Dynamic changes in water resources and comprehensive assessment of water resource utilization efficiency in the Aral Sea basin, Central Asia.

The Aral Sea Basin in Central Asia faces significant challenges in improving water utilization and treatment because of frequent transboundary river water disputes and shortages of water resources. However, the traditional water resource utilization efficiency (WRUE) assessment models generally have the defect of over-validating evaluation results. To solve this problem, this study used the Coefficient of Variation method to constrain the self-contained weights in the traditional Data Envelopment Analysis (DEA) to construct an improved CV-DEA model, and assessed the WRUE of the Aral Sea Basin countries during 2000-2018 and compared the WRUE with that of the countries in the Mekong River Basin and Northeast Asia, then explored the factors influencing water utilization. The conclusions were drawn: since 1960, the runoff from the upper Amu Darya and Syr Darya rivers increased significantly, while the runoff from the lower Amu Darya River into the Aral Sea declined. Meanwhile, the water area of the Aral Sea shrank from 2.56 × 104 km2 to 0.70 × 104 km2 in 2000-2018, with the Northern Aral Sea remaining stable while the southern part shrinking sharply. The WRUE of the Aral Sea Basin (0.599, on average) was higher than that of the Mekong River Basin (0.547) and lower than that of Northeast Asia (0.885). Kazakhstan and Uzbekistan had the highest WRUE of 0.819 and 0.685 respectively, and the WRUE in both two countries improved from 2000 to 2018. Tajikistan (0.495) and Turkmenistan (0.402) experienced decreases in WRUEs. The high input redundancy of agricultural water consumption was the main driving force affecting WRUE in the basin.

Trends in cost and consumption of essential medicines for non-communicable diseases in Azerbaijan, Georgia, and Uzbekistan, from 2019 to 2021.

BACKGROUND: Access to medicines is a global priority. Azerbaijan, Georgia, and Uzbekistan have different approaches to pricing policies for pharmaceuticals. The aim of this study was to analyze recent trends in the consumption and prices of non-communicable disease (NCD) medicines in Azerbaijan, Georgia, and Uzbekistan, in the outpatient setting. METHODS: We included medicines for asthma and COPD, cancer, cardiovascular disease, diabetes, epilepsy, and mental disorders. Sales data for pharmaceutical products in community pharmacies were extracted from a commercial database. Changes in consumption and prices were analyzed across all included NCD medicines, by disease category and pharmacological group. RESULTS: Consumption of NCD medicines was highest in Georgia, at twice the levels in Azerbaijan, and four times levels in Uzbekistan. Average prices of NCD medicines, weighted by consumption, increased by 26% in Georgia, but decreased by 3% in Azerbaijan and by 0.1% in Uzbekistan. Prices increased for all disease groups in Georgia (from +13% for epilepsy medicines to +86% for cancer), varied by group in Uzbekistan (from -22% for epilepsy medicines to +47% for cancer), while changes in Azerbaijan were smaller in magnitude (from -4% for medicines for cardiovascular disease to +11% for cancer). Cancer medicines had markedly higher prices in Uzbekistan, and asthma and COPD medicines had markedly higher prices in Azerbaijan and Uzbekistan. CONCLUSIONS: Georgia showed the highest outpatient consumption of NCD medicines, suggesting the broadest access to treatment. However, Georgia also saw marked price increases, greater than in the other countries. In Georgia, where there was no price regulation, widespread price increases and increases in consumption both contribute to increasing pharmaceutical expenditures. In Azerbaijan and Uzbekistan, increases in outpatient pharmaceutical expenditures were primarily driven by increases in consumption, rather than increases in price. Comparing trends in consumption and pricing can identify gaps in access and inform future policy approaches.

Indicator-based assessments of the coupling coordination degree and correlations of water-energy-food-ecology nexus in Uzbekistan.

