Air quality challenges in Central Asian urban areas: a PM2.5 source apportionment analysis in Dushanbe, Tajikistan.

This work presents the first comprehensive assessment of PM pollution sources in Dushanbe, Tajikistan. A total of 138 PM2.5 samples were collected during 2015-2016 and 2018-2019 and were analyzed through gravimetric, ED-XRF, and multi-wavelength absorption techniques. The results show that PM2.5 concentrations were substantially higher than the European annual limit value and WHO Air Quality Guidelines annual average value, with an average of 90.9 ± 68.5 µg m-3. The PMF application identified eight sources of pollution that influenced PM2.5 concentration levels in the area. Coal burning (21.3%) and biomass burning (22.3%) were the dominant sources during the winter, while vehicular traffic (7.7%) contributed more during the warm season. Power plant emissions (17.5%) showed enhanced contributions during the warm months, likely due to high energy demand. Cement industry emissions (6.9%) exhibited significant contribution during the cold period of 2018-2019, while soil dust (11.3%) and secondary sulphates (11.5%) displayed increased contribution during the warm and cold months, respectively. Finally, waste burning (1.5%) displayed the lowest contribution, with no significant temporal variation. Our results highlight the significant impact of anthropogenic activities, and especially the use of coal burning for energy production (both in power plants and for residential heating), and the significant contribution of biomass burning during both warm and cold seasons.

Parental acceptance of Silver Diamine Fluoride in two lower-middle-income countries: Iran and Tajikistan.

BACKGROUND: Using Silver Diamine Fluoride (SDF) may be an effective public health approach for managing dental caries in children. Parental acceptance of SDF has rarely been investigated in low-income and middle-income countries (LMICs). The aim of this study was to evaluate parental acceptance of SDF to manage dental caries in children aged 2-12 in Iran and Tajikistan. METHODS: This cross-sectional study was conducted in the Kurdistan province of Iran and Khatlon region of Tajikistan, 2022-2023. Parents watched a video about SDF and its weaknesses and strengths as compared to conventional approaches before completing the questionnaire. We also reported Prevalence Ratios with 95% confidence intervals for the relationship between parental acceptance and associated demographic factors as well as dental attitude and experience. RESULTS: Participants were 245 and 160 parents in Iran and Tajikistan, respectively. In both countries, a majority (Iran: 61.6%, Tajikistan: 77.9%) accepted SDF over conventional treatments for all primary teeth. The majority also accepted SDF only for posterior permanent teeth (Iran: 73.5%, Tajikistan: 78.7%). Black discoloration was the main reason for rejecting SDF. Overall, demographic factors and dental experience and attitude were not significantly associated with SDF acceptance. CONCLUSIONS: SDF was widely accepted by Iranian and Tajik parents. Establishing parental acceptance of SDF is an important step toward its application in LMICs where inexpensive solutions are needed.

New coumarin from the roots of Prangos pabularia growing wild in Tajikistan.

Dichloromethane and butanol extracts of the roots of Prangos pabularia were analyzed to determine chemical constituents and biological activity. The new coumarin 1, yuganin B ((5-(((2S,3R,4S,5S,6R)-4,5-dihydroxy-6-(hydroxymethyl)-2-((2-oxo-2H-chromen-7-yl)oxy)tetrahydro-2H-pyran-3-yl)oxy)-3,4-dihydroxytetrahydrofuran-3-yl)methyl 4-hydroxy-3-methoxybenzoate) along with three phenolic and twenty-four known coumarins were isolated from the roots of Prangos pabularia, and the structures of these isolated compounds were elucidated by UV, HR-ESIMS, and 1 D and 2 D NMR spectroscopy. In addition, the anti-melanogenic effect of several of the isolated individual compounds and their inhibitory effect on B16 cells were evaluated. Isolating and testing compounds may proof to be useful in the treatment of hyperpigmentation and as a skin-whitening agent in the cosmetics industry.

Household drug-resistant TB contact tracing in Tajikistan.

