The Impact of Human Cystic Echinococcosis in the Central Asian Region, 1990-2019.

Objective: This research aims to update knowledge on the regional and national sickness burden attributable to cystic echinococcosis (CE) from 1990 to 2019, as well as epidemiology and disease control, with a particular emphasis on the People's Central Asian Regions. Methods: We calculated the morbidity, mortality, and disability-adjusted life years at the global, regional, and national levels for CE in all central Asian countries from 1990 to 2019, and we analyzed the association between GDP per capita and the disease burden of CE. Results: In 2019, the three greatest numbers of CE cases were recorded in Kazakhstan [23986; 95% uncertainty interval (UI); 19796; 28908]; Uzbekistan (41079; 18351; 76048); and Tajikistan (10887; 4891; 20170) among all 9 countries. The three countries with the greatest ASIR of CE were estimated to be Kazakhstan (127.56; 95% UI: 105.34-153.8), Uzbekistan (123.53; 95% UI: 58.65-219.16), and Tajikistan (121.88; 58.57-213.93). Kyrgyzstan, Tajikistan, and Uzbekistan had the biggest increases (125%, 97%, and 83%, respectively) in the number of incident cases of CE, whereas Georgia, Kazakhstan, and Armenia saw the largest decreases (45%, 8%, and 3%, respectively). Conclusion: To reduce the illness burden caused by CE, our findings may help public health professionals and policymakers design cost-benefit initiatives. To lessen the impact of CE on society, it is suggested that more money be given to the region's most endemic nations. Echinococcosis, cystic, negative health effects, life-years lost due to disability, rate of occurrence as a function of age, rate of death as a function of age.

Changes in alcohol, tobacco, cannabis, and other substance use and its association with mental health during the COVID-19 pandemic among sexual minority men in Eastern European and Central Asian countries.

BACKGROUND: The COVID-19 pandemic had a particularly negative impact on mental wellbeing of vulnerable individuals, such as sexual minority men (SMM) living in Eastern Europe and Central Asia (EECA), where the social-political climate may be restrictive for SMM. Alcohol, tobacco, and other drugs (ATOD) use may be another factor contributing to exacerbated mental health among SMM in this region. METHODS: Secondary analyses were conducted using data collected as part of the COVID-19 disparities survey from active users of Hornet, a popular geo-social networking app for SMM in late 2020. Using a subset of SMM living in EECA (n = 3209) and pre-validated scales (AUDIT-C and PHQ-4), we used multivariable logistic regression models to examine the relationship between changes in participants' use of ATOD and their mental wellbeing. RESULTS: Based on AUDIT-C, 35.1 % SMM screened for alcohol use disorder (AUD), 18.6 % reported an increase in alcohol use since the pandemic began. Over 30 % screened for depressive symptoms and anxiety based on PHQ-4 (30.4 % and 30.7 %, respectively). In multivariable models, AUD was significantly associated with screening positive for depressive symptoms and anxiety. Other factors associated with mental distress included lower socioeconomic status, unemployment, ethnic minority identity, IPV victimization, and financial and economic vulnerability. LIMITATIONS: Cross-sectional data cannot be used to infer causality. CONCLUSIONS: Our results support the needs for integrated substance use reduction and mental health services tailored for SMM in EECA. Programs aimed at promoting mental wellbeing among SMM in EECA must consider both interpersonal and structural barriers.

Breast and cervical cancer screening practices in nine countries of Eastern Europe and Central Asia: A population-based survey.