Grappling with the global ecological concern of the Aral Sea disaster, Uzbekistan exemplifies the urgent necessity of unravelling and addressing the complex Water-Energy-Food-Ecology (WEFE) nexus conflicts in arid regions, a critical task yet largely uncharted. Through the strategic process of 'Indicator Articulation - Weight Calibration - Nexus Coordination Quantification - Correlational Analysis', this work has developed a tailored framework that integrates a novel, context-specific indicator system, enabling an illumination of the intricate dynamics within the WEFE nexus in arid regions. During 2000-2018, the WEFE Nexus in Uzbekistan showed low-level coordination, indicating systemic imbalances. The Aral Sea crisis was the central disruptor, resulting in a moderately disordered ecological subsystem. Concurrently, disorder was observed in water resources, signaling inadequate management and potential overutilization. Furthermore, Coordination for energy and food were barely coordinated and under primary coordination respectively, underlining critical challenges in energy efficiency and food security. Over the last two decades, the WEFE Nexus has evolved towards a tighter interlinkage, yet the stability of this coupling coordination has experienced increased fluctuations, indicating that Uzbekistan's policies in the WEFE subsystems have been less stable in the last two decades and are in need of further adjustment and improvement. To address the challenges, we recommend a comprehensive approach that integrates technological, infrastructure, and policy solutions is needed. Specifically, promoting water-saving irrigation technology, renewing and maintaining outdated energy facilities, and raising public awareness of ecological protection are part of the essential measures. Furthermore, alleviating the contradiction between economic growth and ecological conservation remains a major challenge. Collectively, our constructed WEFE Nexus framework, with its extendable and context-specific indicators, holds significant potential for broad application in the analysis of multi-sectoral sustainability, particularly within arid regions globally, and forms a solid foundation for the formulation of effective, targeted policies and sustainable development strategies.

Assessment of the Impact of the Rotavirus Vaccine Against Severe Rotaviral Diarrhea in Uzbekistan.

BACKGROUND: This article presents the results of a long-term study of the impact of rotavirus vaccination in Uzbekistan. Uzbekistan is the first country in the Central Asian region to introduce rotavirus vaccination into the national compulsory vaccination calendar. The study aimed to evaluate the impact of rotavirus vaccination on hospitalizations due to all-cause AGE and RVGE in children < 5 years of age in Uzbekistan. METHODS: Detection of rotavirus antigen was performed using Rotavirus-Antigen-IFA-BEST "Vector Best" kit (Novosibirsk, Russia). RESULTS: The total of 20,128 children under 5 years of age were hospitalized in sentinel hospitals with a diagnosis of acute gastroenteritis during the study period (2019-2020). Of this number of children, 4481 children (22.2%) were included in the study. Of 4481 children, 367 (8.2%) children tested positive for rotavirus. In our study, decrease in the rotavirus rate was noted in all age groups. The peak of rotavirus positivity occurred in the months of January and February. CONCLUSION: The average rotavirus-positive rate in the period (2019-2020) was 8.2% and the absolute percentage decrease was 18.1% compared to the pre-vaccination period (2005-2009) where the rotavirus-positive rate was 26.3%. The percentage of prevented cases averaged 68.8%.

Investigating the association among CO2 emissions, renewable and non-renewable energy consumption in Uzbekistan: an ARDL approach.

This paper examines for the first time the relationship between CO2 emissions and the consumption of renewable and non-renewable energy in Uzbekistan, spanning the period 1985-2020. The analysis uses the Autoregressive Distributed Lags (ARDL) model to estimate the long-run dynamic multipliers and short-run elasticity coefficients of energy consumption variables. Economic factors, such as GDP, are excluded in the analysis as they may cause multicollinearity problems. The empirical results document that in the short- and long-run, hydropower (renewable) energy consumption negatively impacts CO2 emissions per capita, showing a unidirectional causal effect. As regards with non-renewable energy consumption, natural gas and oil energy consumption have a positive impact on CO2 emissions per capita both in the short and long run. Coal consumption positively impacts CO2 emissions in the short run, while it is negative in the long run. Policy measures to enhance the collection of energy from additional renewable energy sources, in particular hydropower, should be taken into account in order to increase the share of renewable energy, and thus, to compensate non-renewable energy consumption which is the main contributor to CO2 emissions. Moreover, solar and wind energy should be explicitly taken into consideration as an additional renewable energy source, which has the lack of attention by policymakers. Furthermore, policy actions, such as the involvement of the private sector into renewable energy projects and the implementation of effective carbon tax policies, could be further options to reduce CO2 emissions.

