The Burden of Disease due to COVID-19 (BoCO-19): A study protocol for a secondary analysis of surveillance data in Southern and Eastern Europe, and Central Asia.

INTRODUCTION: The COVID-19 pandemic has had an extensive impact on public health worldwide. However, in many countries burden of disease indicators for COVID-19 have not yet been calculated or used for monitoring. The present study protocol describes an approach developed in the project "The Burden of Disease due to COVID-19. Towards a harmonization of population health metrics for the surveillance of dynamic outbreaks" (BoCO-19). The process of data collection and aggregation across 14 different countries and sub-national regions in Southern and Eastern Europe and Central Asia is described, as well as the methodological approaches used. MATERIALS AND METHODS: The study implemented in BoCO-19 is a secondary data analysis, using information from national surveillance systems as part of mandatory reporting on notifiable diseases. A customized data collection template is used to gather aggregated data on population size as well as COVID-19 cases and deaths. Years of life lost (YLL), as one component of the number of Disability Adjusted Life Years (DALY), are calculated as described in a recently proposed COVID-19 disease model (the 'Burden-EU' model) for the calculation of DALY. All-cause mortality data are collected for excess mortality sensitivity analyses. For the calculation of Years lived with disability (YLD), the Burden-EU model is adapted based on recent evidence. Because Covid-19 cases vary in terms of disease severity, the possibility and suitability of applying a uniform severity distribution of cases across all countries and sub-national regions will be explored. An approach recently developed for the Global Burden of Disease Study, that considers post-acute consequences of COVID-19, is likely to be adopted. Findings will be compared to explore the quality and usability of the existing data, to identify trends across age-groups and sexes and to formulate recommendations concerning potential improvements in data availability and quality. DISCUSSION: BoCO-19 serves as a collaborative platform in order to build international capacity for the calculation of burden of disease indicators, and to support national experts in the analysis and interpretation of country-specific data, including their strengths and weaknesses. Challenges include inherent differences in data collection and reporting systems between countries, as well as assumptions that have to be made during the calculation process.

Годовой отчет о ходе работы над реализацией Дорожной карты в поддержку здоровья и благополучия в Центральной Азии (2022–2025 гг.)

Дорожная карта в поддержку здоровья и благополучия в Центральной Азии на 2022–2025 гг. (ДКЦА) – первая субрегиональная стратегия в области укрепления здоровья и благополучия, утвержденная министрами здравоохранения стран Центральной Азии (СЦА) – Казахстана, Кыргызстана, Таджикистана, Туркменистана и Узбекистана – в ходе совещания 11 сентября 2022 г., состоявшегося в рамках семьдесят второй сессии Европейского регионального комитета ВОЗ. Дорожная объединяет усилия многих стран и является дополнением к индивидуальной страновой поддержке, нацеленной на ускорение прогресса СЦА и партнеров в области достижения важнейших целевых показателей; в ней выражается неизменная поддержка стран Центральной Азии со стороны ЕРБ ВОЗ в работе по выполнению задач ДКЦА на 2022–2025 гг. Настоящий отчет представляет собой моментальный снимок ситуации и не является подробным отчетом о деятельности Европейского регионального бюро ВОЗ (ЕРБ ВОЗ) в Центральной Азии; его следует рассматривать вместе с публикациями и докладами о ходе работы ЕРБ ВОЗ в СЦА, включая отчет Регионального директора о работе ЕРБ ВОЗ1 в 2021–2022 гг., представленный на семьдесят второй сессии Регионального комитета.

Annual progress report towards the implementation of the Roadmap for health and well-being in Central Asia (2022–2025)

The Roadmap for health and well-being in Central Asia (2022–2025) (CARM) is the first subregional strategy for health and wellbeing endorsed by the Ministers of Health of the following Central Asian countries (CACs): Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan at their meeting on September 11 2022, under the auspices of the 72nd Session of the WHO Regional Committee for Europe. CARM encompasses multi-country efforts and adds to tailored country support to advance CACs and partners coalescing in working towards attaining vital milestones of progress and expresses WHO/Europe’s unwavering support to CACs in achieving their 2022–2025 CARM objectives. This report is intended to present a snapshot rather than a detailed account of WHO/Europe’s engagement in Central Asia and should be read in conjunction with the WHO Regional Office for Europe’s published documents and progress reports, including the Report of the Regional Director on the work of WHO/Europe in 2021–2022 presented at the 72nd Session of the Regional Committee.