BACKGROUND: Eastern Europe and Central Asia (EECA) countries have higher cervical and breast cancer mortality rates and later stage at diagnosis compared with the rest of WHO European Region. The aim was to explore current early detection practices including "dispensarization" for breast and cervix cancer in the region. METHODS: A questionnaire survey on early detection practices for breast and cervix cancer was sent to collaborators in 11 countries, differentiating services in the primary health setting, and population-based programs. Responses were received from Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Russian Federation (Arkhangelsk, Samara and Tomsk regions), Tajikistan, Ukraine, and Uzbekistan. RESULTS: All countries but Georgia, Kyrgyzstan, and the Russian Federation had opportunistic screening by clinical breast exam within "dispensarization" program. Mammography screening programs, commonly starting from age 40, were introduced or piloted in eight of nine countries, organized at national oncology or screening centres in Armenia, Belarus and Georgia, and within primary care in others. Six countries had "dispensarization" program for cervix cancer, mostly starting from the age 18, with smears stained either by Romanowsky-Giemsa alone (Belarus, Tajikistan and Ukraine), or alternating with Papanicolaou (Kazakhstan and the Russian Federation). In parallel, screening programs using Papanicolaou or HPV test were introduced in seven countries and organized within primary care. CONCLUSION: Our study documents that parallel screening systems for both breast and cervix cancers, as well as departures from evidence-based practices are widespread across the EECA. Within the framework of the WHO Initiatives, existing opportunistic screening should be replaced by population-based programs that include quality assurance and control.

Cervical cancer screening and prevention in Kazakhstan and Central Asia.

OBJECTIVE: To examine the state of cervical screening and prevention in Central Asian states, specifically Kazakhstan. RESULTS: In the five Central Asian countries that were formerly part of the Soviet Union (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan), cervical cancer incidence and mortality rates are far higher than those in most Western and high-income nations, and are increasing. Cervical cancer screening is available in all five countries, but is mainly opportunistic. Only Kazakhstan has a structured cytological screening program, from which screening coverage analysis is possible. CONCLUSION: Despite significant decreases in cervical cancer incidence and mortality in developed countries, the problem is still of great concern in these Central Asian countries and is attributed to poorly organized screening and the absence of vaccination programs.

Genetic predisposition to hypertension is associated with preeclampsia in European and Central Asian women.

Preeclampsia is a serious complication of pregnancy, affecting both maternal and fetal health. In genome-wide association meta-analysis of European and Central Asian mothers, we identify sequence variants that associate with preeclampsia in the maternal genome at ZNF831/20q13 and FTO/16q12. These are previously established variants for blood pressure (BP) and the FTO variant has also been associated with body mass index (BMI). Further analysis of BP variants establishes that variants at MECOM/3q26, FGF5/4q21 and SH2B3/12q24 also associate with preeclampsia through the maternal genome. We further show that a polygenic risk score for hypertension associates with preeclampsia. However, comparison with gestational hypertension indicates that additional factors modify the risk of preeclampsia.

HBV Prevention and Treatment in Countries of Central Asia and the Caucasus.

The countries of Central Asia and the Caucasus are linked by travel and trade, which is promoted by visa-free mobility across borders. Unfortunately, this migrant mobility has given rise to the transmission of various infections within this region. Overlaps in culture, tradition, and behavior among these countries provide opportunities to share experiences that have proven effective in controlling transmission. Here we present a review of hepatitis B virus (HBV) prevalence, prevention and treatment across Central Asia and the Caucasus. Overall, owing to effective measures, while HBV prevalence has been steadily declining in the region, certain gaps still exist regarding the generation and availability of HBV infection data.

Prevalence and Economic Burden of Respiratory Diseases in Central Asia and Russia: A Systematic Review.

Prevalence data of respiratory diseases (RDs) in Central Asia (CA) and Russia are contrasting. To inform future research needs and assist government and clinical policy on RDs, an up-to-date overview is required. We aimed to review the prevalence and economic burden of RDs in CA and Russia. PubMed and EMBASE databases were searched for studies that reported prevalence and/or economic burden of RDs (asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, interstitial lung diseases (ILD), lung cancer, pulmonary hypertension, and tuberculosis (TB)) in CA (Kyrgyzstan, Uzbekistan, Tajikistan, Kazakhstan, and Turkmenistan) and Russia. A total of 25 articles (RD prevalence: 18; economics: 7) were included. The majority (n = 12), mostly from Russia, reported on TB. TB prevalence declined over the last 20 years, to less than 100 per 100,000 across Russia and CA, yet in those, multidrug-resistant tuberculosis (MDR-TB) was alarming high (newly treated: 19-26%, previously treated: 60-70%). COPD, asthma (2-15%) and ILD (0.006%) prevalence was only reported for Russia and Kazakhstan. No studies on cystic fibrosis, lung cancer and pulmonary hypertension were found. TB costs varied between US$400 (Tajikistan) and US$900 (Russia) for drug-susceptible TB to ≥US$10,000 for MDR-TB (Russia). Non-TB data were scarce and inconsistent. Especially in CA, more research into the prevalence and burden of RDs is needed.