Costs and import costs of past, present, and future TB drug regimens: a case study for Karakalpakstan, Uzbekistan.

BACKGROUND: Tuberculosis (TB) drugs and their import are costly. We assessed how shorter TB drug regimens, which were non-inferior or superior in recent TB trials, can affect the costs for purchasing and importing TB drugs. METHODS: We estimated the drug costs and import costs of 39 longer and shorter TB drug regimens using TB drug prices from the Global Drug Facility and import cost estimates for a TB program in Karakalpakstan, Uzbekistan. Drug regimens from recent TB trials were compared with TB drug regimens following present or past World Health Organization recommendations. RESULTS: We estimated an import cost of $4.19 and a drug cost of $43 per standard 6-month drug-sensitive (DS)-TB regimen. A new 17-week DS-TB regimen from the TBTC Study 31 currently requires more tablets and is more expensive to import ($6.08) and purchase ($233). The TB program can substantially decrease import costs ($2.26-14) and drug costs ($391-2308) per multidrug-resistant (MDR)-TB regimen when using new 6-month or shorter drug regimens from the Nix-TB, NExT, TB PRACTECAL, ZeNix, or BEAT TB trials instead of 9-20-month regimens with import costs of $9.96-507 and drug costs of $354-15 028. For a commonly used 20-month all-oral, bedaquiline-containing MDR-TB regimen, we estimated costs of $41 for drug import and $1773 for drug purchase. CONCLUSIONS: The implementation of a new and shorter DS-TB regimen may increase the costs for drug purchase and import. The implementation of new and shorter MDR-TB regimens may decrease the costs for drug purchase and/or drug import.

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.

Transforming the health system in Uzbekistan: two-year implementation review

Uzbekistan has started a process of health system reform that includes fundamental changes in service delivery and health financing arrangements, as well as digitalization of the health care sector. The reform was initiated in 2018 by the adoption of high-level legislation, which was put into practice in 2021 by initiation of a pilot project in the Syrdarya Oblast. The Government intention is to expand the new system to other regions and eventually implement planned reforms throughout the country. This review assesses the implementation of system changes and provides recommendations for future reform development. The report is organized around three key topics: transformation of primary health care provision, implementation of health financing reforms and development of the e-health system.

Наличие основных лекарственных средств и цены на них в Узбекистане в 2021 г.

Доступ к лекарствам, вакцинам и изделиям медицинского назначения является важнейшим компонентом достижения всеобщего охвата услугами здравоохранения (ВОУЗ). Доступ к лекарствам представляет собой один из составных элементов эффективно функционирующей системы здравоохранения и является важным фактором, определяющим высокие показатели в области охраны здоровья на индивидуальном и популяционном уровнях. Чтобы обеспечить возможность регулярного мониторинга показателей доступа пациентов к лекарствам, в 2016 г. ВОЗ запустила мобильное приложение для мониторинга цен и наличия основных лекарственных средств и изделий медицинского назначения (MedMon). Этот инструмент, опробованный более чем в 20 странах, предлагает быстрый и недорогой способ сбора данных и оценки наличия лекарственных средств и других товаров для здоровья в медицинских учреждениях. В этом отчете представлены результаты исследования, проведенного в медицинских учреждениях с использованием инструмента MedMon в апреле и мае 2021 г. с целью оценки наличия и цен на основные лекарственные средства в розничных аптеках Узбекистана.

