu ochepa kwambiri amene amazindikira kuti mwa munthu mmodzi aliyense amene anafa ndi Ebola, 12,000 anafa ndi TB. Ndiponsotu, TB ndi yofala kwambiri m’mayiko amene akukwera kumene kotero kuti anthu a m’mayiko ameneŵa tsopano amangoiona ngati mbali ya moyo. Panthaŵi yomweyo, m’mayiko olemera, TB yaloledwa kuti ifale ngakhale kuti mankhwala a mphamvu oichizira ali khale pakabati. Kulekerera kwa padziko lapansi kumeneku kwasonyeza kuti ndi kulakwitsa koopsa kwabasi. Pamene padziko anthu anayamba kuiwalako za TB, tizilombo ta TB timachulukirachulukira. Panopo tikupatsa matenda anthu ambiri m’mayiko ochuluka koposa kale lonse m’mbiri ya anthu.

HIV/AIDS. TB ndi mnzake woyenda naye wa HIV ndi AIDS. Anthu akatenga HIV—imene imafooketsa chitetezo cha thupi—amakhala pangozi yotenga TB nthaŵi 30 moŵirikiza. N’chifukwa chake kuchuluka kwa chiŵerengero cha anthu okhala ndi HIV kwachititsanso kuti anthu odwala TB achuluke! Mongoyerekezera anthu 266,000 okhala ndi HIV mu 1997 anafa ndi TB. “Ameneŵa ndi amuna ndi akazi amene sanapindule ndi mankhwala otsika mtengo amene amafunika kuti amwe kuti achiritse chifuwa cha TB chawocho”, akutero Peter Piot, woyang’anira wa bungwe lotchedwa Joint United Nations Programme on HIV/AIDS.

TB Yosamva Mankhwala. “Tizilombo tokanika” tosagonjetseka ndi mankhwala alionse opanga anthu, takhala tikusimbidwa m’nkhani zongoyerekezera za sayansi, koma tikanena kumbali ya TB, tizilombo timeneti tikusanduka nkhani yeniyeni msangamsanga. Anthu opitirira 50 miliyoni agwidwa kale ndi TB yosamva mankhwala. [Multidrug-resistant (MDR) TB] Odwala TB amene amasiya kumwa mankhwala patangotha milungu ingapo chifukwa chakuti ayamba kupeza bwino, kaya chifukwa chakuti mankhwala atha, kapena chifukwa chakuti matendawo amawachititsa kuti atalikirane ndi anzawo, sapha tizilombo tonse ta TB m’matupi awo. Mwachitsanzo, m’dziko lina ku Asia, odwala TB aŵiri mwa atatu alionse posapita nthaŵi amasiyira panjira kumwa mankhwala awo. Ndiye akadwalanso, matendawo amavuta kuchiza chifukwa chakuti tizilombo timene tinapulumukato timalimbana ndi mankhwala alionse a TB amene anatulukiridwa ndipo timapambana. Ndiyeno, odwalawo amakhala ndi mtundu wa TB umene uli wosachiritsika—mwa iwo komanso munthu aliyense amene angam’patsire. Ndipo MDR yoopsa imeneyi ikangofalikira, ndiye kuti tiyenera kudzifunsa kuti, Kodi munthu adzatha kuthana nako kufala kwake.

[Bokosi patsamba 18]

TB Yapanikiza Mayiko Onse

Chifuwa cha TB chikukulirakulira, chikukwera mtengo mowonjezereka pochichiza, ndipo chikuopsa mopitirira chaka chilichonse. Malipoti amene bungwe la World Health Organization lapeza akusonyeza mmene matenda opha mosadziŵika kwa anthu ambiri ameneŵa akufalikira. Zitsanzo zina ndi izi: “Dziko la Pakistan lakhala likugonjetsedwa ndi chifuwa cha TB.” “Ku Thailand, chifuwa cha TB chabweranso ndi mphamvu zonse.” “Lero chifuwa cha TB ndi amodzi mwa matenda amene akudwalitsa komanso kupha anthu ku Brazil.” “Ku Mexico chifuwa cha TB chawapanikiza kwabasi anthu.” Ku Russia TB yayamba kuchulukirachulukira.” Ku Ethiopia “chifuwa cha TB chikusakaza anthu m’dziko lonselo.” “Dziko la South Africa ndi limodzi mwa mayiko okhala ndi anthu ambiri odwala TB padziko lapansi.”

Ngakhale kuti anthu 95 mwa anthu 100 alionse a padziko lapansi akukhala m’mayiko osauka a padziko lapansi, TB ikugwira anthu ambiri ngakhale ku mayiko olemera. Anthu odwala TB anachuluka kwambiri ku United States kumayambiriro kwa 1990. Mtolankhani wina wa komweko Valery Gartseff akunena kuti TB “yabweranso kudzazunza anthu achimereka.” Mofananamo, Dr. Jaap Broekmans, woyang’anira bungwe lotchedwa Royal Netherlands TB Association, posachedwapa ananena kuti mliri wa TB “wayamba kufika poipa ku Eastern Europe ndi mbali zina za Western Europe.” N’zosadabwitsa kuti nyuzi yotchedwa Science, ya pa August 22, 1997, inanena kuti “Chifuwa cha TB chikuopsezabe kwambiri thanzi la anthu.”

[Bokosi patsamba 20]

Pamene Panagona Mphamvu za TB Apatulukira

Anthu ofufuza posachedwapa atha kupeza pamene panagona mphamvu za kachilombo ka chifuwa cha TB. Ntchito imeneyi ndi “chiyambi cha nkhondo yolimbana ndi amodzi mwa matenda opha anthu kwambiri,” akutero Dr. Douglas Young, wa ku Imperial College School of Medicine ku London. Bungwe la World Health Organization likunena kuti zimene atulukirazi “zingadzakhale zofunika koposa podzachita kafukufuku wina wa mankhwala ndi katemera wa TB m’tsogolo muno.”—Magazini ya The TB Treatment Observer ya pa September 15, 1998.

[Zithunzi patsamba 19]

Mankhwala osanganizidwa ameneŵa angathe kupha kachilombo ka TB

[Mawu a Chithunzi]

Chinthu chaperekedwa ndi Bungwe la WHO, Geneva

Chithunzi: WHO/Thierry Falise

[Zithunzi patsamba 20]

Pamangofunika ndalama zokwanira $100 basi kuti odwala achizidwe

[Mawu a Chithunzi]

Chithunzi: WHO/Thierry Falise

Chithunzi chaperekedwa ndi Bungwe la WHO, Geneva

[Mawu a Zithunzi patsamba 17]

Chithunzi: WHO/Thierry Falise

Chithunzi chaperekedwa ndi bungwe la WHO, Geneva

Chithunzi: WHO/Thierry Falise