BACKGROUND: Tajikistan has a high burden of rifampicin-resistant TB (RR-TB), with 2,700 new cases estimated for 2021 (28/100,000 population). TB is spread among household members through close interaction and children exposed through household contact progress to disease rapidly and frequently.METHODS: We retrospectively analysed programmatic data from household contact tracing in Dushanbe over 50 months. We calculated person-years of follow-up, contact tracing yield, number needed to screen (NNS) and number needed to test (NNT) to find one new case, and time to diagnosis.RESULTS: We screened 6,654 household contacts of 830 RR-TB index cases; 47 new RR-TB cases were detected, 43 in Year 1 and 4 in Years 2 or 3. Ten were aged <5 years; 46/47 had TB symptoms, 34/45 had chest radiographs consistent with TB, 11/35 were Xpert Ultra-positive, 29/32 were tuberculin skin test-positive and 28/47 had positive TB culture and phenotypic drug susceptibility results. The NNS to find one RR-TB case was 141.57 and the NNT was 34.49. The yields for different types of contacts were as follows: 0.7% for screened contacts, 2.9% for tested contacts, 17.0% for symptomatic contacts and 12.1% for symptomatic contacts aged below 5 years.CONCLUSION: RR-TB household contact tracing was feasible and productive in Tajikistan, a low middle-income country with an inefficient healthcare delivery system.

Gahvora cradling in Tajikistan: Cultural practices and associations with motor development.

In Tajikistan, infants are bound supine in a "gahvora" cradle that severely restricts movement. Does cradling affect motor development and body growth? In three studies (2013-2018), we investigated associations between time in the gahvora (within days and across age) and motor skills and flattened head dimensions in 8-24-month-old Tajik infants (N = 269, 133 girls, 136 boys)) and 4.3-5.1-year-old children (N = 91, 53 girls, 38 boys). Infants had later motor onset ages relative to World Health Organization standards and pronounced brachycephaly; cradling predicted walk onset age and the proficiency of sitting, crawling, and walking. By 4-5 years, children's motor skills were comparable with US norms. Cultural differences in early experiences offer a unique lens onto developmental processes and equifinality in development.

Unnecessary hospitalisations and polypharmacy practices in Tajikistan: a health system evaluation for strengthening primary healthcare.

BACKGROUND: Children and pregnant women require multiple contacts with the healthcare system. While most conditions can be managed by primary healthcare (PHC) providers, hospitalisations are common. This health system evaluation in Tajikistan quantifies unnecessary and unnecessarily prolonged hospitalisations and assesses antibiotic and polypharmacy practices. METHODS: Data were retrospectively collected from randomly selected medical records from 15 hospitals. Inclusion criteria were children 2-59 months of age with a primary diagnosis of acute respiratory infection or diarrhoea, or pregnant women with threatened preterm labour, threatened miscarriages, premature rupture of membranes or mild pre-eclampsia, hospitalised between January and September 2021. RESULTS: Among 440 children and 422 pregnant women, unnecessary hospitalisations accounted for 40.5% and 69.2% of hospitalisations, respectively, ranging from 0% to 92.7% across the hospitals. Among necessary hospitalisations, 63.0% and 39.2% were unnecessarily prolonged in children and women, respectively.Prior to admission, 36.8% of children had received antibiotics, in which more than half intramuscularly. During hospitalisation, 92.5% of children and 28.9% of women received antibiotics. Children and women received an average of 5 and 6.5 drugs, respectively; most were not indicated or with no evidence of benefits. CONCLUSIONS: The methodology is applicable across all health systems and can provide important insights on health service use and resource waste. Findings of this assessment in Tajikistan have led to evidence-based decisions and actions from stakeholders and policy makers with the goal of strengthening PHC and improving the management of common diseases in children and pregnant women.

Detection of Mycobacterium tuberculosis Complex Using the Xpert MTB/RIF Ultra Assay on the Stool of Pediatric Patients in Dushanbe, Tajikistan.