Assessment of Soil Salinity Changes under the Climate Change in the Khorezm Region, Uzbekistan.

Soil salinity negatively affects plant growth and leads to soil degradation. Saline lands result in low agricultural productivity, affecting the well-being of farmers and the economic situation in the region. The prediction of soil salinization dynamics plays a crucial role in sustainable development of agricultural regions, in preserving the ecosystems, and in improving irrigation management practices. Accurate information through monitoring and evaluating the changes in soil salinity is essential for the development of strategies for agriculture productivity and efficient soil management. As part of an ex-ante analysis, we presented a comprehensive statistical framework for predicting soil salinity dynamics using the Homogeneity test and linear regression model. The framework was operationalized in the context of the Khorezm region of Uzbekistan, which suffers from high levels of soil salinity. The soil salinity trends and levels were projected under the impact of climate change from 2021 to 2050 and 2051 to 2100. The results show that the slightly saline soils would generally decrease (from 55.4% in 2050 to 52.4% by 2100 based on the homogeneity test; from 55.9% in 2050 to 54.5% by 2100 according to the linear regression model), but moderately saline soils would increase (from 31.2% in 2050 to 32.5% by 2100 based on the homogeneity test; from 31.2% in 2050 to 32.4% by 2100 according to the linear regression model). Moreover, highly saline soils would increase (from 13.4% in 2050 to 15.1% by 2100 based on the homogeneity test; from 12.9% in 2050 to 13.1% by 2100 according to the linear regression model). The results of this study provide an understanding that soil salinity depends on climate change and help the government to better plan future management strategies for the region.

Hydrochemical characteristics, trace element sources, and health risk assessment of surface waters in the Amu Darya Basin of Uzbekistan, arid Central Asia.

Thorough knowledge of hydrochemical characteristics and trace element concentrations in surface waters is crucial for protection of this resource, especially in arid regions. Uzbekistan lies in central, arid Central Asia, and is experiencing severe water scarcity as a consequence of warming climate and accelerated human impacts. Fifty-five surface water samples were collected from the Amu Darya Basin of Uzbekistan (ADBU) and measured for relevant variables, to determine hydrochemical characteristics and evaluate water quality. River water samples from the middle reach and Amu Darya Delta (ADD) were dominantly HCO3-Ca and SO4-Ca·Mg types, respectively, whereas water samples collected near the former shoreline and sewage outlets in the ADD were predominantly Cl-Ca·Mg and Cl-Na types, consistent with the distribution of sites that display high concentrations of trace elements and are seriously affected by human activities. Principal component analysis indicated that Pb and Cd in surface waters of the ADBU had industrial origins. Local agricultural activities are thought to have contributed to the concentrations of NO3, Zn, Ni, Hg, and Mn, through pesticide and fertilizer applications, and concentrations of Cu, Cr, As, and Co are controlled by mixed natural and anthropogenic sources. Water quality and health risk assessments indicated that unsuitable drinking waters are distributed mainly near the former shoreline and sewage outlets in the ADD, making human health risks in these areas high.

Polycyclic aromatic hydrocarbons (PAHs) in soils of an industrial area in semi-arid Uzbekistan: spatial distribution, relationship with trace metals and risk assessment.