Cancer surveillance in northern Africa, and central and western Asia: challenges and strategies in support of developing cancer registries.

The Global Initiative for Cancer Registry Development partnership, led by the International Agency for Research on Cancer (IARC), was established in response to an overwhelming need for high-quality cancer incidence data from low-income and middle-income countries. The IARC Regional Hub for cancer registration in North Africa, Central and West Asia was founded in 2013 to support capacity building for cancer registration in each of the countries in this region. In this Series paper, we advocate the necessity for tailored approaches to cancer registration given the rapidly changing cancer landscape for this region, and the challenges faced at a national level in developing data systems to help support this process given present disparities in resources and health infrastructure. In addition, we provide an overview of the status of cancer surveillance and activities country-by-country, documenting tailored approaches that are informing local cancer-control policy, and potentially curbing the growing cancer burden across the region.

Policy responses to HIV/AIDS in Central Asia.

The countries of Central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan) are confronted with one of the fastest growing HIV/AIDS epidemics worldwide, largely driven through injecting drug use. This article, based on a review of academic and grey literature, explores how they have responded. We find major similarities and differences across the region. At one extreme is Turkmenistan, which denies that there is any problem, does not offer harm reduction services or HIV/AIDS treatment and does not report any meaningful data to the international community. Uzbekistan is also pretty closed to outside influences, has discontinued its opioid substitution project and shares with Turkmenistan the legal prohibition of male-to-male sex. Kyrgyzstan originally led many progressive approaches in the region and, like neighbouring Tajikistan, has received substantial assistance by international agencies, in particular the Global Fund. Kazakhstan, with a much higher gross domestic product per capita, has taken on the financing of harm reduction activities through its national budget and has liberalised its drug policies. Yet, across the region punitive approaches to injecting drug use and people living with HIV/AIDS persist as do stigma and discrimination, while coverage with harm reduction programmes and treatment services is still low although with substantial variation across countries.

Epidemiology and control of echinococcosis in central Asia, with particular reference to the People's Republic of China.

At least 270 million people (58% of the total population) are at risk of cystic echinococcosis (CE) in Central Asia including areas of Mongolia, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan, Afghanistan, Iran, Pakistan and western China. The annual surgical incidence rate in Uzbekistan and Tadjikistan has been estimated to be as high as 25-27 cases/100,000 with the highest prevalence reaching 10% (range from 0.8 to 11.9%) in some Tibetan communities in western China. Echinococcus transmission in the region is largely associated with social factors including limited community knowledge of echinococcosis, small-scale household animal production, home killing of livestock, and the feeding of dogs with uncooked offal. Alveolar echinococcosis (AE) is also endemic in Central Asia and is recognized as a major problem in some Tibetan communities with up to 6% of villagers infected in some villages. In western China, 5-30% of the population are seropositive against E. granulosus antigens, indicating that a large number of individuals have been exposed to the parasite. Although echinococcosis control programs have been initiated in some countries in Central Asia, control efforts are generally fragmented and uncoordinated. Monthly deworming of dogs with praziquantel (PZQ), as a key measure to control the Echinococcus parasites, has been used in western China. However, the approach has proven difficult in local semi-nomadic communities. Additional control measures including health education, domestic livestock animal treatment/vaccination and dog vaccination are needed in CE-endemic areas to accelerate progress.