Expanding antimicrobial resistance surveillance in the WHO European Region: 10 years of the CAESAR Network

The Central Asian and European Surveillance of Antimicrobial Resistance (CAESAR) network has contributed to informing the public and policy-makers about the magnitude and the relevance of antimicrobial resistance (AMR) for both individuals and health systems. Thanks to close collaboration with European Centre for Disease Prevention and Control and European Surveillance of Antimicrobial Resistance Network, the CAESAR Network is contributing to harmonized AMR reporting across the WHO European Region. In combination, these two networks report surveillance data for almost all 53 Member States in the Region, thereby equipping decision-makers and those tackling AMR with better and more complete data than ever before. Over the past ten years, the CAESAR Network has focused on including and engaging as many countries/areas as possible, to strengthen their capacities and capabilities to undertake effective AMR surveillance.

Availability and prices of essential medicines in Uzbekistan in 2021

Access to medicines, vaccines and health products is an essential component of universal health coverage (UHC). It represents one of the building blocks of a well functioning health system and is an essential determinant of better health outcomes at individual and population levels. To enable regular monitoring of indicators of patient access, WHO launched the price and availability monitoring mobile application (MedMon) for essential medicines and health products in 2016. The tool has been piloted in more than 20 countries and enables rapid and inexpensive data collection and assessments of medicines and other health products in health facilities. This report presents results of a facility-based survey using MedMon and conducted in April and May 2021 on the availability and prices of essential medicines in community pharmacies in Uzbekistan.

Дорожная карта в поддержку здоровья и благополучия в Центральной Азии на 2022–2025 гг.

Дорожная карта в поддержку здоровья и благополучия в Центральной Азии на 2022–2025 гг. (далее – Дорожная карта) охватывает следующие страны Центральной Азии (СЦА): Казахстан, Кыргызстан, Таджикистан, Туркменистан и Узбекистан. Данная Дорожная карта опирается на индивидуальные цели и приоритеты СЦА в отношении здоровья через призму ЕПР. Дорожная карта разработана с учетом индивидуальных целей и приоритетов СЦА в отношении здоровья и благополучия, оцениваемых через призму Европейской программы работы на 2020–2025 гг. «Совместные действия для улучшения здоровья» (ЕПР). В ЕПР описывается концепция предоставления Европейским региональным бюро ВОЗ поддержки органам здравоохранения региона с целью успешного решения актуальных задач как на уровне отдельных стран, так и в рамках совместной работы. Кроме того, Дорожная карта также направлена на объединение усилий всех СЦА и развитие сотрудничества с партнерами для достижения политической, инвестиционной и технической целей Дорожной карты. В совокупности данные цели позволяют обеспечить выполнение ключевых приоритетных задач в рамках ЕПР, устранить основные причины возникновения проблем со здоровьем в данном субрегионе, учесть самые важные недостатки систем здравоохранения СЦА и содействовать преодолению отставаний в сфере здоровья и благополучия населения как на уровне СЦА, так и по сравнению с Европейским союзом и Европейским регионом ВОЗ. Дорожная карта была создана совместными силами СЦА с использованием нового подхода, разработанного Европейским региональным бюро ВОЗ для содействия субрегиональному сотрудничеству в целях здоровья и благополучия. Такой подход позволяет СЦА совместно мобилизовать ресурсы и формировать партнерские отношения, необходимые для реализации преобразующих изменений с целью создания политического капитала и последующего расширения возможностей инвестирования в здоровье и благополучие в Центральной Азии. Такие возможности ориентированы на наиболее значимые направления деятельности с высокой отдачей и общим приоритетом для всех стран Центральной Азии с точки зрения улучшения здоровья и благополучия текущего и следующих поколений. Настоящая Дорожная карта представляет собой действенный инструмент, не имеющий политических коннотаций и позволяющий совместно реагировать на масштабные взаимосвязанные кризисы, влияющие на данный субрегион, включая пандемию COVID-19, климатический кризис, а также конфликты и политическую нестабильность в Европейском регионе ВОЗ, преимущественно обусловленные кризисом на территории Украины. Таким образом, Дорожная карта, учитывающая в первую очередь потребности людей, закладывает основы для улучшения здоровья и благополучия с обеспечением возможности СЦА решать социальные проблемы и ускоренно двигаться к выполнению глобальных, региональных и национальных обязательств в области здоровья и благополучия. Для достижения этих целей в рамках Дорожной карты предусмотрено 11 направлений деятельности с высокой отдачей и 32 инициативы по реформированию, которые были определены по итогам обширного процесса консультаций с Европейским региональным бюро ВОЗ и министерствами здравоохранения СЦА, прочими органами государственной власти в сфере здравоохранения и партнерами по развитию