We report the findings of a prospective laboratory diagnostic accuracy study to evaluate the sensitivity, specificity, and predictive values of the Xpert MTB/RIF Ultra assay for Mycobacterium tuberculosis detection in fresh stool specimens from children under 15 years of age with confirmed tuberculosis (TB) disease from Dushanbe, Tajikistan. Six hundred eighty-eight (688) participants were enrolled from April 2019 to October 2021. We identified 16 participants (2.3%) with confirmed TB disease, defined as ≥1 TB sign/symptom plus microbiologic confirmation. With the Xpert MTB/RIF Ultra assay for stool, we found a sensitivity of 68.8% (95% CI, 46.0 to 91.5) and a specificity of 98.7% (95% CI, 97.8 to 99.5) in confirmed TB disease. Our results are comparable to other published studies; however, our cohort was larger and our confirmed TB disease rate lower than most. We also demonstrated that this assay was feasible to implement in a centralized hospital laboratory in a low-middle-income Central Asian country. However, we encountered obstacles such as lack of staffing, material ruptures, outdated government protocols, and decreased case presentation due to COVID-19. We found eight patients whose only positive test was an Xpert Ultra stool assay. None needed treatment during the study; however, three were treated later, suggesting such cases require close observation. Our report is the first from Central Asia and one of a few from a low-middle-income country. We believe our study demonstrates the generalizability of the Xpert MTB/RIF Ultra assay on fresh stool specimens from children and provides further evidence supporting WHO's approval of this diagnostic strategy. IMPORTANCE The importance of this report is that it provides further support for WHO's recent recommendation that fresh stool is an acceptable sample for GeneXpert TB testing in children, especially small children who often cannot produce an adequate sputum sample. Diagnosing TB in this age group is difficult, and many cases are missed, leading to unacceptable rates of TB illness and death. In our large cohort of children from Dushanbe, Tajikistan, the GeneXpert stool test was positive in 69% of proven cases of TB, and there were very few false-positive tests. We also showed that this diagnostic strategy was feasible to implement in a low-middle-income country with an inefficient health care delivery system. We hope that many more programs will adopt this form of diagnosing TB in children.

Contextual Factors Associated With Women's Attitudes Toward Intimate Partner Violence in Tajikistan: Findings From the 2012 and 2017 Demographic and Health Surveys.

The study employed data from the 2012 and 2017 Tajikistan Demographic and Health Surveys to examine two time periods on media access, interview setting, and sociodemographic predictors of intimate partner violence (IPV) justification attitudes among representative samples of women aged 15-49 years old (9,656 and 10,718 women, respectively) in Tajikistan. The odds of justifying IPV were higher for women who had access to radio and lower for those who had access to newspaper and television. The presence of the husband and other women during the interview was associated with lower justification of IPV. The findings emphasize the importance of contextual factors in developing effective IPV intervention policies.

Ottia, a new ennomine genus of moth from Tajikistan (Lepidoptera: Geometridae).

An ennomine species, described earlier as Plagodis ochraceata Viidalepp, 1988, is transferred from Plagodis Hbner, [1823]1816 to a genus of its own: Ottia ochraceata (Viidalepp, 1988) (gen. nov., comb. nov.). The morphology of the adult moth, of its male and female genitalia, phenology and spatial distribution are described and its taxonomic relationships are analyzed.

New and poorly known species of Palpimanus Dufour, 1820 (Araneae, Palpimanidae) from Uzbekistan and Tajikistan.

Two new species, Palpimanus logunovi sp. n. () and P. rakhimovi sp. n. (), are described from Tajikistan and Uzbekistan respectively. Lectotype has been designated for the poorly known species, P. sogdianus Charitonov, 1946 from Uzbekistan and is redescribed based on type and newly collected material. (Re)descriptions, figures, diagnoses, distribution map and photograps of habitats of all the studied species are provided.

Assessment of serological responses following vaccination campaigns with type 2 novel oral polio vaccine: a population-based study in Tajikistan in 2021.