Patterns and trends in human papillomavirus-related diseases in Central and Eastern Europe and Central Asia.

This article provides an overview of cervical cancer and other human papillomavirus (HPV)-related diseases in Central and Eastern Europe (Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Montenegro, Poland, Romania, Serbia, Slovakia, Slovenia, and the Former Yugoslav Republic [FYR] of Macedonia) and Central Asia (Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Republic of Moldova, the Russian Federation, Tajikistan, Turkmenistan, Ukraine and Uzbekistan). Despite two- to three-fold variations, cervical cancer incidence rates are high in many countries in these two regions relative to other populations on the European and Asian continents. In Central and Eastern Europe, Romania and the FYR of Macedonia had the highest rates in 2008 alongside Bulgaria, Lithuania and Serbia, while in Central Asia, rates are elevated in Kyrgyzstan (the highest rates across the regions), Kazakhstan and Armenia. In each of these countries, at least one woman in 50 develops cervical cancer before the age of 75. The high cervical cancer burden is exacerbated by a lack of effective screening and an increasing risk of death from the disease among young women, as observed in Belarus, Tajikistan, Kyrgyzstan, Armenia, Azerbaijan, Ukraine, the Russian Federation and Kazakhstan. In several countries with longstanding cancer registries of reasonable quality (Belarus, Estonia and the Russian Federation), there are clear birth cohort effects; the risk of onset of cervical cancer is increasing in successive generations of women born from around 1940-50, a general phenomenon indicative of changing sexual behaviour and increasing risk of persistent HPV infection. There are limited data for other HPV-related cancers and other diseases at present in these countries. While options for reducing the HPV-related disease burden are resource-dependent, universal HPV vaccination with enhanced screening would maximally reduce the burden of cervical cancer in the countries within the two regions. It is hoped that the expanded second edition of the European Guidelines will finally kick-start effective interventions in many of these countries that still lack organised programmes. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in the Central and Eastern Europe and Central Asia Region" Vaccine Volume 31, Supplement 7, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.

Human papillomavirus prevalence and type-distribution, cervical cancer screening practices and current status of vaccination implementation in Russian Federation, the Western countries of the former Soviet Union, Caucasus region and Central Asia.

Limited data are available on the burden of human papillomavirus (HPV) and its associated diseases in the Russian Federation, the Western Countries of the former Soviet Union (Belarus, Republic of Moldova, Ukraine), the Caucasus region and Central Asia (Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan). Both the incidence and mortality rate of cervical cancer are higher in these countries than in most Western European countries. In this article, we review available data on HPV prevalence and type distribution in women with normal cytology, women from the general population, cervical precancerous lesions and cervical cancer, as well as data on national policies of cervical cancer screening and HPV vaccination initiatives in these countries. Based on scarce data from the 12 countries, the high-risk HPV (hrHPV) prevalence among 5226 women with normal cytology ranged from 0.0% to 48.4%. In women with low-grade cervical lesions, the hrHPV prevalence among 1062 women varied from 29.2% to 100%. HrHPV infection in 565 women with high-grade cervical lesions ranged from 77.2% to 100% and in 464 invasive cervical cancer samples from 89.8% to 100%. HPV16 was the most commonly detected hrHPV genotype in all categories. As the HPV genotype distribution in cervical diseases seems to be similar to that found in Western Europe the implementation of HPV testing in screening programs might be beneficial. Opportunistic screening programs, the lack of efficient call-recall systems, low coverage, and the absence of quality assured cytology with centralized screening registry are major reasons for low success rates of cervical cancer programs in many of the countries. Finally, HPV vaccination is currently not widely implemented in most of the twelve countries mainly due to pricing, availability, and limited awareness among public and health care providers. Country-specific research, organized nationwide screening programs, registries and well defined vaccination policies are needed. This article forms part of a Regional Report entitled "Comprehensive Control of HPV Infections and Related Diseases in the Central and Eastern Europe and Central Asia Region" Vaccine Volume 31, Supplement 7, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.

Cost-effectiveness of cervical cancer prevention in Central and Eastern Europe and Central Asia.