Roadmap for health and well-being in Central Asia (2022–2025)

Asian countries (CACs): the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Tajikistan, Turkmenistan and the Republic of Uzbekistan. The Roadmap builds on the individual health goals and priorities of CACs through the lens of the European Programme of Work (2020–2025) – “United Action for Better Health” (EPW). The EPW outlines a vision for how the WHO Regional Office for Europe can support health authorities across the Region to rise to their challenges individually and collectively. In parallel, the Roadmap aligns CACs’ efforts and fosters cooperation with partners to pursue its political, investment and technical objectives. Together, these objectives synergistically deliver on the core priorities of the EPW, target the subregion’s root causes of ill health, address key weaknesses of CACs’ health systems and help close the gaps in health and well-being between CACs and the European Union and WHO European Region. CACs co-created the Roadmap using a novel approach established by the WHO Regional Office for Europe to facilitate subregional cooperation for health and well-being. This approach enables CACs to synergize resource mobilization and facilitate partnerships for transformative change that will create political capital for health and broaden investment opportunities in Central Asia. These opportunities focus on the most prominent, high impact areas of shared priority for improving the health and well-being of Central Asia’s current and next generation. The Roadmap is a powerful, politically neutral health instrument that allows CACs to cooperatively respond to the intersecting crises of epic proportions affecting them, including the COVID-19 pandemic, the climate crisis and the conflict and political instability in the WHO European Region, predominantly resulting from the crisis in Ukraine. Therefore, the Roadmap is a human-centred cornerstone for health and well-being that will help CACs heal social fractures and accelerate their delivery on global, regional and national commitments for health and well-being. To achieve these goals, the Roadmap has identified 11 High Impact Action Areas and 32 Reform Initiatives following an extensive consultative process with the WHO Regional Office for Europe and CACs’ Ministries of Health, national health authorities and development partners.

Краткое руководство по дорожной карте в поддержку здоровья и благополучия в Центральной Азии на 2022–2025 гг.

Настоящее краткое руководство является дополнительным документом к Дорожной карте в поддержку здоровьяи благополучия в Центральной Азии на 2022–2025 гг. (далее – Дорожная карта), охватывающей следующиестраны Центральной Азии (СЦА): Казахстан, Кыргызстан, Таджикистан, Туркменистан и Узбекистан. Дорожнаякарта разработана с учетом индивидуальных целей и приоритетов СЦА в отношении здоровья и благополучия,оцениваемых через призму Европейской программы работы на 2020–2025 гг. «Совместные действия для улучшенияздоровья» (ЕПР), и определяет общие приоритеты и потенциальные согласованные действия в этом субрегионе.Дорожная карта, разработанная СЦА в сотрудничестве с Европейским региональным бюро ВОЗ, также направленана объединение усилий и развитие сотрудничества с региональными, субрегиональными и страновыми партнерамидля реализации политических, инвестиционных и технических целей, соответствующих основным приоритетамЕПР.Данное краткое руководство состоит из двух разделов. В первом разделе приводятся две вспомогательныетаблицы для Дорожной карты, описывающие: 1) разрывы в показателях здоровья и благополучия между СЦА иЕвропейским союзом, а также Европейским регионом ВОЗ и 2) приоритетные действия на страновом уровне вЦентральной Азии в целях обеспечения здоровья, благополучия и устойчивого развития. Второй раздел содержиткраткие обзоры по пяти странам, составленные для определения и систематизации приоритетов в областиздравоохранения, благополучия и устойчивого развития в СЦА при разработке Дорожной карты. Каждый обзорпредставлен отдельно, чтобы облегчить доступ к соответствующей информации о стране.