BACKGROUND: Novel oral poliovirus vaccine type 2 (nOPV2) was used to control an outbreak of type 2 circulating vaccine derived poliovirus (cVDPV2) in Tajikistan, in 2021. We measured seroconversion and seroprevalence of type 2 polio antibodies in children who were reported to have received two doses of nOPV2 in outbreak response campaigns. METHODS: In this community serosurvey, children born after Jan 1, 2016 were enrolled from seven districts in Tajikistan. Dried blood spot cards were collected before nOPV2 campaigns and after the first and second rounds of the campaigns and were sent to the Centers for Disease Control and Prevention (Atlanta, GA, USA) for microneutralisation assay to determine presence of polio antibodies. The primary endpoint was to assess change in seroprevalence and seroconversion against poliovirus serotype 2 after one and two doses of nOPV2. FINDINGS: 228 (97%) of 236 enrolled children were included in the analysis. The type 2 antibody seroprevalence was 26% (53/204; 95% CI 20 to 33) before nOPV2, 77% (161/210; 70 to 82) after one dose of nOPV2, and 83% (174/209; 77 to 88) after two doses of nOPV2. The increase in seroprevalence was statistically significant between baseline and after one nOPV2 dose (51 percentage points [42 to 59], p<0·0001), but not between the first and second doses (6 percentage points [-2 to 15], p=0·12). Seroconversion from the first nOPV2 dose, 67% (89/132; 59 to 75), was significantly greater than that from the second nOPV2 dose, 44% (20/45; 30 to 60; χ2 p=0·010). Total seroconversion after two nOPV2 doses was 77% (101/132; 68 to 83). INTERPRETATION: Our study demonstrated strong immune responses following nOPV2 outbreak response campaigns in Tajikistan. Our results support previous clinical trial data on the generation of poliovirus type 2 immunity by nOPV2 and provide evidence that nOPV2 can be appropriate for the cVDPV2 outbreak response. The licensure and WHO prequalification of nOPV2 should be accelerated to facilitate wider use of the vaccine. FUNDING: World Health Organization, Centers for Disease Control and Prevention, and Rotary International.

Quantitative evaluation of Zindagii Shoista (Living with Dignity) intervention to prevent violence against women in Tajikistan.

BACKGROUND: Violence against women and girls (VAWG) is a major problem in Tajikistan, driven by conservative gender norms, the culturally ascribed position of young women, and poverty. OBJECTIVE: We evaluated Zindagii Shoista (Living with Dignity), an intervention developed with the aim of reducing VAWG through a combination of gender norm change, communication skills, and income-generating activities (IGA) over a period of 30 months. METHODS: The evaluation used a mixed-methods approach, combining quantitative and qualitative data collection. Eighty families from four villages were enrolled in the intervention and surveyed at baseline and on three subsequent occasions. From these families, 134 women and 102 men were interviewed at baseline, 153 women and 89 men 8 months later, 153 women and 93 men 15 months later, and 143 women and 82 men, 30 months after the baseline. Generalised random effects regression models were used to assess the trend in proportions or mean score over time. RESULTS: Over the 30 months, the proportion of women and men earning in the past month rose from 17.9% to 56.6% and 44.1% to 72%, respectively. Women and men's gender attitudes became significantly less patriarchal, and they reported less harmful gender norms in the community. Women and men reported less male controlling behaviour and greater woman involvement in decision-making. Women's reports of experience of emotional, physical, and sexual IPV significantly reduced. Depressive symptoms and suicidal thoughts reduced significantly for men and women, and self-rated health improved. CONCLUSIONS: The quantitative findings are confirmed by the findings of the qualitative research and monitoring data. They demonstrate that Zindagii Shoista is a very promising intervention for strengthening gender relations, reducing IPV, and improving mental health and socio-economic circumstances for younger married women and their families in Tajikistan.

Vaccine-associated paralytic poliomyelitis in a child: fast transformation from Sabin-like virus to vaccine-derived poliovirus triggered an epidemiological response in two countries of the European region.

