Challenges of palliative care identified by stakeholders in resource-limited settings: A multi-regional study in Kazakhstan.

INTRODUCTION: In Kazakhstan, a country of 19 million residents, more than 100,000 patients need palliative care. Since at least one family member is usually involved in the care of a terminal patient, more than 200,000 people would benefit from high-quality palliative care services in the country. However, with only 45 physicians and 101 nurses attending to 1925 palliative beds, Kazakhstan seeks to develop palliative services that meet the national needs in resource-limited settings and international standards. The objectives of this study are to explore the challenges faced by stakeholders involved in palliative care in Kazakhstan and to subsequently provide recommendations that can guide policymakers towards further developing palliative care services in the country. METHODS: This cross-sectional descriptive study collected narrative data with in-depth interviews from n= 29 palliative stakeholders (family caregivers n= 12, healthcare professionals =12, administrators n= 5) across five regions of Kazakhstan. Verbatim transcripts of interviews were analyzed using content analysis to identify needs and challenges of stakeholders involved in palliative care. RESULTS: Our analysis identified seven main challenges of palliative care stakeholders: high out-of-pocket expenditures; lack of mobile palliative care services for home-based care; severe shortages of opioids to prevent pain suffering; poor formal palliative care education; absence of practical skills training for family caregivers; lack of awareness about palliative care in the society, and lack of state support. CONCLUSION: Implementation of national palliative care strategies and policies require a large-scale coordinated involvement of all stakeholders. Our recommendations are based on the idea that coordinated, targeted, and tailored stakeholder engagement is preferred to a one-size-fits-all strategy.

Preloaded combination nicotine replacement therapy for smoking cessation in Kazakhstan: A randomized controlled trial study protocol.

BACKGROUND: Tobacco use is a major cause of premature death and disease in Kazakhstan, with over 22,500 deaths per year. Although efforts have been made to control tobacco use, smoking-related deaths have continued to increase. One strategy to help smokers quit is to use nicotine replacement therapy (NRT), with combination NRT resulting in higher long-term quit rates than a single form of NRT. A study aims to determine the effectiveness of preloaded combination NRT on smoking cessation, the change in health-related quality of life due to smoking cessation, and explore treatment adherence perceptions. METHODS AND ANALYSIS: The study will be conducted as a randomized, single-blind superiority trial, with 100 participants in each arm. The trial will be carried out at the National Research Cardiac Surgery Center, Astana, Kazakhstan, and will recruit current smokers aged 18 years and above with a motivation to quit. Participants will be randomly allocated to either the intervention group or the control group. The former will receive preloaded combination NRT, while the latter will receive fast-acting NRT alone. The primary outcome measure will be sustained abstinence from smoking after six months. Secondary outcome measures will include health-related quality of life and adherence to the treatment. DISCUSSION: The study may gather further evidence that a combination NRT is more efficient than a fast-acting NRT alone. The findings of this study may help to improve tobacco cessation strategies in Kazakhstan and other countries with high smoking prevalence rates. TRIAL REGISTRATION NUMBER: NCT05484505.

Epidemiology of tuberculosis in Kazakhstan: data from the Unified National Electronic Healthcare System 2014-2019.

OBJECTIVES: This study aims to estimate tuberculosis (TB) incidence, mortality rates and survival HRs in Kazakhstan, using large-scale administrative health data records during 2014-2019. DESIGN: A retrospective cohort study. SETTINGS: Data for patients with TB in Kazakhstan during 2014-2019, reported in the Unified National Electronic Healthcare System. PARTICIPANTS: Patients with TB in Kazakhstan (ICD-10 (The International Classification of Diseases, 10th revision) codes: A15-A19). OUTCOME MEASURES: Demographic factors, diagnoses and comorbidities were analysed using descriptive, bivariate and multivariable statistical analyses. TB incidence and mortality rates were calculated, and Cox regression and Kaplan-Meier survival analysis were performed to assess risk factors for survival rates. RESULTS: Of the 149 122 patients with TB, 91 437 (61%) were males, and 139 931 (94%) had respiratory TB. From 2014 to 2019, TB incidence declined from 227 to 15.2 per 100 000 individuals, while all-cause mortality increased from 8.4 to 15.2 per 100 000. Age-specific TB incidence was lowest for 0-10 years of age and highest for 20 years of age. Being older, man, urban residence versus rural, retired versus employed, having HIV and having diabetes versus no comorbidities were associated with lower survival rates. CONCLUSION: To date, this is the largest TB published study for Kazakhstan, characterising TB incidence and mortality trends by demographic factors, and risk factors for survival rates. The findings highlight the need for targeted interventions to address the growing burden of TB, particularly among older adults, men, urban residents and those with HIV and diabetes. The study underscores the importance of using administrative health data to inform policy and health system responses to TB in Kazakhstan.

Challenges for Developing Palliative Care Services in Resource- Limited Settings of Kazakhstan.

Background: Approximately 40 million people in need of palliative care worldwide, while 80% of them live in low- and middle-income countries. Kazakhstan, a low-to middle-income country with a reforming healthcare system, is committed to improving quality and accessibility of care for its 100,000 terminal patients in need of palliative care. Policy Options and Recommendations: To join the group of countries where palliative care is available, accessible, and affordable, Kazakhstan must integrate palliative services into the mainstream healthcare system at all levels, from primary healthcare to hospices, and from major cities to remote villages. Based on the evidence thoroughly collected directly from the Ministry of Health, authors propose a feasible set of recommendations regarding palliative policy, pain relief, infrastructure, workforce, and education, which could be implemented in LMICs beyond Kazakhstan. Conclusion: This study presents an analysis of challenges, recent developments, and needs of palliative care in Kazakhstan, including funding, policy, workforce, education, and infrastructure, providing an evidence base and recommendations for future development of palliative care in Kazakhstan and in other LMICs.

Hookah venue employees' knowledge and perceptions of hookah tobacco smoking.

BACKGROUND: Recent years showed sharp proliferation of hookah bars worldwide with scarcity of workplace safety regulations. Hookah server employees are at high risk for elevated harm. This study reported hookah smoke exposure, assessed acute problems and evaluated factors related to knowledge of hookah-smoking harm and toxicity among high-risk hookah servers. METHODS: A mixed methods design was employed. A self-reported questionnaire was distributed online, and semistructured in-depth interviews were used. Hookah server employees were recruited using snowball sampling, with 52 participants included in quantitative analyses and 10 participating in semistructured interviews. RESULTS: Hookah server employees took a median 389 hookah puffs per workday compared with 169-170 per session for customers. Servers were limited in knowledge of potential hookah harms and smoke toxicant exposure. Almost all believed that hookah water bowls filtered out toxicants. Smoking with family members (p=0.012) was associated with lower knowledge scores for hookah harms and exposure. Hookah server employees reported carbon monoxide-poisoning symptoms of dizziness, headaches and fainting during work but believed their bodies would adapt. Home remedies were taken to alleviate symptoms. Work environment and salary attracted hookah server employees to their position and none considered quitting for reasons of harm. CONCLUSION: Findings demonstrate need for workplace policies and regulations to protect hookah server employees and provide targets for educational interventions for high-risk hookah server employees.