The concentrations, composition patterns, transport and fate of PAHs in semi-arid and arid soils such as in Central Asia are not well known. Such knowledge is required to manage the risk posed by these toxic chemicals to humans and ecosystems in these regions. To fill this knowledge gap, we determined the concentrations of 21 parent PAHs, 4,5-methylenephenanthrene, 6 alkylated PAHs, and biphenyl in soils from 11 sampling locations (0-10, 10-20 cm soil depths) along a 20-km transect downwind from the Almalyk metal mining and metallurgical industrial complex (Almalyk MMC), Uzbekistan. The concentrations of Σ29 PAHs and Σ16 US-EPA PAHs were 41-2670 ng g-1 and 29-1940 ng g-1, respectively. The highest concentration of Σ29 PAHs occurred in the immediate vicinity of the copper smelting factory of the Almalyk MMC. The concentrations in topsoil decreased substantially to a value of ≤ 200 ng g-1 (considered as background concentration) at ≥ 2 km away from the factory. Low molecular weight PAHs dominated the PAH mixtures at less contaminated sites and high molecular weight PAHs at the most contaminated site. The concentration of Σ16 US-EPA PAHs did not exceed the precautionary values set by the soil quality guidelines of, e.g., Switzerland and Germany. Similarly, the benzo[a]pyrene equivalent concentration in soils near the Almalyk MMC did not exceed the value set by the Canadian guidelines for the protection of humans from carcinogenic PAHs in soils. Consequently, the cancer risk due to exposure to PAHs in these soils can be considered as low.

Investigating and evaluating the dynamics of change in water resources of the Aydar-Arnasay Lake system in Uzbekistan.

The Aydar-Arnasay Lake System (AALS) is located in the middle of the Syrdarya River, to the south of the Chardara Reservoir, and in Jizakh and Navoi provinces of the Republic of Uzbekistan, adjacent to the low plain of South Mirzachul. Currently, the AALS has a significant impact on the regional ecosystem and socio-economic conditions of the region. Studying and evaluating the AALS hydrology, the water volume, surface area, and variability of water levels altogether play an important role in the development of fisheries and ecotourism in the region. However, in the past studies, the dynamic changes in the volume, area, and water levels of the AALS have not been investigated through up-to-the-date geo-information systems (GIS), requiring additional research to formulate a proper methodology considering the potential aspects of GIS. Therefore, this paper aims at analyzing the dynamics of changes in the water level, surface area, and water volume of the AALS by using GIS technologies within 1993-2017 years. During the period from 1993 to 2006, the water level and the surface area of the AALS steeply increased and remained stable with negligible positive and negative fluctuations in the rest of the experimental years. These findings were successfully tested and validated by ANOVA, indicating an exceptionally low F-significance of 0.0008. According to the AALS's water volume dynamics, we investigated here the role of two factors: anthropogenic-the outflow water discharge from the reservoir located in the neighboring country; and natural-the amount of perennial precipitation. Consequently, we ascertained that the role of precipitation as a natural driving factor in expansion is majorly less than the outflow water from the reservoir, despite having a gradual increase in the perennial precipitation trend. As we assume that the hydrological characteristics of the AALS are strongly dependent on air temperature and the amount of precipitation due to the extreme restriction of outflow water discharge from the reservoir, thus the establishment of proper GIS-tracking and monitoring methodology is recommended to early warn the potential minor changes which could become severe in the near future.

Технико-экономическое обоснование для внедрения обязательного медицинского страхования в Узбекистане

В Узбекистане было принято решение о внедении обязательного медицинского страхования (ОМС) с целью обеспечения всеобщего охвата медико-санитарными услугами. Данное технико-экономическое обоснование направлено на оценку влияния потенциальных источников доходов на расширение фискального пространства для здравоохранения в рамках ОМС. На основе данных о численности населения, занятости и экономике, в нем предложены три сценария потенциального сочетания доходов государственного бюджета для здравоохранения. Согласно Сценарию 1, предполагается, что в 2025 году только за счет поступлений от общих налогов в сфере здравоохранения будет доступно 620 000 сумов на душу населения. В Сценарии 2 предполагаются поступления от общих налогов в сочетании с поступлениями от налога в размере 2% на фонд оплаты труда (ФОТ), то добавит еще 35 000 сум на душу населения (5,4% от общей суммы государственного финансирования для сектора здравоохранения). В Сценарии 3 удваивается налог на ФОТ до 4%, что добавляет еще 52 000 сум на душу населения (7,7% от общей суммы государственного финансирования для сектора здравоохранения). В нем сделан вывод о том, что общие налоги позволяют более эффективно обеспечить всеобщий охвата медико-санитарными услугами, а налог на ФОТ позволит сгенерировать лишь незначительные дополнительные ресурсы, идет в разрез с задачами реформирования подоходного налога и отчислений на социальное обеспечение, проведенным в 2019 году и может навредить рынку труда. Вместо этого, Узбекистан может изыскать дополнительные каналы получения доходов из таких альтернативных источников, как налоги на товары, вредные для здоровья, а также дополнительно расширять фискальное пространство для здравоохранения, сосредоточив внимание на повышении эффективности системы оказания медицинских услуг.