Compendium of the Roadmap for Health and Well-being in Central Asia (2022–2025)

This compendium is a supplementary document for the Roadmap for Health and Well-being in Central Asia (2022–2025) (hereinafter, Roadmap), which scopes the following Central Asian countries (CACs): Republic of Kazakhstan, Kyrgyz Republic, Republic of Tajikistan, Turkmenistan, and Republic of Uzbekistan. The Roadmap builds on the individual health and well-being goals and priorities of CACs through the lens of the European Programme of Work (2020–2025) – “United Action for Better Health” (EPW) and identifies shared priorities and potential synergistic actions across the subregion. The Roadmap also aligns efforts and fosters cooperation with regional, subregional, and country partners to implement political, investment and technical objectives that deliver on the core priorities of the EPW. This compendium is comprised of two sections. The first section contains two supporting tables for the Roadmap, which outline: 1) the gaps in health and well-being between CACs and the European Union and WHO European Region and 2) priority actions for health, well-being, and sustainable development at the country-level in Central Asia. The second section contains five country briefs, which were completed to identify and centre the health, well-being, and sustainable development priorities of CACs in the Roadmap’s development. Each brief is independently presented to facilitate easy access to relevant country information.

Assessment of Spatio-Temporal Variation and Driving Mechanism of Ecological Environment Quality in the Arid Regions of Central Asia, Xinjiang.

Grassland ecosystems are increasingly threatened by pressures from climate change and intensified human activity, especially in the arid region of Central Asia. A comprehensive understanding of the ecological environment changes is crucial for humans to implement environmental protection measures to adapt to climate change and alleviate the contradiction between humans and land. In this study, fractional vegetation coverage (FVC), leaf area index (LAI), gross primary productivity of vegetation (GPP), land surface temperature (LST), and wetness (WET) were retrieved from Moderate-Resolution Imaging Spectroradiometer (MODIS) satellite remote sensing products in 2008 and 2018. Principal component analysis (PCA) was used to establish the MODIS data-based ecological index (MODEI) in the study area, and the spatial differentiation characteristics and driving mechanism of ecological quality in the last ten years were explored. The results showed that: (1) FVC, GPP, LAI, and WET had positive effects on the ecological environment, while LST had a negative impact on the ecological environment. FVC and GPP were more significant than other indicators. (2) The MODEI showed a spatial pattern of "excellent in the north and poor in the south" and changed from north to south in the study area. (3) From 2008 to 2018, the average MODEI of Fuyun County increased from 0.292 to 0.303, indicating that the ecological quality in Fuyun County became better overall. The improved areas were mainly located in the summer pastures at higher elevations. In comparison, the deteriorated areas were concentrated in the spring and autumn pastures and winter pastures at lower elevations. The areas where the ecological environment had obviously improved and degraded were distributed along the banks of the Irtysh River and the Ulungur River. (4) With the increase in precipitation and the decrease in grazing pressure, the MODEI of summer pasture was improved. The deterioration of ecological environment quality in spring and autumn pastures and winter pastures was related to the excessive grazing pressure. The more significant changes in the MODEI on both sides of the river were associated with implementing the herdsmen settlement project. On the one hand, the implementation of newly settled villages increased the area of construction land on both sides of the river, which led to the deterioration of ecological quality; on the other hand, due to the increase in cropland land and the planting of artificial grasses along the river, the ecological quality was improved. The study offers significant information for managers to make more targeted ecological restoration efforts in ecologically fragile areas.

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.

Trends and determinants of newborn mortality in Kyrgyzstan: a Countdown country case study.