OBJECTIVES: The detection of a vaccine-derived poliovirus (VDPV) requires an epidemiological assessment and response. Using repeated stool sampling from a child who is immunocompetent and was vaccinated against poliomyelitis with acute flaccid paralysis, a case of an extremely rapid evolution of Sabin-like poliovirus (PV) type 3 was traced in the child's body. METHODS: The case was independently identified in two countries-Tajikistan and Russia. Stool samples for the study were also independently collected in two countries on different days from the onset of paralysis. Virological, serological, and molecular methods; full genome Sanger; and high-throughput sequencing were performed to characterize isolates. RESULTS: PV isolates from samples collected on days 2, 3, and 14 contained eight, seven, and seven mutations in the VP1-coding region, respectively, and were classified as Sabin-like PV type 3. The isolates from samples collected on days 15 and 18 had 11 mutations and were classified as vaccine-derived PVs, which required an epidemiological response in the two countries. CONCLUSION: The results indicate the need to continue acute flaccid paralysis surveillance, maintain high vaccination coverage, and develop and introduce new effective, genetically stable PV vaccines.

Evaluating profitability of beef cattle farming and its determinants among smallholder beef cattle farmers in the Baljovan District of Khatlon region, Tajikistan.

In Tajikistan, owning beef cattle is an important survival mechanism for smallholder farmers to alleviate poverty. Therefore, beef cattle farming enterprises should indeed strive to maximize profit to excel and flourish in a free economy. Nevertheless, smallholder beef cattle farmers are known for making little profit. Thus, this study was set to evaluate the profitability of beef cattle farming and its determinants to enhance profit maximization among smallholder beef cattle farmers in the Baljovan District of Khatlon region, Tajikistan. A total of 388 farming households were chosen at random and purposive for the study. The cross-sectional data collected using questionnaires was analyzed by using descriptive, gross margin (GM), and ordinary least squares (OLS) regression models. Based on the descriptive analyses, the mean age of beef cattle farmers was 52.73 years, with a household size of 7.07 members. The beef cattle farmers had an average of 18.23 cattle herd size with 8.54 years of farming experience. The average land area possessed by farmers was 10.59 hectares. Among farmers, men (98.2%) dominated beef cattle farming activities. Around 83.8% of farmers had a college grade (higher literacy). Besides, around 89.4% of farmers had access to farm credits. However, only 71.4% of farmers used farm credit points to produce beef cattle. Most of the farmers (89.7%) had access to accurate market information. Such market information enabled 75.8% of farmers to sell their beef cattle to open market (profitable) outlets rather than middlemen. About 89.4% had access to veterinary services. Additionally, about 82.7% of farmers acknowledged the availability of pasture for grazing, which motivated 87.6% of farmers to be involved in selling contracts. Furthermore, economic investigation results revealed that on average, farmers had a gross margin (GM-profit) of 353.77 US$ per cattle, with feed costs (58.6%) and medications costs (26.1%) accounting for the largest share of total variable costs. Meanwhile, the profitability of beef cattle farming among farmers was significantly influenced by education level, family size, farming experience, pasture availability, land size owned, selling contract, feed costs, medications expenses, access to credits, and sales costs (P < 0.05). This study concluded that beef cattle production is a feasible business. However, the potential for increased profitability is significant if existing resources are efficiently coordinated and production expenses, notably feed and healthcare costs, are minimized. Thus, the government should develop additional measures for addressing concerns such as capacity building, suitable and freely available pasture as well as health management, to boost beef cattle profitability among farmers in Tajikistan.

Screening for Gestational Diabetes Mellitus and Pregnancy Outcomes: Results from a Multicentric Study in Tajikistan.

The prevalence of gestational diabetes parallels the prevalence of type 2 diabetes mellitus and is associated with adverse pregnancy outcomes. However, these data are not available for many parts of the world. We assessed the prevalence of gestational diabetes and pregnancy outcomes in Tajikistan. This cohort study included 2438 consecutively recruited representative pregnant women from 8 locations in two cities in Tajikistan, in whom an oral glucose tolerance test (75 g, fasting, 1 h, 2 h) was performed during gestational weeks 24-28. Women with known diabetes and twin pregnancies were excluded. Associations between glucose tolerance test results and pregnancy outcomes were examined. According to the WHO 2013 thresholds, 32.4% of women qualified as having gestational diabetes, the vast majority (29.7%) based on an elevated fasting glucose level (5.1-5.6 mmol/L), while only 2.8% had elevated 1- or 2-hour values or met more than one threshold. Women with only elevated fasting glucose (impaired gestational fasting glycemia) had no evidence of adverse pregnancy outcomes, while those with elevated 1- and/or 2-hour values (impaired gestational glucose tolerance) had more pregnancy complications (infection of urinary tract 1.8 vs. 8.8% p<0.001; preeclampsia 0.7 vs. 10.3% p<0.001) and emergency cesarean sections (4.4 vs. 13.2% p=0.002). Neonates from pregnancies with impaired gestational glucose tolerance had lower APGARs, lower birth weights, lower 30 min glucose levels, and a lower probability of being discharged alive (all p<0.05). In conclusion, the formal prevalence of gestational diabetes is high in Tajikistan; however, this does not translate into adverse pregnancy outcomes for women with impaired gestational fasting glycemia.