Feasibility study for the introduction on of mandatory health insurance in Uzbekistan

Uzbekistan has decided to introduce mandatory health insurance (MHI) to move towards universal health coverage. This feasibility study assesses the impact of potential revenue sources to expand the fiscal space for health under MHI. Usingpopulation, employment and economic data, it projects three scenarios of the potential public revenue mix for health.Scenario 1 projects that in 2025, 620 000 som per capita will be available for health from general taxation. Scenario 2projects revenues from general taxation combined with a 2% payroll tax to add 35 000 som per capita (5.4% of totalpublic funding for health). Scenario 3 doubles the payroll tax to 4% and adds 52 000 som per capita (7.7% of total publicfunding for health). It concludes that general taxation offers the most effective way to support progress towards universalhealth coverage, and a payroll tax would generate limited additional resources, be inconsistent with the objectives of the2019 income tax and social security contribution reform, and risk harming the labour market. Instead, Uzbekistan canseek complementary revenue streams from alternatives (e.g. sin taxes), and further expand fiscal space for health throughfocusing on efficiency gains in the service delivery system.

Cost-effectiveness of new MDR-TB regimens: study protocol for the TB-PRACTECAL economic evaluation substudy.

INTRODUCTION: Current treatment regimens for multidrug-resistant tuberculosis (MDR-TB) are long, poorly tolerated and have poor outcomes. Furthermore, the costs of treating MDR-TB are much greater than those for treating drug-susceptible TB, both for health service and patient-incurred costs. Urgent action is needed to identify short, effective, tolerable and cheaper treatments for people with both quinolone-susceptible and quinolone-resistant MDR-TB. We present the protocol for an economic evaluation (PRACTECAL-EE substudy) alongside an ongoing clinical trial (TB-PRACTECAL) aiming to assess the costs to patients and providers of new regimens, as well as their cost-effectiveness and impact on participant poverty levels. This substudy is based on data from the three countries participating in the main trial. METHODS AND ANALYSIS: Primary cost data will be collected from the provider and patient perspectives, following economic best practice. We will estimate the probability that new MDR-TB regimens containing bedaquiline, pretomanid and linezolid are cost-effective from a societal perspective as compared with the standard of care for MDR-TB patients in Uzbekistan, South Africa and Belarus. Analysis uses a Markov model populated with primary cost and outcome data collected at each study site. We will also estimate the impact of new regimens on prevalence of catastrophic patient costs due to TB. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the London School of Hygiene & Tropical Medicine and Médecins Sans Frontières. Local ethical approval will be sought in each study site. The results of the economic evaluation will be shared with the country health authorities and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT04207112); Pre-results.

Organ Donation in Uzbekistan: Achievements and Prospects for Further Development.

Here, we describe the current situation regarding organ transplant in Uzbekistan. The legalization of paired-kidney exchange programs for donors with incompatible blood types in Uzbekistan will allow more opportunities for organ donation. The phased implementation of the transplant program with that of deceased-donor organ transplant can be carried out only with the involvement of public, cultural, and religious figures, and not only health professionals, to permanently shift the paradigm in the population.