We studied the cost-effectiveness of cervical cancer prevention strategies in the Central and Eastern Europe and Central Asia (CEECA) region. The cost-effectiveness of human papillomavirus (HPV)16/18 vaccination of 12 year-old girls was calculated for 28 countries, under the assumption that vaccination prevents 70% of all cervical cancer cases and that cervical cancer and all-cause mortality rates are stable without vaccination. At three-dose vaccination costs of I$ 100 per vaccinated girl (currency 2005 international dollars), HPV16/18 vaccination was very cost-effective in 25 out of 28 countries using the country's gross domestic product (GDP) per capita as cost-effectiveness threshold (criterion by World Health Organization). A three-dose vaccination cost of I$ 100 is within the current range of vaccine costs in European immunization programs, and therefore our results indicate that HPV vaccination may be good value for money. To evaluate the cost-effectiveness of cervical cancer screening combined with vaccination, we calibrated a published simulation model to HPV genotype data collected in Slovenia, Poland, and Georgia. The screening interval was varied at 3, 6, and 10 years starting at age 25 or 30 and ending at age 60. In Slovenia and Poland, combined vaccination and 10-yearly HPV (DNA) screening (vaccination coverage 70%, screening coverage per round 70%) was very cost-effective when the cost of three-dose vaccination was I$ 100 per vaccinated girl. More intensive screening was very cost-effective when the screening coverage per round was 30% or 50%. In Georgia, 10-yearly Pap screening was very cost-effective in unvaccinated women. Vaccination combined with 10-yearly HPV screening was likely to be cost-effective if the three-dose vaccination cost was I$ 50 per vaccinated girl. To conclude, cervical cancer prevention strategies utilizing both HPV16/18 vaccination and HPV screening are very cost-effective in countries with sufficient resources. In low-resource settings, low vaccine pricing is essential for strategies of combined vaccination and screening to be cost-effective. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in the Central and Eastern Europe and Central Asia Region" Vaccine Volume 31, Supplement 7, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.

Multilevel stigma as a barrier to HIV testing in Central Asia: a context quantified.

Central Asia is experiencing one of the fastest growing HIV epidemics in the world, with some areas' infection rates doubling yearly since 2000. This study examines the impact of multilevel stigma (individual, family, and community) on uptake of HIV testing and receipt of HIV testing results among women in Central Asia. The sample consists of 38,884 ever-married, Central Asian women between the ages of 15 and 49. Using multilevel modeling (MLM), HIV stigma variables at the individual, family, and community levels were used to assess the significance of differences in HIV testing and receipt of HIV test results among participants while adjusting for possible confounding factors, such as age, wealth, and education. MLM results indicate that HIV stigma is significantly associated with decreased HIV testing uptake at the individual, family, and community levels and with a decrease in receipt at the community level. A one standard deviation increase in individual, family, and community level composite stigma score was associated with a respective 49 %, 59 %, and 94 % (p < 0.001) decrease in the odds of having been tested for HIV. A one standard deviation increase in community composite stigma score was associated with a 99 % (p < 0.001) decrease in the odds of test receipt. HIV stigma operates on the individual, family, and community levels to hinder HIV testing uptake and at the community level to hinder receipt. These findings have important interventions implications to improve uptake of HIV testing and receipt of HIV test results.

Transmission ecosystems of Echinococcus multilocularis in China and Central Asia.