BACKGROUND: Kyrgyzstan has made considerable progress in reducing child mortality compared with other countries in the region, despite a comparatively low economic standing. However, maternal mortality is still high. Given the availability of an established birth registration system, we aimed to comprehensively assess the trends and determinants of reproductive, maternal, newborn, and child health in Kyrgyzstan. METHODS: For this Countdown to 2030 country case study, we used publicly available data repositories and the national birth registry of Kyrgyzstan to examine trends and inequalities of reproductive, maternal, and newborn health and mortality between 1990 and 2018, at a national and subnational level. Coverage of newborn and maternal health interventions was assessed and disaggregated by equity dimensions. We did Oaxaca-Blinder decomposition to determine the contextual factors associated with the observed decline in newborn mortality rates. We also undertook a comprehensive review of national policies and programmes, as well as a prospective Lives Saved Tool analysis, to highlight interventions that have the potential to avert the most maternal, neonatal, and child deaths. FINDINGS: Over the past two decades, Kyrgyzstan reduced newborn mortality rates by 46% and mortality rates of children younger than 5 years by 69%, whereas maternal mortality rates were reduced by 7% and stillbirth rates by 29%. The leading causes of neonatal deaths were prematurity and asphyxia or hypoxia, and preterm small-for-gestational-age infants were more than 80 times more likely to die in their first month of life compared with those born appropriate-for-gestational age at term. Except for contraceptive use, coverage of essential interventions has increased and is generally high, with limited sociodemographic inequities. With scale-up of a few essential neonatal and maternal interventions, 39% of neonatal deaths, 11% of stillbirths, and 19% of maternal deaths could be prevented by 2030. INTERPRETATION: Kyrgyzstan has reduced newborn mortality rates considerably, with the potential for further reduction. To achieve and exceed the Sustainable Development Goal 3 targets for newborn survival and reducing stillbirths, Kyrgyzstan needs to scale up packages of interventions for the care of small and sick babies, assure quality of care in all health-care facilities with regionalised perinatal care, and create a linked national registry for mothers and neonates with rapid feedback and accountability. FUNDING: US Fund for UNICEF under the Countdown to 2015, UNICEF Kyrgyzstan Office.

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.

The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.

BACKGROUND: Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories. METHODS: We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries. FINDINGS: In 2017, cirrhosis caused more than 1·32 million (95% UI 1·27-1·45) deaths (440 000 [416 000-518 000; 33·3%] in females and 883 000 [838 000-967 000; 66·7%] in males) globally, compared with less than 899 000 (829 000-948 000) deaths in 1990. Deaths due to cirrhosis constituted 2·4% (2·3-2·6) of total deaths globally in 2017 compared with 1·9% (1·8-2·0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21·0 (19·2-22·3) per 100 000 population in 1990 to 16·5 (15·8-18·1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32·2 [25·8-38·6] deaths per 100 000 population in 2017), and the high-income super-region had the lowest (10·1 [9·8-10·5] deaths per 100 000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3·7 [3·3-4·0] per 100 000 in 2017) and highest in Egypt in all years since 1990 (103·3 [64·4-133·4] per 100 000 in 2017). There were 10·6 million (10·3-10·9) prevalent cases of decompensated cirrhosis and 112 million (107-119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the other four causes showed declines in age-standardised death rate. The age-standardised prevalence of compensated and decompensated cirrhosis due to NASH increased more than for any other cause of cirrhosis (by 33·2% for compensated cirrhosis and 54·8% for decompensated cirrhosis) over the study period. From 1990 to 2017, the number of prevalent cases more than doubled for compensated cirrhosis due to NASH and more than tripled for decompensated cirrhosis due to NASH. In 2017, age-standardised death and DALY rates were lower among countries and territories with higher SDI. INTERPRETATION: Cirrhosis imposes a substantial health burden on many countries and this burden has increased at the global level since 1990, partly due to population growth and ageing. Although the age-standardised death and DALY rates of cirrhosis decreased from 1990 to 2017, numbers of deaths and DALYs and the proportion of all global deaths due to cirrhosis increased. Despite the availability of effective interventions for the prevention and treatment of hepatitis B and C, they were still the main causes of cirrhosis burden worldwide, particularly in low-income countries. The impact of hepatitis B and C is expected to be attenuated and overtaken by that of NASH in the near future. Cost-effective interventions are required to continue the prevention and treatment of viral hepatitis, and to achieve early diagnosis and prevention of cirrhosis due to alcohol-related liver disease and NASH. FUNDING: Bill & Melinda Gates Foundation.