An observational prospective cohort study of naloxone use at witnessed overdoses, Kazakhstan, Kyrgyzstan, Tajikistan, Ukraine.

Objective: To determine whether participation in the United Nations Office on Drugs and Crime (UNODC) and the World Health Organization's (WHO) Stop Overdose Safely (S-O-S) take-home naloxone training project in Kazakhstan, Kyrgyzstan, Tajikistan and Ukraine resulted in naloxone use at witnessed opioid overdoses. Methods: An observational prospective cohort study was performed by recruiting participants in the implementation of the S-O-S project, which was developed as part of the broader S-O-S initiative. Training included instruction on overdose responses and naloxone use. Study participants were followed for 6 months after completing training. The primary study outcome was participants' naloxone use at witnessed overdoses, reported at follow-up. Findings: Between 400 and 417 S-O-S project participants were recruited in each country. Overall, 84% (1388/1646) of participants were interviewed at 6-month follow-up. The percentage who reported witnessing an overdose between baseline and follow-up was 20% (71/356) in Tajikistan, 33% (113/349) in Kyrgyzstan, 37% (125/342) in Ukraine and 50% (170/341) in Kazakhstan. The percentage who reported using naloxone at their most recently witnessed overdose was 82% (103/125) in Ukraine, 89% (152/170) in Kazakhstan, 89% (101/113) in Kyrgyzstan and 100% (71/71) in Tajikistan. Conclusion: Implementation of the UNODC-WHO S-O-S training project in four low- to middle-income countries resulted in the reported use of take-home naloxone at around 90% of witnessed opioid overdoses. The percentage varied between countries but was generally higher than found in previous studies. Take-home naloxone is particularly important in countries where emergency medical responses to opioid overdoses may be limited.

Organic aerosol compositions and source estimation by molecular tracers in Dushanbe, Tajikistan.

To elucidate the molecular composition and sources of organic aerosols in Central Asia, carbonaceous compounds, major ions, and 15 organic molecular tracers of total suspended particulates (TSP) were analyzed from September 2018 to August 2019 in Dushanbe, Tajikistan. Extremely high TSP concentrations (annual mean ± std: 211 ± 131 µg m-3) were observed, particularly during summer (seasonal mean ± std: 333 ± 183 µg m-3). Organic carbon (OC: 11.9 ± 7.0 µg m-3) and elemental carbon (EC: 5.1 ± 2.2 µg m-3) exhibited distinct seasonal variations from TSP, with the highest values occurring in winter. A high concentration of Ca2+ was observed (11.9 ± 9.2 µg m-3), accounting for 50.8% of the total ions and reflecting the considerable influence of dust on aerosols. Among the measured organic molecular tracers, levoglucosan was the predominant compound (632 ± 770 ng m-3), and its concentration correlated significantly with OC and EC during the study period. These findings highlight biomass burning (BB) as an important contributor to the particulate air pollution in Dushanbe. High ratios of levoglucosan to mannosan, and syringic acid to vanillic acid suggest that mixed hardwood and herbaceous plants were the main burning materials in the area, with softwood being a minor one. According to the diagnostic tracer ratio, OC derived from BB constituted a large fraction of the primary OC (POC) in ambient aerosols, accounting for an annual mean of nearly 30% and reaching 63% in winter. The annual contribution of fungal spores to POC was 10%, with a maximum of 16% in spring. Measurements of plant debris, accounting for 3% of POC, divulged that these have the same variation as fungal spores.