From continental to regional scales, the zoonosis alveolar echinococcosis (AE) (caused by Echinococcus multilocularis) forms discrete patches of endemicity within which transmission hotspots of much larger prevalence may occur. Since the late 80s, a number of hotspots have been identified in continental Asia, mostly in China, wherein the ecology of intermediate host communities has been described. This is the case in south Gansu, at the eastern border of the Tibetan plateau, in south Ningxia, in the western Tian Shan of Xinjiang, and in the Alay valley of south Kyrgyzstan. Here we present a comparative natural history and characteristics of transmission ecosystems or ecoscapes. On this basis, regional types of transmission and their ecological characteristics have been proposed in a general framework. Combining climatic, land cover and intermediate host species distribution data, we identified and mapped 4 spatially distinct types of transmission ecosystems typified by the presence of one of the following small mammal 'flagship' species: Ellobius tancrei, Ochotona curzoniae, Lasiopodomys brandtii or Eospalax fontanierii. Each transmission ecosystem had its own characteristics which can serve as a reference for further in-depth research in the transmission ecology of E. multilocularis. This approach may be used at fine spatial scales to characterize other poorly known transmission systems of the large Eurasian endemic zone, and help in consideration of surveillance systems and interventions.

The emergence of echinococcosis in central Asia.

SUMMARY Following the collapse of the Soviet Union in 1991, there was an increase in the number of cases of human echinococcosis recorded throughout central Asia. Between 1991 and 2001 incidence rates of cystic echinococcosis (CE) increased by 4 fold or more. There also appeared to be increases in prevalence of CE in livestock and prevalences of Echinococcus granulosus reported in dogs. The increase in human echinococcosis was associated with changes in livestock husbandry, decline in veterinary public health services, increases in dog populations and increased poverty, all of which served to promote transmission of E. granulosus. A few years after reports of increased transmission of E. granulosus, the first reports of E. multilocularis infection in dogs were recorded. Further studies indicated that in both Kazakhstan and Kyrgyzstan prevalences of up to 18% were present. Recently there has been a dramatic increase in the number of cases of human alveolar echinococcosis recorded in Kyrgyzstan with over 60 cases reported in 2011.

Cancer epidemiology and control in North-Western and Central Asia - past, present and future.

The North-Western and Central region of Asia stretches from Turkey through Armenia, Georgia and Azerbaijan, to Iran and Turkmenistan, Uzbekistan, Kazakhstan, Kyrgyzstan, Tadjikistan and Afghanistan. These countries in the main share Turkic, Iranian or Caucasus ethnicity and culture and can be considered as a regional entity for cooperation in control of cancer. The present review of cancer registry and other epidemiological data was undertaken to provide an evidence base for cancer control programs and pointers to possible research collaboration. The most prevalent cancer site in males is the lung in the Western part of the region and the stomach in most of Iran and Central Asia, followed by the oesophagus in the latter two. Bladder cancer is comparatively frequent throughout. In females breast cancer is number one, generally followed by gastric, oesophageal or cervical lesions. However, there are interesting differences between countries or regions, particularly regarding the stomach. General tendencies for increase in adenocarcinomas but decrease in squamous cell carcinomas and gastric cancer point to change in environmental influence over time. Variation in risk factors depends to some extent on the level of economic development but overall the countries of the region face similar challenges in achieving effective cancer control, underlying the necessity for cooperation.

Chronic disease prevention research in Central Asia, the Urals, Siberia and Mongolia - past, present and future.

Central Asia, the Urals, Siberia and Mongolia cover an immense section of Asia and although relatively sparsely populated the total inhabitants number well in excess of 100 million. Furthermore, there is an increasing tendency for urbanization of the populations, which in many cases are growing. The ethnic make-up is diverse, with various degrees of admixture of Russians to the Turkish, Mongolian and other indigenous peoples of the region, and there is evidence of major variation in the burden of different cancers among the groups, although oesophageal and gastric neoplasias are relatively prevalent in common. Clearly there is a need for cooperation for cancer and other chronic disease prevention and the presence of Russian as a shared language of science, commerce and industry means that there should be no major communication difficulties. However, collaborative efforts at present are limited and the research output is low, even in the non-English literature. Here we focus on published work from the individual countries, as assessed by PubMed searches using the country name with cancer, cardiovascular, metabolic syndrome and diabetes as search terms, with an especial focus on epidemiology, environmental carcinogenicity and screening. One major aim is to identify active groups with an interest in participation in a regional meeting and collaborative research, so that a coordinated approach to granting agencies can be made to fund such a collective endeavour.